COMORBIDITY OF CHRONIC TINNITUS AND PSYCHOLOGICAL STRESS - WHICH CAME FIRST, THE CHICKEN OR THE EGG?

Subjective tinnitus is a frequent, debilitating hearing disorder causing severe emotional stress and psychological suffering. Likewise, many reports show that the onset of tinnitus occurs at the time of high stress or after a period of stress. It is also common for existing tinnitus to become worse during exposure to stress. However, in clinical practice the association between tinnitus and stress is often neglected. Extensive search of the Web of Science database has shown a low ratio of scientific articles about coexistence of stress and tinnitus compared to other stress-related conditions. Specifically, there are about sixteen times more articles investigating comorbid stress in chronic pain, about six times more in chronic fatigue, and about four times more in fibromyalgia. Previous studies of biological markers of stress in tinnitus patients showed normal diurnal levels of stress hormone cortisol. However, experimental studies of tinnitus subjects showed a blunted reactive cortisol response after a psychosocial stress test, exposure to noise in the laboratory and a dexamethasone suppression test. In addition, tinnitus subjects showed increased sympathetic tone, and weakened sympathetic response after exposure to mental arithmetic task. In tinnitus subjects oxidative metabolism shows imbalance with shift from antioxidant enzyme preponderance towards oxidative stress predominance. Relaxation therapeutic programs reduce stresssensitive immunological parameter tumor necrosis factor alpha. Although existing data indisputably proves existence of comprehensive connections between tinnitus and psychological stress, there is still no empirical evidence to show whether stress as a etiological, or just contributing factor. Further research should give the ultimate answer on this subject

Ozbiljna hiponatrijemija i intoksikacija vodom - Dijagnostički izazov u hitnoj medicini

Psychogenic polydipsia is a disorder characterized by compulsive drinking of water in a population of psychiatric patients, most often those suffering from chronic psychosis. It can lead to severe dilutional hyponatremia and water intoxication, which is manifested by cerebral edema and associated neurological symptomatology. A 43 years-old patient was admitted to the Department of Emergency Medicine due to convulsions of the right hand and leg, which began one hour before arrival. During the episode, the patient was conscious, vomited once and had urinary incontinence. In the medical history he had epilepsy, chronic psychosis and moderate mental retardation. Vital parameters were stable, and physical examination did not reveal any associated pathological signs. Samples for laboratory analysis were taken and therapy with infusions of Diazepam (20 mg) included, to which patient was resistant. By heteroanamnesis it was acknowledged that in the last few days he spent more time than usual drinking water. Reviewing laboratory results it was found out that sodium concentration was 98 mmol/L. We began the gradual correction of sodium, after which the patient reached the full extent of recovery. Water intoxication is an emergency condition that is in clinical practice often mistaken for other neurological and internal emergency states, because of its non-specific symptomatology. With timely diagnosis and application of adequate treatment, recovery is complete.Psihogena polidipsija je poremećaj kompulzivnog pijenja vode u psihijatrijskih pacijenata, najčešće onih koji boluju od kronične psihoze. Poremećaj može uzrokovati tešku hiponatrijemiju i intoksikaciju vodom, a manifestira se putem cerebralnog edema i popratnih neuroloških simptoma. 43-godišnji pacijent zaprimljen je na odjel hitne medicine zbog konvulzija desne ruke i noge koje su započele jedan sat prije dolaska. Za vrijeme trajanja napada pacijent je bio pri svijesti, jednom je povraćao i imao urinarnu inkontinenciju. Anamneza je pokazala da pacijent boluje od epilepsije, kronične psihoze i umjerene mentalne retardacije. Vitalni parametri su bili stabilni i tijekom fizičkog pregleda nisu uočeni nikakvi popratni patološki znakovi. Uzeti su uzorci za laboratorijsku analizu i i putem infuzije je uključena terapija diazepama (20mg) na koju je pacijent bio rezistentan. Iz heteroanamnestičkih podataka utvrđeno je da je pacijent posljednjih nekoliko dana proveo dosta vremena pijući vodu. Laboratorijski nalazi su pokazali da je koncentracija natrija 98 mmol/l. Postepeno smo počeli normalizirati razinu natrija nakon čega se pacijent u potpunosti oporavio. Intoksikacija vodom je hitno stanje koje se u kliničkoj praksi često zamijeni s drugim neurološkim i internističkim hitnim stanjima zbog svoje nespecifične simptomatologije. Pravovremenom dijagnozom i odgovarajućom terapijom oporavak je potpun

