Definiranje kvalitete života kod bolesnica s lokaliziranim i uznapredovalim stadijem raka dojke - prvi korak prema onkološkom genetskom savjetovanju

The important goal in breast cancer treatment is to improve patient quality of life. Due to the huge economic burden, it is necessary to estimate the health state utility values for different breast cancer stages accurately. A group of 114 women filled out the EuroQol-5D-3L questionnaire at two time points. The participants were divided into three groups, as follows: group 1 including healthy high-risk individuals; group 2 including patients with localized stage breast cancer; and group 3 including patients with advanced stage breast cancer. Results were expressed either as summary health state utility score or summary visual-analog score. The EuroQol utility index score and EuroQol visual-analog score were statistically significantly higher in the group of healthy high-risk individuals. The EuroQol visual-analog score was mostly correlated with the anxiety/depression and pain/discomfort quality of life dimensions. Health state utility values for different breast cancer stages are a necessary tool to perform economic analyses in breast cancer management decision making, due to its huge economic burden. Special attention should be paid to assessment of the psychosocial aspects of the disease, as well as pain management.Važan cilj u liječenju raka dojke je poboljšanje kvalitete života bolesnica. Zbog velikog financijskog opterećenja važno je točno procijeniti parametre kvalitete života (engl. health state utility values) za različite stadije raka dojke. Skupina od 114 žena ispunila je upitnik EuroQol-5D-3L u dvije vremenske točke. Sudionice su podijeljene u 3 skupine: 1. skupina – zdrave visokorizične osobe; 2. skupina – bolesnice s lokaliziranim stadijem raka dojke i 3. skupina – bolesnice u uznapredovalom stadiju raka dojke. Rezultati su predočeni ili kao sveukupni indeks kvalitete života bolesnica (engl. summary health state utility score) ili kao rezultat na vizualno-analognoj ljestvici (engl. summary visual-analog score). EuroQol utility index score i EuroQol visual-analog score bili su statistički značajno viši u skupini zdravih visokorizičnih osoba. Utvrđeno je da EuroQol visual-analog score korelira sa sljedećim dimenzijama kvalitete života: anksioznost/depresija i bol/nelagoda. Parametri kvalitete života (engl. health state utility values) za različite stadije raka dojke važan su alat za provođenje ekonomske analize pri donošenju odluka o liječenju raka dojke, prvenstveno zbog velikog financijskog opterećenja. Osobitu pozornost trebalo bi usmjeriti na procjenu psihosocijalnih aspekata bolesti, kao i liječenju boli

Chronic health conditions after childhood Langerhans cell histiocytosis: Results from the Swiss Childhood Cancer Survivor Study.

PURPOSE Langerhans cell histiocytosis (LCH) is a rare disease characterized by dysregulated proliferation of myeloid marrow progenitors and subsequent organ infiltration. While LCH is associated with a favorable prognosis, some survivors may develop chronic health conditions (CHC) because of the disease. In this study, we aimed to assess the spectrum and prevalence of CHC among LCH survivors compared with siblings and identify factors associated with the development of CHC. METHODS The Swiss Childhood Cancer Survivor Study sent questionnaires to all ≥ 5-year LCH survivors registered in the Swiss Childhood Cancer Registry and diagnosed between 1976 and 2015. Siblings also received similar questionnaires. We compared CHC prevalence between LCH survivors and siblings and used logistic regression to identify determinants of CHC. RESULTS A total of 123 LCH survivors participated in the study, with a response rate of 69%. Median time since diagnosis was 13 years (interquartile range 9-20). Among LCH survivors, 59% had at least one CHC. Cardiovascular (13% vs. 6%), endocrine (15% vs. 2%), musculoskeletal (22% vs. 13%), and digestive (15% vs. 8%) CHC were more common among LCH survivors compared to siblings (all p < 0.05). Factors most strongly associated with the occurrence of CHC were multisystem LCH, multifocal bone involvement, and involvement of the pituitary gland. CONCLUSIONS More than half of long-term LCH survivors suffered from one or more CHC and were affected considerably more than siblings. IMPLICATIONS FOR CANCER SURVIVORS LCH survivors in follow-up care should be screened especially for cardiovascular, endocrine, musculoskeletal, and digestive conditions

