The role of exhaled nitric oxide in asthma control

Porast prevalencije alergijskih bolesti uzrokovan modernim načinom življenja zahtijeva što bržu dijagnozu i kontrolu tih bolesti. Kontrola podrazumijeva što dulje remisije bolesti uz što manju potrebu za lijekovima, osobito kortikosteroidima u slučaju astme. Frakcija izdahnutog dušikova oksida (NO) koristi se kao biomarker u dijagnozi i praćenju bolesti, odnosno kao indikator uspješnosti liječenja astme u odraslih i djece. Astmatičari imaju povišene vrijednosti frakcije izdahnutog dušikova oksida. Ova je pretraga jednostavna za izvođenje, a izuzetna je pomoć pri postavljanju dijagnoze astme, procjene odgovora na terapiju i njene reevaluacije. Broj studija koje govore o vrijednosti testa izdahnutog dušikova oksida je u eksponencijalnom porastu od početka primjene testa, no još se uvijek radi o malom broju ispitanika, te su potrebna daljnja istraživanja.The rate of allergic diseases is increasing which is caused by the modern way of life. Therefore it is crucial to have better control and faster diagnosis of these diseases. The disease is under control if remission persists as long as possible combined with minimal use of drugs such as corticosteroids. The fraction of exhaled nitric oxide is very significant in the diagnosis and follow-up in treatment of allergic diseases in adults and children. This test is simple to perform and has great value in diagnosing asthma, evaluation of drug response and re-evaluation of drugs in use. The number of studies show exponential growth over the years of using this test, but the number of subjects in studies is still rather modest so it requires furthermore research

Utjecaj inhalacija eteričnim uljima kod pacijenta oboljelog od KOPB-a – prikaz slučaja The effect of inhalation of essential oils in patients suffering from COPD – a case report

Dobrobiti uporabe inhalacija eteričnim uljima u medicinske svrhe danas je dokazana značajnim brojem publiciranih znanstvenih studija. Eterična ulja u ovu svrhu su u upotrebi su u Republici Hrvatskoj od 1961.godine po preporuci dr. Ive Padovana, a formula koja je tada nastala, ostala je do danas nepromijenjena zbog dokazanih svojstava i učinkovitosti u liječenju. Kronična opstruktivna plućna bolest je progresivna bolest pluća, karakterizirana smanjenjem protoka zraka kroz dišne putove. Navedena bolest je značajan javno-zdravstveni problem u svijetu, jer je broj oboljelih i umrlih u stalnom porastu. Četvrti je vodeći uzrok smrti u svijetu nakon koronarne bolesti, cerebrovaskularnih bolesti i akutnih respiratornih infekcija

Simple predictors of the re- occurrence of severe febrile neutropenia episode: a single-center retrospective cohort study in pediatric patients with malignant diseases

Aim To identify the risk factors of a repeated episode of severe febrile neutropenia (FN) and to build an accurate and easy-to-use predictive model. Methods This single-center retrospective cohort study conducted at the Clinical Hospital Center Children’s Hospital Rijeka from January 1, 2008 to December 31, 2016 included pediatric patients with malignant diseases who experienced at least one FN episode. The association of the second severe FN episode appearance with relevant clinical and laboratory data was analyzed by logistic regression. Results Out of 45 patients with one FN episode, 25 (56%) had severe FN and 11 (24%) had repeated severe FNs. Significant predictors of a repeated severe FN episode were the first FN episode duration of 9 or more days and red blood cells ≤3.0 × 1012/L. The predictive model constructed by crossing these two indicators had the accuracy of 87% (95% confidence interval [CI] 73%-94%), sensitivity of 82% (95% CI 53%-97%), and specificity of 88% (95% CI 79%-93%). Conclusion The first FN episode duration and anemia are significantly associated with the risk for severe FN re-occurrence. These factors may be useful in the identification of children with cancer who are at high risk for adverse outcome at any future fever onset and may benefit from early intensive treatment

