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Smart glasses evaluation during the COVID-19 pandemic: First-use on Neurointerventional procedures
No full textThe COVID-19 pandemic is rapidly transforming the healthcare system, with telemedicine, or virtual health, being one of the key drivers of the change. Smart glasses have recently been introduced to the public and have generated interest with healthcare professionals as demonstrated by their early adoption in clinics and hospitals. Observing procedures is essential for young interventionalist-in-training, but sometimes it is difficult for them to be able to get the volume of exposure to procedures that they need. Here, we report the first experience using smart glasses for Neurointerventional procedures, highlighting potential benefits and limitations during different scenarios including invitro and life cases. This field is novel, innovative, and may have potential to improve both patient care and patient safety in other health care settings
Humoral immune response in convalescent COVID-19 people with multiple sclerosis treated with high-efficacy disease-modifying therapies: A multicenter, case-control study
No full textAim: To determine the influence of high-efficacy disease modifying therapy (DMT) on the development of IgG SARS-CoV-2 antibody response in COVID-19 convalescent people with multiple sclerosis (pwMS).
Methods: Seventy-four pwMS taking high-efficacy DMTs (specifically natalizumab, fingolimod, alemtuzumab, ocrelizumab, cladribine and ublituximab) and diagnosed with COVID-19 and 44 healthy persons (HC) were enrolled. SARS-CoV2 antibodies were tested with Elecsys® Anti-SARSCoV-2 S assay.
Results: pwMS taking high-efficacy DMTs had a significantly higher chance of having negative titer of SARS-CoV2 antibodies compared to healthy controls (33 negative pwMS [44.6%] compared to one negative HC [2.3%], p < 0.001). pwMS taking B-cell depleting therapy (ocrelizumab and ublituximab) had a significantly higher chance of having negative titer of SARS-CoV2 antibodies compared to pwMS on all other DMTs (29 negative pwMS on B-cell therapy [64.4%] compared to four negative pwMS on all other DMTs [13.8%], p < 0.001). Out of other DMTs, two (33.3%) pwMS taking fingolimod and two (16.7%) pwMS taking cladribine failed to develop IgG SARS-COV-2 antibodies. B-cell depleting therapy independently predicted negative titer of IgG SARS-CoV-2 antibody (Exp[B] =0.014, 95%CI 0.002–0.110, p < 0.001).
Conclusions: A significant proportion of convalescent COVID-19 pwMS on high-efficacy DMTs will not develop IgG SARS-CoV-2 antibodies. B-cell depleting therapies independently predict negative and low titer of IgG SARS-CoV-2 antibody
Ishod kirurškog liječenja i epileptičnih napadaja kod disembrioplastičnih neuroepitelijskih tumora u odraslih: prikaz serije slučajeva
No full textDysembryoplastic neuroepithelial tumors (DNETs) are benign neoplasms classified in the category of glioneuronal tumors. The estimated incidence of DNETs is 0.03 per 100,000 person per year with the age peak in a range between 10 and 14 years, and decreasing dramatically with increasing age. They are seldom diagnosed in persons above 20 years of age, being a cause of tumorrelated intractable epilepsy that begins in childhood or adolescence. They have been proven to be the second most common type of epileptogenic tumors in pediatric population. These rare tumors cause chronic drug-resistant partial complex seizures with or without secondary generalization. Herein, we provide institutional case series of six adult patients with temporal lobe DNET presenting with complex partial seizures. Lesionectomy was performed with tumor resection in toto in three patients. In another three, partial resection was performed, whereas tumor remnant was left intact to avoid possible basal ganglia damage. All patients were seizure free postoperatively. Lesionectomy alone in temporal