Zagreb, Croatia
Zagreb, Croatia

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Plavec D.,Djecja bolnica Srebrnjak | Turkalj M.,Djecja bolnica Srebrnjak | Erceg D.,Djecja bolnica Srebrnjak
Medicus | Year: 2011

The assessment of allergic status is an obligatory and very important diagnostic procedure in patient suspect of suffering from respiratory allergy. Assessment of allergic status has both diagnostic and differential diagnostic values with high predictive diagnostic value for asthma and allergic rhinitis, although not fully specific and sensitive especially for asthma. It is also important in the assessment of possible triggers for the attacks or exacerbations or in indicating of specific immunotherapy. Nowadays in the routine clinical practice we use in-vivo (skin-prick tests) and in-vitro methods (measurement of specific IgE) but medical history and skin-prick test still are the "gold standard" for identification of clinically relevant allergy. Positive results of these tests and without supporting history and clinical presentation suggest sensitization and not allergic disease, while the negative one does not exclude the diagnosis. Elevated levels of total IgE or eosinophilia are nonspecific markers and in this case other reasons for these results should be excluded.

Plavec D.,Djecja Bolnica Srebrnjak | Vuljanko I.M.,Djecja Bolnica Srebrnjak
Paediatria Croatica, Supplement | Year: 2014

According to high prevalence of respiratory disease in the pediatric population, there was a need for the development of noninvasive methods for studying pulmonary function. Nowadays, a new method called impulse oscillometry is available in daily clinical practice, as a type of forced oscillatory techniques. The principle of operation is based on the application of pressure waves from outside the airways and the measurement and analysis of reflected waves and the consequent determination of respiratory impedance as an indicator of lung function. Respiratory impedance is determined using a complex mathematical model, consisting of the actual (real) part called the respiratory resistance and an imaginary part, which is called respiratory reactance. Compared to other methods of lung function testing it requires only passive cooperation with patient in terms of wearing a clamp on his nose and his mouth shut over the mouthpiece with only spontaneous breathing through the mouth. The specific value of IOS is its ability to measure the short-term response to bronchial and therapeutic intervention as well as the long-term monitoring response to therapy.

Turkalj M.,Djecja bolnica Srebrnjak | Erceg D.,Djecja bolnica Srebrnjak
Medicus | Year: 2013

Asthma in childhood is an inflammation of airways, i.e. a heterogeneous disease with different phenotypes and endotypes and variable clinical manifestations which depend on age, gender, genetic background and environmental influences. In children asthma is usually associated with allergic sensitization. Asthma treatment and management is primarily directed towards suppressing airway inflammation with anti-inflammatory drugs (inhaled corticosteroids, leukotriene receptor antagonists etc.) and relieving bronchoconstriction with bronchodilators. Therapy is determined to a large extent following an initial assessment of severity and subsequent establishment of control, both of which can be variable over time. Unfortunately, despite the availability of effective therapies, asthma control is suboptimal in many patients worldwide. There is an urgent need to identify the underlying basis of asthma, understand the complex genetic and environmental influences, and develop an appropriate treatment strategy.

Plavec D.,Djecja Bolnica Srebrnjak | Gluncic T.J.,Djecja Bolnica Srebrnjak | Gudelj I.,Djecja Bolnica Srebrnjak | Mise K.,Djecja Bolnica Srebrnjak
Lijecnicki Vjesnik | Year: 2012

Aim: to assess the proportion of patients with asthma or chronic obstructive pulmonary disease (COPD) with significant bronchoobstruction who do not have inspiratory flows necessary for the adequate use of dry powder inhaler (DPI) devices Diskus® and Turbuhaler® Patients and methods: multicentre cross-sectional study that included 400 patients with asthma or COPD (with FEV, <60%) aged 5-91 years tested during exacerbation or usual control visit. All patients underwent lung function testing and measurement of inspiratory flows using In-check Dial. Results: Significantly lower proportion of patients didn't have inspiratory flows necessary for the regular adequate use of Diskus®than for Turbuhaler® (21.0% vs 87.0%, x 2350.72, p<0.0001). In patients tested during exacerbation these proportions were marginally greater. Regression analysis showed a weak association of inspiratory flows measured with different resistance settings with parameters of lung function (best association was seen between resistance setting for Diskus®and PEF [%], r 20.104). Conclusions: significant proportion of patients with asthma or COPD with significant bronchoobstruction do not exhibit satisfactory inspiratory flows for the use of dry powder inhaler (DPI) devices (Diskus®< Turbuhaler®). Spirometry is not to be used for selection of the device for drug application and In-check Dial should be used instead.

