Merkel Cell Carcinoma: Case Report

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin. Although it is 40 times less common than malignant melanoma, its mortality is much higher compared to melanoma. From 1986 to 2001 there was rapidly increasing incidence in reported cases of MCC, with a tripling in the rate over this 15-year period. The vast majority of MCC presents on sun-exposed skin. The head and neck area is the most common site of tumor occurrence. We present 70-year old female patient with painless red-colored nodule, size 2x2x2 cm on the dorsal side of mid left forearm. The surgical excision with negative margins was performed, and pathohistological analysis confirmed Merkel cell carcinoma. Sentinel lymph node biopsy was negative. In conclusion, as MCC is a very aggressive rare skin carcinoma with lethal outcome, it should be mandatory to perform biopsies of any suspected skin lesion

RISK FACTORS AND INJURY CHARACTERISTICS AMONG YOUNGER SCHOOL CHILDREN

According to the World Health Organization data, millions of young people under the age of 18 die each year from injuries and the consequences of injuries. In developed countries, the mortality rate from child injury is considerably lower, but injuries are still the main cause of death, accounting for about 40% of total child mortality. As a consequence of the injury, disability, increased costs of treatment and rehabilitation, lost productivity and learning motivation arise. The aim of this study was to determine the frequency of injury in younger school children and to investigate the risk factors of these injuries. This cross-sectional study was conducted in April and May 2017. The study subjects were parents and guardians of children who were pupils of the first four grades of elementary school. The specially designed questionnaire that contained questions about sociodemographic characteristics and epidemiology of injury was used as a research tool. There was a total of 379 study subjects, of whom 289 (76.3%) were women. The average age of all study subjects was 39 (26-60) years. There were 316 (83.6%) employed, 58 (15.3%) unemployed, and 5 (1.3%) retired subjects. In the city lived 222 (58.6%) study subjects, in suburban settlement 83 (21.9%) and in village 74 (19.5%). There was statistically significant connection between the number of family members and the frequency of injuries (p=0.029) and the number of children in the family and the frequency of injuries (p=0.041). Injuries in younger school children were frequent in the observed population. Defining risk factors has a major role in preventing child injury

STRESS AT WORKPLACE AND OCCUPATIONAL INJURIES

Nurses and technicians are, at their primary job of patient care, exposed daily to various physical strains and stressful situations, which is why they are at risk of injury. The aim of this study was to investigate the frequency, type and circumstances of work injuries among nurses and technicians as well as to determine whether there is a connection between the injuries and sociodemographic and socioeconomic characteristics of the participants, as well as the connection between the injuries and the stress level at which the participants are exposed during their work. This cross-sectional study was conducted in April 2017 and included 191 nurses/technicians at the General Hospital Pula. A specially designed questionnaire was used to collect data about their age, gender, qualifications and socioeconomic status as well as the frequency and type of injuries that they had been experienced during stressful situations at work. In the last six months, there were 8.9% of those who experienced work injury. The most common were abdominal injuries, lower back and pelvis injuries, while stabs with the sharp object were the most common type of injury. There was statistically significant connection between the incidence of injuries and the shift work (p=0.032) as well as between the injuries and the stress level (p=0.046) in the last six months. To reduce the incidence of work injury in the observed population, it is necessary to reduce the shift work, and consequently reduce level of present stress

EPIDEMIOLOGICAL CHARACTERISTICS OF INJURIES IN YOUNG ADULTS FROM ISTRIA COUNTY

Injuries are among the most common causes of hospitalization, causing 10% of the total mortality in the world and are the cause of disability and professional and general inability to work. The aim of this study was to determine the epidemiological characteristics of injuries of young adults in the area of Istria County, treated for injuries in the General Hospital Pula, and to examine the connection of the recorded injuries with sociodemographic and socioeconomic indicators of the injured patients and their lifestyle habits. This cross-sectional study was conducted in April and May 2017 using a specially designed questionnaire. Out of 202 subjects 131 (64.9%) were men, the average age of all subjects was 28.8 years (19-39), and 150 (74.3%) of the subjects were employed. Women were statistically significantly more often injured as a result of fall, slippage or tripping (43.7%, p=0.010), while men were statistically significantly more often injured when using different tools and during excessive physical activity (44.3%, p=0.003). People of average economic status were more often injured than people with better economic status, both, at home (32.0%, p=0.049) and at work (27.0%, p=0.004). People of better economic status were more often injured on the roads (29.0%, p=0.010), in nature and recreation grounds (39.0%, p=0.030). Gender and socioeconomic status significantly affect the frequency of injury and the method of injury

