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Afatinib‐induced toxic epidermal necrolysis: A case report with a literature review
No full textWe present a 70‐year‐old female patient diagnosed with epidermal growth factor receptor‐mutated metastatic non‐small cell lung cancer (T4N2M1a), who developed afatinib‐induced toxic epidermal necrolysis (TEN). We have also performed a PubMed/Medline literature review to detect other possible cases of TEN/Stevens–Johnson syndrome associated with afatinib treatment and found only 5 other cases reported
Challenges in nutrition in preterm newborns
No full textPreterm newborns exhibit heightened energetic demands due to their immaturity and potential complications, necessitating careful consideration of the composition of their nutrition. Nutrition plays a pivotal role in addressing and attenuating the effects of prematurity as well as underdevelopment.
However, prematurity comprises challenges like the inability to suck and swallow as well as the immaturity of the lung and the GI system all of which impede a proper nutrition and conse-quently complicate adequate growth. Additionally, premature infants are exposed to environ-ments such as NICU and receive medications which may influence their status.
Various feeding methods are evaluated and precisely tailored according to their advantages and disadvantages, specific for the preterm infant’s condition. Parenteral nutrition may be necessary for extremely premature newborns to prevent catabolic processes and ensure consistent supply.
The transition to enteral nutrition should be performed smoothly to prevent a nutrient deficient state. Enteral nutrition is best provided with human breast milk as it meets the caloric goals, as well as provides beneficial immunoactive substances.
Fortifiers and supplementations are required in preterm newborns as their heightened energy demands cannot be solely met with mothers’ milk and preterm infants often lack certain vitamins or trace elements
Fibromyalgia and chronic fatigue syndrome - differential diagnosis and early recognition strategy in primary health care
No full textME/CFS i FM su bolesti koje često koegzistiraju. Sa simptomatologijom boli i/ili umora je povezano 10-20% pregleda u ordinaciji obiteljske medicine. ME/CFS se javlja s učestalošću oko 1.4%, a FM u oko 5% populacije. Etiologija je povezana s virusnim infektivnim bolestima te poremećajem regulacije imunološkog sustava. Primarni simptom u ME/CFS-u je umor dok je u FM-u proširena bol po cijelom tijelu. Prateći poremećaji su depresija, poremećaji spavanja te kognitivni problemi. Preklapanje simptoma između ovih dvaju bolesti je često te 70% pacijenata koji boluju od FM također zadovoljavaju kriterije ME/CFS-a. Bolesti su pogodne za dijagnostiku u primarnoj zdravstvenoj zaštiti. Postoji nekoliko kriterija koji su modificirani kroz godine. Trenutno su najkorišteniji AAPT kriterij za FM te IOM kriteriji za ME/CFS. Vrijeme do postavljanja dijagnoze je 2 godine, a pacijent posjeti prosječno gotovo 4 liječnika. Osim kompletnog pregleda potrebno je napraviti i laboratorijske nalaze kako bi se diferencijalno dijagnostički isključile druge bolesti. Farmakoterapija dosad nije pokazala veliku učinkovitost. NSAID-ovi i opioidni lijekovi (osim tramadola) nisu učinkoviti u liječenju boli kod ovih sindroma. Kod pacijenata s tipičnim simptomima preporuča se liječenje započeti tricikličkim antidepresivima, ukoliko su umor i/ili depresija glavni simptom preporučaju se lijekovi SNRI skupine, a ako je poremećaj sna primarni problem koriste se lijekovi iz skupine alfa 2 liganada. Ove metode bi trebalo koristiti komplementarno kako bi se postigao najbolji ishod.ME/CFS and FM are diseases that often coexist. Ten to twenty percent of examinations in the family medicine office are associated with pain and/or fatigue symptoms. ME/CFS occurs with a frequency of about 1.4%, and FM in about 5% of the population. The etiology is related to viral infectious diseases and