Acta clinica Croatica最新文献

The first carpometacarpal joint is the second most common joint affected by degenerative arthritis. The prevalence of the first carpometacarpal joint arthritis increases with age, especially in postmenopausal women. Ligamentous laxity or injury of the first carpometacarpal joint is thought to be the starting point of development of degenerative changes, accompanied with altered biomechanics of the thumb. As the disease progresses, the joint is destroyed and the thumb and hand function are deteriorating. Although many patients, in different stages of disease, experience pain relief with conservative treatment, surgery is often needed. Decision on the type of surgical procedure depends on the age of the patient, functional demands, and stage of the disease. In early stages of the disease, stabilization of the first carpometacarpal joint, extension osteotomy of the first metacarpal and arthroscopic procedures are used. These are joint-preserving procedures, and they slow down progression of the disease and reduce symptoms. In late stages of the disease, joint arthroplasty procedures and first carpometacarpal arthrodesis are performed. In recent years, late stages of the disease can also be treated arthroscopically. This paper describes different surgical methods, their advantages and drawbacks, with respect to different stages of the disease.

The objective of this study was to compare performance of two authorized tests, the Abbott Real Time SARS-CoV-2 (ACOV) assay (Abbott Molecular Inc., North Chicago, IL, USA) and Liferiver Novel Coronavirus Real Time Multiplex RT-PCR (Liferiver 2019-nCoV) kit (BioVendor Group, Brno, Czech Republic), and to determine whether the selection of targeted genes has an impact on test specificity. We included 105 nasopharyngeal swabs from adult individuals with symptoms or suspected of coronavirus disease 2019 (COVID-19), aged from 26 to 91 years, previously tested by the ACOV and subsequently tested by the Liferiver 2019-nCoV. In this comparative analysis, we found that the ACOV assay detected more cases of COVID-19 infection than the Liferiver 2019-nCoV assay. The Liferiver 2019-nCoV kit showed a high level of agreement with the ACOV assay. The positive percent agreement was 88.89% (95% confidence intervals (95% CI): 77.42%-100.0%), and the kappa coefficient (kappa) was 0.901 (95% CI: 0.817-0.985). The negative percent agreement was 94.12% (95% CI: 89.74%-98.50%), while 4.76% of SARS-CoV-2 cases were false-negative using the Liferiver test. However, due to the possible false-negative results using the Liferiver 2019-nCOV test, we recommend complete testing with the ACOV assay.

The aim was to compare the computed tomography (CT) semi-quantitative severity scoring (CT-SS) system assessments of COVID-19 pneumonia on initial and follow-up examinations according to the presence of comorbidities. Of the 278 real-time reverse transcription-polymerase chain reaction positive patients, 108 with a follow-up CT scan were evaluated. Then, all CT images were independently reviewed for CT-SS analysis by two reviewers. Reviewers were unaware of the patient laboratory and clinical findings. A quarter of patients had negative findings on their initial CTs. Sixty-one (56.4%) patients showed progression. Disease progression was more frequently observed in patients with type 2 diabetes mellitus (DM) and malignancies (p=0.044 and p=0.019, respectively). Follow-up CTs of patients with comorbidities, especially those with cardiovascular disease (56.4%) and type 2 DM (70.0%), demonstrated an increased frequency of diffuse involvement. The white lung sign was more frequently observed in patients with malignancies (60.0%). In this study, COVID-19 patients with comorbidity showed a higher rate of disease progression than those without comorbidity. Patients with comorbidities more frequently had severe CT findings with high CT-SS. These findings may serve as a guide in the COVID-19 pneumonia follow-up and treatment.

