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Orofacijalna bol: dijagnostički i terapijski izazovi
No full textThe concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary co-operation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.Već desetljećima se razvija koncepcija dijagnostike i terapije muskuloskeletalnih i neuropatskih bolesti stomatognatskog sustava, što je predmet ovog članka. Kako bi se izbjegle nedoumice može se reći da orofacijalni bolovi kao klinički problem obuhvaćaju u užem smislu ne-odontogene i ne-maligne uzroke bolova orofacijalne regije. U ovom članku evaluirani su rezultati kliničke dijagnostike populacije od 557 konsekutivnih pacijenata s orofacijalnim bolovima temeljem multidisciplinarne dijagnostike. Od sudjelovanja u studiji odustalo je 15,6% pacijenata. Za pacijente koji su odustali od istraživanja pokazalo se da su bili značajnije stariji (p=0,0411) od onih koji su pristali sudjelovati, ali nije bilo razlike u omjeru spola (p=0,185), jer je prevladavao udio ženskih pacijenata. U analizi 84,4% pacijenata koji su sudjelovali u studiji utvrđene su povišene vrijednosti anksioznosti (prosjek STAI 1 je bio 39,2, a na STAI 2 je bio 41,1), te se je pokazala statistička značajnost u ovisnosti povišene anksioznosti s intenzitetom bolova na vizualno-analognoj skali pri otvorenim ustima (p<0,0001). U odnosu na dob statistička značajnost bilo je za STAI 1 (p=0,0097) ali ne i za STAI 2 (p=0,5599). Najčešći oblik terapije je michiganska stabilizacijska udlaga: za pomak diska temporomandibularnog zgloba (TMZ) kod 38,9% i u kombinaciji s fizioterapijom kod 18,7% pacijenata; za osteoartritis TMZ-a kod 28,4% i u kombinaciji sa fizioterapijom kod 26,4% pacijenata. Za trigeminalnu neuralgiju prevladava kod 54,3% liječenje sa antikonvulzivima, u kombinaciji s akupunkturom 25,7% te samo akupunktura kod 17,1% pacijenata.
ultidisciplinarna suradnja u inicijalnoj dijagnostici i diferencijalnoj dijagnostici u ovoj studiji osmišljena je u svrhu razvijanja subspecijalističkog znanja o orofacijalnim bolovima
Multiple sclerosis and Fabry disease - diagnostic “mixup”
No full textA common disease like multiple sclerosis (MS) usually dominates the arena of demyelinating disorders; however, when a red flag such as a first relative family history of neurologic disease other than MS is present, the diagnostics may be more challenging. Recently, we have come across an intriguing clinical and diagnostic dilemma requiring extensive literature search and finally, decision making. Namely, initial presentation in our patient was that of a frequent condition such as optic neuritis and demyelinating CNS lesions, and then unexpected additional information during the usual diagnostic process, in the matter of first relative being diagnosed with a rare disease - Anderson-Fabry disease, oriented us in another direction. Almost paradoxically, the rare diagnosis being genetically confirmed, initiated treatment first. Furthermore, multitude of published data instigated clinical, radiological and laboratory uncertainty in our minds urging us to use a "wait and see" approach for the potential second diagnosis in order to prevent causing harm or labeling our patient wrongly by a potential misdiagnosis. However, further clinical course, a follow-up MRI, comparison with initial findings, and multi-disciplinary consultation safely directed us to a frequent diagnosis of multiple sclerosis. Our patient is currently treated for both conditions
Proofs for implementation of higher HE4 and ROMA index cut-off values in ovarian cancer preoperative stratification
No full textThis study aimed to identify and quantify the clinical significance of the HE4 and ROMA index in patients with an adnexal tumour. We recruited 159 women and the HE4 and CA125 were measured with an electrochemiluminescence immunoassay in the sera. We used the Kolmogorov–Smirnov test, Mann–Whitney’s test and logistic regression to interpret the data. In the premenopausal group (n = 57), the ROC analysis (with cut-off: 86.1 pmol/L for HE4; 40.7 U/L for CA125 and 21.9% for ROMA) demonstrated the superior prognostic potential of those markers when the higher cut-offs used are compared to producers. The AUC for HE4/CA125/ROMA were 0.846/0.867/0.846, respectively. The HE4/ROMA showed 85.7% sensitivity and 94% specificity. In the postmenopausal group (n = 102), the ROC analysis cut-off values were: 99.8 pmol/L for HE4; 45.8 U/L for CA125 and 38.4% for ROMA. AUC for HE4/CA125/ROMA were 0.928/0.899/0.927, respectively. HE4 had an 86.1% sensitivity at 92.4% specificity, while ROMA showed an 88.9% sensitivity at a 90.9% specificity
Noninvasive recanalization of a coronary chronic total occlusion
No full textBackground. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization
Smjernice za liječenje kronične limfocitne leukemije – veljača 2019.
