Acta clinica Croatica最新文献

Despite new drug alternatives, no curative treatment for idiopathic pulmonary fibrosis (IPF) currently exists. This study aimed to evaluate the effects of artesunate on fibrosis, pulmonary hypertension, and inflammation-related changes in IPF. We divided a total of 32 male Wistar albino rats into four groups: a control group (group A, n=7), a group receiving artesunate (group B, n=7), a group receiving bleomycin (group C, n=9), and a group receiving both bleomycin and artesunate (group D, n=9). Groups A and B received intratracheal saline (0.1 mL), and groups C and D received intratracheal bleomycin (2.5 mg/kg). Groups A and C received intraperitoneal (i.p.) saline (0.1 mL/day), and groups B and D received i.p. artesunate (30 mg/kg/day) for 21 days. We measured the rats' exercise capacity by using a treadmill. We also examined heart and pulmonary tissues for right ventricular hypertrophy (RVH) and pulmonary arteriolar wall thickness for fibrosis, respectively. Finally, for immunohistochemistry, we performed Masson's trichrome stain and a macrophage marker antibody. The rats' measured exercise capacity was 1665 ± 145 m in the control group, 1142 ± 280 m in the group receiving bleomycin, 1490 ± 185 m in the group receiving artesunate, and 1207 ± 231 m in the group receiving both bleomycin and artesunate. The intergroup difference was statistically significant (p=0.001), but the difference between the bleomycin + artesunate and bleomycin-only groups was not statistically significant (p=0.95). RVH was common in the bleomycin group (0.44 ± 0.02). The difference between the bleomycin + a rtesunate and bleomycin groups was significant (0.37 ± 0.03). The medial wall of the pulmonary arterioles was thicker in bleomycin recipients than in artesunate recipients and controls, whereas it was thinner in bleomycin + artesunate recipients (p<0.001, p=0.026, respectively). Fibrosis and inflammatory changes improved in the bleomycin + artesunate group (p<0.001). The authors conclude that artesunate improved fibrosis, inflammatory changes, medial layer thickness of the pulmonary arterioles, and RVH in rats with bleomycin-induced pulmonary fibrosis.

Endoscopic sinus surgery (ESS) is often involved in the treatment of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal irrigation after ESS is recommended to improve healing and nasal symptoms in these patients. This study compared the efficacy of nasal irrigation with either an isotonic solution of 0.9% NaCl or a hypertonic solution of 2.3% NaCl comprising algal extracts. This was a randomized cohort study that included patients with CRSwNP after ESS who used isotonic solution and hypertonic 2.3% solution enriched with algal extracts (Undaria pinnatifida and Spir- ulina platensis). Patients filled out the total nasal symptom score (TNSS) questionnaire on visual analog scale of five symptoms, i.e., nasal obstruction, nasal secretion and/or postnasal discharge, sense of pressure in the face, headache, loss of the sense of smell preoperatively, and on postoperative days 7 and 14. Endo- scopic Lund-Kennedy (LK) score was also recorded. The study included 54 patients with CRSwNP that had undergone ESS, mean age 49.5 years. There were 53.7% of male patients. Thirty (55.56%) patients had other comorbidities such as allergic rhinitis, allergy to food, or/and asthma. Five (9.25%) patients had CRSwNP, asthma and allergy to nonsteroidal anti-inflammatory drugs. TNSS improved after 7 and 14 days in both groups; greater improvement of TNSS and LK score was observed in the group of patients that used hypertonic solution with algae, but it did not reach statistical significance. Improvement in particular symptoms was also recorded in the hypertonic solution group both on postoperative days 7 and 14, especially of sneezing and itching. The results of this study confirmed therapeutic benefits of nasal ir- rigation in CRSwNP patients following ESS. Patients who used hypertonic solution enriched with algae experienced greater improvement in sneezing and itching over the 14-day period.

Acoustic rhinometry is a non-invasive technique that requires minimal cooperation from patients compared to other diagnostic methods. This technique can be used even in children under 3 years of age, which makes it widely applicable in the practice of rhinologists. The aim of this research was to study nasal patency and nasal volume in patients with persistent allergic rhinitis (PAR) and intermittent allergic rhinitis (IAR) using acoustic rhinometry and to compare the degree of swelling of the nasal mucosa in patients with different forms of the disease. The study was conducted on the territory of the University Hospital "Prof. Dr. St. Kirkovich" (Stara Zagora, Bulgaria), where 139 participants (111 with allergic rhinosinusitis [AR] and 28 controls), aged 19 to 84 years, were examined. To compare the results, an acoustic rhinometry study was performed on the participants and the control group. The main indicators considered were the volume of the nasal cavity, the minimum cross-section area of the left and right halves, as well as the distance from the nasal entrance where it is located. To check the reactivity of the nasal mucosa, the same test was repeated after using a nasal decongestant. Increased nasal mucosal swelling in patients with IAR than those with PAR has been found. More manifested nasal congestion is observed in patients with IAR, probably because pollen has a stronger immunological stimulus and causes more manifested expression of symptoms than allergens provoking year-round forms of AR. A severely reduced reactive response to nasal decongestants has been demonstrated in participants with persistent AR.

