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ILO ili? Od kliničke sumnje do dijagnoze: mjesto inducibilne laringealne opstrukcije u diferencijalnoj dijagnozi opstruktivnih smetnji disanja
No full textUvod i cilj: Inducibilna laringealna opstrukcija (ILO) je intermitentna, reverzibilna i funkcionalna opstrukcija
glotisa i/ili supraglotisa koja u, inače anatomski i funkcionalno urednom larinksu, izaziva inspiratornu i/ili
ekspiratornu dispneju kao odgovor na vanjski okidač. ILO je krovni pojam koji obuhvaća i naporom
prouzročenu inducibilnu laringealnu opstrukciju (EILO). Cilj je prikazati ključne dijagnostičke i terapijske
aspekte ILO-a te istaknuti važnost prepoznavanja ovog entiteta u diferencijalnoj dijagnostici dispneje.
Materijali/ispitanici i metode: Provedena je pretraga recentne literature u bazama PubMed, Scopus i Google
Scholar. Ključni pojmovi uključivali su “inducible laryngeal obstruction”, “vocal cord dysfunction” i
“exercise-induced laryngeal obstruction”. Uključeni su retrospektivni i prospektivni radovi, prikazi bolesnika,
kliničke smjernice i sustavni pregledi. Također, prikazujemo seriju slučajeva bolesnika s ILO-om koji su
obrađeni u Fonijatrijskom centru Kliničkog bolničkog centra u Zagrebu. Rezultati: Na ILO treba posumnjati
kod bolesnika s intermitentnom dispnejom, osobito kada je udružena sa stezanjem u grlu, promuklošću i/ili
stridorom. Potrebna je visoka razina kliničke sumnje jer se ILO često pogrešno dijagnosticira kao astma.
Razvijeno je više upitnika koji se upotrebljavaju za probir (PVCDI, VCDQ, EILODI, Dyspnea Index, LHQ).
Za evaluaciju se upotrebljavaju testovi plućne funkcije, provokacijski testovi sa supstitutima okidača te
laringoskopija. Fleksibilna laringoskopija ključna je za dijagnozu ILO-a, a kontinuirana laringoskopija tijekom
vježbanja (CLE test) i slikovne metode mogu dodatno pomoći. Laringoskopija tijekom simptomatske epizode
ostaje zlatni standard za potvrdu dijagnoze. Terapija se temelji na nefarmakološkom pristupu, prije svega
logopedskoj i bihevioralnoj terapiji s tehnikama kontrole disanja, edukaciji bolesnika i eliminaciji okidača.
Farmakološke (antikolinergici, neuromodulatori, botulinum toksin) i kirurške opcije (supraglotoplastika)
rezervirane su za refraktorne oblike. Zaključak: Naše iskustvo potvrđuje važnost multidisciplinarnog pristupa
i rane dijagnostičke obrade. Rano prepoznavanje omogućuje ciljanu terapiju i izbjegavanje nepotrebnog
liječenja, uz značajno poboljšanje kvalitete života bolesni
Optimal Power Control Using Modified Perturb and Observe Algorithm for Photovoltaic System Under Partial Shading
No full textImplementation of photovoltaic systems encounters problems, particularly concerning Partial Shading Conditions (PSC), solar irradiance, and temperature, which influence the generated output power. The PSC can diminish the power efficiency of the photovoltaic system. Consequently, a controller is required to optimize the photovoltaic system’s power output by considering the power supply characteristics. This paper discusses optimal power control in photovoltaic system under PSC. The proposed method employs a Modified Perturb and Observe (MP&O) algorithm based on the observation of current and voltage output from the photovoltaic system. The MP&O algorithm is integrated into a microcontroller and will provide PWM signals to operate the synchronous buck converter. Testing was performed under PSC. The experimental results indicated that the synchronous buck converter achieved a performance efficiency of 85%. The efficacy of the MP&O algorithm was evaluated without the MPPT method and conventional P&O algorithm. The MP&O algorithm outperformed compared to without MPPT method and conventional P&O algorithm. The MP&O algorithm yielded more consistent output power and necessitated a quicker tracking duration. The proposed method achieves an average output power efficiency of 84%; in contrast, without the MPPT method, it only reached 57%, and with the conventional P&O algorithm, it attains an efficiency of just 70%
