Background: The aim of this study was to (i) determine IMP3 protein expression in benign and malignant laryngeal lesions, (ii) compare its expression to Ki-67, p53, cyclin D1, and (iii) finally, to ...examine the prognostic power of IMP3 in squamous cell carcinomas of the larynx (LSSC). Methods: IMP3 protein expression was evaluated in 145 patients, including 62 LSCC, 45 dysplasia (25 with low and 20 with high-grade dysplasia), and 38 benign lesions (vocal cord polyps and nodules). Results: IMP3 was significantly higher expressed in LSCC compared to dysplasia and benign lesions (p < 0.001; p < 0.001, respectively). Similarly, higher expression patterns were observed for Ki-67 and p53, whereas cyclin D1 was equally distributed in all three lesions. IMP3 (p = 0.04) and Ki-67 (p = 0.02) expressions were significantly linked to neck node positivity, and IMP3 overexpression to worse disease-specific survival (p = 0.027). Conclusion: Since IMP3 showed significantly higher expression in laryngeal carcinomas, but not in high- or low-grade dysplasia, it serves as a useful marker to differentiate between invasive and noninvasive lesions. Higher IMP3 expression represented a significantly worse prognosticator for clinical outcomes of patients with squamous cell carcinoma of the larynx.
Cilj : prikaz slučaja bolesnice s dijagnozom invertnog papiloma septuma i retrospektivna analiza dosadašnjih iskustava u liječenju bolesnika sa sinonazalnim invertnim papilomom na Klinici za ...otorinolaringologiju i kirurgiju glave i vrata Kliničkog bolničkog centra Rijeka. Prikaz slučaja: 30-godišnja bolesnica s otežanim disanjem kroz nos i učestalim epistaksama javila se na otorinolaringološki pregled 2022. godine. Endoskopijom nosa utvrđena je perforacija u prednjim regijama septuma. Dijagnostička obrada uključivala je biopsiju sluznice, slikovnu obradu i krvne pretrage za probir na c-ANCA i p-ANCA autoantitijela, kao i test za angiotenzin-konvertirajući enzim (ACE). Nalaz patohistološke analize pokazao je kako se radi o invertnom papilomu te je provedeno kirurško liječenje. Potom je retrospektivnom analizom utvrđeno kako su u razdoblju od travnja 2014. do ožujka 2022. godine u Klinici za otorinolaringologiju i kirurgiju glave i vrata Kliničkog bolničkog centra Rijeka liječena 22 bolesnika s dijagnozom sinonazalnog invertnog papiloma. Iskustva s njihovim liječenjem također su prikazana u ovom radu. Zaključak : Bolesnici sa sinonazalnim invertnim papilomom uspješno se liječe u našoj ustanovi endoskopskom kirurgijom sinusa. Diferencijalno-dijagnostički o ovom je tumoru potrebno razmišljati i u mladih bolesnika i bolesnica s atipičnom prezentacijom bolesti. Potrebna su daljnja istraživanja u svrhu razjašnjenja etiologije bolesti i mogućnosti predikcije recidivizma i/ili maligne alteracije ovih tumora.
Aim : We present a case of a female patient diagnosed with inverted papilloma of the nasal septum and retrospective analysis of previous experiences in the treatment of patients with sinonasal inverted papilloma. The patients were treated at the Clinic for Otolaryngology and Head and Neck Surgery in the Clinical Hospital Center Rijeka. Case report: A 30-year-old patient with difficulty in breathing through the nose and frequent epistaxis came for an otolaryngological examination in 2022. Nasal endoscopy revealed a perforation in the anterior regions of the septum. Diagnostic process included mucosal biopsy, imaging, and blood tests to screen for c-ANCA and p-ANCA autoantibodies, as well as an angiotensin-converting enzyme (ACE) test. Pathohistological analysis established the diagnosis of inverted papilloma and surgical treatment was performed. After this case we did a retrospective analysis and established that in the period from April 2014 to March 2022, 22 patients with sinonasal inverted papilloma were treated in the Clinic for Otorhinolaryngology and Head and Neck Surgery, Rijeka Clinical Hospital Center. Experiences with their treatment are also presented in this paper. Conclusion : Patients with sinonasal inverted papilloma are successfully treated in our institution. Differential diagnosis of this tumor should be considered in young patients with atypical disease presentation. Further research is needed in order to clarify etiology and predict the possibility of recurrence and / or malignant alteration of these tumors.
