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Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose. [ABSTRACT FROM AUTHOR]

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Objective: The objective of this paper is to present the spectrum of surgical procedures that we perform for the purpose of treating oncological patients and the role of surgeons in oncological treatment. Methods: The PubMed medical database was searched with reference to the basic literature in pediatric surgery. Results: By searching and excluding, 18 recent works were considered along with 2 pediatric surgery books on the topic of surgical treatment of solid tumors in childhood. There were no exclusion parameters. Conclusion: The role of surgery in pediatric oncology during the 20th century changed it is position starting from the first and only option for small patients to it is place in the worldwide accepted treatment protocols. The surgical techniques we use in the diagnosis and treatment of childhood tumors continuously evolve according to a specific type of tumor. Methods that were also previously acceptable are now becoming more and more meticulous to preserve the patient's quality of life and fertility. Surgical techniques include tumor biopsy methods, surgery of tumor's primary site (extirpation of tumors, resection of organs or organ systems), staging of tumors according to anatomic extension, operations for disease relapse and metastases, and palliative and supportive procedures. The role of surgery in the prophylaxis of oncological disease is also well defined for various predisposing syndromes and diseases. The most important aspect of surgical oncological treatment is strict adherence to and familiarity with the protocol for a certain type of tumor, as well as a multidisciplinary and individual approach to the pediatric oncologic patient. [ABSTRACT FROM AUTHOR]

Introduction: Nutrition is of great importance in the treatment of malignant diseases because the nutritional status affects the outcome of the disease itself, the tolerance of chemotherapy and the overall survival and quality of life. This is especially important in childhood when, in addition to the treatment of the underlying disease, it is necessary to ensure the normal growth and development of the child. Objective: The aim of this paper was, based on a review of the literature, to point out the importance and show the basics of nutritional assessment and monitoring, as well as nutritional interventions in children suffering from malignant diseases. Methods: The available scientific and professional literature (PubMed) for the last 10 years was searched, and the following keywords were used: nutrition, malignant disease, diet, nutritional assessment, and nutritional intervention. All received abstracts were screened and selected were publications that included above keywords as a main topic. Results: Based on the reviewed literature, presented are the basics of nutritional assessment and when to perform it, risks for nutritional disorders and available nutritional interventions. Conclusion: In pediatric oncology patients, it is important to carry out a nutritional assessment not only at the time of diagnosis, but also during the further course of treatment and follow-up of the patient, to determine individual nutritional interventions that will prevent or treat an already occurring nutritional disorder, and to ensure the growth of the child in accordance with the genetic potential. [ABSTRACT FROM AUTHOR]

Malignant diseases in the paediatric population are rare and account for only 0.5% of all newly diagnosed malignant diseases. In Croatia, 105 to 125 children are diagnosed with malignant diseases every year. As in most countries of the European Union, they are the second most common cause of death in this age group, after accidents. Treatment outcomes for children with malignant diseases in Croatia are comparable to those in other countries of the European Union. Due to the small number of patients, only slightly more than one hundred new patients per year, it would be necessary to centralize the treatment of all high-risk patients. Such children should be treated in two centers, one of which would be a center for solid tumors and the other a center for haematological neoplasms. Such an approach would probably allow an additional improvement in treatment outcomes with practically same resources. [ABSTRACT FROM AUTHOR]

With current treatment protocols, over 90% of children with acute lymphoblastic leukemia (ALL) are cured. Simultaneously with these excellent results, there is an increasing importance of the recognition of possible late effects of antileukemic treatment. The most frequent late effects of therapy for childhood ALL include endocrine abnormalities, obesity, growth disturbances, neurocognitive deficits, psychosocial adverse effects, cardiotoxicity, gonadotoxicity and reproductive changes, neurotoxicity, bone toxicity, secondary malignancies, and premature late mortality. Better recognition of late effects has resulted in the modifications of treatment regimens and development of guidelines for lifelong follow-up of survivors. [ABSTRACT FROM AUTHOR]

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Introduction and Importance: Pediatric patients with neuromotor disorders frequently experience various podiatric conditions. The effectiveness and implications of treatments like orthotics and insoles in this demographic are not thoroughly understood, highlighting a significant gap in podiatric research and clinical practice. Case Presentation: This observational study analyzed 20 pediatric patients with neuromotor disorders. The focus was on common foot conditions such as ingrown toenails and hyperhidrosis, and their association with treatments like orthotics, insoles, and surgical interventions like Achilles tendon lengthening. Clinical Discussion: Statistical analysis using chi-square tests revealed significant associations. Notably, orthotic use was linked to a higher incidence of ingrown toenails (χ² = 5.69, p = 0.017). In contrast, insole usage correlated with increased hyperhidrosis (χ² = 4.44, p = 0.035). Additionally, a significant tendency for orthotic use was observed in patients who underwent Achilles tendon lengthening (χ² = 8.15, p = 0.017). The study also highlighted the prevalence of brittle nails and hyperkeratosis among the participants. Conclusion: The findings emphasize the critical role of podiatrists in the management of foot conditions in pediatric neuromotor disorder patients. While interventions like orthotics are generally beneficial, they may also exacerbate or contribute to other conditions, necessitating regular and careful podiatric monitoring. The study advocates for future research with larger sample sizes and controlled study designs to further validate and expand upon these observations. [ABSTRACT FROM AUTHOR]

