The main aim of this study was to establish the relationships between several psychosocial characteristics in children and adolescents differently treated for isolated long tubular bones' fractures. Examined variables were: self-esteem, basic emotional reactions toward illness or injury including depression and anxiety, as well as perception of quality of life and social support during the treatment. Whole sample comprehends 135 patients, both gender, 10-18 years of age, treated for mentioned fractures in period 2003-2005 at the Departments of Pediatric Surgery of 3 hospitals: University Hospital Centre in Rijeka and Clinical Children's Hospital in Zagreb, both in Croatia and University Hospital in Mostar, BiH. 73 patients were treated conservatively (CT), 40 of them underwent Elastic Stable Intramedullary Nailing (ESIN) and 22 of them underwent other surgical techniques (OST). Basic methods of work were: interview to collect data for half-structured socio-demographical questionnaire, evaluation of medical records and self-reported questionnaires including: Rosenberg Self-esteem Scale (RSS), Children Depression Inventory (CDI), Spielberg State Trait Anxiety Inventory (STAI), Short Form 36 Health Survey (SF-36) and Test of Perception of Social Support (TPSS). RSS, CDI and STAI were administered to the patients at baseline and after 6 months of the trauma, while SF-36 and TPSS after 1 month of the trauma. Results of this study point to close and strong relationships between examined variables, mostly statistically significant at level p < 0.01 in all patients with fractures, regardless of the type of the treatment. There were also statistically significant differences in all variables between first and second measure; self-esteem increased and depression and anxiety decreased during the time in all patients (with different dynamics regarding the type of treatment); higher perception of social support enhanced that effect. Perception of quality of life in whole sample in summary measures was statistically significant at level p < 0.01 correlated positively with self-esteem and negatively with depression and anxiety, thus connection with perception of social support was statistically significant only in sibdomain of physical pain. There was also statistically significant difference in self-perception of quality of life related to psychosocial variables according to the type of treatment (F = 3.27; p = 0.01). Results of this study suggest that there are strong connections between physical trauma and different psychosocial variables in patients which point at need of understanding locomotory trauma in children in wider context including physical state and social functioning of the patient as well as the choice of type of treatment of fractures which influences complete process of healing.

Allergies and bacterial colonization are frequently found in patients with chronic rhinosinuitis with nasal polyposis (CRSwNP). The aim of this study was to identify patients with allergy and present microorganisms in ethmoid sinus among the patients with refractory CRSwNP undergoing surgical treatment at the University Hospital Centre Osijek, and to compare their life quality, defined by SNOT-20 analysis (sinonasal outcome test) to the rest of patients, and a control group consisting of patients undergoing septoplasty but free of allergy and/or CRS. An additional aim was to identify specific types and strains of microorganisms (bacteria and fungi) found in these patients, in order to compare them to other reports, and to revise the empirical antimicrobial therapy. In this paper we demonstrate a high incidence of bacterial colonization (83.3%) among CRSwNP patients. As in previous studies, gram positive aerobes were the most frequently isolated bacteria and all of them were covered by specific antibiotics given before the specimen collection. Allergy was found in only 20% of these patients, who presented with a reduced quality of life when compared to the control group and CRSwNP without allergy. Significantly more frequent dominant symptoms in these patients were cough, frustration and irritation. In the line with this finding is the objective assessment by endoscopy (Malm score) that showed more prominent nasal polyposis in allergy patients.

During the past several decades there has been a substantial increase in the incidence of malignant melanoma worldwide. The highest incidences were reported in New Zealand and Australia. In Europe the northern countries generally have a higher incidence. The aim of this retrospective study was to provide the incidence and mortality for all patients with malignant melanoma diagnosed in Osijek-Baranya County, Eastern Croatia, during 2000-2008. In the past 30 years in the Republic of Croatia the incidence of melanoma increased by 337%. During the period of 2000-2006 in Osijek-Baranja County, the incidence of melanoma increased by 13%. The incidence of melanoma increases with age, but in past decades melanoma is more often diagnosed in people aged 25-40. The mortality between 2000 and 2008 increased by 18%. The incidence of melanoma generally increases equally in men and women. The most common localization of skin melanoma in males was trunk and in females the lower extremities. Presently, in Osijek-Baranya County melanoma is 15th on the list of malignant tumors and represent 2% of all malignant tumors. In New Zealand, Australia and European northern countries mortality is reduced, as result of earlier diagnosis and education of risk groups. Unfortunately, in Osijek-Baranya County, in a comparison with these countries, the mortality is higher although incidence is the same or lower.

The extent of clinical expression in cases of segmental aneuploidy often varies depending on the size of the chromosomal region involved. Here we present clinical and cytogenetic findings in a 5-month old boy with a duplication of a chromosomal segment 4p16.1-->4pter and a deletion of a chromosomal segment 8p23.1-->8pter. His karyotype was determined by applying classical GTG banding and FISH method (WHCR region, centromere 4, centromere 8, telomere 8p) as 46,XY,der(8)t(4;8)(p16.1;p23.1).ish der(8)t(4;8)(D8S504-,WHCR+,D8Z2+)dn. Parents are not related and have normal karyotypes, indicating de novo origin. We have compared similarity of the clinical features in our proband to other patients carrying only a duplication of the distal part of 4p or a deletion of distal part of 8p or similar combination described in the literature.

