26 research outputs found
Brain drain: final year medical students' intentions of training abroad
BACKGROUND:
In Croatia, a new European Union (EU) member state since July 2013, there is already a shortage of around 3280 doctors to reach the European average. -----
OBJECTIVES:
To investigate the emigration intentions of the current cohort of final year medical students at Zabreb School of Medicine. -----
METHODS:
An electronic questionnaire was used in June 2013 to assess the attitudes of 232 final year medical students towards working conditions abroad and expectations for career opportunities in Croatia following accession to the EU. -----
RESULTS:
With an overall response rate of 87%, more than half of the surveyed students (106/202, 53%) intended to travel abroad, either for specialty (52/202, 26%) or subspecialty (54/202, 27%) training. More female students (58/135, 43%) than male students (17/62, 27%) indicated they would not emigrate. Most attractive emigration destinations were: Germany (34/121, 28%), USA (19/121, 16%), the UK (19/121, 16%), Switzerland (16/121, 13%) and Canada (11/121, 9%). The most important goals that respondents aimed to achieve through training abroad were to excel professionally (45/120, 38%), to prosper financially (20/120, 17%) and to acquire new experiences and international exposure (31/120, 26%). -----
CONCLUSIONS:
Students' motivating factors, goals for and positive beliefs about training abroad, as well as negative expectations regarding career opportunities in Croatia, may point towards actions that could be taken to help make Croatia a country that facilitates medical education and professional career development of young doctors
Sindrom kubitalnog kanala
Sindrom kubitalnog kanala susreÄemo relativno Äesto te on predstavlja znaÄajan javnozdravstveni problem. SpecifiÄnost tijeka ulnarnog živca niz ruku, a napose anatomski meÄuodnosi s koÅ”tanim i mekotkivnim strukturama u podruÄju lakta Äine ga vrlo podložnim vanjskim utjecajima, ponajviÅ”e silama kompresije. Progresija parestezija na ulnarnoj strani Äetvrtog prsta i na Äitavom petom prstu zahvaÄene Å”ake uz pojavu motoriÄke slabosti i atrofije miÅ”iÄa Å”ake uvelike ograniÄava bolesnike, najÄeÅ”Äe one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliniÄkom pregledu uz pomoÄ niza specifiÄnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspjeÅ”nost daljnjeg lijeÄenja. Blaži oblici sindroma kubitalnog kanala uspjeÅ”no se lijeÄe konzervativnim naÄinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno lijeÄenje treba lijeÄiti kirurÅ”ki. Metode kirurÅ”kog lijeÄenja sindroma možemo podijeliti na one koje ostavljaju živac u ležiÅ”tu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premjeÅ”ta u novo ležiÅ”te ispred i iznad medijalnog epikondila, Å”to nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspjeÅ”nima, no usprkos tomu istraživanja pokazuju da se u danaÅ”nje vrijeme kao metoda izbora kirurÅ”kog lijeÄenja sindroma kubitalnog kanala najÄeÅ”Äe koristi in situ dekompresija
Anti-neutrophil Cytoplasmic Antibody Positivity in Five Children with Systemic Lupus Erythematosus - What is the Importance of this Finding?
Juvenile systemic lupus erythematosus (JSLE) is a systemic autoimmune chronic disease that can affect any part of the body. It is characterized by the formation of antibodies against nuclear antigens. Vasculitis may be found in SLE, but it scarcely complies with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) criteria. We report five cases of severe JSLE associated with AAV diagnosed between 1991 and 2013 in three university-based tertiary care centers. The patients (3 girls and 2 boys, aged 12 to 17) presented with a severe clinical picture and the following features: cytopenia (n=5), autoimmune hepatitis (n=3), lupus nephritis (n=1), pancreatitis (n=1), secondary antiphospholipid syndrome (n=2), impending respiratory failure (n=2), and gastrointestinal bleeding (n=1).All patients were proteinase 3 (PR3) ANCA positive, while two of them were myeloperoxidase (MPO) and PR3 ANCAs positive at the same time. They were treated with corticosteroids and immunosuppressive drugs. Remission of the disease was achieved in three patients. The course of the disease was worsening in two patients and we included rituximab (anti-CD20) in therapy. All of our patients presented as the most severe SLE patients, who must be diagnosed as soon as possible and treated very intensively. Since the comorbidity of JSLE and AAV occurs very rarely in children, presentation of such patients, their clinical pictures, treatment, and the course of the diseases are experiences that can be of great help.</p
Advantages, disadvantages and environmental effects of biodiesel fuel
