Zagreb - Centar, Croatia
Zagreb - Centar, Croatia

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Pelicaric D.,Klinicki bolnicki centar Zagreb | Popovic-Grle S.,Klinicki bolnicki centar Zagreb
Medicus | Year: 2016

The treatment of chronic obstructive pulmonary disease (COPD) has a long history of clinical guidelines enabling physicians to apply integrated knowledge through best therapeutic algorithms when treating their patients. The latest studies have used cluster analyses for grouping heterogeneous characteristics into relatively homogenous groups (the subjects in the same group are more similar to each other than to subjects in other groups). This classifies the patients suffering from COPD into the so-called phenotypes. A phenotype is generally defined as a sum of an organism’s external characteristics, and it reflects the interaction of genotypes and the impact of external factors. It encompasses structure and function, as well as morphological, anatomic, physiologic, biochemical and biophysical characteristics. This article deals with the most common COPD phenotypes, mentioned in the largest number of studies: 1. frequent exacerbation phenotype, 2. emphysema-hyperinflation phenotype, 3. rapid decline in lung function phenotype, 4. chronic bronchitis phenotype, 5. systemic manifestations (comorbidities) phenotype, and 6. asthma-COPD overlap syndrome. The phenotype classification has occurred as a result of the fact that the prognosis and therapeutic approach to COPD patients are reliant on the clinical phenotype. The aim of the classification is to group the heterogeneous population of COPD patients into phenotypes with different prognoses and to define an optimal therapeutic approach. © 2016, PLIVA d.d. All rights reserved.


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.


Marinovic Kulisic S.,Klinicki Bolnicki Centar Zagreb | Lipozencic J.,Klinicki Bolnicki Centar Zagreb
Acta Medica Croatica | Year: 2011

The signs of chronic venous insufficiency (CVI) include telangiectasias, reticular or varicose veins, edema, skin changes such as hyperpigmentation, lipodermatosclerosis, eczema and ulcer. Ulcus cruris hypostasicum resulting from CVI is the most common wound in people older than 60. Care of the skin surrounding venous ulcer is essential in preventing new ulcer and complications in the skin. The surrounding skin is hyperpigmented, often irritated with exudates and inflamed. Therefore, it is necessary to apply a neutral formulation for care, according to dermatologic status of local skin. The paper describes these preparations.


Aim: To demonstrate that in well-controlled asthma with stable spirometric values, the values of airway resistance (Raw) vary depending on climatic conditions. Subjects and methods: This study included 42 patients with well-controlled asthma aged 18-77 years. Spirometry and body plethysmography wasbmeasuredbin all patients, 4 times during the year - in October, February, May and August, as typical representatives of the different seasons. Patients were divided into 2 groups: patients with obstruction in spirometry and patients with normal spirometry. Results: The analysis results showed that with stable spirometric values (FVC - forced vital capacity, FEV1 - forced expiratory volume in first sec, FEF50 - expiratory flow at 50% VC) changes in Raw existed. Values varied depending on the season. In August and February, values of Raw decreased, and in October and May values increased. These trends were confirmed in 78.57% patients. Conclusion: It is possible that Raw is dependent on climatic conditions. The summer and winter seasons are stable, unlike spring and autumn, where there are fluctuations in temperature, humidity, barometric pressure. Long-term weather fluctuations affect the variability of Raw. Stable time with uniform parameters (summer, winter) reduces the value of Raw, in contrast to unstable weather (spring and autumn), where Raw increases. Raw could be a useful parameter in monitoring long-term stability control of diseases, as FEV1 is a current indicator of the degree of obstruction.


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.


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.


Medanic D.,Klinicki bolnicki centar Zagreb
Acta medica Croatica : časopis Hravatske akademije medicinskih znanosti | Year: 2012

Obesity is a major health problem today that grows into a global epidemic. According to the World Health Organization report, 1.5 billion adults were overweight, over 500 million of them were obese, and the prevalence of obesity is expected to rise in the years to come. A similar situation is recorded in Croatia, where there are 25.3% of obese men and 34.1% of obese women. There are multiple factors that cause obesity. Accelerated lifestyle, fast food, unhealthy eating habits and sedentary lifestyle are considered as the major risk factors of overweight and obesity development. Accumulation of fat tissue, especially visceral fat tissue has been demonstrated to be associated with some chronic changes and diseases of different organ systems. Some anthropometric measurements, especially body mass index, waist circumference and waist-to-hip ratio, have been used to diagnose obesity and estimate the health risk. Developing well-structured prevention programs that would encourage people to become aware of obesity as a disease and that imbalanced dietary habits and physical activity are important for obesity prevention and health, is a major public health challenge.


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.


Ljubojevic S.,Klinicki Bolnicki Centar Zagreb | Lipozencic J.,Klinicki Bolnicki Centar Zagreb
Acta Medica Croatica | Year: 2011

Reaction to insect sting and bite may be local, such as erythema, edema and pruritus, or systemic, such as anaphylactic reaction. Diagnosis can be made by patient history, clinical picture, skin testing, total and specific IgE level, and provocation test. Local reactions are treated with cold compresses, topical corticosteroids and oral antihistamines. Oral and intramuscular antihistamines and corticosteroids are used for the treatment of mild systemic reactions, and in severe reaction epinephrine injections are added. Hyposensitization is indicated in patients with severe systemic reaction, positive skin tests and high level of specific IgE antibodies.

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