Promjene kalendara cijepljenja - lobiranje ili struka?

Kurativna i preventivna medicina su dva osnovna dijela medicine. U prošlosti, preventivna medicina je bila prevladavajuća jer se nisu poznavali uzročnici zaraznih bolesti niti lijekovi s kojima se zaraza mogla liječiti. Da bi se preventivne mjere provodile, morale su postati dogme i biti napisane u vjerskim dokumentima ili slično. Kurativna medicina kakvu danas poznajemo započinje svoj razvoj tek primjenom asepse i antisepse, pronalaskom antibiotika i općenito, spoznajama o uzročnicima i uzrocima bolesti. Tada postupno započinje otklon od preventivne medicine i zajednice kao subjekta zanimanja prema kurativnoj medicini i bolesniku kao subjektu. Takvom preraspodjelom unutar medicine započinje moderna medicina vezana i ovisna gotovo isključivo o financijskim izvorima. Danas kurativna medicina u Hrvatskoj košta više od 98% ukupnog novca s kojim zdravstvo raspolaže što se može iščitati i iz podataka Hrvatskog zavoda za zdravstveno osiguranje. Danas preventivne mjere pretjerano ne zanimaju mnoge ljude u zdravstvu i u politici jer polako donose rezultate i onaj koji ih započne, teško može i dočekati rezultate. Zato je danas lakše otvoriti neki novouređeni odjel u bolnici, kupiti skupocjeni uređaj (što je i potrebno) i slično nego snažno i beskompromisno poduprijeti i aktivno sudjelovati u nekom preventivnom programu. Ipak, preventivna se medicina zadržala i bitno unaprijedila jednu aktivnost koja će se u budućnosti sve više i više razvijati i to u svim medicinskim granama, a ne samo u infektologiji. Tu mjeru zovemo cijepljenje

Fiziološke reakcije muških i ženskih sprintera na 400m

The primary objective of this study was to determine the differences between male and female athletes competing in the 400m running event, in the parameters for the assessment of not only aerobic and anaerobic energy capacity but also other physiological parameters. Trained 400m (14 male and 14 female) track athletes volunteered to take part in this study. All subjects performed an incremental treadmill test (1 km/h speed increase per minute, 1.5% gradient). The parameters FVC and FEV1S in the male athletes were of higher values than in the female athletes, while there were no significant differences in FEV1S%. A statistically significant difference was found in the parameters for the assessment of aerobic energy capacity in favour of male athletes. Significantly higher values of anaerobic capacity were found in male sprinters (5.7  km/h) compared to female sprinters (4.5 km/h). In other physiological parameters such as HRmax values and HR at VT there were no statistically significant differences. It can be concluded that it is necessary to determine whether there are differences in these parameters between male and female sprinters which will result in a more organized plan for the collective training process. Studies like this can help coaches develop athletes’ performance according to their abilities.Primarni cilj ovog istraživanja bio je utvrditi razlike između muških i ženskih atletičara koji se natječu u trčanju na 400 m, u parametrima koji procjenjuju ne samo aerobni i anaerobni energetski kapacitet već i druge fiziološke parametre. Trenirani atletičari na 400 m (14 muških i 14 ženskih) dragovoljno su sudjelovali u ovom istraživanju. Svi ispitanici izvodili su inkrementalni treadmill test (1 km/h povećanje brzine u minuti, 1,5% nagib). Parametri FVC i FEV1S su kod muških atletičara većih vrijednosti nego u ženskih atletičarki, dok nije bilo značajne razlike u FEV1S%. Statistički značajna razlika pronađena je u parametrima za procjenu aerobnog kapaciteta energije u korist muških atletičara. Značajno više vrijednosti anaerobnog kapaciteta pronađene su kod muških (5,7 km/h) sprintera u odnosu na ženske (4,5 km/h). U drugim fiziološkim parametrima, kao što su HRmax vrijednosti i HR na VT nema statistički značajne razlike. Može se zaključiti da je potrebno utvrditi postoje li razlike u tim parametrima između muških i ženskih sprintera, koje će rezultirati organiziranijim planiranjem kolektivnog procesa obuke. Studije kao što je ova mogu pomoći trenerima razvijati atletičareve performanse u skladu s njihovim sposobnostima

Local or Spinal Anesthesia in Acute Knee Surgery

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group=250) or spinal (SA group=186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0=no pain, 10=extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied, 4=very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need of postoperative analgesics was higher in SA compared with LA group (p=0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p=0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p=0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery

Local or spinal anesthesia in acute knee surgery [Bol pri kirurškoj artroskopiji koljena kod lokalne versus spinalne anestezije]

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group=250) or spinal (SA group=186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0=no pain, 10=extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied, 4=very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need of postoperative analgesics was higher in SA compared with LA group (p=0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p=0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p=0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery

Tibial stress fracture in handball player

Cilj: Autori predstavljaju slučaj pogrešne dijagnoze stres frakture proksimalnog dijela tibije s naglaskom na dijagnostičkim metodama i metodama liječenja. Prikaz slučaja: Vrhunski međunarodni rukometaš u dobi od 27 godina javio nam se sa stres frakturom prednje strane gornje trećine desne tibije, što je povezano s prekomjernim i repetitivnim stresom na potkoljenicu. Igra poziciju desnog krila, te koristi desnu nogu za odskok. Sportaš nije imao prethodnih ozljeda. Koristili smo novi neoperativni pristup u liječenju vrhunskog rukometaša i proveli detaljno dijagnostičko praćenje ozljede i oporavka. Sportaš je izvrsno reagirao na neoperativni pristup liječenja nakon pogrešne dijagnoze. Dokumentirano praćenje trajalo je 3,5 godina, nakon što je završeno konzervativno liječenje. Zaključak: Naglasak je stavljen na važnost pravovremeno postavljene dijagnoze te odabir adekvatnog liječenja kako bi se smanjilo vrijeme potrebno za oporavak i vraćanje vrhunskog sportaša u formu jednaku onoj prije ozlijede. Nakon detaljnog pretraživanja relevantne literature autori nisu pronašli opis stres frakture kod rukometaša do sada.Aim: Authors present a misdiagnosed case of proximal tibial stress fracture emphasizing diagnostical and treatment methods. Case report: A 27-year-old international top-level handball player, presented to us with a stress fracture of the right proximal anterior tibia in connection with repetitive and excessive stress to lower leg. He plays right wing position and uses his right leg for jumping. There was no history of previous injuries. We used a new nonoperative approach in treating a top-level handball player as well as detailed diagnostic monitoring of both the injury and the recovery. Athlete’s response to the new non-operative approach was excellent after having been misdiagnosed. Documented monitoring lasted for 3.5 years after the conservative treatment had been finished. Conclusion: The emphasis is put on the importance of making a diagnosis at the right time and choosing adequate treatment with the aim of reducing time needed for recovery and returning top-level athletes’ performance to the same level as prior to injury. Based on a detailed search of relevant literature, the authors have found that stress fractures have never before been described in handball players