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Hajnsek S.,Klinicki bolnicki centar Zagreb
Neurologia Croatica | Year: 2010

Due knowledge of the semiology of epileptic seizures and of the classification of the respective type of epilepsy or epileptic syndrome is necessary to reach an accurate diagnosis and to choose optimal antiepileptic drug. Following diagnostic guidelines, history, heterohistory and videopolygraphic data may occasionally suffice to delineate the clinical picture, which will then serve to define quite precisely the anatomic origin of epileptogenesis and localize the epileptic focus. A correctly made initial diagnosis will reduce the time needed for patient work-up and enable faster choice and introduction of the most potent antiepileptic or decision on a more radical mode of treatment, thus substantially decreasing the risk of developing a pharmacoresistant form of disease. At the same time, identification of the clinical phenotype and its anatomic correlate reduces the possibility of diagnostic error, which may result in extensive and unnecessary diagnostic procedures and specialist examinations.

Popovic-Grle S.,Klinicki bolnicki centar Zagreb
Acta Medica Croatica | Year: 2011

Cigarette smoking is a major risk to the overall burden of disease in developed countries. Smoking influences disease development, disease outcome and therapeutic success. Cigarettes with low tar, which do less harm, do not exist, nor there is a safe level of smoking. Passive smoking is involuntary inhalation of tobacco smoke. Environmental tobacco smoke is the second most common cause of carcinogen exposure. Passive smoking, whether prenatal or postnatal in children, increases the likelihood of asthma, similar as in adults. Active smoking increases total immunoglobulin E (IgE) level and inflammatory cell infiltration, especially eosinophils. Tobacco smoking increases bronchial hyperreactivity. Clinical picture of asthma in smokers is more severe in terms of symptoms, with more frequent exacerbations and invasive intubation with increased mortality rate than in asthmatics nonsmokers. Smokers have a higher prevalence of allergic rhinitis and atopic dermatitis.

Prosinecki N.,Klinicki bolnicki centar Zagreb
Socijalna Psihijatrija | Year: 2011

The concept of psychosocial approach or work has been present since the beginnings of social work as a profession and also in psychiatry as part of a much broader biopsychosocial model. Psychosocial approach was implemented in the practice even before its definition and creation of theoretical framework. Nowadays, there are numerous definitions by many authors of the psychosocial model. The idea of combining psychic and social elements, which are interwoven and inseparable, is responsible for the wellbeing and quality of life of these people. Emphasis is on the integration of the psychic and the social, giving importance to psychic characteristics, social environment, culture and interpersonal relations as relevant factors of integration. There are two significant concepts related to psychosocial approach, i.e. the idea of empowerment and assessment in psychosocial perspective. The fact that traditional model as it is no longer sustainable in psychosocial approach is of great importance. All experts who use the new concept will find themselves it the empowerment model.

Richter D.,Klinicki bolnicki centar Zagreb
Acta Medica Croatica | Year: 2011

Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indication for concomitant combination treatment with antihistamines and leukotriene antagonists. Intranasal corticosteroids should not be withheld in more severe forms. Shortterm (up to 3 months) use of intranasal corticosteroids has not been associated with any significant local or systemic side effects.

Congenital adrenal hyperplasia (CAH) is an inherited autosomal recessive disorder caused by an enzyme deficiency in steroid biosynthesis. The most common form of congenital adrenal hyperplasia is 21-hydroxylase deficiency (21-OHD) which in it's severe form can cause genital ambiguity in females. Steroid 21-hydroxylase deficiency can be diagnosed in utero by molecular genetic analysis of fetal DNA. Prenatal treatment successfully reduces genital ambiguity, thus avoiding genitoplasty in affected females. Current data from large studies show that prenatal diagnosis and treatment are safe for both the fetus and the mother. Preliminary data from long-term studies support these results. Since1985. in our Clinic, 52 prenatal diagnosis CAH due 21-OH deficiency have been performed. In 27 fetuses the diagnosis was made with measurements of 17-hydroxyprogesterone and androstendion in amniotic fluid, HLA typing of amniotic cells as well as kariotyping between 16 and 18 weeks. The rest of them have been performed due to chorionic villus sampling between 10 to 12 weeks and molecular genetic analysis. Prenatal therapy was started in 10 mothers, but was stopped after 9 to 16 weeks because fetuses were either males or healthy females.

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