Klinička bolnica "Sveti Duh"

Background/Objectives: To describe a previously unreported compensatory behavior used by an infant with severe bilateral congenital ptosis associated with blepharophimosis syndrome (BPES). Methods: Observational case report of a 4.5-month-old infant with severe bilateral congenital upper eyelid ptosis due to BPES. Results: The infant demonstrated classic compensatory mechanisms, including frontalis overaction and chin elevation, which were insufficient to clear the visual axis. Notably, she repeatedly used the dorsal surfaces of both fists to elevate the upper eyelids simultaneously and maintain fixation on faces. This behavior ceased following bilateral frontalis suspension surgery with silicone rods. Conclusions: In early infancy, severe bilateral ptosis may prompt the emergence of alternative, developmentally constrained compensatory behaviors. The bilateral fist lid-lift appears to represent a visually driven, sensorimotor strategy to clear the visual axis when conventional mechanisms are ineffective. Recognition of this behavior expands understanding of early compensatory responses in congenital ptosis and BPES.

Introduction: Intensive Care Units (ICUs) provide advanced, evidence-based care for critically ill patients. Physiotherapy is a vital component of ICU care but is often unavailable or insufficiently standardized. This study examined physicians’ and nurses’ satisfaction with physiotherapy care in Croatian ICUs and identified potential areas for improvement. Methods: A 26-item digital questionnaire was disseminated throughout Croatian ICUs to physicians and nurses. The items addressed included physiotherapy availability, equipment accessibility, satisfaction with the quality and effectiveness of care, and their perspectives on improvement. Responses were rated on a 5-point Likert scale or by selecting predefined options. Data analysis was performed using descriptive statistics in R Studio. Results: In total, 120 participants from 12 Croatian counties were included. The majority of responses (105) were from nurses/technicians, and only 15 from physicians. Physiotherapists were available in all ICUs, mainly on a consultative basis and mostly during morning shifts. Participants reported that physiotherapy interventions were effective in reducing pain, improving joint mobility, and enhancing respiratory function. Despite high overall satisfaction, participants emphasized the need for extended physiotherapist availability, improved ICU-specific training, and greater professional autonomy. Conclusion: Physicians and nurses expressed general satisfaction with ICU physiotherapy care but suggested improvements in physiotherapy availability and staff competence. Implementing standardized physiotherapy practices across ICUs could improve treatment outcomes and contribute to earlier patient discharge.

Epilepsija je kronična neurološka bolest obilježena trajnom predispozicijom mozga za nastanak epileptičkih napadaja. Radi se o ponavljanim, neprovociranim epileptičkim napadajima koji su posljedica poremećene sinkronizacije i prijenosa električnih impulsa među neuronima u mozgu. Klinička prezentacija epileptičkih napadaja izrazito je heterogena, od kratkotrajnih poremećaja svijesti do izraženih generaliziranih konvulzija, što dodatno naglašava složenost dijagnostike i liječenja. Poseban klinički i terapijski izazov predstavlja epileptički status, jedno od najhitnijih stanja u neurologiji, definiran kao produljeni epileptički napadaj ili niz napadaja bez potpunog oporavka svijesti između epizoda. Prekasno započeto liječenje ili neliječeni epileptički status povezan je s visokim rizikom trajnog oštećenja mozga, sistemskih komplikacija i smrtnog ishoda. Liječenje epileptičkog napadaja i epileptičkog statusa mora započeti što ranije, idealno već u izvanbolničkim uvjetima, uz paralelnu stabilizaciju vitalnih funkcija. Terapija se provodi u jasno definiranim fazama: benzodiazepini kao prva linija liječenja, ne-benzodiazepinski antiepileptici kao druga linija u slučaju trajanja epileptičkog statusa te nadalje opći anestetici kod refraktornog epileptičkog statusa. Brzo i pravilno zbrinjavanje napadaja, pravodobna primjena lijekova te kontinuirano praćenje bolesnika ključni su za smanjenje komplikacija, prevenciju recidiva i poboljšanje ishoda liječenja. Ovaj rad prikazuje pregled spoznaja o vrstama epileptičkih napadaja, dijagnostičkom pristupu u u hitnoj medicini te načelima akutnog zbrinjavanja i liječenja, s posebnim naglaskom na terapijske algoritme kod epileptičkog statusa.

Psychogenic non-epileptic seizures (PNES) present a significant diagnostic and management challenge in the emergency department (ED). Although PNES may closely resemble epileptic seizures, their origins are functional and psychological rather than electrical, often leading to misdiagnosis and unnecessary interventions. In emergency settings, this confusion can result in inappropriate antiepileptic medication use, intubation, and prolonged hospitalization. This review summarizes current evidence on the epidemiology, proposed pathophysiology, and characteristic clinical features of PNES, with emphasis on bedside indicators that can assist clinicians in distinguishing PNES from epileptic events during acute presentations. Key diagnostic considerations, including the role and limitations of history, physical examination, and video assessment are discussed, along with strategies for communicating the diagnosis sensitively and effectively to patients. The review further outlines principles of acute management focused on patient safety, avoidance of iatrogenic harm, and appropriate disposition planning, including when referral for definitive evaluation such as video-EEG monitoring is warranted. By increasing clinician awareness and confidence in recognizing PNES, emergency providers can improve patient outcomes, reduce unnecessary resource utilization, and facilitate timely engagement with mental health and neurological services.