Computed tomography (CT) is an essential tool in diagnosing and treating traumatic brain injury (TBI). Marshall CT classification, Rotterdam and Helsinki CT scores were consecutively developed as prediction outcome scales by computing TBI CT abnormalities. None of them classifies the pathological CT findings in the same manner. We aimed to determine which one is most accurate and has the best grading discriminatory power in determining early outcome. All TBI patients treated at a single center in a one-year period having undergone a CT scan on admission were retrospectively included. After calculation of all three scores, comparison among scale performances, as well as their accuracy in predicting patient 6-month outcome by the Glasgow Outcome Scale (GOS) was made. We used the Receiver Operating Characteristic curves to analyze correlation between all scales and early outcome. We calculated the area under the curve (AUC) to determine the power of each system while paired samples T-test was used to determine correlation among the scales. Mann-Whitney U test was performed to determine difference in outcome groups. A total of 1006 patients were included in final analysis. The mean patient age at presentation was 55.6 (±20.1) years, overall mortality was 6.4%, mean GOS was 3.00 (±1.4), and mean Glasgow Coma Score (GCS) was 13.9 (±0.2). Mortality was higher among patients with lower scores (p<0.01 all). The AUCs indicated that all scoring systems had a similarly high discriminative power in predicting early unfavorable outcome (Marshall AUC 0.86 vs. Rotterdam AUC 0.82 vs. Helsinki AUC 0.84). High correlation was found between Marshall and Rotterdam grading, r = 0.78, and moderate correlation between the other two pairs (Marshall vs. Helsinki, r=0.62, and Rotterdam vs. Helsinki, r=0.51). Additionally, low GCS and high injury severity score (ISS) could be identified as strong predictors of early death and poor outcome. In conclusion, all classification systems demonstrated a similar, strong predictive power for early outcome, but even greater discrimination results could be obtained if GCS and ISS were incorporated in the calculation. Helsinki CT score was least predictable of all three, and had the lowest correlation with the other two. Although Marshall CT classification was the oldest and simplest, it had at least the same prediction power as the newer scoring scales and should remain in use. Therefore, for prognostic purposes, this study recommends using one individual scale in clinical application to get the best possible prediction for TBI.

Intraluminal duodenal diverticulum is a rare entity that may cause recurrent pancreatitis. We report a case of a 36-year-old female admitted with etiologically unclear, recurrent pancreatitis. Radiographic study and endoscopy revealed a sac-like structure of the second portion of the duodenum near the minor duodenal papilla. Endoscopic diverticulotomy was successfully performed. No complications were observed and the patient was discharged home a day later. After 62-month follow-up, the patient was active and without symptoms. To our knowledge, this is the first reported case of recurrent pancreatitis caused by intraluminal duodenal diverticulum near the minor duodenal papilla, treated with endoscopic diverticulotomy performed from the apex to the base of the diverticulum.

The aim of this study was to determine whether body mass index and age had an impact on functional recovery two years after total knee replacement. The research was conducted at the Lovran Hospital of Orthopedics and Traumatology, School of Medicine, University of Rijeka, Croatia. Study sample included patients who underwent total knee replacement surgery with median parapatellar approach in 2019. Morphological measurements, knee range of motion and WOMAC questionnaire score were examined before and two years after surgery. Descriptive statistics was used for gender, age and body mass index, and inferential statistics was employed to check the correlation of recovery measured by changes in the WOMAC score and change in the range of motion results with age and body mass index. According to study results, male and female patients did not differ in body mass index (t=1.184; p>0.05). There was no statistically significant correlation of functional recovery of the patients with age (p=0.556), or between body mass index and differences in the range of motion (p=0.927) from flexion to extension. The study indicated that knee arthroplasty and thus the impact on functional recovery had an equally good effect regardless of age. In patients who had flexion contracture before surgery, the surgery improved motion amplitude.

