Epididimo-orhitis u 13-godišnjeg dječaka tokom varicella infekcije – ultrazvučno praćenje

Varicella is a highly contagious infectious disease that can cause various complications. One of them, epididymo-orchitis, is rare and poorly described in literature, and thus remains seldom thought of, under-diagnosed, and poorly treated. In this report we present the case of a 13-year-old boy initially examined by an infectologist and a pediatric surgeon under the diagnosis of a scrotal bacterial superinfection during a varicella infection. Wrongly treated with antibiotics, he was then examined by a pediatric endocrinologist, diagnosed with epididymoorchitis as a varicella complication, and treated with acetaminophen, ice packs and scrotum suspension, as the 24-hour window for antiviral therapy initiation was missed. Laboratory test showed no signs of infection, while ultrasonography showed enlargement of the right testicle and epididymis with thickening of tunica albuginea and paratesticular effusion. The ultrasound follow up then showed improvement with each examination and a year later a completely normal finding. The hormonal status was normal during the follow up, so was the sperm count. However, sperm mobility was reduced 5 years later and the patient was diagnosed with asthenozoospermia. Hence we must emphasize the role of a varicella infection and its ability to leave a long term consequence to reproductive health. Having in mind the diminished antiviral therapy and still doubtful complication prevention we have to point out the prevention measures, including vaccination and the development of new antiviral methods.Varicella je visoko zarazna infektivna bolest koja može uzrokovati brojne komplikacije. Jedna od rijeđih, epididimo-orhitis, je samim time i rijetko opisana u literaturi, rijetko dijagnosticirana te neadekvatno liječena. U ovom prikazu opisat ćemo slučaj 13-godišnjeg dječaka koji je inicijalno pregledan od strane infektologa i dječjeg kirurga pod dijagnozom skrotalne bakterijske superinfekcije tijekom varicella infekcije. Pogrešno liječen antibioticima, dječak je potom pregledan od strane pedijatrijskog en-dokrinologa, dijagnosticiran mu je epididimo-orhitis te je liječen acetaminofenom, hladnim oblozima i skrotalnom suspenzijom, s obzirom da je 24-satni ‘prozor’ za uključivanje antiviralne terapije već bio prošao. U laboratorijskim testovima nisu zabilježeni znakovi upale, a ultrazvučni pregled pokazao je uvećanje desnog testisa i epididimisa uz zadebljanje tunike albuginea i paratesti-kularni izljev. Pacijent je potom ultrazvučno praćen pri čemu je zabilježeno postupno poboljšanje uz potpuno normalan nalaz go-dinu nakon infekcije. Hormonski status bio je uredan tokom praćenja. Nakon 5 godina napravljen je spermatogram uz uredan broj spermija, ali i smanjenu mobilnost, te je pacijentu dijagnosticirana astenozoospermija. Na temelju ovog slučaja moramo naglasiti ulogu varicella infekcije u mogućem razvitku dugoročnih posljedica na reproduktivno zdravlje. S obzirom na smanjenu ulogu anti-viralne terapije te još uvijek upitnu mogućnost prevencije komplikacija, moramo naglasiti važnost preventivnih mjera, uključujući cijepljenje, te pogled na razvitak novih antiviralnih metoda

Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children. We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight

