Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in ...0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with 'light perception' or 'no light perception' vision, making TON a significant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of 'counting fingers at 2 meters' on the right eye due to keratoconus and 'counting fingers at 1 meter' on the left eye as a consequence of trauma. The Octopus visual field showed diffuse re-duction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative afferent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the findings, conservative corticosteroid therapy without surgery was conducted. The patient responded well to treatment with complete ophthalmologic recovery.
Neurofibromatosis type 1 (NF1) is an autosomal dominant a multisystem genetic disorder that primarily involves the skin and the nervous system. The incidence of the disease is 1:3000-4000 live-born ...children, equally in both sexes. The diagnosis of NF1 is determined individually with any two of the following clinical features: café-au-lait spots, intertriginous freckling, Lisch nodules, neurofibromas, optic glioma, distinctive bone lesions and first-degree family relative with NF1. NF1 is a disease most commonly diagnosed and treated by neuropediatricians.
Cognitive and behavioral disorders affect between 50-80% of all children with NF1. Children with NF1 show impairments in attention, visual perception, language, executive function, academic skills, and behavior. This requires a multidisciplinary approach to the treatment s as seen in the case we present. Furthermore, NF1 is often associated with psychiatric disorders, which are more frequent in this disease than in general population, according to some studies even up to 33% patients. Psychiatric disorders are more frequent in NF1 than in the general population, particularly in children. They include dysthymia, depressive mood, anxiety, and personality disorders. Bipolar mood disorders or schizophrenia are rather rare. The majority of studies have focused on physical health and neurocognitive function in NF1, whereas psychiatric disorders associated with this disease remain unclear and poorly documented.
We present a case of an eight-year-old boy with behavioural and learning disabilities referred for psychological and psychiatric evaluation as well as an overview of NF-related psychiatric illnesses described in the literature.
Conjunctival melanoma is a rare but sight and life threatening malignancy. It accounts for 2%–5% of all ocular tumours and 5%–7% of all ocular melanomas with an incidence of 0.2–0.8 per million in ...the Caucasian population with rare cases reported in the non-Caucasians. In recent decades the incidence of uveal melanoma has been relatively stable whilst conjunctival and cutaneous melanoma have shown increasing incidence which may be connected to the result of environmental exposure to ultraviolet light. The dissimilarity in incidence between light and dark pigmented individuals observed in conjunctival melanomas compared to uveal and cutaneous melanomas may be related to differences in their histological structures and genetic profile. Recent molecular biological studies support the fact that each type of melanoma undergoes its own molecular changes and has characteristic biological behaviour. Further studies are required for each type of melanoma in order to ascertain their individual etiology and pathogenesis and based on this knowledge develop relevant preventative and treatment procedures.
Ekonomske krize tijekom povijesti često su bile poticaj za zdravstvene i socijalne reforme.
Rezultat toga bilo je uvođenje sustava opće zdravstvene zaštite i socijalne jednakosti u velikom
broju ...zemalja. Ovim radom željeli smo kronološki prikazati velike gospodarske krize
i njihove učinke na zdravstveni i socijalni sustav. Dva najpoznatija modela zdravstvene
zaštite, Bismarckov i Beveridgeov, na kojima se temelji funkcioniranje većine zdravstvenih
sustava u svijetu, upravo su proizišli iz velikih ekonomskih kriza.
Pregled povijesnih događaja i iskustva iz prošlosti mogu biti korisna u predviđanju budućih
zbivanja i učinaka krize na zdravstvene sustave i zdravlje. Analiza prijašnjih kriza, kao i
trenutačne zdravstvene i gospodarske krize uzrokovane pandemijom bolesti COVID-19, i
njihova učinka na sustav zdravstva može pomoći u razumijevanju mehanizama djelovanja
i posljedica recesije na zdravlje te određivanju smjernica i promjena kojima bi se umanjile
potencijalne štete budućih kriza. Upravo iz iznesenih povijesnih primjera vidi se da kriza
može biti poticaj promjena koje u svojoj suštini ne moraju biti negativne. O reakciji društva
ovisi koji će biti smjer tih promjena i na samom je društvu da negativne okolnosti koje donosi
recesija transformira u aktivnosti koje donose dobrobit i napredak.
Background and methods: Diabetes mellitus is the most prevalent endocrine disease in developed countries. In people with diabetes in addition to vision loss caused by diabetic retinopathy transient ...visual disturbances may occur frequently caused by refractive changes. These changes in refraction are associated with variations in blood glucose levels but the underlying mechanism is still not fully understood. A systematic review with a comprehensive literature search was performed in order to clarify the underlying mechanisms regarding the connection of glycaemic control and refractive shift.
Results: Some studies have shown that increased blood sugar leads to a myopic shift whilst others demonstrated that this change is in a hyperopic direction. Changes in visual acuity in patients with diabetes could be an indicator of inadequate metabolic control or even the first sign of diabetes mellitus.