immune system regulation disorder. The primary symptom in ME/CFS is fatigue, while in FM there is widespread pain throughout the body. Accompanying disorders are depression, sleep disorders, and cognitive problems. Overlap of symptoms between these two diseases is common and 70% of patients suffering from FM also meet the criteria of ME/CFS. Diseases are suitable for diagnosis in primary health care. Several criteria have been modified over the years. Currently, the most widely used are the AAPT criteria for FM and the IOM criteria for ME/CFS. The time until diagnosis is 2 years, and the patient visits an average of almost 4 doctors. In addition to a complete examination, it is necessary to perform laboratory tests to rule out other diseases in the differential diagnosis. Pharmacotherapy has so far not shown great effectiveness. NSAIDs and opioid drugs (except tramadol) are not effective in treating pain in these syndromes. In patients with typical symptoms, it is recommended to start treatment with tricyclic antidepressants, if fatigue and/or depression are the main symptoms, drugs from the SNRI group are recommended, and if sleep disturbance is the primary problem, medications from the alpha 2 ligand group are used. These methods should be used complementary to achieve the best outcome
Učestalost koegzistencije migrene i gastrointestinalnih bolesti
No full textUVOD: Migrena je rašireni neurološki poremećaj od koje obolijeva svaka šesta osoba u općoj populaciji. Crijevno-moždana barijera je dvosmjerna komunikacija gastrointestinalnog i središnjeg živčanog sustava s potencijalnim terapijskim mogućnosti i razumijevanjem patofiziologije migrene. Svrha ovog istraživanja je utvrditi koegzistenciju migrene i gastrointestinalnih bolesti s osvrtom na dosadašnja saznanja.
CILJ ISTRAŽIVANJA: Ciljevi ovog istraživačkog rada su utvrditi pojavnosti: pojedinih gastrointestinalnih bolesti uz migrenu, migrene i gastrointestinalnih bolesti s obzirom na spol i dob, najčešćih gastrointestinalnih simptoma uz migrenu te pojavnosti ostalih komorbiditeta migrene uz gastrointestinalnu bolest na Klinici za internu medicinu KBC-a Rijeka.
ISPITANICI I METODE: Istraživanje je retrospektivnog tipa. Prikupljeni su podatci (spol, dob, gastrointestinalna bolest i simptomi, dosadašnje bolesti) dostupni putem IBIS-a.
REZULTATI: Među 52 ispitanika 81% su žene i 19% muškarci. Najveći broj bolesnika je starosne dobi 51-65 godine (36,54%). Gastritis, dispepsija (20%) i IBS (20%) su najčešće GI bolesti prisutne uz migrenu. Najčešći GI simptom je nadutost (35%) Najčešći komorbiditet uz migrenu i gastrointestinalnu bolest su respiratorna stanja 36,36%) u cijelom uzorku, a kod žena psihijatrijski poremećaji (7,14%) i respiratorna stanja (7,14%).
ZAKLJUČAK: Koegzistencija migrene i gastrointestinalnih bolesti češća je kod žena. Zbog malog uzorka hipoteza vezana uz dob nije potvrđena. IBS je, uz gastritis i dispepsiju, najčešća gastrointestinalna bolest. Najčešći gastrointestinalni simptom je dispepsija. Psihijatrijski poremećaji jesu jedni od najčešćih komorbiditeta kod žena, ali ne i u cijelom uzorku zbog čega hipoteza vezana uz komorbiditete nije potvrđena.INTRODUCTION: Migraine is a common neurological disorder affecting every sixth person in population. The gut-brain barrier is a two-way communication between the gastrointestinal and central nervous system with potential therapeutic possibilities and understanding of migraine pathophysiology.
OBJECTIVES: The aim of this study is to determine the incidence of: gastrointestinal diseases with migraine, migraine and gastrointestinal diseases with regard to gender and age, the most common gastrointestinal symptoms with migraine and the incidence of other migraine comorbidities with gastrointestinal disease at the Clinic for Internal Medicine of CHC Rijeka.
PARTICIPANTS AND METHODS: This research is retrospective. Collected data (gender, age, gastrointestinal disease and symptoms, previous diseases) are available through IBIS.