Introduction: Children and adolescents use computers, cell phones, and tablets, among other electronic devices, daily in non-academic activities. It is essential to characterize the impact these devices have on the socialization, interaction, and learning processes in this population segment. We should also investigate possible harmful effects that may be related to their use. The objective was to characterize how these devices are used and their impact on school performance, behavior, and physical activity in children and adolescents from 6 to 14 years of age. Materials and methods: This is a cross-sectional analytic study of 510 schoolchildren ages 6 to 9 and 10 to 14 from Bogotá and Cundinamarca, Colombia. They were surveyed with a 38-question survey characterizing the use of the devices and the symptoms of anxiety and depression, conflict resolution, sleep, and school performance. Results: The average age for initiation on the use of devices was four years. Cell phones were the most used in both groups (56.3% and 78.04%). Parents monitor the use of the device in 80% of cases. 40% of the time, device usage was greater than 90 minutes per day. About 16% reported sleep disturbance, frustration (48%), emotional lability (20%), and suicidal ideations (11%) also were reported. 19% did not play with their peers, and 7% did not report having close friends. Conclusions: This study shows the high exposure to electronic devices from an early age and their relation to behavioral factors. Future studies should explore the relationship between these factors and electronic devices in depth. [ABSTRACT FROM AUTHOR]

Aim: To present a patient with a diagnosis of Type 2 diabetes mellitus (T2DM) in childhood and to raise awareness of the increasing incidence of T2DM in the pediatric population and the importance of early detection and treatment. Case report: During the neurological treatment of a nine-year-old boy, it was found that the boy was overfed and had acanthosis on the neck. Laboratory tests revealed elevated liver enzymes, and ultrasound examination of the abdomen revealed diffuse echogenicity of the liver with homogeneous echoes. From the family history, it was learned that both parents suffer from T2DM, and the sister had gestational diabetes during pregnancy. Only two years later, the boy comes to see a gastroenterologist because of elevated liver enzymes. Due to obesity, he was referred to an endocrinologist. According to laboratory tests, he was admitted for newly diagnosed diabetes – fasting blood glucose was elevated (11.3 mmol/L) as well as glycosylated hemoglobin (HbA1c) (9.3%). They denied symptoms of polyuria, polydipsia and weight loss. Based on age, obesity, acanthosis and positive family history, a diagnosis of T2DM was made. Negative antibodies to T1DM – ICA (Islet cell antibodies), GAD (glutamic acid decarboxylase), IA2 (Islet antigen 2) – confirmed the diagnosis of T2DM. During hospitalization, hypertriglyceridemia and hypertension were diagnosed. Metformin therapy was introduced and the boy and his parents were educated about the importance of lifestyle changes, a balanced diet and daily physical activity. Metabolic control of the disease is poor, and check-ups are irregular. Conclusion: The differential diagnosis of T2DM should be considered in those children and adolescents with diabetes who are obese and have a positive family history of T2DM. The fact that these patients usually already have one or more comorbidities at the time of diagnosis can be helpful in making a diagnosis of T2DM. [ABSTRACT FROM AUTHOR]

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Vrtoglavica je subjektivni osjećaj stanja okretanja ili stanje gubitka ravnoteže u prostoru, često udruženo s mučninom, glavoboljom i povraćanjem, nesigurnošću i zanošenjem u hodu. Vrtoglavica ukazuje na oštećenje centralnoga ili perifernoga vestibularnog sustava. Gubitak sluha i tinitus uz vrtoglavicu najčešće ukazuju na periferno oštećenje koje zahvaća unutarnje uho (labirint). Vestibulospinalni sustav omogućuje orijentaciju u prostoru, kontrolu ravnoteže kretanja, stabilizaciju i fiksaciju slike predmeta u očima. Centralno (intrakranijalno) oštećenje vestibularnog sustava povezano je s disartrijom, disfagijom, diplopijama i hemiparezom. Najčešći uzroci centralnog oštećenja su neurovaskularni, demijelinizirajuće bolesti, ozljede glave te tumori mozga. Najčešći uzrok centralnog vertiga je vestibularna migrena. Vrtoglavica udružena s izraženim autonomnim simptomima poput povraćanja, znojenja, bljedila i mučnine upućuju ponajprije na oštećenje perifernoga vestibularnog sustava. Benigni paroksizmalni vertigo (BPV) i labirintitis najčešći su uzroci periferne vrtoglavice i povezani su s perifernim oštećenjem vestibularnog sustava. Akutna vrtoglavica povezana je s vestibularnim neuritisom, demijelinizirajućom bolesti, moždanim udarom, infekcijom središnjeg živčanog sustava (SŽS) i traumom glave. Subakutni i kronični vertigo pojavljuju se u ekspanzivnim intrakranijalnim procesima stražnje lubanjske jame te u okviru toksičnog oštećenja vestibularnog sustava. Racionalni dijagnostički pristup djetetu s vrtoglavicom periferne i centralne etiologije temelji se ponajprije na detaljnim anamnestičkim podatcima i detaljnom neurološkom statusu. Predloženi su dijagnostički algoritmi/postupnici (diferencijalno-dijagnostički pristup) koji omogućuju racionalizaciju pretraga u djece s perifernim i centralnim uzrocima vrtoglavice.