Ekstremno teška deficijencija vitamina B12 – prikaz slučaja i pregled literature

Aim: Vitamin B12 (cobalamin) is nutrient from the vitamin B complex family. It is essential in the human body for deoxyribonucleic acid (DNA) synthesis and for cellular energy production. Vitamine B12 deficiency is decrease in its serum concentration below 220 pmol/L, and it can be present in various range of hematologic and systemic symptoms and signs. The aim of this article is to provide extensive information on extreme forms of deficiency of vitamin B12. Case report: 83-year-old men presented with fatigue, intolerance of physical activity, vertigo, paresthesia in fingers, dispersion, epigastric pain, vomitting and loss of apetite. Vital parameters were within normal range, and physical examination did not reveal any patological findings, except icterus of sclera and subicterus of skin. Urgent laboratory findings showed erythrocytes 1.18 x 1012/L (4.34-5.72 x 1012/L), hemoglobin 50 g/L (138-175 g/L), mean corpuscular volume (MCV) 123.6 fL (83.0-97.2 fL), vitamin B12 < 61 pmol/L (220-665 pmol/L). Patient started parenteral therapy with vitamin B12. After 5 days, rapid increase in reticulocyte count was observed, with haemogram stabilization within 6 weeks. In a follow-up period of two years, the patient had no symptoms. Conclusion: We presented patient with extreme deficiency of vitamin B12. Screening for vitamin B12 deficiency should be established in each patient with macrocytic anemia, even with slightly elevated MCV.Cilj: Vitamin B12 (kobalamin) je nutrijent iz porodice vitamina B-kompleksa. U ljudskom organizmu esencijalan je za sintezu deoksiribonukleinske kiseline (DNK) i proizvodnju energije u stanicama. Deficijencija vitamina B12 jest pad njegove koncentracije u serumu ispod 220 pmol/L, a može se prezentirati u širokom rasponu hematoloških i sistemskih simptoma i znakova. Cilj ovog članka je pružiti ekstenzivnu informativnost o ekstremnim oblicima deficijencije vitamina B12. Prikaz slučaja: Pacijent u dobi od 83 godine javio se zbog iznemoglosti, intolerancije napora, vrtoglavica, trnaca u prstima, dekoncentracije, bola u epigastriju, povraćanja i gubitka apetita. Bio je normalnih vitalnih parametara, a fizikalnim pregledom nije pronađeno patološkog nalaza, osim žutice. Hitni laboratorijski nalazi bili su: eritrociti 1.18 x 1012/L (4.34 – 5.72 x 1012/L), hemoglobin 50 g/L (138 – 175 g/L), prosječni volumen eritrocita (MCV) 123.6 fL (83.0 – 97.2 fL), vitamin B12 < 61 pmol/L (220 – 665 pmol/L). Započeta je parenteralna terapija s vitaminom B12. Nakon 5 dana zapažen je rapidan rast retikulocita, uz stabilizaciju hemograma u roku od 6 tjedana. U kontrolnom razdoblju od dvije godine nakon liječenja pacijent nije imao simptoma. Zaključak: Prikazali smo pacijenta s ekstremnom deficijencijom vitamina B12. Probir na deficijenciju vitamina B12 trebao bi biti proveden kod svakog pacijenta s makrocitnom anemijom, čak i s blago povišenim MCV-om

Aktivna okularna toksoplazmoza pacijenata dijagnosticiranih i liječenih u Općoj bolnici Zadar