BackgroundPrevious research has identified that, in individuals with lower folate and/or vitamin B12 levels, homocysteine is associated with specific elements, while amino acids are associated with folate, thereby influencing folate availability during supplementation. This study investigates the impact of the MTHFR 677C/T polymorphism on levels of these compounds in individuals with differing meat consumption preferences, non-vegetarians and vegetarians.MethodsThe study was conducted on 162 Croatian subjects. MTHFR gene polymorphism was determined by PCR-RFLP, elements by ICP-QQQ, amino acids by GC–MS, and biochemical parameters by chemiluminescent immunoassay and enzymatic methods. Differences between the groups were tested by ANOVA, while associations between the parameters were examined by multiple regression analyses.ResultsThe CT + TT genotype had lower folate levels in comparison to the CC genotype. The influence of MTHFR 677C/T polymorphism on element levels was limited to Al and Ca: individuals with the CT + TT genotype exhibited higher plasma Ca levels than the wild-type (CC) genotype, while lower plasma Al values were observed only in vegetarians with the CT + TT genotype. The CT + TT genotype was also associated with higher levels of glutamic acid, proline, glycine (only in vegetarians), and aspartic acid.ConclusionAlthough we observed an effect of the MTHFR 677C/T polymorphism on folate, certain elements and amino acid levels, further research is required to validate our findings and establish a more comprehensive understanding of the link between elements, amino acids and the MTHFR gene polymorphism.

Introduction. Good preoperative preparation as one of the most important predictors of overall patient satisfaction increases cooperation and their desire to continue treatment.Aim. The aim of the research was to examine the respondents’ satisfaction with the pre-operative preparation and post-operative health care of patients treated at the Surgery Clinic of the “Sveti Duh” Clinical Hospital in Zagreb, Croatia.Methods. The measuring instrument of this research was an anonymous questionnaire created for the purposes of the research itself. The survey included 60 respondents with an average age of 51.Results. The results of the conducted research showed that the majority of respondents were satisfied with the healthcare provided, with 53 (88.3%) responding that they were satisfied, and 54 (90%) of the respondents answered that they could confidently to contact the health workers of the clinic, who showed concern and understanding for their problem. An important factor in postoperative satisfaction was postoperative pain. After the procedure, the median pain (on a scale of 0 to 5) was 4, and immediately after the subjects started to feel pain and asked the nurse/technician for analgesic, 35 (58%) patients received it. A total of 44 (73%) patients expressed satisfaction with the speed of the nurses’ intervention after they reported feeling pain.Conclusion. A survey conducted at the Surgery Clinic of the “Sveti Duh” Clinical Hospital showed that the largest number of respondents, a total of 53 (88.3%) were satisfied with the healthcare provided during hospitalization. It was observed that women were more satisfied than men, and that respondents aged 46 to 60 reported significantly higher levels of satisfaction compared to those aged up to 45.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1421:"<h3>Background</h3> Fenebrutinib is a potent, highly selective, noncovalent, reversible Bruton’s tyrosine kinase inhibitor. In the Phase II FENopta study (NCT05119569), participants received Fenebrutinib 200mg orally BID or placebo. Fenebrutinib reduced inflammatory disease activity in RMS and demonstrated CNS penetrance during the 12-week double blind treatment period. Here we present open label extension study results through Week 48, during which all participants received Fenebrutinib 200 mg BID. <h3>Results</h3> 99 participants enrolled in the OLE; and 96 (97%) remain. At OLE week 48, 96% of participants were relapse free (ARR 0.04) and mean T1 Gd+ lesions were 0.015 lesions per scan (n=67), with 99% of participants free of T1Gd+ lesions. T2 lesion volume decreased in both groups during the OLE. Median EDSS change from baseline was 0 for each arm. The most common AEs were UTI (8%), COVID-19 (7%) and pharyngitis (5%). Serious AEs occurred in one participant (1%) as did asymptomatic ALT elevation (1%), which resolved with treatment discontinuation. <h3>Conclusions</h3> 1 year of fenebrutinib treatment resulted in low ARR, stable EDSS and low MRI activity in participants with RMS, with a favourable safety profile. Ongoing Phase III trials will better characterise the effects of fenebrutinib on disease progression across MS phenotypes. sophie.wrigley{at}roche.com ";}

Chronic venous insufficiency (CVI) is a common peripheral vascular condition characterised by the retrograde blood flow in the lower extremities and its consequences such as oedema and other complications. Clinical severity of CVI is assessed according to the CEAP (Clinical, Etiological, Anatomic, and Physiopathologic) classification, which recognises seven grades of increasing clinical severity (C0–C6). Compression therapy aims to accelerate vein, lymph, and microcirculation flow and therefore reduce chronic nonbacterial inflammation and oedema of the extremities. In accordance with the elasticity and stiffness, compression bandages and garments are divided into short-stretch and long-stretch compression materials. Compression therapy is applicable in all stages of CVI. Moreover, compression therapy in conjunction with physical therapy and lifestyle modifications is more effective in reducing oedema, preventing venous distension, and reducing venous wall tension, all while improving calf muscle pump function. Physical therapy in CVI treatment combines everyday lifestyle modifications, physical activity, medical exercise, sports activity, hydrotherapy, and electrotherapy. Therefore, physical therapy is used either for prevention or either for therapeutic purposes in CVI. For grades CEAP C0–C2, preventive measures consist of education and counselling, medical exercise and general fitness, and sports and physical activities. However, for therapy in grades CEAP C3–C6, medical exercise and a specific rehabilitation programme, manual lymphatic drainage and massage, balneotherapy, and electrotherapy are recommended.