Copyright of Knowledge: International Journal is the property of Institute for Knowledge Management and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: There is evidence that high titers of diphtheria antibodies are more often associated with an asymptomatic or less severe course of COVID-19. The aim of the study was to determine the features of the COVID-19 course in school-aged children depending on the state of postvaccination immunity against diphtheria toxin. Methods. In total, 90 children aged 6 to 18 years were examined: 60 patients with confirmed SARS-CoV-2 infection and 30 children without signs of the disease (control group). There were 20 patients with a mild COVID-19 course, 31 patients with moderate disease severity and 9 patients with severe disease severity. All children were tested for the level of immunoglobulin G (IgG) against diphtheria toxin by immune-enzymatic analysis. Results. Total serum immunoglobulin G against diphtheria toxin was 0.431 (0.113; 0.828) IU/mL. Antitoxic immunoglobulin G was 2.5 times higher in children in the control group than in patients with SARS-CoV-2 infection. A decreased level of immunoglobulin G was associated with increased disease severity. In children with specific IgG 0.01-0.2 IU/mL revaccination is recommended; therefore, 4.2% of the children in the control group, 6.8% with a mild COVID-19 course, 50% with moderate disease severity and 100% of children with severe COVID-19 needed a booster dose of diphtheria toxoid. A moderate negative correlation was observed between the level of immunoglobulin G against diphtheria toxin and ESR (r=-0.38, p=0.004), CRP (r=-0.32, p=0.021), D-dimer (r =-0.35, p=0.009), duration of hyperthermia (r=-0.49, p=0.003), and duration of treatment (r=-0.43, p=0.012). Conclusions. Children with manifested SARS-CoV-2 infection had significantly lower levels of immunoglobulin G against diphtheria toxin compared to the control group, indicating a lower level of humoral immunity. Children with a mild course of COVID-19 had a significantly higher level of specific IgG against diphtheria toxin than those with a moderate and severe disease course. [ABSTRACT FROM AUTHOR]

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Aim: To present the case of a pediatric patient with superior mediastinal syndrome (SMS) in whom a preliminary diagnosis of T-cell non-Hodgkin lymphoma (T-NHL) was established by cytological analysis of pleural and pericardial effusion and due to the lifethreatening condition, chemotherapy was initiated with an excellent response. Case report: A 15-year-old girl was examined in the emergency pediatric department due to unspecified loss of consciousness. Five days before the admission, she was complaining of tinnitus, dizziness, night sweats, diffuse abdominal pain and vomiting, and dry cough on the day of the admission. Her clinical condition worsened rapidly with cyanosis and hypoxia, and she was admitted to the Intensive Care Unit. Imaging studies demonstrated a mediastinal mass, and large pericardial and pleural effusion. Along with intensive supportive measures, pericardiocentesis and pleural drainage were performed. Cytological examination of fluids established a preliminary diagnosis of T-NHL, and chemotherapy according to EURO-LB 02 protocol was started without histological confirmation, with excellent response. Five years after the end of the treatment, the patient is in complete remission. Conclusion: SMS is an emergency in pediatric oncology. The rapid development of typical SMS signs and symptoms in a child should arouse clinical suspicion of a mediastinal tumor. In life-threatening cases, along with intensive care treatment, it is necessary to start anticancer therapy based on a preliminary diagnosis without histological confirmation. Early identification and adequate treatment of SMS are crucial for a favorable outcome. [ABSTRACT FROM AUTHOR]