Toxoplasma gondii is responsible for the 20-60% of all the cases of chorioretinitis. Causes of permanently reduced vision (found in about 25% of the patients) include macular active lesions and macular oedema, optic nerve involvement, vascular occlusion, retinal detachment, and late secondary choroidal neovascularization. A retrospective, non-consecutive chart review was performed on 11 patients with active ocular toxoplasmosis. At examination, all patients had central active lesions on retina. Preexisting chorioretinal scars were found in seven patients (63.6%). Eight patients (72.7%) had vitritis, while three patients (27,3%) had iridocyclitis. Six patients (54.6 %) had macular inflammatory lesions, four (36,37%) of them had active lesions out of vascular arcades, and one (9.1%) had active lesions inside vascular arcades, while macula was not affected. The mean value of visual acuity at first visit of the patients was 0,5. The mean value of visual acuity was 0.9 after the healing process. All the patients were treated with oral antibiotics. Seven patients also received oral corticosteriods, and seven of them were also treated with pyrimethamine. All patients with signs of iridocyclitis were also treated with topical corticosteroids. Although toxoplasmosis chorioretinitis is usually a self-limited infection and generally resolves spontaneously, unrecognised cases can result in severe visual impairments.Toxoplasma gondii je uzročnik 20-60 % svih slučajeva korioretinitisa. Uzroci trajno smanjenog vida (slučaj kod otprilike 25% pacijenata) uključuju aktivne lezije u makuli, makularni edem, lezije optičkog živca, vaskularne okluzije, ablacije mrežnice i kasne koroidalne neovaskularizacije. Prilikom pregleda, svi su pacijenti imali aktivne lezije na mrežnici. Raniji korioretinalni ožiljci pronađeni su u sedam pacijenata (63,6%). Osam pacijenata je imalo vitritis (72,7%), dok su tri pacijenta imala iridociklitis (27,3%). Šest pacijenata (54,6 %) imalo je upalne lezije u makuli, četvero (36,37%) je imalo aktivne lezije izvan krvožilnih arkada, a jedan (9,1%) je imao aktivne lezije unutar krvožilnih arkada, dok makula nije bila zahvaćena. Srednja vrijednost vidne oštrine prilikom prvog pregleda bila je 0,5. Poslije izlječenja srednja vrijednost vidne oštrine bila je 0,9. Svi pacijenti liječeni su peroralnim antibioticima. Sedam pacijenata je, također, primilo peroralne kortikosteroide, a sedam pirimetamin. Svi pacijenti s iridociklitisom su, također, primili topičke kortikosteroide. Iako je korioretinitis uzrokovan toksoplazmom uobičajeno samolimitirajuća bolest koja se može spontano izliječiti, nedijagnosticirani slučajevi mogu rezultirati ozbiljnim oštećenjima vida

Aktivna okularna toksoplazmoza pacijenata dijagnosticiranih i liječenih u Općoj bolnici Zadar

Toxoplasma gondii is responsible for the 20-60% of all the cases of chorioretinitis. Causes of permanently reduced vision (found in about 25% of the patients) include macular active lesions and macular oedema, optic nerve involvement, vascular occlusion, retinal detachment, and late secondary choroidal neovascularization. A retrospective, non-consecutive chart review was performed on 11 patients with active ocular toxoplasmosis. At examination, all patients had central active lesions on retina. Preexisting chorioretinal scars were found in seven patients (63.6%). Eight patients (72.7%) had vitritis, while three patients (27,3%) had iridocyclitis. Six patients (54.6 %) had macular inflammatory lesions, four (36,37%) of them had active lesions out of vascular arcades, and one (9.1%) had active lesions inside vascular arcades, while macula was not affected. The mean value of visual acuity at first visit of the patients was 0,5. The mean value of visual acuity was 0.9 after the healing process. All the patients were treated with oral antibiotics. Seven patients also received oral corticosteriods, and seven of them were also treated with pyrimethamine. All patients with signs of iridocyclitis were also treated with topical corticosteroids. Although toxoplasmosis chorioretinitis is usually a self-limited infection and generally resolves spontaneously, unrecognised cases can result in severe visual impairments.Toxoplasma gondii je uzročnik 20-60 % svih slučajeva korioretinitisa. Uzroci trajno smanjenog vida (slučaj kod otprilike 25% pacijenata) uključuju aktivne lezije u makuli, makularni edem, lezije optičkog živca, vaskularne okluzije, ablacije mrežnice i kasne koroidalne neovaskularizacije. Prilikom pregleda, svi su pacijenti imali aktivne lezije na mrežnici. Raniji korioretinalni ožiljci pronađeni su u sedam pacijenata (63,6%). Osam pacijenata je imalo vitritis (72,7%), dok su tri pacijenta imala iridociklitis (27,3%). Šest pacijenata (54,6 %) imalo je upalne lezije u makuli, četvero (36,37%) je imalo aktivne lezije izvan krvožilnih arkada, a jedan (9,1%) je imao aktivne lezije unutar krvožilnih arkada, dok makula nije bila zahvaćena. Srednja vrijednost vidne oštrine prilikom prvog pregleda bila je 0,5. Poslije izlječenja srednja vrijednost vidne oštrine bila je 0,9. Svi pacijenti liječeni su peroralnim antibioticima. Sedam pacijenata je, također, primilo peroralne kortikosteroide, a sedam pirimetamin. Svi pacijenti s iridociklitisom su, također, primili topičke kortikosteroide. Iako je korioretinitis uzrokovan toksoplazmom uobičajeno samolimitirajuća bolest koja se može spontano izliječiti, nedijagnosticirani slučajevi mogu rezultirati ozbiljnim oštećenjima vida

