Acta clinica Croatica最新文献

Here we report a case of a 5-year-old boy with Ebstein anomaly and supraventricular tachycardia. He was diagnosed with Ebstein anomaly at the age of 3 months during the workup for afebrile convulsions, and has been followed by a pediatric cardiologist since. Electrocardiography recorded a small Rr` pattern in V1 on a few occasions, without other abnormalities. At the age of 2.5 years, the first episode of supraventricular tachycardia was recorded and stopped with adenosine. He was started on atenolol and was asymptomatic until a year later when he presented with the second recorded supraventricular tachycardia. He was referred to our institution for an electrophysiology study with ablation. Tachycardia was entrained and all the maneuvers were in accordance with atrioventricular reentry tachycardia. Tricuspid annulus was mapped during tachycardia. The earliest atrial signals appeared in the posteroseptal region of the valve, mechanical blocking of the tachycardia was recorded in that region, and early fractionated signal was present during ventricular retrograde pacing. The pathway was successfully ablated. Basal electrocardiogram was without change after ablation and the patient did not experience recurrence of tachycardia during follow-up. This case shows the efficacy and importance of ablation in Ebstein anomaly, without x-ray or intracardiac echocardiography.

The aim was to investigate patient attitudes regarding psychiatrist attire, sociodemographic characteristics, and mutual addressing. A total of 340 both inpatients and outpatients at a psychiatric hospital in Croatia were assessed about their preferences regarding psychiatrist wearing a name badge, gender, age, ways of mutual addressing, and attire. The majority of patients, inpatients significantly more often, thought that a psychiatrist should wear a name badge. Female patients preferred female psychiatrist more than male and vice versa. Inpatients also preferred female psychiatrist. Patients with affective and anxiety disorder were more likely to choose female psychiatrists, patients with addiction more often had no preferences, and patients with psychotic disorders preferred male psychiatrists. Younger patients preferred younger psychiatrists and inpatients preferred psychiatrists in the 35-50 age group. Patients with anxiety disorder more often opted for psychiatrists older than 50. Patients with anxiety disorders would rather be addressed by their first name, whereas patients with psychotic disorders more often preferred to be addressed by their title and surname. Patient attitude about how they should address the psychiatrist did not differ according to any of the variables assessed. Most patients thought that white coat was most appropriate attire for psychiatrist and psychiatrists in white coat were considered most competent, empathic, accessible, and friendly in comparison with psychiatrists wearing suits, smart attire, or casual clothing. Other than preference for white coat, patient preferences significantly differed according to their sociodemographic characteristics and diagnosis. Psychiatrists should bear that in mind to establish better rapport in doctor-patient relationship.

This case report details the management of low-velocity gunshot wounds (GSWs) in a 28-year-old man, emphasizing the distinctive challenges and treatment strategies in urban civilian settings. This study contributes to medical literature by providing insights into the complexities of treating atypical fractures caused by GSWs, especially involving nonstandard ammunition. The patient, involved in an urban gunfight, sustained multiple low-velocity GSWs to his lower limbs. The diagnoses included an atypical intra-articular fracture in the left distal femur and a foreign body in the right lower leg. Treatment involved emergency surgery with K-wire stabilization for the left femur fracture and exploratory surgery for the right leg. No foreign bodies were found in the right leg, but subsequent analysis revealed pseudo-encapsulated calcification, indicative of previous fat necrosis. In 15 days after the initial trauma, the final surgical intervention took place, during which a low-contact condylar plate was placed on the left distal femur. Postoperative recovery was successful, with the patient regaining full mobility and range of motion after one year. Low-velocity GSWs in civilian settings can result in complex atypical fractures requiring specialized surgical intervention and management.

The onset of multiple sclerosis (MS) in childhood is a diagnostic challenge. The aim of our study was to analyze the parameters of MS with an early onset in relation to the symptoms and course of the disease in adult patients. This study included patients treated with signs and symptoms of initial central nrvous system demyelinating disease, which were divided into a group of 52 patiensts who developed the disease before the age of 18 (children) and another group aged 20-55 years (adults). Children rarely had polysymptomatic onset (p=0.020). The most common initial symptoms in children were optic neuritis (35.3%) and ataxia (35.3%). In the group of adult patients, sensory disturbances (41.6%) were the most common initial symptoms, followed by pyramidal symptoms (37.6%). Monitoring the time of second relapse revealed it to have occurred in 40 (78.4%) pediatric patients and 79 (78.2%) adult patients after a median of 12 months and 9 months, respectively. In conclusion, the initial manifestations of MS in children do not differ much from MS in adults according to the disease characteristics.

Hip osteoarthritis is the leading cause of hip pain around the world. Patients are aiming to relieve pain as fast as possible and return to everyday activities. The aim of the study was to investigate the effect of preoperative physical education on postoperative rehabilitation in patients after total hip arthroplasty (THA). There were 60 patients divided in two equal groups. One group underwent 3-day preoperative education and the other did not. The two groups were compared according to their preoperative and postoperative visual analog scale (VAS), range of motion (ROM), Harris Hip Score (HHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 36-Item Short Form Survey (SF-36). Patient general characteristics were similar in the two groups. Patients that received preoperative training had lower VAS scores, greater ROM, higher HHS and lower WOMAC score on postoperative day 42 (p<0.05 all). These patients had no complications. There were no between-group differences in the SF-36 questionnaire. In conclusion, patients that underwent preoperative rehabilitation protocol before THA had lower pain and disability scores and better functional outcomes.

