What the Croatian Doctors Want to be Learning About?

The aim of the study was to examine doctor’s attitude about topics in continuing medical education (CME) using anonymous questionnaire that was given to the members of the Croatian Medical Association in Rijeka. The questions concerned doctor’s interest of certain medical fields, influence of CME to their everyday practice, and importance of getting credits for re-licensure as a motive to participate in CME. The highest interest was shown for CME in emergency/intensive medicine and the lowest for transplantation medicine. The doctors in primary care showed statistically significantly higher interest for CME in family medicine, pulmology, rheumatology and rehabilitation medicine than hospital doctors. The influence of CME in everyday practice and the importance of getting credits for re-licensure as a reason to participate in CME, in the most cases, have been graded with medium grade 3. The results indicated the existence of specific needs in CME and stressed the importance of having CME with topics from clinical practice

FERTILITY IN ADOLESCENTS WITH EPILEPSY

SAŽETAK Napredak u neuropedijatriji, a posebno u epilepsiji, ide velikim koracima naprijed, od razumijevanja patogenetskih mehanizama do novih antiepileptika, neurokirurških i ostalih vrsta liječenja. Budući da većina bolesnika s epilepsijom postaje kronično bolesno već u djetinjstvu, taj napredak je jednako značajan i za pedijatre i za neurologe za odrasle. Čak i zdravi adolescenti imaju specifične probleme s usvajanjem zdravih navika i stila života (debljina, mentalno zdravlje, smrtnost u prometu, samoubojstva, abuzus droga i alkohola koji kasnije rezultiraju asocijalnim ponašanjem, te posebno tinejdžerske trudnoće koje su u porastu, kao i spolno prenosive bolesti). Teret kronične bolesti u adolescenciji povećava se u svim razvijenim zemljama, budući da tada kada kronično bolesna djeca dožive svoje tinejdžersko doba i dvadesete, moraju istovremeno donositi važne odluke (poput izbora zvanja), međuljudski odnosi unutar obitelji i prijatelja postaju zamršeniji, spomenimo i spolnost, kontracepciju i pitanje koje uvijek visi u zraku – prekinuti terapiju ili ne. Tek nedavno se pažnja usmjerila na važnost i neadekvatno zbrinjavanje te dobne skupine. Treba prepoznati specifične potrebe mladih ljudi koji prolaze kroz period koji je sam po sebi turbulentan, a kada je još opterećen epilepsijom, predstavlja veliki izazov, kako za njih, tako i za njihove liječnike.ABSTRACT Progress in neuropediatrics, especially in pediatric epilepsy is advancing on a broad front, from new understandings of pathogenetic mechanisms to novel pharmacologic, surgical and nonsurgical various treatments.Because most epilepsy patients have epilepsy from childhood, these developments are relevant to both pediatric and adult neurologists. Even healthy adolescents have specific problems with adopting helathy life habits and life –styles (obesity, mental health, traffic traumas, suicide attempts, abuse of recreational drugs and alcohol which later result in asocial behaviour, and especially teenager pregnancies which are in constant uprise, together with sexually transmitted diseases. The burden of chronic illness in adolescence is increasing in all developed countries, because all chronically ill patients live through their teens until their twenties. This is the time in their lives when young people at the same time have to make serious decisions- the choice of employment, relationships within the family and friends, issue of sexuality, contaception and the ever present question – whether to discontinue the antiepileptic therapy or not. Recent attention has focused on the importance, but inadequacy, of adolescent medicine and the paucity od medical services for this specific population.Adolescence is in itself, a difficult and traumatic time, when complicated by epilepsy it poses a great challenge not only to the young people themselves, but also to their carers and physicians