RESULTS: Among the 52 participants, 81% are female and 19% male. Most patients are aged 51-65 (36,54%). Gastritis, dyspepsia (20%) and IBS (20%) are the most common GI diseases present with migraine. The most common GI symptom is flatulence (35%) The most common comorbidity with migraine and gastrointestinal disease in the entire sample is respiratory conditions (36,36%) while in women psychiatric disorders (7,14%) and respiratory conditions (7,14%).
CONCLUSION: Coexistence of migraine and gastrointestinal diseases is more common in women. Due to the small sample, the hypothesis related to age was not confirmed. Along with gastritis and dyspepsia, IBS is the most common gastrointestinal disease. The most common gastrointestinal symptom is dyspepsia. Psychiatric disorders are one of the most common comorbidities just in women which is why the hypothesis related to comorbidities was not confirmed
The Effect of Prehospital Therapy on the Course of Treatment of Status Epilepticus in Children in University Hospital Centre Rijeka
No full textEpileptički status je najčešće hitno stanje u pedijatrijskoj neurologiji. Nastaje zbog neuspjeha mehanizama odgovornih za prekid napadaja ili iz pokretanja mehanizama koji dovode do abnormalno dugotrajnih napadaja. Klinički se definira kao epileptički napadaj koji traje dulje od pet minuta.
Cilj ovog istraživanja je ustanoviti utječe li rana prehospitalna primjena antikonvulzivne terapije na duljinu liječenja i razvoj komplikacija.
Retrospektivno smo analizirali podatke o 61 djetetu hospitaliziranom zbog epileptičkog statusa na Odjelu intenzivnog liječenja djece Klinike za pedijatriju KBC-a Rijeka u petogodišnjem razdoblju (01.01.2018-31.12.2023). Djeca su bila podjednako raspoređena po spolu, prosječne dobi 5,67 godina. Polovica ispitanika je imala od ranije poznate neurološke bolesti. Epileptički status prosječno je trajao 45 minuta. Terapija je u najviše slučajeva bila ordinirana od strane hitne medicinske pomoći, pri čemu je najčešće primjenjivan diazepam rektalnim putem. Djeca koja su zaprimila antikonvulzivnu terapiju prije dolaska na Odjel u prosjeku su tamo provela 1,53 dana naspram prosječnih 2,67 dana koliko su boravila ona djeca koja nisu prehospitalno zaprimila terapiju. Djeca s prvotno zaprimljenom terapijom također su razvila manje komplikacija. U navedenom razdoblju nije bilo smrtnih ishoda liječenja.
Kao i u brojnim sličnim istraživanjima, rezultati prikazuju da prehospitalno primijenjena antikonvulzivna terapija skraćuje dužinu boravka u JILu.Status epilepticus is a condition that arises either from the failure of mechanisms responsible for terminating seizures or from the activation of mechanisms that lead to abnormally prolonged seizures. Clinically, it is defined as a seizure lasting longer than five minutes. It is one of the most common emergencies in pediatric neurology. The aim of this study is to determine whether prehospital administration of anticonvulsant therapy positively affects the duration of treatment and the development of complications. We retrospectively analyzed data on 61 children hospitalized for status epilepticus in the Pediatric Intensive Care Unit of the University Hospital Center Rijeka over five years (January 1, 2018 - December 31, 2023). The children were evenly distributed by gender, with an average age of 5.67. Half of the patients had pre-existing conditions. Status epilepticus lasted an average of 45 minutes. In most cases, therapy was administered by emergency medical personnel, with rectal diazepam being the most commonly used. The study found that children who received therapy earlier had shorter stays in the unit. On average, they spent 1.53 days in the unit compared to 2.67 days for those who did not receive therapy. Children who initially received therapy also developed fewer complications. There were no fatalities during the study period. As in many similar studies, the results support prehospital therapy administration because it shortens the lenght of hospitalization in the Intensive Care Unit
REFRACTIVE SURGERY – NEED OR WHIM
No full textRefraktivne greške danas su globalni problem, odražavaju neusklađenost između aksijalne duljine oka i njegove optičke snage. Miopija je vrsta refraktivne greške kod koje se paralelne zrake svjetlosti koje dolaze iz beskonačnosti fokusiraju ispred mrežnice bez akomodacije oka. Kod hiperopije se paralelne zrake svjetlosti koje dolaze iz beskonačnosti fokusiraju iza neurosenzorne mrežnice bez akomodacije oka. Prezbiopija je stanje povezano sa starenjem, a do kojeg dolazi zbog progresivnog funkcionalnog opadanja akomodacijske sposobnosti kristalne leće. Astigmatizam je vrsta refraktivne greške koju karakterizira nejednaka refrakcija svjetla u različitim meridijanima. Refraktivna kirurgija je područje oftalmologije koje se bavi kirurškom korekcijom refraktivnih grešaka ljudskog oka. Može se podijeliti na refraktivnu kirurgiju rožnice koja koristi tehnike excimer lasera i incizijske postupke, i na refraktivnu kirurgiju leća. Najčešće korištena metoda je LASIK koja se izvodi u lokalnoj anesteziji. Zahvat se izvodi tako što se prvo stvori flap, a zatim se excimer laserom napravi ablacija rožnice nakon čega se flap vraća na mjesto.