lobe epilepsy was associated with less favorable outcome than anterior temporal lobectomy. Total tumor removal is considered a major prognostic factor in most studies.Disembrioplastični neuroepitelijski tumori (DNET) dobroćudne su novotvorine koje se svrstavaju u skupinu glioneuralnih tumora. Njihova je godišnja učestalost 0,03 na 100.000 stanovnika s vrškom pojavnosti u dobi između 10 i 14 godina života. Učestalost se smanjuje s porastom dobi, a tumori se rijetko javljaju nakon 20. godine života. Dokazani su kao uzrok epilepsije koja započinje u djetinjstvu i adolescenciji te kao drugi najčešći tip tumora koji uzrokuje epileptične napadaje u dječjoj dobi. Ovi rijetki tumori uzrokuju kronične i na terapiju otporne parcijalne složene epileptične napadaje s generalizacijom ili bez nje. U ovom radu prikazujemo institucijsku seriju šest odraslih bolesnika s DNET-om u području temporalnog režnja koji su se prezentirali složenim parcijalnim epileptičnim napadajima. Tri su bolesnika kirurški liječena lezionektomijom s totalnom resekcijom tumora. U preostala tri bolesnika učinjena je parcijalna resekcija, a dio tumora je ostavljen kako bi se izbjeglo oštećenje bazalnih ganglija. Svi su bolesnici nakon zahvata bili bez epileptičnih napadaja. U slučaju temporalne epilepsije, a u usporedbi s prednjom temporalnom lobektomijom, selektivno uklanjanje tumorske lezije bilo je povezano s lošijim ishodom liječenja. Uklanjanje tumora u cijelosti smatra se važnim prognostičkim pokazateljem ishoda liječenja u većini provedenih istraživanja
Non-pharmacological Methods of Treating Headaches
No full textGlavobolja je jedno od najčešćih neuroloških stanja koje zahtijeva akutno ili u određenim slučajevima profilaktično liječenje. Detaljnija klasifikacija glavobolja objašnjena je u Međunarodnoj klasifikaciji glavobolja. Iako je zbog same komponente boli kod glavobolje najvažnije provesti akutno liječenje, u određenim slučajevima važno je djelovati profilaktično (primjerice, kod migrene ili cluster glavobolje). S obzirom na mogućnost prekomjerne upotrebe analgetika, velik broj liječnika i pacijenata postaje skloniji nefarmakološkim metodama liječenja glavobolja. Nefarmakološke metode liječenja glavobolje koje navodimo u ovom radu uključuju: akupunkturu, psihološke tehnike (kognitivno bihevioralna terapija, neurofeedback), neuromodulaciju i prehranu.Headache is one of the most common neurological conditions that requires acute, chronic or preventative treatment. A detailed classification of headaches is explained in the International Classification of Headache Disorders. Although it is most important to provide acute treatment due to the component of pain in headache attacks, in certain cases it is important to act prophylactically (for example in migraine or cluster headache). Given the possibility of overuse of analgesics, a large number of physicians and patients are becoming more prone to nonpharmacological methods of treating headaches. Non-pharmacological methods of headache treatment listed in this paper include: acupuncture, psychological techniques (cognitive behavioral therapy, neurofeedback), neuromodulation and nutrition
Bleeding risk stratification in coronary artery surgery: the should-not-bleed score
No full textBackground: An estimated 20% of allogeneic blood transfusions in the United States are associated with cardiac surgery. It is estimated that 11% of red cell resources were used for transfusion support of patients undergoing coronary artery bypass grafting (CABG) with a documented wide variability in transfusion rate (7.8 to 92.8%). To address the issue of unnecessary transfusions within the CABG population, we developed a model to predict which patients are at low risk of bleeding for whom transfusion treatment might be considered unnecessary. Herein we present our “SHOULD-NOT-BLEED-SCORE” application developed for the Windows® software platform which is based on our previous research.