Etiology and frequency of precocious pubertal development in children treated at the Department of Pediatrics University Hospital Center Zagreb from 2009 to 2019

UVOD: Preuranjeni pubertet (PP) definiramo početkom razvoja sekundarnih spolnih oznaka prije osme godine u djevojčica i devete godine u dječaka. Sekularni trend snižavanja dobi početka puberteta dovodi do porasta broja djece upućene na obradu zbog sumnje na PP. ----- CILJ: Ispitati etiologiju preuranjenog pubertetskog razvoja u bolesnika liječenih u Klinici za pedijatriju KBC Zagreb te ispitati kliničke, biokemijske i radiološke osobine djece s pravim preuranjenim pubertetom (CPP). METODE: Retrospektivna analiza podataka iz medicinske dokumentacije pacijenata liječenih u Klinici u razdoblju 2009. – 2019. godine koji se vode pod dijagnozom PP-a. ----- REZULTATI: Od ukupno 680 pacijenata upućenih na obradu zbog sumnje na PP, u 184 (27,1 %) postavljena je dijagnoza CPP-a. Učestalost CPP-a 15,7 puta je veća u djevojčica nego u dječaka. Najčešći vodeći simptom u djevojčica je povećanje dojki (83,1 %), dok je u dječaka razvoj pubične dlakavosti (100 %). Pacijenti sa CPP-om imaju ubrzanje rasta i veći prirast na tjelesnoj težini u odnosu na vršnjake te je 41,7 % pacijenata bilo visinom iznad 95.percentile, a indeks tjelesne težine iznad 95. percentile imalo je njih 20,2 %. Povišenu bazalnu koncentraciju LH-a (> 0,3 IU/l) imalo je 51,6 % pacijenata. Koštana dob pacijenata odstupala je za +2,0 ± 1,2 godine od kronološke. Prevalencija patološkog nalaza MR-a HH regije bila je veća u dječaka (40 %) nego u djevojčica (19,6 %). Liječenje GnRH analogom provedeno je u 58,2 % pacijenata. ----- ZAKLJUČAK: Učestalost preuranjenog pubertetskog razvoja je u porastu što zahtijeva bolju informiranost zdravstvenih djelatnika i rano prepoznavanje. Praćenjem bolesnika i dijagnostičkom obradom potrebno je utvrditi etiologiju CPP-a te izdvojiti bolesnike u kojih je indicirano liječenje.INTRODUCTION: Precocious puberty refers to the appearance of secondary sex characteristics before age 8 in girls and age 9 in boys. Secular trend of earlier pubertal onset has led to an increase in the number of children referred for evaluation of precocious puberty (PP). ----- AIM: To determine the etiology of premature pubertal development in patients treated at the Department of Pediatrics, University Hospital Centre Zagreb and to examine the clinical, biochemical and radiological characteristics of children with central precocious puberty (CPP). ----- METHODS: Retrospective analysis of medical records of patients treated at the Clinic during the period 2009 – 2019 with the diagnosis of PP. ----- RESULTS: Among 680 patients referred to treatment due to an indication of PP, 184 (27.1%) were diagnosed with CPP. The CPP’s frequency is 15.7 times higher in girls than in boys. The most common initial symptom in girls is breast augmentation (83.1%) and in boys development of pubic hair (100%). CPP patients have accelerated growth and higher weight gain compared to their peers and therefore 41.7% of patients had a height above the 95th percentile, while the body mass index above the 95th percentile was present in 20.2% of patients. Elevated basal concentration of LH (> 0.3 IU/l) was found in 51.6% of patients. The bone age advancement was +2.0 ± 1.2 years in our study group. Prevalence of pathological findings on MR HH region was higher in boys (40%) than in girls (19.6%). Treatment with GnRH analogue was performed in 58.2% of patients. ----- CONCLUSION: The incidence of premature pubertal development is increasing, requiring better awareness of medical professionals and early recognition. The patients’ evaluation and follow-up enables appropriate diagnosis and selection of patients with CPP requiring therapy

Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor

Aim: To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). Methods: We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. Results: IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. Conclusions: Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs