Inervacijsko područje glosofaringealnog živca kao ishodište orofacijalne boli - dijagnostički i terapijski izazov

Chronic neuropathic orofacial pain along with physical suffering can cause emotional, psychological and social difficulties, which significantly affects the quality of life of patients. Pain in the area of glossopharyngeal nerve innervation, especially chronic neuropathic, is relatively rare, but is significant because of the great suffering it causes to sufferers. It can be life threatening, due to the cardiac arrhythmia, syncope or convulsions it can cause. Drug treatment is often of limited effectiveness and can be fraught with side effects. It is necessary to look for the etiology of the underlying disease, and if possible, to take adequate causal treatment. This review article discusses the etiology, clinical features, differential diagnosis, and treatment modalities of neuropathic pain in the area of glossopharyngeal nerve innervation.Kronična neuropatska orofacijalna bol uz fizičku patnju može uzrokovati emocionalne, psihičke i socijalne poteškoće, što značajno utječe na kvalitetu života bolesnika. Bol u inervacionom području glosofaringealnog živca, osobito kronična neuropatska, relativno je rijetka, ali je značajna zbog velike patnje koju može uzrokovati oboljelima. Istodobno, može biti životno ugrožavajuća, zbog srčane aritmije, sinkope ili konvulzija koje može uzrokovati. Medikamentno liječenje je često ograničene učinkovitosti i može biti opterećeno nuspojavama. Neophodno je tragati za etiologijom poremećaja, te po mogućnosti poduzeti adekvatno kauzalno liječenje. Ovaj pregledni članak govori o etiologiji, kliničkim značajkama, diferencijalnoj dijagnostici i modalitetima liječenja kronične neuropatske boli koja potječe iz inervacionog područja glosofaringealnog živca

Učestalost konverzije epiduralne analgezije u regionalnu ili opću anesteziju kod carskog reza

Introduction: Epidural analgesia is acknowledged as the most common method of analgesia during labor. If emergent Caesarean section (CS) is indicated in parturient with existing labor epidural, the need for conversion from epidural analgesia to regional (RA) or general anesthesia (GA) increases accordingly. Recent guidelines suggest the rate of conversion to general anesthesia shows the quality of obstetric anesthesia care and should be under 5%. The aim: The aim of this study is to determine the conversion rate from epidural analgesia to Caesarean section anesthesia in “Sveti Duh” University Hospital Zagreb in order to enhance the quality of anesthetic care for obstetric patients. Methods: We retrospectively included in the study all parturients who received epidural labor analgesia but needed subsequent regional or general anesthesia for Caesarean section in our institution for the period of 1st January 2021 to 31st December 2021. After the data analysis on the conversion rate from epidural analgesia to Caesarean section anesthesia had been performed, we compared our data to current standards and relevant literature findings. Results: Altogether 1202 epidural catheters were placed for labor analgesia in the study period, and in 199 of these cases, the emergent Caesarean section was indicated. Epidural analgesia was converted to epidural anesthesia (EA) in 153 (76,9%) parturients, to general anesthesia in 40 (20,1%), and to spinal anesthesia (SA) in six (3%) parturients. After comparison with recommended quality standards and with the results of similar studies by other authors, our findings show a significantly higher rate of conversion from epidural analgesia to general anesthesia than has been desirable since then. Conclusion: In order to reach the required quality standards regarding the conversion rate from epidural analgesia to Caesarean section anesthesia, it is necessary to improve the organization of the work of the obstetric anesthesiology team according to the principle of subspecialization. It is imperative to implement the best clinical practice protocols for obstetric anesthesiologists, but also to enhance the communication and coordination with the obstetric team.Uvod: Epiduralna analgezija za porođaj danas je najčešća metoda analgezije tijekom porođaja. Zahvaljujući tome sve češće se javlja potreba za konverzijom iz epiduralne analgezije u regionalnu ili opću anesteziju u slučaju indikacije za hitni carski rez. Prema standardima kvalitete konverzija u opću anesteziju ne bi trebala prelaziti 5%. Cilj: Na vlastitom uzorku provesti analizu prakse konverzije epiduralne analgezije u anesteziju za carski rez retrospektivnom analizom jednogodišnjeg razdoblja kako bi se utvrdila područja za poboljšanjem u dnevnoj praksi. Ispitanici i metode: Analizirana je učestalost i konverzije epiduralne analgezije u regionalnu ili opću anesteziju u razdoblju od 01. 01. 2021. do 31. 12. 2021. Dobiveni podaci o učestalosti konverzije u pojedinu vrstu anestezije za carski rez uspoređeni su sa standardom kao i podacima sličnih istraživanja. Rezultati: Tijekom ispitivanog razdoblja stavljena su 1202 epiduralna katetera za analgeziju porođaja od čega je u 199 slučajeva nastupila indikacija za hitni carski rez te je epiduralna analgezija u 153 (76,9%) slučaja konvertirana u epiduralnu anesteziju, u 40 (20,1%) slučajeva u opću anesteziju i u 6 (3%) slučajeva u spinalnu anesteziju. Usporedba dobivenih rezultata s rezultatima drugih autora kao i zadanim standardima kvalitete ukazuje na značajno višu učestalost konverzije epiduralne analgezije u opću anesteziju u odnosu na poželjno. Zaključak: Za približavanje svjetskim standardima kvalitete opstetričke anestezije u segmentu konverzije epiduralne analgezije u anesteziju za carski nužno je unaprijediti organizaciju rada opstetričkog anesteziološkog tima prema principu subspecijalizacije. Potrebno je uvesti jasne zajedničke protokole za rad opstetričkih anesteziologa te unaprijediti komunikaciju i koordinaciju s opstetričkim timom

