Svjetska provincija kritičke rasudbe

Prikaz knjige Marka Grčića, Provincia deserta, Kolo, Zagreb, 1971

Venomous Snakebites in Southern Croatia

This retrospective study is based on the analysis of 542 snakebite envenomation cases in southern Croatia, which were treated in the University Hospital Split over the period of 21 years. The aim of this study was to determine the incidence of venomous snakebite in southern Croatia, epidemiological and clinical features of snakebite and treatment in the region. The mean annual snakebite incidence in southern Croatia was 5.2 per 100,000 inhabitants. The nose- horned viper (Vipera ammodytes) was responsible for most bites, only a small proportion being inflicted by the adder (Vipera berus). People of all ages were affected (1 – 82 year old), but the bites were more frequent in individuals older than 50 (46% of the cases) and in children and adolescents 19 year old and younger (27% of the cases). Most snakebite accidents happened in warm spring and summer months, the highest number occurring in May (22%). A majority of the victims were rural people engaged in agricultural activities. Bites on the upper limbs were more frequent (57%) than bites on the lower limbs (42%). With regard to envenomation severity, there were 15.1% minor, 40.5% mild, 26% moderate and 18% severe cases. Two victims died (0.4%). The antivenom produced by the Institute of Immunology in Zagreb was given to virtually all patients, and complications following its administration were rare. The antivenom was used more often than it was suggested by the symptoms present

Diagnosis of Visceral Leishmaniasis by Fine Needle Aspiration Cytology of an Isolated Cervical Lymph Node: Case Report

A 61-year-old woman presented with an isolated, painless, slightly enlarged right laterocervical lymph node without any other signs and symptoms of disease. Laboratory test including hematological and biochemical parameters were normal. A cervical ultrasonography demonstrated one lymph node (10 mm) on the right laterocervical side and one small reactive lymph node on the left laterocervical side. The fine needle aspiration (FNA) smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, epitheloid cells, plasma cell, tingible body macrophages and macrophages infiltrated with Leishmania amastigotes. Treatment was initiated with Stiboglukonat Na (Pentostam) and led to a full recovery

Diagnosis of Visceral Leishmaniasis by Fine Needle Aspiration Cytology of an Isolated Cervical Lymph Node: Case Report

A 61-year-old woman presented with an isolated, painless, slightly enlarged right laterocervical lymph node without any other signs and symptoms of disease. Laboratory test including hematological and biochemical parameters were normal. A cervical ultrasonography demonstrated one lymph node (10 mm) on the right laterocervical side and one small reactive lymph node on the left laterocervical side. The fine needle aspiration (FNA) smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, epitheloid cells, plasma cell, tingible body macrophages and macrophages infiltrated with Leishmania amastigotes. Treatment was initiated with Stiboglukonat Na (Pentostam) and led to a full recovery

Kolonizacija vankomicin rezistentnom bakterijom Enterococcus faecium i Clostridium difficile infekcija u hematološke bolesnice

Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. The patient received prolonged broad-spectrum antimicrobial therapy. During hospital stay, the patient developed Clostridium difficile infection (CDI) and was found to be colonized with a strain of Enterococcus faecium resistant to vancomycin during therapy for CDI. This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory.Vankomicin-rezistentni enterokoki (VRE), naročito Enterococcus faecium, spadaju među najznačajnije bolničke patogene, pri čemu su naročito ugroženi bolesnici oslabljenog imunosnog statusa. Pritom je najčešća pojava asimptomatske kolonizacije probavnog sustava koja može ustrajati duže vremena i biti rezervoar za širenje VRE na ostale bolesnike. Donosimo prikaz slučaja bolesnice s dijagnozom akutne mijelomonocitne leukemije praćene aplazijom koštane srži nakon indukcijske terapije. Bolesnica je liječena antibioticima širokog spektra. Tijekom hospitalizacije u bolesnice se razvila infekcija bakterijom Clostridium difficile (CDI) uz dokazanu kolonizaciju sojem Enterococcus faecium rezistentnog na vankomicin tijekom terapije zbog CDI. Također su prikazani čimbenici rizika koji su u navedenom slučaju mogli poslužiti kao potencijalni okidač za razvoj rezistencije, s osobitim naglaskom na CDI. Rano otkrivanje kolonizacije ili infekcije navedenim sojevima je iznimno značajan čimbenik bolničkog programa za prevenciju širenja bolničkih infekcija. Mikrobiološki nadzor uzimanjem nadzornih kultura mora biti obvezni dio protokola pri hospitalizaciji takvih bolesnika

Klinički prikaz genitourinarne tuberkuloze sa sumnjom na abdominalnu neoplazmu

Genital tuberculosis is a rare and unexpected disease in European countries including Croatia. Diagnosis of female genital tract tuberculosis is challenging and is rarely pin-pointed by clinical symptoms because of their low specificity. The authors decided to present a case of genitourinary tuberculosis in a young, immunocompetent fertile woman with high clinical suspicion of abdominal tumor mass. Although considered a desease of the past, rare clinical presentation of genital tuberculosis should be expected and taken into account.Genitalna tuberkuloza rijetka je i neočekivana bolest u zemljama Europske unije uključujući i Hrvatsku. Postavljanje dijagnoze tuberkuloze genitalnog sustava otežano je nespecifičnim simptomima. Prikazujemo slučaj genitourinarne tuberkuloze kod mlade imunokompetentne žene generativne dobi gdje je klinička dijagnoza upućivala na abdominalnu neoplazmu. U vremenu velikih društvenih promjena prisutnih posljednjih godina rijetke kliničke prezentacije tuberkuloze i dalje su moguće kao diferencijalna dijagnoza

Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

Aim Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV). Methods Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV. Results In the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients. Conclusion This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients