Poremećaji stanja svijesti djece uzrokovani su različitim poremećajima, od hipoglikemije do traumatskih intrakranijalnih krvarenja. Mogu trajati od nekoliko sekunda, poput sinkope, nekoliko dana i ...tjedana, pa sve do doživotnog stanja s protrahiranim poremećajima svijesti kao što su minimalno svjesno stanje ili perzistentno vegetativno stanje. Dobro poznavanje neuroanatomije i dobra vještina primjene tog znanja na ispitivanje neurološkog statusa omogućuje međusobno razlikovanje različitih stanja poremećaja svijesti te rano prepoznavanje
uzroka. Ascendentni retikularni aktivacijski sustav moždanog debla, koji sadrži glavne strukture za regulaciju budnosti i spavanja, smješten je blizu jezgara čija se funkcija može klinički ispitati čak i u djece bez svijesti, što omogućuje lokalizaciju lezije i procjenu oštećenja. Radiološke, laboratorijske i elektrofiziološke pretrage služe daljnjem prepoznavanju različitih uzroka poremećaja svijesti. Ovaj rad ima za cilj dati kratak pregled uzroka poremećaja stanja svijesti, patofiziologije oštećenja koja stvaraju, specifičnosti kliničke prezentacije na osnovi kojih se mogu razlikovati i temeljna načela dijagnostičkog i terapijskog pristupa djetetu s akutnim poremećajem stanja svijesti.
Neurogenic bladder is a bladder dysfunction caused by impaired innervation of the lower urinary tract. The most common causes of neurogenic bladder in children are congenital anomalies of the spinal ...cord. Acquired causes of neurogenic bladder in children can be: cerebral palsy, transverse myelitis, spinal cord tumors, trauma, progressive neurodegenerative diseases, multiple sclerosis, Guillain-Barre syndrome and iatrogenic damage to the pelvic plexus.Urodynamic testing is the gold standard in the diagnosis and monitoring of children with neurogenic bladder.The most common form of treatment is clean intermittent catheterization. In terms of drugs, anticholinergics are most commonly used. The main goals of treatment are to preserve renal function and achieve continence.Children with neurogenic bladder are monitored in the Laboratory for Urodynamics and in the Voiding Disorders Clinic, Department of Pediatrics in University Hospital Centre Split. We retrospectively analyzed data from the medical records of children with neurogenic bladder in the period from Year 2015 to 2019.Over a period of five years, neurogenic bladder was diagnosed in total of 20 girls and 16 boys. The mean age of diagnosis of neurogenic bladder was 8.3 years. The mean age of children with congenital anomalies of the spine and spinal cord was 4.9 years, while the mean age of children with acquired patterns of neurogenic bladder dysfunction was 11.0 years. Urodynamic examination was done in all children. The diagnosis of neurogenic overactive detrusor and detrusor sphincter dyssynergia was made in a total of 13 children with congenital anomalies and in 9 children with acquired anomalies. Thus, 61% of children had the most severe form of bladder dysfunction A total of fifteen children were treated with clean intermittent catheterization.The anticholinergic was administered to ten children with neurogenic overactive detrusor and congenital anomalies and to eight children with acquired neurogenic bladder causes.In most children with neurogenic bladder, early urodynamic diagnosis and early initiation of treatment may preserve renal function.Further monitoring of our patients is needed.
U posljednjih desetak godina sve se veći broj pacijenata odlučuje na ortodontsku terapiju, najčešće zbog narušene estetike ili jače izraženih poremećaja oralne funkcije. Nakon pregleda i kliničke ...obrade pacijenta, terapeut postavlja dijagnozu na osnovi koje odlučuje o početku terapije i vrsti ortodontskih naprava. Najučestalije ortodontske anomalije su kompresija (zbijenost zubi), pokrovni zagriz (klasa II/2), progeny kompleks anomalija i otvoreni zagriz. Najpovoljnije je vrijeme za početak terapije kod većine ortodontskih anomalija u dobi od 9 do 10 godina djeteta, tj. u vrijeme izmjene mliječnih zubi. U toj dobi terapija najčešće započinje mobilnim ortodontskim napravama i nastavlja se, ako je potrebno, u trajnoj denticiji. Kod određenih anomalija terapijom se započinje nakon izmjene zubi, rjeđe mobilnim, a češće fiksnim ortodontskim napravama. Tijekom terapije mogu se uz fiksne naprave, prema potrebi, aplicirati i intraoralne ili ekstraoralne naprave. Nakon aktivne faze terapije slijedi retencijski period, u kojem terapeut nastoji zadržati postignuti terapijski učinak i spriječiti recidiv
The objective of this epidemiological study was to assess the incidence at birth of orofacial clefts in Croatia.
