bluuebunny/crossref_metadata_2025 huggingface dataset:
Spiked-helmet Sign: A Rare but Alarming Sign on Electrocardiogram
Authors: Adithiyaa Nithin V. , Yeriswamy M. C.
Published: March 2024

Spiked Helmet Sign was first described by Littman and Munroe in 2011 in a case series of 8 patients. This novel ECG sign is a predictor of death in critically ill patients. It resembles the German military helmet of the Prussian empire. 27-year-old male came with chief complaints of upper epigastric pain and chest pain for 2 hours. ECG showed ST elevation in the anterior and inferior leads, patient was diagnosed as STEMI and lysed with streptokinase, on further interrogation patient had binge of alcohol last night and had sudden onset of upper abdominal pain and Serum amylase and lipase was elevated and USG abdomen showed acute pancreatitis. SHS is associated with critical non cardiac illness and the association with pancreatitis is very rare.
Electroacupuncture Inhibited the Spinal Glial Activation in Neuropathic Pain via Glucagon-like Peptide-1/Glucagon-like Peptide-1 Receptor Signaling
Authors: Zhong Ke , Long Xiang , Wan Yun-Qiang , Zhou Yu
Published: March 2024

Background:

The enhancement of glucagon-like peptide 1 (GLP-1)/GLP-1 receptor (GLP-1R) may be considered a novel therapeutic idea for neuropathic pain. Electroacupuncture (EA) has been widely used as an ideal nonpharmacological treatment for neuropathic pain, but the underlying mechanisms remain largely unknown. Therefore, we aim to explore whether repetitive EA stimulation could activate the spinal GLP-1/GLP-1R signaling in neuropathic pain.

Materials and Methods:

Paw withdrawal threshold and thermal withdrawal latency analyses were used to evaluate the effects of 2HZ/1 mA EA on pain-related behaviors of rats with spared nerve injury (SNI). Expressional levels of protein molecules in spinal dorsal horn were detected by Western blot and immunofluorescence staining.

Results:

Application of 2HZ/1 mA of EA at “ST36” and “SP6” effectively and persistently relieved nerve injury-induced pain hypersensitivity. Ionized calcium-binding adapter molecule 1 (Iba-1) and glial fibrillary acidic protein (GFAP) were highly expressed in the ipsilateral spinal dorsal horn of SNI rats but inhibited by EA. In addition, EA increased the expression levels of GLP-1 and GLP-1R in the ipsilateral spinal dorsal horn. Pharmacological activation of GLP-1R mimicked the analgesic effects of EA on pain hypersensitivity, whereas blocking of GLP-1R reversed these effects.

Conclusions:

These results revealed that 2HZ/1 mA of EA at “ST36” and “SP6” alleviated nerve injury-induced pain hypersensitivity via mechanisms possibly involving enhancement of GLP-1/GLP-1R signaling, which further suppresses spinal glial activation.
Dynamic Sleep Architecture Revealed: Sleep Auditory Evoked Potentials from N100 to P900
Authors: Atlı Sibel Kocaaslan , Inanc Gonca , Oniz Adile , Ozgoren Murat
Published: March 2024

Background:

The research landscape in sleep is currently shifting toward minute changes in brain functioning during different stages. This fine approach necessitates a dynamic assessment as in the case of electrophysiology. The present study aimed to investigate brain responsiveness during different stages and times of nocturnal sleep using auditory evoked potentials (AEPs).

Materials and Methods:

Sleep recordings of 18 volunteer subjects were analyzed. During sleep recordings, auditory stimuli were presented in the ear channels. Sleep stages were scored according to the American Academy of Sleep Medicine system. AEPs were analyzed in nonrapid eye movement sleep stages. Alterations of N100, P200, N300, P450, N550, and P900 waveforms were investigated in the first and second halves of sleep duration.

Results:

N100 amplitude was higher in light sleep, both in the first and the second halves of the night (sleep duration). The amplitude of P900 was higher in the deep sleep stage in both halves. Significant amplitude reductions were found in N100, P200, P450, and P900 in the second half of the sleep.

Conclusions:

The changes found suggest that they are related to the dynamics of sensory processing to maintain functional sleep. The findings of the present study emphasize that in the course of sleep, both the proportions of sleep stages and the microarchitecture within the stages alter between the first and second halves of sleep.
To study the efficiency of high-flow nasal cannula in improving the arterial blood gas parameters in children admitted to pediatric intensive care unit with respiratory distress
Authors: Balleda Lokeswari , Kolla Sravani , Thimmapuram Chandrasekhara Reddy
Published: March 2024

Background:

In recent times, heated humidified high-flow nasal cannula has become increasingly popular and is now recognized as a standard respiratory support method for pediatric patients experiencing acute respiratory distress.

Aims and Objectives:

To study the correlation of high-flow nasal cannula (HFNC) with arterial blood gas (ABG) and clinical parameters.

Materials and Methods:

This prospective observational study included children aged 1 month to 14 years experiencing acute respiratory distress receiving HFNC support. Demographic information, vital signs, and ABG parameters were collected at four-time points: the first ABG at “0” h, indicating admission; the second ABG at “1” h, approximately 1 h after HFNC initiation; the third ABG at “12” h, as a follow-up after the initiation of respiratory support; and the fourth ABG at “24” h, representing daily monitoring for assessing the child’s condition and outcomes. The collected data was subjected to analysis.

Results:

The study included 133 children, of which 64.66% were male and 35.34% were female, with a mean age of 0.9 years (ranging from 0.3 to 3 years) and a mean weight of 7.8 kg (ranging from 4.7 to 11.8 kg). Over time, there was a statistically significant decrease in heart rate, respiratory rate, and the need for FiO2. Significant reductions in these parameters were observed within the first hour of initiating HFNC therapy, and improvements continued at 12 and 24 h compared to the baseline values (P value < 0.05). The study also revealed a decreasing trend in pCO2 and lactate levels over time. Statistically significant reductions in these parameters were noted at the first hour of HFNC initiation, and improvements persisted at 12 and 24 h compared to the baseline (P value < 0.05). On the other hand, there was an increasing trend in SpO2, pO2, base excess, and HCO3 over time. Significant increases in these parameters were observed at the first hour of HFNC initiation, and the positive trend continued at 12 and 24 h compared to the baseline (P value < 0.05).