To the best of our knowledge, no previous study has reported characteristics of C-reactive protein (CRP) levels in COVID-19 patients with comorbidities such as sciatica and lumbar syndrome. The objective of this study was to examine whether CRP levels rose significantly in COVID-19 patients with acute sciatica as compared to COVID-19 patients without it. This prospective study was performed on 147 patients previously diagnosed with COVID-19 infection who were admitted to the COVID hospital. Myalgia (p=0.00008) and lower back pain (p=0.00001) occurred much more frequently in the study group than in the control group. There was a high probability that patients with a previous history of sciatica may experience it again during their stay in COVID-19 hospital and that patients without it would not (p=0.00001). There was a significant correlation between the severity of sciatica and CRP levels (r=0.19, p=0.0174). Our results suggest that serum CRP levels are significantly higher in COVID-19 patients with concomitant sciatica in comparison to patients without sciatic pain, indicating a connection between the increased systemic inflammation in COVID-19 and sciatica. Given that the occurrence of COVID-19 in patients with sciatica is not rare, the knowledge about this matter is of high medical relevance.

The most frequent surgical procedure in oral surgery is extraction of mandibular third molars, which could be associated with postoperative complications such as pain, swelling, and trismus. We aimed to investigate the association of salivary urea and antioxidative enzyme activities with the intensity of postoperative pain after wisdom tooth extraction. This cross-sectional prospective study included 66 subjects (median age 25, range 17-47 years). Salivary urea and superoxide dismutase (SOD) were determined by enzymatic colorimetric tests. The questionnaire for study participants included demographic and history data, as well as data on personal experience of pain in grade 0-10 according to the visual analog scale (VAS). Grading 1-3 was considered as low (VAS-1), 4-6 mild (VAS-2) and 7-10 as severe pain (VAS-3). Moderate positive correlation was recorded between urea concentration and SOD activity in saliva (r=0.46). Moderate negative correlations were found between urea salivary concentration and VAS grading value reported after 12 hours (r=0.51). The concentrations of urea significantly differed among the three VAS categories (p<0.001), whereas salivary SOD activities did not differ among the categories. Preoperative salivary urea concentration and SOD activity might be associated with postsurgical pain after surgical removal of mandibular third molars.

In this article, we present a neonate with the vein of Galen aneurysmal malformation, a rare blood vessel malformation of the brain, which was clinically manifested by signs of cardiac failure. Cranial ultrasound suspected the existence of the vein of Galen aneurysmal malformation, and the diagnosis was confirmed by computed tomography and magnetic resonance imaging. Based on our case, we believe that cranial ultrasound should be included in the screening protocol for neonates with cardiac failure. In addition, we believe that endovascular embolization of the blood vessels that supply the aneurysm is the method of choice in treating the vein of Galen aneurysmal malformation. Treatment of neonates with the vein of Galen aneurysmal malformation is challenging and requires a multidisciplinary approach (neonatologists, cardiologists, neuroradiologists, and neurosurgeons).

We aimed to explore variations in dietary habits in cancer patients according to clinical and demographic characteristics. We conducted a cross-sectional survey on cancer patients treated with systemic therapy. The survey included 42 items concerning demographic and clinical data, observed dietary modifications and oncologist implication. All patients gave their informed consent to participate in the study. Statistical Package for Social Sciences for Windows software version 20 was used on statistical analysis. The study involved 110 patients (female 71.8% and male 28.2%), mean age 53.4 years. They were treated mostly for breast cancer (58.2%). Patients reduced or stopped taking canned products (70%), milk (59.1%), red meat (80%), processed meat (76.4%), fatty food (88%) and sugar (83.6%). Conversely, preferred food were fish (73.6%), fruits and vegetables (95.5%), and honey (54.5%). Weight loss of 5 kg or more was higher among patients on a sugar restrictive diet (p=0.026). Thirty-five patients discussed diet with their oncologist. Patients received information on diet from the internet and other patients. Our findings suggested that patients were aware of the role of a balanced diet and made many changes. However, most of the patient information was derived from informal sources.

Shift work has many detrimental effects on health and work ability of workers. These effects could increase with age, especially due to workforce aging. The aim of the study was to examine the effect of a single night shift on the Work Ability Index (WAI) scores of hospital healthcare workers. A prospective survey was conducted on a convenience sample of 49 on-call residents working 12- or 16-hour night shifts and 47 nurses working 12-hour night shifts in the emergency department of an urban teaching hospital. The study included analysis of sociodemographic, occupational and medical data collected through a questionnaire during a morning shift change. The participant work capacity was assessed using the short form of the WAI Questionnaire. The mean WAI score for nurses was 40.98 before a night shift and 37.15 after a night shift, which was a statistically significant decrease (p<0.01, 95% CI: 2.39-5.27). Similarly, among residents, the mean WAI score decreased from 43.02 before a night shift to 38.76 after a night shift (p<0.0001, 95% CI: 2.95-5.58). There was a statistically significant difference in WAI scores between nurses and residents (p<0.05). Our results showed that even a single night shift negatively affected the work ability of emergency healthcare workers. We recommend scheduling shift work with fewer night shifts to preserve healthcare worker work ability.