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Copyright of Sarajevo Social Science Review is the property of University of Sarajevo, Faculty of Political Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Fizikalna i Rehabilitacijska Medicina is the property of Croatian Society of Physical & Rehabilitation Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pedagogical Reality / Pedagoška Stvarnost is the property of University of Novi Sad, Faculty of Philosophy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To present a case of a small child swallowing a sharp metallic object (hair clip) and point out the approach to prevent complications from the ingested sharp metallic object in children. Ingestion of foreign bodies in the paediatric population is common, especially in children under the age of five. Young children examine objects by putting them in their mouths and other natural body openings, often resulting in injury. Foreign body ingestion in older children requires a multidisciplinary approach and consideration of other factors, including eating disorders, abuse, child neglect, and psychiatric illness. The clinical picture depends on the type, shape and size of foreign bodies, the trapped location after ingestion, the child's age and the association of comorbidity. Neck, chest and abdominal radiography is the gold standard for diagnosis. Case report: A 21-month-old girl swallowed a 41 mm long and 10 mm wide metallic hair clip during play. The hair clip opened up in the intestine, and the pointed upper end broke, creating three spikes. The girl remained asymptomatic throughout the entire time. The hair clip passed in the stool on the third day without complications. Conclusion: Most ingested foreign bodies pass spontaneously through the gastrointestinal tract without complications. Sharp metal objects, long objects, button batteries and two or more magnets may lead to severe complications. Timely diagnosis and treatment prevent possible complications. One of the most important prevention measures is to educate parents about this specifi c public health problem. [ABSTRACT FROM AUTHOR]

Early diagnosis of neurodevelopmental disorders is challenging. Developing neuroimaging diagnostic tools and the application of reliable clinical tests contibuted to the reduced prevalence of the most severe neurodevelopmental disorder, cerebral palsy. The results of magnetic resonance imaging of the brain, General Movement Assesment and Hammersmith Infant Neurologic Examination before the age of 4 months have the most predictive value for severe neurodevelopmental disorder and after the age of 4 months the most predictive value has magnetic resonance imaging of the brain and Hammersmith Infant Neurologic Examination. Infants at high risk for neruodevelopmental disorders need to be included in the early intervention and habilitation process. According to the available evidence, early habilitation is based on better acceptance and commitment of the family. Stimulation process is based on interventions that practice tasks and activities from everyday life using their own high-intensity active movements. The exercise itself directly affects the achievement, hence the plasticity of the brain. [ABSTRACT FROM AUTHOR]

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Obilježjima i značajkama slikovnica bave se brojni stručni i znanstveni radovi. Najvećim dijelom oni su upućeni pedagoškom kadru koji u institucionalnom kontekstu, vođen standardima poticajnog čitanja i kvalitetne slikovnice, posreduje djeci njima namijenjenu knjigu. Ipak, poput brojnih stavova, čitalačke navike dijete dominantno formira u domu svoje obitelji, pa je bitan i istraživački uvid u roditeljsku procjenu važnosti prve djetetove knjige. U radu se predstavljaju rezultati anketnog ispitivanja kojim se utvrđuje roditeljska procjena važnosti slikovnice. Inicijalno se pretpostavlja da su dob i stupanj obrazovanja povezani s roditeljskim pristupom knjizi. Predviđa se da oni više razine obrazovanja i starije životne dobi pozitivnije percipiraju slikovnicu. Provedenim istraživanjem te su pretpostavke odbačene.

Aim: to evaluate demographic characteristics, course of disease, treatment and outcome of disease of children treated due ro COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Patients and methods: retrospective medical chart review of children traeted during 2020 and 2021 in Department of Paediatrics of University Hospital Centre Split in Split, Croatia. Results: a total number of 59 children were treated due to COVID-19 in observed period of time, mostly infants and toddlers. Most of them had mild clinical presentation of disease, but five of them required intensive care treatment, and two children died. In most of the cases they were treated with symptomatic and supportive therapy, but 50.85% were treated with antibiotics and 23.73% with glucocorticoids. During observed period of time 26 children were treated due to MIS-C. Their age distribution was more even, but also most of the children were younger than 10 years of age. More than 90% of patients were treated with intravenous immunoglobulines, glucocorticoids anda acetylsalicylic acid, but also with antibiotics. 53.85% of children required intensive care treatment. Both in groups of children with COVID-19 and MIS-C most of the patients were male. Conclusion: COVID-19 patients most often were children with a mild clinical picture, while in the group of children treated for MIS-C the clinical picture and the course of the disease were more severe. Our experiences are similar to those described in the literature. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the characteristics of the family environment, including protective and risk factors of children who are involved in psychiatric treatment due to mental health difficulties. Participants and Methods: The study was conducted on a clinical sample of 112 participants, 56 children aged 12-19 years and 56 of their parents/guardians. In addition to the characteristics of parents/guardians, the risk and protective factors in the family and the risk factors related to the characteristics of the child and of the family were examined. The target variables were examined using the Family Resilience Questionnaire and the List for assessing risk factors affecting child development, which consists of an assessment of the family circumstances and characteristics of the parent as a factor in the developmental risk of the child and the assessment of the characteristics of the child and his behaviour. In addition, for each child included in the study, we gathered data from medical records on the children’s clinical diagnoses and the aetiology of specific disorders. The study was a part of the project “The specific characteristics of families at risk: contribution to complex interventions planning – FamResPlan”. Results: Families of children with mental health difficulties are characterized by the lack of environmental support, the presence of parents’ emotional difficulties due to family stress, and mental illness or untreated parental mental illness. On a sample of 56 children, 49 had internalising and 7 had mixed internalising and externalising problems. Conclusion: The characteristics of the families of children involved in psychiatric treatment suggest the need to provide appropriate and comprehensive support to parents in early childhood in order to prevent subsequent mental health disorders in children and youth. [ABSTRACT FROM AUTHOR]

Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and different underlining endotypes. According to different studies, there are several clinical phenotypes of severe asthma in children. Most children are allergic to multiple aeroallergen sensitization (house dust mites, pollen, molds) and have high levels of total and specific IgE, reversible airflow obstruc-tion and early signs of remodelation. A small subgroup of children has persistent airflow limitation (FEV1 <80% predicted). There are two major underlining functional or pathophysiologic mechanisms for different phenotypes of asthma and severe asthma accord-ing to the immune mechanism: Type 2 asthma (Th2-high asthma, eosinophils in serum and sputum, high IgE levels, high FeNO; key cytokines IL-4, IL-5, IL-13) and non-Type 2 asthma (Th2-low asthma, neutrophilic, paucigranulocytic and mixed granulocytic inflam-mation; key cytokines IL-8, IL-17, IL-22). The type 2 asthma endotype is more common in children, while biomarkers involved in the pathogenesis, such as IgE and IL-5 have become targets for biological therapy. The non-type 2 asthma endotype, less frequent in children with severe asthma, has fewer therapeutic options. The effect of azithromycin is still under investigation. Severe asthma, although uncommon, is a complex and high-risk phenotype of childhood asthma. Close monitoring of the patient and precise definition of underlying endotype during evaluation enables identification and use of personalized, endotype-targeted treatment. [ABSTRACT FROM AUTHOR]

Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and underlining endotypes. It is estimated that severe asthma affects 2-5% of all children with asthma. It occurs more frequently in children older than ten years of age, with a slight prevalence among the male sex. Although severe asthma is uncommon, this group of children has an increased risk of drug side effects and life-threatening exacerbations that impair quality of life. Also, the financial burden from medication, scheduled and unscheduled doctor visits, hospitalizations and absence from school and work by parents have to be considered. There is no uniform definition of severe asthma, but the common characteristic is the need for maximal maintenance therapy, including high-dose inhaled steroids, long-acting beta-agonists, and/or leukotriene receptor antagonists/theophylline. Despite the highest doses of maintenance therapy, patients with severe asthma fail to control the disease. Uncontrolled asthma has to be re-evaluated by confirming the diagnosis and modifying factors contribut-ing to symptoms and exacerbations like poor adherence, environmental risks (persistent allergen and pollutant exposure) and co-morbidities (upper airway disease, gastroesophageal reflux, obesity, anxiety). Children with poor asthma control due to misdiagnosed asthma, poor adherence or environmental risks have difficult-to-treat asthma, whereas children who still have poor control despite re-education to improve adherence and modification of environmen-tal risks have severe, therapy-resistant asthma. The approach to children with difficult-to-treat-asthma, which includes systematic evaluation and acting on modifying factors, enables achieving the long-term goals of asthma treatment in approximately two-thirds of patients. The remaining children, whose asthma is still uncontrolled despite optimized therapy, have severe, therapy-resistant asthma. Those children are candidates for bio-logical treatment based on the determination of phenotypic features. [ABSTRACT FROM AUTHOR]

Context: Assessment of visual function often poses a challenge for a paediatrician in primary practice. However, due to the simplic-ity of basic visual assessment methods, paediatricians have the means to evaluate a child's visual function. As a crucial part of every preventive physical examination of a child, the red reflex test is the most important tool for discovering obstruction of the visual axis as the cause of deprivational amblyopia. The visual axis can be obstructed due to various vision - or even life-threatening conditions. Aim: To present visual assessment methods available to the paediatrician in primary practice. Data source: PubMed, Google Scholar, Scopus, and available Internet screening guidelines. Conclusion: If obstruction of the visual axis is suspected, immediate referral to a paediatric ophthalmologist is mandatory. [ABSTRACT FROM AUTHOR]

Copyright of Magistra Iadertina is the property of University of Zadar, Department of Teacher & Preschool Teacher Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obnovljeni zivot is the property of University of Zagreb, Society of Jesus and Faculty of Philosophy & Religious Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducion. COVID-19 in children is a relatively mild disease. Though a more serious condition characterized by systemic inflammation does occur in children in a Kawasaki disease-like form named multisystem inl ammatory syndrome (MIS-C). MIS-C in children is a less common pathology. Case Report. A clinical case of multisystem inl ammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection in a previously healthy preschool-age girl is presented. The disease had an incomplete Kawasaki disease-like form corresponding to this syndrome in children and adolescents as dei ned by WHO and CDC criteria. Conclusion. This clinical case draws the attention of general practitioners and pediatricians to the peculiarities of this type of syndrome diagnosis and management. [ABSTRACT FROM AUTHOR]

