Ima li spol djeteta utjecaj na poslijeoperacijsku bol i odgovor na stres?

Surgical procedure causes multisystem stress response reactions. The aim of this study was to assess whether gender has an impact on the level of neuroendocrine response to surgical stress and intensity of postoperative pain in children undergoing inguinal hernia repair surgery, as well as satisfaction of their parents with preoperative and postoperative care. The study included 60 children aged 3-6 years, all of them the only child in the family. All children included in the study were categorized as American Society of Anesthesiologists PS Class I, and divided into two groups: group 1 composed of 30 boys and group 2 composed of 30 girls. After oral premedication with midazolam, general anesthesia with endotracheal intubation was performed in all patients. Ketorolac, 1 mg.kg-1, was administered for postoperative analgesia. Serum cortisol was measured in all children preoperatively and postoperatively. The quality of postoperative analgesia was evaluated by Wong-Baker (FACES) scale, along with parental satisfaction. Male children who were the only child in the family had stronger neuroendocrine response to surgical stress and stronger intensity of postoperative pain. The parents of the girls expressed greater satisfaction with preoperative and postoperative care.Kirurški zahvat uzrokuje multisistemsku reakciju organizma u odgovoru na stres. Cilj ovog istraživanja je bio procijeniti ima li spol djeteta i ponašanje roditelja utjecaj na razinu neuroendokrinog odgovora bolesnika na kirurški stres i intenzitet poslijeoperacijske boli u djece koja su podvrgnuta operaciji preponske kile. Studija je uključivala 60 djece u dobi od 3 do 6 godina, od kojih su svi bili jedino dijete u obitelji. Sva djeca uključena u studiju kategorizirana su kao klasa I. Američkog društva anesteziologa i podijeljena u dvije skupine: prvu skupinu od 30 dječaka i drugu skupinu od 30 djevojčica. Nakon oralne premedikacije midazolamom kod svih bolesnika je provedena opća endotrahealna anestezija. Ketorolak u dozi od 1 mg.kg-1 je primijenjen za poslijeoperacijsku analgeziju. Kortizol u serumu mjeren je prijeoperacijski i poslijeoperacijski. Kod sve djece provedena je procjena kvalitete poslijeoperacijske analgezije pomoću Wong-Bakerove ljestvice (FACES) i zadovoljstva roditelja. Muška djeca koja su bila jedino dijete u obitelji imala su jači neuroendokrini odgovor na kirurški stres i jači intenzitet poslijeoperacijske boli. Roditelji djevojčica bili su zadovoljniji prijeoperacijskim i poslijeoperacijskim tretmanom njihove djece

Acute diarrhea in children

© 2015, Serbia Medical Society. All rights reserved. Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for seven to 10 days, 14 days at most. It mainly occurs in children until five years of age and particularly in neonates in the second half-year and children until the age of three years. Its primary causes are gastrointestinal infections, viral and bacterial, and more rarely alimentary intoxications and other factors. As dehydration and negative nutritive balance are the main complications of AD, it is clear that the compensation of lost body fluids and adequate diet form the basis of the child’s treatment. Other therapeutic measures, except antipyretics in high febrility, antiparasitic drugs for intestinal lambliasis, anti-amebiasis and probiotics are rarely necessary. This primarily regards uncritical use of antibiotics and intestinal antiseptics in the therapy of bacterial diarrhea. The use of antiemetics, antidiarrhetics and spasmolytics is unnecessary and potentially risky, so that it is not recommended for children with AD

Anaesthesiological problems in children with congenital laryngeal stenosis

Congenital laryngeal stenosis is a rare condition, which can be diagnosed in the early neonatal period. Manifest stenosis can be life threatening. Severe ("critical") types of stenosis require securing an adequate airway just after the birth, as well as early tracheotomy as a life-saving procedure. This paper presents a case report of a preterm newborn with severe laryngeal stenosis diagnosed at birth. It was not possible to secure the airway even with endotracheal tubes of the smallest diameter, thus a laryngeal mask (LMA) was placed to provide adequate ventilation and oxygenation. Anaesthesia was administered in the same way during the tracheotomy procedure, which was performed in the earliest hours of the baby\u27s life