Thyrotoxicosis in children and adolescents – diagnostic and therapeutic dilemmas

Tirotoksikoza je uzrokovana različitim čimbenicima, a manifestira se šarolikim kliničkim znakovima hipermetaboličkog stanja. Primjeren terapijski pristup ovisi o uzrocima bolesti i bolesnikovom stanju te zahtijeva brzu i pravilnu dijagnostičku obradu. Ovaj članak iznosi pregled liječenja tirotoksikoze zasnovano na klinički utemeljenim podatcima, a donosi i pregled vlastitih iskustava u četrnaestgodišnjem razdoblju. Pregledom literature, posebno različitih smjernica i drugih publiciranih materijala, služeći se PubMed-om, izdvojili smo podatke koje iznosimo u kritičkom tonu. Iskustva u četrnaestgodišnjem liječenju djece i adolescenata s tirotoksikozom u Klinici za dječje bolesti KBC-a Split usporedili smo s iskustvima drugih autora. Klinički opis uključuje početnu kli ničku evaluaciju i dijagnostički pristup tirotoksikozi, uključujući subkliničku hipertireozu, Hashimotovu i Gravesovu bolest. Pristup Gravesovoj bolesti uključuje tirostatske lijekove, terapiju radioaktivnim jodom i operativno liječenje. U našoj ustanovi u četrnaestgodišnjem razdoblju pregledali smo 59-ero bolesnika s tirotoksikozom, Hashimotovu bolest imalo je 17/59 (28,8%) bolesnika, a Gravesovu bolest 41/59 (69,5%), dok je 1/59 (1,7%) imao rijetki nedostatak TBG-a (engl. Thyroxine Binding Globulin). Remisiju bolesti doživjelo je 12/41 (29,2%) bolesnika s Gravesovom bolešću, a relaps 4/12 (33,3%). Terapija radioaktivnim jodom primijenjena je u 3/41 (7,3%), a operacija u 13/41 (31,7%) bolesnika s Gravesovom bolešću. Doneseno je više preporuka i zaključaka na utemeljenim kliničkim podatcima racionalnog, pouzdanog i optimalnog kliničkog pristupa oboljelima od tirotoksikoze. Odabir načina liječenja Gravesove bolesti složen je proces. Razgovor o prednostima i rizicima predloženih terapijskih mjera s bolesnikom i njegovim roditeljima je nužan. U našoj ustanovi preporuča se poticati roditelje bolesnika s Gravesovom bolešću koji imaju malu mogućnost za postizanje remisije na bržu odluku o defi nitivnom liječenju.Thyrotoxicosis is caused by diff erent etiologic factors and is manifested by various clinical signs of hypermetabolism. Appropriate therapeutic approach demands prompt and correct diagnosis and depends on the cause and condition of the patient. This article presents a clinical review of thyrotoxicosis treatment based on clinically acquired data and brings a review of personal experiences during a 14-year period. We searched the literature, on PubMed and other published materials. We compared our experience at Clinical Department of Pediatrics, Split University Hospital Center, with experiences of others. Clinical description includes initial evaluation and approach to thyrotoxicosis; subclinical hyperthyroidism/thyrotoxicosis; Hashimoto’s and Graves’ disease, and approach to Graves’ hyperthyroidism including antithyroid drugs, radioactive iodine and surgical treatment. During the 14-year period, we examined 59 patients with thyrotoxicosis, including 7/59 (28.8%) patients diagnosed with Hashimoto’s disease, 41/59 (69.5%) patients diagnosed with Graves’ disease, and 1/59 (1.7%) patient diagnosed with rare thyroxine binding globulin (TBG) insuffi ciency. Twelve of 41 (29.2%) patients with Graves’ disease had remission and relapse occurred in one-third (n=4) of these 12 (33.3%) patients. Radioiodine therapy was used in 3/41 (7.3%) patients with Graves’ disease, whereas 13/41 (31.7%) patients underwent surgical operation. Many recommendations and conclusions have been drawn on the basis of clinical data on the rational, safe and optimal medical approach to patients with thyrotoxicosis. Choosing treatment for Graves’ disease is a complex process. Discussing advantages and risks of recommended therapies with patients and parents is desirable and necessary. In our institution, it is necessary to encourage parents of Graves’ disease patients with minor chance of remission to make quick decision on defi nitive care

Insulin pump in treating patients with diabetes type 1

Tip 1 šećerna bolest (T1ŠB) nastaje zbog samorazaranja beta stanica gušterače. Uzrok nastanka T1ŠB-a je međudjelovanje nasljednih čimbenika i čimbenika okoliša. Primjenom inzulinske pumpe u oboljelih od T1ŠB-a poboljšava se kakvoća života i postiže se bolja regulacija glikemije, što smanjuje rizik razvoja komplikacija.U ovom radu istražena je promjena vrijednosti glikoliziranog hemoglobina (HbA1c) prije i nakon primjene inzulinske pumpe, njen utjecaj na promjenu indeksa tjelesne uhranjenosti (BMI-SDS), učestalost pojave teških hipoglikemija i ketoacidoza (DKA). Vrijednosti HbA1c-a su se statistički značajno smanjile nakon primjene inzulinske pumpe. BMI-SDS je očekivano značajno porastao nakon primjene inzulinske pumpe s obzirom na slobodu unosa namirnica. Učestalost pojave teških hipoglikemijskih kriza i DKA u naših ispitanika vrlo je mala, s obzirom na rezultate istraživanja drugih centara u svijetu.Diabetes type 1 (T1D) originates from beta cell destruction. Heredity and environmental factors influence the genesis of T1D. The use of an insulin pump in patients with T1D improves their quality of life and attains better regulation of glycaemia, which reduces the risk of complications. In this study we documented the variation in HbA1c values before and after using insulin pumps and its influence on body mass index (BMI-SDS) changes, the frequency of severe hypoglycaemia and ketoacidosis (DKA). HbA1c values were greatly reduced after insulin pump use. BMI-SDS confirmed the expected significant growth using the insulin pump in regards to free eating habits. The frequency of severe hypoglycaemia and DKA in our patients was very small compared to results published in other diabetic centres throughout the world

