A 76-year-old woman presented to our emergency department with hard periumbilical mass around irreducible umbilical hernia. Abdominopelvic computed tomography scan revealed large abdominal wall ...tumor, adherent to the small and large intestine, with a solitary 4-cm liver lesion in the right lobe. En bloc resection including umbilical skin, rectus muscle, infiltrated jejunum, and transverse colon was made with direct closure of the abdominal wall defect. Simultaneous excision of the liver lesion was also performed. The diagnosis was made but not until histopathological analysis. It revealed chronic inflammation and the presence of Actinomyces in the abdominal mass as well as in the liver lesion. The purpose of this report is to introduce readers to the differential diagnosis of this rare disease and thus enable them to recognize findings which would lead them to interpret this condition as actinomycosis.
In 2018, Croatia reported the largest outbreak of West Nile virus (WNV) infections as well as the re‐occurrence of human Usutu virus (USUV) infections. For the first time, fatal WNV and USUV ...infections were detected in wild birds. We analysed epidemiological characteristics and molecular epidemiology of WNV and USUV infections detected during 2018 transmission season. From April to November, 178 patients with neuroinvasive disease and 68 patients with febrile disease were tested for WNV and USUV. Viral RNA was detected in cerebrospinal fluid (CSF) and urine samples using a real‐time RT‐PCR. Positive samples were tested by nested RT‐PCR and nucleotide sequencing. IgM/IgG antibodies were detected in serum/CSF samples using ELISA with confirmation of cross‐reactive samples by virus neutralization test (VNT). WNV neuroinvasive disease was confirmed in 54 and WNV fever in seven patients from 10 continental Croatian counties. Areas affected in 2018 were those in which cases occurred in previous seasons, while in three areas human cases were reported for the first time. Phylogenetic analysis of six strains from patients residing in different geographic areas showed circulation of WNV lineage 2. In three patients, neuroinvasive USUV infection was confirmed by RT‐PCR or VNT. Sequence analysis of one detected strain revealed USUV Europe 2 lineage. During the same period, a total of 2,574 horse and 1,069 poultry serum samples were tested for WNV antibodies using ELISA. Acute asymptomatic WNV infection (IgM antibodies) was documented in 20/0.7% horses. WNV IgG antibodies were found in 307/11.9% horses and in 125/12.7% poultry. WNV RNA was detected in two goshawks and USUV RNA was detected in one blackbird from north‐western Croatia. In the Zagreb area, 3,670 female mosquitoes were collected. One Culex pipiens pool collected in July tested positive for USUV RNA. Our results highlight the importance of continuous multidisciplinary ‘One health’ surveillance of these emerging arboviruses.
Unatoč napretku moderne medicine, određeni broj hospitaliziranih bolesnika stekne infekciju različitog intenziteta vezanu uz zdravstvenu skrb. Prvi cilj ovoga rada je utvrditi broj bolesnika kod ...kojih je registrirana kolonizacija rezistentnim uzročnicima, te detektirati eventualno postojanje razlika u broju i vrsti kolonizacija među ustanovama s kojima surađujemo. Budući da suradni centri nisu učinili ulazne obriske predilekcijskih mjesta, koristiti ćemo samo podatake našega mikrobiološkog laboratorija. Radom smo htjeli još procijeniti da li nova situacija uvjetovana relativno velikim brojem bolesnika s pozitivnim obriscima na rezistentne bakterije produljuje i poskupljuje liječenje na odjelu. Ispitanici u ovom radu su bolesnici Odjela kardiologije Opće županijske bolnice u Požegi (ustanova) u razdoblju od 1. 1. 2014. do 31. 12. 2014. godine kod kojih je učinjena invazivna dijagnostika i terapija u drugim tercijarnim bolnicama (centrima). Tijekom tog razdoblja iz naše ustanove u druge centre upućeno je 145 bolesnika, od kojih se 131 ponovno vratio na naš odjel. Kod 77 bolesnika, 42 muška i 35 žena, što čini 54% ukupno poslanih bolesnika, iz uzoraka obrisaka uzetih s predilekcijskih mjesta, izolirali smo potencijalno patogene uzročnike. Uvažavajući prosjeke ležanja izražene u bolničkim danima, tijekom 2012. i 2013. god. koji su iznosili 8,4 ± 0,6, te za 2014. 7,9 ± 0,54, nismo utvrdili da je boravak bolesnika u drugim centrima zbog provođenja invazivne dijagnostike i terapije utjecao na produljenje bolničkoga liječenja, a niti ga učinio skupljim. Troškovi za antibiotsku terapiju bili su veći tijekom ranijih godina, nego 2014. god. Zaključno možemo konstatirati da je zbrinjavanje akutnog koronarnog sindroma po postojećem nacionalnom programu u naših bolesnika bilo sigurno, da nije produljilo liječenje, te nije dovelo do povećanja troškova liječenja.