Uloga regionalne anestezije u postoperativnoj analgeziji pedijatrijskih bolesnika

Introduction/Objective Pain is a disturbing experience associated with existing or potential tissue damage, with a sensory, emotional, cognitive, and social component. The aim of this study was to show the efficiency of regional anesthetic techniques in postoperative pain in children. Methods The retrospective cohort study was conducted on a group of 564 pediatric patients during the period from 2013 to 2016. Types of regional anesthesia were classified into the following six groups: caudal, epidural, spinal block, upper limb blocks, lower limb blocks, and truncal nerve block. From statistical methods, we used descriptive statistical methods of absolute and relative numbers, measurements of variability, central tendencies for numerical features, and methods of inferential statistics. We used the ch2 test for the attributive features of observations. Results In relation to the postoperative time when an analgesic was required, a statistically significant difference was observed in the age of children (p = 0.000), disease diagnosis (p = 0.000), type of block (p = 0.000), type of local anesthetic (p = 0.000), and type of anesthesia or sedation preoperatively (p = 0.005). Conclusion Postoperative analgesia was most needed by older children and children who were awake during surgery. Children with injuries and tumors need postoperative analgesia the earliest. The longest postoperative analgesia was recorded in patients who received caudal block. The longest postoperative analgesia can be seen in patients who received levobupivacaine, bupivacaine or levobupivacaine combined with lidocaine to perform the block.Uvod/Cilj Bol predstavlja uznemirujuće iskustvo koje je povezano sa postojećim ili mogućim oštećenjem tkiva, sa senzornom, emocionalnom, kognitivnom i socijalnom komponentom. Cilj ove studije je prikaz efikasnosti tehnika regionalne anestezije na postoperativni bol kod dece. Metode Retrospektivna kohortna studija je sprovedena na grupi od 564 pedijatrijskih bolesnika u periodu od 2013. do 2016. godine. Vrste regionalne anestezije su klasifikovane u šest grupa: kaudalna, epiduralna, spinalna, blokovi gornjih ekstremiteta, donjih ekstremiteta i blok trupa. Od statističkih metoda koristili smo deskriptivne statističke metode apsolutnih i relativnih brojeva za atributivna obeležja posmatranja, mere varijabiliteta, centralne tendencije za numerička obeležja i metode inferencijalne statistike. Izbor testova za numerička obeležja posmatranja zavisiće od raspodele podataka. Za atributivna obeležja posmatranja koristili smo ch2 test. Rezultati U odnosu na postoperativno vreme kada je bio potreban analgetik, statistički značajna razlika uočena je u uzrastu dece (p = 0,000), dijagnozi bolesti (p = 0,000), vrsti bloka (p = 0,000), vrsti korišćenog lokalnog anestetika (p = 0,000), kao i vrsti perioperativne anestezije ili sedacije (p = 0,005). Zaključak Postoperativna analgezija je najpotrebnija starijoj deci i deci koja su bila budna tokom hirurške intervencije. Najranija postoperativna analgezija je potrebna deci sa povredama i tumorima. Najduža postoperativna analgezija je zabeležena kod bolesnika koji su dobili kaudalni blok, kao i bolesnika koji su primili levobupivakain, bupivakain ili levobupivakain u kombinaciji sa bupivakainom za izvođenje bloka

Moebiusov sindrom: izazov za zbrinjavanje dišnoga puta

Moebius syndrome is a rare nonprogressive congenital neurological disorder with a wide range of severity and variability of symptoms. This diversity is a consequence of dysfunction of different cranial nerves (most often facial and abducens nerves), accompanying orofacial abnormalities, musculoskeletal malformations, congenital cardiac diseases, as well as specific associations of Moebius and other syndromes. The authors present anesthesia and airway management during the multiple tooth extraction surgery in a 10-year-old girl with Moebius syndrome associated with Poland and trigeminal trophic syndromes.Moebiusov sindrom je rijedak kongenitalni neprogresivni neurološki poremećaj obilježen širokim rasponom težine i varijabilnosti simptoma. Ova raznolikost je posljedica disfunkcije različitih kranijskih živaca (najčešće facijalnog i abducentnog živca), pratećih orofacijalnih abnormalnosti, muskuloskeletnih malformacija, prirođenih srčanih mana, kao i specifičnih asocijacija Moebiusovog i drugih sindroma. Autori opisuju anesteziološke postupke i zbrinjavanje dišnoga puta tijekom višestruke ekstrakcije zuba kod desetogodišnje djevojčice s Moebiusovim sindromom udruženim s Polandovim i trigeminalnim trofičkim sindromom