Conclusion: This review gives a brief overview of current research regarding potential mechanisms of glycemic control influence on refractive error. The aim is to emphasize the importance of understanding the relationship of blood glucose concentration and refractive changes as one of the common but overlooked diabetic complications.
Economic crises throughout history have often given an impetus for health and social reforms leading to the introduction of general healthcare systems and social equality in a large number of ...countries. The aim of this paper is to present the major economic crises and their effect on healthcare and social system chronologically. Bismarck's and Beveridge's model, the two most prominent healthcare models, which emerged primarily as a response to major economic crises, constitute the basis for the functioning of most health care systems in the world. An overview of historical events and experiences may be valuable in predicting future developments and potential effects of the crisis on healthcare systems and health in general. An analysis of past crises as well as current health and economic crisis caused by the COVID-19 pandemic and their impact on the healthcare system can facilitate the comprehension of the mechanisms of action and consequences of economic recession. It may also help identify guidelines and changes that might reduce the potential damage caused by future crises. The historical examples presented show that a crisis could trigger changes, which, in theiressence, are not necessarily negative. The response of society as a whole determines the direction of these changes, and it is up to society to transform the negative circumstances brought about by the recession into activities that contribute to general well-being and progress.
Neurofibromatoze (NF) su skup različitih genetskih poremećaja kojima je zajednička karakteristika pojava tumora živčanog sustava. Razlikuju se tri oblika bolesti: NF1, NF2 i švanomatoza, a najčešći ...oblik je NF1 ili von Recklinghausenova bolest. Neurofibromatoze se nasljeđuju autosomno dominantno s visokom stopom novih mutacija i varijabilnom ekspresijom. Iako se NF1 smatra bolešću s povećanim rizikom za razvoj tumora, njena najčešća komplikacija u djetinjstvu je oštećenje akademskog postignuća i spoznaje, pri čemu su često pogođene pozornost, izvršne, jezične i vizualno-prostorne funkcije. Stoga se ovim radom željelo ukazati na važnost psihičkih poremećaja i poteškoća kod osoba oboljelih od NF1. Njihovo rano uočavanje otvara mogućnost ranijeg početka liječenja, a time bolje kvalitete života bolesnika. U radu je dan pregled novih spoznaja o psihičkim poremećajima koji se mogu javiti kod oboljelih od NF. Prikazana su istraživanja koja su pokušala
objasniti pojedine psihičke funkcije kod oboljelih osoba. Najveći broj istraživanja bavi se kognitivnim poteškoćama čija je učestalost kod oboljelih od NF1 vrlo visoka. Ostala istraživanja opisuju probleme socijalizacije i kvalitete života te mogućnosti medikamentoznog liječenja psihičkih poremećaja. Važno je i korisno da stručnjaci različitih specijalnosti imaju šire znanje o psihičkim poremećajima i poteškoćama koje se mogu javiti kod osoba oboljelih od NF1. Također se ovim radom
željela naglasiti važnost multidisciplinarnog pristupa kod liječenja NF čime će se postići i uspješnije liječenje i poboljšati kvaliteta života bolesnika.
Melanom srednje očne ovojnice predstavlja 5% svih melanoma. Oko je, nakon kože, drugo primarno sijelo melanoma. Kasna ili kriva dijagnoza može imati ozbiljne posljedice. Napredak u dijagnostici te ...lokalnom i sustavnom liječenju doveo je do češće primjene metoda kojima je cilj očuvati oko i vid. Radioterapija, kao danas najčešći oblik liječenja, može biti primjenjena kao: brahiterapija - radioaktivni plak, najčešće korištena metoda, potom stereotaktička radioterapija vanjskim zračenjem, tzv. radiokirurgija, kao i čestično zračenje, npr. protonska radioterapija. Enukleacija oka se, kao neizbježni oblik liječenja, ipak mora primijeniti u određenim slučajevima. Kod primarnog tumora, lokalne metode liječenja učinkovite su u sprječavanju lokalnog recidiva u više od 95% slučajeva. Međutim, metastatska bolest razvija se u oko 50% bolesnika, a najčešće sijelo presadnica je jetra. Stopa preživljenja bolesnika s presadnicama je 4-15 mjeseci i gotovo je nepromijenjena tijekom posljednjih desetljeća. Iako se otkrivaju potencijalne ciljne mete sistemske terapije, ne postoji još djelotvorna metoda liječenja metastatske bolesti. U tijeku su klinička ispitivanja liječenja kemoterapijom i imunoterapijom koja otvaraju mogućnosti uspješne kontrole i liječenja tumora uz očuvanja vida bolesnika te prevencije razvoja metastatske bolesti i povećanja stope preživljenja bolesnika.
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