Refraktivne greške moguće je korigirati na nekoliko načina, naočalama, kontaktnim lećama, ortho-k te metodama refraktivne kirurgije. Prednost naočala je što nema direktnog kontakta s očima te relativno laka zamjena, ali estetski nekim ljudima ne odgovaraju, potrebno ih je održavati čistima, nositi ih sa sobom te ne pokrivaju cjelokupno vidno polje. Kontaktne leće rješavaju zadnji problem naočala, ali s obzirom da su u direktnom kontaktu s okom, najčešći su uzrok infekcija od svih drugih metoda.
Metode refraktivne kirurgije imaju nisku stopu komplikacija i visoku učinkovitost, ali mogu uzrokovati nepovratna oštećenja oka i puno veće troškove liječenja samih komplikacija. S ekonomskog aspekta pacijenta, trošak refraktivne kirurgije u tom trenutku je velik, ali u usporedbi s troškovima zamjene, popravka ili gubitka naočala ili kontaktnih leća kroz godine ispada manji. Bitna je preoperativna procjena kojim se utvrđuje je li pacijent dobar kandidat za operaciju. Područja evaluacije uključuju dob, vrstu i stupanj refrakcijske pogreške, a zatim slijedi opsežan oftalmološki pregled nakon kojeg se pacijentu objasne svi detalji. Kako bi se komplikacije smanjile na minimum, a uspješnost maksimalno povećala postoje brojne kontraindikacije za ove zahvate kao što su: dijabetes mellitus, trudnoća, autoimune bolesti, vaskularni poremećaji kolagena, bolesti štitnjače te abnormalno cijeljenje rana. Uz to postoje i oftalmološke kontraindikacije poremećaja suznog filma, poremećaja koji se sami mogu pogoršati fotoablacijom, abnormalnosti topografije rožnice i nerefrakcijski izvori smanjenog vida. Najčešća komplikacija je suho oko, zatim nepotpuno ispravljena greška, haloo, otežana vožnja noću zbog odbljeska te infekcija. Većina ih se može spriječiti dobrom postoperativnom njegom.Refractive errors are a global problem today, reflecting a mismatch between the axial length of the eye and its optical power. Myopia is a type of refractive error in which parallel rays of light coming from infinity are focused in front of the retina without accommodation of the eye. In hyperopia, parallel rays of light coming from infinity are focused behind the neurosensory retina without accommodation of the eye. Presbyopia is a condition associated with aging, which occurs due to the progressive functional decline of the accommodative ability of the crystalline lens. Astigmatism is a type of refractive error characterized by unequal refraction of light in different meridians. Refractive surgery is a subfield of ophthalmology that deals with the surgical correction of refractive errors of the human eye. It can be divided into corneal refractive surgery, which uses excimer laser techniques and incisional procedures, and lens refractive surgery. The most commonly used method is LASIK, which is performed under local anesthesia. The operation is performed by first creating a flap, then ablating the cornea with an excimer laser, after which the flap is returned to its place.
