HAND-FOOT-AND-MOUTH-DISEASE (HFMD)

Bolest šaka, stopala i usta je akutna zarazna bolest karakterizirana vrućicom, vezikularnim lezijama u ustima te osipom na dlanovima, tabanima i/ili genitalnom području. U većini slučajeva HMFD je uzročnik Coxsackie A virus tip 16. Najčešće se javlja među mlađom djecom. Dijagnoza HFMD se postavlja na temelju kliničkog pregleda. Laboratorijske pretrage najčešće nisu potrebne. Etiološkog liječenja nema. Terapija je simptomatska i suportivna. Potrebno je uputiti pacijenta kako su potrebne dobre higijenske mjere kako bi se spriječilo širenje bolesti.Hand-foot-and-mouth disease (HFMD) is an acute viral illness that presents swith fever, vesicular eruption in the mouth and exanthema involving the hands, feet, and/orgenitalia. Coxsackie virus A type 16 is the etiologic agent involved in most cases of HFMD. Younger children are most commonly affected. The diagnosis of HFMD is typically based on clinical grounds. Laboratory studies are usually unnecessary. There is no antiviral agent specific for HFMD. Instead, the treatment is symptomatic and supportive. Patients should be aware of the need for good hygiene practices to avoid transsmision

Diagnostic and therapeutic approaches to multiple myeloma patients - case report

Multipli mijelom je zloćudno bujanje plazma stanica koje stvaraju abnormalni imunoglobulin, zbog čega dolazi do monoklonske gamapatije, a karakterizira ju prisutnost M proteina u serumu i urinu. Elektroforeza serumskih proteina je jednostavan dijagnostički test koji se koristi za dokazivanje i kvantifikaciju monoklonske gamapatije, te ga je potrebno učiniti kao preliminarni test kod sumnje na multipli mijelom. U radu su kroz prikaz bolesnika ilustrirana ključna pitanja u skrbi o bolesnicima oboljelima od multiplog mijeloma, a opisana je relevantna patofiziologija, klinička slika, dijagnostički postupci, te liječenje oboljelih.Multiple myeloma is a neoplasm characterized by excessive proliferation of the plasma cells, secreting abnormal immunoglobulin causing monoclonal gammopathy and it is characterised by the presence of M protein in serum and urine. Electrophoresis of serum protein is an easy laboratory test which can be used for detection and quantification of monoclonal gammopathy and should be used as a preliminary test for detecting multiple myeloma. In this paper we described key issues in the care of patients with multiple myeloma. Using the case report, we showed the pathophysiology, clinical picture, diagnostic procedures and treatment of patients with multiple myeloma

SUDDEN SENSORINEURAL HEARING LOSS – CASE REPORT

Iznenadna zamjedbena nagluhost je najčešće idiopatski unilateralan gubitak sluha koji se javlja u periodu kraćem od 72 sata. Vrijeme za provođenje efektivne terapije je kratko. Važno je da liječnik obiteljske medicine bude upoznat sa faktorima i stanjima koja mogu imitirati SSHR te na vrijeme uputi pacijenta konzultantu otorinolaringologu da se što prije postavi ispravna dijagnoza i počne sa liječenjem. S obzirom na nepoznatu etiologiju terapija je empirijska. Najčešće se primjenjuju kortikosteroidi, a osim njih u terapiji se mogu primijeniti antibiotici, antivirotici, diuretici, vazodilatatori, antikoagulansi, vitamini i to naročito skupine B, hiperbarična komora, betahistin, atropin. Iznenadno zamjedbeno oštećenje sluha je jedino stanje u audiologiji koje nastaje naglo, a liječenje je to uspješnije što se ranije započne. U ovom radu prikazuje se pacijentica koja se javila u ambulantu zbog iznenadnog gubitka sluha na lijevom uhu što je i potvrđeno audiogramom. Kod nje je provedeno liječenje kortikosteroidima po preporuci konzultanta otorinolaringologa.Sudden sensorineural hearing loss involves acute unexplained hearing loss, mostly unilateral, developing in less than 72 hour period. Most cases are idiopathic, and the prognosis depends on the severity of hearing loss. Time for effective therapy is short. It is important for the family practitioners to be aware of the factors and conditions that could imitate SSHL so that they could send the patient to otolaryngologist in time. Otolaryngologist will give the right diagnosis and start the treatment. Because the etiology of this disease is unknown therapy is empirical. Corticosteroids are the most common therapy. Antibiotics, antivirals, diuretics, vasodilators, anticoagulants, vitamins - especially group B, hyperbaric chamber, betahistine, atropine can be used as well. Sudden sensorineural hearing loss is the only state in audiology that occurs suddenly and treatment is more successful if we start with the therapy as early as possible. A case of the patient who answered the emergency room because of sudden hearing loss in the left ear which was confirmed with the audiogram is presented in this paper. The aptient was treated with corticosteroids recommended by the otolaryngologist

