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Leveraging digital medication adherence technologies to enhance sustainability of European health systems: ENABLE’s key recommendations
No full textThe determination of endogenous steroids in hair and fur: A systematic review of methodologies
No full textBackground: Endogenous steroid hormone assessment is essential for clinical practice. These hormones are typically measured in blood. More recently, measurement of steroids in hair samples has been gaining in popularity, so we have reviewed the methodologies used for this to-date.
Methods: Ovid Medline, CINAHL, Psychinfo, and EMBASE were searched to identify manuscripts that analysed cortisol, testosterone, androstenedione, 17-hydroxyprogesterone (17OHP), dehydroepiandrosterone sulphate (DHEAS), and/or 25-hydroxyvitamin D (25(OH)D), in hair or fur. Data related to sampling and measurement procedures were extracted and analysed.
Results: The systematic review included a total of 180 papers, with 82 % published in the past 8 years; 67 % were human and 33 % animal studies. Cortisol was by far the most common analyte. Incomplete reporting on sample harvest, preparation, and measurement procedures was common. Typically, samples were collected from posterior vertex of humans or back/neck of animals, weighing between 11 and 50 mg (with a range of 1.25–1000 mg). Samples were usually stored at room temperature, often using aluminium foil. Isopropanol was the most common cleaning solution. Hair was normally powdered or segmented prior to extraction. Extraction was typically carried out over 18–24 hours using methanol. Validation and precision information was provided in 47 % of studies.
Conclusions: This systematic review highlights the lack of standardisation in the analysis of endogenous steroids in hair. Reporting was typically incomplete, and assay validations were partial or absent. Together, these limit the value of these exciting new methods and hold back transition to clinical use
Foot deformities in children
No full textCilj ovog stručnog rada je obraditi tematiku deformacija stopala u djece s kojima se najčešće susrećemo u kliničkoj praksi, kao i pristup liječenju istih. Stopalo je specifičan dio lokomotornog sustava koji ima statičku ulogu noseći težinu cijelog tijela i dinamičku kojom omogućava kretanje. Malformacije stopala javljaju se tijekom embrionalnog razvoja i njih karakteriziraju anatomski defekti. Deformacije se javljaju uslijed različitih čimbenika tijekom fetalnog razdoblja na prethodno anatomski normalno konfiguriranom stopalu. Već tijekom prve godine uočavaju se različita odstupanja od fiziološkog mišićno-koštanog razvoja stopala i predstavljaju fiziološke varijacije i prolaze spontano. Teže deformacije potrebno je pravovremeno prepoznati kako bi se prevenirale kasnije komplikacije u funkcionalnosti stopala, prvenstveno u kinematici hoda. Najčešće deformacije stopala su prirođeno spušteno stopalo, aduktus metatarzus, kalkaneovalgus i ekvinovarus. Važno je prepoznati njihove kliničke značajke i modalitete konzervativnog liječenja u smislu konvencionalnih pasivnih terapijskih vježbi i trodimenzionalne manualne terapije. Pri fleksibilno spuštenim stopalima najbitnije je pratiti dijete i prepoznati da će se oni koji su asimptomatski, bez bolova i narušene funkcije, oporaviti spontano sukladno fiziološkom neuromotoričkom razvoju, unatoč mišljenju brojnih stručnjaka da je potrebno liječenje, a da to nije znanstveno dokazano. Učinkovitost upotrebe ortoza za liječenje fleksibilno spuštenih stopala nije jasno znanstveno dokazana. Kod rigidno spuštenih stopala kirurška je intervencija neophodna, no odgađa se u vrlo ranoj dobi i inicijalno pokušava liječiti konzervativno. Uz specijalista fizikalne medicine i rehabilitacije i fizioterapeuta potrebno je naglasiti važnost edukacije roditelja na koji način trebaju provoditi pasivne vježbe, budući da se aktivne vježbe u pedijatrijskoj dobi ne mogu izvoditi prije treće godine. Kod gotovo svih deformacija terapijske vježbe kao oblik konzervativnog liječenja ne samo da su indicirane, nego se moraju provoditi čak i u onih deformacija kod kojih su kirurške intervencije neophodne i nakon njih. Dokazana je učinkovitost vježbi istezanja te trodimenzionalne manualne terapije prema Barbari Zukunft-Huber pri liječenju deformacija stopala u djece.This work aims to address the topic of foot deformities in children, which are often encountered in clinical practice, and the treatment approach. The foot is a specific part of the locomotor system whose static role is carrying