Acta clinica Croatica最新文献

Paralysis of the facial nerve represents an exceptional functional, social and cos- metic problem for the patient. Loss of function directly leads to the inability to protect the eyes, as well as oral competence, while indirectly affecting breathing and verbal communication. Patients often encounter social stigmatization and isolation, which is direct consequence of the loss of mimic function and disfiguration that is necessary for everyday nonverbal communication. Thus, the quality of life is strongly impaired, and patients are prone to developing depression. The primary goal of reanimation is establishment of facial tone at rest, mimic function, and symmetry. The method of choice is directly dependent on the time elapsed from the onset of paralysis. Facial reanimation methods can be divided into static and dynamic. In reanimation procedures, we usually divide the face into thirds. Procedures for reanimation of the upper third of the face include oculoplastic procedures, which are divided according to the place of intervention into procedures aimed at the eyebrow, upper and lower eyelid. Static methods predominate here, i.e., endoscopic eyebrow lifting, tightening of the upper eyelid, and tightening of the lower eyelid. Procedures for reanimation of the lower third of the face are mainly based on restoring oral competence and smile, therefore the method of choice is dynamic reanimation. Direct repair of the nerve either by direct anastomosis or interposition provides the best results. In the absence of the proximal part of the facial nerve, and functional distal branches, local motor nerves and/or cross facial nerve graft (CFNG) are used as a source. In the case of long-term paralysis of the facial nerve (>2 years), muscle tissues are used in reanimation using local or innervated free flaps. Of the local muscle flaps, we most often use the minimally invasive temporalis tendon transfer (MIT3) method. The gracilis free flap is most often used in younger patients who desire to achieve a more accentuated smile, and the procedure can be performed in one or two acts. Reanimation of the face is an often neglected but extremely important procedure that should provide the patient with partial function resumption while significantly improving the quality of life.

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has had a global effect on mortality. Many attempts were made to identify those at the highest risk of death if infected with SARS-CoV-2, yet the relative importance and global generalizability of individual risk factors remain unclear. At the Croatian Institute of Public Health, electronic health data from multiple databases were combined to examine factors associated with COVID-19 related death. Data on 212 615 patients confir med to have COVID-19 by a positive RT-PCR in 2020 were pseudonymously linked to hospital records and 16 150 hospitalized patients were identified. Apart from older age and male sex, major factors associated with an increased rate of mortality among patients hospitalized with COVID-19 were cardiovascular diseases (adjusted HR: 1.20; 95% CI 1.12-1.28); diabetes (adjusted HR: 1.17; 95% CI 1.09-1.25); and chronic lower respiratory diseases (adjusted HR: 1.10; 95% CI 1.02-1.18). This Croatian study used primary care and hospital data to establish factors associated with COVID-19 related death among patients hospitalized with COVID-19. The results of this study provide rigorous evaluation of the previously defined risk factors and offer guidance for further studies that will create prognostic models based on empirical data from 2020.

The COVID-19 pandemic has put a tremendous burden on the medical community and brought a great number of accompanying issues, as well as other closely associated diseases. The response to this public health and medical challenge was outstanding. However, dealing with the COVID-19 pandemic and various issues brought on by the earthquake was successfully facilitated by the use of teledermatology. This innovative technology enabled dermatovenereologists to stay in continuous touch with their patients and provide much needed care and assistance in difficult circumstances caused by several crises.

In search for the ways to cure and improve skin condition of patients with inflammatory skin diseases, vitamin D supplementation has been shown to be useful, primarily due to its effects on a number of skin functions, e.g., keratinocyte proliferation, differentiation and apoptosis, maintenance of the epidermal barrier, and regulation of immune processes in the skin, among others. Vitamin D is essential for good general health and healthy skin, but deficiency can occur due to various factors that result in increased time spent indoors and limited sunlight exposure, such as geography (place of residence) and genetic factors. Although some results are inconsistent, previous research indicates that multiple inflammatory skin diseases can be affected by vitamin D deficiency, particularly atopic dermatitis, but also other inflammatory skin diseases. There is also evidence for an association between vitamin D deficiency and the risk of worsening of skin diseases such as psoriasis, chronic urticaria, contact dermatitis, etc. For these and several other inflammatory skin diseases, most research suggests that patients benefit from vitamin D supplementation.

Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old). The etiology of pilonidal disease is unclear, but literature describes a wide range of factors such as keratin plugs, foreign substance reaction related to hairs, as well as dermatopathy and debris in hair follicles in the natal cleft. PD and also its classic treatment can cause discomfort and very much deteriorate the patient's quality of life. There are many possibilities (conservative or surgical) in the treatment of pilonidal disease, but there is no gold standard. In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough. In the chronic phase, there are many possibilities like phenol treatment, surgical excision with lay open and secondary wound healing. There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap. A recently minimally invasive technique such as endoscopic surgical procedure or filling pilonidal tract with fibrin glue or phenol have been introduced. We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease.

Brain-derived neurotrophic factor (BDNF) is essential for neuronal development, differentiation and survival, and aberrant BDNF expression in retina is associated with glaucoma. Peroxisome proliferator-activated receptor gamma (PPAR-γ) in retinal pigment epithelium plays a significant role in ocular pathophysiology. PPARG c.34C>G (rs1801282) (p.Pro12Ala) modulates transcriptional activity. This study aimed to determine whether BDNF in aqueous humor and serum could be used as a biomarker for primary open angle glaucoma (POAG) and to examine differences between PPARG genotype and BDNF concentrations in aqueous humor and serum in POAG patients. The study included 140 POAG patients and 87 non-glaucoma controls. BDNF concentrations were measured by ELISA methods and PPARG genotype was determined by PCR-RFLP. BDNF concentrations in aqueous humor were significantly higher in POAG patients compared to controls (p=0.001). A significant difference in aqueous humor BDNF concentration was observed between early and moderate (p=0.008) and early and advanced stages of POAG (p=0.022). There was no significant difference between BDNF concentration in aqueous humor and PPARG genotype in POAG patients (p=0.184). BDNF in aqueous humor may serve as a dynamic biomarker for POAG. No significant differences were found between PPARG genotypes and BDNF concentrations.