Kvaliteta života zaposlenih majki u Primorsko-goranskoj županiji The quality of life of working mothers in the Croatiain Primorje-Gorski Kotar County

Uvod: Današnji način života uvelike je povezan s globalnim poslovnim i obiteljskim trendovima u kojima majka mora biti i uspješna poslovna žena i brižna majka, što ponekada dovodi do izgaranja. Metode: Istraživanje je provedeno tijekom tri mjeseca uporabom anketnog upitnika. U istraživanje su uključene zaposlene majke s prebivalištem u Primorsko-goranskoj županiji. Za potrebe istraživanja izrađen je upitnik koji se sastojao od više kategorija. Kvaliteta života određivala se tzv. validiranom metodologijom, uporabom skraćene modifikacije upitnika o kvaliteti života SF-12. Rezultati: Dobiveni rezultati nisu verificirali hipotezu o boljoj kvaliteti života zaposlenih majki. Zaključak: Postotak visokoobrazovanih ispitanica ukazuje da su iste imale veći stupanj kvalitete života u odnosu na nižeobrazovanemajke što se objašnjava većim stupnjem neovisnosti

The approach to a child with severe asthma

Teška astma je složena i heterogena bolest obilježena neprimjerenom kontrolom unatoč visokom stupnju liječenja. Procjenjuje se kako je prisutna u 2 - 5% djece s astmom, češće u djece starije od 10 godina i u dječaka. Iako je teška astma rijetka, ova skupina djece ima povećani rizik nuspojava liječenja, kao i teških i po život opasnih egzacerbacija. Povećani su izravni i neizravni troškovi u vidu potrošnje lijekova, češćih redovitih i hitnih posjeta liječniku, hospitalizacija, izostanaka s nastave i roditeljskih odsustava s posla. Definicije teške astme nisu ujednačene, ali im je svima zajednička potreba za kombinacijskim liječenjem inhalacijskim kortikosteroi- dima i bronhodilatatorima dugog djelovanja u visokim dozama neophodnima za kontrolu simptoma, ili, čak nedostatnima za punu kontrolu bolesti. Nekontrolirana astma zahtijeva iscrpno preispitivanje koje uključuje diferencijalno dijagnostičku reevaluaciju i nedvojbenu potvrdu dijagnoze astme, otkrivanje otegotnih čimbenika poput neredovitog uzimanja i/ili loše tehnike primjene inha- lacijskih lijekova, utjecaja okoliša (izloženost alergenima i iritansima) te komorbiditeta (bolesti gornjeg dišnog puta, gastroezofagu- sni refluks, pretilost i anksioznost). Ukoliko je dijagnoza astme potvrđena, a otegotni čimbenici ispravljeni, te je postignuta kontrola bolesti, radi se o teško lječivoj astmi (engl. difficult-to-treat asthma). Ako se ovim mjerama ne postigne kontrola, radi se o teškoj rezi- stentnoj astmi (engl. severe, therapy-resistant asthma). U pristupu djetetu s teško lječivom astmom slijedimo sistematičnu evaluaciju kojom u približno dvije trećine bolesnika djelovanjem na modificirajuće čimbenike ispunjavamo dugoročne ciljeve liječenja kroz postizanje kontrole simptoma te smanjenje rizika za po- goršanja i nepovratna oštećenja bronha/komplikacija liječenja. U preostale djece, u koje primjena ovih mjera ne dovodi do usposta- ve kontrole, radi se o teškoj, na terapiju rezistentnoj astmi. U njih slijedi, kroz određivanje fenotipskih obilježja, izbor biološkog liječenja temeljnog na pretpostavljenom endotipu.Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and underlining endotypes. It is estimated that severe asthma affects 2-5% of all children with asthma. It occurs more frequently in children older than ten years of age, with a slight prevalence among the male sex. Although severe asthma is uncommon, this group of children has an increased risk of drug side effects and life-threatening exacerbations that impair quality of life. Also, the financial burden from medication, scheduled and unscheduled doctor visits, hospitalizations and absence from school and work by parents have to be considered. There is no uniform definition of severe asthma, but the common characteristic is the need for maximal maintenance therapy, including high-dose inhaled steroids, long-acting beta-agonists, and/ or leukotriene receptor antagonists/theophylline. Despite the highest doses of maintenance therapy, patients with severe asthma fail to control the disease. Uncontrolled asthma has to be re-evaluated by confirming the diagnosis and modifying factors contribut- ing to symptoms and exacerbations like poor adherence, environmental risks (persistent allergen and pollutant exposure) and co- morbidities (upper airway disease, gastroesophageal reflux, obesity, anxiety). Children with poor asthma control due to misdiagnosed asthma, poor adherence or environmental risks have difficult-to-treat asthma, whereas children who still have poor control despite re-education to improve adherence and modification of environmen- tal risks have severe, therapy-resistant asthma. The approach to children with difficult-to-treat-asthma, which includes systematic evaluation and acting on modifying factors, enables achieving the long-term goals of asthma treatment in approximately two-thirds of patients. The remaining children, whose asthma is still uncontrolled despite optimized therapy, have severe, therapy-resistant asthma. Those children are candidates for bio- logical treatment based on the determination of phenotypic features