Turkalj M.,Djecja Bolnica Srebrnjak | Mrkic I.,Djecja Bolnica Srebrnjak
Lijecnicki Vjesnik | Year: 2012

Food allergy is common disease that affects 11-26 million people in Europe. The incidence is estimated to be greater in children (5-8%) than the in adults (1-3%). Currently, the mechanisms of food allergy are not well characterized. There are a lot of open questions, for example: Why do some individuals develop allergy to food? Why is some food more allergenic than other? Why do some children become tolerant?Recognition of food allergy is largely based on symptoms and in a number of cases its recognition can be difficult. The spectrum of food allergy consists of a variety of different clinical presentations, and can range from chronic gastrointestinal symptoms to severe, life threatening, and anaphylactic reactions. The diagnosis of food allergy is mostly limited by the lack of reliable in vitro tests, especially for non-IgE mediated diseases. Currently, there is no safe and efficient treatment for food allergy, and the treatment relies on avoidance diets, that significantly affect the quality of life of allergic patients.

Bukovac L.T.,Djecja bolnica Srebrnjak
Reumatizam | Year: 2012

Juvenile dermatomyositis is the most common idiopathic inflammatory myopathy in children, and presents a heterogeneous group of subacute, chronic and acute diseases of skeletal muscles. Its unique presentation is marked with characteristic skin rushes and progressive muscle weakness. JDM is clinically distinct from adult dermatomyositis, because it is a systemic vasculopathy not associated with malignancy and it often overlaps with other chronic childhood inflammatory diseases. Although immunopathology of JDM is complex, new studies are completing our knowledge of disease pathogenesis. Corticosteroids represent the first line therapy, afterwards combined with immunomodulatory drugs and biological agents. Better knowledge of the disease combined with modem treatment modalities resulted in reduced mortality rates and in much improved quality of life in patients with JDM.

In patients with chronic inflammatory myositis noninvasive diagnostic modalities, such as magnetic resonance (MR) imaging, and ultrasonography (US), are able to demonstrate muscular edema, fluid collections, fatty infiltration, atrophy, fibrosis, and calcifications. Because MR imaging is sensitive to the presence of edema and offers better tissue differentiation, current MR imaging with fat suppressed T2-weighted techniques or STIR images appears to be more efficient than US in the diagnosis and management of inflammatory myopathies. MR imaging has also been proposed as a means to guide biopsy in an area of active disease, thereby reducing the problem of sampling error. These changes in signal intensity, however, are not specific for myositis. Although MR imaging is now the imaging modality of choice in this issue, reduced availability, patient discomfort, and exclusion of certain patients with indwelling metal objects, such as pacemakers, are disadvantages. The availability and ease of use of US makes it preferable to MR imaging. Real-time sonoelastography can be used for various musculoskeletal applications, but the clinical utility in diagnosis of myositis is yet to be established. On the other hand, the contrast-enhanced US is a feasible method for noninvasively demonstrating increased perfusion in the involved muscle groups, and most likely, will soon become preferable, noninvasive imaging method in patients with myositis.

Raos M.,Djecja Bolnica Srebrnjak | Markovic J.,Djecja Bolnica Srebrnjak
Medica Jadertina | Year: 2010

An 11-month-old infant with staphylococcal sepsis and empyema of the right thorax is presented. An adequate antibiotic therapy was administered, and purulent content was eliminated by thoracocentesis. On the 5thday of treatment, a tension pneumothorax developed, and negative succion drainage was performed. Empyema therapy is under the competence of the paediatrician and surgeon, and early performed drainage of pleural cavity can prevent the development of complications.

The classification of juvenile spondyloarthritides is presented.

Pavic I.,Klinika za Pedijatriju | Drinkovic D.T.,Klinika za Pedijatriju | Bogovic J.C.,Klinika za Pedijatriju | Dodig S.,Djecja Bolnica Srebrnjak
Paediatria Croatica | Year: 2014

Interferon-gamma release assays (IGRAs) have offered signifi cant progress in the detection of M. tuberculosis infection. In addition to obtaining negative or positive results of IGRAs, there is a possibility of getting indeterminate results. An indeterminate test result indicates situations where it is not possible to determine the state of M. tuberculosis infection. Interpretation and accurate follow-up of children with indeterminate test results pose diagnostic challenges for clinicians. The aim of the present review is to show an illustrative case of a 15-month-old boy with indeterminate result of the QuantiFERON-TB Gold In-Tube test (QFT-GIT, Cellestis Ltd., Carnegie, Australia) during pneumonia, to point out the problems associated with getting indeterminate results. Follow-up test result after recovery was negative. QFT-GIT should preferably be performed upon resolution of acute infl ammation with standardization of preanalytical and analytical factors in order to avoid indeterminate results. Furthermore, evidence-based guidelines on the optimal follow-up of children with indeterminate results will be important as IGRAs use becomes increasingly widespread.

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