Vogt-Koyanagi-Harada syndrome – a case report and differential diagnosis of uveitis and meningitis

Vogt-Koyanagi-Harada sindrom je autoimuna, multisistemska bolest i važan uzrok uveitisa. Ovim prikazom bolesnika naglašavamo važnost pouzdane dijagnostike te uključivanje autoimunih bolesti u diferencijalnu dijagnozu sindroma uveitisa i meningitisa.Vogt-Koyanagi -Harada syndrome is an autoimmune, multisystem disease and important cause of uveitis. In this case report we address the significance of reliable diagnostics and including autoimmune diseases in differential diagnosis of uveitis and meningitis syndrome

CHANGE OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITOR IN THE TREATMENT OF WET FORM OF SENILE MACULAR DEGENERATION: META-ANALYSIS AND LITERATURE REVIEW

Cilj: Provesti sustavni pregled i meta-analizu znanstvenih radova koji su analizirali ishod liječenja u bolesnika s eksudativnom degeneracijom makule povezane s dobi nakon terapijskog prelaska s bevacizumaba / ranibizumaba na afl ibercept. Materijali i metode: Pretražene su proširene baze podataka Pubmed (Medline) i Science Citation Index u posljednjih 5 godina, uz kombinaciju ključnih riječi. Defi nirani su jasni kriteriji i istražene su najbolje korigirane oštrine vida, uz mjerenje središnje debljine makule pomoću koherencijske tomografi je očiju prije i nakon promjene lijeka. Rasprava: U nedavno objavljenim publikacijama koje su analizirale rezultate liječenja rezistentne senilne degeneracije makule konverzijom na afl ibercept objavljene su dvije meta-analize, sa sličnim kriterijima uključivanja, od kojih je najvažniji najmanje šestomjesečno praćenje bolesnika nakon terapijske konverzije. Prva meta-analiza uključivala je 7, a druga 28 studija, prospektivnih i retrospektivnih. Obje meta-analize pokazale su značajno poboljšanje središnje debljine makule nakon prelaska na afl ibercept, dok je poboljšanje oštrine vida u jednoj skromno, a u drugoj nepromijenjeno. Tako je promjena lijeka značajno poboljšala anatomski ishod; međutim, nije primijećeno značajno poboljšanje vidne funkcije. Razlog je kronicitet bolesti i posljedično oštećenje, što podrazumijeva ograničenu mogućnost za oporavak vida. Naša analiza pokazala je, slično rezultatima prethodno spomenutih meta-analiza, da se promjenom terapije može postići poboljšanje anatomske strukture makule. U završnici je u meta-analizu uključeno jedanaest od dvadeset studija koje su istraživale ishod konverzije jednog lijeka protiv vaskularnog endotelnog faktora rasta na drugi lijek. Rezultati su pokazali statistički značajno smanjenje debljine makule nakon konverzije na afl ibercept u svim studijama (ukupna razina značajnosti p <0,001). Zaključci: Provedena analiza pokazala je značajno poboljšan anatomski ishod, ali je skromno poboljšanje vida nađeno u samo nekoliko studija. Taj se rezultat vjerojatno može objasniti činjenicom da dugotrajna kronična bolest uzrokuje nepovratna oštećenja i sprečava značajan funkcionalni oporavak. Prospektivne studije s jednako definiranim ulaznim kriterijima omogućile bi bolju usporedbu rezultata liječenja dobivenih nakon promjene lijeka.The aim was to perform a systematic review and meta-analysis of scientifi c papers that analyzed treatment outcome in patients with exudative age-related macular degeneration after therapeutic switch from bevacizumab/ranibizumab to afl ibercept. Pubmed (Medline) and Science Citation Index expanded databases were searched over the last 5 years, with a combination of keywords. Clear criteria were defi ned, and evaluation of the best corrected visual acuity, with measurement of the central macular thickness by ocular coherence tomography before and after drug conversion was performed. Two meta-analyses have been published in recent literature analyzing studies with the results of treatment of resistant senile macular degeneration by conversion to afl ibercept, with somewhat similar inclusion criteria, the most important of which is the minimum six-month follow-up of patients after conversion therapy. The fi rst meta-analysis included 7 and the second 28 studies, prospective and retrospective. Both meta-analyses showed a signifi cant improvement in the central macular thickness after conversion to afl ibercept, while the improvement in visual acuity was very modest in one and unchanged in the other. Thus, a change in drug signifi cantly improved the anatomic outcome; however, no signifi cant improvement in visual function was observed. The reason is chronic illness and impairment, which implies a limited potential for vision recovery. Similar to the results of the previously mentioned meta-analyses, our analysis showed that improvement in the anatomic structure of the macula can be achieved by changing therapy. Finally, eleven of twenty studies that investigated the outcome of conversion from one anti-vascular endothelial growth factor drug to another were included in meta-analysis. The results showed a statistically signifi cant decrease in macular thickness after conversion to afl ibercept in all studies (overall signifi cance level p<0.001). The analysis performed showed a signifi cantly improved anatomic outcome, but visual improvement was found to be modest in only a few studies. This result could probably be explained by the fact that a longlasting chronic disease causes irreversible damage and prevents signifi cant functional recovery. Prospective studies with uniformly defi ned input criteria would allow better comparison of the results obtained after change in the treatment

Preschool teachers' knowledge and attitudes about dental trauma in Rijeka, Croatia: a cross-sectional study

Introduction: Traumatic tooth injuries often occur in childhood. They are not life-threatening, but they can cause a number of complications that can affect the quality of life. Proper first aid can significantly facilitate further dental treatment. The aim of this research was to evaluate preschool teachers’ knowledge and attitudes about dental trauma and their motivation for further education. Material and Methods: This cross-sectional study included 54 preschool teachers. It was carried out in the form of a questionnaire consisting of 23 questions regarding traumatic tooth injuries, experiences and knowledge and teachers’ interest in additional education.Results: Most of the preschool teachers, 68.51%, did not witness any dental traumas during their work experience. From the teachers who witnessed dental trauma, only 11.76% gave first aid and none of them called the dentist and followed their instructions. In case of dental avulsion 72.22% would keep the avulsed tooth in a dry gauze or tissue. Even though 81.49% consider themselves uninformed about dental, all of them are interested in additional education. Conclusion: Despite the insufficient knowledge about dental trauma, its management, and first aid it is encouraging that all of the preschool teachers included in this research are motivated to educate themselves more on this subject