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Biološki, psihološki i socijalni čimbenici kao predskazatelji zapuha u bolesnika s kroničnim opstrukcijskim bolestima pluća [Biological, psychological and social factors as dyspnea predictors in patients with chronic obstructive respiratory diseases]
Get PDFDyspnea is a specific sensation of uncomfortable, diffucult breathing. It has long been considered as only a physical symptom of illness, but today we know it has two components (sensoric and affective) and that it is influenced by various factors. We aimed to determine the predicitive value of biological, psychological and social factors regarding dyspnea intensity among patients with asthma and chronic obstructive pulmonary disease (COPD). Study included data from 147 patients (73 asthma, 74 COPD). Biological variables included: age, gender, number of comorbidities, smoking status, body mass index, FVC, FEV1 and blood oxygen saturation (SaO2). Psychological variables included: anxiety sensitivity, positive and negative affect, personality traits, locus of control and stress coping strategies. Social variables included: degree of education, working status, socioeconomic status, marital status, place of residence, number of household members, importance of religion and percieved social support. Combination of biopsychosocial predictors explained 33% of dyspnea intensity. Dominant dyspnea intensity predictors among asthma and COPD patients were psychological factors with the biggest single contribution (18%), followed by biological (9%) and social factors (6%) proving the importance of understanding dyspnea as a multidimensional phenomenon
Učinak lateralne epiziotomije na funkciju zdjeličnoga dna i seksualnu funkciju poslije vaginalnoga porođaja u prvorodilja [Effect of lateral episiotomy on the function of pelvic floor and sexual function after vaginal delivery in primiparas]
Get PDFEpisiotomy is an obstetrical procedure which extends the vaginal vestibule during fetal expulsion. Lateral episiotomy is widely used, but is rarely mentioned in the literature and its effect on the pelvic floor is unexplored. The available data largely support the theory of the negative or neutral effect of median and mediolateral episiotomy on the pelvic floor. The hypothesis of this study was that lateral episiotomy in primiparas has a protective effect on the emergence of urinary and anal incontinence, as well as sexual dysfunction during the first year postpartum. The aim of this study was to investigate the effect of lateral episiotomy on the pelvic floor in the primiparas in comparison to the group without episiotomy. Prospective study was conducted and consisted of 2 groups, with 100 examinees in each group. The first group consisted of women who had a delivery with lateral episiotomy and another group of women who had a delivery with perineal tears of I. and II. degree and intact perineum. The study included primiparas with singleton pregnancies and spontaneous onset of labor with fetuses in cephalic presentation. Examinations of pelvic floor were conducted at 5 and 8 months after delivery accompanied by specific questionnaires. International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form was used to assess urinary incontinence, while Wexner Scale was used to assess anal incontinence. Female Sexual Function Index was used to assess sexual function. The clinical examinations were consisted of: Pelvic Organ Prolapse Quantification system, cough stress test, transperineal sonography of anal sphincter and pelvic floor muscles and vaginal manometry. There were no significant differences in emergence of stress urinary incontinence between groups in two-time points (episiotomy: 16% and 13.5%; ruptures: 20% and 14.9%). There were also no differences in the occurrence of prolapse. Pelvic floor muscle strength was almost equal by groups as well as the occurrence of symptoms of anal incontinence and sexual dysfunction. There were certain relations between the ages of the examinees, oxytocin and weight of the newborn to poorer results of the questionnaires in episiotomy group. Obstetric and anthropometric variables were not associated with emergence of urinary and anal incontinence in episiotomy group. Our results indicate that the effect of lateral episiotomy on the pelvic floor is comparable to delivery with minimal perineal injuries. Rates of pelvic floor disorders as well as sexual dysfunction were similar by groups. No substantial associations between episiotomy and pelvic floor disorders have been found which is in accordance with majority of studies on other types of episiotomy. To conclude, lateral episiotomy has neither protective, nor negative effect on the onset of pelvic floor disorders and sexual dysfunction in the primiparas
Dugotrajno neurološko i kognitivno praćenje prvoga i drugoga dvojajčanoga blizanca
Get PDFIntroduction brings perinatal mortality of twins and other consequences of premature labor
and low birth weight which influence the incidence of cerebral pulsy and mental retardation as
well as incidence of cognitive impairment and behavioral disorders. The basic elements of
cognitive and social development in twins are described and causes of retarded speech
development explained. Introduction contains review of psychological difficulties in twins and
etiology of attention deficit hyperactivity disorder (ADHD) as well as its diagnostic criteria.
