Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators.

OBJECTIVE: To test a feasible and reliable model for diagnosing obstructive sleep apnea (OSA) in children, based on the clinically relevant parameters, in comparison to a polysomnography. METHODS: A total of 94 children with the suspected underlying OSA were included in the analyses. An association between clinical parameters (modified Mallampati score, tonsil size, adenoid size, age, gender, and body mass index) and apnea-hypopnea index (AHI) obtained following an overnight polysomnography was assessed, and significant variables were incorporated in the logistic regression model. Also, the sensitivity and specificity calculations of the model with the inclusion of ROC curve analysis were performed. RESULTS: All tee local clinical parameters were significantly associated with AHI (P < 0.001). The most significant correlation with AHI was shown with the modified Mallampati score (r = 0.723), following with tonsil size (r = 0.673), and adenoid size (r = 0.502). The sensitivity of the tested model was 84%, and specificity was 74%. CONCLUSION: This study derived a model based on the local clinical findings that significantly overlapped with the results of an overnight polysomnography, in diagnosing OSA in children.

Surgical Treatment of Recurrent Metastatic Parathyroid Gland Carcinoma.

AIM: We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient's right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. RESULTS: The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. CONCLUSION: With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.

Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

PURPOSE OF THE STUDY: The aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics. MATERIALS AND METHODS USED: The study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20. RESULTS: In total 60 children were included in the study. The median of age was 5 years (range 2-9). There were 19 (32%) girls and 41 (68%) boys. Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis. CONCLUSION: Even though we are aware that PSG is the gold standard for diagnostics of SDB there is a significant financial burden for this diagnostic procedure. That is why there is a necessity for establishing good clinical standards and possible formula for OSA severity evaluation. We propose formula which includes Mallampati score and tonsillar size for OSA -risk calculation in order to perform early therapeutic intervention thereby reducing the risk of long-term negative consequences. We recommend this formula as the screening formula in circumstances where PSG is not available, in cases when the "waiting list" is too long or when a child can not cooperate to perform it. In developing countries like Croatia on time intervention with reduced procedure-associated costs is of the utmost importance.

Prevalence and risk factors for developing oral allergy syndrome in adult patients with seasonal allergic rhinitis.

The aim of this study was to assess the prevalence of oral allergy syndrome (OAS) in patients with seasonal allergic rhinitis (SAR) and the possible risk factors for its development. This cross-sectional study was conducted in primary care offices in the Split-Dalmatia County during the period from March 1 to September 30, 2012. Data sources were medical history with confirmation of SAR (positive skin-prick test to seasonal inhalant allergens: grass, tree and weed pollens), anthropometric patient data (age, sex, weight and height), and a questionnaire in which patients evaluated their nasal and ocular symptoms, comorbidities and lifestyle. The χ2-test, Pearson χ2-test, Spearman's rho correlation coefficient and Kolmogorov-Smirnov test were used on statistical analysis. The prevalence of OAS was 45.7%. The risk factors for OAS development were diabetes (p < 0.001), severity of nasal symptoms (p < 0.05) and severity of ocular symptoms (p < 0.001). In conclusion, the prevalence of OAS in the Split-Dalmatia County is very high. The risks factors for OAS in patients with SAR are diabetes and severity of nasal and ocular symptoms.

The Epidemiological Characteristics of Hepatitis B in Croatia: The Results of the Prevention.

This study shows epidemiological characteristics and preventive measures implemented for the prevention and control of hepatitis B infections in Croatia. We analyzed the data from obligatory infectious disease reports and notifications of death due to infectious diseases, data on the hepatitis B infections in Croatia, and data collected by survey of the population. The average prevalence of the disease is 3.67 per 100,000 annually. All age groups are affected, but still a higher rate of the disease is found in the age groups from 15-19 and 20-29 years of age. Hepatitis B disease is 1.4 times more likely in men than in women. For the past 18 years, the average rate of mortality was 0.2%. The incidence of HbsAg-positive donors of blood is within the range of 0.65% in 1992 to 0.012% in 2011. The largest part of preventive measures implemented in Croatia against hepatitis B is predicted and required by legislation. The registrations of acute and chronic carriers of the virus are obligatory. High-risk groups have started being vaccinated since 1992. The obligatory vaccination of infants was introduced in the mandatory vaccination program in 2007. Routine testing of blood exclusively from voluntary donors for HbsAg presence is obligatory. The non-governmental organization "Help" created for intravenous drug users, along with the "Harm reduction" program implemented hepatitis B, C, and HIV/AIDS prevention program in 1995. In order to gain a better understanding of epidemiological characteristics of hepatitis B in Croatia, the specifics of its dynamics in small communities are required since the research of Croatian public health officials and researchers have shown that hepatitis B is spread in different ways.

Polypoid angiomyofibroblastoma tumor of nasal cavity: case report.

We report an extremely rare case and localization of polypoid angiomiofibroblastoma tumour, a case report and review of the world literature concerning angiomiofibroblastoma tumour. We present the case of a 74-year-old man who underwent left anterior and posterior ethmoidectomy with extirpation of tumour mass from left nasal cavity, epipharinx and left sphenoid sinus. The prognosis for this group of tumour is good and patient didn't receive any kind of therapy except surgical treatment. To our knowledge, this is a rare report in the world literature of polypoid angiomiofibroblastoma tumour of nasal cavity. This case indicates that angiomiofibroblastoma tumour of nasal cavity and paranasal sinuses is a rare disease including its localisation which otolaryngologists should be aware of and one which should be included in the differential diagnosis of tumours involving sinonasal tract.

Direct molecular detection of Mycobacterium tuberculosis suspected to be the specific infection in a case of recurrent tonsillitis.

We report a case of a 21-year-old man with recurrent tonsillitis caused by Mycobacterium tuberculosis. For a period of 5 months, the patient had tonsillitis seven times and was treated with several oral or parenteral antibiotics. On one of these occasions, tonsillitis was complicated with a peritonsillar abscess that was treated by incision. According to relevant bibliographic data, this is the first case of Mycobacterium tuberculosis confirmed by direct molecular microbiology methods from the tonsillar tissue of a young immunocompetent male reported in Europe. In a case of recurrent tonsillitis, Mycobacterium tuberculosis infection should be considered as a possible cause.

Incidence of acute angle-closure attacks in Split-Dalmatia County, Croatia.

The aim of the study was to determine the incidence of acute angle-closure attacks among residents of the Split-Dalmatia County, Croatia, during a 6-year period. In this retrospective, interventional case series study, hospital records of 53 consecutive patients (33 female, mean age 71.7 +/- 16.6 and 20 male, mean age 66.2 +/- 23.2) with acute angle-closure attacks, treated at University Department of Ophthalmology, Split University Hospital Center, Split, Croatia, from January 2002 to December 2007 were reviewed. The annual incidence of acute angle-closure attacks was 2 cases per 100,000 (95% CI, 0-3.4). The incidence of acute angle-closure was 0.6 (95% CI, 0-1.4) cases/100,000 per year. The incidence of acute angle-closure glaucoma was 1.5 (95% CI, 0-2.8) cases/100,000 per year. The incidence was 1.5 (95% CI, 0-3.4) cases/100,000 per year in males and 2.3 (95% CI, 0-4.6) in females. Nine (17%) patients were treated by medicamentous therapy, peripheral iridectomy was performed in 19 (36%) patients and laser iridotomy in 16 (30%) patients, whereas nine (17%) patients underwent filtering surgery. Median time between the onset of symptoms to presentation at the hospital was two days (range 1-21 days). There was no statistically significant association between the acute angle-closure attacks and seasonal variation (chi2-test = 4.6; p = 0.20). In conclusion, the number of patients with acute angle-closure attacks in the Split-Dalmatia County is relatively small; however, the significant incidence of acute angle-closure glaucoma could pose a social and health care problem in the County.

Q fever in Croatia: war-induced changes in epidemiological characteristics.