Conclusion:

HFNC can serve as the primary noninvasive respiratory support for children facing respiratory distress. The majority of patients in our study demonstrated good tolerance to the HFNC. Notably, the utilization of HFNC resulted in a significant enhancement of the comfort scale among the participants. Positive changes were observed in vital parameters, comfort scale, and ABG parameters within just 1 h of initiating HFNC.
Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease
Authors: Tisavipat Nanthaya , Juan Hui Y. , Chen John J.
Published: March 2024

Monoclonal antibody therapies mark the new era of targeted treatment for relapse prevention in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD). For over a decade, rituximab, an anti-CD20 B-cell-depleting agent, had been the most effectiveness treatment for AQP4-IgG+NMOSD. Tocilizumab, an anti-interleukin-6 receptor, was also observed to be effective. In 2019, several randomized, placebo-controlled trials were completed that demonstrated the remarkable efficacy of eculizumab (anti-C5 complement inhibitor), inebilizumab (anti-CD19 B-cell-depleting agent), and satralizumab (anti-interleukin-6 receptor), leading to the Food and Drug Administration (FDA) approval of specific treatments for AQP4-IgG+NMOSD for the first time. Most recently, ravulizumab (anti-C5 complement inhibitor) was also shown to be highly efficacious in an open-label, external-controlled trial. Although only some patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) warrant immunotherapy, there is currently no FDA-approved treatment for relapse prevention in MOGAD. Observational studies showed that tocilizumab was associated with a decrease in relapses, whereas rituximab seemed to have less robust effectiveness in MOGAD compared to AQP4-IgG+NMOSD. Herein, we review the evidence on the efficacy and safety of each monoclonal antibody therapy used in AQP4-IgG+NMOSD and MOGAD, including special considerations in children and women of childbearing potential.
Teprotumumab in thyroid eye disease
Authors: Goldberg Hila , Malik Amina I.
Published: March 2024

Thyroid eye disease (TED) is an inflammatory condition involving the periocular and orbital soft tissues, affecting most commonly patients with hyperthyroid disorders. Traditional treatments used for the active phase of the disease range from conservative lubrication for mild symptoms to systemic immunomodulating drugs for moderate-to-severe symptoms. Teprotumumab (Tepezza) is a monoclonal antibody with an inhibitory effect on insulin-like growth factor 1 and is the first Food and Drug Administration (FDA) approved targeted medical therapy for reducing the inflammatory signs and symptoms associated with TED. Two large multicenter, randomized, double-masked, placebo-controlled trials have confirmed the efficacy and safety of teprotumumab in patients with active, moderate-to-severe TED. Recent reports and publications have also demonstrated the efficacy of teprotumumab in a wider range of patients. In this review, we summarize the clinical features and pathophysiology of TED, disease course, and traditional management methods. We further detail the development of teprotumumab, the founding studies that brought it to its FDA approval, adverse events profile, and ongoing as well as future investigations.
Incidence of Raised Intra-Ocular Pressure Post Penetrating Keratoplasty at a Tertiary Care Hospital in Central India
Authors: Tiwari Sakshi , Shukla Durgesh , Chhawania Pramod Kumar , Dubey Harshita
Published: March 2024

Background:

Penetrating keratoplasty (PK) is done for a variety of reasons, such as corneal opacity, bullous keratopathy, corneal stromal dystrophies, Fuchs' endothelial dystrophy, ectasia, and perforation. Management of raised intra.ocular pressure (IOP) after keratoplasty is necessary to maintain the visual outcome. The purpose of this study was to find the incidence of raised IOP after keratoplasty.

Material and Methods:

This prospective study was conducted on 67 eyes of 67 patients attending the ophthalmic out.patient department of the upgraded department of MY Hospital Indore from November 2021 to November 2022. One-way analysis of variance test, Chi-square test, and Fisher exact test were applied, and the P value was judged at 5% level of significance.

Results:

The main indication for PK was infectious keratitis (52.3%), corneal scars (32.8%), regrafts (7.5%), bullous keratopathy (5.9%), and staphyloma (2.9%). In this study, the overall incidence of raised IOP (>21 mmHg) was 25.37% (17 cases). Raised IOP was observed among the 20% of infectious keratitis, 27.3% of corneal scars, 40% of regraft, and 50% of bullous keratopathy. Steroid-induced rise in IOP (47.05%; n = 8) was the most common post-operative factor.

Conclusion:

Maximum cases in which PK was done were of infectious keratitis. Post PK rise in IOP is a serious complication that is significantly associated with an increased risk of graft failure and poor visual outcome. Thus, rise in IOP was associated with a significant reduction in the percentage of eyes achieving good visual acuity.
Prevalence and Distribution of Retinal Pathologies in Patients with Chronic Kidney Disease in a Tertiary Eye Clinic in South India
Authors: Mohan Sashwanthi , Mohankumar Arthi , Khatri Manoj , Dabir Supriya , Mohan Sujatha , Rajan Mohan
Published: March 2024

Purpose:

Chronic kidney disease (CKD) is an emerging global health challenge characterized by progressive irreversible damage to the kidneys. The aim is to determine the prevalence and types of retinal pathologies noted in patients diagnosed with CKD presenting to a tertiary eye clinic in South India.

Methods:

In this retrospective cross.sectional observational study, electronic medical records of patients with a documented history of CKD between 2019 and 2022 were selected with the help of pre.determined keywords. Basic demographic parameters and the presence of retinal pathologies were documented and analyzed.