Popliteal artery injury following traumatic knee joint dislocation in a 14-year-old boy: A case report and review of the literature

Introduction. Posterior knee joint dislocation associated with injury of the popliteal artery in children is an extremely rare condition. Rapid diagnosis and treatment are essential for limb salvage and function. Case report. We reported a 14-year-old boy who suffered traumatic displacement of the right knee and contusion of the popliteal artery during motorcycle accident. The diagnosis was confirmed using Doppler and duplex ultrasonography and digital substraction transfemoral arteriography. The urgent surgical procedure was performed using posterior approach to the popliteal artery. During the surgical exploration, rupture of the posterior cruciate ligament associated with thrombosed popliteal artery have been found. The damaged popliteal artery was resected and replaced with autologous saphenous vein graft. The last stage of the procedure was a transosseous femoral fixation of posterior circuate ligament. A 3-year-follow-up after the surgery demonstrated intact arterial perfusion and very good function of the knee with a minimal difference as compared with the contralateral knee. Conclusion. Combined orthopedic and vascular injuries are very rare in children. They require combined treatment. [Projekat Ministarstva nauke Republike Srbije, br. 175008

Food allergy in children

© 2016, Serbia Medical Society. All rights reserved. Food allergy represents a highly up-to-date and continually increasing problem of modern man. Although being present in all ages, it most often occures in children aged up to three years. Sensitization most often occurs by a direct way, but it is also possible to be caused by mother’s milk, and even transplacentally. Predisposition of inadequate immune response to antigen stimulation, reaginic or nonreaginic, is of nonselective character so that food allergy is often multiple and to a high rate associated with inhalation and/ or contact hypersensitivity. Also, due to antigen closeness of some kinds of food, cross-reactive allergic reaction is also frequent, as is the case with peanuts, legumes and tree nuts or cow’s, sheep’s and goat’s milk. Most frequent nutritive allergens responsible for over 90% of adverse reactions of this type are proteins of cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish, crustaceans, and cephalopods. Allergy intolerance of food antigens is characterized by a very wide spectrum of clinical manifestations. Highly severe systemic reactions, sometimes fatal, are also possible. The diagnosis of food allergy is based on a detailed personal and family medical history, complete clinical examination, and corresponding laboratory and other examinations adapted to the type of hypersensitivity and the character of patient’s complaints, and therapy on the elimination diet. A positive effect of elimination diet also significantly contributes to the diagnosis. Although most children “outgrow” their allergies, allergy to peanuts, tree nuts, fish, shellfish, crustaceans, and cephalopods are generally life-long allergies

Poboljšanje rasta lucerke, Medicago sativa L. - pomoću inokulacije preduseva rizosfernim bakterijama