The aim of this study was to evaluate knowledge on pre-hospital emergency management of tooth avulsion among Croatian kindergarten teachers. A cross-sectional study was conducted among 33 educators in kindergarten (average 43.9±9.7 years). The questionnaire contained 10 close-ended questions with two or eleven possible answers. Statistical significance was determined using chi-square test. Majority of participants had no experience with tooth injury among children in kindergarten. Questions about the familiarity with the terms of a knocked-out tooth and tooth replantation and whether the knocked-out tooth should be replanted were confirmatively answered by 90.9%, 57.6% and 63.6% of participants, respectively. Only 9.1% of participants provided the correct answer that replantation should be done within 30 minutes. 78.8% of participants would choose correct medium for cleaning if avulsed tooth got dirty. Tooth would be transported in appropriate medium by 48.5% of participants. Correct answers on both the transport medium and the cleaning of knocked-out tooth were provided by 45.5% participants. 57.6% participants would seek help for replantation by visiting the nearest dentist. None of the participants had ever received any kind of information on management of a knocked-out tooth. The kindergarten teachers have a lack of knowledge for immediate response to tooth avulsion. Every kindergarten teacher should be well informed what should be done if some type of dental injury happens. The official communication between dental professionals and kindergarten teachers should be improved at local and regional level.

Due to the spread of coronavirus people throughout the world, many countries, Croatia included, have been forced to impose social distancing resulting in an increased number of people at risk of another public health problem – loneliness. Loneliness can be defined as the presence of negative emotions associated with the perceived social exclusion and is identified as one of the major issues of the aging population. There is a relatively small number of studies either dealing with the use of various communication methods, particularly information and communication technologies, by the elderly during the COVID-19 pandemic or determining potential benefits of such activities. The aim of this research was to determine the difference in self-assessment of social and family loneliness according to the means of communication used by the elderly during the COVID-19 pandemic. The research was conducted in March and April 2020 covering the period from the introduction of the epidemiological measures of social distancing and self-isolation until the relaxation of virus-related restrictions in Croatia. The research included 107 subjects over the age of 65 living in their own homes in the Croatian city of Bjelovar. A Frequency of the Used Communication Methods Questionnaire was constructed for the purpose of this research. The Social and Emotional Loneliness Scale for Adults was used to determine the level of loneliness. The obtained results indicate that lower levels of social and family loneliness were shown by subjects who stated in their self-assessment a higher intensity level of communication during the COVID-19 pandemic, such as making telephone/mobile phone calls, using information technology (computers for video calls, social networks, etc.) and mobile chat applications (Viber, Skype, WhatsApp, etc.), as well as having face-to-face communication. Subjects who rarely or never communicated by using any means of the abovementioned communication showed higher levels of social and family loneliness. Results of this research suggest that using various communication methods, particularly modern communication technologies, have a positive effect on reducing the level of loneliness in the elderly. Teamwork of gerontologists, communication technologists and other experts who work with older population could introduce them to communication technology thus making them more satisfied and improving their quality of life.

This study aimed to evaluate the association between the index to ring (2D:4D) finger length ratio and aging-related traits (hand osteoarthritis (OA), the osseographic score (OSS), and reproductive period), as well as to assess the heritability of finger length. A Chuvashian population-based sample included 802 males (mean age 46.98±17.10 years) and 738 females (mean age 48.65±16.62 years). Age, sex, basic demographics, anthropometric data, reproductive indices (age at menarche, menopausal age, and length of the reproductive period), and x-rays of both hands were collected. Finger length ratio was measured on x-ray and each hand was visually classified as either type 1 – 2D&amp;gt;4D; type 2 ― 2D=4D; or type 3 ― 2D&amp;lt;4D. Hand OA was defined by the number of affected joints (Kellgren-Lawrence score ≥2) and the total of Kellgren-Lawrence scores (total OA score). OSS is a skeletal biomarker that comprises osteoporotic and OA changes observable on a hands x-ray. We calculated the familial correlations and performed a heritability analysis of 2D:4D ratio traits in a studied sample. After comparing the OA variables of individuals with different finger length ratio types (after adjustment for age and BMI) significant differences were found only in females between finger ratio types of the right hand in a number of affected joints (F=3.153, p=0. 043) and finger ratio types of the left (F=3.330, p=0. 036) and right (F=2.397, p=0. 047) hands of the total OA score. Females with type 3 ratio had the highest adjusted values of hand OA parameters. Results of one-way ANCOVA for finger length ratio types of the right hand showed a significant difference in OSS (df =2, F=7.569, P=0.001), after adjustment for age, sex, and BMI. The posthoc comparison showed that individuals with type 3 (2D&amp;lt;4D) ratio showed significantly higher OSS scores than ones with type 1 (p=0.012) and type 2 (p=0.003). In an analysis of finger length ratio types of left hand also a significant difference in OSS was found (df=2, F=3.290, P=0.038). The posthoc comparison showed that individuals with type 3 ratio showed significantly higher OSS scores than ones with type 2 (p=0.33) ratio. We found that a low finger length ratio, a masculine visually evaluated finger length ratio type, was associated with later menarche and a shorter reproductive period. No association was found with menopausal age. Familial correlations of finger length ratio traits showed no significant correlation for spouses, however, parent-offspring (0.15―0.28, p&amp;lt;0.001) and sibling correlations (0.13―0.38, p&amp;lt;0.009) were found significant. Heritability (H2) of visual classification of finger length ratio was 0.36 for the left and 0.28 for the right hand; finger ratio was 0.55 and 0.66, respectively; the ray ratio was 0.49 and 0.59, respectively, thus indicating the existence of a clear familial aggregation of finger length ratio variation in the Chuvashian pedigrees, which cannot be explained by pure common environmental effects.

