Lajm neuroborelioza

Lyme borreliosis (LB) is a multisystemic zoonotic disease which in humans can involve the skin, joints, heart and/or nervous system. In this study a total of 11 patients with clinical manifestations have been assessed at the Institute for Occupational Health. Evaluation of the patients was done in order to determine their working capability and further professional orientation. Patients were of different gender, age, education and profession. They fulfilled at least two of the three criteria: tick infestation data (epidemiological criteria), central and/or peripheral neurological symptoms (clinical criteria) and a positive serological finding. Diagnosis was done upon classical clinical criteria: electromyeloneurography (EMNG) analysis, neurological impairments, electroencephalography (EEG), computer tomography (CT) and/or magnetic resonance imaging (MRI). IgM and IgG antibodies against B. burgdorferi were determined by commercial ELISA kits. IgM antibodies were recorded in the serum of 4 (44.4%) and IgG in 6 (66.7%) patients. Electro-myeloneurography findings of the upper and lower limbs were positive in 5 (83.3%), electroencephalography in 4 (66.6%) of the 6 observed patients and CT was positive in 4 (36.4%) of the 5 observed patients. The study has established that in patients with neuroborreliosis (NB) the capability to carry out intellectual tasks, as well as responsible duties is impaired due to poor memory. Patients suffering from peripheral neuropathies are not fit to withstand longterm walks, weight lifting and carrying or any other form of physical stress.Lajm borelioza je multisistemsko oboljenje, iz grupe zoonoza koje kod ljudi može zahvatiti kožu, zglobove, srce i/ili nervni sistem. Istraživanjem je obuhvaćeno 11 bolesnika sa kliničkim manifestacijama neuroborelioze koji su ispitivani u Institutu za medicinu rada Srbije u cilju ocene radne sposobnosti i dalje profesionalne orijentacije. Ispitani su bolesnici različite starosti, pola, nivoa obrazovanja i različitih zanimanja koji su ispunili minimalno dva od tri kriterijuma i to: podatak o ubodu krpelja (epidemiološki kriterijum), ispoljavanje centralnih i/ili, perifernih neuroloških simptoma (klinički kriterijum) i pozitivan serološki nalaz. Dijagnoza neuroborelioze je postavljena na osnovu klasičnih kliničkih kriterijuma: neurološ kih ispada, analize elektro-mioneurografije (EMNG), elektroencefalografije (EEG), kompjuterske tomografije (CT) i/ili magnetne rezonance (MRI). Ispitivanje prisustva antitela IgM i IgG klase u krvnom serumu prema B. burgdorferi vršeno je komercijalnim ELISA testom. Antitela IgM klase registrovana su u serumu četiri (44,4%), dok su IgG antitela registrovana kod 6 (66,7%) ispitanih pacijenata. Nalaz elektro-mioneurografije gornjih i donjih ekstremiteta je bio pozitivan kod pet (83,3%), nalaz elektroencefalografije kod četiri (66,6%) od šest ispitanih pacijenata, dok je nalaz CT bio pozitivan kod 4 (36,4%) od pet ispitanih pacijenata. Sprovedenim ispitivanjem je utvrđeno da je kod bolesnika sa razvijenom neuroboreliozom smanjena sposobnost za bilo koju vrstu intelektualnog rada, kao i za poslove koji su povezani sa moralnom i materijalnom odgovornošću zbog problema sa pamćenjem. Kod bolesnika sa perifernim neuropatijama postoji nesposobnost za poslove koji uključuju dugotrajno stajanje i hodanje, dizanje i nošenje tereta, kao i bilo koju vrstu fizičkog rada

Destruction of diagonal and off-diagonal long range order by disorder in two-dimensional hard core boson systems

We use quantum Monte Carlo simulations to study the effect of disorder, in the form of a disordered chemical potential, on the phase diagram of the hard core bosonic Hubbard model in two dimensions. We find numerical evidence that in two dimensions, no matter how weak the disorder, it will always destroy the long range density wave order (checkerboard solid) present at half filling and strong nearest neighbor repulsion and replace it with a bose glass phase. We study the properties of this glassy phase including the superfluid density, energy gaps and the full Green's function. We also study the possibility of other localized phases at weak nearest neighbor repulsion, i.e. Anderson localization. We find that such a phase does not truly exist: The disorder must exceed a threshold before the bosons (at weak nn repulsion) are localized. The phase diagram for hard core bosons with disorder cannot be obtained easily from the soft core phase diagram discussed in the literature.Comment: 7 pages, 10 eps figures include