Peptic ulcer induced by acetylsalciylic acid and Helicobacter pylori infection - Case report

Starenjem populacije sve je veći broj bolesnika koji boluju od bolesti krvožilnog sustava, zbog čega u terapiji imaju neki od antitrombocitnih lijekova, najčešće acetilsalicilnu kiselinu, čime se povećava rizik od razvoja peptičkoga ulkusa. Infekcija bakterijom Helicobacter pylori (H. pylori) je dobro poznat uzrok kroničnog gastritisa, te želučanog i duodenalnog ulkusa. Liječenje infekcije predstavlja sve veći izazov za liječnike obiteljske medicine s obzirom da raste prevalencija rezistencije bakterije na najčešće korištene antibiotike, naročito klaritromicin. U ovom radu kroz prikaz bolesnika opisano je na koji način pristupiti bolesniku s peptičkim ulkusom i oštećenjem želučane sluznice nastale zbog infekcije H. pylori i kroničnog uzimanja acetilsalicilne kiseline.Helicobacter pylori is a well-known pathogen that plays a role in the pathogenesis of chronic gastritis and peptic ulcer disease. The growing number of older adults increases the number of patients suffering from cerebrovascular or cardiovascular diseases. These patients take antiplatelet drugs, usually aspirin, which increases the risk of developing peptic ulcer. This infection has proven challenging to cure because of the increasing prevalence of bacterial resistance to the most commonly used antibiotics, particularly clarithromycin. This paper describes a case report on how to approach the patient with peptic ulcer and gastric mucosal damage caused by H. pylori infection and chronic intake of aspirin

EVALUATING INHALER USE TECHNIQUE IN ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS IN FAMILY MEDICINE PRACTICE IN VARAŽDIN COUNTY

Uvod: Ispravnom upotrebom inhalatora omogućuje se maksimalni prijenos lijeka u pluća čime se postiže terapijski učinak. Na taj način dolazi do bolje kontrole simptoma bolesti, naročito noćnih simptoma i kašlja. S obzirom na to da je kvalitetan dotok lijeka u pluća ključan za dobru kontrolu plućnih bolesti, kod nedovoljno dobro reguliranih pacijenata prije promjene doze ili skupine lijeka potrebno je provjeriti ispravnost korištenja inhalatora i inhalatornu tehniku. Cilj ovog rada bio je procijeniti znanje o pravilnoj upotrebi inhalatora među pacijentima za koje se skrbi na području grada Varaždina. Metode rada: Ovom prospektivnom studijom obuhvaćeno je 100 pacijenata s dijagnozom astme ili KOPB-a koji su od listopada 2016. godine do travnja 2017. godine koristili zdravstvene usluge u ambulantama obiteljske medicine. Praktična upotreba inhalatora procijenjena je tako da su pacijenti zamoljeni da demonstriraju svoju tehniku uzimanja lijeka pomoću placebo-uređaja, a ispravnost upotrebe procjenjivao je liječnik obiteljske medicine. Inhalatori su prema specifi čnim karakteristikama bili podijeljeni u dvije velike skupine: engl. dry powder inhaler (DPI) i engl. metered-dose inhaler (MDI). Svi su ispitanici ispuniliupitnik koji je sadržavao pitanja koja su se, između ostalog, odnosila i na način stjecanja znanja o inhalatorima te na edukaciju o pravilnoj upotrebi inhalatora. Za opis karakteristika varijabli ispitanika te za njihov prikaz u obliku tablica korištena je deskriptivna statistika. Rezultati: U istraživanje je bilo uključeno 100 pacijenata, 39 muškaraca i 61 žena. Dijagnozu astme imalo je 76 pacijenata, a njih 24 KOPB. Nešto više od polovice pacijenata (53 %) pokazalo je loše znanje o pravilnoj upotrebi inhalatora. Najčešće greške u koracima koje su zajedničke za oba tipa inhalatora su sljedeće: pacijenti nisu prije inhalacije lijeka izdahnuli rezidualni volumen (64 %) te nisu zadržali dah 5-10 sekundi nakon inhalacije (56 %). Zaključak: Rezultati istraživanja pokazuju da je najčešće korišteni uređaj pMDI, a najučestalija pogreška kod upotrebe je izostanak izdisaja rezidualnog volumena zraka iz pluća prije primjene doze lijeka. Redovita i česta edukacija pacijenata o novostima i pravilnoj upotrebi inhalatora pridonijela bi poboljšanju kontrole plućnih bolesti pacijenata.Introduction: Correct use of inhalers allows maximum delivery of the drug to the lungs, thus achieving therapeutic effect that leads to better control of disease symptoms, especially night time symptoms and coughs. Since optimal drug delivery is a key to good control of lung disease, it is necessary to check the correctness of the use of inhalers and inhalation techniques in patients with insuffi ciently regulated disease before changing the dose of medication or drug group. The aimof this study was to evaluate the knowledge about proper use of inhalers among patients in Varaždin County. Methods: This prospective study included one hundred patients with asthma or chronic obstructive pulmonary disease (COPD) who used healthcare services in family medicine practice from October 2016 to April 2017. Practical use of the inhaler was evaluated by asking the patients to demonstrate their drug-taking technique using a placebo-controlled device, and a family medicine physician evaluated the correct use. The inhalers, according to their specifi c characteristics, were divided into two large groups of dry powder inhaler (DPI) and metered dose inhaler (MDI). All patients completed a questionnaire that included questions about how they acquired knowledge of the proper use of inhalers. Data were analyzed using descriptive statistics. Results: The study comprised 39 males and 61 females. There were 76 patients diagnosed with asthma and 24 patients with COPD. More than half of the patients (53%) reported poor knowledge of the proper use of the inhaler. The most common mistakes in using both types of inhaler were that the patients did not exhale the residual volume (64%) before inhalation of the drug and sustained for 5-10 s after inhalation (56%). Conclusion: The most commonly used device was pMDI, and the most common error in their use was the absence of exhalation of residual lung volume before inhalation of the drug. The study emphasized the need to conduct a larger research on the issue to get better insight into it with the aim of improving the quality of life in asthma and COPD patients