the body weight, and dynamic enabling movement. Foot malformations are characterized by anatomical defects during embryonic development. Deformities occur on a previously normally configured foot during the fetal period due to various factors. Foot deviations that appear during the first year throughout physiological musculoskeletal development represent variations and pass spontaneously. More severe deformities must be recognized promptly to prevent later functional complications, primarily in the gait kinematics. The most common foot deformities are congenital flat foot, adductus metatarsus, calcaneovalgus and clubfoot. It is important to recognize clinical features and conservative treatment modalities in terms of conventional passive therapeutic exercises and three-dimensional manual therapy. Despite the judgment of many specialists who have advocated treatment that has not been scientifically demonstrated, asymptomatic flexible flat feet recover naturally during physiological neuromotor development, with no discomfort or reduced function. The effectiveness of orthoses used for the treatment of flexible flat feet has not been scientifically proven. Surgical intervention of rigid flat foot is necessary, but it is postponed at a very early age and initial conservative treatment is proposed. Along with physiatrists and physiotherapists, it is inevitable to emphasize parental education on how to perform passive exercises, since active exercises in pediatric age cannot be performed before the age of three. Even for defects that require surgery, therapeutic exercises are not only recommended but also required to be performed both during and after the surgical procedure. The effectiveness of stretching exercises and three-dimensional manual therapy according to Barbara Zukunft-Huber has been proven
Differential diagnosis of hypotonia in infancy
No full textHipotonija ili smanjeni mišićni tonus je klinički simptom koji može upućivati na brojne sistemne bolesti i poremećaje živčanog sustava. S obzirom na velik broj potencijalnih uzroka hipotonije, u postavljanju diferencijalne dijagnoze važno je obradi dojenčeta pristupiti sistematično i multidisciplinarno. Hipotonija se klinički manifestira oskudnim repertoarom prezentirane motorike (spontane i svjesne), smanjenim otporom prilikom ispitivanja pasivne pokretljivosti vratne kralježnice, gornjih i donjih ekstremiteta i kašnjenjem u usvajanju motoričkih vještina, odnosno miljokaza. Potrebno je naglasiti važnost detaljne osobne anamneze, obiteljske anamneze i kliničkog pregleda u otkrivanju uzroka hipotonije. Daljnju dijagnostičku obradu usmjerava detaljan fizijatrijski i neurološki pregled, koji pomažu u razlikovanju centralne hipotonije od hipotonije perifernog podrijetla. Najčešći uzorci centralne hipotonije su intrakranijalno krvarenje, malformacije mozga, kromosomopatije, genetski poremećaji, peroksisomalni poremećaji, endokrini poremećaji, prirodne greške metabolizma i bolesti vezivnog tkiva. Najčešći uzroci periferne hipotonije su bolesti donjeg motoneurona, bolesti neuromuskularne spojnice, kongenitalne motorne ili senzorne neuropatije, kongenitalne miopatije, metaboličke miopatije, kongenitalne mišićne distrofije i miotona distrofija. U slučaju da se dijagnostičkom obradom ne dokaže postojanje bolesti u podlozi hipotonije, tada govorimo o benignoj idiopatskoj hipotoniji. Postavljanje točne diferencijalne dijagnoze hipotonije u dojenčadi nužno je kako bi se planiralo ciljano usmjereno liječenje i omogućila što bolja prognoza. Pristup liječenju hipotonije u dojenačkoj dobi mora biti prilagođen specifičnom stanju odgovornom za smanjeni mišićni tonus. Habilitacija u obliku motoričkih vježbi neizostavni je modalitet liječenja kojim se stimulira pravilni motorički razvoj u cilju postizanja optimalnog neurorazvojnog ishoda ili, kada to nije moguće, onda u najvećoj mogućoj mjeri. Kako se paralelno uz motorički razvoj odvija i kognitivni, takva djeca zahtijevaju timski pristup u smislu praćenja i liječenja, koji uključuje suradnike drugih struka kao što su logopedi, psiholozi, radni terapeuti i edukacijski rehabilitatori.Hypotonia or reduced muscle tone is a clinical symptom that may indicate numerous systemic diseases and nervous system disorders. Given the wide range of potential causes of hypotonia, it is essential to approach the diagnostic evaluation of infants systematically and multidisciplinary. Reduced spontaneous and voluntary movements characterize hypotonia, decreased resistance to passive movement of the cervical spine, and upper and lower extremities, and