Methods: This study is aimed to develop a user-friendly application that stratifies patients with respect to bleeding risk. The statistical model we used in our previous research was focused on detection of CABG patients at low risk of bleeding. The rationale behind such an approach was to identify a CABG patient subgroup at low risk of bleeding. By identifying patients at low risk of bleeding we can define a subgroup of patients for whom transfusion treatment might be considered unnecessary. We developed a Windows platform application based on risk modelling which we previously calculated for 1426 patients undergoing elective CABG from January 2010 to January 2018.
Results: The SHOULD-NOT-BLEED-SCORE risk score is developed for the Windows software platform. A mathematical model that is based on multivariate analysis was used for app development. The variables that entered the scoring system were: Age; Body Mass Index; Chronic Renal Failure; Preoperative Clopidogrel Exposure; Preoperative Red Blood Cells Count; Preoperative Fibrinogen Level; Preoperative Multiplate ASPI test area under the curve (AUC) units. The SHOULD-NOT-BLEED-SCORE identifies/predicts patients without a risk for excessive bleeding with strong discriminatory performance (Receiver Operating Curve (ROC) analysis AUC 72.3%, p < 0.001).
Conclusion: The SHOULD-NOT-BLEED risk scoring application may be useful in the preoperative risk screening process. The clinical and economic burden associated with unnecessary transfusions may be adequately addressed by a preoperative scoring system detecting patients at low risk of bleeding for whom transfusion treatment might be considered unnecessary
Računalno potpomognuti uređaj za praćenje pokreta oka u otkrivanju manifestnog strabizma
No full textStrabismus is a common disorder in which eyes are not aligned with their optical axis, resulting in an abnormal binocular interaction, thus leading to amblyopia. Accordingly, early detection and diagnosis are mandatory. Despite technology development and constant knowledge growth, the foundations of physiology and the diagnosis of strabismus were set back in the 19th or early 20th century and have not changed since. In this paper, a novel, properly tested and evaluated eye-tracking based method for manifest strabismus diagnosis is presented. The evaluation showed the aforementioned method to have both high sensitivity and specificity in detecting manifest strabismus without the need for a skilled examiner, thus being suitable for population screening and highlighting the need for future research regarding testing of latent strabismus.Strabizam je relativno učestali poremećaj očiju s neusklađenosti optičkih osi, što dovodi do nenormalne binokularne interakcije
i razvoja slabovidnosti. Unatoč napretku tehnologije posljednjih godina, temelj dijagnosticiranja strabizma te fizikalnog pregleda postavljen je još u 20. odnosno u 19. stoljeću. U ovom radu predstavljen je suvremeni, računalno potpomognuti uređaj za praćenje pokreta oka u dijagnosticiranju manifestnog strabizma. Procjena je pokazala kako je metoda dovoljno osjetljiva i specifična za dijagnosticiranje manifestnog strabizma bez postojanja školovanog ispitivača, ukazujući na mogućnost njezine primjene u probiru, ali s naglaskom na potrebu budućih istraživanja po pitanju otkrivanja latentnog strabizma
Epistemic responsibilities in the COVID-19 pandemic: Is a digital infosphere a friend or a foe?
No full textDigital technologies have a significant role in collecting, filtering and disseminating information, allowing for social, healthcare and economic activities even in the context of highly restrictive public health measures in the current COVID-19 pandemic. As personal contact is greatly reduced, they also create a shared informational landscape, allowing for a shared threat response. This is a difficult task, since truthfulness of content that leads to actionable knowledge is impossible to consistently validate. So, not only that curation of information is rarely congruent with pressing health issues, but digital spaces may also become fertile ground for misinformation and disinformation, contributing to the devastating effects of an infodemic. Digital intermediaries are useful exactly because their representation of reality is not a true construct, but a result of purposely curated information. However, they are active, dynamic epistemological agents with their own logic and aim. In dealing with a pandemic, we should reconsider the ways how our digital informational landscapes are created and sustained. This urges us to consider ethical governance of digital data curation and dissemination, alongside forms of control of the truthfulness and reach of its content. Some of the most fundamental issues in dealing with the COVID-19 pandemic, including the newly available vaccines are reliant on digital information and data sharing among experts, and the role of informing the general public. The need to create a reproducible, valid and truthful informational landscape is paramount, while allowing for free and rational, behavioral individual choices oriented toward preserving and promoting healthy behavior. These are issues at the heart of dealing with any pandemic, as well as a well-organized health care policy
Djelomična laparoskopska adrenalektomija kod aldosteronoma: naše iskustvo
No full textBackground: Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. We demonstrated the safety and feasibility of the laparoscopic technique in patients with primary hyperaldosteronism caused by solitary aldosteronoma treated by laparoscopic partial adrenalectomy.