In the greenhouse experiment, the possibility of alfalfa (Medicago sativa L.) growth promotion by inoculation of preceding barley (Hordeum vulgare L.), with plant growth promoting rhizobacteria (PGPR) was examined. The aim of experiment was to select the effective strains as biofertilizer applied in plant rotation. Effects of inoculation with two Azotobacter and two Pseudomonas strains as well as one Sinorhizobium, Enterobacter and Bacillus strain on shoot dry weight and total N content of alfalfa were determined. The results pointed out significant plant growth promotion abilities of strains A1, A2 and P1 which increased alfalfa shoot dry weight over untreated control Ø, by 41, 39 and 35 %, respectively. These three strains increased total N content of alfalfa plants by 34.92 - 40.45% in respect to control Ø. The presented study showed a significant positive influence of preceding barley inoculation with rhizobacteria alone and their mixture on shoot yield and total N content of alfalfa. Results indicated that strains of Azotobacter sp., Pseudomonas sp. and Enterobacter sp. alone can be investigated in further researches as potential agents of biofertilizer for plant growth promotion of alfalfa.U eksprimentu u sudovima ispitana je mogućnost poboljšanja rasta lucerke (Medicago sativa L.) pomoću inokulacije ječma (Hordeum vulgare L.) kao preduseva bakterijama koje poboljšavaju rast biljaka (PGPR). Cilj eksperimenta je bio odabiranje efikasnih sojeva koji bi se primenili u plodoredu u formi biološkog đubriva. U radu je korišćeno sedam sojeva koji pripadaju sledećim bakterijskim vrstama: Sinorhizobium meliloti, Bacillus megaterium, Enterobacter sp, Azotobacter sp, kao i vrsti Pseudomonas sp. Efekat inokulacije ječma primenjenim sojevima je određen na osnovu suve nadzemne mase (SDW) i sadržaja ukupnog azota (N) u biljnoj masi lucerke. Rezultati su ukazali na sposobnost nekih sojeva da poboljšaju rast biljaka. Značajno je povećan prinos lucerke u odnosu na kontrolu Ø (lucerka gajena posle neinokulisanog ječma kao preduseva) inokulacijom sojevima Azotobacter-a A1 (41%) i A2 (39%) i Pseudomonas-a P1 (35%). Sadržaj ukupnog N je bio u korelaciji sa vrednostima SDW. Rezultati su ukazali na uticaj inokulacije ječma kao preduseva na prinos lucerke i njen kvalitet kao i da sojevi Azotobacter sp., Pseudomonas sp. i Enterobacter sp. imaju PGPR potencijal što daje osnovu za dalja ispitivanja i mogućnost primene kao bio­đubriva

Metamizole: Current status of the safety and efficacy

Metamizole is a nonsteroidal anti-inflammatory drug, with analgesic, antipyretic, spasmolytic, and weak anti-inflammatory properties. The analgesic effect of metamizole seems to be based on the inhibition of cyclooxygenase enzyme activity and stimulation of cannabinoid receptors. Its use is still controversial, mainly due to agranulocytosis, metamizole-induced serious adverse reaction. While in many countries it is withdrawn from the market, in some countries metamizole is available as a medication prescribed for strictly defined indications, while in the others like Mexico, Brazil and China it can be obtained as an Over-The-Counter drug. The most common adverse effects of metamizole are the skin and subcutaneous tissue disorders. Metamizole appears to be of similar efficacy to analgesics which are frequently used in the treatment of moderate to severe postoperative pain

Rana alergijska reakcija na metilprednizolon sa tolerancijom drugih kortikosteroida

Introduction. In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. Case Outline. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT) was positive. Conclusion. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of cross-reactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.Uvod. Uprkos širokoj primeni kortikosteroida u lečenju od različitih bolesti, oni ponekad mogu izazvati ranu alergijsku reakciju. Prikaz bolesnika. Kod dvanaestogodišnjeg dečaka došlo je do rane alergijske reakcije izazvane intravenskom primenom metilprednizolona neposredno pre hirurške intervencije, tačnije, korekcije kontrakture šake koja se javila kao komplikacija opekotine. Mesec dana pre pojave alergijske reakcije dete je primalo metilprednizolon i dobro ga podnosilo. Šest nedelja posle operacije ponovo se javila anafilaktička reakcija tokom kožnog testiranja metilprednizolonom. Primenjen je i test aktivacije bazofila (BAT) ovim lekom, čiji je nalaz bio pozitivan. Zaključak. Ovo je prvi prikaz dve vrste anafilaktičke reakcije izazvane metilprednizolonom kod iste osobe. Klinička slika, pozitivni nalaz BAT i pozitivne kožne probe na metilprednizolon pokazuju da se kod deteta razvio prvi tip hipersenzitivne reakcije. Nedostatak unakrsne reaktivnosti s ostalim kortikosteroidima ukazuje na to da je alergijska reakcija izazvana steroidnim molekulom