From phenotype to biological treatment of severe asthma

Teška astma je složena i heterogena bolest koja kliničara stavlja pred težak zadatak razlikovanja bolesnika prema rizičnim manife- stacijama bolesti (fenotipovi) i specifičnim patofiziološkim mehanizmima u podlozi bolesti (endotipovi), a sve u cilju odabira što učinkovitijeg liječenja prilagođenog potrebama pojedinog bolesnika. Dosadašnja istraživanja i pokušaji fenotipiziranja bolesnika s astmom, pa tako i teškom astmom, kod djece nisu dovela do jedno- značnog zaključka, osim već otprije poznatih činjenica da najveći dio djece ima atopiju s višestrukim preosjetljivostima (nerijetko kombinacija nutritivnih i aeroalergena, uloga plijesni), reverzibilnu bronhoopstrukciju i rane znakove remodelacije bronha. Samo mali broj djece ima trajnu bronhoopstrukciju (FEV1< 80%). Endotipovi teške astme ne razlikuju se od onih opisanih u astmi općenito: tip 2 (visoki Th2; eozinofili u serumu i sputumu, visoki IgE, FeNO; ključni citokini IL-4, IL-5, IL-13) i ne-tip 2 (niski Th2, neutrofilna, pau- cigranulocitna ili miješana upala; ključni citokini IL-8, IL-17, IL-22). Tip 2 je češći endotip kod djece i za njega postoji dostupna i odo- brena biološka terapija (anti-IgE i anti-IL-5). Ne-tip 2 je rjeđi endotip, obilježen općenito ograničenim terapijskim opcijama, među kojima se razmatra primjena azitromicina. Teška astma, iako kod djece rijetko zastupljena, predstavlja rizični fenotip koji ozbiljno narušava kvalitetu života. Pažljivo praćenje bolesnika i određivanje temeljnog endotipa omogućuje izbor i primjenu ciljanog i personaliziranog liječenja.Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and different underlining endotypes. According to different studies, there are several clinical phenotypes of severe asthma in children. Most children are allergic to multiple aeroallergen sensitization (house dust mites, pollen, molds) and have high levels of total and specific IgE, reversible airflow obstruc- tion and early signs of remodelation. A small subgroup of children has persistent airflow limitation (FEV1 <80% predicted). There are two major underlining functional or pathophysiologic mechanisms for different phenotypes of asthma and severe asthma accord- ing to the immune mechanism: Type 2 asthma (Th2-high asthma, eosinophils in serum and sputum, high IgE levels, high FeNO; key cytokines IL-4, IL-5, IL-13) and non-Type 2 asthma (Th2-low asthma, neutrophilic, paucigranulocytic and mixed granulocytic inflam- mation; key cytokines IL-8, IL-17, IL-22). The type 2 asthma endotype is more common in children, while biomarkers involved in the pathogenesis, such as IgE and IL-5 have become targets for biological therapy. The non-type 2 asthma endotype, less frequent in children with severe asthma, has fewer therapeutic options. The effect of azithromycin is still under investigation. Severe asthma, although uncommon, is a complex and high-risk phenotype of childhood asthma. Close monitoring of the patient and precise definition of underlying endotype during evaluation enables identification and use of personalized, endotype-targeted treatment