Results:

During the study period, 263 patients with CKD presented to us for ophthalmic examination. Among them, 156 patients were found to have retinal pathologies (59.3%). Thirty patients (19.2%) had unilateral involvement, and 126 (80.8%) had bilateral involvement. The most common retinal pathology was proliferative diabetic retinopathy (PDR) (both treatment naive and status post.pan.retinal photocoagulation) in 110 of 312 eyes (35.2%), followed by non.proliferative diabetic retinopathy (NPDR) in 83 of 312 eyes (26.6%). Other pathologies noted were hypertensive retinopathy (7.05%) and retinal vein occlusions (4.1%).

Conclusion:

There is a high prevalence of retinal pathologies in CKD patients, of which diabetic retinopathy is the most common, followed by hypertensive retinopathy. A thorough ocular examination of these patients is essential for timely diagnosis and intervention.
Mental Health Care in Poland
Authors: Korolkiewicz Paweł K. , Salloum Amir , Gaba Gursimran , Bidzan Leszek , Grabowski Jakub
Published: March 2024

Background:

Like in other industrialized countries, the development of Polish psychiatry has followed a typical trajectory, initially marked by the establishment of large mental health hospitals using an isolation-based care model. Subsequently, there has been a decline in these institutions, characterized by a reduction in the number of hospital beds, and an ongoing evolution toward decentralized community psychiatry, specifically mental health-care centers. The hospitalizations are for emergency/acute care only. The authors describe how clinical services and personnel training in Poland that have been adjusted in response to societal changes and global trends in mental health care.

Methods:

The authors collected and critically reviewed information based on literature relevant to the organization of mental health care in Poland. In addition, official government publications such as reports from the Central Statistical Office and Ministry of Health were perused to gather data on the population structure, gross domestic product, and the organizational structure of the mental health care and relevant health-care indices.

Results:

Mental health care in Poland is evolving and gradually improving, providing more opportunities for collaboration and networking among nongovernmental organizations, patients’ associations, and psychiatrists working toward common goals. Training curricula have been updated and/or modified, with new specialty and subspecialty trainings being offered to meet the demands of health-care professionals and patients alike.

Conclusion:

Demographic changes, the presence of Ukrainian war refugees, and global trends in psychiatry profoundly influence the delivery of mental health-care services in Poland.
Analysis of Heart Rate Variability in Young Male Adults with Depression and Anxiety during Warm-water Footbath
Authors: Kung Fan-Hsuan , Tai Yueh-Ming , Kao Yu-Chen , Yang Szu-Nian , Hsu Chung-Chih
Published: March 2024

Background:

Heart rate variability (HRV) modulates both the sympathetic nervous system and the parasympathetic nervous system (PNS) of the autonomic nervous system. Mood disorder is one of the contributing factors to influence HRV. The warm-water footbath as a relaxing way is used to enhance the PNS. In this study, we intended to explore the association between HRV and a footbath in the mood disorder group.

Methods:

We recruited 14 young male study participants to receive a 30-minute warm-water footbath three times a week. Furthermore, we monitored the heart rates electrocardiographically before, during, and after the intervention.

Results:

This study showed that the footbath not only significantly enhanced standard deviation of NN (SDNN) intervals, high-frequency (HF) power, and low-frequency (LF) power during the first five minutes footbath (p < 0.01) but also increased all the parameters in five minutes after finishing the footbath. SDNN intervals, HF power, and LF power remained significantly upward in the next five minutes (p < 0.05).

Conclusion:

In line with previous studies, this study showed that a footbath elevated the PNS-related HRV parameters. We suggest that a warm-water footbath improves the PNS modulation possibly through baroreflex. In addition, those with cardiac conditions and depression should be particularly attentive to their condition during and following a footbath.
C-reactive Protein and Suicidality in Patients with Treatment-resistant Depression
Authors: Chen Mu-Hong , Su Tung-Ping , Bai Ya-Mei , Tsai Shih-Jen
Published: March 2024

Objective:

Increasing evidence suggests a crucial rȏle of C-reactive protein (CRP) in the pathological mechanisms of suicide. Whether CRP levels may be associated with suicidal ideation (SI) among patients with treatment-resistant depression (TRD) remains unclear. In this study, we intended to explore the relation between TRD and SI.

Methods:

Totally 36 patients with TRD and SI, 24 with TRD without SI, and 32 healthy controls were enrolled in the present study. SI was defined based on scores of ≥ 2 at the 17-item Hamilton Depression Rating Scale item 3. Fasting serum CRP levels were also measured.

Results:

The generalized linear model with gamma log link demonstrated that patients with TRD and SI had significantly higher CRP levels (p < 0.05) than the control group after adjusting for age, sex, and body mass index.

Conclusion:

Patients with TRD and SI, but not those without SI, were associated with increased CRP levels. Whether CRP may be a predictor of further suicidal risk among such high-risk patients would need further investigation.
The investigation of the effects of calcitriol on human ovarian carcinoma cells
Authors: Kartal Bahar , Alimoğulları Ebru
Published: March 2024

Objective: Ovarian cancer is the fifth leading cause of cancer death in women, the leading cause of death from gynecologic malignancies, and the second most commonly diagnosed gynecologic malignancy, however the underlying pathophysiology is not clearly understood. Calcitriol, the active form of vitamin D serves its activity through binding to vitamin D receptor (VDR). Calcitriol regulates multiple signaling pathways such as proliferation, apoptosis, differentiation, inflammation, invasion, angiogenesis and metastasis. It has been found to have a broad effect on several cancer types such as colon, breast and prostate cancer. Therefore, the aim of the study was to investigate the effects of calcitriol on the human ovarian cancer cells.

Material and methods: The human MDAH-2774 ovarian carcinoma cells were exposed to different dose ranges of calcitriol for 24 and 48 hours. Cultured cells were evaluated in terms of MTT assay and quantitative- Real time-PCR.