Koegzistencija sinkronog bilateralnog Wilmsova tumora i trisomije 21 – prvi prikaz i pregled literature

Introduction: Bilateral form of the Wilms tumor appears only in 5% of cases, and incidence in children before the age of 15 years is about 1: 250,000. Contrary to expectations, large population-based studies have shown that incidence of Wilms tumor is much lower in population with trisomy 21 than in the general population. To our knowledge, this is the first reported case of synchronous bilateral Wilms tumor appearing in patient with trisomy 21. Case report: 19-months-old male, previously known for trisomy 21, was admitted to hospital because of chronic constipation and abdominal pain. A month ago the child started to cry and suffer pain during defecation. He had last stool seven days before the examination. Abdominal palpation in left hypochondriac region revealed solid mass of about 6x6 cm in size. Ultrasound and Multislice Computed Tomography showed tumor on both kidneys; right smaller, and left larger - destroying most of the parenchyma and causing bowel obstruction. After 3 weeks of chemotherapy, left radical nephrectomy and right partial nephrectomy were made. 28-week chemotherapy continued postoperatively. Histopathology confirmed diagnosis of Wilms tumor. After recovery, the patient had a sufficient renal function. Conclusion: Coventional treatment with a combination of chemotherapy and surgical resection showed a good long-term outcome. However, in these cases special caution should be focused on the quantity of preserved renal tissue, because of an increased risk of renal failure.Uvod: Bilateralna forma Wilmsovog tumora javlja se samo u 5% slučajeva, a incidencija kod djece do 15. godine života iznosi oko 1:250 000. Suprotno očekivanjima, velike population-based studije pokazale su da je incidencija Wilmosovog tumora kod trisomije 21 mnogo manja nego kod opće populacije. Prema našim saznanjima, ovo je prvi prijavljeni slučaj sinkronog bilateralnog Wilmsovog tumora kod pacijenta s trisomijom 21. Prikaz slučaja: Muško dijete u dobi od 19 mjeseci, od ranije poznato zbog trisomije 21, dovedeno zbog kronične opstipacije i boli u trbuhu. Prije mjesec počeo se mučiti i plakati za vrijeme defekacije. Nije imao stolicu 7 dana pred pregled. Kliničkim pregledom se palpacijom lijevo hipohondralno pipala tvorba 6x6 cm. Ultrazvuk i višeslojna kompjuterizirana tomografija pokazali su u svakom bubregu po jednu tumorsku tvorbu; desno manju, a lijevo veću - koja destruira veći dio parenhima i urokuje opstukciju kolona. Nakon 3 tjedna kemoterapije, napravljena je lijevostrana radikalna nefrektomija i desnostrana parcijalna nefrektomija. Postoperativno je nastavljena kemoterapija u trajanju 28 tjedana. Patohistološka analiza potvrdila je dijagnozu Wilmsovog tumora. Nakon oporavka pacijent je imao zadovoljavajuću renalnu funkciju. Zaključak: Konvencionalno liječenje kombinacijom kemoterapije i kirurške resekcije imalo je dobar dugoročni ishod. Ipak, u ovakvim slučajevima poseban oprez je potrebno usmjeriti na količinu očuvanog renalnog tkiva, zbog povećanog rizika od bubrežnog zatajenja

