Intoksikacija nafazolin kapima za nos u djece

Naphazoline, a sympathomimetic and an imidazoline derivative, is used as 0.05-0.1% solution for local decongestion of the nasal and ocular mucosa. In excessive dosage, or if ingested by accident, may cause depression of the central nervous system (disturbances of consciousness progressing to coma), hypothermia, bradycardia and sweating. These naphazoline effects are particularly strongly pronounced in children. Anglo-Saxon pharmacotherapy excludes the application of naphazoline nasal drops in children younger than six years, whereas the Croatian pharmacotherapeutic literature (and practice) allows its use even in infancy. At the Kantrida Paediatric Clinic, Clinical Hospital Centre in Rijeka, 11 children with signs of intoxication with naphazoline nasal drops were hospitalized from 1990 to 1992. The symptoms pertaining to the central nervous system i.e. disturbances of consciousness in the form of somnolence were dearly marked in all children. Some children developed skin pallor, bradycardia, bradypnoea and hypothermia. Resolution occurred within 24 hours and the findings relumed to normal values. Clinical picture followed by rapid resolution and normal findings, with a personal history of drug taking, is a safe indication for diagnosis. There are several reasons to account for intoxication (drops difficult to use with children, containers inadequate for proper dosage), but the major factor is the age of the patient - all hospitalized children were younger than six years. It is pointed out that administration of naphazoline drops at an early age is not advisable.Nafazolin je simpatomimetik, derivat imidazolina, a primjenjuje se kao 0,05-0,1 % otopina za lokalnu dekongestiju sluznice oka i nosa. Predoziran ili slučajno uzet peroralno može uzrokovati depresiju središnjeg živčanog sustava (poremećaje svijesti sve do kome) te hipotermiju, bradikardiju i znojenje. Navedeni učinci nafazolina napose su izraženi u djece. Anglosaksonska farmakoterapija isključuje primjenu nafazolina u djece do šest godina starosti doćim naša farmakoterapijska literature (a i praksa) dopušta njegovu uporabu već od dojenačke dobi. Na Klinici za dječje bolesti Kantrida Kliničkog bolničkog centra u Rijeci, u razdoblju od 1990. do 1992. godine hospitalizirano je 11-ero djece sa znacima trovanja nafazolin kapima za nos. U sve djece bili su izraženi simptomi poremećaja središnjeg živčanog sustava i to poremećaji svijest u vidu somnolencije. U neke djece pridruženo je bilo i bljedilo kože, bradikardija, bradipneja i hipotermija. Oporavak je u sve djece uslijedio unutar 24 sata, a učinjenom obradom dobiveni su uredni nalazi. Klinička slika s brzim oporavkom i urednim nalazima uz anamnestički podatak o uzimanju lijeka siguran je putokaz k dijagnozi. Razloga koji su doveli do otrovanja ima više (otežano ukapavanje djeci neadekvatna ambalaža za ispravno doziranje) no svakako je najistaknutiji faktor uzrast. Sva hospitalizirana djeca bila su naime mlađa od šest godina. Zaključuje se da u ovoj starosnoj skupini nije uputno primjenjivati nafazolin kapi. Farmaceutsku industriju valja upozoriti na neke osobitosti dječje dobi koja postavlja specifične zahtjeve za oblikom i ambalažom ljekovitog pripravka, a domaću farmakoterapijsku literaturu obogatiti ovim spoznajama

Financial performance–efficiency nexus in public health services: A nonparametric evidence-based approach

Public health services, as a preventive aspect of health care, are essential for the sustainability of the entire health care system. However, the context of public health services, which focus is primarily on prevention, is not a common setting when measuring the efficiency within nonparametric evidence-based approach. The aim of this study is to measure the efficiency of the financial performance of organizational units of the public health institute in Croatia, the Health Ecology Department in particular, during the period 2016–2018 using data envelopment analysis. Among the many reasons behind choosing this nonparametric method is the fact that it identifies the sources of inefficiency and specifies the directions and magnitudes of improvements required. Two input-oriented models – CCR under constant and BCC under variable returns-to-scale assumption – are employed for evaluating three types of efficiency – technical, pure technical and scale efficiency. Two hypotheses are examined and empirically confirmed: first, that there is significant between-unit variability in financial performance, and second, that investments are the major source of inefficiency among the observed indicators. The results have additionally revealed that the mentioned differences are less pronounced in the case of pure technical efficiency, implying that the overall inefficiency of the Health Ecology Department units can be generally attributed to scale efficiency. Besides, only three out of twelve department units are considered efficient. The implications of the research results are aimed at further research and testing the efficiency of the entire network of public health institutes, as well as to provide policy makers with new insights when considering different modes of organizing and delivering public health services