The main aim of this work was to analize the final intellectual development and behavior of
dizygotic twins compared to control singletons born from single pregnancies as well as between
themselves. Specific aims included analysis of epilepsy and ADHD occurrence and observed
frequency of other neurolological diseases. Hypothesis of this research expected in twins more
frequent disturbances in intellectual functioning, more frequent occurrence of ADHD and
neurological diseases with inferior final cognitive development and inferior academic achievements
when compared with control examinees.
Examinees and methods. 36 pairs of dizygotic twins took part in this research and all of
them participated in the first research of their neurological development 25 years ago when they
were in preschool and early school age. Responding rate of previous control singletons for this
research was significantly lower and new smaller control sample of 27 examinees was created for
this research which included partially new controls. All examinees, twins and controls were born
in the same period from 1981. until 1985. in the same Maternity Hospital in Zagreb and were
chosen by the lottery method. The data were collected by 7 Questionnaires including ones used in
the first research, basic Questionnaire about general health, “ASQ-Attachment style questionnaire,
“ The adult ADHD Self - Report Scale”, “PBI-Parental Bonding Instrument” and “Beta II- revised
Beta examination- second edition ” as well as by clinical neurological examination. The data
processing was done on personal computer with IBM SPSS Statistics (version 25) Programe
support in modeling of data base and statistical interpretation. All P values lower than 0,05 were
thought and interpreted as statistically significant in further analysis.Results of this research confirmed the hypothesis only partially. The first group of results is
related to the pregnancy and perinatal outcomes. The following differences between twins and
controls were statistically significant (P<0,001): the gestational age in twins was shorter, twin
pregnancies were more complicated, more deliveries were terminated by Cesarian section in twins,
twin perinatal complications were more frequent, birth weight and birth length in twins were
smaller and Apgar scores in first and fifth minute after delivery were in twins lower than in controls
(P<0,001). The second group of results reports about speech development, intelectuall functioning,
learning difficulties and problematic behaviors with special interest in ADHD frequency in twins
and controls in childhood and in adult age. It is interesting that first born twins had statistically
significant higher ADHD frequency in childhood (P=0,034) while there is no difference in adult
age between themselves as well as between twins and controls. First born twins had also
statisctically significant higher frequency of speech difficulties (P=0,045). Except for speech
retardation (P=0,033) and lower education level (P=0,045) in twins what made statictically
significant difference compared to control examinees all other observed parameters including
occurrence of epilepsy and other neurological diseases didn’t show statistically significant
difference between compared samples.
Discussion analizes the results in attempt to interpret and compare them with the results
from the literature. The subject of discussion is risk for appereance of neurological and cognitive
damage in children with very low birth weight what happens more often in prematurely born
children, especially frequent in twins. The retarded development of speech found in twins in this
research is compared with the similar findings in recent literature. The discussion turns back to
evolution of ADHD through adolescence to adult age trying to explain the differences in its
frequency in twins in childhood and in adult age. The need and importance of further ADHD
research is emphasized suggesting that this disorder should be rather understood as extreme
behavior which genetically varies through entire population than as disorder limited only to
persons who fulfill clinical criteria. Conclusions include the following facts: there is no statistically significant difference
between twins and controls in intelectuall functioning, frequency of ADHD and other problematic
behaviors in adult age as well as no difference in frequency of epilepsy and other neurological
diseases between what was expected by hypothesis. The research confirmed statistically significant
lower educational level in twins what can be explained by higher frequency of ADHD
symptoms in twins, lower levels of their verbal functioning, more frequent learning difficulties
and psychological problems than in controls although all followed parameters didn’t show
statistically significant difference
Transplantacija srca u djece u Hrvatskoj – naša prva iskustva [Heart transplantation in children in Croatia – our first experiences]