Insulin pump in treating patients with diabetes type 1

Tip 1 šećerna bolest (T1ŠB) nastaje zbog samorazaranja beta stanica gušterače. Uzrok nastanka T1ŠB-a je međudjelovanje nasljednih čimbenika i čimbenika okoliša. Primjenom inzulinske pumpe u oboljelih od T1ŠB-a poboljšava se kakvoća života i postiže se bolja regulacija glikemije, što smanjuje rizik razvoja komplikacija.U ovom radu istražena je promjena vrijednosti glikoliziranog hemoglobina (HbA1c) prije i nakon primjene inzulinske pumpe, njen utjecaj na promjenu indeksa tjelesne uhranjenosti (BMI-SDS), učestalost pojave teških hipoglikemija i ketoacidoza (DKA). Vrijednosti HbA1c-a su se statistički značajno smanjile nakon primjene inzulinske pumpe. BMI-SDS je očekivano značajno porastao nakon primjene inzulinske pumpe s obzirom na slobodu unosa namirnica. Učestalost pojave teških hipoglikemijskih kriza i DKA u naših ispitanika vrlo je mala, s obzirom na rezultate istraživanja drugih centara u svijetu.Diabetes type 1 (T1D) originates from beta cell destruction. Heredity and environmental factors influence the genesis of T1D. The use of an insulin pump in patients with T1D improves their quality of life and attains better regulation of glycaemia, which reduces the risk of complications. In this study we documented the variation in HbA1c values before and after using insulin pumps and its influence on body mass index (BMI-SDS) changes, the frequency of severe hypoglycaemia and ketoacidosis (DKA). HbA1c values were greatly reduced after insulin pump use. BMI-SDS confirmed the expected significant growth using the insulin pump in regards to free eating habits. The frequency of severe hypoglycaemia and DKA in our patients was very small compared to results published in other diabetic centres throughout the world

Determinants of thyroid volume in healthy young adults of Dalmatia

Background and purpose: The aim of this study was to investigate thyroid volume (TV) and its determinants in healthy young adults without present or previous thyroid disease. Materials and methods: The study was performed in a sample of 145 healthy young participants aged 19-29 years, living in an iodine-sufficient area of Dalmatia. Dimensions of the thyroid gland were obtained by ultrasound and used to determine TV. Anthropometric data was collected, and measurements of serum TSH, fT4, Tg, TgAb, and TPOAb levels were determined. Correlations between TV and other continuous variables were determined using the Pearson correlation test, while multivariate linear regression analysis was used to determine the associations of the potential predictors for the TV. Results: TV in men was larger than in women (p=3.53x10-8) and was positively correlated with anthropometric measurements, with the highest correlation coefficient for height (r=0.53, p=6.36x10-12), then body surface area, BSA (r=0.48, p=1.68x10-9), weight (r=0.43, p=8.28x10-8) and body mass index, BMI (r=0.17, p=0.04). Age and cigarette smoking did not appear to be significantly associated with TV (p=0.13 and p=0.95, respectively). Univariate analysis showed TV correlated with fT4 plasma levels (r=0.35, 1.73x10-5), while multivariate analysis showed height and fT4 levels to be important parameters with a significant role in TV. Conclusions: We confirmed previously observed association of TV with sex and anthropometric parameters and reported a significant correlation between TV and fT4 levels. Furthermore, fT4 levels and height were found to be the important parameters for predicting TV.</p

The Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors in Obese Children and Adolescents in Dalmatia: A Hospital Based Study

Obesity and metabolic syndrome (MS) are one of the biggest public health issues in child and adolescent population. To the best of the authors’ knowledge, this hospital based study is the first report on the prevalence of MS in obese children and adolescents in Dalmatia, the Mediterranean part of Croatia. The objectives of this study were to determine the prevalence of individual cardiovascular risk factors and MS. Between January 2009 and June 2014, 201 obese subjects aged 6 to 18 were analyzed retrospectively from our Pediatric Endocrine Unit database. The subjects were then classified in two groups of obesity; subjects with BMI z score 2.0–3.0 were classified as moderately obese and subjects with BMI z score > 3.0 were classified as severely obese. The overall prevalence of MS using the modified IDF criteria was 30.3%. The most common component of MS in both groups was arterial hypertension, while impaired fasting glucose was the least common component of MS. Our finding of high prevalence of MS underlines the importance of early childhood obesity treatment