FERTILITY IN ADOLESCENTS WITH EPILEPSY

SAŽETAK Napredak u neuropedijatriji, a posebno u epilepsiji, ide velikim koracima naprijed, od razumijevanja patogenetskih mehanizama do novih antiepileptika, neurokirurških i ostalih vrsta liječenja. Budući da većina bolesnika s epilepsijom postaje kronično bolesno već u djetinjstvu, taj napredak je jednako značajan i za pedijatre i za neurologe za odrasle. Čak i zdravi adolescenti imaju specifične probleme s usvajanjem zdravih navika i stila života (debljina, mentalno zdravlje, smrtnost u prometu, samoubojstva, abuzus droga i alkohola koji kasnije rezultiraju asocijalnim ponašanjem, te posebno tinejdžerske trudnoće koje su u porastu, kao i spolno prenosive bolesti). Teret kronične bolesti u adolescenciji povećava se u svim razvijenim zemljama, budući da tada kada kronično bolesna djeca dožive svoje tinejdžersko doba i dvadesete, moraju istovremeno donositi važne odluke (poput izbora zvanja), međuljudski odnosi unutar obitelji i prijatelja postaju zamršeniji, spomenimo i spolnost, kontracepciju i pitanje koje uvijek visi u zraku – prekinuti terapiju ili ne. Tek nedavno se pažnja usmjerila na važnost i neadekvatno zbrinjavanje te dobne skupine. Treba prepoznati specifične potrebe mladih ljudi koji prolaze kroz period koji je sam po sebi turbulentan, a kada je još opterećen epilepsijom, predstavlja veliki izazov, kako za njih, tako i za njihove liječnike.ABSTRACT Progress in neuropediatrics, especially in pediatric epilepsy is advancing on a broad front, from new understandings of pathogenetic mechanisms to novel pharmacologic, surgical and nonsurgical various treatments.Because most epilepsy patients have epilepsy from childhood, these developments are relevant to both pediatric and adult neurologists. Even healthy adolescents have specific problems with adopting helathy life habits and life –styles (obesity, mental health, traffic traumas, suicide attempts, abuse of recreational drugs and alcohol which later result in asocial behaviour, and especially teenager pregnancies which are in constant uprise, together with sexually transmitted diseases. The burden of chronic illness in adolescence is increasing in all developed countries, because all chronically ill patients live through their teens until their twenties. This is the time in their lives when young people at the same time have to make serious decisions- the choice of employment, relationships within the family and friends, issue of sexuality, contaception and the ever present question – whether to discontinue the antiepileptic therapy or not. Recent attention has focused on the importance, but inadequacy, of adolescent medicine and the paucity od medical services for this specific population.Adolescence is in itself, a difficult and traumatic time, when complicated by epilepsy it poses a great challenge not only to the young people themselves, but also to their carers and physicians

FERTILITY IN ADOLESCENTS WITH EPILEPSY

SAŽETAK Napredak u neuropedijatriji, a posebno u epilepsiji, ide velikim koracima naprijed, od razumijevanja patogenetskih mehanizama do novih antiepileptika, neurokirurških i ostalih vrsta liječenja. Budući da većina bolesnika s epilepsijom postaje kronično bolesno već u djetinjstvu, taj napredak je jednako značajan i za pedijatre i za neurologe za odrasle. Čak i zdravi adolescenti imaju specifične probleme s usvajanjem zdravih navika i stila života (debljina, mentalno zdravlje, smrtnost u prometu, samoubojstva, abuzus droga i alkohola koji kasnije rezultiraju asocijalnim ponašanjem, te posebno tinejdžerske trudnoće koje su u porastu, kao i spolno prenosive bolesti). Teret kronične bolesti u adolescenciji povećava se u svim razvijenim zemljama, budući da tada kada kronično bolesna djeca dožive svoje tinejdžersko doba i dvadesete, moraju istovremeno donositi važne odluke (poput izbora zvanja), međuljudski odnosi unutar obitelji i prijatelja postaju zamršeniji, spomenimo i spolnost, kontracepciju i pitanje koje uvijek visi u zraku – prekinuti terapiju ili ne. Tek nedavno se pažnja usmjerila na važnost i neadekvatno zbrinjavanje te dobne skupine. Treba prepoznati specifične potrebe mladih ljudi koji prolaze kroz period koji je sam po sebi turbulentan, a kada je još opterećen epilepsijom, predstavlja veliki izazov, kako za njih, tako i za njihove liječnike.ABSTRACT Progress in neuropediatrics, especially in pediatric epilepsy is advancing on a broad front, from new understandings of pathogenetic mechanisms to novel pharmacologic, surgical and nonsurgical various treatments.Because most epilepsy patients have epilepsy from childhood, these developments are relevant to both pediatric and adult neurologists. Even healthy adolescents have specific problems with adopting helathy life habits and life –styles (obesity, mental health, traffic traumas, suicide attempts, abuse of recreational drugs and alcohol which later result in asocial behaviour, and especially teenager pregnancies which are in constant uprise, together with sexually transmitted diseases. The burden of chronic illness in adolescence is increasing in all developed countries, because all chronically ill patients live through their teens until their twenties. This is the time in their lives when young people at the same time have to make serious decisions- the choice of employment, relationships within the family and friends, issue of sexuality, contaception and the ever present question – whether to discontinue the antiepileptic therapy or not. Recent attention has focused on the importance, but inadequacy, of adolescent medicine and the paucity od medical services for this specific population.Adolescence is in itself, a difficult and traumatic time, when complicated by epilepsy it poses a great challenge not only to the young people themselves, but also to their carers and physicians

