Bronchoscopic treatment of pediatric atelectasis: A modified segmental insufflation-surfactant instillation technique.

BACKGROUND: Atelectasis is a condition characterized by the collapse and nonaeration of lung regions and is considered a manifestation of an underlying disease process. The goal of atelectasis treatment is the restoration of volume loss. In the range of different treatment options, chest physiotherapy is often used as a first-line approach, and some cases require bronchoscopic interventions. METHODS: In this case series, we describe a modified bronchoscopic treatment procedure using pressure-controlled bronchoscopic segmental insufflation with surfactant application. RESULTS: The proposed approach resulted in significant improvement of lung volume across a range of patients including massive lobar, atypical rounded atelectasis in previously healthy patients, and in a particularly challenging case involving an infant suffering from spinal muscular atrophy type I. CONCLUSION: The modified segmental insufflation-surfactant instillation technique offers a safe and promising easily implementable treatment of persistent atelectasis caused by different underlying disease processes with positive long-term outcomes.

Geospatial clustering of childhood IgA vasculitis and IgA vasculitis-associated nephritis.

OBJECTIVES: Research on spatial variability of the incidence of IgA vasculitis (IgAV) in children and its potential implications for elucidation of the multifactorial aetiology and pathogenesis is limited. We intended to observe spatial variability of the incidence of IgAV and IgA vasculitis-associated nephritis (IgAVN) using modern geostatistical methods, and hypothesised that their spatial distribution may be spatially clustered. METHODS: Patients' data were retrospectively collected from 2009 to 2019 in five Croatian University Hospital Centres for paediatric rheumatology, and census data were used to calculate the incidence of IgAV. Using spatial empirical Bayesian smoothing, local Morans' I and local indicator of spatial autocorrelation (LISA), we performed spatial statistical analysis. RESULTS: 596 children diagnosed with IgAV were included in this study, of which 313 (52.52%) were male. The average annual incidence proportion was estimated to be 6.79 per 100 000 children, and the prevalence of IgAVN was 19.6%. Existence of spatial autocorrelation was observed in both IgAV and IgAVN; however, clustering distribution differed. While IgAV showed clustering in Mediterranean and west continental part around cities, IgAVN was clustered in the northern Mediterranean and eastern continental part, where a linear cluster following the Drava and Danube river was observed. CONCLUSION: IgAV incidence in Croatia is similar to other European countries. Spatial statistical analysis showed a non-random distribution of IgAV and IgAVN. Although aetiological associations cannot be inferred, spatial analytical techniques may help in investigating and generating new hypotheses in non-communicable diseases considering possible environmental risk factors and identification of potential genetic or epigenetic diversity.

Multi-lag tone-entropy in neonatal stress.

Heart rate variability (HRV) has been analysed using linear and nonlinear methods. In the framework of a controlled neonatal stress model, we applied tone-entropy (T-E) analysis at multiple lags to understand the influence of external stressors on healthy term neonates. Forty term neonates were included in the study. HRV was analysed using multi-lag T-E at two resting and two stress phases (heel stimulation and a heel stick blood drawing phase). Higher mean entropy values and lower mean tone values when stressed showed a reduction in randomness with increased sympathetic and reduced parasympathetic activity. A ROC analysis was used to estimate the diagnostic performances of tone and entropy and combining both features. Comparing the resting and simulation phase separately, the performance of tone outperformed entropy, but combining the two in a quadratic linear regression model, neonates in resting as compared to stress phases could be distinguished with high accuracy. This raises the possibility that when applied across short time segments, multi-lag T-E becomes an additional tool for more objective assessment of neonatal stress.

Asymmetric detrended fluctuation analysis in neonatal stress.

OBJECTIVE: To detect stress in newborns by observing heart rate (HR) variability utilizing an asymmetric detrended fluctuation analysis (ADFA), we sought to determine the fractal structure of the series of inter-beat intervals, so as to distinguish the periods of acceleration of the HR from decelerations. Thus, two scaling exponents, α + and α -, representing decelerations and accelerations respectively, are obtained. APPROACH: Forty healthy term newborns were included in this study, undergoing two different types of stress stimuli: routine heel lance blood sampling for metabolic screening purposes, and its simulation by applying dull pressure on the heel. MAIN RESULTS: It appears that when newborns face stress, the scaling exponent related to accelerations significantly increases and becomes higher than the deceleration scaling exponent. To test the diagnostic properties of the scaling exponents, an ROC curve analysis was applied; α - showed good diagnostic performance with an AUC between 0.626 and 0.826, depending on the length of the time series. The joint use of α + and α - further increased the diagnostic performance, in particular for shorter series of RR intervals, with an AUC between 0.691 and 0.833. SIGNIFICANCE: ADFA, particularly of the acceleration scaling exponent, may be a useful clinical diagnostic tool for monitoring neonatal stress.

