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Outbreak of hantavirus disease caused by Puumala virus, Croatia, 2021
No full textIn 2021, a large outbreak of hantavirus disease (HAVID) in Croatia with 334 notified cases coincided with a COVID-19 wave and included patients from areas previously not considered endemic, challenging HAVID recognition and patient management. We analysed clinical and epidemiological data on all 254 patients with HAVID treated in the Clinical Hospital Center Rijeka (CHC Rijeka) between February and November 2021. Most patients (n = 246; 96.9%) had antibodies against Puumala virus, 212 (83.5%) were residents of endemic areas for HAVID, 93 (36.6%) reported occupational exposure and 86 (33.9%) had observed rodents or rodent excreta. Thirty-seven (14.6%) patients were not notified to the public health authorities. Most patients (n = 177; 69.7%) were male. The median age of the patients was 43 years (range: 17–79 years) in males and 54 years (range: 14–77 years) in females. More severe courses of disease were observed in males age
In the Digestive Danger Zone: Emergency Management of Swallowed Nail Clipper – A Case Report
No full textCilj: Ingestija stranog tijela u odrasloj populaciji može biti namjerna ili nenamjerna. Moguće su komplikacije u smislu impakcije, perforacije, krvarenja i opstrukcije određenog dijela gastroinestinalnog trakta, stoga je potrebno neodgodivo medicinsko zbrinjavanje. Cilj rada je prikazati neobičan slučaj ingestije stranog tijela koji zahtijeva hitno liječenje. Prikaz slučaja: Zatvorenik u dobi od 47 godina dolazi u pratnji policije na hitni bolnički prijam zbog navoda o progutanom stranom tijelu – grickalici za nokte, s ciljem samoubojstva. Dan prije, bio je na hitnom prijamu zbog pokušaja samoubojstva zarezivanjem vrata britvicom. Nakon dolaska na hitni prijam vitalni parametri i fizikalni status bolesnika bili su uredni. Uzorkovani su laboratorijski nalazi koji su uključili kompletnu krvnu sliku, metabolički profil, testove koagulacijskih parametara te je učinjen radiogram abdomena. Na snimci je uočena metalna sjena u projekciji trećeg i četvrtog lumbalnog kralješka bez znakova mehaničke opstrukcije ili perforacije te bolesnik biva upućen gastroenterologu. S obzirom na ingestiju oštrog stranog tijela indicirana je hitna ezofagogastroduodenoskopija te je tijelo i odstranjeno. Nakon psihijatrijskog pregleda bolesnik je otpušten na liječenje u Bolnicu za osobe lišene slobode zbog pokušaja samoubojstva. Zaključak: Ovaj prikaz slučaja predstavlja rijedak nalaz metalnog stranog tijela u specifičnim okolnostima kod bolesnika lišenog slobode. Ističe integralnu ulogu liječenja metodom hitne endoskopije, naglašavajući njezinu životno važnu ulogu u sprječavanju potencijalnih letalnih komplikacija ingestije stranog tijela.Aim: Ingestion of foreign bodies in the adult population is either intentional or unintentional. Complications in the form of impaction, perforation, hemorrhage and obstruction may occur and immediate investigation is required. The aim of this case report is to present an unusual cause of foreign body ingestion that required urgent treatment. Case Report: A 47-year-old male patient was admitted to the emergency room because of swallowing a foreign body. This was a case of an inmate who had attempted suicide the day before by inflicting wounds to his neck with a razor blade. Suicide attempts were also the reason for the ingestion. On admission, his vital signs were within reference values and the physical examination showed no abnormalities. Complete blood count, metabolic panel and coagulation tests were obtained. Abdominal x-ray showed a metallic foreign body in the projection of the third and fourth lumbar vertebrae with no signs of mechanical obstruction or perforation. The patient was referred to a gastroenterologist. As the patient had swallowed a sharp object, an urgent upper endoscopy was performed, and the foreign body was extracted. After a psychiatric evaluation, the patient was discharged for treatment at the Hospital for Persons Deprived of Liberty due to a suicide attempt. Conclusion: To summarize, this case report represents a rare finding of a metal foreign body under special circumstances. It highlights the important role of emergency endoscopic treatment and emphasizes the life-saving importance of preventing potentially fatal complications that can result from ingestion of a foreign body
Vrijednosti doznih indikatora za postupke standardne mamografije i digitalne tomosinteze u KBC-u Rijeka