The aim of the present study was to analyse the character and incidence of orofacial ...clefts in Croatia and to compare the data with reports from other countries.
All the material for the epidemiological study was retrieved from the documented files from all the neonatal units and hospitals in Croatia providing surgical treatment.
A total of 525,298 livebirths were documented during 11 years (1988–1998); 903 among them with orofacial clefts, 24 (2.7%) of them twins. Sixty (6.6%) infants died between birth and the age of 6 months. The incidence of orofacial clefts during the study period was 1.71 per thousand. When eliminating syndromic clefts, the incidence of non-syndromic clefts was 1.56 per thousand. Analysis of cleft lip with or without cleft palate (CL±P) and isolated cleft palate only (CP) revealed their incidence to be 1.05 and 0.66 per 1000, respectively. Of all types of clefting, CL and CLA was found in 17.2%, CL±P in 43.9%, CP in 38.2% and atypical facial clefts (AFC) in 0.8% of children. Left-sided clefts were most common (51%), followed by bilateral (30.5%) and right-sided (18.5%) clefts. The male to female ratio was 1.3. CL±P predominated in male and CP in female children. In 220 cases (24.4%) orofacial clefts were either associated with other anomalies or the clefts occurred as one feature of a syndrome.
Data obtained from different sources yielded a cleft incidence of 1.71 per 1000 in Croatia. There were no differences in the incidences of orofacial clefts in comparison with similar data from other European countries.
The aim of the study was to explore the association between Glasgow Coma Scale (GCS), Paediatric Index of Mortality (PIM2) and Injury Severity Score (ISS), and the long-term outcome of children with ...injuries. The health related quality of life (HRQL) was assessed by using the Royal Alexandra Hospital for children Measure of Function (RAHC MOF), 12 months post discharge. Out of 118 children with injuries (9% of all patients), 75 had injury of the head as the leading injury. There were no significant differences at admission in the severity of clinical condition, as expressed by PIM2 and ISS, between patients with head injuries and patients with other injured leading body regions. Children with head injuries had significantly worse HRQOL than children with other leading injured body region (p < 0.045), and children from road traffic accidents had significantly worse HRQL (p = 0.004), compared to other mechanisms of injury. HRQL correlated significantly with GCS (p = 0.027), but not with ISS and PIM2. As the conclusion, among all scoring systems applied, only GCS, which demonstrates severity of head injury, showed significant impact on long-term outcome of injured children.
Križevačka kukmasta kokoš nastala je u osamdesetim godinama 20. stoljeća selekcijskim radom na domaćim kokošima uzgajanim u Kalničkom prigorju, koje je karakterizirala osrednja kukmica te srednje ...teško tijelo. Te su kokoši planski križane s pijetlovima pasmine Orpington. Do današnjeg vremena nisu provedena znanstvena istraživanja kako bi se dobile spoznaje o njihovim fenotipskim i proizvodnim karakteristikama pa je stoga cilj ovog istraživanja bio utvrditi vrijednosti tjelesnih mjera kokoši i pijetlova te odrediti izgled i kakvoću jaja kako bi se moglo započeti s izradom pasminskog standarda potrebnog za njezino priznavanje kao autohtone pasmine kokoši. U istraživanje su bile uključene kokoši i pijetlovi s četiri obiteljska gospodarstva na području grada Križevaca. Utvrđena je boja perja, nogu i podušnjaka kod životinja u dobi od šest mjeseci i godinu dana te su iste izvagane, a provedeno je i mjerenje vrijednosti za još deset tjelesnih mjera. Prikupljena su i kokošja jaja kako bi se utvrdile vrijednosti mase jaja, čvrstoće ljuske, udjela žutanjka, bjelanjka i ljuske te utvrdila boja žutanjka. Križevačka kukmasta kokoš je skladnog tijela kvadratnog oblika i bujnog perja žute boje obrubljenog tamnom gotovo crnom bojom. Glava je srednje veličine, na njoj se nalazi kukmica narančasto-žute boje kod pijetlova, a crno-smeđe kod kokica. Tjelesne mase pijetlova u dobi od 6 i 12 mjeseci u prosjeku su iznosile 2,33 i 2,95 kg, a kod kokoši u istoj dobi 2,06 i 2,71 kg.