Acute generalized exanthematous pustulosis (AGEP) is a rare disease, usually associated with drug intake or infections. It is characterized by generalized acute pustules and non-follicular exanthema together with systemic symptoms. Histologically, it is characterized by a subcorneal intraepidermal spongiform pustule, papillary edema and dermal vasodilatation surrounded by a polymorphous infiltrate of neutrophils, eosinophils and mononuclear cells. The aim of this article is to present current knowledge regarding the etiology and treatment, as well as the clinical and histologic features of AGEP. We present a case of a 50-year-old male patient who was prescribed several antibiotics and developed a drug-related cutaneous adverse effect. Treatment involved rapid identification of the causative agent and its discontinuation together with supportive measures, with resolution of symptoms within two weeks. Early diagnosis and timely treatment result in a favorable outcome and prevent systemic complications.

We aimed to compare three commonly used computed tomography (CT) reporting systems for COVID-19, i.e., Radiological Society of North America (RSNA) Consensus, British Society of Thoracic Imaging (BSTI) Guideline, and Dutch Radiological Society Categorical CT Assesment Scheme: COVID-19 Reporting and Data System (CO-RADS). Three thousand thoracic CT scans taken consecutively because of COVID-19 suspicion, diagnosis or follow-up after admission to our hospital between March 2020 and May 2020 were studied. All CT examinations were assigned to the appropriate groups of the aferomentioned CT reporting systems and these systems were compared with each other. Thorax CT imaging did not reveal any findings indicative of infection (RSNA: 40.7%, BTSI: nonapplicable, and CO-RADS: 40.1%) in the vast majority of polymerase chain reaction (PCR) (+) cases in all three reporting systems. The highest number of cases was included in the groups classified as typical/classic/CO-RADS 5 findings in all three reporting systems (RSNA: 213, BSTI: 212, and CO-RADS:101) in COVID-19 diagnosed cases with lung findings. There was no significant difference between PCR (+) and (-) cases with probable COVID-19 infection according to BSTI reporting system and CO-RADS 4 cases (30/23, p=0.381 and 22/19, p=0.245, respectively). In addition, typical thoracic CT findings were observed in RSNA: 70, BSTI: 71, CO-RADS: 71 individuals in all three classifications, but the PCR result was detected negative. When the three reporting systems were compared, we concluded that they did not show distinct advantage to each other and all three ensured that patients were properly classified with similar accuracy.

The aim of this cross-sectional study was to determine the knowledge, attitudes and behavior of medical students in relation to COVID-19 according to different medical schools and duration of studies. A validated questionnaire was administered to 192 medical students at two universities in Croatia and one from Bosnia and Herzegovina. Fisher-Freeman-Halton and Kruskal-Wallis tests were used to examine differences among study groups. The association of variables was tested with a linear regression model. A negative correlation was found between adherence to measures and attitudes (ß=-0.36; p<0.001). Studying at the University of Zagreb was positively associated with students' knowledge about COVID-19 (ß=0.24; p=0.033) but negatively with students' attitudes (ß= 0.26; p=0.013). Compared to the last study year students, second-year students had lower knowledge (ß=-0.28; p=0.040) and statistically nonsignificant negative attitudes (ß=-0.24; p=0.055). Fifth-year students had more negative attitudes (ß=-0.24; p=0.008) compared to sixth-year students. The association between knowledge and attitudes was weak and statistically borderline nonsignificant (ß=0.14; p=0.056). The lack of association between knowledge and attitudes requires additional research to identify the potential factors that favor the formation of attitudes toward appropriate protection against COVID-19.

