22-GODIŠNJA PACIJENTICA S BOLI U PRSIMA – ANKSIOZNOST ILI NEŠTO DRUGO?

Chest pain is one of the most common clinical entities in the emergency room (ER) and it can be divided into the pain of cardiac and non-cardiac origin. This report aims to show the importance of diagnostic treatment for a patient with chest pain.Bol u prsima jedan je od najčešćih kliničkih entiteta s kojim se susrećemo na objedinjenom hitnom bolničkom prijemu (OHBP), a prema uzroku može se podijeliti na bol kardijalnog i nekardijalnog podrijetla. Cilj je rada ukazati na važnost dijagnostičke obrade pacijenta s boli u prsima

Utjecaj bolesti uzrokovane koronavirusom na primarnu i tercijarnu razinu zdravstvene zaštite iz perspektive otorinolaringologa

Cilj istraživanja: Pandemija koronavirusa ima značajan utjecaj na društvo i zdravstveni sustav. Cilj ovoga rada je usporediti podatke o broju i strukturi dijagnoza i obavljenih pregleda iz područja otorinolaringologije i kirurgije glave i vrata na razini primarne (PZZ) i tercijarne zdravstvene zaštite, u razdoblju od godinu dana prije i godinu dana nakon proglašenja pandemije koronavirusa. Bolesnici i metode: Podaci su prikupljani retrospektivno, za razdoblja od 20.3.2019. do 19.3.2020. i od 20.3.2020. do 20.3.2021. Uzorak je prigodan, prikupljen iz jedne ustanove na razini primarne i jedne ustanove na razini tercijarne zdravstvene zaštite. Iz dobivenih podataka isključene su one dijagnoze koje se ne odnose na stanja i bolesti iz otorinolaringologije i kirurgije glave i vrata. Rezultati: Tijekom promatranog razdoblja 20.3.2020.-20.3.2021. došlo je do značajnog pada broja pregleda u objema ustanovama u odnosu na razdoblje 20.3.2019.-19.3.2020. Na razini PZZ bilo je ukupno 533 pregleda, što predstavlja 50,5% pregleda obavljenih u istom razdoblju 2019.godine, dok je na razini specijalističko-konzilijarne zdravstvene zaštite (SKZZ) obavljeno 1672 pregleda, odnosno 56,4% pregleda obavljenih 2019. godine. Do najvećeg pada broja pregleda na razini PZZ došlo je među dijagnozama: zloćudni melanom kože, gripa, akutni bronhitis i bronhiolitis, akutne infekcije gornjeg dišnog sustava i bronhitis, emfizem, astma i druge kronične opstruktivne bolesti. Analizirajući preglede obavljene u SKZZ, najveći pad broja pregleda zabilježen je za dijagnoze: pneumonija, bronhitis, emfizem, astma i druge kronične opstruktivne bolesti, oštećenje sluha, zloćudni melanom kože i ostale bolesti dišnog sustava. Zaključci: Smanjeni broj pregleda i hospitalizacija u odnosu na vrijeme prije početka pandemije kao posljedicu mogu imati povećani broj bolesnika s novim dijagnozama, među kojima i karcinoma otkrivenih u kasnijim stadijima bolesti, što će u konačnici rezultirati kasnijim početkom liječenja i lošijim ishodom bolesti, ali i povećanim opterećenjem zdravstvenog sustava i povećanim troškovima liječenja

Multifocal metachronous occurence of different hystologic sinonasal-type papilloma: a case report

Introduction: Sinonasal-type papilloma is a very rare tumor, most commonly connected with the sinonasal space, and very rarely with the middle ear. Primary tumors of the temporal bone are extremely rare and only 28 cases have been described in literature, with additional 29 cases of tumor spreading from the sinonasal tract to the temporal bone. Case presentation: We discuss the case of a 49-year-old woman who had a primary right-sided exophytic form of the sinonasal papilloma of the middle ear, which led to right-sided hearing loss, aural fullness, and otorrhea. During postoperative CT and MRI follow-up one year after surgery, a sinonasal oncocytic-type papilloma was discovered in the sphenoid sinus. To our knowledge, this is the first described case of histologically two different primary sinonasal-types of papilloma in a patient. Common presenting symptoms associated with sinonasal papilloma of the middle ear can be easily misdiagnosed with chronic otitis media or Eustachian tube dysfunction. Although primarily benign, sinonasal papillomas are locally aggressive and pose a risk of recurrence and malignant transformation. Therefore, surgery remains the treatment of choice with necessary long-term follow-up, to detect relapse or even a completely new tumor in that area

Comparison of intratympanic steroid and hyperbaric oxygen salvage therapy hearing outcomes in idiopathic sudden sensorineural hearing loss : a retrospective study