No full textNove smjernice (KroHem v1.2019) su rezultat prethodnih smjernica, relevantnih kliničkih studija faze 3 i sukladne su s najvažnijim međunarodnim smjernicama za liječenje KLL (NCCN, ESMO)
Je li dobrobit od liječenja aspirinom u bolesnika koji ga uzimaju zbog primarne prevencije moždano- i srčanokrvožilnih bolesti veća od rizika krvarenja?
No full textDaily aspirin use has long been heralded for its cardioprotective effects, particularly in at-risk individuals like those with diabetes mellitus. However, a signifi cant amount of research published in the last 5 years has called into question the benefits of aspirin for primary prevention of cardiovascular disease. Risk factors for gastrointestinal bleeding with aspirin use include higher dose and longer duration of use, history of gastrointestinal ulcers or upper gastrointestinal pain, bleeding disorders, renal failure, severe liver disease, and thrombocytopenia. Other factors that increase the risk of gastrointestinal or intracranial bleeding with low-dose aspirin use include concurrent anticoagulation or nonsteroidal anti-infl ammatory drug use, uncontrolled hypertension, male sex, and older age. Aspirin for primary cardiovascular disease prevention should be highly individualized, based on the benefi t-risk ratio assessment for the given patient.Dnevna upotreba aspirina već je dugo poznata zbog svojih zaštitnih moždano- i srčanokrvožilnih učinaka, što je osobito izraženo u osoba s visokim rizikom (npr. osoba sa šećernom bolesti). Međutim, značajan broj istraživanja objavljenih u posljednjih pet godina dovodi u pitanje prednosti aspirina u primarnoj prevenciji moždano- i srčanokrvožilnih bolesti. Čimbenici rizika za krvarenje iz probavnog sustava uzrokovanog aspirinom uključuju veću dozu i dugotrajno uzimanje lijeka, anamnezu o ulkusnoj bolesti, bolnost u žličici, poremećaje zgrušavanja krvi, zatajenje bubrega, tešku bolest jetre i trombocitopeniju. Drugi čimbenici koji povećavaju rizik od krvarenja iz probavnog sustava ili moždano krvarenje u osoba koje uzimaju nisku dozu aspirina uključuju istodobnu uporabu antikoagulacijskih lijekova ili nesteroidnih protuupalnih lijekova, nekontroliranu hipertenziju, muški spol i stariju dob. Primarna prevencija moždano- i srčanokrvožilnih bolesti uzrokovanih aspirinom mora biti prilagođena svakom pojedinom bolesniku pri čemu treba uzeti u obzir omjer koristi i štete od uzimanja lijeka
An internal carotid artery pseudoaneurysm with neck hematoma: A rare cause of a life-threatening neck mass mimicking an abscess
No full textA neck mass has a broad and complex differential diagnosis, generally divided into neoplastic, congenital and inflammatory categories. An internal carotid artery hemorrhage with pseudoaneurysm formation is a very rare entity that may resemble other common conditions in the differential diagnosis. Large, expanding or symptomatic pseudoaneurysm is critical to efficiently diagnose and manage, due to risk of life-threatening hemorrhage. We present a case of an adult male patient with clinical and laboratory signs of severe neck cellulitis and a large gradually increasing neck mass, primarily suggestive of an abscess. Neck CT and MRI imaging revealed the presence of a disruption of the internal carotid artery resulting in a large hematoma and formation of pseudoaneurysm. A multidisciplinary team of interventional radiologists and ENT surgeons successfully treated the patient by endovascular placement of stents and subsequent surgical drainage. Awareness of such a rare, life-threatening condition and efficient multidisciplinary teamwork are essential for patient management
Lažno pozitivna fenotipska detekcija metalo-beta-laktamaza u Acinetobacter Baumannii
No full textPhenotypic detection of metallo-β-lactamases (MBLs) in Acinetobacter (A.) baumannii is a serious challenge to clinical microbiologists. MBLs are inhibited by metal chelators such as ethylenediaminetetraacetic acid) (EDTA). Production of MBLs cannot be recognized based on resistance phenotype. Therefore, phenotypic tests using EDTA are recommended. The aim of this study was to investigate the sensitivity and specificity of inhibitor based tests (EDTA) for detection of MBL. A total of 172 A. baumannii strains (123 carbapenemase positive and 49 carbapenemase negative) were analyzed. Phenotypic detection of MBLs was performed by the combined disk test with EDTA (CDT-EDTA) and EPI-dilution test (EPI-DT). Both tests were positive in all 11 isolates possessing VIM-1 MBL, showing 100% sensitivity. However, false positive results were observed in strains with class D carbapenemases using both tests, i.e. all OXA-23 and OXA-24/40 producing organisms and most OXA-58 positive strains (77% with CDT-EDTA vs. 65% with EPI-DT). False positive results can occur because oxacillinases are converted to a less active state in the presence of EDTA, leading to augmentation of the inhibition zone around the carbapenem disk or reduction of carbapenem minimum inhibitory concentrations. This study showed high sensitivity but low specificity of phenotypic methods in the detection of MBLs.Fenotipska detekcija metalo-β-laktamaza (MBL) u Acinetobacter (A.) baumannii je velik izazov kliničkim mikrobiolozima. MBL su inhibirane metalnim kelatorima kao što je etilendiamin tetraoctena kiselina (EDTA). Produkcija MBL ne može se prepoznati na temelju fenotipa rezistencije. Zbog toga se preporuča primjena fenotipskih testova koji rabe metalne kelatore kao što je EDTA. Cilj istraživanja bio je utvrditi osjetljivost i specifičnost testova s inhibitorom (EDTA) u otkrivanju MBL u A. baumannii. Analizirana su 172 izolata A. baumannii (123 karbapenemaza pozitivnih i 49 karbapenemaza negativnih). Fenotipska detekcija MBL je provedena metodom kombiniranih diskova (EDTA CDT-EDTA) i EPI-dilucijskom metodom (EPI-DT). Oba testa su bila pozitivna u svih 11 izolata pozitivnih na VIM-1 MBL, što odgovara osjetljivosti od 100%. Lažno pozitivni rezultati su dobiveni u karbapenem-rezistentnim izolatima pozitivnim na klasu D karbapenemaza u oba testa: svi OXA-23 i OXA-24/40 kao i većina OXA-58 pozitivnih sojeva (77% u CDT-EDTA i 65% u EPI-DT). Lažno pozitivni rezultati u testovima s inhibitorom nastaju zbog toga što oksacilinaze prelaze u stanje manje aktivnosti u prisustvu EDTA, što dovodi do smanjenja minimalne inhibitorne koncentracije karbapenema ili do uvećanja zone oko diska karbapenema. Studija je pokazala visoku osjetljivost, ali nisku specifičnost fenotipskih testova za dokaz MBL u A. baumannii, što ukazuje na neophodnost korištenja molekularnih metoda
Izgradnja zbirki u specijalnoj knjižnici – primjer knjižnice KBC Sestre milosrdnice
Get PDFU radu će se na primjeru specijalne bolničke knjižnice dati pregled zbirki koje izgrađuje specijalna knjižnica, s obzirom na vrstu i potrebe svojih korisnika. Specijalna knjižnica je prema definiciji Standarda za specijalne knjižnice samostalna knjižnica ili knjižnica u sastavu koja pokriva neku znanstvenu disciplinu. Knjižnica Kliničkog bolničkog centra Sestre milosrdnice je specijalna bolnička knjižnica koja djeluje kao posebna ustrojbena jedinica unutar Sektora za opće, pravne i kadrovske poslove Kliničkog bolničkog centra Sestre milosrdnice, te se tako izgradnja njenih zbirki profilira za područje kliničke medicine. Knjižnica djeluje na tri lokacije: Središnja knjižnica nalazi se u sjedištu KBC Sestre milosrdnice, na adresi Vinogradska 29, te dva ogranka na lokacijama u Klinici za traumatologiju, Draškovićeva 19 te u Klinici za tumore, Ilica 197. U otvorenom pristupu Središnje knjižnice KBCSM nalazi se bogati fond kojeg zajedno čine opća referentna zbirka, zbirka literature s područja povijesti medicine i povijesti KBC Sestre milosrdnice, zbirka medicinske pretkliničke i kliničke literature na hrvatskom i engleskom jeziku, zbirka domaćih i stranih časopisa, zbirka časopisa u izdanju KBC Sestre milosrdnice, zbirka autora KBC Sestre milosrdnice koja sačinjava sve radove djelatnika ustanove, zbirka popularne medicinske literature za pacijente te zbirka Croatica. Za klasifikaciju knjižne građe koristi se Klasifikacija Nacionalne medicinske knjižnice u SAD-u (NLM Classification), a za predmetnu obradu koriste se predmetnice i potpredmetnice tezaurusa MeSH (Medical Subject Headings). Zbirka Knjižnice KBCSM – lokacija Draškovićeva, specijalizirana je za literaturu s područja kirurgije, ortopedije, traumatologije, fizikalne medicine i rehabilitacije te povezanih medicinskih struka, a knjižnica KBCSM – lokacija Ilica izgrađuje zbirku uglavnom onkološke literaturu. Izgradnja zbirki ovisi prvenstveno o znanstvenom području koje pokriva a to je klinička medicina, te o financijskoj potpori osnivača. Priroda znanstvenih medicinskih informacija je vrlo promjenjiva te brzo zastarijeva, tako da Knjižnica KBCSM u duhu vremena počinje i sa izgradnjom zbirke e-knjiga za sve tri lokacije