Upala tipa 2 – osnova za razumijevanje i personalizirano liječenje nosne polipoze
No full textUpala tipa 2 (Th2) razvila se kao koristan obrambeni mehanizam protiv parazita i toksina. U današnjem
okolišu, gdje parazitske infekcije više nisu vodeći zdravstveni izazov, ista imunološka os postaje odgovorna
za nastanak brojnih kroničnih upalnih bolesti. Oštećene epitelne stanice pritom otpuštaju tzv. alarminske
citokine (TSLP, IL-25 i IL-33) koji aktiviraju urođene limfoidne stanice tipa 2 te potiču diferencijaciju Th2
limfocita. Oni zajedno putem IL-4, IL-5 i IL-13 pokreću stvaranje IgE protutijela, regrutaciju i aktivaciju
eozinofila, pojačanu sekreciju sluzi i remodeliranje tkiva. Kao rezultat upale tipa 2 nastaju bolesti alergijskog
tipa u kojima dominira IgE – posredovana reakcija (alergijski rinitis, alergijska astma, anafilaksija, alergije na
hranu i lijekove) i eozinofilne bolesti u kojima prevladava tkivna infiltracija eozinofila (kronični rinosinuitis,
eozinofilna astma, eozinofilni ezofagitis, eozinofilni sijalodohitis i eozinofilni otitis). Kronični rinosinuitis
najčešći je i klinički najznačajniji u otorinolaringologiji. EPOS 2020 smjernice naglašavaju važnost endotipske
klasifikacije kroničnog rinosinuitisa. Razlikuju se tri osnovna upalna endotipa: tip 1 (IFN-γ), tip 2 (IL-4, IL-5,
IL-13) i tip 3 (IL-17). Unutar tipa 2 kroničnog rinosinuitisa razlikuje se nekoliko endotipova. Najčešći je
eozinofilni kronični rinosinuitis (eCRS), obilježen difuznom eozinofilnom upalom i polipoznom bolešću.
Central compartment atopic disease (CCAD) povezan je s atopijom i alergijskim rinitisom te se prepoznaje po
dominantnoj IgE-posredovanoj upali i zahvaćenosti središnjeg nosnog prostora. Alergijski gljivični
rinosinuitis (AFRS) nastaje kao izrazita reakcija preosjetljivosti na gljivične antigene, uz obilnu eozinofilnu
upalu i karakterističan mukozni detritus. Samterova trijada označava podskupinu bolesnika s kroničnim
rinosinuitisom i polipima u kojih se bolest udružuje s astmom i intolerancijom na acetilsalicilatnu kiselinu.
Razvoj biološke terapije usmjerene na Th2 os (dupilumab, mepolizumab, benralizumab, omalizumab)
značajno je unaprijedio ishode liječenja. Upravo je razumijevanje ovog endotipa temelj za primjenu biološke
terapije te otvara mogućnost personalizirane medicine u otorinolaringologiji
Chondrosarcoma of the larynx – a case report with a brief literature review
No full textThis case report presents a 65-year-old male with a primary complaint for hoarseness. There were no
difficulties in breathing or swallowing, and he had a neck lump. The endoscopic appearance revealed poor
mobility of the right vocal cord and swollen and prominent right lateral and posterior wall of the subglottic
area, covered with intact mucosa. Neck ultrasonography and MSCT showed no suspicious pathologic lymph
nodes but MSCT revealed pathologic growth (44 x 35 x 30 mm), containing calcifications, circularly infiltrated
into the cricoid cartilage and caudally into the trachea. Two direct laryngoscopies with biopsy were performed
but there was no histopathological evidence of malignancy. Finally, a tissue sample obtained by a third biopsy
revealed malignant cells. Control neck MSCT showed a size enlargement of the tumor (47 x 45 x 30 mm). A
total laryngectomy was done. Histopathologic diagnosis of grade 3 laryngeal chondrosarcoma was established.
The patient was discussed at the Oncology Tumor Board, and postoperative radiotherapy was indicated and
completed without complications. A brief literature review revealed 766 laryngeal chondrosarcoma cases
reported in English literature. Most of the patients were in the seventh decade of life. There were more males
than females (the ratio 3:1). The most common surgical approaches were local excision and total laryngectomy.