Interventions For Harmful and Risky Alcohol Consumption in Family Medicine

Alkoholizam je kronična i progresivna bolest koja uključuje sljedeće simptome: žudnja, gubitak kontrole, fizička ovisnost, tolerancija, nastavak pijenja unatoč spoznaji o štetnosti alkohola te zanemarivanje radnih i drugih obveza. Kod osoba koje nisu razvile ovisnost o alkoholu već mogu kontrolirati svoje pijenje te prilikom prestanka ne osjećaju posljedice ustezanja govorimo o zlouporabi ili štetnom uzimanju alkohola. To su osobe koje konzumiraju veću količinu alkohola dulje vrijeme pri čemu nastaju obiteljski i zdravstveni problemi, ali i oni koji negativno utječu na širu zajednicu. Ovim radom željeli smo prikazati kako u ordinaciji liječnika obiteljske medicine pristupiti pacijentu koji ima probleme s prekomjernom konzumacijom alkohola.Alcoholism is a chronic and progressive disease that includes problems controlling alcohol intake, being preoccupied with alcohol, continuing to use alcohol even when it causes problems and physical dependence. It is possible to have a problem with alcohol even when it has not progressed to the point of alcoholism. A drinking problem means that a person drinks too much at times, causing repeated problems in their family, although they are not completely dependent on alcohol. Identifying and managing alcoholism before it has interfered with the patient’s career and family may increase the possibility of long-term recovery. The purpose of this article is to present how to manage alcohol problems in family medicine