Vrtoglavica i omaglica jedni su od najčešćih razloga zbog kojih bolesnici traže liječničku pomoć te su uzrok otprilike 3,5 % svih posjeta hitnoj medicinskoj službi. Veoma je bitno prepoznati životno ...ugrožavajuće vrtoglavice, koje zahtijevaju neposredno zbrinjavanje, te ih razlikovati od „benignih“, samolimitirajućih stanja. Upravo stoga bolesnici s akutnom vrtoglavicom često predstavljaju dijagnostički i terapijski izazov nadležnom liječniku. Aktualan pristup bolesniku s akutnom vrtoglavicom ne uzima u obzir samo kvalitetu simptoma, već stavlja naglasak i na vrijeme nastanka tegoba, trajanje, provokacijske čimbenike, prateće simptome i informacije o potencijalnim prijašnjim epizodama. S obzirom na vrijeme trajanja simptoma i provokacijske čimbenike, akutne vrtoglavice možemo svrstati u tri skupine: akutni (jednokratni) vestibularni sindrom, spontani povratni vestibularni sindrom i izazvani povratni vestibularni sindrom. Akutni vestibularni sindrom (AVS) označava iznenadnu pojavu vrtoglavice koja traje dulje od 24 sata, povezan je s mučninom, povraćanjem, nestabilnošću i nistagmusom, a simptomi su dodatno pogoršani pokretima glave. Razni središnji i periferni uzroci mogu potaknuti nastanak AVS-a, od kojih su najčešći vestibularni neuronitis (VN) i moždani udar stražnje cirkulacije. Kao moćan alat za prepoznavanje perifernog vestibularnog sindroma i moždanog udara u literaturi se zadnjih godina zagovara HINTS (engl. Head Impulse, Nystagmus, Test of Skew) plus protokol. Najčešći uzroci perifernog vestibularnog sindroma su benigni paroksizmalni pozicijski vertigo (BPPV), vestibularni neuronitis i Ménièreova bolest. U ovom članku donosimo pregled novijih pristupa koji pomažu u lakšem i bržem razlikovanju „benignih“ od ugrožavajućih oblika vrtoglavica, suvremenog liječenja, kao i pregled najčešćih perifernih vrtoglavica.
Vertigo and dizziness are among the most common reasons for patients to seek medical help and approximately 3.5 % of all emergency department visits are related to them. The acutely dizzy patient can present a diagnostic and management dilemma for emergency departments and physicians in charge of those patients. Hence, it is of great importance to distinguish the life-threatening conditions, which require acute treatment, from “benign”, self-limiting conditions. While the traditional approach to dizziness relies on “symptom quality” or “type”, the new approach is based on symptom timing, triggers, duration, associated symptoms and patient history. Based on timing and triggers, this new approach divides patients into three key categories: acute vestibular syndrome, spontaneous episodic vestibular syndrome and triggered episodic vestibular syndrome. The acute vestibular syndrome (AVS) is defined as the acute onset of persistent dizziness associated with nausea or vomiting, gait instability, nystagmus, and head-motion intolerance lasting longer than 24 hours. AVS is provoked by a variety of central and peripheral causes, the most common of which are vestibular neuritis and acute stroke (posterior circulation). The HINTS (Head Impulse, Nystagmus, Test of Skew) plus protocol is a powerful tool for distinguishing a possible posterior stroke from peripheral vestibular dysfunction and it has been highly recommended recently. The most common causes of peripheral vertigo are benign paroxysmal positioning vertigo (BPPV), vestibular neuritis and Ménière’s disease. In this article we bring a review of new approaches to vertigo which contribute to faster and easier differentiation of benign and life-threatening conditions. A review of the most common types of peripheral vertigo is also included.
Poremećaji gutanja učestala su tegoba kod neuroloških bolesnika. Radi se o tegobama koje znatno narušavaju kvalitetu života, mogu uzrokovati poremećaje hranjenja, malnutriciju, dehidraciju, ali i ...dovesti do aspiracije i aspiracijske pneumonije. Dostupne dijagnostičke metode obuhvaćaju upitnike za probir i samoprocjenu simptoma, protokole logopedske dijagnostike te fiberendoskopiju i videofluoroskopiju, a važna je i procjena nutritivnog statusa bolesnika. Nakon postavljene dijagnoze disfagije poseže se za brojnim rehabilitacijskim postupcima koji omogućavaju ublažavanje simptoma i smanjenje rizika od aspiracije. Katkad se tegobe pokušava umanjiti i kirurškim metodama. U liječenju disfagije u oboljelih od Parkinsonove bolesti istražuje se i korist od duboke moždane stimulacije.
Swallowing disorders are common among neurological patients. They can significantly impair the quality of life, cause eating disorders, malnutrition, dehydration, and increase the risk of aspiration and aspiration pneumonia. Available diagnostic methods include questionnaires for screening of dysphagia symptoms, speech therapy diagnostic protocols, fiberoendoscopy and videofluoroscopy. It is also important to assess the patient’s nutritional status. Plenty of rehabilitation procedures are available for the relief of symptoms and reduction of the risk of aspiration. Surgical methods are sometimes used in the process of treatment. The benefits of deep brain stimulation are being investigated in the treatment of dysphagia in Parkinson’s disease patients.