Refractive errors can be corrected in several ways, with glasses, contact lenses, orthokeratology and refractive surgery methods. The advantage of glasses is that there is no direct contact with the eyes and they are relatively easy to replace, but aesthetically they do not suit some people, they need to be kept clean, carried with them, and they do not cover the entire field of vision. Contact lenses solve the last problem of glasses, but since they are in direct contact with the eye, they are the most common cause of infections than all other methods.
Refractive surgery methods have a low rate of complications and high efficiency, but cause irreversible damage to the eye and much higher costs of treating the complications themselves. From the patient's economic point of view, the cost of refractive surgery at that moment is high, but compared to the costs of replacing, repairing or losing glasses or contact lenses over the years, it turns out to be smaller. A preoperative assessment is essential to determine whether the patient is a good candidate for surgery. Areas of evaluation include age, type and degree of refractive error, followed by a comprehensive ophthalmic examination, after which all details are explained to the patient. In order to minimize complications and maximize success, there are numerous contraindications for these procedures, such as: diabetes mellitus, pregnancy, autoimmune diseases, vascular collagen disorders, thyroid diseases, and abnormal wound healing. In addition, there are ophthalmological contraindications for tear film disorders, disorders that can be worsened by photoablation, corneal topography abnormalities, and non-refractive sources of reduced vision. The most common complication is dry eye, then an incompletely corrected error, halo, difficulty driving at night due to glare and infections. Most of them can be prevented with good post-operative care
Lysosomal storage diseases
No full textLizosomske bolesti nakupljanja heterogena su skupina rijetkih nasljednih bolesti. Iako se klinička obilježja pojedinih bolesti razlikuje, zajedničko im je da imaju progresivan tijek. Nastaju zbog nemogućnosti lizosoma da svojim enzimima, odnosno hidrolazama, potpuno razgrade proteine, ugljikohidrate, lipide i nukleinske kiseline, što dovodi do nakupljanja intermedijatnih makromolekula u lizosomima, koje ostaju nerazgrađene, te posljedično tomu dolazi do oštećenja stanica, odnosno tkiva. Liječenje je dostupno za neke bolesti, ali povećana smrtnost od ovih bolesti i dalje ostaje ista. Razvoj novih mogućnosti liječenja i uključivanje ovih bolesti u novorođenački probir dodatno će promijeniti svijest prirodi ovih poremećaja. Prema tome, sve navedeno ima za cilj približiti znanje i svjesnost o rijetkim i nasljednim bolestima, njihovim uzrocima i učestalosti, kliničkoj slici i dijagnostici, te mogućnostima trenutnog liječenja i onoga u razvijanju.Lysosomal storage diseases are a heterogeneous group of rare inherited diseases. Although the clinical features of individual diseases differ, they all have in common a progressive course. They arise due to the inability of lysosomes to complete a breakdown of proteins, carbohydrates, lipids and nucleic acids with their enzymes, that are called hydrolases, which leads to the accumulation of intermediate macromolecules in lysosomes, which remain undegraded. As a result, cells and tissues become damaged. Treatment is available for some diseases, but the increased mortality from these diseases still remains the same. The development of new treatment options and the inclusion of these diseases in newborn screening will change further awareness of the nature of these disorders. Therefore, all of the above aims to bring knowledge and awareness of rare and hereditary diseases, their causes and frequency, clinical picture and diagnosis, and the possibilities of current and developing treatment
Oral and oropharyngeal cancer