No full textAim: The aim of the study is to determine typical values of dose indicators for standard mammography and digital breast tomosynthesis at the Department of Diagnostic and Interventional Radiology at the Clinical Hospital Center Rijeka, to assess whether the determined typical values of the dose indicators for standard mammography procedures are in accordance with the national diagnostic reference values and whether the determined typical values of the dose indicators for digital breast tomosynthesis are in accordance with the data published in current international publications. This is one of the first studies in the Republic of Croatia with the aim of determining typical values of dose indicators for digital breast tomosynthesis procedures. Participants and methods: Data from a total of 135 women who had undergone planar mammography and 285 women who had undergone digital breast tomosynthesis were analyzed. Median values of average glandular dose for standard mammography and tomosynthesis were calculated for a compressed breast thickness of 5-6 cm. Results: The median values of the average glandular dose for standard mammography at a compressed breast thickness of 5-6 cm at Clinical Hospital Center Rijeka are 1.51 mGy per projection, while for digital breast tomosynthesis, they are 1.99 mGy per projection. It was found that the values of the typical dose indicator for standard mammography procedures determined at the Clinical Hospital Center Rijeka are lower than the national diagnostic reference values. The determined values of the typical dose indicator for digital breast tomosynthesis are consistent with the values published in recent international publications. Conclusions: The results of this study have shown that the values of the average glandular dose for planar mammography and digital breast tomosynthesis at the Clinical Hospital Center Rijeka are in accordance with national and international recommendations.Cilj: Cilj rada je odrediti tipične vrijednosti doznih indikatora za postupke standardne mamografije i digitalne tomosinteze dojke na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju Kliničkog bolničkog centra Rijeka, utvrditi jesu li dobivene tipične vrijednosti doznih indikatora za standardne mamografske postupke u skladu s nacionalnim dijagnostičkim referentim razinama u Republici Hrvatskoj te utvrditi jesu li dobivene tipične vrijednosti doznih indikatora za digitalnu tomosintezu dojke u skladu s podatcima objavljenim u recentnim međunarodnim publikacijama. Rad predstavlja jedno od prvih istraživanja u Republici Hrvatskoj čiji je cilj odrediti tipične vrijednosti doznih indikatora za postupke digitalne tomosinteze dojke. Ispitanici i metode: Analizirani su podatci 135 žena koje su podvrgnute standardnoj mamografiji te 285 žena kod kojih je učinjena digitalna tomosinteza dojke. Medijani vrijednosti srednje glandularne doze za standardnu mamografiju i digitalnu tomosintezu dojke izračunati su za debljinu komprimirane dojke od 5 do 6 cm. Rezultati: Medijan srednje glandularne doze za standardnu mamografiju po jednoj projekciji u Kliničkom bolničkom centru Rijeka iznosi 1,51 mGy za debljinu komprimirane dojke od 5 do 6 cm, dok za digitalnu tomosintezu iznosi 1,99 mGy. Utvrđeno je da su dobivene tipične vrijednosti doznih indikatora u Kliničkom bolničkom centru Rijeka za standardne mamografske postupke manje od nacionalnih dijagnostičkih referentnih razina. Dobivene tipične vrijednosti doznih indikatora za digitalnu tomosintezu dojke sukladne su vrijednostima objavljenim u recentnim međunarodnim publikacijama. Zaključci: Rezultati istraživanja pokazuju da su vrijednosti srednje glandularne doze za standardnu mamografiju i digitalnu tomosintezu dojke u Kliničkom bolničkom centru Rijeka u skladu s nacionalnim i međunarodnim preporukama
Funkcionalni poremećaji pokreta i fizioterapija
No full textUvod: Funkcionalni poremećaji pokreta onesposobljavajuće
su neuropsihijatrijsko stanje koje predstavlja dijagnostički
i terapijski izazov. U zbrinjavanju osoba s funkcionalnim
poremećajem pokreta bitan je multidisciplinarni pristup,
a fizioterapija se pokazala kao jedna od ključnih
komponenti.
Cilj: Istražiti utjecaj fizioterapije kod funkcionalnih
poremećaja pokreta
Materijali i metode: Literatura je pretraživana u
elektronskim bazama podataka Medline i PubMed,
a korištene su ključne riječi: functional movement
disorder, psychogenic movement disorder, physical
therapy, multidisciplinary team.
Rezultati: Nakon pretraživanja i filtriranja radova
sukladno navedenom cilju u obzir je uzeto 10 radova
koji daju relevantne i detaljne podatke te tematikom
odgovaraju cilju istraživanja.