Copyright of Collected Papers of the Faculty of Law in Split / Zbornik Radova Pravnog Fakulteta u Splitu is the property of Split Faculty of Law and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oral health is an important element in overall human health. Oral health care begins at an early age, therefore the first visit to dental office is very important for the positive child's attitude formation. The use of methods for controlling the behaviour of children in dental office achieves gradual habituation of the child to the overall environment of the office and its content, reduces the possibility for appearing of dental fear and anxiety, and shapes the child's behavior that is cooperative and willing to undergo dental interventions. Achieving good communication with the child and parents, using empathy and the right approach at work achieves success in the treatment of the youngest patients to mutual satisfaction. [ABSTRACT FROM AUTHOR]

Recently, the increasing occurrence of orthodontic anomalies raises the question of how often care is taken of children's visits to the dentist, prevention of caries, and the basics of oral hygiene. This paper will analyse the causes and consequences of deciduous tooth destruction and the possibility of preventing their loss. What are the changes that occur after the loss of a baby tooth? Does their loss affect further development of the jaw and quality of life of the child? Can their total destruction be prevented and what happens to the space after their loss? [ABSTRACT FROM AUTHOR]

Copyright of Legal Thought / Pravna Misao is the property of Legal Thought / Pravna Misao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Humani herpesvirus tip 6 (HHV-6) je virus proširen diljem svijeta koji najčešće izaziva infekcije praćene osipom, poznate kao šesta osipna bolest - exantema subitum, u kojih je liječenje simptomatsko. Kod 15% oboljele djece javljaju se febrilne konvulzije koje mogu prerasti i u konvulzivni ili epileptički status. Takvi pacijenti tretiraju se kao hitni i smještaju u jedinice intenzivnog liječenja. Najčešće se HHV-6 infekcije javljaju kod djece od 4 mjeseca pa do 3 godine starosti. Intervencije medicinskih sestara usmjerene su na zbrinjavanje djeteta u konvulzivnom napadu po načelu hitnog zbrinjavanja. [ABSTRACT FROM AUTHOR]

Intoksikacije predstavljaju veliki javno zdravstveni problem. Prema karakteru, intervenciji i zbrinjavanju ubrajaju se u hitna stanja. U dječjoj dobi, koju obilježava znatiželja i nedostatak znanja, ubrajaju se u najčešće nesretne slučajeve. Porast broja potencijalno toksičnih tvari koje nas okružuju rezultira porastom incidencije intoksikacija u dječjoj dobi. Prema bolničkom pobolu intoksikacije čine 2-5% bolnički liječene djece. Najčešći uzroci su lijekovi, alkohol te sredstva u domaćinstvu. U prevenciji intoksikacija važno je staviti naglasak na odgovornost roditelja koja je obrnuto proporcionalna incidenciji intoksikacija. Pristup akutno intoksiciranom djetetu temelji se na inicijalnom stabiliziranju i zbrinjavanju djeteta, te pravovremenom uzimanju anamnestičkih podataka. Zadaci medicinske sestre u timu usmjereni su izvršavanju intervencija u najboljem interesu djeteta, pazeći pritom na trenutno tjelesno i psihološko stanje djeteta i roditelja. [ABSTRACT FROM AUTHOR]

Otrovanje ugljik monoksidom (CO) je među vodećim uzrocima smrti kada je riječ o slučajnim trovanjima. Ugljik monoksid je plin bez boje, okusa i mirisa, zapaljiv je i eksplozivan. U kompeticiji je s kisikom za vezno mjesto na hemoglobinu, ali njegov afinitet za hemoglobin je oko 200 puta veći. Takav, blokirani hemoglobin - karboksihemoglobin (COHb), smanjuje zasićenost krvi sa O2, što uzrokuje tkivnu i staničnu hipoksiju. Time najviše biva pogođen miokard, a dekompenzacija srca dovodi do daljnje tkivne hipoksije i na taj način se zatvara začarani krug koji rezultira smrću, ako se osoba ne udalji od izvora ugljik monoksida i ako se adekvatno ne liječi. Liječenje podrazumijeva primjenu 100% 02 preko maske i hiperbaričnu oksigenoterapiju (HB0T), koja se temelji na primjeni čistog kisika pod povećanim tlakom. Otrovanje ugljik monoksidom je hitno stanje koje uzrokuje poremećaj životnih funkcija i kao takvo zahtjeva liječenje u jedinici intenzivnog liječenja. U ovom radu se prikazuje slučaj trovanja ugljik monoksidom u dvoje djece. [ABSTRACT FROM AUTHOR]