A mammography response rate exceeding 70% is one of the parameters for monitoring the success of a national breast cancer screening program (BCS). The aim was to explore the potential for improving the response rate in the BCS in Croatia, based on the accuracy of the invitation database and availability of mammography services. In this cross-sectional study, data from the fifth and sixth implementation cycles were collected through a questionnaire from the BCS county coordinators (N=21). The quality of the invitation database and the number of available mammography appointments were analyzed using Microsoft Office Excel. Seventeen percent of women were not available at the address listed in the database and could not be invited for mammography, with variations observed across counties ranging from 31% (Lika-Senj County) to 7% (Krapina-Zagorje County). Only eight counties had a sufficient number of mammography appointments for initial and repeat invitations. With a higher estimate of unavailable women by counties at the end of the fifth cycle, the response rate at the end of the cycle was lower (^ρ=-0.51, p=0.018). In conclusion, participation in the BCS could be increased with a more accurate invitation database, thereby freeing up additional mammography appointments for both initial and repeat invitations.

The aim of this study was to determine the prevalence of vitamin D deficiency (VDD) and metabolic syndrome (MetS) including individual MetS components in Croatian women with newly diagnosed breast cancer (BC), exploring differences according to menopausal status. This cross-sectional, observational study recruited 203 adult female patients with newly diagnosed BC of any stage from all Croatian regions (median age 59, range 28-87 years), hospitalized consecutively for their first treatment between December 2016 and August 2017. We analyzed pretreatment fasting serum concentrations of 25-hydroxycholecalciferol (25(OH)D), high density lipoprotein, low density lipopro- tein, triglycerides, plasma glucose, and measured systolic and diastolic blood pressure, weight and waist circumference; defining VDD as 25(OH)D concentrations <50 nmol/L and MetS according to the 2006 International Diabetes Federation consensus. Consistency of the results was explored according to sampling periods, regions and size of settlements. In total sample, 28.6% of patients presented with concomitant VDD+MetS, whilst VDD was found in 55.1% of women (the finding was consistent by menopausal status), and 48.3% had MetS (65.4% of postmenopausal vs. 15.7% of premenopausal wom- en). Concomitant VDD+MetS was more frequent in the inland region (p=0.043), and VDD in inland postmenopausal women (p=0.024), whereas in premenopausal women VDD was more frequent during winter period (p=0.038). In conclusion, a high prevalence of VDD and MetS was found in newly diag- nosed BC patients, with some regional and seasonal differences.

It is known that patients with lung cancer have a considerably higher incidence of cardiovascular complications that lead to venous or arterial events, and malignant pericardial effusion can often be observed due to pericardial metastases. Simultaneous occurrence of cardiac tamponade and venous thromboembolism almost always happens in patients with lung malignancy. Our case report describes a patient with concurrent pulmonary embolism and cardiac tamponade as the initial manifestation of lung cancer, which, apart from pericardiocentesis and symptomatic therapy, was treated at long term with a direct oral anticoagulant (apixaban). Therapy was well tolerated by the patient and there were no bleeding complications related to primary disease and anticoagulant treatment. The course of the disease was complicated by repetitive strokes, which were treated with mechanical thrombectomy. Because of this scenario, a systematic review of the literature was conducted, listing all available case reports of patients with the simultaneous occurrence of cardiac tamponade and pulmonary embolism. In all patients, the underlying condition was lung malignancy, often as the first manifestation of the disease. This is a relatively rare event, and the approach to long-term treatment varied from case to case in the absence of valid guidelines. Our case demonstrated that, in the light of new studies and guidelines, apixaban represented a safe and effective treatment option even in patients at a high risk of bleeding.

In this study, we translated the Tinnitus Handicap Inventory questionnaire into Croatian language, and determined the reliability and validity of the Croatian adaptation (THI-HR). Tinnitus sufferers (N=130) underwent audiometry and completed the THI-HR, the Depression Anxiety Stress Scale (DASS), and the Eysenck Personality Questionnaire Revised/Short Scale (EPQ R/S). Sociodemographic data on the patients and descriptive data on tinnitus were collected. The THI-HR internal consistency, construct validity, factor structure and repeatability were evaluated. The Cronbach's alpha coefficients for the THI-HR Total, Functional, Emotional, and Catastrophic subscales were 0.96, 0.76, 0.78, and 0.76, respectively. Moderate correlations of the THI-HR total and subscales with the three DASS subscales (r_s=0.42 to r_s=0.61) and the EPQ R/S-Neuroticism subscale (r_s=0.56 to r_s=0.64) were observed. The THI-HR factor analysis revealed that the original THI three-factor solution was a good fit to the data. Three factors explained 48.7% of the total variance. The test-retest reliability was high (r_p=0.89 to r_p=0.93). It was established that the THI-HR had high internal consistency reliability and good construct validity. The THI-HR is a valid and reliable measure of tinnitus complaint that can be used for assessment of the impact of tinnitus symptoms in daily life in the adult Croatian population.