Solitarna neurocisticerkoza je vrlo rijedak oblik bolesti CNS-a u Hrvatskoj. Obično se javlja u multiploj formi, a rezultat je prodora larve Teniae solium u moždano tkivo i njezinoga razvoja unutar ...ciste. Ovisno o lokalizaciji unutar CNS-a manifestira se fokalnim ili generaliziranim epileptičkim napadajima, senzomotoričkim deficitom, intelektualnim ili psihološkim ispadima, razvojem hidrocefalusa, a može i doživotno ostati asimptomatska. Prikazali smo bolesnicu u dobi od 18 godina s pojavom prvog epileptičkog napadaja tipa grand mal. Učinjenom neuroradiološkom obradom nalazi se temporalno lijevo ovalna tumorska tvorba. Neurokirurškim zahvatom ekstirpirana je tumorska tvorba, a patohistološki nalaz upućuje
na kalcificirani cisticerk. Po provedenom liječenju stanje bolesnice je dobro, bez neuroloških ispada i diseminacije parazitarne bolesti. Cilj ovoga rada je prikazati kako je u slučaju pojave prvog epileptičkog
napadaja i radiološki verficirane nejasne tumorske tvorbe potrebno diferencijalno dijagnostički razmišljati i o solitarnom cisticerk granulomu.
The largest outbreak of hemorrhagic fever with renal syndrome (HFRS) to date occurred in Croatia in the year 2002. The epidemic started in winter, lasted throughout spring to summer months, ending ...not earlier than November.
The aim of this study was to investigate and analyze the basic epidemiologic and clinical features of HFRS in Croatia by uniform and standardized prospective-retrospective analysis of all patients affected by the epidemic.
When the epidemic started, a patient questionnaire with questions on the basic demographic data, site of infection and other epidemiologic characteristics, clinical symptoms, disease severity and laboratory results was designed. Data on 401 patient with a clinical diagnosis of HFRS were collected. The etiologic diagnosis of the disease was confirmed by ELISA, and in some patients by indirect immunofluorescence test (IFT). The results were analyzed using a descriptive statistical method.
HFRS was clinically diagnosed in 401 patients from all over Croatia. A total of 320 (79.8%) cases were reported to the Epidemiology Service of the National Institute of Public Health. The majority of patients (n = 128) were registered in June. Males were three times more affected than females. Apart from its long duration, this epidemic was characteristic for the involvement of general population, with only a small number of the affected from the potential risk groups (forestry workers 28, soldiers 14, farmers 18). The epidemic spread almost throughout inland Coratia. At least 44 patients were infected in the Plitvice Lakes area, 32 in Slunj, 27 on Sljeme, 24 in Velika, and at least 19 in the area of Kutjevo. The youngest patient was aged 4 and the oldest 80 years. The majority of patients were treated in Zagreb (University Hospital for Infectious Diseases--110, Zagreb University Hospital Center--3), followed by Karlovac (71 inpatients and 39 outpatients), Pozega (n = 79), and Rijeka (n = 37). Serologic analysis (ELISA method) detected Puumala virus in 161 and Dobrava virus in only 17 patients. The disease was confirmed by immunofluorescence method in 53 patients (mostly in Kariovac). During the 2002 outbreak, HFRS clinically manifested mostly in a milder form with general symptoms and transitory renal insufficiency, while hemorrhages were rarely recorded. According to our disease severity score, a mild form of the disease was recorded in 65%, moderately severe in 28%, severe in 5% and extremely severe form in 2% of the patients. One patient died. Two thirds of the patients were hospitalized during the febrile stage of the disease. All patients had fever, whereas headache and pain in the lumbar region were recorded in more than 90% of cases, polyuria in 75%, oliguira and vomiting in approximately 50%, respiratory symptoms in 35%, and hemorrhages (mostly on the skin and mucous membranes), vision disturbances, conjunctivitis and diarrhea in approximately 25% of patients. ESR was elevated in 64% and CRP in 93% of patients. Leukocytosis was recorded in 25% and thrombocytopenia in 70% of patients. Increased values of urea and creatinine and signs of liver damage were recorded in approximately 50% of the patients.
The largest outbreak of HFRS occurred in Croatia in 2002, with more than 400 diseased throughout Croatia. This epidemic confirmed our previous assumption that the whole Croatia, apart from its narrow coastline area and islands, is a natural focus of HFRS with different causative types of hantaviruses. Efforts should be made to conduct a comprehensive ecologic and mammologic study on hantaviruses and their biologic characteristics in these areas.
Epileptički status jedno je od hitnih neuroloških stanja, a definira se kao epileptički napad koji traje dulje od 30 minuta ili kao serija epileptičkih napada koji se ponavljaju tako da nema oporavka ...između dvaju napada. Liječenje epileptičkoga napada počinje ukoliko traje dulje od pet minuta.
Cilj je ovoga preglednog članka dati uvid u definiciju, kliničku sliku, pojavnost, patofiziologiju i način liječenja epileptičkoga statusa. Pregledom trenutačno važećih smjernica predlažemo način liječenja epileptičkoga statusa u primarnoj zdravstvenoj zaštiti kao i u bolnici. Što prije započne liječenje epileptičkoga statusa, manji je rizik od mortaliteta i nastanka trajnih oštećenja
mozga tijekom epileptičkoga statusa.