Aim: To demonstrate safety and feasibility of laparoscopic partial adrenalectomy in aldosterone-producing adenomas. Materials and methods: From 1992. to the present time, 13 patients presented with hyperaldosteronism and a single adrenal adenoma (Conn’s syndrome) and were treated with laparoscopic partial adrenalectomy. The mean age was 65 years, and the average tumor size was 1.35 cm in diameter. The mean follow-up of our patients for hypertension and local reccurence was 36 months (range 6 – 72 months). A transperitoneal approach was used in all patients, tumors were resected with safety margins by ultrasonic device.
Results: All procedures were finished laparoscopically, and no conversion was necessary. The mean duration of the operations was 65 minutes, with a mean bleeding rate of 40 ml. No major intraoperative or postoperative complication was observed. Postoperative mean hospital stay was 4 days. In all the cases, hypertension improved totally or partially, and no local recurrence was observed.
Conclusion: Laparoscopic partial adrenalectomy for aldosterone-producing adenomas is a minimally invasive procedure with a low complication rate. This procedure can be performed with good results for patients with small aldosteronomas of the adrenal gland, even with a healthy contralateral adrenal gland.Uvod: Od kada je po prvi puta opisana, laparoskopska adrenalektomija postala je zlatni standard u liječenju većine tumora nadbubrežne žlijezde. Pokazali smo sigurnost laparoskopskog pristupa kod bolesnika s primarnim hiperaldosteronizmom uzrokovanog solitarnim aldosteronomom liječenih djelomičnom adrenalektomijom.
Cilj: Pokazati sigurnost i izvedivost laparoskopske djelomične adrenalektomije kod adenoma koji luče aldosteron.
Materijali i metode: Od 1992. godine do danas, 13 bolesnika s primarnim hiperaldosteronizmom uzrokovanim solitarnim adenomom nadbubrežne žlijezde bilo je liječeno djelomičnom laparoskopskom adrenalektomijom. Prosječna dob bolesnika bila je 65 godina i veličina tumora 1,35 cm u promjeru. Pacijenti su praćeni kroz prosječno razdoblje od 36 mjeseci (raspon od 6-72 mjeseca). Kod svih bolesnika korišten je transperitonealni pristup pri čemu je za resekciju tumora korišten ultrazvučni nož.
Rezultati: Svi operacijski postupci završeni su laparoskopski, bez potrebe za konverzijom. Prosječno trajanje operacijskog zahvata bilo je 65 minuta, s prosječnim gubitkom krvi od oko 40 ml. Nije bilo većih intraoperativnih ili postoperativnih komplikacija. Prosječno trajanje hospitalizacije bilo je 4 dana. Kod svih bolesnika postoperativno je došlo do potpune ili djelomične korekcije hipertenzije bez pojave lokalnog recidiva.