SOCIAL INCLUSION AND INJURIES AMONG ELDERLY

Social inclusion, besides positively contributing to the longevity of an individual, can be a protective factor against various depressive and psychological states with preventative action on injury to older persons as well. The aim of this study was to investigate the association between epidemiological, socioeconomic and sociodemographic features of injuries occurring in the elderly, as well as the association of the social inclusion of the elderly and epidemiological characteristics of the injuries. This cross-sectional study was conducted in the Osijek area from June to August 2017 and involved 215 elderly people who independently completed an anonymous questionnaire that contained questions about sociodemographic, socioeconomic and epidemiological features associated with injuries that they had experienced during the last year as well as about their social inclusion. During one year, 54.9% of the elderly experienced an injury. Participants indicated fall or slip as the most common cause of injury and most commonly outside the home, while the most commonly injured parts of body were knee and ankle. Also, the study has shown how elderly with lower family contact (p=0.035) are at increased risk of injury. Given the frequency of injuries among elderly, an important factor in prevention of this public health problem should certainly be the possibility of their social inclusion as well as larger integration into society

CHARACTERISTICS AND INCIDENCE OF HEAD AND NECK SKIN MALIGNANT NEOPLASMS IN THE POPULATION OF THE OSIJEK-BARANYA COUNTY 2004-2012

Cilj studije bio je istražiti učestalost i karakteristike malignih neoplazmi kože glave i vrata područja Osječko-baranjske županije u razdoblju od 2004. do 2012, u odnosu na spol, dob, mjesto boravka, radno mjesto, zanimanje, tip i lokaciju neoplazme te fenotipske odlike oboljelih. Istraživanje je obuhvatilo sve ispitanike kojima je PHD nalazom potvrđena dijagnoza, a stanovnici su Osječko-baranjske županije. Obrađena su ukupno 2.952 oboljela od kojih je bilo 1.487 (50,4 %) muškaraca i 1.465 (49,6 %) žena, što čini približnu godišnju incidenciju od 104/100 000. Srednja dob ispitanika bila je 72 godine. Ispitanici su većinom sa sela, 1952 (66,2 %). Na otvorenom je radilo 2.137 (72,4 %) ispitanika. Najčešće su to poljoprivrednici, 907 (42,4 %) i građevinski radnici (889 ili 41,6 %). S obzirom na tip neoplazme, najčešći je bio bazocelularni tip (2.160 - 73,2 %) oboljelih. Maligni melanom imala su 93 (3,1 %) ispitanika. Lokalizacija maligne neoplazme je najčešće lice (839 - 28,7 %) i nos (643 - 22,0%) ispitanika. Muškaraci su imali značajno više (341 - 56,6 %) planocelularih malignih neoplazmi od žena (262 - 43,4 %) (p=0,005). Značajno su bili mlađi ispitanici s malignim melanomom (medijan dobi 67 godina). Nema značajne razlike vrste maligne neoplazme i mjesta stanovanja, radnog mjesta i zanimanja s obzirom na rad na otvorenom ili zatvorenom prostoru. Dokazano je, s obzirom na lokalizaciju, na uhu i na usni značajno više planocelularnih malignih neoplazmi (p=0,039; p<0,001), na vratu, oku i na glavi malignih melanoma (p=0,004; p<0,001; p=0,026), a na nosu bazocelularih neoplazmi (p=0,002). Nema značajne razlike u vrsti i učestalosti malignih neoplazmi povezano s bojom kose i očiju ispitanika. Očito je da bolest nastaje nakon višedesetljetne inkubacije te kumulativnog učinka izloženosti rizičnim faktorima, pri čemu direktna izloženost suncu, čini se, ima značajnu ulogu. Potrebna su daljnja istraživanja.The aim of this study was to investigate the incidence and characteristics of malignant neoplasms of the skin of the head and neck region in the Osijek-Baranya County during the 2004-2012 period according to gender, age, place of residence, place of work, occupation, type and location of the neoplasm, and phenotypic characteristics of patients. Subjects: The study included all subjects with the diagnosis confirmed by histopathology finding and residents of the Osijek-Baranya County. The study included a total of 2952 persons, 1487 (50.4%) male and 1465 (49.6%) female, yielding an approximate annual incidence of 104/100,000. Mean age was 72 years. Respondents were mostly from rural areas (n=1952, 66.2%). There were 2137 (72.4%) of respondents mostly working outdoors, mainly farmers (n=907, 42.4%) and construction workers (n=889, 41.6%). Results: According to the type of neoplasm, the basal cell type was most common with 2160 (73.2%) patients. Ninety-three (3.1%) patients had malignant melanoma. According to localization, face was the most common site of malignant neoplasms with 839 (28.7%) and nose with 643 (22.0%) patients. Squamous cell carcinoma was significantly more common in men (n=341, 56.6%) as compared with women (n=262, (43.4%; p=0.005). Subjects with malignant melanoma were significantly younger, with median age of 67 years. There were no signifi cant differences according to the type of malignant neoplasms and place of residence, place of business, and occupation with regard to working outdoors or indoors. According to localization, significantly more squamous cell malignancies were found on the ears and lips (p=0.039 and p<0.001, respectively), malignant melanomas on the neck, head and eyes (p=0.004, p<0.001 and p=0.026, respectively), and basal cell neoplasms on the nose (p=0.002). There were no significant differences in the type and frequency of malignant neoplasms according to hair and eye color. Conclusion: It is obvious that the disease occurs after a decades-long incubation period and the cumulative effect of exposure to risk factors, with direct sun exposure, seems to have a significant role. Additional research is needed