Results: As evidenced by MTT assay, calcitriol treatment resulted in the reduction of cell viability in human MDAH-2774 cells. The gene expressions of VDR and p53 were increased with the calcitriol treatment compared to control. Additionally the gene expression of proapoptotic marker Bax was increased and the anti-apoptotic marker Bcl-2 decreased with the presence of the calcitriol.

Conclusion: In conclusion calcitriol treatment decreased cell proliferation and induced apoptosis in ovarian cancer cells, therefore we can suggest that alone calcitriol or in combination with chemotherapy drugs may be useful for treatment of ovarian cancer.
Evaluation of the Adequacy Level of Nutritional Substances (Vitamins) with the Incident of Stunting in Children in the Working Area of the Surabaya City Health Center
Authors: Septi Fandinata Selly , Mas Ulfa Ninik , Puspa Novita Rennie , Aryanda Putra Deddy
Published: March 2024

Stunting is a condition where height growth disorders arise due to malnutrition, so that a child's height does not correspond to his age. The aim of this research is to evaluate the use of vitamins and minerals in stunting cases in several Surabaya Community Health Centers. The results of this research are descriptive with prospective data collection. The number of respondents obtained was 64 stunting child patients who met the inclusion criteria. Based on the results of child demographics according to age, the most stunting child patients were 32 patients aged 48 – 60 months (50%). Based on gender, the results were balanced between women and men. Based on a history of exclusive breastfeeding, the majority had a history of exclusive breastfeeding, 52 patients (81.25%). Based on birth weight, the highest number of patients with a normal weight (>2500) grams was 53 patients (82.82%). Based on disease history, the majority did not have a history of disease, 53 patients (82.82%). The vitamins and minerals used in stunting cases in several Surabaya Community Health Centers are Optima Zinc Syrup, Vitamin and Mineral Powder, Taburia, and Vitamin A Capsules, with the rules and duration of use according to those given. Based on the results of nutritional status assessments at several Surabaya Community Health Centers, it was found that the majority of children were underweight based on Z-Score BW/U, had short status based on Z-Score BH/U, and had good nutritional status based on Z-Score BW/BH. The results of the nutritional status assessment concluded that the majority of children were underweight based on Z-Score BW/U, had short status based on Z-Score BH/U, and had good nutritional status based on Z-Score BW/BH.
The Influence of Psychological Capital and Affective Commitment on Organizational Citizenship Behavior of Hospital Staff
Authors: Puspitaloka Mahadewi Erlina , Muchtadin Muchtadin
Published: March 2024

Organizational Citizenship Behavior (OCB) is important to apply to hospital staff. This research aims to determine the simultaneous and partial influence of psychological capital and affective commitment on OCB. Respondents were 196 officers from two hospitals in Indonesia. The sampling method uses stratified random sampling. The data analysis method uses multiple linear regression. Data was processed with the help of Jamovi 2.3.28 software. The research results found that psychological capital and affective commitment had a significant positive effect on OCB both partially and simultaneously. Hospital management can increase the voluntary behavior of its staff in working beyond formal rules by increasing psychological capital such as self-efficacy, hope, optimism, resilience. Factors that increase affective commitment also need to be implemented so that officers' OCB increases, followed by better service provided. Future researchers can limit the study population to certain areas and combine private and government hospitals to obtain greater generalization. Future researchers can add other variables such as work motivation and job satisfaction to the simultaneous and partial effects.
Traffic Engineering At The Kim Ii Roundabout
Authors: Amrizal Amrizal , Juni S Br Tarigan Pagit , Pramono Egi
Published: March 2024

As the manager of the industrial area, currently PT. KIM has problems related to traffic jams that occur around the KIM roundabout and to reduce the number of traffic accidents at KIM due to collisions between vehicles from opposite directions, it is necessary to carry out traffic engineering in the area. Traffic engineering is related to the implementation of repair work Roundabouts are not only road construction improvements but also include traffic engineering before, during and after construction. Simulation of traffic conditions to provide alternative solutions to traffic problems that occur at the KIM II Roundabout using VISSIM software. From the results of the simulations that have been carried out, it can be seen that almost all road sections have a level of service F, which means they have a VCR value > 1. This is included in the oversaturated category, side obstacles and delays increase, stopping and moving events increase, if the flow increases, the vehicle speed is equal to zero (complete stop). This condition causes delays on one of the sections of 151 vehicle seconds and this condition is not very good because it will lengthen the queue of vehicles crossing the roundabout. In accordance with the simulation that has been carried out, and based on several applicable regulations regarding the traffic system at roundabouts, several alternatives for handling traffic problems in the KIM II Roundabout area are provided.
PREVENCIJA ZLOSTAVLJANJA I ZANEMARIVANJA DECE
Authors: Mošković Luka
Published: March 2024

Nasilje nad decom ne predstavlja izolovani problem (pojedinačni ili porodični), već problem društva u celini, i kao takvom, treba mu se pristupiti oraganizovano, sistematski, na svim društvenim nivoima.

Činjenica da jos uvek ne postoje adekvatni podaci o obimu i posledicama zlostavljanja i zanemarivanja dece u velikoj meri usporava donošenje odgovarajućih mera prevencije. Na žalost, danas se većina preventivnih mera fokusira na žrtve i počinioce, dok se akcije koje se bave rešavanjem osnove problema stavljaju u drugi plan.