Radiotherapy and chemotherapy were rarely used in less than 1% of cases. The disease-specific 5-year survival
rate was 91.4% with no differences when comparing the rates for location, grade, and therapy. A submucosal
spread of chondrosarcoma often resulted in histopathological diagnoses which were false negative for
malignancy. Therefore, an alternative open approach and laryngeal tissue harvesting through the cricoid
cartilage fissure was recommended
Piomukokela frontalnog sinusa – pregled literature i prikaz bolesnika
No full textUvod: Piomukokela paranazalnih sinusa je epitelom obložena cistična tvorba ispunjena mukopurulentnim
sadržajem koja nastaje bakterijskom superinfekcijom u 5 – 10%, već postojećih mukokela, prethodno nastalih
najčešće zbog opstrukcije sinusnih otvora. Javlja se, kao i mukokela, najčešće u području frontalnog sinusa, u
muških odraslih osoba srednje životne dobi. Udružena je s orbitalnim komplikacijama u oko 30 – 40%, a rjeđe
s intrakranijalnim u 10 – 20% slučajeva. Prikaz bolesnika: 58-godišnji bolesnik javlja se na hitni ORL pregled
zbog otoka u području medijalnih očnih kutova u trajanju od tri mjeseca, uz pogoršanje otoka i pojave bolnosti
prethodnih sedam dana te zamućenja vida bez febriliteta. U kliničkom statusu vidljiv je otok i crvenilo u
području iznad oba medijalna očna kuta, više lijevo, uz urednu bulbomotoriku te uredan neurološki status.
Fiberendoskopskim pregledom obostrano su vidljivi MALM 3 polipi te gnojna sekrecija iz desnog OMC-a.
Hitno je učinjen CT paranazalnih sinusa koji je pokazao upalnu kolekciju veličine do 4,5 cm obostrano u
frontalnim sinusima i djelomično u etmoidima s destrukcijom stražnje i prednje stijenke lijevog frontalnog
sinusa i intrakranijalnom propagacijom procesa, uz znakove pansinuitisa. U općoj endotrahealnoj anesteziji
učinjen je hitni FEKS, uz prikaz frontalnih ušća te marsupijalizaciju piomukokele. Postoperacijski tijek
protječe uredno, uz primijenjenu parenteralnu antibiotsku terapiju. Kontrolni CT je bez znakova hernijacije
mozgovine, uz zadebljanje dure lijevo dorzalno od frontalnog sinusa. Devetog postoperacijskog dana otpušta
se iz Klinike, a kontrolnim endoskopskim pregledom vidljivo je otvoreno ušće frontalnog sinusa, čiji je stražnji
zid obložen urednom sluznicom, uz vidljivo pulsiranje dure. Rezultati patohistološke analize upućuju na
subakutnu polipoznu upalu. Planira se kontrolni endoskopski pregled s nalazom CT-a paranazalnih sinusa za
tri mjeseca. Zaključak: Piomukokela je rijetka, ali potencijalno vrlo ozbiljna komplikacija upale sinusa.
Destrukcija kosti kod mukokela pojavljuje se u oko 80 – 90%, a destrukcija stražnje stijenke frontalnog sinusa
u oko 20 – 25% slučajeva te je ujedno i najopasnija komplikacija jer vodi do mogućeg bržeg razvoja
intrakranijalnih komplikacija, zbog čega je potrebno hitno kirurško liječenje
A very rare case of middle ear adenoma in a pediatric patient
No full textIntroduction: The aim of this paper is to present a very rare case of a benign middle ear tumor in a 17-year-old
girl, which manifested as sensorineural hearing loss and tinnitus. Only four cases of this tumor have been
reported until now in the pediatric population. Middle ear adenoma is a rare benign epithelial tumor arising
from the mucosal cells of the middle ear, exhibiting both epithelial and neuroendocrine features. The most
frequent symptoms are conductive hearing loss and tinnitus. Surgical excision is the recommended treatment.
A major concern described in literature is the potential for tumor recurrence. The occurrence of this tumor in
pediatric patients is extremely rare, with only four cases of middle ear adenoma with neuroendocrine
differentiation reported to date. Material and methods: We present the case of a 17-year-old female patient
with tinnitus and sensorineural hearing loss in the left ear. Pure-tone audiometry revealed a high-frequency
sensorineural hearing loss in the left ear, with normal hearing in the right ear. Due to the suspicion of
retrocochlear pathology, an MRI of the temporal bone and brain was performed. Imaging revealed an 8 × 5
mm mass located in the middle ear. Surgical exploration was undertaken, during which the tumor was excised
and the ossicular chain was preserved. Intraoperatively, no bony erosion of the labyrinth was observed.