U radu su pojaÅ”njene glavne ekoloÅ”ke, ekonomske i gospodarske prednosti i nedostaci biodizelskog goriva, te ekoloÅ”ki uÄinci. U distribuciji i proizvodnji biodizel nije opasan, nije Å”tetan za zdravlje, nije lako zapaljiv te nije opasan u smislu zagaÄivanja voda i zraka. Primjenom biodizelskoga goriva znaÄajno se doprinosi oÄuvanju okoliÅ”a, buduÄi da je uz smanjenje Å”tetnih plinova znatno manje stakleniÄkih plinova. Biodizelsko gorivo je biorazgradivo te se time smanjuje rizik zagaÄivanja tla i voda.In this article the main ecological, economical and commercial advantages and disadvantages of biodiesel fuel are being explained, as well as ecological effects. When distributed or produced, biodiesel is not dangerous, a health hazard, easily flammable or a pollution hazard for water and air. Usage of biodiesel fuel significantly contributes to environmental protection because it lowers the harmful gases emission and with it the greenhouse gas emission. Biodiesel fuel is biodegradable and as such lowers the pollution hazard for soil and water
Advantages, disadvantages and environmental effects of biodiesel fuel
U radu su pojaÅ”njene glavne ekoloÅ”ke, ekonomske i gospodarske prednosti i nedostaci biodizelskog goriva, te ekoloÅ”ki uÄinci. U distribuciji i proizvodnji biodizel nije opasan, nije Å”tetan za zdravlje, nije lako zapaljiv te nije opasan u smislu zagaÄivanja voda i zraka. Primjenom biodizelskoga goriva znaÄajno se doprinosi oÄuvanju okoliÅ”a, buduÄi da je uz smanjenje Å”tetnih plinova znatno manje stakleniÄkih plinova. Biodizelsko gorivo je biorazgradivo te se time smanjuje rizik zagaÄivanja tla i voda.In this article the main ecological, economical and commercial advantages and disadvantages of biodiesel fuel are being explained, as well as ecological effects. When distributed or produced, biodiesel is not dangerous, a health hazard, easily flammable or a pollution hazard for water and air. Usage of biodiesel fuel significantly contributes to environmental protection because it lowers the harmful gases emission and with it the greenhouse gas emission. Biodiesel fuel is biodegradable and as such lowers the pollution hazard for soil and water
Survey of self-assessed preparedness for clinical practice in one Croatian medical school
<p>Abstract</p> <p>Background</p> <p>The Croatian higher education system is in the process of reforming its medical curricula to comply with European Union standards. We conducted a survey of students enrolled at the University of Zagreb (Croatia) asking them to rate their perception of preparedness for clinical practice prior to initiation of the reform process. The purpose of the survey was to identify self-perceived deficiencies in education and to establish a reference point for the later assessment of ongoing educational reform.</p> <p>Findings</p> <p>One-hundred and forty seven (N = 147) graduates reported the levels of perceived preparedness on 30 items grouped into 8 educational domains. Main domains were: understanding science, practical skills/patient management, holistic care, prevention, interpersonal skills, confidence/coping skills, collaboration, and self-directed learning. For each item, graduates self assessed their preparedness on a scale ranging from 1 to 4, with 1 = "Very inadequate", 2 = "Somewhat inadequate", 3 = "Somewhat adequate", and 4 = "Very adequate". In 7 out of 8 domains the achieved median score was ā„ 3. Students expressed low confidence (defined when ā„ 25% of respondents supplied a rating for the survey question as: "very inadequate" or "somewhat inadequate") with interpersonal skills (discussing terminal disease, counseling distraught patients, balancing professional and personal life), and in performing certain basic semi-invasive or invasive procedures.</p> <p>Conclusion</p> <p>Zagreb medical graduates identified several deficiencies within educational domains required for standard clinical practice. Ongoing educational efforts need to be directed towards the correction of these deficiencies in order to achieve standards required by the European Union.</p
RARE LOCALIZATION OF OSTEOID OSTEOMA ā DISTAL PHALANX OF THE RING FINGER
Ovim kliniÄkim zapažanjem želimo upozoriti na osteoid osteom kao moguÄi uzrok tegoba u podruÄju distalne falange prstiju Å”ake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za prepoznavanje i zbog atipiÄne prezentacije. DvadesetogodiÅ”nji bolesnik se pet godina žalio na bol u podruÄju jagodice IV. prsta desne Å”ake koja je bila praÄena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u podruÄju baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, Å”to je potvrÄeno kompjuteriziranom tomografi jom. Nakon kirurÅ”kog lijeÄenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je veÄ tri mjeseca nakon zahvata pao sa 54,5 na 0 Å”to je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praÄena bolovima koji se smanjuju koriÅ”tenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti naÄinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog
blizine neurovaskularnih struktura i tetiva najboljim oblikom lijeÄenja osteoid osteoma u podruÄju distalne falange prstiju Å”ake smatra se kirurÅ”ka ekscizija ili ekskohleacija.With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fi ngers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fi ngertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fi ngertip of his right ring finger persisting for fi ve years. Swelling and redness of the fi ngertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confi rmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring fi nger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring fi nger was immobilized in a plaster splint for a three-week period. After
removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confi rmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical fi ndings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the fi nger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be diffi cult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling
and redness of the fi nger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fi ngers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the fi nger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger
Pregnancy and Vaginal Delivery in Epidural Analgesia in Woman with Cerebrospinal Fluid Shunt
Hydrocephalus is a medical condition characterized by enlargement of cerebral ventricles due to abnormal cerebro- spinal fluid accumulation. Hydrocephalic women with cerebrospinal fluid (CSF) shunts are now surviving to reproduc- tive age, but still there are doubts regarding the mode of delivery, analgesia and anesthesia. Postpartal complications are more frequently described in deliveries ended by cesarean section than in spontaneous vaginal deliveries. We present a case of labor in the 32-year old woman, with congenital hydrocephalus and a preexisting ventriculoperitoneal (VP) shunt. After thorough review of current literature, we came to conclusion that without absolute neurosurgical indication or acute development of listed symptoms (headaches, irritability, light sensitivity, hyperesthesia nausea, vomiting, ver- tigo, migraines, seizures, weakness in the arms or legs, strabismus and double vision) the best way to finish the preg- nancy of woman with VP shunt is spontaneous vaginal delivery with the use of epidural analgesia, mediolateral episiotomy and vacuum extraction
Survival prediction of high-risk outborn neonates with congenital diaphragmatic hernia from capillary blood gases
BACKGROUND:
The extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH. -----
METHODS:
We retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission. -----
RESULTS:
Higher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUCā=ā0.69, Pā=ā0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUCā=ā0.87, Pā=ā0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91āĀ±ā31 vs. 70āĀ±ā25 mmHg, Pā=ā0.02), and their PcCO2 remained high during the first 24 h of treatment. -----
CONCLUSION:
The inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH. We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates
Survival of outborns with congenital diaphragmatic hernia: the role of protective ventilation, early presentation and transport distance: a retrospective cohort study
BACKGROUND:
Congenital diaphragmatic hernia (CDH) is a congenital malformation associated with life-threatening pulmonary dysfunction and high neonatal mortality. Outcomes are improved with protective ventilation, less severe pulmonary pathology, and the proximity of the treating center to the site of delivery. The major CDH treatment center in Croatia lacks a maternity ward, thus all CDH patients are transferred from local Zagreb hospitals or remote areas (outborns). In 2000 this center adopted protective ventilation for CDH management. In the present study we assess the roles of protective ventilation, transport distance, and severity of pulmonary pathology on survival of neonates with CDH. ----- METHODS:
The study was divided into Epoch I, (1990-1999, traditional ventilation to achieve normocapnia), and Epoch II, (2000-2014, protective ventilation with permissive hypercapnia). Patients were categorized by transfer distance (local hospital or remote locations) and by acuity of respiratory distress after delivery (early presentation-occurring at birth, or late presentation, ā„ 6 h after delivery). Survival between epochs, types of transfers, and acuity of presentation were assessed. An additional analysis was assessed for the potential association between survival and end-capillary blood CO2 (PcCO2), an indirect measure of pulmonary pathology. ----- RESULTS:
There were 83 neonates, 26 in Epoch I, and 57 in Epoch II. In Epoch I 11 patients (42%) survived, and in Epoch II 38 (67%) (P = 0.039). Survival with early presentation (N = 63) was 48 % and with late presentation 95% (P <0.001). Among early presentation, survival was higher in Epoch II vs. Epoch I (57% vs. 26%, P = 0.031). From multiple logistic regression analysis restricted to neonates with early presentation and adjusting for severity of disease, survival was improved in Epoch II (OR 4.8, 95%CI 1.3-18.0, P = 0.019). Survival was unrelated to distance of transfer but improved with lower partial pressure of PcCO2 on admission (OR 1.16, 95%CI 1.01-1.33 per 5 mmHg decrease, P = 0.031). ----- CONCLUSIONS:
The introduction of protective ventilation was associated with improved survival in neonates with early presentation. Survival did not differ between local and remote transfers, but primarily depended on severity of pulmonary pathology as inferred from admission capillary PcCO2