Pertusis ili hripavac je akutna zarazna bolest koju uzrokuje gram-negativni bacil Bordetella pertussis. Dijagnoza hripavca temelji se na karakterističnoj kliničkoj slici i laboratorijskim nalazima gdje se iz brisa nazofarinksa izolira uzročnik, a u krvi je značajna leukocitoza s limfocitozom. Inkubacija traje uglavnom 6 do 10 dana, a sama bolest traje barem 6 tjedana i podijeljena je u tri faze. Terapija je simptomatska i uzročna (antibiotik). Cijepljenje je ključna preventivna mjera u sprječavanju nastanka zaraznih bolesti, pa tako i pertusisa, a u Hrvatskoj je zakonski propisano i određeno s nekoliko zakona i pravilnika, među kojima su najvažniji Zakon o zdravstvenoj zaštiti i Pravilnik o načinu provedbe obvezne imunizacije, seroprofilakse i kemoprofilakse. U najtežim slučajevima hripavca može doći do teške upale pluća koja je povezana s hipoksijom, plućnom hipertenzijom i kardiogenim šokom, dok je hipertoksični pertusis povezan sa stupnjem limfocitoze i leukocitoze koje su pokazatelj prisutnosti toksina uzročnika u krvi. Tada je potrebno učiniti eksangvinotransfuziju ili leukoferezu. [ABSTRACT FROM AUTHOR]

Akutne respiratorne infekcije su česte bolesti s kojima se svakodnevno susrećemo u radu s djecom. Djeca godišnje u prosjeku prebole 6 do 9 akutnih infekcija dišnih organa. Uzročnici infekcija su virusi, mikoplazme i bakterije. Jedna od najčešćih respiratornih infekcija donjih dišnih puteva novorođenčadi, dojenčadi i male djece je infekcija respiratornim sincicijskim virusom (RSV) koji kod ostale populacije izaziva infekciju gornjih dišnih puteva bez većih i ozbiljnih tegoba. Posebno osjetljivu skupinu čine djeca rođena prije 33. tjedna trudnoće, te djeca rođena s prirođenim srčanim greškama. Jedna od karakteristika RSV je sezonsko pojavljivanje od kasne jeseni do početka proljeća. Većina djece oboljele od RSV, nakon preboljene virusne infekcije tijekom života pokazuju veću sklonost za razvoj bronhoopstrukcija. Simptomi RSV infekcije očituju se dispnejom, tahipnejom, cijanozom, padom saturacije O2 što zahtijeva oprez prilikom provođenja postupaka zdravstvene njege. Težina kliničke slike može jako varirati i brzo se mogu razviti izraženiji simptomi i pogoršanje općeg stanja pa je za kvalitetnu skrb za male pacijente potrebno imati u timu medicinske sestre koje su dobro educirane o specifičnostima skrbi kod djece s ovom dijagnozom. [ABSTRACT FROM AUTHOR]

The clinical use of lung ultrasound in respiratory departments, critical care units and emergency departments have increased substantially. Because children have thin thorax and pulmonary lesions tend to reach pleura it is a method of choice. It can be easily performed aside patient bed. Exam have to be systematic and detailed, starting from diaphragm and moving forward head. Normal pattern of lung ultrasound includes pleural line with dynamic signs (lung point, lung sliding, lung pulse) and static signs (A, B, Z, E lines). We have to use longitudinal and transversal scans. Alveolar consolidation, pleural effusion, acute interstitial syndrome, pulmonary abscess, pneumothorax and atelectasis have distinguish ultrasound pattern. Pleural effusion quantity and quality can hardly be seen with other diagnostic tools as it is chest X ray or lung CT. There are many lung ultrasound courses but it is recommended to perform minimum 200 examinations in total (100 on healthy lungs). Lung ultrasound is powerful tool in hands of experienced clinician, can easily be incorporated in algorithm of Community Acquired Pneumonia and help to reduce X-ray exposure. [ABSTRACT FROM AUTHOR]

Komunikacija je spontan i vrlo složen proces te ima mnoštvo definicija koje ju opisuju. Ljudska komunikacija može se pobliže odrediti kao proces stvaranja značenja između dvoje ili više ljudi. Kako bi komunikacija bila uspješna, značenje koje se prenosi trebalo bi ostati nepromijenjeno, odnosno doći do primatelja što sličnije onomu što je pošiljatelj imao na umu. Prema jednoj od definicija, komunikacija je određena sa tri glavna čimbenika, a to su sadržaj, forma i cilj. Znanje i umijeće kvalitetne komunikacije preduvjeti su kvalitetnog djelovanja za mnoge struke, a poglavito za medicinsku. Uspjeh liječenja neupitno je vezan za komunikaciju unutar zdravstvenog tima. Vrlo često prepoznajemo komunikaciju kao glavni uzrok poteškoća i problema u zdravstvu, a o istom problemu govore i mnoge provedene studije u posljednjih tridesetak godina. Cilj ovog rada bio je utvrditi koji su najčešći problemi u komunikaciji na dječjoj onkologiji s kojima se svakodnevno susrećemo, koliko nam je komunikacijsko znanje ili neznanje kamen spoticanja u dinamičnom procesu rada, te kako spoznati načine za poboljšanje komunikacijskih vještina. [ABSTRACT FROM AUTHOR]