SUDDEN SENSORINEURAL HEARING LOSS – CASE REPORT

Iznenadna zamjedbena nagluhost je najčešće idiopatski unilateralan gubitak sluha koji se javlja u periodu kraćem od 72 sata. Vrijeme za provođenje efektivne terapije je kratko. Važno je da liječnik obiteljske medicine bude upoznat sa faktorima i stanjima koja mogu imitirati SSHR te na vrijeme uputi pacijenta konzultantu otorinolaringologu da se što prije postavi ispravna dijagnoza i počne sa liječenjem. S obzirom na nepoznatu etiologiju terapija je empirijska. Najčešće se primjenjuju kortikosteroidi, a osim njih u terapiji se mogu primijeniti antibiotici, antivirotici, diuretici, vazodilatatori, antikoagulansi, vitamini i to naročito skupine B, hiperbarična komora, betahistin, atropin. Iznenadno zamjedbeno oštećenje sluha je jedino stanje u audiologiji koje nastaje naglo, a liječenje je to uspješnije što se ranije započne. U ovom radu prikazuje se pacijentica koja se javila u ambulantu zbog iznenadnog gubitka sluha na lijevom uhu što je i potvrđeno audiogramom. Kod nje je provedeno liječenje kortikosteroidima po preporuci konzultanta otorinolaringologa.Sudden sensorineural hearing loss involves acute unexplained hearing loss, mostly unilateral, developing in less than 72 hour period. Most cases are idiopathic, and the prognosis depends on the severity of hearing loss. Time for effective therapy is short. It is important for the family practitioners to be aware of the factors and conditions that could imitate SSHL so that they could send the patient to otolaryngologist in time. Otolaryngologist will give the right diagnosis and start the treatment. Because the etiology of this disease is unknown therapy is empirical. Corticosteroids are the most common therapy. Antibiotics, antivirals, diuretics, vasodilators, anticoagulants, vitamins - especially group B, hyperbaric chamber, betahistine, atropine can be used as well. Sudden sensorineural hearing loss is the only state in audiology that occurs suddenly and treatment is more successful if we start with the therapy as early as possible. A case of the patient who answered the emergency room because of sudden hearing loss in the left ear which was confirmed with the audiogram is presented in this paper. The aptient was treated with corticosteroids recommended by the otolaryngologist

PRIKAZ SLUČAJA: Hipotireoza (Hashimotov tiroiditis)

Hipotireoza je jedna od najčešćih endokrinoloških bolesti s većom učestalošću među ženama i starijim osobama. Procjenjuje se da danas u svijetu boluje ili se liječi od bolesti štitnjače oko 200 milijuna ljudi. Iako je hipotireoza lako izlječiva bolest i dalje ostaju izazovi vezani uz dijagnozu i liječenje. Liječnici obiteljske medicine imaju dovoljno znanja i iskustva kako bi mogli dijagnosticirati i liječiti hipotireozu. Da bi liječenje bilo što uspješnije potreban je individualan pristup i partnerski odnos s pacijentom. U ovom radu opisano je kroz prikaz slučaja, na koji način pristupiti pacijentu sa simptomima koji upućuju na bolest štitnjače. Prikazano je koji se dijagnostički postupci provode te načini na koji se uvodi i titrira terapija.Hypothyroidism is one of the most common endocrine diseases with a higher incidence among women and the elderly. It is estimated that 200 million people in the world have some form of thyroid disease. Although hypothyroidism is easily curable disease still remain challenges related to diagnosis and treatment. Family physicians have sufficient knowledge and experience to be able to diagnose and treat hypothyroidism. In order to get the most out of treatment it requires an individual approach and partnership with the patient. This paper describes the case report on how to approach a patient with symptoms suggestive of thyroid disease. In this paper is represent diagnostic algorithm for investigation of thyroid dysfunction and dose titration method

Contact dermatitis – case report

Dermatitis je upala kože koja nastaje nakon kontakta s tvarima koje mogu nadražiti kožu ili izazvati alergijsku reakciju. Praćen je simptomima koji uključuju svrbež, osip, crvenilo, otok, a mogu se javiti i bule koje pucaju te kraste koje predstavljaju sasušeni sadržaj puknutog mjehurića. Promjene su obično oštro ograničene i javljaju se na otkrivenim dijelovima tijela, naročito šakama. Prema mehanizmu djelovanja razlikujemo dva tipa kontaktnog dermatitisa: kontaktni nealergijski koji se javlja u 80% slučajeva i kontaktni alergijski koji čini oko 20% svih slučajeva. Cilj liječenja je djelovati na postojeću upalu (obično lokalnom primjenom kortikosteroida), obnoviti kožnu barijeru i izbjeći ponovnu pojavu kontaktne upale kože. U ovom radu prikazano je na koji način pristupiti pacijentu sa simptomima kontaktnog dermatitisa.Dermatitis is a general term that describes an inflammation of the skin and appears after a contact with a substance that can irritate the skin or cause an allergic reaction. Symptoms include itching, rash, redness, swelling. Skin affected by dermatitis may blister, ooze and develop a crust. Changes are usually clearly limited and appear on the exposed parts of the body, especially hands. Dermatitis may have many causes and occurs in many forms. There are two types of contact dermatitis: non-allergic which occurs in 80% of cases and allergic which comprises about 20%. The goal of the treatment is to affect the existing inflammation (usually with topical corticosteroids), restore the skin barrier and prevent reappearance of dermatitis. This paper describes the approach to the patient whit symptoms of contact dermatitis