Patofiziološke osnove i indikacijsko područje primjene lasera male snage u liječenju akutne i kronične boli

Primjena lasera male snage u liječenju akutne i kronične boli datira unatrag 30 godina. Cilj su ovog članka opis spoznaja o mehanizmima djelovanja lasera na bol te upute za njegovu učinkovitiju primjenu u terapiji pojedinih bolnih stanja. Prema zadanim ključnim riječima, pregledali smo literaturu na engleskom i hrvatskom jeziku objavljenu od 1988. do 2018. godine u bazama Scopus, Medline, Embase, Web of Science i Cochrane Library. Izdvojeni su i citirani radovi primjereni ciljevima ovoga kratkog pregleda. Iako patofiziološki učinci laserske zrake na oštećeno tkivo nisu potpuno poznati ni danas, dosadašnje spoznaje upućuju na biostimulativne efekte koji potiču brže saniranje i regeneraciju oštećenih tkiva poboljšanjem dopreme energenata i kisika u stanice, smanjenje upalne komponente i edema, a time i smanjenje boli te oporavak funkcije. Velik je broj objavljenih kliničkih studija koje dokazuju djelotvornost lasera u terapiji različitih bolnih stanja, ali brojne dobro dizajnirane randomizirane studije pokazale su da su ti učinci često na razini placeba ili usporedivi s učinkom drugih metoda u fizikalnoj terapiji. Poseban problem u istraživanju čini velika paleta laserskih uređaja čije sonde isporučuju zrake različitih valnih duljina, od 600 do 1000 nm, u širokom rasponu snage od 5 do 500 mW te različitih modaliteta emitiranja, od kontinuiranoga do pulsirajućega. Da bismo postigli biostimulativno djelovanje na oštećeno tkivo, ono mora primiti odgovarajuću količinu energije od 1 do 2 J/cm2 pri akutnim stanjima odnosno od 4 do 8 J/cm2 kod kroničnih stanja. Da bi primjena lasera bila djelotvorna komplementarna metoda liječenja boli, moraju se optimizirati parametri valne duljine, snaga sonde i modalitet emitiranja