No full textRak usne šupljine i orofarinksa spada među deset najčešćih zloćudnih bolesti u svijetu, a među prve tri u zemljama u razvoju. Javlja se dvostruko češće kod muškaraca. Glavni rizični čimbenici su uporaba duhanskih i alkoholnih proizvoda, kao i HPV infekcija. HPV se posebno ističe kao rizični faktor za orofaringealni karcinom. Neki pacijenti razviju prekancerozne lezije, a leukoplakija i eritroplakija su najčešće; potonja nosi značajno veći rizik od maligne transformacije. Rak usne šupljine klinički je lako dijagnosticirati budući da se većina tumora prezentira kao ulkus s nepravilnim rubovima. Primarno liječenje je kirurško i uključuje eksciziju tumora i disekciju vrata. U uznapredovalim stadijima bolesti koristi se i adjuvantna radioterapija. Cilj istraživanja bio je prikazati, analizirati i usporediti opće, kliničke i patohistološke podatke kirurški liječenih bolesnika KBC-a Rijeka u četverogodišnjem razdoblju (2020.-2023.). Studija uključuje 34 pacijenta. Analiza podataka otkrila je da su većina pacijenata bili muškarci i da su konzumirali duhanske proizvode, a polovica je patila od hipertenzije. Dno usne šupljine i jezik bile su najčešće zahvaćene podlokacije, a četiri pacijenta imala su karcinom orofarinksa. Svi tumori bili su planocelularnog porijekla. Približno jedna trećina pacijenata imala je tumor veličine T3 i T4, a najveći udio pacijenata bio je u četvrtom stadiju bolesti. Većina bolesnika podvrgnuta je istodobnoj eksciziji tumora i disekciji vrata, a otprilike polovica je primila adjuvantnu radioterapiju.Cancer of the oral cavity and oropharynx ranks among the top ten most common malignancies worldwide and is among the top three in developing countries. It occurs twice as often in men. The main risk factors are the use of tobacco and alcohol products, as well as HPV infection. HPV is particularly noted as a risk factor for oropharyngeal cancers. Some patients develop precancerous lesions, with leukoplakia and erythroplakia being the most common; the latter carries a significantly higher risk of malignant transformation. Oral cavity cancer is clinically easy to diagnose since most tumors present as ulcers with irregular edges. The primary treatment is surgical and involves tumor excision and neck dissection. In advanced stages of the disease, adjuvant radiotherapy is also used. The aim of the research was to present, analyze, and compare general, clinical, and pathohistological data of surgically treated patients at KBC Rijeka over a four-year period (2020-2023). The study includes 34 patients. Data analysis revealed that the majority of patients were male and consumed tobacco products, with half suffering from hypertension. The floor of the mouth and tongue were the most commonly affected sublocations, and four patients had oropharyngeal cancer. All tumors were of squamous cell origin. Approximately one-third of patients were diagnosed with T3 and T4 classified tumors at the time of diagnosis, with the largest proportion of patients being in the fourth stage of the disease. Most patients underwent simultaneous tumor excision and neck dissection, and approximately half received adjuvant radiotherapy
Functional movement disorders
No full textFunkcionalni poremećaji pokreta neuropsihijatrijska su stanja koja uključuju abnormalna kretanja ili izostanak normalnog kretanja, a nemaju prepoznatljive strukturne ili degenerativne promjene u živčanom sustavu. Ovi poremećaji su dijagnostički i terapijski izazov jer se često pogrešno interpretiraju kao organski neurološki poremećaji.
Njihova prevalencija varira, ali u tercijarnim zdravstvenim centrima čine 2-4% svih poremećaja pokreta. FPP se češće javljaju kod žena nego kod muškaraca, može se pojaviti u različitoj životnoj dobi, a prosječna dob pri prvom pojavljivanju simptoma je 40 godina. Etiologija FPP-a je složena i još uvijek nije potpuno razjašnjena. Smatra se da različiti faktori mogu doprinijeti njihovom nastanku, uključujući genetsku predispoziciju, prethodne traume, emocionalne ili fizičke stresore te psihološke čimbenike kao što su npr. disocijacija ili somatizacija.
Klinička slika FPP-a uključuje različite poremećaje pokreta kao što su tremor, distonija, mioklonus, parkinsonizam ili tikovi, koji mogu imitirati organske poremećaje. Dijagnoza se postavlja na osnovi karakterističnih kliničkih značajki i pozitivnih znakova, uz isključenje drugih neuroloških bolesti koje mogu uzrokovati slične simptome.