Zaključak: Uloga fizioterapeuta neophodna je u
fizioterapijskoj procjeni i provođenju fizioterapijskih
postupak kod pacijenata s funkcionalnim poremećajima
pokreta. Fizioterapija doprinosi smanjena simptoma i
poboljšanja kvalitete života kod osoba s funkcionalnim
poremećajem pokreta
Development and Validation of the CARRA-VID Prognostic Score: C Reactive Protein to Albumin Ratio, Red Blood Cell Distribution Width and Age-Based Score for Prognostication of Hospitalized COVID-19 Patients
No full textPatients hospitalized due to coronavirus disease 2019 (COVID-19) usually present with severe or critical intensity of symptoms, accompanied by a marked systemic inflammatory response. Classical inflammatory biomarkers, C-reactive protein (CRP), albumin, and red blood cell distribution width (RDW) have previously been reported to be prognostic in hospitalized COVID-19 patients. We performed a retrospective analysis of two large cohorts (2305 and 2328 patients, respectively) of consecutive hospitalized COVID-19 patients with mostly severe and critical symptoms admitted to the tertiary referral center to develop and validate a prognostic score for 30-day mortality based on CRP-to-Albumin-Ratio (CAR), RDW, and age (termed CARRA-VID score). We identified 6 prognostic categories: very low, low, intermediate-1, intermediate-2, high, and very high risk, with corresponding 30-day mortality rates of 2.7%, 10.7%, 30.9%, 47.1%, 61.9%, and 89.7%, respectively. Effective risk stratification was validated in an independent cohort of patients and remained independent of the World Health Organization-defined disease severity and other commonly utilized risk scores. Additional analyses evaluated the score across different time periods dominated by distinct viral variants. We also present a simplified 3-tiered version of the score. A Microsoft Excel Workbook containing the score calculator is provided
Iodine and Selenium Status in Relation to Thyroid and Immune Functions—The Analysis of Their Dependencies in a Group of Women of Reproductive Age from the Southern Region of Poland
No full textObjectives: Iodine and selenium are key elements for thyroid. There is also evidence of their immunoregulatory potential. However, the current state of knowledge of potential interactions among iodine—selenium—thyroid—immune system is not sufficient. The aim of the study was to evaluate iodine and selenium statuses and examine the relationship between them and the functioning of the thyroid and immune system in a group of women of reproductive age, without previously diagnosed disease. Methods: The study involved a group of 60 women aged 19–40 from southern Poland. The concentrations of iodine and selenium were determined in serum samples using the ICP-MS and AAS methods, respectively. Thyroid function was assessed by determining serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and anti-thyroid peroxidase antibodies (anti-TPO) by electrochemiluminescence methods. Glutathione peroxidase 3 (GPX3) and ferric ion reducing antioxidant power (FRAP) in serum were measured by spectrophotometric methods. Immune functions were evaluated by analyzing cytokine levels using ELISA tests, including interferon-γ, interleukin-4, interleukin-17, and transforming growth factor-β. Results: No significant correlations between selenium and thyroid or immunological parameters were observed. The level of iodine in serum positively correlated with free thyroxine, indicating its importance for maintaining normal thyroid function, as well as with FRAP in serum, suggesting a protective role of iodine-mediated antioxidant activity on thyroid function. Conclusions: Our results underline the complexity of the system of correlations between iodine–selenium–thyroid–immune function. Nevertheless, understanding them may turn out to be crucial for developing preventive and therapeutic strategies in the context of thyroid diseases
Radiogenomics of Stereotactic Radiotherapy: Genetic Mechanisms Underlying Radiosensitivity, Resistance, and Immune Response
No full textStereotactic body radiotherapy (SBRT) delivers ablative radiation doses with sub-millimeter precision. Radiogenomic studies, meanwhile, provide insights into how tumor-intrinsic genetic factors influence responses to such high-dose treatments. This review explores the radiobiological mechanisms underpinning SBRT efficacy, emphasizing the roles of DNA damage response (DDR) pathways, tumor suppressor gene alterations, and inflammatory signaling in shaping tumor radiosensitivity or resistance. SBRT induces complex DNA double-strand breaks (DSBs) that robustly activate DDR signaling cascades, particularly via the ATM and ATR kinases. Tumors with proficient DNA repair capabilities often resist SBRT, whereas deficiencies in key repair genes can render them more susceptible to radiation-induced cytotoxicity. Mutations in tumor suppressor genes may impair p53-dependent apoptosis and disrupt cell cycle checkpoints, allowing malignant cells to evade radiation-induced cell death. Furthermore, SBRT provokes the release of pro-inflammatory cytokines and activates innate immune pathways, potentially leading to immunogenic cell death and reshaping the tumor microenvironment. Radiogenomic profiling has identified genomic alterations and molecular signatures associated with differential responses to SBRT and immune activation. These insights open avenues for precision radiotherapy approaches, including the use of genomic biomarkers for patient selection, the integration of SBRT with DDR inhibitors or immunotherapies, and the customization of treatment plans based on individual tumor genotypes and immune landscapes. Ultimately, these strategies aim to enhance SBRT efficacy and improve clinical outcomes through biologically tailored treatment. This review provides a comprehensive summary of current knowledge on the genetic determinants of response to stereotactic radiotherapy and discusses their implications for personalized cancer treatment