The Survival Rate of Lung Transplant Patients in Croatia

INTRODUCTION AND OBJECTIVE Nowadays, lung transplantation is accepted modality of treatment for well-selected patients suffering from terminal, non-malignant respiratory disease. The aim of this study was to determine post-transplant survival rate and to give general overview of lung transplant patients in Croatia. Patients studied in this research were transplanted through the lung transplantation programme at Clinical Centre for Pulmonary Diseases Jordanovac, University Hospital Centre Zagreb. METHODS The research is retrospective analysis of prospectively collected data on 71 patients from year 2001 until February 2019. Descriptive statistics were calculated and survival outcomes were analysed by the Kaplan-Meier method. RESULTS Since the first transplantation in February 2001 to February 2019 all transplantations through lung transplantation programme in Croatia were performed in AKH Vienna. Total number of transplanted patients, was 71 (33 male (46,48%) and 38 female (53,52%)) with median of age 52. Survival rate after the 1 st post-transplant year was 79,1% after 3 rd year 69,8% and after 5 th year 63,0% with mean survival rate of 78,96 months. The time on the waiting list increased from median of 61,5 days (in years 2010-2015) to 138,5 days (in years 2015-2018). Clinically significant graft rejection experienced 39,4% of patients after median time of 61,56 months. CONCLUSION Survival rate of lung transplanted patient in Croatia is comparable to other European countries. Analysing such a type of data is crucial in addressing possible improvement measures and broadening general knowledge in the field. In the aim to improve patient outcomes excellent teamwork among all involved specialists and strict patient follow-up are of utmost importance

Monitoring of Large Mammals on Velebit Mountain During 2018 and 2019

Tijekom posljednjih trideset godina fotozamke su se razvile u najvažniju neinvazivnu metodu praćenja divljih životinja. Pravilno postavljanje, odabir lokacija i odgovarajućih postavki fotozamki uvelike utječu na količinu i kvalitetu prikupljenih podataka te na završne analize. Cilj ovog rada bio je uspostaviti sustav praćenja velikih vrsta sisavaca na području Velebita i optimizirati metodologiju. Tijekom 2018. i 2019. godine na ukupno 64 lokacije na Velebitu postavljene su fotozamke koje su bile aktivne 8068 dana. U ukupno 4444 događaja zabilježeno je 6912 pojedinačnih životinja, koje pripadaju u 23 divlje vrste te pet vrsta domaćih životinja. Zabilježene su sve vrste velikih sisavaca prethodno opisane na području Velebita. Potvrđeno je da su šumske ceste i životinjski putovi odgovarajuće lokacije za praćenje velikih sisavaca te da su životinje najviše aktivne u razdoblju od lipnja do rujna.Over the last 30 years, camera traps have become the most important non-invasive tool for monitoring wildlife. Proper placement, location selection and suitable camera settings greatly affect the quantity and quality of data collected, and therefore the final results. The objective of this research was to establish the monitoring of large mammals on Velebit mountain with camera traps and to optimize the methodology used. During 2018 and 2019, camera traps were set at 64 different locations on Velebit and were active for 8068 days. In total of 4444 events, there were 6912 different individual animals recorded, of which 23 species were belonging to wildlife and five species of domestic animals. All species of large mammals previously described on Velebit were recorded. We confirmed that forest roads and animal paths are the best locations for monitoring large mammals and that animals are the most active in the period from June to September

WEIGHT GAIN IN LUNG TRANSPLANTATION PATIENTS DURING THE COVID-19 PANDEMIC IN CROATIA

Background: To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic. Subjects and methods: We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status. Results: An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable. Conclusion: Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation

WEIGHT GAIN IN LUNG TRANSPLANTATION PATIENTS DURING THE COVID-19 PANDEMIC IN CROATIA

Background: To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic. Subjects and methods: We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status. Results: An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable. Conclusion: Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation

Treatment outcomes and five-year survival of patients with nontuberculous mycobacterial pulmonary disease in Croatia

