„Mouse fever“ – hemorrhagic fever with renal syndrome – case report

U ovom članku prikazan je slučaj prethodno zdravog 42-godišnjeg drvosječe koji je obolio od hemoragijske vrućice s bubrežnim sindromom (HVBS) ili epidemijske nefropatije. Hemoragijska vrućica s bubrežnim sindromom akutna je infektivna bolest uzrokovana hantavirusima, a glavni rezervoar su glodavci (riđa voluharica i miševi). U Hrvatskoj postoje dva tipa hantavirusa: Puumala i Dobrava-Belgrade. Puumala virus je najčešći oblik hantavirusa u našoj zemlji. Uzročnik je blagog i srednje teškog oblika HVBS. Čovjek se najčešće zarazi udisanjem aerosola koje sadržavaju virus ili drugim kontaminiranim izlučevinama (mokraćom, stolicom, slinom) inficiranih glodavaca. Osnovna značajka HVBS je oštećenje bubrežne funkcije različitog stupnja sve do bubrežnog zatajenja. Česti simptomi su vrućica, glavobolja, bolovi u leđima i bolovi u trbuhu. Dobrava-Belgrade tip virusa uzrokuje težu kliničku sliku s krvarenjima, plućnim i neurološkim simptomima. Tijek HVBS može se podijeliti u pet faza, a to su: febrilna, hipotenzivna, oligurijska, poliurijska i rekonvalescentna faza. Ne postoji specifično liječenje za HVBS, stoga je vrlo važna rana dijagnostika i adekvatno simptomatsko liječenje.PA case of previously healthy 42-year-old woodman who saffered from haemorrhagic fever with renal syndrome (HFRS), also called epidemic nephropathy, is presented. Haemorrhagic fever with renal syndrome belongs to emerging infections. It is caused by hantaviruses. Those viruses are transmitted to humans by rodents, bank vole and mice being the main reservoirs. Two types of hantaviruses are identified in Croatia: Puumala virus and Dobrava-Belgrade virus. Puumala virus is the most frequent hantavirus in our country. It causes mild to moderate form of HFRS. People are infected by inhaling aerosolised virus particles shed through urine, faeces or saliva. The main characteristic of HFRS is renal dysfunction or renal failure with rare haemorrhagic anifestations. Other frequent symptoms are fever, headache, backpain and gastrointestinal symptoms. Dobrava-Belgrade type of virus causes more severe disease with bleedings, pulmonary symptoms and neurological complications. The course of HFRS is divided into five stages: febrile, hypotensive, oliguric, diuretic and convalescent phase, but these phases are not always clinically evident. There is no specific antiviral therapy. Therefore, it is very important that family physicians working in the regions where HFRS usually occures, have it in mind in cases of patients with sudden onset of fever or flu-like symptom

The role, characteristics and justification of home visits in the work of family medicine doctors who practice in rural Croatia

Kucne posjete (KP) bitna su znacajka rada lijecnika obiteljske medicine (LOM). Upravo je zbrinjavanje bolesnika izvan zdravstvene ustanove jedna od temeljnih razlika medu lijecnicima koji rade u bolnicama i LOM-a. Tijekom kucne posjete lijecnik i bolesnik susrecu se na najneposredniji nacin. Porast prevalencije kronicnih bolesti i smanjenje funkcionalne sposobnosti dijela populacije radi starenja uzrokuju sve vecu potrebu za zbrinjavanjem bolesnika u kuci. Cilj rada bio je analizirati udio KP u ukupnim posjetima pacijenata u skrbi LOM-e u seoskom podrucju, utvrditi znacajke i opravdanost KP koje su obavili pet LOM-e, te analizirati najcešca stanja, odnosno bolesti zbog kojih LOM ide u KP. Podaci o ukupnom broju posjeta ordinaciji LOM-a, i podaci o broju obavljenih KP prikupljeni su iz mjesecnih izvješca o radu LOM-a koja se redovito upucuju Hrvatskom zavodu za zdravstveno osiguranje (HZZO). Podaci o dobi, spolu, vrsti KP i morbiditetu prikupljeni su iz knjige kucnih posjeta. Pored toga, dva su lijecnika nakon obavljene KP procijenila i evidentirala u knjigu kucnih posjeta opravdanost obavljene KP. Podaci su obradeni postupcima deskriptivne statistike i prikazani numericki i graficki. Od ukupno 58.995 ambulantnih posjeta ordinacijama OM, lijecnici su napravili 1970 KP (3,3%), najcešce osobama starije dobi (85,4% posjeta) i ženama (65,2% posjeta). Najcešci razlozi KP bile su kardiovaskularne bolesti, bolesti lokomotornog sustava, te novotvorevine. Dva su lijecnika procijenila da je neopravdanih KP bilo kod jednoga 49,4%, odnosno 18,8% kod drugoga lijecnika. Iako je prema statistickim izvješcima prisutan trend smanjenja broja KP, lijecnici OM pružaju ih u skladu sa standardom posjeta Hrvatskog zavoda za zdravstveno osiguranje, što ukazuje na cinjenicu da su KP i dalje važan djelokrug rada LOM-a.Home visits (HVs) represent an essential characteristic of Family Medicine practice (FMP). In fact, patient management outside healthcare facility accounts for the fundamental difference between hospital and Family Medicine practice. During the course of a home visit, the physician and the patient get into an immediate contact. The rise in prevalence of chronic diseases and the reduction of functional capabilities encountered in some population segments due to aging, impose a steadily increasing need for homecare and home treatment. This study aims at analysing the frequency, role and characteristics of all patient HVs made by five FMPs in rural areas. Further on, this study aims to describe the characteristics and justify HVs and analyse the common diseases treated by five MFCs. Surgery treatment data and HVs data were completed from the five FMPs’ monthly reports which were also sent to the Croatian Health Insurance Company. The data on age, gender and HVs, and morbidity rate were collected from the HV evidence book. Moreover, after performing HVs two FMPs estimated and evaluated the justification of the HV, which was registered in the HV register. The data were evaluated using descriptive statistical methods, and displayed both numerically and graphically. Out of 58,995 outpatient visits, the FMPs in reference made a total of 1,970 HVs (3.3%), most frequently conducted among elderly patients (85.4% of all visits) and women (65.2% of all visits). The most common reasons for these HVs were cardiovascular and locomotive conditions and neoplasmas. Two FMPs concluded that 49.4% HVs were unjustified by one doctor and 18.8% by the second one. Despite the trends towards the decrease in number of HVs, highlighted by statistical reports, FMPs provide those services in line with the pertinent standard established by the Croatian Institute of Health Insurance, suggesting that HVs still represent an important aspect of FM practice