A PREDICTIVE MODEL OF A REPEATED FEBRILE NEUTROPENIA EPISODE IN CHILDREN WITH CANCER

Ciljevi: Identificirati čimbenike rizika za ponovljenu epizodu neutropenijske vrućice (NV) u djece s malignim bolestima te izraditi prediktivni model za ponovljenu epizodu NV s adekvatnom specifičnošću i senzitivnošću u djece s malignim bolestima. Ispitanici i metode: U retrospektivnu studiju uključene su 182 epizode NV u 45 djece s malignim bolestima koja su liječena na Odjelu za hematologiju i onkologiju Klinike za pedijatriju Kliničkog bolničkog centra Rijeka u razdoblju od 1.1.2008. do 31.12.2016. Kriterij uključenja u studiju bila je barem jedna epizoda NV. Povezanost ponovljene epizode NV i njene težine s relevantnim kliničkim i laboratorijskim parametrima analizirana je putem logističke regresije. Rezultati: Trideset osam (84%) pacijenata je imalo ponovljenu epizodu NV, od toga dvadeset pet (56%) tešku epizodu NV. Značajni čimbenici predikcije za ponovljenu epizodu NV su trajanje prve epizode NV 9 ili više dana te broj eritrocita ≤3.0×1012/L. Prediktivni model deriviran iz ova dva čimbenika ima točnost od 87% (95% interval pouzdanosti [CI] 73%-94%), senzitivnost od 82% (95% CI 53%-97%) i specifičnost od 88% (95% CI 79%-93%). Zaključak: Trajanje prve epizode NV i anemija su značajno povezani s rizikom za ponavljanje epizode NV. Ovi prediktori su korisni u identifikaciji pacijenata visokog rizika za neželjene događaje koji imaju korist od brze intervencijeObjectives: To identify risk factors of a repeated episode of severe febrile neutropenia (FN) in children with malignant diseases and to create an accurate and easy-to-use predictive model. Materials and methods: This retrospective cohort study conducted at the Division of Hematology and Oncology, Department of Pediatrics, Clinical Hospital Center Rijeka, from January 1, 2008 to December 31, 2016. included 182 episodes of FN in 45 children with malignant diseases who experienced at least one FN episode. The association of the second severe FN episode appearance with relevant clinical and laboratory data was analyzed by logistic regression. Results Thirty eight patients (84%) had repeated FN, of which twenty five (56%) had severe FN. Significant predictors of a repeated FN episode were duration of the first FN episode of 9 or more days and red blood cells ≤3.0×1012/L. The predictive model constructed by crossing these two indicators had the accuracy of 87% (95% confidence interval [CI] 73%-94%), sensitivity of 82% (95% CI 53%-97%), and specificity of 88% (95% CI 79%-93%). Conclusion The duration of the first FN episode and anemia are significantly associated with the risk for FN re-occurrence. These factors may be useful in the identification of children with cancer who are at high risk for adverse outcome and may benefit from rapid intervention

A PREDICTIVE MODEL OF A REPEATED FEBRILE NEUTROPENIA EPISODE IN CHILDREN WITH CANCER

Ciljevi: Identificirati čimbenike rizika za ponovljenu epizodu neutropenijske vrućice (NV) u djece s malignim bolestima te izraditi prediktivni model za ponovljenu epizodu NV s adekvatnom specifičnošću i senzitivnošću u djece s malignim bolestima. Ispitanici i metode: U retrospektivnu studiju uključene su 182 epizode NV u 45 djece s malignim bolestima koja su liječena na Odjelu za hematologiju i onkologiju Klinike za pedijatriju Kliničkog bolničkog centra Rijeka u razdoblju od 1.1.2008. do 31.12.2016. Kriterij uključenja u studiju bila je barem jedna epizoda NV. Povezanost ponovljene epizode NV i njene težine s relevantnim kliničkim i laboratorijskim parametrima analizirana je putem logističke regresije. Rezultati: Trideset osam (84%) pacijenata je imalo ponovljenu epizodu NV, od toga dvadeset pet (56%) tešku epizodu NV. Značajni čimbenici predikcije za ponovljenu epizodu NV su trajanje prve epizode NV 9 ili više dana te broj eritrocita ≤3.0×1012/L. Prediktivni model deriviran iz ova dva čimbenika ima točnost od 87% (95% interval pouzdanosti [CI] 73%-94%), senzitivnost od 82% (95% CI 53%-97%) i specifičnost od 88% (95% CI 79%-93%). Zaključak: Trajanje prve epizode NV i anemija su značajno povezani s rizikom za ponavljanje epizode NV. Ovi prediktori su korisni u identifikaciji pacijenata visokog rizika za neželjene događaje koji imaju korist od brze intervencijeObjectives: To identify risk factors of a repeated episode of severe febrile neutropenia (FN) in children with malignant diseases and to create an accurate and easy-to-use predictive model. Materials and methods: This retrospective cohort study conducted at the Division of Hematology and Oncology, Department of Pediatrics, Clinical Hospital Center Rijeka, from January 1, 2008 to December 31, 2016. included 182 episodes of FN in 45 children with malignant diseases who experienced at least one FN episode. The association of the second severe FN episode appearance with relevant clinical and laboratory data was analyzed by logistic regression. Results Thirty eight patients (84%) had repeated FN, of which twenty five (56%) had severe FN. Significant predictors of a repeated FN episode were duration of the first FN episode of 9 or more days and red blood cells ≤3.0×1012/L. The predictive model constructed by crossing these two indicators had the accuracy of 87% (95% confidence interval [CI] 73%-94%), sensitivity of 82% (95% CI 53%-97%), and specificity of 88% (95% CI 79%-93%). Conclusion The duration of the first FN episode and anemia are significantly associated with the risk for FN re-occurrence. These factors may be useful in the identification of children with cancer who are at high risk for adverse outcome and may benefit from rapid intervention

The role of exhaled nitric oxide in asthma control

Porast prevalencije alergijskih bolesti uzrokovan modernim načinom življenja zahtijeva što bržu dijagnozu i kontrolu tih bolesti. Kontrola podrazumijeva što dulje remisije bolesti uz što manju potrebu za lijekovima, osobito kortikosteroidima u slučaju astme. Frakcija izdahnutog dušikova oksida (NO) koristi se kao biomarker u dijagnozi i praćenju bolesti, odnosno kao indikator uspješnosti liječenja astme u odraslih i djece. Astmatičari imaju povišene vrijednosti frakcije izdahnutog dušikova oksida. Ova je pretraga jednostavna za izvođenje, a izuzetna je pomoć pri postavljanju dijagnoze astme, procjene odgovora na terapiju i njene reevaluacije. Broj studija koje govore o vrijednosti testa izdahnutog dušikova oksida je u eksponencijalnom porastu od početka primjene testa, no još se uvijek radi o malom broju ispitanika, te su potrebna daljnja istraživanja.The rate of allergic diseases is increasing which is caused by the modern way of life. Therefore it is crucial to have better control and faster diagnosis of these diseases. The disease is under control if remission persists as long as possible combined with minimal use of drugs such as corticosteroids. The fraction of exhaled nitric oxide is very significant in the diagnosis and follow-up in treatment of allergic diseases in adults and children. This test is simple to perform and has great value in diagnosing asthma, evaluation of drug response and re-evaluation of drugs in use. The number of studies show exponential growth over the years of using this test, but the number of subjects in studies is still rather modest so it requires furthermore research