Plućne manifestacije netuberkuloznih mikobakterijskih infekcija (NTM-PD) najčešći su oblik bolesti i sve se više prepoznaju kao važan klinički entitet u ljudi. Najčešće zahvaćaju stariju populaciju s predležećim kroničnim plućnim bolestima. Cilj ove studije bio je utvrditi karakteristike bolesnika s NTM-PD u Hrvatskoj te zabilježiti kliničke ishode i dugoročno preživljavanje nakon završetka terapije. Ovaj stručni rad predstavlja retrospektivnu kohortnu studiju na svim hrvatskim stanovnicima s NTM izoliranim iz respiratornih uzoraka u razdoblju od 1. siječnja 2006. do 31. prosinca 2015. i praćenjem do 31. prosinca 2018. Podaci analizirani u ovoj studiji predstavljaju centralizirane podatke Nacionalnoga registra bolesnika s izoliranim NTM koji se od 2008. godine vodi u Nacionalnome referentnome laboratoriju za mikobakterije (NRML) pri Hrvatskom zavodu za javno zdravstvo (HZJZ), a sadrži kliničke, radiološke te podatke o ishodu liječenja i datum smrti. Tijekom promatranoga razdoblja, u registru je identificirano ukupno 2109 epizoda plućnih NTM izolata kod 2050 bolesnika. Kriteriji za definitivnu bolest zadovoljilo je 137 (29,3%), a bez bolesti 302 (64,3%) od ukupno 468 epizoda s potpunom medicinskom dokumentacijom. Preostalih je 29 (6,2%) epizoda klasificirano kao vjerojatna bolest. Medijan dobi bolesnika s definitivnom NTM plućnom bolesti iznosio je 66,5 (16-90) godina. Od ukupnoga broja bolesnika u ovoj skupini, 62 (45,3%) bolesnika su bile žene. Najčešći komorbiditet u 44,5% bolesnika bila je kronična opstruktivna plućna bolest. Mikrobiološko izlječenje postignuto je u 82,8% bolesnika nakon adekvatnoga NTM liječenja, u 64,7% bolesnika liječenih TB protokolom, te u 64,3% bolesnika liječenih kratkim NTM protokolom, a spontana konverzija kulture u 41,2% neliječenih bolesnika. U Hrvatskoj NTM plućnu bolest najčešće uzrokuje M. xenopi i MAC s ukupnim 5- godišnjom smrtnošću od 36.5%. Terapija prema smjernicama rezultirala je četiri puta većom vjerojatnošću izlječenja u usporedbi s neadekvatno liječenima ili neliječenim bolesnicima. Ishodi liječenja razlikuju se prema terapijskom režimu i uzročnoj vrsti mikobakterije. Rano započinjanje terapije moglo bi unaprijediti kratkoročne ishode. Potrebna su daljnja istraživanja kako bi se utvrdio utjecaj na dugoročno preživljenje.Pulmonary manifestations of non-tuberculous mycobacterial infections (NTM-PD) are the most common form of the disease and are increasingly recognized as an important clinical entity in humans, most commonly affecting the elderly population with pre-existing chronic lung disease. The aim of this study was to determine characteristics of NTM-PD patients in Croatia, and record clinical outcomes and long-term survival after therapy completion. This study represents a retrospective cohort study on all Croatian residents with NTM isolates from respiratory samples in the period from 1 January 2006 to 31 December 2015 and a follow-up until 31 December 2018. The data analyzed in this study represent centralized data from the National registry of patients with NTM isolate founded in 2008 and managed at the National Reference Mycobacteria Laboratory (NRML) at the Croatian Institute of Public Health (CIPH), containing clinical, radiological and data on treatment outcomes and date of death. During the observed period, in the NRML a total of 2109 episodes of pulmonary NTM isolates were identified in 2050 patients. Criteria for definite disease were met by 137 (29.3%) while for no disease by 302 (64.3%) from total of 468 episodes with full medical records. Remaining 29 (6.2%) episodes were classified as probable disease. The median age of patients with definitive NTM lung disease was 66.5 (16-90) years. Of the total number of patients in this group, 62 (45.3%) patients were women. The most common comorbidity was chronic obstructive pulmonary disease, in 44.5% of patients. Microbiological cure was observed in 82.8% of patients after adequate NTM treatment, in 64.7% of patients treated with TB protocol, and in 64.3% of patients treated with short NTM protocol while spontaneous culture conversion was observed in 41.2% of untreated patients. In Croatia, NTM-PD was most commonly caused by M. xenopi and MAC with 36.5% 5-year mortality. Guideline-compliant treatment resulted in a four times higher chance of being cured. Treatment outcomes differed with respect to different treatment regimens and causal species. Early treatment initiation may improve short term outcomes while further investigations are needed to determine impact on the long-term survival

Treatment outcomes and five-year survival of patients with nontuberculous mycobacterial pulmonary disease in Croatia