Ocjena radne sposobnosti pacijenta s Wilsonovom bolesti - prikaz bolesnika

Wilson’s disease (WD) is a rare, progressive autosomal recessive disorder characterised by impaired transport and excessive accumulation of copper in the liver, brain, and other tissues. The disease is diagnosed based on clinical manifestations and screening tests results. Work ability assessment of patients with WD is based on the analysis of liver, kidney, neurological, and cognitive impairments, and takes into account patient’s level of education. This article presents a case with a 48-year-old male patient, who was admitted for work ability assessment due to polymorphic symptoms. The patient had been working as a salesman for 28 years. A detailed interview and examination by occupational health and other medical specialists revealed that the patient had been suffering from Wilson’s disease from the age of 13, and had now developed hepatic manifestations (compensated liver cirrhosis with portal hypertension), neurological manifestations (dystonia, dysarthria, muscle weakness, vertigo), and psychiatric manifestations (depression, insomnia, cognitive impairment) of the disease, including problems partially caused by long-lasting treatment with copper chelating agents (neurological and haematological manifestations). There were no ocular manifestations of Wilson’s disease (Kayser-Fleischer rings or sunflower cataract). The patient was assessed as having drastically diminished general work ability, dominantly due to neurological and psychiatric impairments caused by Wilson’s disease.Wilsonova je bolest rijetka, progresivna autosomno recesivna bolest karakterizirana poremećajem transporta bakra i posljedičnim prekomjernim nakupljanjem bakra u jetri, mozgu i drugim tkivima i organima. Dijagnoza bolesti postavlja se na osnovi kliničkih manifestacija bolesti i nalaza laboratorijskih ispitivanja. Ocjena radne sposobnosti pacijenata s Wilsonovom bolesti zasniva se na analizi postojanja oštećenja i stupnja oštećenja hepatičkih, neuroloških, bubrežnih i kognitivnih funkcija, kao i na analizi stupnja obrazovanja pacijenata. Prikazan je slučaj D. M., 48-godišnjeg pacijenta, koji je primljen zbog polimorfnih tegoba na bolničko ispitivanje radi ocjene radne sposobnosti. Pacijent je radio kao prodavač posljednjih 28 godina. Nakon detaljne anamneze i pregleda koje su obavili specijalisti medicine rada i drugi specijalisti utvrđeno je da pacijent boluje od Wilsonove bolesti od 13. godine života i da u ovom trenutku ima izražene hepatične manifestacije (kompenzirana ciroza jetre s portalnom hipertenzijom), neurološke manifestacije (distonija, dizartrija, mišićna slabost, vrtoglavica) i psihijatrijske manifestacije (depresija, nesanica, kognitivno oštećenje) Wilsonove bolesti, kao i da su prisutne tegobe djelomično uzrokovane dugotrajnom upotrebom kelatne terapije (neurološki i hematološki poremećaji). Nisu uočene karakteristične očne promjene Wilsonove bolesti (Kayser-Fleischerov prsten, katarakta u obliku suncokreta). Ocjenom radne sposobnosti utvrđeno je da pacijent ima drastično smanjenu radnu sposobnost pretežno zbog neuroloških i psihičkih poremećaja u sklopu Wilsonove bolesti

Rewarming curves and derived parameters in the diagnosis of hand-arm vibration syndrome

Background: Exposure to hand-arm vibrations is a known cause of the Hand-arm vibration syndrome (HAVS), a progressive syndrome beginning with sensory loss and leading to gangrene, making timely diagnosis essential. Objectives: Assessment of the usefulness of 9 diagnostic parameters claimed as being of greatest value in the diagnosis of HAVS, and examination of the complementary diagnostic value of the curve shapes. Methods: Three groups of subjects (HAVS cases, exposed workers without irreversible changes, and controls) were examined by cold provocation followed by thermographic imaging, obtainment of rewarming curves for four preselected regions and calculation of parameters. The discriminative value of individual parameters and the discriminative power of a combination of all the parameters were assessed. Qualitative curve shape analysis was included. Results: The greatest individual discriminative ability is associated with RT (rewarming time to pre-cooling value, p lt 0.001), Tmax (maximum temperature during the 10-minute recovery, p lt 0.001), k (rewarming rate, p lt 0.012) and RD (rewarming delay, p lt 0.031). The discriminant analysis yielded one significant discriminant function (Wilks' Lambda = 0.278, chi(2)(18)=48.67, p lt 0.001, canonical R(2)=0.63). Four types of rewarming curves were identified. Conclusions: RT, Tmax, k and RD appear to be the most suitable individual parameters for group discrimination. When linearly combined, the parameters can be useful for discriminating HAVS cases from both Controls and Claimants, which constitutes the main task of an occupational health physician. Additional information is available from the qualitative assessment of the rewarming curve shape

Procjena grube i fine motoričke funkcije šake u asimptomatičnih osoba izloženih vibracijama koje se prenose preko ruke i šake

A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures.U suvremenim uvjetima profesionalne izloženosti vibracijama koje se prenose preko ruke i šake, često se mogu vidjeti radnici koji su, i pored dugotrajne povremene izloženosti, i dalje bez uočljivih simptoma vibracijske bolesti. U većini dosadašnjih istraživanja analizirani su ispitanici s razvijenom kliničkom slikom vibracijske bolesti, uz rijetka razmatranja bioloških procesa koji mogu biti uključeni u degradaciju ručne spretnosti i snage stiska šake, osobito u asimptomatskoj fazi, kada bi to bilo od najveće koristi. U ovom su istraživanju uspoređene dvije skupine ispitanika: izložena skupina – 31 radnik izložen lokalnim vibracijama koji prema Stockholmskoj klasifikaciji nema simptome vibracijske bolesti, i kontrolna skupina – 30 radnika koji nisu izloženi lokalnim vibracijama. Svaki je ispitanik bio podvrgnut dinamometrijskom i deksterimetrijskom testiranju (model za grubu i finu motoričku funkciju šake) te testu provokacije hladnoćom radi usporedbe pada motoričkih funkcija šake. U izloženoj skupini zabilježen je pad fine motoričke funkcije, ali ne i snage stiska šake. Rezultati upozoravaju na mjerljiv deficit grube ali ne i fine motoričke funkcije šake kod povremene izloženosti s malim kumulativnim dozama, čak i kada se radi o dugotrajnoj izloženosti nezanemarivim razinama A(8). Vibracijama inducirane lezije živčanih vlakana i/ili mehanoreceptora, koji osiguravaju senzornu povratnu vezu za signale pokreta – čime kontroliraju zadatke koji iziskuju precizno kretanje prstiju – mogle bi biti odgovorne za uočeno smanjenje ručne spretnosti. Taj mehanizam, međutim, nije potreban za kontrolu grube sile stiska