Sistemski kortikosteroidi (KKS) najčešće predstavljaju prvu liniju liječenja iznenadnog zamjedbenog gubitka sluha, sa značajnim poboljšanjem u ishodima sluha u preko 60 % bolesnika. Terapije spašavanja uključuju intratimpanalnu primjenu steroida (ITS) i hiperbaričnu oksigenacijsku terapiju (HBOT), a dosadašnji rezultati nisu konzistentni. Cilj je ove studije usporediti rezultate ITS i HBOT kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha koji prethodno nisu odgovorili na terapiju sistemskim KKS. U istraživanju je sudjelovalo 126 bolesnika s iznenadnim zamjedbenim gubitkom sluha. Od njih 126, 35 je primilo HBOT, 43 ITS, a 48 nije primilo nikakvu terapiju spašavanja (kontrolna skupina). Tonski audiogrami snimljeni su prije i poslije primjene terapije spašavanja, kao i u kontrolnoj skupini u istom vremenskom intervalu. Varijable koje su se pratile uključivale su dob, vrijeme do početka terapije, prisutnost tinitusa (šuma u uhu) i ishode sluha, s graničnim kriterijima za kumulativno poboljšanje od >30 dB na svim frekvencijama, što ukazuje na oporavak. ITS i HBOT povezane su sa statistički značajnim oporavkom sluha na svim frekvencijama, u usporedbi s primjenom sistemskih KKS. U usporedbi s kontrolnom skupinom, nakon primjene ITS, zabilježeno je prosječno poboljšanje sluha za 13,6 dB na svim frekvencijama (250-8000 Hz), a nakon HBOT poboljšanje za 7,4 dB. Značajno poboljšanje sluha pozitivno korelira s dobi, ITS i HBOT. Prisutnost tinitusa prije započinjanja terapije spašavanja negativno korelira s poboljšanjem sluha. Bolesnici koji su imali tinitus prije početka terapije spašavanja imali su za prosječno 4,67 dB manje poboljšanje sluha, u usporedbi s bolesnicima koji nisu imali tinitus prije početka terapije spašavanja. ITS značajno smanjuje tinitus, u usporedbi s druge dvije terapijske opcije. ITS i HBOT pokazuju bolje rezultate u oporavku sluha u osoba s iznenadnim zamjedbenim gubitkom sluha, u usporedbi s kontrolnom skupinom, nakon prethodno neuspješne primjene sistemskih KKS.Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60 % of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation therapy (HBOT), with inconsistent results reported. This study aimed to compare the results of ITS and HBOT in patients with SSNHL that previously failed systemic steroid therapy. This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBOT, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Puretone audiograms were performed before and after the salvage therapy in the ITS and HBOT groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. ITS and HBOT were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13,6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7,4 dB in HBOT in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBOT. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4,67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. ITS and HBOT show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy

Comparison of intratympanic steroid and hyperbaric oxygen salvage therapy hearing outcomes in idiopathic sudden sensorineural hearing loss : a retrospective study

Sistemski kortikosteroidi (KKS) najčešće predstavljaju prvu liniju liječenja iznenadnog zamjedbenog gubitka sluha, sa značajnim poboljšanjem u ishodima sluha u preko 60 % bolesnika. Terapije spašavanja uključuju intratimpanalnu primjenu steroida (ITS) i hiperbaričnu oksigenacijsku terapiju (HBOT), a dosadašnji rezultati nisu konzistentni. Cilj je ove studije usporediti rezultate ITS i HBOT kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha koji prethodno nisu odgovorili na terapiju sistemskim KKS. U istraživanju je sudjelovalo 126 bolesnika s iznenadnim zamjedbenim gubitkom sluha. Od njih 126, 35 je primilo HBOT, 43 ITS, a 48 nije primilo nikakvu terapiju spašavanja (kontrolna skupina). Tonski audiogrami snimljeni su prije i poslije primjene terapije spašavanja, kao i u kontrolnoj skupini u istom vremenskom intervalu. Varijable koje su se pratile uključivale su dob, vrijeme do početka terapije, prisutnost tinitusa (šuma u uhu) i ishode sluha, s graničnim kriterijima za kumulativno poboljšanje od >30 dB na svim frekvencijama, što ukazuje na oporavak. ITS i HBOT povezane su sa statistički značajnim oporavkom sluha na svim frekvencijama, u usporedbi s primjenom sistemskih KKS. U usporedbi s kontrolnom skupinom, nakon primjene ITS, zabilježeno je prosječno poboljšanje sluha za 13,6 dB na svim frekvencijama (250-8000 Hz), a nakon HBOT poboljšanje za 7,4 dB. Značajno poboljšanje sluha pozitivno korelira s dobi, ITS i HBOT. Prisutnost tinitusa prije započinjanja terapije spašavanja negativno korelira s poboljšanjem sluha. Bolesnici koji su imali tinitus prije početka terapije spašavanja imali su za prosječno 4,67 dB manje poboljšanje sluha, u usporedbi s bolesnicima koji nisu imali tinitus prije početka terapije spašavanja. ITS značajno smanjuje tinitus, u usporedbi s druge dvije terapijske opcije. ITS i HBOT pokazuju bolje rezultate u oporavku sluha u osoba s iznenadnim zamjedbenim gubitkom sluha, u usporedbi s kontrolnom skupinom, nakon prethodno neuspješne primjene sistemskih KKS.Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60 % of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation therapy (HBOT), with inconsistent results reported. This study aimed to compare the results of ITS and HBOT in patients with SSNHL that previously failed systemic steroid therapy. This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBOT, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Puretone audiograms were performed before and after the salvage therapy in the ITS and HBOT groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. ITS and HBOT were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13,6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7,4 dB in HBOT in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBOT. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4,67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. ITS and HBOT show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy

Comparison of intratympanic steroid and hyperbaric oxygen salvage therapy hearing outcomes in idiopathic sudden sensorineural hearing loss : a retrospective study

Sistemski kortikosteroidi (KKS) najčešće predstavljaju prvu liniju liječenja iznenadnog zamjedbenog gubitka sluha, sa značajnim poboljšanjem u ishodima sluha u preko 60 % bolesnika. Terapije spašavanja uključuju intratimpanalnu primjenu steroida (ITS) i hiperbaričnu oksigenacijsku terapiju (HBOT), a dosadašnji rezultati nisu konzistentni. Cilj je ove studije usporediti rezultate ITS i HBOT kao terapije spašavanja u bolesnika s iznenadnim zamjedbenim gubitkom sluha koji prethodno nisu odgovorili na terapiju sistemskim KKS. U istraživanju je sudjelovalo 126 bolesnika s iznenadnim zamjedbenim gubitkom sluha. Od njih 126, 35 je primilo HBOT, 43 ITS, a 48 nije primilo nikakvu terapiju spašavanja (kontrolna skupina). Tonski audiogrami snimljeni su prije i poslije primjene terapije spašavanja, kao i u kontrolnoj skupini u istom vremenskom intervalu. Varijable koje su se pratile uključivale su dob, vrijeme do početka terapije, prisutnost tinitusa (šuma u uhu) i ishode sluha, s graničnim kriterijima za kumulativno poboljšanje od >30 dB na svim frekvencijama, što ukazuje na oporavak. ITS i HBOT povezane su sa statistički značajnim oporavkom sluha na svim frekvencijama, u usporedbi s primjenom sistemskih KKS. U usporedbi s kontrolnom skupinom, nakon primjene ITS, zabilježeno je prosječno poboljšanje sluha za 13,6 dB na svim frekvencijama (250-8000 Hz), a nakon HBOT poboljšanje za 7,4 dB. Značajno poboljšanje sluha pozitivno korelira s dobi, ITS i HBOT. Prisutnost tinitusa prije započinjanja terapije spašavanja negativno korelira s poboljšanjem sluha. Bolesnici koji su imali tinitus prije početka terapije spašavanja imali su za prosječno 4,67 dB manje poboljšanje sluha, u usporedbi s bolesnicima koji nisu imali tinitus prije početka terapije spašavanja. ITS značajno smanjuje tinitus, u usporedbi s druge dvije terapijske opcije. ITS i HBOT pokazuju bolje rezultate u oporavku sluha u osoba s iznenadnim zamjedbenim gubitkom sluha, u usporedbi s kontrolnom skupinom, nakon prethodno neuspješne primjene sistemskih KKS.Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60 % of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation therapy (HBOT), with inconsistent results reported. This study aimed to compare the results of ITS and HBOT in patients with SSNHL that previously failed systemic steroid therapy. This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBOT, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Puretone audiograms were performed before and after the salvage therapy in the ITS and HBOT groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. ITS and HBOT were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13,6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7,4 dB in HBOT in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBOT. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4,67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. ITS and HBOT show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy

22-GODIŠNJA PACIJENTICA S BOLI U PRSIMA – ANKSIOZNOST ILI NEŠTO DRUGO?

Chest pain is one of the most common clinical entities in the emergency room (ER) and it can be divided into the pain of cardiac and non-cardiac origin. This report aims to show the importance of diagnostic treatment for a patient with chest pain.Bol u prsima jedan je od najčešćih kliničkih entiteta s kojim se susrećemo na objedinjenom hitnom bolničkom prijemu (OHBP), a prema uzroku može se podijeliti na bol kardijalnog i nekardijalnog podrijetla. Cilj je rada ukazati na važnost dijagnostičke obrade pacijenta s boli u prsima