Procjena kvalitete života žena operiranih od karcinoma dojke u Osječko-baranjskoj županiji

Cilj: Cilj rada je ispitati kvalitetu života žena nakon mastektomije i nakon kvadrantektomije, te ispitati razliku u kvaliteti života žena nakon mastektomije u odnosu na kvalitetu života nakon kvadrantektomije. Ispitanici i metode: Prospektivno kohortno istraživanje u kojem su sudjelovale 204 sudionica: 101 sudionica je bila u grupi nakon mastektomije, a 103 sudionice nakon kvadrantektomije. Korištena je anonimna anketa primjenom hrvatske inačice upitnika Europske organizacije za istraživanje i liječenje raka EORTC QLQ-C 30 (version 3), upitnika s modulom raka dojke EORTC QLQ – BR 23. Rezultati: Na ljestvici EORTC QLQ C 30, mjesec dana nakon operacije, sudionice nakon kvadrantektomije značajno su bolje ocijenile svoj opći zdravstveni status (p = 0,007). Poremećaj spavanja imaju značajno više sudionice s mastektomijom (p = 0,03). Ljestvicom QLQ-BR23 mjesec dana od operacije, sudionice s mastektomijom značajno su lošije ocijenile seksualno funkcioniranje (p < 0,001) i užitak u seksu (p < 0,001), dok su im značajnije izražene nuspojave uz sistemske terapije (p = 0,04). Godinu dana nakon operacije, još uvijek je značajno lošije seksualno funkcioniranje (p < 0,001) i užitak u seksu (p = 0,04) kod sudionica nakon mastektomije. Ukupna skala funkcionalnosti je značajno niža za sudionice s mastektomijom (p = 0,03) Zaključak: Kvaliteta života žena nakon kvadrantektomije bolja je u odnosu na kvalitetu života nakon mastektomije. Žene kojima je učinjena kvadrantektomija bolje su ocijenile svoj opći zdravstveni status u odnosu na žene kojima je učinjena mastektomija. Seksualno funkcioniranje bolje je u žena s kvadratektomijom

Clinical Characteristics of Patients with Spondyloarthritides and HLA-B27 Positive Antigen

The aim of this study was to present our experiences in diagnosing spondyloarthritides (SpA), and to list the most common clinical features of HLA-B 27 positive patients.The study included 65 HLA-B 27 positive patients with confirmed diagnosis of ankylosing spondylitis(AS) and psoriatic arthritis (PsA) who were analyzed between 2009 and 2010 in Clinic of Internal Medicine in Osijek. The diagnosis of seronegative spondyloarthritides was based on the ASAS (Assessment in AS Working Group) classification criteria for axial and then supplemented with ASAS criteria for peripheral SpA and was confirmed by radiological techniques. For diagnosing the ankylosing spondylitis (AS), there have been applied the modified New York criteria. Radiological criteria for definite sacroiliitis according to the modified New York criteria is bilateral sacroiliitis, grade 2–4 (2) or unilateral sacroiliitis, grade 3–4. For diagnosing the psoriatic arthritis (PsA), there were used CASPAR diagnostic criteria. Other features of SpA are defined within the existing classification criteria. HLA-B27 antigen was determined by direct immune-fluorescence technique using flow cytometer. The average age of patients was 50.34 years, of whom 27 female (41.53%), 38 male (58.46%). Duration of illness was 15.79 years on average.With 75.38% of patients, there had been determined the diagnosis of AS; 24.62% of patients had the diagnosis of PsA. The most common clinical characteristics that patients had were: inflammatory back pain (pain Inflammation along the lumbosacral spine), peripheral arthritis, intermittent pain in the gluteus, sacroiliitis, enthesitis, uveitis, dactilitis

Does the type of Anesthesia Administered Affect Theefficacy of Medicinal Leech Therapy After Fingerreplantation: Clinical Observations in a 6-year-old boy

SIR — A surgical technique for the replantation andmicrovascular repair of amputated fingers has beenpreviously described Recently, medicinal leecheshave been increasingly used for venous decongestion,which is a common problem after the replantation surgery. This method is based on reducing venous conges-tion by ‘blood-letting’ and on the antithromboticproperties of hirudin in leech saliva. Anestheticmanagement for the treatment with leeches in childrenhas not been described until now