Utjecaj psa vodiča na regulaciju glikemije u slijepih/slabovidnih osoba sa šećernom bolešću

The aim was to assess glycemia regulation in a blind diabetic patient after getting a guide dog. Glycosylated hemoglobin (HbA1c) results of a blind patient before and after getting the guide dog were retrospectively collected. The paired t-test results yielded a two-tailed P value of 0.0925, a difference considered not statistically significant; the 95% confidence interval of this difference varied from -0.2494 to 1.889. An improvement of glycemia regulation was observed with the guide dog compared to previous glycemia regulation, however, the difference was not statistically significant. The moderate improvement could probably be attributed to the mobility of the blind person having a guide dog. Standard quality of life tests should be included in the evaluation of diabetic blind persons, especially the impact of a guide dog on glycemic control or other chronic complications of diabetes.Cilj je bio procijeniti regulaciju glikemije kod slijepe osobe sa šećernom bolešću nakon što je ta osoba dobila psa vodiča. Retrospektivno su se prikupljali rezultati HbA1c u slijepe osobe prije i nakon dobivanja psa vodiča. Primjenom rezultata parnog t-testa dobivena je dvosmjerna vrijednost P od 0,0925. Razlika nije bila statistički značajna, dok se 95% interval pouzdanosti te razlike kretao od -0,2494 do 1,889. Zabilježeno je poboljšanje regulacije glikemije uz psa vodiča u usporedbi s vrijednostima prije dobivanja psa vodiča, ali razlika nije bila statistički značajna. Smatramo da bi to umjereno poboljšanje moglo biti povezano s pokretljivošću slijepe osobe uz psa vodiča. U procjenu slijepe osobe sa šećernom bolešću treba uključiti standardne testove za kvalitetu života, osobito utjecaj psa na regulaciju glikemije ili na druge kronične komplikacije šećerne bolesti

Retinopathy and Nephropathy in Type 1 Diabetic Patients – Association with Polymorphysms of Vitamin D-Receptor, Tnf, Neuro-D and Il-1 Receptor 1 Genes

Retinopathy and nephropathy are common late type 1 diabetes mellitus (T1D) complications. In this study we investigated whether individual differences in 4 candidate genes significantly contribute to development and progression of late complications in T1D patients. We examined 121 patients for the presence of diabetic retinopathy and nephropathy. We genotyped variants in vitamin D receptor (VDR) and tumor necrosis factor (TNF) genes in 47 patients and in NeuroD1 and interleukin-1 receptor 1 (IL1R1) genes in 35 patients. Diabetic retinopathy had 66 (55%) patients after a median of 13.0 years after diagnosis. Diabetic nephropathy had 14 (11.66%) patients, all of whom had already developed retinopathy. A significant correlation between the degree of diabetic retinopathy and mean microalbuminuria (MA) value has been found (c2=54.18, p<0.001). After correcting for duration of disease, only the VDR gene BsmI genotypes showed significant association with cumulative prevalence of diabetic retinopathy, while no investigated genetic polymorphysms could reliably predict diabetic nephropathy

NeuroD1 Gene and Interleukin-18 Gene Polymorphisms in Type 1 Diabetes in Dalmatian Population of Southern Croatia

Aim: To evaluate the frequency of known polymorphisms in the exon 2 of the NeuroD1 gene and in the interleukin (IL)-18 promoter region in patients with type 1 diabetes mellitus (T1DM) and in healthy control subjects in Dalmatia, Southern Croatia. Methods: A total of 134 unrelated patients (73 men and 61 women) and 132 consecutive unrelated healthy controls (61 men and 71 women) from the Dalmatian region of southern Croatia were recruited for the study. NeuroD1 genotypes (GG, GA, AA) were identified by means of polymerase chain reaction followed by restriction fragment length polymorphism (PCR/RFLP). IL-18 polymorphism in the position –137 of the promoter region was detected by using PCR sequence-specific primers. Results: Genotype distributions of both genes did not show significant difference between patients and controls. Conclusion: Our results suggest that NeuroD1 exon 2 and IL-18 promoter gene polymorphisms are not associated with development of T1DM susceptibility in the population of South Croatia. In addition to previously published positive correlations of these polymorphisms with development of T1DM among different world populations, our findings indicate the existence of ethnic variations in the association of these genes with disease development