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Vladimir Janjic, Branimir Radmanovic, Zoran Bukumiric, Slavica Djukic Dejanovic, Nemanja Muric and Milica Borovcanin

Abstract

Insomnia is a condition of inadequate quality or quantity of sleep that has extremely adverse effects on daytime activities. Th e aim of this study was to compare the quality of life in patients with primary insomnia before and after a 3-week treatment with lorazepam (n=20) and zolpidem (n=21) and to compare the potential differences in dysfunctional beliefs and attitudes regarding patients’ sleep between the two groups. Th e diagnosis of primary insomnia was established using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and patients had to complete a specially designed sleep log every day; on scheduled visits, we also administered a Visual Analogue Scale for quality of life and a self-evaluation questionnaire about Dysfunctional Beliefs and Attitudes related to Sleep at the beginning and end of this study. In summary, the examinees in our study had significantly decreased parameters of quality of life, quite lower than expected based on previous findings in this area. However, by the end of the study, quality of life significantly improved with treatment: it improved by approximately 2/3 in the Lorazepam group and more than twice in the Zolpidem group, with a significant difference in favour of Zolpidem (p=0.047). Th is finding is most likely a consequence of its better safety profile and in part its better efficiency in terms of influence on certain domains of sleep itself, as previously discussed. Further specialized studies in this area with larger samples and a more detailed methodology are clearly warranted.

Open access

Tanja Prodovic, Branko Ristic, Nemanja Rancic, Zoran Bukumiric, Stepanovic Zeljko and Dragana Ignjatovic-Ristic

Abstract

Background

There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients.

Methods

The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study.

Results

Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease.

Conclusion

Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened.

Open access

Radojica V. Stolic, Zoran Bukumiric, Ivana R. Matijasevic, Masa D. Jaksic, Milena Jovanovic and Kostic G. Teodora

Abstract

Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fi stulas for hemodialysis in the elderly. Th e study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. Th e study included patients older than 65 years with arteriovenous fi stula thrombosis, in the period of four years, in which there is information on the length of the functioning fi stula. Th e study included 48 patients, mean age 71.3 ± 5.2 years, 29 (60%) men and 19 (40%) women. Th e data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fi stulas, and the lumen diameter of the arteries and veins that are used to create a fi stula. Th e median length of functioning arteriovenous fi stula, based on Kaplan-Meier model, is 16 months (95% CI 6.9- 25.1). Median functioning for proximaly located fi stulas was 24 months (range, 1-259), while median functioning in patient with distally located fi stulas was 8 months (range, 1-96). Th e diff erence in relation to the positioning of the fi stula was statistically signifi cant (p= 0.006). In univariate Cox regression model, a statistically signifi cant predictor of the functioning of arteriovenous fi stulae is fi stula positioning (B = 0.700; p = 0.022). Th e predictive parameter of survival of arteriovenous fi stulas in elderly is proximally located fi stula.