Prevalence of Severe Retinopathy of Prematurity in a Geographically Defined Population in Croatia

The aim of this study was to evaluate the prevalence of stage III of retinopathy of prematurity (ROP) among newborns of birth weight <1500 g and gestational age (GA) 32 weeks, and to compare these prevalences during two time periods (1998–2002 and 2003–2007). The investigation was conducted at the Department of Gynecology and Obstetrics, University Hospital in Rijeka, Croatia. The screening for ROP was performed by an ophthalmologist using a binocular indirect ophthalmoscope. Over a period of 10 years, there were 28,627 liveborn newborns, with 136 (0.48%) premature newborns with a birth weights <1500 g and 226 (0.79%) newborns with GA at birth 32 weeks. The proportions of survivors among newborns with birth weights <1500 g (51.1% vs.70.5%) and among newborns with GA at birth 32 weeks (67.9% vs. 77.0%) were significantly higher in the later period. During the period 2003–2007, the proportion examined for ROP was higher among newborns with birth weight <1500 g (52.9% vs. 97.1%) and among newborns with GA at birth 32 weeks (46.5% vs. 96.9%). The prevalence of stage III ROP was significantly lower in 2003–2007 compared to that in 1998–2002 among newborns with birth weight <1500 g (30.6% vs. 14.0%) and newborns with GA at birth 32 weeks (22.4% vs. 8.8%). The prevalence of total ROP among newborns was significantly lower in 2003–2007 compared with 1998–2002. This decrease in prevalence may be explained by advances in neonatal intensive care unit, increased survival of very low birth weight infants and carefully timed retinal examinations

Direct Medical Cost of Children and Adolescents Epilepsy at a University Setting in Croatia

The aim was to study the direct medical cost of epilepsy in children and adolescents and to determine the impact of epilepsy type and child’s age on total costs of treatment. One-year prospective, prevalence based, »bottom up« analyses of sixty-nine (69) children with epilepsy (International League Against Epilepsy criteria was used). Direct medical costs were calculated by summing annual costs of hospital care, outpatient visits and antiepileptic drug (AED) treatment. The average annual cost per patient was 1293.0 €. The costs of hospital admissions were 942.9 € (72%), followed by drug treatment 240.0 € (19%) and outpatient medical services 121.2 € (9%). The costs of epilepsy were significantly higher for children under 5 year of age. AED costs were statistically significantly lower for children who received traditional AED (€122.0) than modern AED (571.2€). The costs of epilepsy in children and adolescents in Croatia are congruent to those of developed countries. Costs significantly varied regarding the child’s age. The cost of illness studies are an important first step towards the rational use of available resources

Gorski Kotar – An Endemic Region for Primary Gastric Non-Hodgkin Lymphoma?

Primary gastric non Hodgkin lymphoma (PGNHL) is a distinct group of extranodal lymphomas with interesting geographical distribution and variable prevalence in different countries. We analysed epidemyological data of our patients with PGNHL in Primorsko-goranska County. Clinical data of 30 patients with PGNHL diagnosed and treated in Clinical Hospital Center of Rijeka, Croatia between January 1995 and December 2005 were prospectively analyzed. We used statistical analysis (t-test, c2-test) for small groups. Out of 30 pts with PGNHL, 19 were born in Primorsko-goranska County, part of Croatia situated by the Adriatic sea which consists of three regions: City of Rijeka, Islands and Gorski Kotar. 6 of 19 patients (31.6%) were originally from Gorski Kotar which made incidence rate of PGNHL in Gorski Kotar 7 times higher than in other two regions. Many authors emphasized that relative frequency of PGNHL is very variable in various countries and regions. Geographical distribution of our patients was very surprising because Gorski Kotar is the region with lowest number of citizens, rural area without any known pollutants, and ecologically one of the most preserved microsystem in this part of Croatia. Gorski Kotar is known to be an endemic region for multiple sclerosis and lyme borreliosis. Is it for PGNHL too

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines