Indeed, nowadays there is no clear agreement about the ideal treatment (conservative or surgical) of posterior intraorbital bullet in view of possible serious damage to vital structures such as the ...possibility of compromising the optic nerve. The decision to remove an orbital foreign body should always be made on an individual basis, with due consideration of the benefits and dangers of surgery.
A 12-year-old girl presented to the emergency department after being shot with a .177 (4.5 mm) air gun stuffed diabolo pellet. The pellet shot the girl’s left infraorbital. The entry wound in a size ...of 3 mm was barely noticeable, located 0.9 cm below the lower eyelid and 3.6 cm laterally to the nasal sidewall. Before the accident, her ocular history included diplopia (anamnestically, the girl’s mother said that the girl had diplopia before but she was never referred to an ophthalmologist). At the first examination, the mydriasis and ptosis on the left eye were noticed. The left pupil did not react to the light. The right eye status was normal. After an emergency craniogram was performed, a foreign body was verified in the projection of the left orbit. Upon the arrival of an ophthalmologist, the eye status was as follows: visus oculi dextri (VOD) sine correctione (sc) 1.0, visus oculi sinistri (VOS) sine correctione (sc) 0.5, left bulbus in exodeviation of 10 PD with convergence insufficiency, double vision in the direction of looking straight, occasionally in elevation and depression, with no double vision in the terminal abduction right and left. The girl did not notice the pain. The pupil was in the mydriasis with a very slow motion in the light. Other status of the anterior eye segment as well as of the eye fundus was normal. A computed tomography scan showed a metallic foreign body in the left orbital conus, without fractures or intracranial intrusion. Immediate tetanus prophylaxis, antimicrobial therapy (amoxicillin/clavulanic acid, metronidazole), neuroprotective therapy (methylprednisolone) and local therapy (tobramycinum) were introduced. Given the high risk of surgical treatment, the girl was conservatively treated and monitored. The girl was relieved of physical activity at school due to the possibility of moving the foreign body. Three years after the injury, the girl has only a pupil in semi mydriasis and a slower reaction to direct light. The visual acuity is as follows: VOD sc 1.0, VOS sc 0.9. Other eye status is normal.
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare condition. Here, we present a case of a male patient with a very unique combination of symptoms ...that started at the age of 12. Transient symptoms manifested after 4 days of high fever and included lethargy, a loss of appetite, and an inability to recognize faces. After that, the patient was symptom-free for 4 years before he was hospitalized again with a working diagnosis of acute disseminated encephalomyelitis. The ophthalmic symptoms at this stage were photophobia and discrete horizontal nystagmus. One year later, the patient had another seizure and during hospitalization, predominantly displayed cerebral symptoms such as dystaxia, dysmetria, generalized muscle hypotrophy, and absent myotonic reflexes. Like before, an ophthalmic examination demonstrated a best-corrected visual acuity of 1.0 and a normal anterior segment. A fundus examination revealed a slightly rarefied retina, along with areas of perifoveal and parapapillary atrophy, in addition to increased vascular tortuosity. Optical coherence tomography scans of the macula and the optic disc depicted a mild thinning of the retinal layers. Visual field testing showed an isopter contraction with a predominant loss of the temporal visual field in both eyes. A genetic serum analysis was positive for mitochondrial mutation m.3243A>G, and a diagnosis of MELAS was confirmed. The treatment included anticonvulsive drugs and dietary precautions. Patients with MELAS syndrome can manifest a wide range of visual disturbances, meaning that a detailed ophthalmic examination is required.
Djelatnost zdravstvene zaštite i socijalne skrbi, u hrvatskim i europskim, a posebice u američkim okvirima zauzima visoko mjesto prema područjima djelatnosti u kojima se dogodi najveći broj ozljeda ...na radu, s tendencijom k daljnjem rastu. Kada se tome doda činjenica da navedena djelatnost generira iznimno velik broj izgubljenih radnih dana i financijske gubitke kako za samog poslodavca tako i za državu, tijekom posljednjeg desetljeća niz eksperata posvetio je posebnu pozornost navedenoj djelatnosti. Koliko su nove tehnologije djelatnosti zdravstva donijele niz prednosti bez kojih današnja medicina u ovom obliku ne bi postojala, s druge strane, u određenim segmentima, otvorio se niz potencijalnih opasnosti za same radnike. Cilj ovog rada, kao prvog takvog i u ovom obliku, bio je iznijeti pokazatelje sigurnosti zaposlenika Klinike za dječje bolesti Zagreb, središnje i jedinstvene ustanove za zdravstvenu skrb djece i adolescenata u Republici Hrvatskoj te ih usporediti s dostupnim pokazateljima na razini države, Europske unije i Sjedinjenih Američkih Država. U dvanaestogodišnjem razdoblju evidentirano je 113 ozljeda na radu, od kojih se 56,64 % dogodilo na mjestu obavljanja radnih zadataka. Većinom se radilo o lakim ozljedama (59,29 %), a najveći udio odnosio se na iščašenja, uganuća i istegnuća. Najveći udio izgubljenog radnog vremena također se odnosio na ozljede koje su se dogodile na mjestu obavljanja radnih zadataka. Klinika je u devetogodišnjem razdoblju zabilježila 105 ekspozicijskih incidenata. Ubodni incidenti generirali su najveći udio (80,95 %), a kao grana najviše je bilo ugroženo sestrinstvo (69,52 %). Kod 16 osoba utvrđena je profesionalna bolest, od čega su gotovo sve uzrokovane SARS-CoV-2 virusom.
Health care and social work, in Croatia and Europe, and especially in the United States, occupies a high place according to the areas of activity in which the largest number of injuries at work occurs, with a tendency to further growth. Add to this the fact that this activity generates an extremely large number of lost working days and financial losses for both the employer and the state, and over the last decade, a number of experts have paid special attention to this activity. To the extent that new technologies in health care have brought a number of advantages without which today's medicine in this form would not exist, on the other hand, in certain segments, a number of potential dangers have opened up for workers themselves. The aim of this paper, as the first of its kind in this form, was to present the safety indicators of employees of the Children's Hospital Zagreb, a central and unique institution for health care of children and adolescents in Croatia, and compare them with available indicators at the state, European Union and of the United States. In the twelve-year period, 113 injuries at work were recorded, of which 56.64% occurred at the place of work. Most of them were minor injuries (59.29%), and the largest share was related to sprains, strains, and sprains. The largest share of lost working time also related to injuries that occurred at the place of work. The clinic recorded 105 exposure incidents over a nine-year period. Needle-stick injuries generated the largest share (80.95%), and as a branch, nursing was the most affected (69.52%). The occupational disease was diagnosed in 16 people, almost all of whom were caused by the SARS-CoV-2 virus.
The goal of every organisation is to have employees with high self-esteem and employees with a good work-related quality of life (WRQoL), given that such employees are more satisfied and provide ...better service, which is ultimately a benefit for the organization. In order for employees to have the best possible WRQoL, the responsibility lies with the administration or health system of a particular country, which is obliged to improve the organisation in all aspects. A sample of 409 participants in the Children’s Hospital Zagreb examined their self-esteem and WRQoL. The research included both health and non-health employees. For the purpose of the research, the Rosenberg self-esteem scale and the WRQoL scale were used. The Pearson correlation coefficient between these two variables was calculated, which is the first such study. The results showed that we have employees with a high level of self-esteem, which is an excellent resource given the fact that high self-esteem has positive implications for job satisfaction and job performance. In contrast to self-esteem, employees were extremely dissatisfied with the quality of life-related to work, especially in the following categories; Working Conditions, Job and Career Satisfaction, and Control at Work. Following the above, and qualitative research, key factors were found that the management needs to address to raise the WRQoL of employees.
Unatoč iskustvu kirurga, kvalitetno uzetoj anamnezi, kvalitetnom kliničkom pregledu te suvremenoj radiološkoj dijagnostici, do pouzdane i konačne dijagnoze dolazimo temeljem patohistološke dijagnoze. ...Patohistološka analiza započinje biopsijom ili operacijom nakon koje se uzorak tkiva stavlja u fi ksativ. Fiksacijom se tkivo stabilizira, sprječavajući njegovo propadanje. Uzorci tkiva režu se na tanke slojeve koji se nakon fi ksiranja na predmetno stakalce standardno boje kombinacijom hematoksilina i eozina. Standardno bojenje se prema potrebi nadopunjuje histokemijskim ili imunohistokemijskim metodama, ovisno o odluci patologa. Izgled promjene može prikriti njen karakter te je stoga nužna suradnja između liječnika operatera i patologa (1, 2). Točnost u potvrđivanju kliničkih dijagnoza mjerljiva je komponenta svakog cjelovitog programa osiguranja kvaliteta i prognostičke korisnosti. Do danas je zlatni standard za provjeru kliničkih dijagnoza, bez obzira na organski sustav i klasifi kaciju bolesti, bila i ostala patohistološka dijagnoza (3).