Stvaranje sigurnog i podsticajnog okruženja za decu postiže se kroz primarnu, sekundarnu i tercijarnu prevenciju. Sva tri nivoa prevencije u međusobnoj su interakciji, prožimaju se i dopunjuju, a pojedinačno ih treba posmatrati isključivo kao delove prevencije u celini.
UTICAJ I ZNAČAJ RESPIRATORNE REHABILITACIJE NA LEČENJE I PREVENCIJU DEČJE ASTME
Authors: Živanović Mirjana , Vidanović Gordana , Kovandžić Radica , Bojić Vesna , Milojević Prilagija , Milojković Ljiljana
Published: March 2024

Uvod: Astma je jedna od najčešćih hroničnih respiratornih bolesti u detinjstvu. Glavni cilj u lečenju pacijenata nije samo u poboljšanju kvaliteta života, već takođe i u smanjenju rizika od narednih egzacerbacija. Cilj ove studije bio je da ustanovi da li paralelno primenjena respiratorna rehabilitacija sa medikamentnim tretmanom ima za rezultat bolju kontrolu astme bez egzacerbacija bolesti.

Metode: Ispitivano je ukupno 180 pacijenata (100 dečaka i 80 devojčica), podeljenih u tri grupe u odnosu na primenjenu terapiju: I grupa su bili pacijenti koji su lečeni samo medikamentnom terapijom, II grupa su bili pacijenti koji su lečeni samo procedurama respiratorne rehabilitacije i III grupa su bili pacijenti koji su podvrgnuti i medikamentnom lečenju i respiratornoj rehabilitaciji istovremeno. Svaka grupa je podeljena u dve podgrupe oni koji su bili na prevenciji i oni koji to nisu.

Rezultati: Analizom rezultata dobijenih u studiji pokazali smo da su bolesnici lečeni medikamentnom terapijom i istovremeno respiratornim rehabilitacionim procedurama imali statistički značajno veće poboljšanje (p<0,05) u odnosu na one koji su lečeni samo medikamentnom terapijom, odnosno statistički značajno veće poboljšanje (p<0,001) u odnosu na one koji su tretirani samo respiratornim rehabilitacionim procedurama. Bolesnici koji su imali preventivnu terapiju postigli su značajnost u poboljšanju u toku ove dvojne istovremene terapije (p<0,05).

Zaključak: Za dobru kontrolu astme neophodna je dobra opservacija i kombinovani tretman: medikamentna i preventivna terapija uz primenu respiratornih rehabilitacionih procedura.
PODRŠKA PORODICI U PREVENCIJI PUŠENJA ADOLESCENATA
Authors: Milošević Jasmina
Published: March 2024

Uvod: Pušenje predstavlja jedan od najznačajnijih faktora narušavanja zdravlja ljudi u svetu i ima brojne zdravstvene, socijalne, ekonomske i ekološke posledice. Razvojni stadijum adolescencije smatra se fazom najvećeg rizika za započinjanje pušenja. Razumevanje specifičnosti socijalnog konteksta u kome dolazi do pojave pušenja mladih, veoma je važno za kreiranje politike kontrole pušenja i programa prevencije.

Metodologija: Istraživanje je sprovedeno tokom školske 2010/2011. godine u šest osnovnih škola, sa područja grada Beograda. Uzorak je činilo 515 učenika osmog razreda, oba pola. Za prikupljanje podataka upotrebljen je Upitnik o pušenju mladih.

Rezultati: Rezultati ovog istraživanja potvrđuju da postoji povezanost između ponašanja članova porodice u vezi sa pušenjem i pušenja adolescenata: statistički značajno veća učestalost probanja cigareta (χ2 = 20,23; df = 2; p < 0,001) i trenutnog pušenja (χ2 = 6,36; df = 2; p < 0,05) otkrivena je kod adolescenata u čijim kućama je pušenje dozvoljeno; učestalost probanja cigareta je statistički značajno veća kod ispitanika koji žive sa nekim ko puši (χ2 = 6,65; df = 1; p < 0,01).

Zaključak: Glavni zaključak ovog istraživanja je da porodica utiče na pojavu pušenja kod adolescena
GESTALT THERAPY AS PREVENTIVE MEASURE IN EVERYDAY WORK IN PAEDIATRICIANS PRACTICE
Authors: Ćirković Olivera M.
Published: March 2024

Gestalt therapy as a humanistic therapy with holistic approach uses techniques that focuses on gaining an awareness of emotions and behaviors in the present rather than in the past, here rather that there. Due to etiology of most commonly health disturbance in everyday paediatrician’s practice psychological reasons is one of commonly mentioned risk factors. This article shows how gestalt therapy can be used as preventive measures and support to everyday paediatrician’s practice. Aim of this work was to implement gestalt therapy in paediatrician’s practice due to achieving completely holistic health care and prevent possible episode of asthma attack, eczema or vomiting or diarrhea as most common symptoms in practice. Beside medical treatment, we practice gestalt therapy together with children and parents. Number of asthma attack episodes decreased same as intensity. This was really considerable in ordinary “stressful” situations that were earlier very significant detail in anamnesis. Same was with vomiting or diarrhea. Picture of gestalt therapy in named situations was one based on a horizontal relationship. Exactly that provided me a holistic approach as paediatrician and therapist. Together with children and parents we explored nuances within relationships (paying careful attention to present experience). Through different cases we realized that important (support) factor for children with asthma, eczema and some gastrointestinal disorders and their recovery is one of parents, mostly mother.
HOW GOOD IS EARLY INTRODUCTION OF COMPLEMENTARY FOOD?
Authors: Sansotta Naire , Peroni Diego
Published: March 2024

Timing of first exposure to solid foods for children has been changed over the last 40 years. In the 1970s, there was growing evidence supporting an association between timing of weaning and the increasing prevalence of allergic diseases. Many studies recommended delaying solids after 6 months of age based on the concept that introducing solids too early could play a role in food allergy.