Prolonged cocaine inhalation can cause destruction of nasal mucosa and ethmoid sinuses and palate perforation, thus inducing cocaine-induced midline destructive lesions (CIMDL) that affect only a limited number of predisposed patients. CIMDL are an autoimmune necrotizing inflammatory phenomenon associated with the presence of atypical antineutrophil cytoplasmic antibody (ANCA). Patients complain of epistaxis, nasal obstruction, hyposmia, sinus infections, and facial pain. Protocol for the CIMDL diagnosis includes medical history, clinical examination, magnetic resonance imaging, laboratory tests, immunology and serology tests, and chest x-ray. A 68-year-old man presented with a brain extension mimicking an ischemic-like lesion with surrounding edema. A diagnosis of CIMDL was made in the light of the patient's medical history, imaging studies, and laboratory testing including pANCA positivity which seems to promote disease phenotype.

Orthorexia nervosa (ON) is pathological obsession and preoccupation with 'healthy' and 'clean' eating, which is more pronounced in specific population groups such as fitness enthusiasts. The aim of this observational study was to determine the prevalence and characteristics of ON symptoms among gym attendees in Croatia based on ORTHO-15 questionnaire. A number of individual characteristics were considered too, from eating habits, anthropometry, personality traits, psychophysical state, to the presence of irritable bowel syndrome symptoms. Out of 126 participants who completed the questionnaire, 99 were analyzed (female 68.7% and male 31.3%, median age 24 years). Based on the traditional criterion (ORTHO-15 score <40), the prevalence of ON was 77.8% and 33.3% according to the modified criterion (ORTHO-15 <35). Women were two times more likely to have high ON tendency in comparison to men (39.7% vs. 19.4%, p=0.037). Participants with high ON tendency avoided a wide variety of foods, especially sugar, processed food and gluten, and did not skip meals. There were no significant differences in orthorexic tendencies according to nutritional status, personality traits, psychophysical state, or irritable bowel symptoms. For gym attendees in Croatia, being a woman and dietary restrictions were identified as independent risk factors for ON.

Smoking is a major risk factor for the development of chronic obstructive pulmonary disease (COPD), which is thought to be caused by smoking in even 8 out of 10 cases. One of the first clinical signs in patients with COPD is reduced physical ability, which is usually attributed to reduced lung function, although a significant role is played by a disorder of the musculoskeletal system. The aim of the study was to examine differences in fitness and locomotor status between smokers and non-smokers, as well as the effect of oral administration of L-arginine on the strength of the quadriceps depending on smoking status. The study included 164 subjects, 84 non-smokers and 81 smokers not diagnosed with COPD. All subjects completed CAT and IPAQ questionnaires, and performed spirometry, 6-minute walking test and quadriceps strength testing without therapy and after oral administration of 500 mg L-arginine. The results showed that the increase in quadriceps strength after oral administration of L-arginine was not dependent on smoking status but was more pronounced in smokers who started smoking at an earlier age and who smoked more cigarettes, as well as a generally higher physical activity of non-smokers. These results could become relevant for recognizing the development of skeletal musculature hypotonus and hypotrophy in smokers who are prone to develop COPD.

Calcitonin gene-related peptide (CGRP) plays a key role in the pathophysiology of migraine, acting on CGRP receptors in the trigeminovascular system, causing neurogenic inflammation and vasodilation, and promoting nociception. Four specific monoclonal antibodies targeting CGRP are available for prevention of episodic and chronic migraine in adults with at least four migraine days per month. The aim of these guidelines is to provide evidence-based recommendations for the use of monoclonal antibodies targeting CGRP in migraine prevention in Croatia. The questions were formulated using the Patients, Intervention, Comparison, Outcome (PICO) criteria, with evidence-based answers. To assess the quality of scientific evidence, a review of the literature available in PubMed was performed. Relevant studies were reviewed by the Expert Group of the Headache Section of the Croatian Neurological Society, and served as the basis for formulating the recommendations outlined in these guidelines. We found high quality evidence for good safety and efficacy of anti-CGRP monoclonal antibodies in the preventive treatment of episodic and chronic migraine. These medications may be considered as first-line prophylactic therapy depending on the patient's history, concomitant diseases, and disease burden. Further real-world studies are needed to elucidate other aspects of their application.