Primary brain calcification (PBC), a neurodegenerative disorder with characteristic calcium deposits in the basal ganglia and other brain areas, typically presents with various neurological and ...psychiatric symptoms in the fourth or fifth decade of life or later. We present the case of a patient with psychiatric manifestations much earlier than usual, in the second decade of life.
The case of an adolescent female with acute psychotic symptoms, emotional instability, disorganized and suicidal behavior, stereotypical movements, below average intelligence and a three-year history of headaches is reported. Among others, the presentation included tactile hallucinations with secondary hypochondriacal delusions, which are rarely described in this diagnosis. Massive calcinations in the area of the basal ganglia and thalamus were determined by computerized tomography. Other causes of brain calcification were excluded. No causative mutations were found in selected genes. All the symptoms apart from lower intellectual abilities improved with quetiapine and sertraline. The patient showed no side effects.
This case report highlights the successful use of quetiapine for symptomatic treatment of acute psychosis due to PBC in an adolescent without exacerbating extrapyramidal symptoms.
Background Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin ...(HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D). Research design and methods 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes. Results More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = -0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = -8.543, p = 0.002). Conclusions Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D. Keywords: Attachment, Childhood and adolescence, Diabetes control, Time in range, Cortisol
Introduction:
A traumatic event is an extremely threatening and frightening experience in an individual's life. Children who are exposed to traumatic events are twice as likely to develop a mental ...disorder. Screening can provide insight into the traumatic experience of children, identifying those eligible for further evaluation, and support. With this aim, we evaluated the psychometric properties of the Lifetime Incidence of Traumatic Events questionnaire (LITE) in Slovene by calculating retest reliabilty, construct validity (cross-informant agreement) and external validity, where we calculated the correlation of the number of differenet traumatic events with psychopathological symptoms.
Methods:
280 child-parent pairs (children aged 11.3 ± 2.2 years) from various Slovenian primary schools participated in the study. They were divided into two groups: 180 healthy primary school students and 100 children with Type 1 Diabetes (our study was a part of a larger study
The Influence of Psychobiological Adversity on Children and Adolescents with Type 1 Diabetes Study
). Two versions of the LITE questionnaire were used. Children completed the child report (LITE-S) and parents the parent report (LITE-P) version. After 4 weeks, 117 children, and 114 parents filled out the LITEs again. External validity was assessed using the Youth Self Report and Child Behaviour Checklist syndrome-oriented scales.
Results:
Retest reliability for individual scales was
r
= 0.469–0.639 (ρ = 0.443–0.636;
p
< 0.001), but higher for individual items (κ = 0.263–0.821;
p
< 0.001). Correlations between reports from parents and children were
r
= 0.313–0.345 (ρ = 0.317–0.348;
p
< 0.001). The number of different events experienced by children correlated significantly with the measured depressive—anxiety, and posttraumatic stress disorder symptoms.
Conclusions:
Based on our results, the LITE-S and LITE-P “All events” scale have acceptable psychometric properties for use in research and in clinical practise screening. We recommend looking at single items, taking into consideration the responses from both the child and the parent for more precise information. To improve the precision of the psychodiagnostic capacity of the questionnaire, further research on various populations should be performed.
Background/Objective:
Type 1 diabetes (T1D) is among the most common chronic diseases in children/adolescents, and the incidence continues to rise worldwide. Different environmental factors have been ...evaluated in the etiology. In the present study, we investigated the role of attachment examining whether insecure attachment to carers or carers' own attachment insecurity was related to a higher risk of T1D in children.
Methods:
We included 101 children with T1D (mean age 11.8 years), 106 healthy controls (11.6 years), and one of their carers. We assessed children's attachment using the Child Attachment Interview and carers' attachment using the Relationship Structures Questionnaire. We constructed binary multinomial logistic regression models using attachment to mothers, carers' attachment representations, and stressful life-events as T1D predictors.
Results:
Higher carer attachment anxiety was associated with the child's T1D diagnosis (
p
< 0.05;
R
2
= 0.0613) while security of attachment to mothers showed no significant association. When mothers' education was included in the model, both attachment anxiety in higher educated mothers and stressful life events showed a significant association with the child's T1D (
p
< 0.001;
R
2
= 0.293).
Conclusions:
Our findings suggest that higher attachment-related anxiety in carers with high education and stressful life events are associated with T1D in children.
In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the ...impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from “medium” (> 50%) in 2020 to “strong” or “extreme” (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals.
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