Plućne manifestacije netuberkuloznih mikobakterijskih infekcija (NTM-PD) najčešći su oblik bolesti i sve se više prepoznaju kao važan klinički entitet u ljudi. Najčešće zahvaćaju stariju populaciju s predležećim kroničnim plućnim bolestima. Cilj ove studije bio je utvrditi karakteristike bolesnika s NTM-PD u Hrvatskoj te zabilježiti kliničke ishode i dugoročno preživljavanje nakon završetka terapije. Ovaj stručni rad predstavlja retrospektivnu kohortnu studiju na svim hrvatskim stanovnicima s NTM izoliranim iz respiratornih uzoraka u razdoblju od 1. siječnja 2006. do 31. prosinca 2015. i praćenjem do 31. prosinca 2018. Podaci analizirani u ovoj studiji predstavljaju centralizirane podatke Nacionalnoga registra bolesnika s izoliranim NTM koji se od 2008. godine vodi u Nacionalnome referentnome laboratoriju za mikobakterije (NRML) pri Hrvatskom zavodu za javno zdravstvo (HZJZ), a sadrži kliničke, radiološke te podatke o ishodu liječenja i datum smrti. Tijekom promatranoga razdoblja, u registru je identificirano ukupno 2109 epizoda plućnih NTM izolata kod 2050 bolesnika. Kriteriji za definitivnu bolest zadovoljilo je 137 (29,3%), a bez bolesti 302 (64,3%) od ukupno 468 epizoda s potpunom medicinskom dokumentacijom. Preostalih je 29 (6,2%) epizoda klasificirano kao vjerojatna bolest. Medijan dobi bolesnika s definitivnom NTM plućnom bolesti iznosio je 66,5 (16-90) godina. Od ukupnoga broja bolesnika u ovoj skupini, 62 (45,3%) bolesnika su bile žene. Najčešći komorbiditet u 44,5% bolesnika bila je kronična opstruktivna plućna bolest. Mikrobiološko izlječenje postignuto je u 82,8% bolesnika nakon adekvatnoga NTM liječenja, u 64,7% bolesnika liječenih TB protokolom, te u 64,3% bolesnika liječenih kratkim NTM protokolom, a spontana konverzija kulture u 41,2% neliječenih bolesnika. U Hrvatskoj NTM plućnu bolest najčešće uzrokuje M. xenopi i MAC s ukupnim 5- godišnjom smrtnošću od 36.5%. Terapija prema smjernicama rezultirala je četiri puta većom vjerojatnošću izlječenja u usporedbi s neadekvatno liječenima ili neliječenim bolesnicima. Ishodi liječenja razlikuju se prema terapijskom režimu i uzročnoj vrsti mikobakterije. Rano započinjanje terapije moglo bi unaprijediti kratkoročne ishode. Potrebna su daljnja istraživanja kako bi se utvrdio utjecaj na dugoročno preživljenje.Pulmonary manifestations of non-tuberculous mycobacterial infections (NTM-PD) are the most common form of the disease and are increasingly recognized as an important clinical entity in humans, most commonly affecting the elderly population with pre-existing chronic lung disease. The aim of this study was to determine characteristics of NTM-PD patients in Croatia, and record clinical outcomes and long-term survival after therapy completion. This study represents a retrospective cohort study on all Croatian residents with NTM isolates from respiratory samples in the period from 1 January 2006 to 31 December 2015 and a follow-up until 31 December 2018. The data analyzed in this study represent centralized data from the National registry of patients with NTM isolate founded in 2008 and managed at the National Reference Mycobacteria Laboratory (NRML) at the Croatian Institute of Public Health (CIPH), containing clinical, radiological and data on treatment outcomes and date of death. During the observed period, in the NRML a total of 2109 episodes of pulmonary NTM isolates were identified in 2050 patients. Criteria for definite disease were met by 137 (29.3%) while for no disease by 302 (64.3%) from total of 468 episodes with full medical records. Remaining 29 (6.2%) episodes were classified as probable disease. The median age of patients with definitive NTM lung disease was 66.5 (16-90) years. Of the total number of patients in this group, 62 (45.3%) patients were women. The most common comorbidity was chronic obstructive pulmonary disease, in 44.5% of patients. Microbiological cure was observed in 82.8% of patients after adequate NTM treatment, in 64.7% of patients treated with TB protocol, and in 64.3% of patients treated with short NTM protocol while spontaneous culture conversion was observed in 41.2% of untreated patients. In Croatia, NTM-PD was most commonly caused by M. xenopi and MAC with 36.5% 5-year mortality. Guideline-compliant treatment resulted in a four times higher chance of being cured. Treatment outcomes differed with respect to different treatment regimens and causal species. Early treatment initiation may improve short term outcomes while further investigations are needed to determine impact on the long-term survival