SAŽETAK
Međunarodne smjernice za farmakološko liječenje epilepsija općenite su, sveobuhvatne i ne prepoznaju lokalne specifičnosti poput ekonomskih i tehničkih mogućnosti u pojedinim državama, ...dostupnosti pojedinih antiepileptika ili drugih metoda liječenja i slično. Stoga se nameće potreba izrade nacionalnih smjernica, čiji su zapravo temelj međunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakološko liječenje epilepsija plod su suradnje svih relevantnih stručnih društava i referentnih centara u RH, na čelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neurološkim društvom i Hrvatskim društvom za dječju neurologiju Hrvatskoga liječničkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifičnosti u našoj zemlji, najnovije spoznaje farmakoloških profila i učinkovitosti pojedinih antiepileptika kao i ekspertna mišljenja. Antiepileptička terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktička primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, mogućnostima liječenja i samopomoći, životnim ograničenjima te mogućim neželjenim događajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljšanje kvalitete života. Zlatni standard liječenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za liječenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifičnim čimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestičkih i dijagnostičkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika različitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, različitog profila nuspojava i sinergističkog ili aditivnog djelovanja. Zamjena generičkih ili originalnog i generičkog oblika lijeka nije preporučljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptičke terapije treba biti postupno i sporo, u slučaju politerapije jedan po jedan lijek, a u donošenju odluke o ukidanju, kao i o uvođenju antiepileptika, mora biti uključen bolesnik i njegova obitelj.
Our study aimed to assess differences in the susceptibility to severe acute illness in children with and without chronic health conditions treated in a pediatric intensive care unit (PICU).
Data on ...age, gender, need for ventilator support, length of stay, as well as other parameters for the Paediatric Index of Mortality (PIM2) score were collected. Data were analyzed and compared across three patient groups: those with a neurodevelopmental disability, those with a chronic condition other than a neurodevelopmental disability, and those with no chronic condition. Reasons for admission of patients were classified according to the Australia and New Zealand Paediatric Intensive Care Registry (ANZPIC Registry) diagnostic codes. In the multidisciplinary, seven-bed, level I PICU of the Split University Hospital, the admission data were collected prospectively for 591 consecutively admitted patients aged<or=18 years.
Patients with a neurodevelopmental disability had a significantly higher rate of respiratory-related admissions compared to patients with other chronic health conditions and those with no chronic condition (chi2=33.72, P<0.001). There was a significant difference in the age at admission (f=6.04, P=0.003), median length of stay (f=7.94, P<0.001), need for ventilation during the first hour of admission (chi2=14.74, P<0.001) and PICU mortality (chi2=9.91, P=0.007) of patients with neurodevelopmental disabilities, compared to the other two groups of patients.
Children with neurodevelopmental disabilities are more susceptible to acute illness compared to children with other chronic health conditions and those with no chronic condition.
The changes in long-term quality of life (QOL) of children treated in paediatric intensive care unit (PICU) were investigated in relation to their QOL before critical illness together with the ...influence of underlying chronic health condition and severity of illness estimated by Paediatric Index of Mortality 2 on the long-term outcome. This study included 189 children treated in PICU and 179 children from outpatient clinics as controls. QOL was evaluated according to the Royal Alexandra Hospital for Children Measure of Function (RAHC MOF). The long-term QOL in 70 % of children treated in PICU was good, although there was a significant diminution of QOL in children treated in PICU in comparison with their preadmission scores and with the children from outpatient clinics who served as controls (
p
< 0.001). Severity of illness had a significant impact on children’s QOL (
p
= 0.016) 6 months after treatment in PICU. Twenty-four months after discharge, the RAHC MOF score was still decreased in 19 % of children treated in PICU, and in significantly more patients with a chronic health condition (CHC) treated in PICU, than in their peers from outpatient clinics (
p
= 0.029). Reduced QOL was significantly more frequent in children with neurodevelopmental disability than in children without CHC 24 months after discharge from PICU (
p
= 0.013).
Conclusion:
Acute illness has a significant impact both on children with and without CHC after treatment in PICU 6 months after discharge. Twenty-four months after discharge, comorbidity was identified as the decisive factor for diminished QOL in children after PICU treatment.
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