To evaluate visual impairment (VI) in children with cerebral palsy (CP).
This population-based study included 419 children from the Surveillance of Cerebral Palsy in Europe (SCPE) C28 RCP-HR - ...Register of Cerebral Palsy of Croatia born 2003-2008. Vision in children with CP (according to SCPE) was classified as normal or impaired, with the subcategory of severe VI. The proportion of children with VI was assessed in groups with different CP type/subtype, gross and fine motor function, and gestational age (GA).
A total of 266 children had some degree of VI (266/400; 66.5%), 134 had normal vision, and data on VI were unknown for 19 children. Severe VI was present in 44 children (44/400; 11%). The proportion of children with VI and severe VI increased with the Gross Motor Function Classification System and Bimanual Fine Motor Function levels. Children with bilateral spastic CP had the highest frequency of severe VI (14.9%). The percentage of severe VI in children with bilateral spastic CP was 53.8% in the group born <28 weeks of GA, 13.3% in the group born 28-31 weeks of GA, 11.1% in the group born 32-36 weeks of GA, and 24.4% in the group born >36 weeks of GA (λ2=4.95; df=6; P<0.001).
Children with CP have a high prevalence of VI and severe VI, which is increasing with the level of motor impairment. Severe VI is significantly more common in children with bilateral spastic CP, especially among extremely premature infants.
BACKGROUNDFear is a negative emotion induced by the threat of danger, pain and harm. Cataract surgery is one of the most performed surgeries in the world. The aim of this study was to investigate and ...analyze the predominant fears in patients undergoing cataract surgery. SUBJECTS AND METHODSIn this cross-sectional study 152 patients were examined. Self-designed questionnaires to examine emotions of the fear, anxiety, nervousness frequency gratitude was used and insecurity immediately before cataract surgery. We also examined what the greatest fear during the cataract surgery was. The fear of blindness was compared with other life fears such as cancer, memory loss, AIDS, stroke and heart attack. The presence of fear was compared in patients having had previous cataract surgery with those undergoing their first cataract surgery. Including criteria were adults with senile cataract. Excluding criteria was ocular co-morbidity, psychiatric disorders, inability to read, deafness and surgery under general anesthesia. Completed questionnaires were analyzed. Pearson's chi-squared test was used. RESULTSFear was the most frequent emotion before cataract surgery, present in 60.5% patients. Fear of blindness was the greatest fear during cataract surgery in 55.3% of patients. There was no statistically significant difference in fear in patients having undergone their first cataract surgery and patients before their second cataract surgery (p<0.05). CONCLUSIONFear is the predominant emotion before cataract surgery which is in correlation to the leading life fear - fear of blindness. Good preoperative preparation and a trusting doctor-patient relationship are important for reducing the fear of the procedure.
Epidermolysis bullosa is a group of inherited disorders characterized by blister formation on the skin and mucous membrane as the result of molecular defects in genes coding for different structural ...proteins. They present with a wide clinical spectrum of manifestations because of a variety of molecular defects. Therapy depends on the form of the disease, severity and extent of skin involvement and extracutaneous manifestations, and consists of supportive skin care and supportive care for other organ systems. Skin care includes protection against trauma, proper skin care, treatment of blisters and erosions, and regular dermatological controls for early detection of skin cancer.
The ophthalmologic examination of the child consists of an assessment of the physiological function, anatomic eye, and visual system status. A comprehensive eye examination of the child should ...include history of presenting problem, patient’s and family’s medical histories, estimation of fixation and measurement of visual acuity, assessment of binocular vision, Bruckner test, assessment of ocular motility, Hirschberg’s test, cover/uncover test, and assessment of anterior and posterior segments. The order of examination may vary depending on the child’s cooperation. The record of the child’s level of cooperation during the examination is of great benefit in the interpretation of the results.
PDF