Traumatic Brain Injury: Novel Experimental Approaches and Treatment Possibilities
No full textTraumatic brain injury (TBI) remains a critical global health issue with limited effective treatments. Traditional care of TBI patients focuses on stabilization and symptom management without regenerating damaged brain tissue. In this review, we analyze the current state of treatment of TBI, with focus on novel therapeutic approaches aimed at reducing secondary brain injury and promoting recovery. There are few innovative strategies that break away from the traditional, biological target-focused treatment approaches. Precision medicine includes personalized treatments based on biomarkers, genetics, advanced imaging, and artificial intelligence tools for prognosis and monitoring. Stem cell therapies are used to repair tissue, regulate immune responses, and support neural regeneration, with ongoing development in gene-enhanced approaches. Nanomedicine uses nanomaterials for targeted drug delivery, neuroprotection, and diagnostics by crossing the blood–brain barrier. Brain–machine interfaces enable brain-device communication to restore lost motor or neurological functions, while virtual rehabilitation and neuromodulation use virtual and augmented reality as well as brain stimulation techniques to improve rehabilitation outcomes. While these approaches show great potential, most are still in development and require more clinical testing to confirm safety and effectiveness. The future of TBI therapy looks promising, with innovative strategies likely to transform care
Accuracy of Imaging Scoring Indexes in Pediatric Crohn’s Disease Patients
No full textBackground: Crohn’s disease (CD) is a chronic inflammatory condition that can affect the gastrointestinal tract and cause significant extraintestinal manifestations. Diagnosing and monitoring disease activity, especially in pediatric patients, remains a challenge due to the variable clinical presentations and limitations of traditional imaging methods. Objective: This study aimed to evaluate and compare the diagnostic accuracy and clinical utility of small bowel capsule endoscopy (SBCE) versus magnetic resonance enterography (MRE) for assessing disease activity and extent in pediatric Crohn’s disease using the Pediatric Crohn’s Disease Activity Index (PCDAI) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) as reference standards. Methods: In this prospective study, 52 pediatric patients with newly diagnosed CD underwent upper and lower endoscopy, MRE, and SBCE. The SBCE images were analyzed using the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI), while the MRE images were scored using the Crohn’s Disease MRI Index (CDMI). Correlations of these findings with PCDAI and SES-CD were statistically analyzed. Results: CECDAI and CDMI demonstrated strong correlations with PCDAI (r = 0.517 and r = 0.525, respectively; p < 0.001). The correlations between CECDAI and SES-CD were less pronounced but significant. SBCE and MRE showed comparable efficacy in detecting small bowel lesions, with both methods offering valuable insights into the disease status. Conclusions: SBCE is a reliable, non-invasive tool for diagnosing and monitoring pediatric CD, comparable to MRE. While SBCE offers higher resolution for mucosal evaluation, it requires additional expertise for optimal interpretation. The adoption of SBCE alongside MRE could enhance diagnostic accuracy and early therapeutic interventions for pediatric CD
Daratumumab for PRCA after HCT: study and practical considerations from the EBMT Transplant Complications Working Party
No full textAbstract Pure red cell aplasia (PRCA) is a relevant complication after ABO-mismatched allogeneic hematopoietic cell transplantation (HCT). No standard treatment exists, and practice is heterogenous. In this study, we took advantage of an international collaboration to describe characteristics and outcomes of patients receiving daratumumab for PRCA following first allogeneic HCT. We identified 45 patients meeting these criteria (median patient age, 56 years). The median time from HCT to PRCA was 55 days (IQR, 36–116) and all patients were transfusion-dependent at time of daratumumab start. Daratumumab was first-line treatment in 16 patients (36%), most patients (67%) received daratumumab intravenously, and median time from PRCA diagnosis and daratumumab start was 88 days (IQR, 59–219). Incidence of transfusion independence was 69% (95% confidence interval [CI], 52–80%) at 6 months and 80% (95% CI, 62–90%) at 12 months. Incidences of hemoglobin and reticulocyte recoveries were respectively 56 and 78% at 6 months and 65 and 83% at 12 months. Survival at 12 months was 81%, and of 8 deaths, 7 were GVHD- or infection-related. One death was associated with hemolytic anemia. This is the first international and largest study on the use of daratumumab for PRCA after allogeneic HCT, showing high response rates superior to that reported for other treatments. Seven incidents of severe adverse events (mostly infections) underscore the need for close monitoring, proactive management, and comparative studies to determine the role for daratumumab for PRCA. Last, based on these data and a comprehensive literature review, we provide practical consideration for modern PRCA treatment