EVALUATING INHALER USE TECHNIQUE IN ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS IN FAMILY MEDICINE PRACTICE IN VARAŽDIN COUNTY

Uvod: Ispravnom upotrebom inhalatora omogućuje se maksimalni prijenos lijeka u pluća čime se postiže terapijski učinak. Na taj način dolazi do bolje kontrole simptoma bolesti, naročito noćnih simptoma i kašlja. S obzirom na to da je kvalitetan dotok lijeka u pluća ključan za dobru kontrolu plućnih bolesti, kod nedovoljno dobro reguliranih pacijenata prije promjene doze ili skupine lijeka potrebno je provjeriti ispravnost korištenja inhalatora i inhalatornu tehniku. Cilj ovog rada bio je procijeniti znanje o pravilnoj upotrebi inhalatora među pacijentima za koje se skrbi na području grada Varaždina. Metode rada: Ovom prospektivnom studijom obuhvaćeno je 100 pacijenata s dijagnozom astme ili KOPB-a koji su od listopada 2016. godine do travnja 2017. godine koristili zdravstvene usluge u ambulantama obiteljske medicine. Praktična upotreba inhalatora procijenjena je tako da su pacijenti zamoljeni da demonstriraju svoju tehniku uzimanja lijeka pomoću placebo-uređaja, a ispravnost upotrebe procjenjivao je liječnik obiteljske medicine. Inhalatori su prema specifi čnim karakteristikama bili podijeljeni u dvije velike skupine: engl. dry powder inhaler (DPI) i engl. metered-dose inhaler (MDI). Svi su ispitanici ispuniliupitnik koji je sadržavao pitanja koja su se, između ostalog, odnosila i na način stjecanja znanja o inhalatorima te na edukaciju o pravilnoj upotrebi inhalatora. Za opis karakteristika varijabli ispitanika te za njihov prikaz u obliku tablica korištena je deskriptivna statistika. Rezultati: U istraživanje je bilo uključeno 100 pacijenata, 39 muškaraca i 61 žena. Dijagnozu astme imalo je 76 pacijenata, a njih 24 KOPB. Nešto više od polovice pacijenata (53 %) pokazalo je loše znanje o pravilnoj upotrebi inhalatora. Najčešće greške u koracima koje su zajedničke za oba tipa inhalatora su sljedeće: pacijenti nisu prije inhalacije lijeka izdahnuli rezidualni volumen (64 %) te nisu zadržali dah 5-10 sekundi nakon inhalacije (56 %). Zaključak: Rezultati istraživanja pokazuju da je najčešće korišteni uređaj pMDI, a najučestalija pogreška kod upotrebe je izostanak izdisaja rezidualnog volumena zraka iz pluća prije primjene doze lijeka. Redovita i česta edukacija pacijenata o novostima i pravilnoj upotrebi inhalatora pridonijela bi poboljšanju kontrole plućnih bolesti pacijenata.Introduction: Correct use of inhalers allows maximum delivery of the drug to the lungs, thus achieving therapeutic effect that leads to better control of disease symptoms, especially night time symptoms and coughs. Since optimal drug delivery is a key to good control of lung disease, it is necessary to check the correctness of the use of inhalers and inhalation techniques in patients with insuffi ciently regulated disease before changing the dose of medication or drug group. The aimof this study was to evaluate the knowledge about proper use of inhalers among patients in Varaždin County. Methods: This prospective study included one hundred patients with asthma or chronic obstructive pulmonary disease (COPD) who used healthcare services in family medicine practice from October 2016 to April 2017. Practical use of the inhaler was evaluated by asking the patients to demonstrate their drug-taking technique using a placebo-controlled device, and a family medicine physician evaluated the correct use. The inhalers, according to their specifi c characteristics, were divided into two large groups of dry powder inhaler (DPI) and metered dose inhaler (MDI). All patients completed a questionnaire that included questions about how they acquired knowledge of the proper use of inhalers. Data were analyzed using descriptive statistics. Results: The study comprised 39 males and 61 females. There were 76 patients diagnosed with asthma and 24 patients with COPD. More than half of the patients (53%) reported poor knowledge of the proper use of the inhaler. The most common mistakes in using both types of inhaler were that the patients did not exhale the residual volume (64%) before inhalation of the drug and sustained for 5-10 s after inhalation (56%). Conclusion: The most commonly used device was pMDI, and the most common error in their use was the absence of exhalation of residual lung volume before inhalation of the drug. The study emphasized the need to conduct a larger research on the issue to get better insight into it with the aim of improving the quality of life in asthma and COPD patients