The article describes the epidemiological characteristics of Q fever in Croatia, during the period before and after the Homeland War. In the ten years prior to the Homeland War (1983-1992) 1053 cases of Q fever were recorded, 16.2% (171) of which on islands and in coastal areas. In the period after the Homeland War (1995-2008), a total of 654 cases was recorded, 59.9% (392) of which on islands and in coastal areas. In addition to reduced incidence, geographic distribution of the disease also changed. Before the war, the highest morbidity rate was recorded in the Sisak-Moslavina County. After the war, the Split-Dalmatia County recorded the highest morbidity rate because in the post-war period sheep from Bosnia and Herzegovina went to this county for winter grazing. The disease might be relevant to the Croatian Army and other armed forces that stay in Croatia as part of NATO forces.

Self-perception of drug abusers and addicts and investigators' perception of etiological factors of psychoactive drug addiction.

The aim of this study was to compare investigators' perception of three most important etiological factors for drug addiction and drug abuse with the self-perception of heroin addicts and drug abusers who used cannabis products and/or ecstasy. The study included 207 heroin addicts (mean age, 26.7 +/- 5.8 years) and 238 drug abusers (mean age, 19.3 +/- 1.9 years). Each study participant selected the three most important etiological factors for drug addiction or drug abuse from the list in the Pompidou questionnaire according to his or her perception. An investigator also selected the three most important etiological factors for drug addiction or abuse according to his or her perception for each study participant. The self-selected factors were compared with those selected by the investigators. Heroin addicts most often selected hedonism as the first (n = 97 [46.9%]) and the second (n = 87 [42.0%]) most important factor for starting using drugs, whereas family reasons were most often selected as the third most important factor (n = 58 [28.0%]). Cannabis and ecstasy abusers most frequently selected hedonism as the first (n = 149 [62.6%]), second (n = 128 [53.8%]), and third (n = 76 [31.9%]) most important factor for starting using drugs. According to investigators' perception, family reasons were the first most important etiologic factor in both heroin addicts (n = 93 [44.9%]) and drug abusers (n = 144 [60.5%]). Psychological reasons were significantly more often selected as the first most important factor for heroin addiction than for cannabis or ecstasy abuse by both participants and investigators (P < 0.001 for both). Also, according to investigators' perception, the lack of knowledge was significantly more frequent as the second most important factor in heroin addicts than in cannabis or ecstasy abusers (55 [26.6%] vs 19 [8.0%], respectively; P < 0.001). Drug addicts and drug abusers considered hedonism the most important reason for starting drug use, whereas investigators considered family reasons to be the primary reason. Both factors seemed to play the crucial role in the development of both drug addiction and drug abuse.

Visual acuity and acute angle-closure glaucoma in Split-Dalmatia County.

The aim of this study was to determine the incidence of acute angle-closure glaucoma in Split-Dalmatia County and correlation between visual acuity and time (days) elapsed from the disease onset to hospital admission. Twenty-nine cases were retrospectively analyzed. There were 19 female patients aged 36-91 (median age 68) years and 10 male patients aged 35-88 (median age 70) years, with attacks of acute closure glaucoma treated at University Department of Ophthalmology, Split University Hospital Center from January 2002 until December 2005. Annual incidence was 1.6 cases per 100,000. The time elapsed from the disease onset to hospital admission was 1-21 (median 2) days. Visual acuity before and after treatment was reversely proportional to the number of days to hospital admission (d = -0.466; p = 0.011). Visual acuity was found to depend on age as well (z = 1.999; p = 0.044). The best visual acuity was obtained in those cases that were admitted within two days (z = 2.014; p = 0.044). There was no significant sex difference in the incidence of angle-closure glaucoma (t = 0.389; p = 0.699). No statistically significant association was found between acute angle-closure glaucoma and seasonal variation (chi2 = 5; p = 0.167). In conclusion, earlier recognition of the symptoms of acute angle-closure glaucoma and initiation of treatment within two days of the disease onset were associated with better visual acuity.