Get PDFHeart transplantation (HT) is an acceptable method of treating severe heart diseases in children when all other options have been exhausted. It is primarily intended for children suffering from cardiomyopathies, less often for children with severe arrhythmias and congenital heart defects. This method of treating children requires a multidisciplinary specialist cooperation and support in the child’s home surroundings. Goal: The main goal is to present the development of Croatian paediatric transplantation cardiology. The secondary goal is to raise awareness of heart transplantations in children in order to motivate organ donations, it being the most limiting factor of the method. Results of study: The first heart transplantation in a child in Croatia was performed in 2011. Transplantation preparations were performed in eleven children. Two of the children died while on the waiting list, one child was removed from the waiting list due to recovery, and in eight of the children a transplantation was performed. Two of the eight died, one during transplantation and one in the early post-transplantation period. All patients met the heart insufficiency criteria, four in stage C – status 2 and seven in stage D – status 1A and 1B. Of the initial eleven who met the HT criteria all had cardiomyopathies, eight dilated and three restrictive. In the dilated cardiomyopathy group of patients there were four with post-myocarditis DCM, one idiopathic, one within the arrhythmogenic CM, one within an entity form called the Carvajal syndrome (ARVCM/LV), while one child had DCM in HLHS, but as an NCCM. As for the two deceased before transplantation, one had post-myocarditis DCM, and one had Carvajal syndrome. An infant who died immediately after transplantation had hypoplastic left heart syndrome with previous Norwood I and Norwood II (Glenn or PCPC) surgeries, and the indication was severe DCM caused by and within NCCM.The death occurred because of hyperacute cellular rejection (PhD). A fifteen-year-old boy with arrhythmogenic DCM died in early postsurgical period due to RV failure (possibly because of acute cellular rejection). He had previously been subjected to a long-term conventional treatment and electrotherapy. Sex distribution (m, f) within the entire group (6:5) and within the HT group (4:4) was even. Mean age in heart transplantations was 84.8 months (22-167 months), and mean donor waiting period was 53 days (7-147 days). Kaplan-Meier curves for a six-year period indicate a 75% survival rate. The study describes numerous post-transplantation complications, immunosuppressive therapy, patient monitoring protocol and quality of life. A significant increase in quality of life is found according to the NYHA criteria (shift from 3-4 to 1-2) for all patients. Conclusion: Our Clinic has been performing heart transplantations since 2011. The success depends on timely diagnosing and identifying the terminal stage of the disease which also meets the transplantation criteria (PVR<6Wj, TPG <15mmHg), on public awareness and on the ability of doctors to recognize potential donors. The six-year period survival rate of 75% testifies to the ability of our team to make such a complex medical step forward
Angiosarkom desne pretklijetke kao uzrok tamponade srca i letalnog ishoda u tridesettrogodišnje bolesnice – prikaz nalaza obdukcije [Primary angiosarcoma of the right atrium as a cause of cardiac tamponade and death of a 33-year-old female patient – autopsy report]
Get PDFSudden death most commonly occurs due to cardiac-related disorders, namely coronary artery disease or cardiomyopathies, while primary cardiac tumors are exceptionally rare. Three quarters of primary cardiac tumors are benign and the rest are malignant, mainly sarcomas and rarely lymphomas. The most common histological subtype of primary cardiac sarcoma is angiosarcoma, which is usually located in the right atrium and sometimes in the pericardium. Here, we report a case of a female patient admitted to our institution due to suspected septic shock, who died within a few hours of admission, despite given supportive measures.The autopsy revealed a tumor of the right atrium showing histological and immunohistochemical characteristics of angiosarcoma. Infiltration of epicardium and hemorrhage in the pericardial cavity caused cardiac tamponade and death. This report also provides a brief review of epidemiological and clinical features, as well as diagnostic and treatment options for primary cardiac angiosarcoma
Epifizeoliza distalne tibije u zagrebačke djece [Distal tibial epiphyseal fractures]
Get PDFDistal tibial epiphyseal fractures are significant because they often cause tibial growth disturbance. Distal tibial epiphyseal fractures are the second most common epiphyseal fractures, after distal radial epiphysis. Despite prompt diagnosis and correct treatment, serious complications, such as progressive deformation and permanent disability, are possible. Therefore, it is necessary to prevent these injuries. Prevention is possible only by studying injury pattern, mechanism and locations where fractures occur. In total, medical records of 197 children treated for distal tibia epiphyseal fracture in the period from January 1st , 2010 to January 1st , 2017 were analyzed. Due to insufficient data, 80 of them were excluded from the study. Thirty-seven children were treated in Clinical Hospital Center Zagreb and eighty in the Children’s Hospital Zagreb. In the studied group of children, there were 81 (69.2%) boys and 36 (30.8%) girls. The average age at the time of injury was 12.3 years, with boys being on average 17 months older than girls. ICD 10 classification was used. The most common mechanism of injury was falling, in 90 cases (76.9%). Sport grounds were the most common location where injuries occurred, in 36 cases (30.8%), while the household was the second most common, 27 (23.1%) cases. The most common activities during which injuries occurred were leisure activities, in 52 (44.4%) patients, and sports in 47 (40.2%) patients. The most common activity during which distal tibial epiphyseal fractures occurred was football and leisure activities on inadequate sport grounds. Prevention measures should mainly focus on the sports activities in children aged between 10 and 16 years