Conversely, through the last years, several studies have investigated whether delay in timing of solid food introduction after 6 months of age could determine food allergy instead of preventing it. Furthermore if an early weaning could have more favorable results than postponing it. This review discusses the current guidelines about the optimal timing of introduction of solids in children.
GOJAZNOST KOD DECE – PREVENCIJA
Authors: Jocić Stojanović Jasmina , Veković Vesna , Živković Zorica , Prijić Andreja
Published: March 2024

U poslednje tri decenije zabeležen je porast prevalencije gojaznosti kod dece širom sveta, sa brojnim konsekvencama po zdravlje. Gojaznost je prepoznata kao jedan od najvažnijih problema i izazova javnog zdravlja u 21. veku. Kontrolom faktora rizika, u koje spada i gojaznost, ostvarila bi se prevencija brojnih hroničnih bolesti. Epidemiološka istraživanja identifikovala su faktore rizika za nastanak gojaznosti u dečjem uzrastu, koji se mogu svrstati u tri velike grupe: demografski, navike u vezi sa fizičkom aktivnošću, navike u vezi sa ishranom. Posebno je značajna činjenica da se radi o faktorima koji su potencijalno podložni modifikaciji. U skladu sa time, potrebna je intervencija na nivou celokupne društevene zajednice kako bi se omogućila edukacija roditelja i dece o zdravim životnim navikama uz dostupnost sadržaja za fizičku aktivnost kao i redovne kontakte sa medicinskim stručnjacima.
KONCEPT SAČUVANJA FUNKCIJE SLEZINE U PREVENCIJI POSTSPLENEKTOMIČNE SEPSE
Authors: Jokić Radoica , Antić Jelena , Bukarica Svetlana , Fratrić Ivana
Published: March 2024

Uvod: Slezina je krvni organ čija ruptura može da izazove ozbiljno unutrašnje krvarenje koje ugrožava život. Hirurgija slezine se u dugom vremenskom periodu praktično svodila na splenektomiju. Postsplenektomična sepsa je najozbiljnija komplikacija splenektomije.

Cilj rada: Prikaz analize i primene novih dijagnostičko-terapijskih principa sačuvanja funkcije slezine u dečjem uzrastu radi prevencije nastanka postsplenektomične sepse.

Metode rada: U radu su analizirani pacijenti sa povredom slezine, koji su lečeni na Klinici za dečju hirurgiju u Novom Sadu, u periodu od 1990-2002. godine, a praćeni sve do kraja 2016. godine. Kontrolna grupa od 32 pacijenta je formirana retrospektivnom, a ispitivana grupa od 39 pacijenata prospektivnom studijom. Izdvojeni su ključni kriterijumi za donošenje odluke o izboru terapijskog tretmana i predložen je  algoritam postupanja kod povreda slezine. Dat je prikaz novih minimalno invazivnih operacija.

Rezultati: U kontrolnoj grupi neoperativni tretman je primenjen kod 7 pacijenata, operativna prezervacija slezine kod 11, a splenektomija kod 14 pacijenata. U ispitivanoj grupi neoperativni terapijski tretman je primenjen kod 28 pacijenata, operativna prezervacija slezine kod 8, a splenektomija samo kod 3 pacijenta. Postignuto je sačuvanje organa u 92,18% slučajeva. Neoperativni terapijski tretman je primenjen kod 71,79% pacijenata ispitivane grupe, a u kontrolnoj grupi kod 21,88% pacijenata.

Zaključak: Primenom novog koncepta sačuvanja funkcije slezine, kod najvećeg broja povreda slezine realno je moguća primena neoperativnog tretmana ili operativnih metoda prezervacije funkcije slezine. Uvođenjem minimalno invazivne hirurgije otvoreno je novo poglavlje u okviru hirurških metoda. Imajući u vidu doživotan rizik od nastanka fatalnih postsplenektomičnih infekcija, nužno se nameće potreba prevazilaženja splenektomije kao dominantne procedure u zbrinjavanju povreda slezine.
SPINALNI DISRAFIZAM – NEUROHIRURŠKI PROBLEM DEČIJEG UZRASTA
Authors: Raičević Mirjana , Mrdak Milan , Radovanović Maša , Nikolovski Srđan
Published: March 2024

Spina bifida je jedna od najkompleksnijih i najtežih urođenih anomalija. Raniji naziv spina bifida danas je potisnut terminima „defekt neuralne tube“ (NTDs) i „spinalni dizrafizam“ koji mnogo bolje  determinišu njenu suštinu. U osnovi ove anomalije je neadekvatno „zatvaranje  –  srastanje srednje linije„  kičmenog stuba te je termin spinalni dizradfizam najadekvatnji. Defekt srastanja srednje linije može nastati u različitim nivoima kičmenog kanala te govorimo o  cervikalnom, torakalnom, lumbalnom i sakralnom spinalnom disrafizmu. Spinalni disrafizam se javlja u dva osnovna entiteta – otvoreni i zatvoreni, koji se suštinski razlikuju. Incidenca  ove anomalije u svetu pokazuje geografsku i etničku osobenost – najčešća je kod keltskih naroda (12,5 na 10.000 ž.r.), a retka je kod azijata i u crnačkoj populaciji. Devojčice češće obolevaju nego dečaci. Etiologija je još uvek nepoznata. Dijagnoza otvorenog spinalnog dizrafizma  se mora postaviti prenatalno. Otvorenu spinu treba operisati  u prvih 48h po rođenju, pogotovu ako je rupturirana. U svetu postoje medicinski centri gde se primenjuje prenatalni – fetalni  hirurški zahvat. Benefit ovakvih hirurških zahvata još uvek nije  dokazan. Zatvoreni spinalni dizrafizam je veoma  podmukla, prikrivena anomalija, te stoga i naziv okultni spinalni dizrafizam (OSD). Incidenca ove anomalije je nepoznata, zna se samo da je češća kod ženske dece. Etiologija je takođe nepoznata. Dijagnozu OSD je praktično nemoguće postaviti prenatalno. Izuzetno važan problem u sklopu spinalnog disrafizma je „tethered cord sy“ koji označava stanje u kome je kičmena moždina pričvršćena za neku nepokretnu strukturu kao što je dura, pršljen, lipom, koža. Lečenje spinalnog disrafizma je izuzetno kompleksno i zahteva multidisciplinarni pristup.
CURRENT APPROACHES TO PREVENT AND DIAGNOSE CONGENITAL TOXOPLASMOSIS: THE ITALIAN EXPERIENCE
Authors: Salvottini Chiara , Caminati Marco , Meroni Valeria
Published: March 2024

