Zabok General Hospital

Primaljstvo je jedna od najstarijih profesija u ljudskoj povijesti, neraskidivo povezana s temeljnim životnim procesima – trudnoćom, porodom i majčinstvom. U hrvatskom kontekstu tradicija primaljstva, osobito kroz likove tzv. babica, ima duboko ukorijenjeno značenje u kolektivnoj memoriji, narodnoj medicini i kulturnoj baštini. Babice su stoljećima bile ključne osobe u lokalnim zajednicama, često jedine koje su imale znanje i iskustvo potrebno za pomoć pri porodu, osobito u ruralnim i teško dostupnim područjima. S vremenom se od samoukih, iskustveno oblikovanih babica dolazi do školovanih, zakonski reguliranih primalja i profesionalizirane zdravstvene djelatnosti. Rad prikazuje tradicijske oblike primaljske skrbi u Hrvatskoj, razvoj profesionalnog i reguliranog primaljstva te specifičnosti razvoja primaljstva na području Hrvatskog zagorja, s naglaskom na ulogu vanbolničkih rodilišta i iskustva primalja koje su radile u razdoblju prijelaza s kućnih poroda na bolničke porode. Posebno se razmatra fenomen nadriprimaljstva kao društveno-povijesnog problema uvjetovanog siromaštvom, nedostatkom zdravstvene prosvijećenosti i ograničenom dostupnošću obrazovanih zdravstvenih djelatnika. Cilj rada jest prikazati razvoj primaljske profesije u Hrvatskoj s naglaskom na nematerijalnu kulturnu baštinu te istaknuti važnost očuvanja tradicijskog znanja u suvremenom pristupu porodu i skrbi o rodiljama. Rad se temelji na analizi povijesnih i stručnih izvora te kvalitativnoj analizi svjedočanstava primalja iz Krapinsko-zagorske županije. U zaključku se naglašava da očuvanje baštine u primaljstvu nije samo čuvanje prošlosti, nego i temelj profesionalnog identiteta, humanizacije poroda i razumijevanja žene kao središta primaljske skrbi

Tuberculosis (TB), primarily recognized as a pulmonary disease, can manifest in various extrapulmonary forms, with abdominal tuberculosis (ATB) being one of the most common. Abdominal tuberculosis is one of the diseases known as "the great imitator" - it can mimic the clinical presentation of various diseases that are more common, such as appendicitis, acute cholecystitis, colitis, and some malignant diseases such as colon or stomach neoplasms. Diagnosis of ATB is often delayed, especially if a clinician in a nonendemic country does not include ATB in the differential diagnosis. Given the rising migration of people from the endemic to the nonendemic countries, we believe it is mandatory to raise consciousness about this clinical entity, as well as to lower a threshold to include ATB in the differential diagnosis. We present a case of a 31-year-old patient from Nepal, who was admitted through the emergency department of General Hospital Zabok, Croatia, with signs of acute abdomen, later successfully diagnosed and treated for ATB. We also deliver a brief literature review, summarizing the epidemiology, clinical presentation, diagnostic and therapeutic algorithms for ATB. Migrations are inevitably changing the vaccination status and epidemiological risks of any host country. Medical personnel should keep upgrading and revising their knowledge of the "usual suspects" whilst differentially diagnosing both immigrants and non-immigrants, in order to make timely and good quality diagnosis and treatment.

We present a challenging case of a loss of domain (LOD) inguinoscrotal hernia in a 77-year-old high-risk patient, successfully managed with the complementary preoperative use of progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) without complications. Giant inguinoscrotal and LOD hernias, particularly in multimorbid patients, are highly complex and require meticulous preoperative preparation. In this case, PPP was performed with ambient air and a gradual increase in insufflation volume, while BTA was injected at three points on each side, with a total dose of 300 IU. This approach facilitated a complication-free increase in abdominal cavity volume and the repositioning of chronically eventrated abdominal contents. The technique proved safe, feasible, and effective, contributing to atraumatic adhesiolysis, reduced operative time, and avoidance of more invasive surgical methods. A Shouldice pure tissue repair was performed, successfully avoiding the need for prosthetic materials.

Children were often referred to as "therapeutic orphans" in the past due to different reasons such as ethical, regulatory, economic, scientific, etc., ones. They were exposed to avoidable risks while missing out on therapeutic advances. Pediatric patients have suffered from a lack of scientific and regulatory standards (e.g., proper drug testing, authorization of medicines for their use, etc.), although the pharmaceutical legislative framework, which ensures the high standards of safety, quality, and efficacy of medicinal products for use in adults, was developed primarily in response to past "drug disasters," mainly involving children. The adoption of pediatric regulatory initiatives first in the USA and then in Europe and other countries and regions has significantly changed the worldwide frameworks and permanently changed pediatric drug research and development. This article tries to give various perspectives with historical context, a review of the different challenges and opportunities as well as important stakeholders in pediatric drug development. The pediatric trial networks are probably the most important stakeholder that enables efficient patient recruitment, access to better resource utilization, and global collaboration of different stakeholders necessary for performing quality and well-designed clinical trials.

ObjectiveTo understand primary care physicians’ perspectives on academic detailing from an antimicrobial stewardship team to combat antibiotic overuse for upper respiratory infections and bronchitis in the COVID-19 era, which will help prevent avoidable outpatient visits.MethodsIn this prospective study, 14 female Croatian physicians completed standardized qualitative interviews using a semi-structured guide. The data were analyzed using inductive methodology based on reflexive thematic analysis. We used a theoretically informed approach based on a conceptual framework of healthcare intervention implementability focused on three domains: acceptability, fidelity, and feasibility.ResultsWe identified six key themes highlighting barriers to changing prescribing practices, with patient pressure and specialist recommendations having an impact on the effectiveness of academic detailing. Despite challenges, primary care physicians described appreciation of direct interaction with evidence-based practices and reported usefulness, effectiveness, and further need for academic detailing.ConclusionThis study highlights the complex dynamics involved in implementing healthcare interventions and provides valuable insights for enhancing strategies directed at improving antibiotic prescribing practices. Specifically, our findings emphasize factors influencing behavior changes in physicians’ antibiotic prescribing. The authors advocate for a collaborative approach involving community and hospital-based professionals to provide tailored guidance and address questions, ultimately improving prescribing practices.

The attitudes of breastfeeding mothers and healthcare professionals greatly influence decisions about initiation of breastfeeding, duration of breastfeeding, and repeated breastfeeding in multiparous women. This research aimed to examine, through a questionnaire, the attitudes of breastfeeding mothers and healthcare professionals about breastfeeding in the area covered by the district nurses of the Zagreb-West Health Center. 76 mothers and 74 healthcare professionals participated in the study, which was conducted during 2021. All healthcare professionals (100%) believe that breastfeeding in the first 6 months is important, and 97% of them believe that they are adequately educated about proper breastfeeding techniques. Furthermore, 98% of them believe that they provide mothers with all the necessary help and support regarding breastfeeding. 93% of healthcare professionals support breastfeeding in public. Most breastfeeding mothers were over 30 years old and had a higher level of education. Only 47% of women in the maternity unit had skin-to-skin contact, while 73% stayed in the room with their baby. In 89% of women, the first breastfeeding occurred within the first hour after birth. The greatest assistance during breastfeeding was provided to mothers by healthcare personnel (94%). Continuous education of healthcare professionals and raising public awareness about the importance of breastfeeding must be a priority for every society.

Myopericarditis is inflammatory disease caused by various, often unidentified, factors. Although considered the gold standard for diagnosis of myocarditis, endomyocardial biopsy in clinical pactice is often substituted with clinical, biochemical and imaging parameters. Echocardiography with speckle tracking strain analysis is a valuable tool for diagnosis of myocarditis, estimation of regional and global systolic function showing good correlation with cardiac magnetic resonance imaging (cMRI). We present the case of a 19-year-old male with chest pain, elevated troponin and ST segment elevation who underwent urgent coronary angiography. Normal angiogram steered diagnosis toward myopericarditis, considering information about recent enterocolitis and vaccination against SARS-CoV-2. Transthoracal echocardiography with speckle tracking analysis showed longitudinal strain reduction in several segments of the left ventricle. Small pericardial effusion alongside those segments was also found supporting our diagnosis. After 3 months of treatment with antiinflammatory drugs, ACE inhibitor and beta blocker, the patient recovered and a repeated echo showed complete recovery of systolic function without pericardial effusion. We conclude that echocardiography, including global and regional longitudinal strain analysis, is a valuable diagnostic tool in patients with myopericarditis, complementary with not widely available cMRI. It can detect subtle systolic dysfunction not visible with conventional echocardiography, thus having implications on therapy and prognosis.

Falls are the most common cause of spinal cord injuries (SCIs) in patients older than 65. The worldwide annual incidence of SCIs is reported to be around 15 – 40/ 1000000.