Quantification of coronary atherosclerotic burden with coronary computed tomography angiography: adapted Leaman score in Croatian patients
Get PDFThe aim of the study was to quantify the total coronary atherosclerotic burden in patients with suspected coronary artery disease (CAD) defined by coronary computed tomography adapted Leaman score (CT-LeSc) and to estimate its cut-off level for high coronary atherosclerotic burden. We enrolled 434 consecutive patients referred to coronary computed tomography angiography, of which 261 patients fulfilled the study inclusion criteria. Demographic and clinical characteristics, as well as CAD risk factors were obtained. CAD pre-test probabilities were estimated by the Diamond-Forrester model and Morise score. The coronary atherosclerotic burden was estimated using CT-LeSc. As a cut-off for a high coronary atherosclerotic burden, we used 3rd tercile (Tc3) (CT-LeSc ≥ 5.52). We evaluated the association of clinical characteristics and risk factors with Tc3 in univariate and multivariate analysis. There were 60.9% males and 39.1% females, 81% of patients had above-normal weight, 68.2% hypertension, 54.0% dyslipidemia, 15.3% diabetes mellitus, 12.3% positive smoking history and 11.9% had a family history of CAD. According to the Diamond-Forrester model and Morise score the majority of patients had intermediate risk, 59.7 and 52.8%, followed by the high-risk group, 36.0 and 34.4%, respectively. Age, dyslipidemia, hypertension and pre-test risk scores in the univariate analysis significantly predicted Tc3. In the multivariate analysis, male sex (p = 0.004), dyslipidemia (p = 0.002) and coronary calcium score (< 0.001) were identified as predictors of Tc3. CT-LeSc quantified the total coronary atherosclerotic burden and showed an association of risk factors and pre-test probabilities with Tc3
The effect of delayed anti-NMDAR encephalitis recognition on disease outcome
Get PDFAnti-NMDA receptor encephalitis is an acute form of brain inflammation that is potentially lethal but has a high probability for recovery with treatment. Although the clinical picture of anti-NMDAR encephalitis is usually recognizable due to its relatively well-known symptoms, the disorder can sometimes present itself in an unpredictable and atypical way. In this case report, we wish to present the influence of different delay times prior to the establishment of diagnosis. Thus, our first patient was diagnosed with anti-NMDAR encephalitis 4 years after the initial symptoms, the second one after 8 years, and the third one after 13 months. The outcomes of the three presented patients indicate the importance of being aware of many clinical presentations of this disorder, as its early diagnosis greatly affects the outcome and may reduce permanent damage, especially in cognitive functions
In vitro synergy and postantibiotic effect of colistin combinations with meropenem and vancomycin against Enterobacteriaceae with multiple carbapenem resistance mechanisms
Get PDFAim: The aim of the study was to determine in vitro synergy and postantibiotic effect of colistin alone and combined with meropenem or vancomycin against Enterobacteriaceae producing multiple carbapenemases; combinations of two metallo-β-lactamases (MBL) or MBL with OXA-48. Colistin-resistant strain positive for OXA-48 was also included in the study. ----- Methods: The antibiotic susceptibility was tested by broth microdilution method. Synergy was tested by chequerboard, time-kill and 2-well method. PAE was determined by viable counting. ----- Results: The chequerboard analysis revealed synergy for colistin combination with meropenem in all isolates with FICI values ranging from 0.12 to 0.24. FICI values for combinations with vancomycin were below 0.5 indicating synergy in two out of four isolates. K. pneumoniae 609815 positive for OXA-48 and colistin resistant showed the most pronounced and consistent synergy effect with meropenem in both chequerboard and time-kill method. Synergy effect in time-kill curves, was observed for K pneumoniae 145846 with two MBLs and colistin resistant K. pneumoniae 609815 positive for OXA-48, with both combinations including meropenem and vancomycin. Colistin alone exhibited short postantibiotic effect (PAE) against all tested isolates. Meropenem markedly prolonged the PAE in two isolates in contrast to vancomycin which did not demonstrate significant effect on the duration of PAE. ----- Conclusions: The synergy effect and the duration of PAE was strain and antibiotic dependent but not related to the resistance gene content