Congenital toxoplasmosis is an important cause of morbidity and mortality in congenitally infected newborns: even if the classic triad of hydrocephalus, intracranial calcifications and chorioretinitis  is  almost a remnant from the past, the infection can still cause retinal disease during childhood or adolescence.  Preventive strategies and a correct diagnosis in pregnant women and in newborns are very important. The infection usually runs asymptomatic and the diagnosis relies primarily on serological tests. In pregnant women the differential diagnosis between early seroconversion and false positive IgM is always puzzling. The diagnosis of congenital toxoplasmosis at birth is usually a complicated task; the decision to treat with potentially harmful compounds relies exclusively on laboratory findings (either the detection of anti-Toxoplasma IgM and IgA, or the detection of persistent production of specific IgG during the first year of life) and their interpretation can be challenging when they give heterogeneous results. Researchers are trying to develop new tests that exploit the cellular immunity involved during the course of the infection like an interferon-gamma release assay similar to the Quantiferon for Mycobacterium tuberculosis.
LEČENJE SIMPTOMA I PREVENCIJA RESPIRATORNIH INFEKCIJA KOD DECE DIJETETSKIM SUPLEMENTOM – EFIKASNOST I KVALITET ŽIVOTA
Authors: Prijić Andreja , Ostojić Olivera , Jocić-Stojanović Jasmina , Živković Zorica , Veković Vesna , Korčok Davor , Agić Anita
Published: March 2024

Uvod. U zimskom periodu velika je zastupljenost respiratornih infekcija virusnog i bakterijskog porekla kod dece. Fitoterapija, koja predstavlja kombinaciju biljnih preparata, ima ulogu u lečenju pored standardne terapije. Cilj našeg istraživanja je  procena kvaliteta života kod roditelja i efikasnost dece sa respiratornim infekcijama koji su koristili PropoMucil® sirup.

Metod rada: Istraživanje je sprovedeno u Dečjoj bolnici za plućne bolesti i tuberkulozu KBC ″Dr. D. Mišović - Dedinje″ od decembra 2016. do februara 2017. godine.  Istraživanje je učinjeno pomoću upitnika koji je popunjen na osnovu odgovora roditelja dece sa kašljem. Upitnik se sastojao od tri  dela. Prvi deo upitnika se odnosio na demografske podatke, drugi deo upitnika se odnosio na karakteristike kašlja, a treći deo se odnosio na kvalitet života roditelja dece koji imaju kašalj.

Rezultati. U istraživanju je učestvovalo 75 dece koja su prema uzrastu podeljenja u dve grupe, grupa predškolskog uzrasta (grupa A) i grupa školskog uzrasta (grupa B).  Prema polu deca nisu imala statistički značajnu razliku. Statistički značajna razlika je bila između grupa u odnosu na uzrast kada su krenuli u kolektiv. U grupi A registrovan je veći broj respiratornih infekcija koje traju duže od dve godine u odnosu na grupu B.  U grupi A kašalj nije remetio decu u obavljanju  dnevnih aktivnosti (77,6%). U grupi B 57,7% slučajeva kašalj je remetio obavljanje dnevne aktivnosti i taj broj je smanjen za 11,5% posle primene terapije. Takođe, u grupi B 15,4% više dece nije imalo noćne simptome nakon primene sirupa. Na kontrolnom pregledu uočena je razlika u pogledu redovnog uzimanja sirupa, grupa A je uzimala sirup (59,2%), dok je grupa B uzimala sirup u znatno većem procentu (92,3%). U pogledu kvaliteta života u porodici sa detetom koja imaju kašalj nije uočena statistički značajna razlika. 

Zaključak. Fitoterapija zauzima značajno mesto u prevenciji i lečenju bolesti sa visokom stopom učestalosti. Naše istraživanje je potvrdilo da je PropoMucil® sirup za decu efikasan i bezbedan za primenu u svim životnim dobnim grupama, i značajno popravlja kvalitet života kako deteta, tako i roditelja.
IRRITABLE BOWEL SYNDROME IN CHILDREN - HOW TO GET DIAGNOSED
Authors: Radovanović-Dinić Biljana , Tešić-Rajković Snežana
Published: March 2024

Irritable bowel syndrome (IBS) is a chronic and relapsing functional gastrointestinal disorder. IBS affects 9%-23% of the population across the world. Epidemiologic studies in populations less than 18 years of age suggest higher prevalence among teenagers and children compared to adult population. The pathophysiology of IBS is not yet completely understood and seems to be multifactorial. Many pathogenetic factors, in various combinations, and not all necessarily present in each patient, can play an important role. Discomfort or abdominal pain relieived by defecation, asociated with a change in stool form, is a typical clinical manifestation of IBS. Some factors, such as emotional stress and some food, may initiate and exacerbate the symptoms. A timely diagnosis of IBS is important so that treatment which will provide adequate symptomatic relief (pain and bloating, diarrhoea, constipation) can be introduced. There is no specific test for diagnosing IBS. The diagnosis is made using criteria based on clinical symptoms such as Rome criteria. Today the Rome Criteria IV is the gold-standard for the diagnoses of IBS in the adult and child populations. Treatment of patients with IBS requires a multidisciplinary approach. Some patients respond well to non-pharmacological treatment, while others require pharmacological treatment.
AKUTNI ENTEROKOLITIS KOD DECE - ASPEKTI ORALNE REHIDRACIJE
Authors: Bojadzieva Sonja
Published: March 2024