Bolesnica kod koje smo postavili dijagnozu sporadičnog oblika Creutzfeldt-Jakobove bolesti (CJB) prezentirala se vrlo kratkim tijekom bolesti od pojave prvih simptoma pa sve do smrti. Bolest je u ove ...56-godišnje bolesnice započela konfuzijom, dezorijentacijom, zaboravljivošću i nesanicom koji su trajali svega nekolio dana prije hospitalizacije na Odjel psihijatrije Opće bolnice Požega. Produbljivanje psihičkih smetnji i mentalno propadanje brzo se nastavilo tijekom hospitalizacije, uz progresivni razvoj neurološke simptomatologije: sve učestalijih tikova, povremenih mioklonusa, neobičnih grimasa lica i nesuvislih krikova uz razvoj retencije urina. Bolesnica je uskoro postala nekontaktibilna. Nalazi inicijalno učinjenih laboratorijskih pretraga krvi i cerbrospinalnog likvora, uz MSCT i MR mozga te EEG, bili su uredni ili nespecifični, kao i nalazi seroloških testova na neurotropne viruse, B. burgdorferi i bartonele. U trećem tjednu hospitalizacije učinjen je kontrolni EEG kojega je nalaz pokazao trifazični šiljak-val kompleks, karakterističan za CJB. Naknadno učinjeni testovi karakteristični za dokaz CJB potvrdili su dijagnozu: pozitivan NSE (16,1 μg/L), Tau-protein (>1200 ρg/mL) i S-100B protein (>4,25 μg/L) uz pozitivan 14-3-3 protein. U nedostatku specifičnog liječenja, a uz primijenjene mjere simptomatskog liječenja i skrbi, bolesnica je umrla četiri i pol mjeseca od pojave prvih simptoma bolesti.
Najčešće opisane nuspojave unutar 24 sata od cijepljenja su lokalne reakcije i febrilitet. Vrlo rijetko su opisane sustavne reakcije: febrilne konvulzije, hipotono-hiporesponzivni poremećaji, ...gastrointestinalni poremećaji, razdražljivost, slabost i neutješni plač. Zabilježene su i akutne alergijske reakcije –također vrlo rijetke: dispneja, cijanoza, angioneurotski edem, hipotenzija i rijetko anafilaktička reakcija. Opisana je i reakcija lokalnog edema s cijanozom, crvenilom, purpurom i jakim plačem. Dječak L.G. u dobi od 5 mjeseci prvi je put primljen na Odjel pedijatrije Opće županijske bolnice Požega radi purpure koju je majka primjetila dan nakon cijepljenja DTP-polio + HIB cjepivom. Nakon obrade dokazana je kod djeteta latentna infekcija koja je tretirana antibiotikom. U velikom koagulogramu uočena je potpuna odsutnost agregacije trombocita i postavljena je sumnja na nuspojavu cjepiva. Dječak je primio svježu smrznutu plazmu i kortikosteroid, nakon čega se postepeno oporavlja (petehije se povlače, a agregacija trombocita se uspostavlja). Tijekom iduće dvije godine nije cijepljen. Dogovoreno je s roditeljima da se dijete primi na odjel i provjeri reakcija na DTP-polio + HIB cjepivo. Po primitku agregacija trombocita bila je uredna. Zatim je dječak cijepljen Pediacel cjepivom i opserviran. Nakon 24 sata agregacija trombocita bila je poremećena, ali bez kliničkih simptoma. Unutar iduća 24 sata dolazi do spontanog oporavka s uspostavom uredne agregacije trombocita i bez terapije.
Insect flight research is propelled by their unmatched flight capabilities. However, complex underlying aerodynamic phenomena make computational modeling of insect-type flapping flight a challenging ...task, limiting our ability in understanding insect flight and producing aerial vehicles exploiting same aerodynamic phenomena. To this end, novel mid-fidelity approach to modeling insect-type flapping vehicles is proposed. The approach is computationally efficient enough to be used within optimal design and optimal control loops, while not requiring experimental data for fitting model parameters, as opposed to widely used quasi-steady aerodynamic models. The proposed algorithm is based on Helmholtz–Hodge decomposition of fluid velocity into curl-free and divergence-free parts. Curl-free flow is used to accurately model added inertia effects (in almost exact manner), while expressing system dynamics by using wing variables only, after employing symplectic reduction of the coupled wing-fluid system at zero level of vorticity (thus reducing out fluid variables in the process). To this end, all terms in the coupled body-fluid system equations of motion are taken into account, including often neglected terms related to the changing nature of the added inertia matrix (opposed to the constant nature of rigid body mass and inertia matrix). On the other hand—in order to model flapping wing system vorticity effects—divergence-free part of the flow is modeled by a wake of point vortices shed from both leading (characteristic for insect flight) and trailing wing edges. The approach is evaluated for a numerical case involving fruit fly hovering, while quasi-steady aerodynamic model is used as benchmark tool with experimentally validated parameters for the selected test case. The results indicate that the proposed approach is capable of mid-fidelity accurate calculation of aerodynamic loads on the insect-type flapping wings.
