70 research outputs found
Technological design – Research and practice in the architectural project. Progettazione tecnologica - Ricerca e pratica nel progetto di architettura
Technological culture, theories and practice in architectural design
Neuroinvazivna West Nile virusna (NI WNV) bolest predstavlja rijetko, ali teÅ”ko oÄitovanje WNV infekcije. Na ovaj naÄin oboli manje od 1% bolesnika. RiziÄni Äimbenici za pojavu NI WNV infekcije su starija životna dob, kroniÄne bolesti (Å”eÄerna bolest, hipertenzija) te imunosupresija (najÄeÅ”Äe zbog transplantacije solidnih organa). NI WNV infekcija najÄeÅ”Äe se oÄituje sindromom meningoencefalitisa, mijelitisa ili flakcidne pareze. Kako je u Hrvatskoj 2018. godine zabilježena do sada najveÄa epidemija WNV bolesti, u ovom radu želimo prezentirati kljuÄne znaÄajke bolesnika s teÅ”kim oblikom NI WNV infekcije koji su lijeÄeni u Zavodu za intenzivno lijeÄenje i neuroinfektologiju Klinike za infektivne bolesti āDr. Fran MihaljeviÄā u Zagrebu tijekom navedenog epidemijskog razdoblja. LijeÄeno je 12 bolesnika, od toga 8 muÅ”karaca, medijan dobi iznosio je 73 (minimum 59, maksimum 84) godine. Pet bolesnika bili su iz Grada Zagreba, 2 iz ZagrebaÄke, te po jedan bolesnik iz KarlovaÄke, MeÄimurske, KoprivniÄko-križevaÄke, Varaždinske i VirovitiÄke županije. Polovica bolesnika su stanovnici prigradskih naselja, dok su polovica bili stanovnici gradova. Za dvojicu bolesnika je bilo poznato da su 4 tjedna ranije putovali (iz Ohio, SAD i u Bosansku GradiÅ”ku, BIH). Niti jedan bolesnik nije imao podatak o prethodnom cijepljenju protiv krpeljnog meningoencefalitisa i/ili žute groznice. VeÄina bolesnika su naveli komorbiditete, od kojih su najÄeÅ”Äi bili arterijska hipertenzija (11/12), Å”eÄerna bolest (4/12) i hiperlipidemija (3/12). Dvojica bolesnika su imali transplantiran bubreg (4 tjedna ranije i 5 godina ranije) te su primali imunosupresiju. Vrijeme od pojave prvih simptoma do hospitalizacije iznosilo je medijan 5 (minimum 1, maksimum 13) dana. NajÄeÅ”Äi kliniÄki simptomi bili su vruÄica (12/12), kvantitativni poremeÄaj svijesti (6/12), gastrointestinalni simptomi (6/12), glavobolja (4/12) te opÄa slabost (4/12). Svi bolesnici su se prezentirali kliniÄkom slikom meningoencefalitisa. Tijekom lijeÄenja u intenzivnoj jedinici 8 bolesnika su intubirani i mehaniÄki ventilirani, medijan trajanja mehaniÄke ventilacije bio je 14.5 dana (minimum 5, maksimum 73 dana). Medijan trajanja hospitalizacije u JIL-u iznosio je 24.5 dana (minimum 4, maksimum 73 dana), dok je medijan trajanja ukupne hospitalizacije iznosio 51.5 dan (minimum 19, maksimum 97 dana). Dva bolesnika su preminula tijekom lijeÄenja u JIL-u. Medijan Glasgow outcome score (GOS) kod otpusta iz JIL-a iznosio 3 (minimum 3, maksimum 4). Karnofsky performance score iznosio je median je 40% (minimum 30% do 70%).
ZakljuÄno se može reÄi da je u RH, NI WNV bolest rijetka, uglavnom pogaÄa bolesnike starije životne dobi sa znaÄajnim komorbiditetima (arterijska hipertenzija, Å”eÄerna bolest, stanje nakon transplantacije bubrega). Ovi bolesnici Äesto imaju potrebu za intenzivnim lijeÄenjem, intubacijom, produženom mehaniÄkom ventilacijom, dugim boravkom u JIL-u i dugotrajnom hospitalizacijom te kasnijom medicinskom rehabilitacijom. Dakle, radi se o životno ugrožavajuÄi bolesti koja pacijentima može teÅ”ko naruÅ”iti zdravlje, te predstavlja veliki izazov za lijeÄenje.Neuroinvasive West Nile viral (NI WNV) disease is a rare but difficult manifestation of WNV infection. Less than 1% of infected patients will be affected with neuroinvasive disease. The risk factors for NI WNV infection are older age, chronic illness (diabetes, hypertension) and immunosuppression (most commonly due to organ transplantation). NI WNV infection is most often manifested by meningoencephalitis syndrome, myelitis, or flaccid paresis. The largest epidemic of WNV infection ever recorded in Croatia was in 2018. In this paper, we will present the key features of the severe form of NI WNV infection that has been treated at the Department for intensive medicine and neuroinfections of the University Hospital for Infectious Diseases "Dr. Fran MihaljeviÄ ", Zagreb during 2018 epidemic period. Of the 12 patients treated, 8 were males, the median patient age was 73 (minimum 59, maximum 84) years. Five patients were from the Grad Zagreb County, 2 from ZagrebaÄka County and one from KarlovaÄka, MeÄimurska, KoprivniÄko-križevaÄka, Varaždinska and VirovitiÄka County. Half of the patients were residents of suburb areas, while half of them were town residents. Two patients reported traveling 4 weeks earlier (from Ohio, USA and Bosanska GradiÅ”ka, BIH). None of the patients provided any information on previous vaccination against tick-borne encephalitis and/or yellow fever. Most patients reported comorbidities, most commonly arterial hypertension (11/12), diabetes (4/12) and hyperlipidemia (3/12). Two patients had transplanted kidney (4 weeks earlier and 5 years earlier) and received immunosuppression. The time period from first symptoms onset to hospitalization was median 5 (minimum 1, maximum 13) days. The most common clinical symptoms were fever (12/12), altered mental status (6/12), gastrointestinal symptoms (6/12), headache (4/12) and general weakness (4/12). All patients presented with a clinical feature of a meningoencephalitis. During treatment in the Intensive care unit (ICU), 8 patients were intubated and mechanically ventilated, the median duration of mechanical ventilation was 14.5 days (minimum 5, maximum 73 days). The median duration of hospitalization in ICU was 24.5 days (minimum 4, maximum 73 days), while the median duration of total hospitalization was 51.5 days (minimum 19, maximum 97 days). Two patients died during treatment at ICU. Median Glasgow score (GOS) at the time of release from the ICU was 3 (minimum 3, maximum 4). Karnofsky performance score averaged 40% (minimum 30% to 70%).
To conclude, NI WNV disease in Croatia is rare, mainly affects elderly patients with significant comorbidities (arterial hypertension, diabetes mellitus, kidney transplant status). These patients often require intensive treatment, intubation, extended mechanical ventilation, long stay in ICU, long-term hospitalization and medical rehabilitation. NI WNV infection is a life-threatening disease that can severely affect patientās health and it presents a great therapeutic challenge
ES-LCA e patrimonio naturale. Life Cycle Analisi ambientale e sociale di un'area protetta
Accessibility indicator for a trails network in a Nature Park as part of the environmental assessment framework
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