Liječenje FPP-a zahtjeva multidisciplinarni pristup koji uključuje neurološke, psihijatrijske i rehabilitacijske metode. Kognitivno-bihevioralna terapija, fizikalna terapija i psihijatrijska podrška često su ključne komponente u upravljanju ovim poremećajima. U svakodnevnoj kliničkoj praksi, važno je educirati zdravstvene radnike o prepoznavanju i upravljanju funkcionalnim poremećajima pokreta kako bi se osigurala pravovremena dijagnoza i terapija za pacijente. Kontinuirano istraživanje i edukacija ključni su za daljnje razumijevanje ove kompleksne skupine neuroloških poremećaja i poboljšanje pristupa u njihovom liječenju.Functional Movement Disorders (FMD) are neuropsychiatric conditions that involve abnormal movements or the absence of normal movements, without identifiable structural or degenerative changes in the nervous system. These disorders pose diagnostic and therapeutic challenges because they are often misinterpreted as organic neurological disorders.
Their prevalence varies, but in tertiary health centers they constitute 2-4% of all movement disorders. FMD are more common in women than in men and can occur at different ages, with the average age of symptom onset being around 40 years old.
The etiology of FMD is complex and not fully understood. It is believed that various factors may contribute to their development, including genetic predisposition, previous trauma, emotional or physical stressors, and psychological factors such as dissociation or somatization.
The clinical presentation of FMD includes various movement disorders such as tremor, dystonia, myoclonus, parkinsonism, or tics, which can mimic organic disorders. Diagnosis is based on characteristic clinical features and positive signs, with the exclusion of other neurological diseases that may cause similar symptoms.
The treatment of FMD requires a multidisciplinary approach involving neurological, psychiatric, and rehabilitation methods. Cognitive-behavioral therapy, physical therapy, and psychiatric support are often key components in managing these disorders. In everyday clinical practice, it is important to educate healthcare professionals about recognizing and managing functional movement disorders to ensure timely diagnosis and therapy for patients.
Continuous research and education are crucial for further understanding this complex group of neurological disorders and improving approaches to their treatment
Intensive treatment of pregnant women with HELLP syndrome
No full textHELLP sindrom je ozbiljna komplikacija tijekom trudnoće s hemolizom, sniženim vrijednostima trombocita i povišenim vrijednostima jetrenih enzima. Etiopatogeneza HELLP sindroma nije u potpunosti poznata. Postoje brojni čimbenici rizika za razvoj HELLP sindroma. Za postavljanje dijagnoze korisna su dva klasifikacijska sustava (Tennessee i Mississippi-Triple). Simptomi su najčešće nespecifični i postoji širok spektar diferencijalne dijagnoze. Liječenje HELLP sindroma veoma je složeno i često zahtjeva multidisciplinarni pristup, osobito ako se razviju komplikacije. Komplikacije poput, diseminirane intravaskularne koagulacije, akutnog respiracijskog distres sindroma, akutne ozljede bubrega i ruptura jetre najčešće su indikacije za hospitalizaciju pacijentica u jedinice intenzivnog liječenja. Kod trudnica s HELLP sindromom i dalje je visoka stopa maternalnog mortaliteta. Pacijentici s HELLP sindromom potreban je stalni nadzor i adekvatna suportivna terapija. U jedinicama intenzivnog liječenja koriste se brojni bodovni sustavi (APACHE II, MPM, GCS, SAPS II, SOFA score) za ranu procjenu težine bolesti, ni jedan od tih sustava nije u potpunosti prilagođen opstetričkim pacijenticama.HELLP syndrome is a serious complication durirng pregnancy associated with hemolysis, low platelets count and elevated liver enzymes. The etiopathogenesis of HELLP syndrome is not known. There are many risk factors for HELLP syndrome. Two classification systems (Tennessee and Mississippi-Triple classification) are usefull for the diagnosis of HELLP syndrome. Symptoms are often nonspecific and there are many differential diagnosis. Treatment of HELLP syndrome is complex and requires a multidisciplinary approach, especially when complications arise. Complication such as, disseminated intravascular coagulation, acute respiratory distress syndrome, acute kidney injury and liver rupture, are the most common reasons for admission to an intensive care unit (ICU). The maternal mortality rate due to HELLP syndrome is still very high. Obstetric patients with HELLP syndrome require monitoring and supportive therapy. In the intensive care unit some predictive scoring systems (APACHE II, MPM, GCS, SAPS II, SOFA score) are used as an early prognostic indicator of disease severity. These scoring systems are not fully suitable for obstetric patients