Differential-diagnostic approach to sesamoid injuries of foot: case report

Cilj: Sezamoidni koštano-tetivni kompleks stopala sastoji se od dvije sezamoidne kosti - medijalne i lateralne. Kada dođe do njihove ozljede, diferencijalna dijagnoza se uglavnom svodi na onu između frakture i sezamoiditisa. U kliničkoj praksi problem stvara razlikovanje između frakture i sezamoiditisa bipartitne sezamoidne kosti, koja je normalna anatomska varijanta u 7-30% ljudi iz opće populacije. Cilj je prikazati slučaj pacijenta s naglo nastalom sezamoidnom boli koja se javila za vrijeme igranja nogometne utakmice. Prikaz slučaja: 27-godišnji muškarac došao je zbog boli u području palca desnog stopla, koju je osjetio za vrijeme nogometne utakmice, 24 sata pred prijem. Bol nije mogao povezati s nekim specifičnim događajem za vrijeme igre, nije pretrpio direktni udarac u stopalo. Kliničkim pregledom u području glave prve metatarzalne kosti plantarno su nađeni minimalni otok i crvenilo. Osjećao je bol na palpaciju i pasivnu dorzifleksiju. Rentgenskim (RTG) snimanjem desnog stopala postavila se sumnja na bipartitnu medijalnu sezamoidnu kost združenu sa sezamoiditsom, ali se zbog dvojbenog nalaza nije isljučila diferencijalna dijagnoza frakture. Pacijentu je ordinirana standardna konzervativna terapija, te ga se pratilo na redovitim tjednim kontrolama. Nakon 2 tjedna simptomi su se povukli, a kontrolnim RTG snimkama potvrđena je dijagnoza sezamoiditisa bipartitne kosti. Nakon 6 tjedana pacijent se vratio sportskim aktivnostima. Zaključak: Kada imamo dvojbenu situaciju sezmoidinim ozljedama je najbolje pristupiti konzervativnom terapijom, te nastaviti redovite kontrole pacijenta. Praćenjem kliničkog tijeka i komparacijom kontrolnog RTG-a uspostavlja se konačna dijagnoza. U slučaju perzistencije boli i/ili kontrolnog RTG-a koji upućuje na komplikacije, treba pristupiti naprednoj slikovnoj dijagnostici te u skladu s nalazom odlučiti o eventaulnoj invazivnoj terapiji. Sezamoidne ozljede se u većini slučajeva mogu lako izliječiti, ali postavljanje pogrešne dijagnoze može voditi u nepotrebne komplikacije.Introduction: The sesamoidal skeletal-tendon complex of the foot consists of two sesamoidal bones - medial and lateral. When their injury occurs, differential diagnosis is usually reduced to that between fracture and sesamoiditis. In clinical practice, the problem creates a distinction between fracture and sesamoiditis of bipartite sesamoid bone, which is a normal anatomical variant in 7-30% of people in the general population. The aim is to present a patient with acute sesamoid pain, which occured during a soccer match. Case report: The 27-year-old male came due to the pain in the right toe area, which he felt during the soccer match, 24 hours before the reception. He could not associate pain to any specific event during the game, denying a direct impact on the foot. On clinical evaluation there was discreet swelling and hyperemia in the area of the first metatarsal head. Pain was aggravated on palpation and passive dorsiflexion. X-ray of the right foot was suspicious on bipartite medial sesamoid bone associated with sezamoiditis, but the fracture was not excluded. The patient was treated with conservative therapy and monitored on regular weekly controls. After 2 weeks the symptoms retreated, and the control X-ray confirmed the diagnosis of bipartite sesamoid bone. After 6 weeks, the patient returned to sports activities. Conclusion: When we have a dubious diagnostic situations regarding sesamodial injuries, it is best to approach with conservative therapy and regular patient controls. By monitoring clinical course and taking control X-ray we\u27ll establish a final diagnosis. In the case of persistent pain and/or control X-ray that suggests complications, an advanced imaging diagnostics is needed and, according to the findings, decidon on eventual invasive therapy. Sesamoid injuries can be easily cured in most cases, but setting the wrong diagnosis can lead to unnecessary complications

The impact of demographic and socio-economic factors on the prevalence of syndromes of autosomal chromosomal anomalies in post-war Bosnia and Herzegovina

