[Croatian Medical Association in the period of transition 1989-1997]. / Hrvatski lijecnicki Zbor u razdoblju tranzicije 1989-1997.

By reviewing the minutes of the 56 sessions of the Presidency and thereafter of the Management council of the Croatian Medical Association, the minutes of annual conventions and other relevant publications, the events in the Croatian Medical Association in the first period of social and market transition, from the first democratic elections in the country up to the beginning of the year 1997 are presented. The construction of the Association before transition, its changes in the statutes during the first three years are demonstrated: the Association restores its old and previous denominations, the professional sections convert to professional societies, the secret elections for all leading places in the organization are introduced. One after another are presented the appeals, meetings and symposia that were sent or held in the headquarter at a time of aggression against Croatia with an aim to ask international help in the defense of the homeland. The conflict between the president of the Association and the Ministry of health and social affairs is presented, as well as the introducing of the Association and its societies in international organizations, the establishing of new scientific/professional societies, the founding of the Commission for human rights and medical ethics, the Norwegian initiative for conciliation of conflicted parties during the war, the non-held 9th and the held 10th Congress of Croatian physicians in Zadar. The list of succumbed Croatian physicians during war is presented. The Association's activity in establishing the Croatian Medical Chamber and thereafter the encounter Association-Chamber is presented as well. The review ends by demonstration of less pronounced activities and by efforts to provide money necessary for renovation ofAssociation's building. Separately the names of colleagues who actively participated in often dramatic moments of transition are mentioned.

Is referring patients with a positive history of allergic drug reactions or atopy for allergy testing to local anesthetics justified?

Although no more than 1% of adverse reactions to local anesthetics (LA) are thought to be immunologically mediated, many patients continue to be referred to allergy clinics for allergy workup. We evaluated the impact of a history of drug hypersensitivity or atopy on results of allergy testing to LA, with the aim of determining the appropriateness of allergy testing to LA in such patients. We retrospectively analyzed medical records of 112 consecutive patients referred for allergy testing to LA in a 9-year period (1996-2005). Intradermal tests with diluted (1:10) LA were performed to identify patients at risk for immunoglobulin E (IgE)-mediated hypersensitivity reaction. The odds for being testpositive were calculated with regard to the defined risk factors (atopy, history of adverse reactions to LA or other drugs, underlying autoimmune disease). Eleven of 112 patients (9.8%) tested positive for allergy to LA. Atopy, history of adverse reactions to LA or other drugs and underlying autoimmune disease did not increase the odds for being test-positive. The prevalence of multiple drug hypersensitivity, IgE values and eosinophil count were not significantly higher among the patients who tested positive as compared to the patients who tested negative. According to our data, allergy testing to LA is not justified in patients with atopy or histories of adverse drug reactions other than to LA. Further studies using validated methods of allergy testing to LA coupled with analysis of defined risk factors are needed to definitively establish the indications for referral of patients for allergy testing to LA.

[Doctors and tobacco smoking]. / Lijecnici i pusenje duhana.

A survey undertaken at three hospitals in Zagreb in 1988 showed that 32.1% of doctors employed were smokers. Another survey found that 31.5% of doctors in 10 health centers in Zagreb in 1993 were smokers. In the same year, some 44 percent of male doctors in health centers in Bjelovar were found to be smokers, along with 40 percent of women. In the beginning of 1999, the Croatia Medical Association undertook an international survey on smoking by doctors who were members of the Association. The survey was in cooperation with the European Forum of Medical Associations (EFMA). The survey showed that only 13% of doctors were still smokers, while 28% were former smokers and 59% had never smoked. The cause for this decrease in smoking by doctors was better information on the scientific evidence about the harmfulness of smoking. One element contributing to the greater availability of information was the work of the Anti-Smoking Coordinating Committee of the Croatian Medical Association.

Acquired coagulopathy due to anticoagulant rodenticide poisoning.

A 35-year-old woman was admitted to hospital because of epistaxis, hematomas, and metrorrhagia. Laboratory data indicated severe coagulopathy with prolonged prothrombin time and decreased serum concentrations of vitamin K-dependent clotting factors II, VII, IX, and X. The patient denied taking any oral anticoagulants. She was given transfusions of red blood cells, fresh frozen plasma (1,180 mL) and phytomenadione daily for 6 weeks (total dose 550 mg), which normalized the coagulation factors concentration. After all other possible causes of acquired coagulopathy had been excluded, rodenticide poisoning was suspected on the basis of her epidemiologic history. The patient was a war refugee from Bosnia and Herzegovina. During her absence, the troops of United Nations Protection Force performed rodent extermination in and around her house. History data and therapeutic effects suggested that the coagulopathy had been caused by prolonged exposure to long-acting anticoagulant rodenticide. This could also explain the need for protracted phytomenadione therapy.

Health-care resource use by asthmatics in Croatia.

We report a survey of the impact of asthma on daily life and on health-care resource use by adult asthma patients in four counties in Croatia. Over a 1-year period beginning November 1998, 185 general practitioners recruited 504 asthma patients, who completed a questionnaire about their drug therapy, health-care resource use, symptoms, limitations in daily activities, and work loss due to asthma. Over a 2-week period, inhaled corticosteroids were used by 51.5% of patients, short-acting and long-acting beta-agonists by 70.8% and 53.5%, respectively, and oral extended-release theophyllines by 29.8%. Nocturnal awakenings were experienced by 58.7% of patients, 75.5% experienced daytime symptoms, and 42.5% were limited in their daily activities. In the previous year, 12.5% of the patients were hospitalized, 33% missed work, and 70% reported reduced effectiveness in the workplace. In the previous 6 months, 35.2% of the patients visited an emergency room due to worsening of asthma symptoms. The human and socioeconomic burden of asthma in Croatia is considerable. These results can help guide the development of asthma policy in Croatia and raise awareness of asthma as a public health issue.