delays in acquiring motor skills or milestones. A detailed patient medical history, family history, and clinical examination are essential in identifying the underlying cause of hypotonia. Further evaluation of hypotonia is guided by a thorough physiatric and neurologic assessment, which helps distinguish between central and peripheral hypotonia. The most common causes of central hypotonia are intracranial hemorrhage, brain malformations, peroxisomal disorders, endocrine disorders, inborn errors of metabolism, and connective tissue diseases. The most common causes of peripheral hypotonia are lower motoneuron disorders, neuromuscular junction disorders, metabolic myopathies, congenital muscular dystrophies, and myotonic dystrophy. In cases where no underlying disease is found during the diagnostic workup, the condition is referred to as benign congenital hypotonia. An accurate differential diagnosis of hypotonia in infants is essential for further management and prognosis of the condition. Treatment of hypotonia is tailored to the symptoms, and it depends on the underlying cause. Habilitation through motor exercises is an important therapeutic approach that promotes proper motor development to achieve the best possible neurodevelopmental outcome. As cognitive development occurs alongside motor development, hypotonic infants require a multidisciplinary approach to monitoring and treatment. This approach includes collaboration with speech therapists, psychologists, occupational therapists, and educational rehabilitators
Time trend of BMI-SDS before, during and after the COVID-19 pandemic: data from the SWEET diabetes registry
No full textThe overshadowed scientific endeavours of Berengario Da Carpi, a renaissance physician and the Forerunner of neurosurgery: a historical vignette
No full textJacopo Berengario da Carpi was Renaissance-era physician, surgeon, and anatomy lecturer who transformed medieval anatomy and surgery—which were, at the time, dominated mostly by religious dogma—into a modern science based on direct observation, experience, and cadaveric dissection. He was an accomplished and innovative neuroanatomist and educator, a prolific researcher and publisher, and a successful practicing surgeon who treated the head injuries of many renowned patients of that period. He published a landmark commentary on skull fractures that was the first printed book in history devoted to head injuries, which became a model of new medical understanding. Nonetheless, Berengario’s achievements in anatomy, medicine, neuroanatomy, and what would later become neurotraumatology and neurosurgery, would have been more widely known had his work and research not been surpassed by Andreas Vesalius and Ambroise Paré, both of whom advanced anatomic and medical knowledge even further. In this historical vignette, we discuss the political conditions of sixteenth Century Italy and pay a homage to Berengario da Carpi, emphasizing his work in establishing neuroanatomy as a field of medicine that became a precursor to modern neuroscience. We also describe the improvements he made in neurotraumatology technique and instrumentation, and his explanations of skull fractures and other brain injuries outlined in ground-breaking clinical books he published. Finally, we try to elucidate possible reasons why his scientific and professional achievements—despite of their enormous impact—were overshadowed by the achievements of his more famous immediate successors
Case report: Herpetic keratitis after cross-linking of corneal collagen with riboflavin and ultraviolet - A for keratoconus in a healthy 20-year-old patient
No full textIn this case report, we present patient who developed clinically diagnosed herpetic keratitis in the early postoperative period after CXL
Multidisciplinary Treatment Care of a Patient With Microduplication Syndrome in the Background of Neurodevelopmental Delay
No full textFunkcionalni testovi za procjenu i praćenje funkcionalnog oštećenja gornjeg ekstremiteta nakon operacije karcinoma dojke – pregled literature
No full textZnačajan udio onkoloških bolesnika s karcinomom dojke (engl. breast cancer survivors, skr. BCS) suočen je sa smanjenom funkcionalnošću gornjeg ekstremiteta i ograničenjima u ASŽ, koji mogu perzistirati godinama nakon postavljanja dijagnoze (1). Ključni aspekt u razvoju rehabilitacijskih pristupa za poboljšanje funkcije ovih bolesnika je identificiranje mjernih instrumenata, tzv. upitnika kojima će se prepoznati funkcionalna ograničenja za potrebe izrade individualnog rehabilitacijskog hodograma