Uvod: Sindromi autosomnih kromosomskih anomalija imaju prevalenciju od 1 : 500 kod živorođene djece, a često su praćeni teškim zdravstvenim i društvenim problemima. Osim starije dobi majke u trenutku začeća, malo se zna o faktorima rizika za njihov razvoj. Ispitanici i metode: U istraživanju je sudjelovalo 97 ispitanika s dijagnosticiranim sindromima autosomnih kromosomskih anomalija rođenih u razdoblju od 2000. do 2015., s mjestom stanovanja u tri županije Federacije Bosne i Hercegovine. Provedeno je povijesno kohortno istraživanje, a analizirana je prevalencija sindroma s obzirom na mjesto stanovanja roditelja u ruralnoj ili urbanoj sredini te na indeks razvijenosti općina iz kojih dolaze. Rezultati: Od 50 458 živorođene djece u razdoblju od 2000. do 2015. godine sindromi autosomnih kromosomskih anomalija otkriveni su u 97 (0,19%) novorođenčadi. Od ukupnog broja živorođene djece 21 116 ih je rođeno u urbanom području, a 29 342 u ruralnom području. U istom je periodu u urbanom području zabilježeno 30 (0,14%), a u ruralnom 67 (0,23%) oboljelih. Prevalencija sindroma autosomnih kromosomskih anomalija u 11 različitih općina, razvrstanih po indeksu razvijenosti, u razdoblju od 2007. do 2015. godine bila je 0,19% u skupini općina indeksa razvijenosti > 100, a 0,30% u skupini < 100. Zaključak: Analizom prevalencije sindroma autosomnih kromosomskih anomalija utvrđeno je da je mjesto stanovanja roditelja u ruralnoj sredini Federacije Bosne i Hercegovine čimbenik rizika za njihov razvoj.Introduction: Syndromes of autosomal chromosomal anomalies have a prevalence of 1: 500 in live-born children and are often associated with severe health and social problems. Except for the advanced maternal age at the moment of conception, little is known about the risk factors for their development. Respondents and Methods: The respondents in this research were 97 children diagnosed with syndromes of autosomal chromosomal anomalies, born from 2000 to 2015, with a place of residence in 3 municipalities of Federation of Bosnia and Herzegovina. A chronologic cohort research has been conducted. The prevalence of syndromes was analyzed with respect to the parents’ place of residence (rural or urban area) and theirs municipality development index. Results: Of 50,458 live-born children, between 2000 and 2015, syndromes of autosomal chromosomal anomalies were detected in 97 (0.19%) newborns. Out of the total number of live-born children, 21116 were born in the urban area, and 29342 in the rural area. In the same period in the urban area, there were 30 (0.14%) and in rural 67 (0.23%) affected. The prevalence of syndromes of autosomal chromosomal anomalies in 11 different municipalities, classified by the development index, in the period from 2007 to 2015, was 0.19% in the group of municipalities with the development index > 100, and 0,30% in the group with <100. Conclusion: Analyzing the prevalence of syndromes of autosomal chromosomal anomalies it has been established that the parents’ place of residence in the rural area of the Federation of Bosnia and Herzegovina is a risk factor for their occurrence

Intensive care of newborn with edwards syndrome – case report

Introduction. Edwards syndrome is the second most common autosomal chromosome anomaly in humans, with a prevalence of 1: 6,000–1: 8,000 in live births. The syndrome includes a recognizable pattern of major and minor anomalies, and prominent psychomotor and cognitive impairments. It carries an increased risk of neonatal and infant mortality. More than 50% of children die in the fi rst week of their life, and less than 10% of them survive until the age of one year. The approach to the treatment of such patients has so far caused many controversies among pediatricians. Whereas some believe that the use of intensive therapy prolongs survival, others believe that it has no long-term effect and due to the severe psychomotor and cognitive impairment its application is not justifi ed. Case report. A female newborn, born on January 11th, 2014, immediately after birth, was transferred to Neonatal Intensive Care Unit of Department of Pediatrics, University Clinical Hospital Mostar, because of hypotonia, pale-grayish color of the skin, defi cient spontaneous motor skills and respiratory insuffi ciency. Clinically, the newborn showed phenotypic characteristics typical of Edwards syndrome. Immediately upon receipt the patient was intubated and connected to mechanical ventilation. The same day diaphragmatic hernia was diagnosed and a corresponding surgery was performed. Cytogenetic fi ndings confirmed complete trisomy 18. Heart echography showed VSD input type (size 8 mm), ASD II (5 mm), PDA (3 mm). Further diagnostic examination showed other congenital malformations with less clinical importance. After stabilization, the patient continued post-intensive treatment with cardiac therapy and physiatric treatment. After being discharged, the patient was repeatedly hospitalized, among other things due to the development of pulmonary hypertension and its complications. The child died in June 2016 of heart failure at the age of two years and six months. Conclusion. The application of intensive treatment had a certain impact on our patient’s survival. It has also been shown that intensive care is followed by cardiovascular events as major mechanisms of death, as opposed to non-invasive approach where high percentage of deaths are associated with central apnea