Akutni enterokolitis (AE) je najčešći problem u detinjstvu, posebno u prve tri godine života. Akutni enterokolitis definira se kao smanjenje konzistencije izmeta i/ili uvećane frekvencije sto-lice (≥ 3 za 24 sata) sa ili bez povećanom temeperaturom i povraćanjem. Učestalost dijareje je  0,5 do 2 epizode po detetu godišnje za decu mlađu od tri godine.  Rota virus je najčešći entero-patogen sa najvećom čestoćom od januara do marta. Procena stepena  dehidracije je ključan parametar u tretmanu akutne dijareje kod dece. Najbolji su tri individualni parametri za procenu dehidracije: produženo punjenje kapilare; abnormalni turgor kože; respiratorni simptomi. Generalno, dehidracija je glavni klinički pokazatelj težine bolesti. Aktivni tretman akutnoga en-terokolitisa sa probioticima uz dodatak oralne rehidratacione solucije (ORS) je preporuka Evro-pskog  udruženja za pedijatrisku gastroenterohepatologiju i nutriciju  (ESPGHAN). Preporučuju se probiotici Lactobacillus rhamnosus (LGG) i Saccharomyces boulardii. Tretman AE treba za-početi kod kuće sa oralnim rehidraticionim solucijama.Preporučuje se rehidracija sa „ESPGHAN”  hipotona osmolarna oralna solucija kod dece. Hospitalizacija je namenjena onoj deci koja zahtevaju intravenoznu rehidraciju u teškim slučajevima. Rano započeta rehidracija može prevenirati komplikacije i bolničke hospitalizacije. Redovna svakodnevna ishrana se ne prekida i treba se produžiti nakon inicijalnu rehidraciju. Prevenciju sa anti Rota virusnom vakci-nom primenjuje se u Evropi i očekuje se postupno smanjivanje težine bolesti AE i prevencija najteže forme bolesti kod dece.
NEW INSIGHTS INTO RARE METABOLIC DISEASES IN PAEDIATRIC PRACTICE
Authors: Filipović Ivana
Published: March 2024

Rare diseases are those that affect at most one in 2000 persons worldwide. According to the date around 6000-7000 rare diseases have been described until now. Although there are so many differences between rare diseases patents that are affected are facing with the more or less same difficulties. Before a final diagnose they usually spend a few years losing a precious time for the treatment. The aim of this review article is to give insight into a several rare diseases that are successfully treated by enzyme replacement therapy (ERT). A complete search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Pub Med up to January 2018 was carried out. Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism due to deficient or absent lysosomal a-galactosidase A activity. Gaucher disease is characterized by a deficiency of acid β-glucosidase and accumulation of glucosylceramide within lysosomes of tissue macrophages. The accumulation of glucosylceramide is responsible for the manifestations of Gaucher disease, including hepatomegaly, splenomegaly, thrombocytopenia, and anemia. MPS I characterized the defect in the gene for α-L-iduronidase (IUDA), an enzyme that degrades glycosaminoglycans (GAGs) in lysosomes. Pompe disease is a rare, progressive, debilitating and often fatal neuromuscular disorder resulting from the deficiency of a lysosomal enzyme, acid alpha-glucosidase (GAA). Enzyme testing on Dried Blood Spots (DBS) is a 1st tier/screening test for all four above mentioned metabolic rare diseases. An enzyme replacement therapy is the only effective treatment patients with Fabry disease, Pompe disease, Gausher disease and MPS I.
POST İNFECTİOUS BRONCHİOLİTİS OBLİTERANS İN CHİLDREN: LONG TERM FOLLOW-UP
Authors: Eyuboglu Tugba Sismanlar , Gursoy Tugba Ramaslı , Aslan2 Ayse Tana , Onay Zeynep Reyhan , Hangul Melih , Kibar Busra Sultan , Pekcan Sevgi , Kose Mehmet , Gokturk Bahar
Published: March 2024

Objective: Post infectious bronchiolitis obliterans (PIBO) is a chronic lung disease which is caused by lower respiratory tract infections (LRTI) especially in children who are under 3 years of age. Adenovirus is the major pathogen in the etiology. There are no clinical controlled trials for treatment. Long term follow up varies.  We aimed to investigate long term follow-up results of PIBO patients.

Material and methods: We analyzed the long term follow up results of PIBO patients in three pediatric pulmonology centers. Demographic fetaures, clinical, laboratory findings, treatments, treatment results were evaluated.

Results: In ten-year period 70 patients were followed with diagnosis of PIBO in three pediatric pulmonology centers.  Mean age of patients was 9.24 ± 5.76 years and51 (72%) of them were male. Mean age of patients at the diagnosis was 3.96 ± 3.85 years and 23 (32%) of them had family consangunity. Pathogen was detected in 19 patients and adenovirus was the major pathogen which was detected in 9 patients. Oxygen supplementation was present in 26 patients at the time of LTRI.

Pulse steroid was given only in 5 patients, oral prednisolone in 30 patients, azithromycin in 10 patients, inhaled steroid in 36 patients and IVIG in 8 patients who had accompanying immunodeficiency.

Mean FEV1 was 56.99 ± 21.73 before treatment and 69.26 ± 21.45 after treatment. Mean FVC was 61.60 ± 21.47 before treatment and 71.61 ± 20.40 was after treatment. Mean MEF25-75 was 46.39 ± 24.47 and 59.11 ± 23.92 after treatment. There were statistically significant differences in FEV1, FVC, MEF25-75 between before and after treatments (p<0.05).

Mean body mass index (BMI) was 16.67 ± 3.55 before treatment and 16.87 ±3.44 after treatment and there was no statistically significant difference (p>0.05).

FEV1, FVC, MEF25-75 and BMI had statistically significant differences before and after treatments in patients who was given oral and/or inhaled steroid treatments (p<0.05).

Conclusion: Although there is no definitive treatment recommendations for PIBO, steroid seems to be useful in children. Clinical controlled trials are needed for definitive treatment recommendations.