Zaključak: Laparoskopska djelomična adrenalektomija kod aldosteronoma je minimalno invazivna procedura s malom pojavnošću komplikacija. Proceduru je moguće izvesti s dobrim rezultatima kod bolesnika s malim aldosteronomima nabubrežne žlijezde čak i slučajevima zdrave kontralateralne žlijezde
Guidelines for diagnosis and treatment of patients with neck pain – Part 2
No full textVratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. Part 1 relates to diagnosis, while the complementary Part 2 relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community
Sigurnost i učinkovitost robotom potpomognute stereotaksijske biopsije gliomskih tumora mozga: rana institucijska iskustva i vrednovanje literature
No full textRobot-assisted brain tumor biopsy is becoming one of the most important innovative technologies in neurosurgical practice. The idea behind its engagement is to advance the safety and efficacy of the biopsy procedure, which is much in demand when planning the management of endocranial tumor pathology. Herein, we provide our earliest institutional experiences in utilizing this mesmerizing technology. Cranial robotic device was employed for stereotactic robot-assisted brain glioma biopsy in three consecutive patients from our series: an anaplastic isocitrate dehydrogenase (IDH) negative astrocytoma (WHO grade III) located in the right trigone region of the periventricular white matter; a low grade diffuse astrocytoma (WHO grade II) of bilateral thalamic region spreading into the right mesencephalic area; and an IDH-wildtype glioblastoma (WHO grade IV) of the right frontal lobe producing a contralateral midline shifting. Robot-assisted tumor biopsy was successfully performed to get tissue samples for histopathologic and immunohistochemical analysis. The adjacent tissue iatrogenic damage of the eloquent cortical areas was minimal, while the immediate postoperative recovery was satisfactory in all patients. In conclusion, considering the preliminary results of our early experiences, robot-assisted tumor biopsy was proven to be a feasible and accurate procedure when surgery for brain glioma was not an option. It may increase safety and precision, without expanding surgical time, being similarly effective when compared to standard stereotactic and manual biopsy. Using this method to provide accurate sampling for histopathologic and immunohistochemical analysis is a safe and easy way to determine management strategies and outcome of different types of brain glioma.Robotom potpomognuta tumorska biopsija postaje jednom od najvažnijih inovativnih tehnologija u neurokirurškom radu. Razlog njezine uporabe nalazi se u daljnjem poboljšanju sigurnosti, učinkovitosti i preciznosti biopsijske metode koja je osobito značajna u planiranju opskrbe endokranijske tumorske patologije. Ovim radom donosimo prva institucijska iskustva u primjeni ove začudne tehnologije pri biopsiji gliomskih tumora mozga. Kranijski robotički uređaj korišten je pri tereotaksijskoj robotom potpomognutoj tumorskoj biopsiji u tri susljedna slučaja iz naše serije, koja je uspješno učinjena radi uzimanja uzorka tumorskoga tkiva za patohistološku i imunohistokemijsku dijagnostiku u bolesnice s anaplastičkim izocitrat dehidrogenaza (IDH) negativnim astrocitomom (SZO st. III.) smještenim u periventrukulskoj bijeloj tvari desnoga trigonuma, u bolesnika s difuznim astrocitomom niskoga stupnja malignosti (SZO st. II.) smještenim obostrano u talamičkom području sa širenjem u desni mezencefalon, kao i u bolesnika s IDH-wildtype glioblastomom (SZO st. IV.) desnog čeonog režnja s pomakom središnjih tvorba. Jatrogena lezija pripadajućeg elokventnog moždanog korteksa bila je minimalna, dok je neposredni poslijeoperacijski oporavak bio uspješan u svih bolesnika. Uzimajući u obzir preliminarne rezultate našega početnog iskustva, zaključujemo kako je robotom potpomognuta tumorska biopsija dokazano izvodljiva i primjerena metoda u kirurgiji gliomskih tumora mozga kojom se može poboljšati sigurnost i preciznost bez produljenja vremena operacije, a koja je podjednako učinkovita u usporedbi sa standardnom stereotaksijskom i manualnom biopsijom. Uporaba navedene metode omogućuje precizno uzorkovanje tumorskoga tkiva za patohistološku i imunohistokemijsku analizu na siguran i lak način, što doprinosi odabiru strategije liječenja i predviđanju ishoda različitih tipova gliomskih tumora mozga