Comparative measurements were made of 144 orthopantomographs in 50 patients with successful and 94 patients with unsuccessful inferior alveolar nerve block anesthesia. The results show that the bony lingula is prominent in 28.5% of all patients, or in 56.0% of those with unsuccessful anesthesia. The variables mandibular notch vs. mandibular foramen (MN-MF) and the anterior ramus ridge vs. mandibular foramen (ARR-MF) show greater distances in the group of patients with successful anesthesia, while the variables of posterior ramus ridge vs. mandibular foramen (PRR-MF) and mandibular angle vs. mandibular foramen (MA-MF) were greater in the group of patients with unsuccessful anesthesia (p > 0.05). It is concluded that the variability in position of the mandibular foramen among others may be responsible for an occasional failure of inferior alveolar nerve block.

The patients with intensive pain caused by the vertebra body fracture were treated by application of bone cement under local or general anesthesia, by means of diascopy through unilateral transpedicular approach. The intensity of pain was followed-up on the VAS scale before surgery, 24 hours after surgery and three months after surgery. The cement was applied in 55 patients (43 women, 12 men). The average age of the tests was 68.43 years (38 to 82 years). Fifty five procedures were implemented on 85 vertebrae, i.e. 32 metastatic fractures and 23 osteoporotic fractures. The procedures were applied on 28 thoracal and 57 lumbar vertebrae. The average VAS before surgery was 8.36 and 2.23 (p < 0.005) 24 hours after surgery, and it remained almost unchanged three months later. There were 1 serious complication, a paraparesis caused by the leakage of cement into the spinal canal, which was partially recovered after decompression and rehabilitation treatment, and 2 superficial infections with S. epidermidis which were cured by means of antibiotics. By means of Wilcoxon paired test a significant difference was found between the preoperative VAS and the value 24 hours after surgery (n = 55, Z = 6.451, p < 0.00001) and 3 months after surgery (Z = 6.45, p < = 0.00001), while there was a compliance between two VAS measurements after surgery (Z = 1.308, p = 0.191) which indicates that the fast pain reduction remained stable during the 3 month follow-up. The vertebroplasty is a safe and efficient surgical method in treatment of compressive vertebrae fractures which do not react to the conventional method of treatment. The achieved analgesic effect 24 hours after surgery is a good predictor of pain intensity 3 months after surgery.

Williams-Beuren syndrome is a multysistem genetic disorder caused by the 1.6Mb hemizygous deletion involving the elastin gene in the region q11.23 of chromosome 7. The phenotype of Williams-Beuren syndrome is extremelly variable but the most common findings include cardiovascular disease, distinctive facies, mental retardation, a specific congitive profile, endocrine abnormalities, growth retardation and connective tissue abnormalities. Although gastrointestinal difficulties are one of the most constant and prominent finding of the syndrome, including gastro-esophageal reflux (GER), poor suckling, vomiting, constipation, prolonged colic, rectal prolapse, inguinal, umbilical and hiatal hernia, there have been no reports of achalasia in association with Williams-Beuren syndrome in the literature. We present the case of a boy with Williams-Beuren syndrome, achalasia and recurrent postoperative stenosis of the cardia. After Heller myotomy, the boy developed severe restenosis of the cardia with abundant adhesions which repeated after every treatment, five times in periods shorter than one month. Eventually, he developed GER, errosive gastritis and hiatal hernia which led to severe malnutrition and failure to thrive. Although the genetic defect causing Williams-Beuren syndrome might not be the direct cause of achalasia we suggest that the frequent development of severe restenosis of cardia due to tight adhesions could be the consequence of elastin gene haploinsufficiency and altered structure and function of elastic fibers in esophageal connective tissue. This case highlights the importance of early diagnosis of esophageal motor disorders in childhood which should be included in the differential diagnosis when a child with Williams-Beuren syndrome presents with dysphagia and/or regurgitation.