Histopathological analysis confirmed the diagnosis of middle ear adenoma. Sensorineural hearing loss has
previously been described only in cases where labyrinthine erosion was present. In this case, the etiology of
high-frequency sensorineural hearing loss remains unclear. Conclusion: Middle ear adenoma is a very rare
tumor, particularly in the pediatric population, with only four cases reported to date. Radiological imaging is
essential for accurate diagnosis. Surgical excision is the treatment of choice, and long-term follow-up is
necessary due to the high risk of recurrence
Analyzing clinical laboratory data outcomes in retrospective cohort studies using TriNetX
No full textTriNetX, a rapidly growing global network of anonymized patient data, enables clinical researchers to perform large-scale retrospective cohort studies. However, its functionality for querying laboratory data outcomes is significantly constrained, as it only provides the results of the most recent test within a specified observation period. Consequently, the platform is not optimized for analyzing laboratory data collected at multiple time points during an observation period. This paper introduces innovative, data-informed solutions to address these limitations, offering practical guidance for researchers aiming to leverage TriNetX for examining clinical laboratory data
Ispitivanje transformacije nacionalnog sigurnosnog sustava Sjedinjenih američkih država nakon 2001.
No full textToday’s security challenges are far more complex than ever before. The hypothesis
of this article is that timely adaptation and innovation in response to new security
circumstances, along with the development of innovative capabilities, are critical
factors for effectively addressing the intelligence and defense challenges of the 21st
century. Using a scientific approach through the analysis of available scientific
research, congressional reports, and other relevant information associated with
the United States of America (US) after September 11, 2001 (09/11), this article
systematically explores the approaches taken by the US during the reformation of
its national security system. It also synthesizes conclusions and identifies key
shortcomings related to US national security system operations. The resulting
conclusions and proposals in support of the stated hypothesis indicate that the
transformation of national security related intelligence and defense systems require
optimal reor ganization, the development of new and improved business processes,
and the implementation of innovative technology that enable better and more efficient
operation of the entire system.Sigurnosni izazovi s kojima se države danas suočavaju složeniji su nego ikad
prije. Ovaj rad polazi od temeljne pretpostavke da su pravodobna prilagodba
novim sigurnosnim okolnostima i razvoj novih sposobnosti ključni preduvjeti
za učinkovito suočavanje suvremenih sigurnosno-obavještajnih i obrambenih
sustava s izazovima 21. stoljeća. Korištenjem znanstvenog pristupa, kroz
analizu dostupnih znanstvenih istraživanja, kongresnih izvješća i drugih
relevantnih dokumenata, na primjeru Sjedinjenih Američkih Država nakon
11. rujna 2001., ovaj rad sustavno prikazuje kako su Sjedinjene Američke Države
pristupile reformi nacionalnog sigurnosnog sustava. U završnom dijelu donosi se
sinteza stečenih spoznaja i identifikacija ključnih nedostataka u funkcioniranju
američkog nacionalnog sigurnosnog sustava. Iz analize se izvode zaključci i prijedlozi
koji ukazuju na to da transformacija sigurnosno-obavještajnog i obrambenog sustava
mora uključivati njegovu optimalnu reorganizaciju, razvoj novih i unaprjeđenje
postojećih poslovnih procesa te implementaciju novih tehnoloških dostignuća koja će
omogućiti bolje i učinkovitije funkcioniranje sustava u cjelini
Effects of a 12-week supervised resistance training on quality of life and physical fitness in older adults: A randomized controlled trial
Get PDFThe main aim of the study was to examine the effects of a 12-week resistance training (RT) programme on HRQoL scores and physical fitness components. One hundred and fourteen older adults aged between 60 and 70 years were recruited (mean ± SD; age = 66.2 ± 3.0 years; 48.2% women) and randomly assigned to RT (n = 57; age = 66.0 ± 2.9 years; 48.5% women) or control (CON; n = 57; age = 66.4 ± 3.1 years; 47.9% women) groups. Baseline and follow-up data included Health-related Quality of Life (HRQoL) questionnaire, and Senior Fitness Test. No significant differences in outcome variables between the two groups were observed (p>.05). After a 12-week intervention, RT group improved physical (80.5%, ES = 4.7), psychological (60.2%, ES = 3.0), social (39.1%, ES = 1.5), and environmental (51.7%, ES = 3.9) components of HRQoL. Over the 12 weeks, RT group decreased body-mass index (-9.7%, ES = -0.4), fat mass percentage (-11.4%, ES = -0.6), and visceral fat (-17.2%, ES = -0.8) and increased muscle mass percentage (13.2%, ES = 1.0), muscular (20.9% and 12.4%, ES = 0.7 and 0.4) and cardiorespiratory fitness (7.2%, ES = 0.2), flexibility (62.5% and 34.6%, ES = 0.3), and agility (-14.8%, ES = -1.0). No significant time changes in the CON group were observed. A 12-week RT programme increases HRQoL and overall physical performance in older adults, making RT an effective intervention method for improving broad-spectrum HRQoL and physical fitness components