Carpal tunnel syndrome is the most common upper extremity compression neuropathy caused by compression of the median nerve at the wrist. Along with motor and sensory fibers, sympathetic fibers also pass through the median nerve, playing an important role in the regulation of blood flow to the skin which interacts between the body interior and its environment. The aim of this study was to examine the preand postoperative correlation between skin temperature changes in the area innervated by compressed median nerve compared to the skin areas innervated by radial and ulnar nerve and median nerve of the unaffected hand. The study included 16 patients with carpal tunnel syndrome with an indication for open carpal tunnel decompression. Skin temperature was measured preoperatively, at 2-week, 2and 6-month follow-ups on the areas innervated by median, ulnar and radial nerve of the affected hand and median nerve of the non-affected hand. On the affected hand, median nerve innervated skin temperature showed maximum increase at 2-month follow-up before decreasing to a level higher than preoperatively. Radial nerve innervated skin temperature was lower than the preoperative value at 2-week follow-up, increasing to higher levels afterwards. Ulnar nerve temperature followed the curve of the median nerve innervated skin at all follow-ups. Unaffected median nerve innervated skin temperature increased at all follow-ups compared to the preoperative values. In conclusion, two or even five additional measurements should be made after at least one year. The results should be correlated with clinical and electromyoneurography recovery.

Pheochromocytomas are rare neuroendocrine tumors that originate in chromaffin cells of the adrenal medulla and excessively secrete catecholamines, which leads to a multitude of different symptoms. The most common symptoms include headaches, palpitations, and sweating. Because of a diverse clinical presentation, pheochromocytomas pose a major diagnostic challenge and often go unidentified. These tumors can occur sporadically or as a part of hereditary syndromes. The diagnosis is confirmed by measuring plasma and 24-hour urinary metanephrine and normetanephrine. Computed tomography, magnetic resonance imaging, and functional morphological examinations are used for tumor localization. The treatment is operative and requires special preoperative patient preparation to prevent hypertensive crisis and arrhythmias. Due to the possibility of recurrence, the patient needs to be monitored. Pheochromocytoma has a high fatality rate if not recognized on time due to the effect of catecholamines on the cardiovascular system.

Urinary tract infection (UTI) occurs in approximately 15% of full-term neonates and 8% of those born before 37 weeks of gestation. Severe UTI can lead to sepsis or long-term complications such as renal scarring and hypertension. Given the rising concern of bacterial resistance to antibiotics, this research aimed to examine the epidemiology of neonatal UTI, most common antibiotic prescription patterns, as well as resistance of the causative agents in Croatia. This retrospective multicenter analysis was focused on neonates born in 2005 and 2015. Of the 103 bacterial UTI cases, 78.6% affected term neonates. Male neonates constituted 62.1% of the study population. Eutrophic neonates accounted for 87.4%, and hospital-acquired infections were prevalent in 47.6% of cases. The main causative pathogens were Escherichia coli (60.2%) and Klebsiella pneumoniae (28.2%). Most commonly prescribed empirical antibiotics included ceftriaxone (31.1%) and the ampicillin-gentamicin combination (10.7%). In 2005, 72.7% of isolates were sensitive to empirical therapy. In 2015, sensitivity to empirical antibiotic therapy was observed in 75.6% of cases. In this study, Escherichia coli frequently exhibited antibiotic resistance to ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, and gentamicin. For UTIs attributed to Klebsiella pneumoniae, the prevailing bacterial resistance was observed against gentamicin, ceftibuten, ampicillin, cefazolin, and piperacillin. The predominance of Escherichia coli as the most common pathogen causing UTI was consistent with global trends. Founded on continuous differences in bacterial resistance, this study can serve as a basis for comprehending local resistance patterns of pathogens causing neonatal UTI, highlighting the need of additional prospective research.

Patients with systemic sclerosis (SSc) are at an increased risk of developing interstitial lung disease (ILD) and esophageal dysfunction, with frequently present esophageal dilatation. Our study aimed to investigate the relationship between esophageal diameter (ED) analyzed on high-resolution computed tomography (HRCT) with lung function tests and ILD evaluated with Warrick score. Thirty-nine patients with SSc were enrolled in this study. ED and Warrick score were evaluated by HRCT. The relationships between Warrick score, lung function, and ED were analyzed. Multivariate regression analysis was used to determine the effect of individual predictors on SSc-ILD. ILD was present in 25 (64%) patients. ED >10 mm in one or more of the measured locations on HRCT was present in 25 (64%) patients and 19 (76%) of these patients had concurrent ILD. Subjects with esophageal dilatation had a higher Warrick score and lower lung function tests. The measurement of ED was able to predict the presence of ILD in 69% of patients. Results suggest that evaluation of ED during regular HRCT follow-up could be useful in patients with SSc due to the association of esophageal dilatation with worse lung function tests and a more severe form of ILD.