Zloćudne bolesti značajan su javno zdravstveni problem. Zahvaljujući mogućnostima ranog otkrivanja zloćudnih bolesti preživljenje je, u odnosu na 70-e godine prošlog stoljeća, poraslo za 20% pa se zloćudne bolesti danas smatraju kroničnim bolestima. Hrana koju konzumiramo može smanjiti mogućnost za razvoj bolesti, a kod već oboljelih može znatno utjecati na kvalitetu života i tijek bolesti. Maligne bolesti koje se javljaju u dječjoj dobi predstavljaju medicinski i psihosocijalni problem za dijete, obitelj i zajednicu i drugi su uzrok smrtnosti iza nesreća u djece. Kod velikog broja onkoloških bolesnika nailazimo na značajan gubitak tjelesne mase, masnog tkiva te proteina, uz naglašenu upalnu aktivnost. Tijekom liječenja i oporavka iznimno je važna pravilna prehrana prilagođena stanju organizma, fazi liječenja te odgovoru na terapiju. Pravilna prehrana ne zahtijeva nužno drastične promjene, nego individualnu prilagodbu trenutnom stanju i potrebama djeteta. U uznapredovalom stadiju maligna bolest dovodi do smanjenja tjelesne težine, malnutricije, malresorpcije i kaheksije. Uzroci gubitka tjelesne težine mogu biti posljedica kemoterapije i radioterapije, zatim ubrzani metabolizam uslijed infekcija, kalorijska potrošnja tumora ili kirurški stres. Djetetove nutritivne potrebe mogu se nadoknaditi enteralnim ili parenteralnim putem, ovisno o stanju djeteta. [ABSTRACT FROM AUTHOR]

Sideropenična anemija (SA) je najčešća anemija u djece i predstavlja javnozdravstveni problem. Većina djece sa SA se uspješno liječi peroralnim preparatima željeza. Parenteralna terapija željezom je vrlo rijetko indicirana i to u slučajevima izostanka odgovora na peroralnu terapiju, radi neuzimanja ili nepodnošenja željeza ili loše intestinalne apsorpcije. Cilj rada je analizirati institucionalna iskustva u liječenju SA parenteralnim pripravcima željeza. Ispitivanje je obuhvatilo 61 pacijenta sa SA, liječenih parenteralnim željezom na Zavodu za hematologiju, onkologiju i kliničku genetiku Klinike za pedijatriju Kliničkog bolničkog centra Rijeka, u razdoblju od 1. siječnja 2014. do 31. prosinca 2018. godine. Prosječna dob ispitanika je iznosila 7,2 (± 6,7) godina, s najvećom učestalošću u djece do 3 godine starosti. Zastupljenost SA je podjednaka u oba spola. U male djece je najčešći uzrok SA nedovoljan unos željeza hranom, a u dobi adolescencije menoragija. 40 ispitanika (65,6%) je prije parenteralne terapije primalo peroralne pripravke željeza, od kojih su 34 ispitanika imala patološki test apsorpcije željeza. Prosječna vrijednost hemoglobina prije parenteralne terapije željezom je iznosila 80,3 (± 16,7) g/L, a prosječna vrijednost serumskog feritina 9,0 (± 2,1) μg/L. Najčešća je indikacija za parenteralnu primjenu željeza neadekvatan odgovor na peroralni preparat željeza, slijede nesuradljivost roditelja ili pacijenta i nepodnošenje peroralnog preparata željeza. Ukupno je primijenjeno 296 infuzija željeza: željezov hidroksi-saharat (82,1%), željezova karboksimaltoza (15,5%) i željezov glukonat (2,4%). Parenteralno željezo je vrlo učinkovito u liječenju SA u djece i adolescenata, sa srednjim porastom hemoglobina od 39,1 (±19,2) g/L dva mjeseca nakon provedene terapije. Neželjene reakcije su izuzetno rijetke i blage (1%). Zbog mogućih težih nuspojava potrebna je primjena parenteralnog željeza u bolničkim uvjetima. [ABSTRACT FROM AUTHOR]

Haemophilia is rare, inherited disorder with incidence of 2-5 new new-born boys per year in Croatia. Haemophilia is treated principally with intravenous factor VIII/IX concentrates. The education of parents and children is the basis of disease control. The nurses education process begins with the first hospitalization of a child due to newly discovered haemophilia. Education continues on a permanent basis, adapts to the age of the child and changes as the child grows up. In addition to training on daily care it is of great importance to improve the emotional adaptation of the whole family to the newly discovered disease. Parents are expected to have an active approach, day-to-day self-assessment and decision-making. The result of a quality approach of a nurse to a child and their family is a well-educated parent and child, strong motivation and excellent communication with the team. A nurse as a member of a health team and as an educator plays a significant role in treating the disease because the way the parents and the child deal with the disease depends on their education about the disease and therefore influences the quality of their life. The most important outcome of pediatric care is improving the health of the child. In order to provide the child with the best possible heath care, it is essential that parents are involved in the treatment process. With continued education and good disease control, children with haemophilia can grow as actively and carelessly as their peers. [ABSTRACT FROM AUTHOR]