Neurological Complications of Influenza

Neurološke komplikacije influence smatraju se rijetkima i pojavljuju se najčešće u dječjoj dobi. Od posebnog su interesa encefalitis i encefalopatija (IAEE) povezani s influencom zbog nepoznate patogeneze, dramatične kliničke prezentacije, dijagnostičkih teškoća, nepostojanja učinkovitog lijeka te često nepovoljnog ishoda osobito među malom djecom. Opisane su kliničke karakteristike neuroloških komplikacija influence. Neurološke komplikacije povezane s cjepivom protiv influence ekstremno su rijetke.Neurological complications of influenza are considered rare and occur mainly in children. Influenza associated encephalitis and encephalopathy (IAEE) are particularly interesting because of their unknown pathogenesis, dramatic clinical presentation, diagnostic difficulties, lack of effective treatment and frequently poor outcome, especially in small children. The clinical features of neurological complications of influenza have been described. Neurological complications associated with influenza vaccination are extremely rare

Severova bolest komplicirana osteomijelitisom

Sever’s disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever’s disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever’s disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient’s condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever’s disease. MRI should be done in all atypical cases of Sever’s disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najčešće u mladih sportaša, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostička obrada uključuje rendgenske snimke i ultrazvučni pregled. Bolest se liječi konzervativno, budući da prolazi sama od sebe. Prikazali smo devetogodišnjaka sa Severovom bolesti kod kojega standardna terapija nije polučila klinički učinak. Učinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo učiniti u svim atipičnim slučajevima Severove bolesti kako bi se isključila druga patološka stanja uključujući osteomijelitis

Severova bolest komplicirana osteomijelitisom

Sever’s disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever’s disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever’s disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient’s condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever’s disease. MRI should be done in all atypical cases of Sever’s disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najčešće u mladih sportaša, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostička obrada uključuje rendgenske snimke i ultrazvučni pregled. Bolest se liječi konzervativno, budući da prolazi sama od sebe. Prikazali smo devetogodišnjaka sa Severovom bolesti kod kojega standardna terapija nije polučila klinički učinak. Učinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo učiniti u svim atipičnim slučajevima Severove bolesti kako bi se isključila druga patološka stanja uključujući osteomijelitis

Kasni nastup teške nozokomijalne pneumonije uzrokovane bakterijom chlamydophila pneumoniae

We report two cases of severe late-onset nosocomial pneumonia caused by Chlamydophila pneumoniae. The clinical course of the disease in these patients suggests that nosocomial pneumonia caused by this agent can lead to profound respiratory insufficiency and acute respiratory distress syndrome, particularly in patients with significant comorbidities and during the postoperative period. Intravenous azithromycin treatment was used to cure pneumonia in both of our patients.Prikazuju se dva slučaja kasnog nastupa teške bolnički stečene pneumonije uzrokovane bakterijom Chlamydophila pneumoniae. Klinički tijek bolesti u ovih bolesnika ukazuje na to da bolnički stečena pneumonija izazvana ovim uzročnikom može dovesti do teške respiracijske insuficijencije i sindroma akutnog respiracijskog distresa, poglavito u bolesnika sa značajnim istodobno prisutnim bolestima i tijekom poslijeoperacijskog razdoblja. U oba bolesnika se za liječenje pneumonije primijenio intravenski azitromicin

Atipični slučaj subakutnog sklerozirajućeg panencefalitisa u odraslog bolesnika

Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.U ovom radu prikazujemo atipični slučaj subakutnog sklerozirajućeg panencefalitisa u odraslog bolesnika koji se prezentirao nalik multiploj sklerozi. Bolest je bila obilježena dugotrajnim i podmuklim tijekom s naknadnim razvojem brzo progresivne faze uz atipičan EEG nalaz i izostanak mioklonizama. U raspravi se analiziraju teškoće u interpretaciji dijagnostičkih testova, kao i nepovoljan utjecaj terapijskih postupaka u postavljanju definitivne dijagnoze

Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study

The objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis. A cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 C

Koronavirusna bolest 2019 (COVID-19)

Krajem prosinca 2019. godine prepoznati su prvi slučajevi nove, teške virusne respiratorne bolesti u kineskom gradu Wuhanu (3). Već početkom siječnja 2020. godine utvrđen je uzročnik bolesti, nazvan SARS-CoV-2, a bolest je nazvana koronavirusna bolest 2019 (COVID-19). Otkrivanje virusnog genoma pokazalo je da se radi o potpuno novom virusu, iako sličnom SARS i MERS virusima (4). Izolacija virusa omogućila je brojna istraživanja usmjerena na razvoj dijagnostičkih testova, potencijalnih cjepiva i lijekova

Procjena vrijednosti određivanja CO2 reaktivnosti moždanih arterija transkranijskim Dopplerom u infekcijama središnjeg živčanog sustava

AIM AND PURPOSE OF STUDY The objective of this prospective study was to assess the association between cerebral CO2 reactivity (CO2R) in patients with CNS infections and the severity, etiology and outcome of the disease. An additional objective was to assess the prognostic value of CO2 reactivity in these patients. The purpose of the study was to create a symptomatic treatment algorithm. EXAMINEES AND METHODS Sixty-eight patients with CNS infection and 30 healthy volunteers aged 18 years and more were included in this prospective study. The study was performed at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in Zagreb. Observational period was between January 2005 and May 2009. CO2 reactivity was measured by using a transcranial Doppler ultrasound (TCD) and "breath-holding" method. TCD measurement of CO2 reactivity (CO2 R) was performed by using a Multidop 4 X (DWL, Sipplingen, Germany) with two 2-MHz pulsed wave probes 1.7 cm in diameter. The software used was TCD-8 for MDX (Version 8.0, Aaslid Rune). The probes were secured to the head of the patient with a specially designed spectacle frame. The mean blood flow velocities (MBFV) were continuously recorded during normal ventilation and during the intervention (induced hypercapnia). The breath-holding index (BHI) was calculated by dividing the percentage of MBFV increase during breath holding by the duration of apnea (in seconds) in both middle cerebral arteries (MCA) and the average index (BHIm) was noted. RESULTS Advanced age (52 vs 37 years, p=0,002), lower GCS (7,5 vs 15, p<0,001) and mechanical ventilation (87,5% vs 32,1% ; p <0,001) were associated with impaired cerebral vasoreactivity (BHIm <1,18). Unfavorable outcome (GOS 1-3) was found in 28 (41,1%) patients. In this group, BHIm was significantly lower compared to the favorable group (0,835 vs 1,285). Comparison of BHIm between bacterial and non-bacterial groups according to the outcomes of disease showed no differences (p=0,460). Logistic regression analysis revealed that impaired CO2R was independently associated with unfavorable outcome (OR=4,922; 95%CI 1,161-20,875). CONCLUSION CO2R was confirmed as a reliable indicator of disease severity and a valuable prognostic factor in infections of the CNS. The etiology of disease (bacterial vs non-bacterial) showed no association with CO2R

Patogeneza infektivnih bolesti

Poznavanje patogeneze infektivnih bolesti važno je zbog razumijevanja nastanka i simptomatologije bolesti, njezinih komplikacija, ali i dijagnostičkih te terapijskih mogućnosti. Pored toga, na njoj se temelje i mjere prevencije širenja zaraznih bolesti

Acute pneumococcal myelitis in an adult patient

Pneumococcal meningitis represents the most severe community-acquired bacterial meningitis. The disease is frequently associated with various complications. We present a case of pneumococcal meningitis in an immunocompetent adult patient treated with hypothermia. The disease course was complicated with severe myelitis and consequent paraplegia which is an extremely rare complication of pneumococcal disease