Malignant neoplasms of male genital organs (C60-C63) in the Osijek-Baranja County, Croatia.

Cancers of male genital organs (C60-C63) and in particular, prostate cancer, represent one of the most frequent cancer groups among males in economically developed countries and growing cancer group in developing countries. The Institute of Public Health of the Osijek-Baranja County in collaborate with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The aim of this article is to provide information on the tendencies relating to this cancer group in the OBC during the period from 2001 to 2009, which will be the first report on these cancer sites on a county level in Croatia. This article processes data on cancer incidence and mortality, appertaining age distribution, median age at diagnosis and at death, cancer survival and length of stay in hospital in the OBC. From 2001 to 2009, a total of 891 males were diagnosed with cancers of male genital organs and treated in either of the two OBC hospitals. These cancers accounted for 6.2% of all registered cancers and for 12.5% of all registered cancers among males. Overall age-standardized incidence rate was 60.9/100,000 and it growing strongly during the nine-year period. Although the mortality rate increased too (overall rate was 30.5/100,000), the increase was not as huge as the one in the rate of incidence. Overall median ages at diagnosis and at death were 67.1 years and 74.6 years, respectively. The 5-year relative survival rate was estimated to be 53.4%. This report reveals weak reduction in the average length of stay in hospital per patient in the 9-years period (from 11.8 to 11.3 days) and at the same time, the number of admissions almost tripled (from 84 to 221), which is a consequence of the same rise in the number of newly registered cases. During the course of the illness, an average patient was hospitalized 1.6 times and the average length of hospital care was 11.0 days. All the indicators of the quality of the health care provided to C60-C63 cancer patients in the OBC suggest that further advancement in raising the level of diagnostics and treatment should and can be expected in order to reach the corresponding EU standards. An increased incidence and mortality rate from C60-C63 cancers leads to the conclusion that great efforts should be invested into raising the awareness of the male population over 45 years of age on the recognition of the first symptoms of this cancer group and on early preventive examination as to decrease the mortality rate and increase the survival rate and the quality of life of patients suffering from this cancer group.

Malignant neoplasms of breast and female genital organs (C50, C51-C58) in the Osijek-Baranja County, Croatia.

Breast cancer (C50) and neoplasms of female genital organs (C51-C58) represent one of the most frequent cancer groups among females in economically developed countries. The Institute of Public Health of the Osijek-Baranja County in collaboration with different county institutes provide updated information on the cancer occurrence and trends in the Osijek-Baranja County (OBC). The aim of this article is to provide information on the tendencies relating to these cancer groups in the OBC during the period from 2001 to 2009, which will be the first report on these cancer sites on a county level in Croatia. This article processes data on cancer incidence and mortality, appertaining age distribution, median age, cancer survival and length of stay in the county hospitals collected in period 1996-2010. In the OBC, the overall incidence rates of breast, cervix uteri, corpus uteri and ovary cancer were, using the EU standard population, 82.9, 13.0, 19.0 and 14.5/100,000, respectively, and are all characterized by a declining tendency in the second period except breast can- cer. The overall breast incidence rate resembles the Croatian average and way exceeds the corresponding Central and Eastern Europe incidence rates, but is still bellow the Northern Europe ones. Also, the overall mortality rates of breast, cervix uteri, corpus uteri and ovary cancer were 29.6, 5.0, 8.1 and 9.6/100,000, respectively, and are all featured by a increasing tendency. The cancer 5-year relative survival rate from breast, cervix uteri, corpus uteri and ovary cancer in period 2001-2005 amounted to 64.2%, 66.1%, 57.4% and 43.0%, respectively. The overall median ages at diagnosis of breast, cervix uteri, corpus uteri and ovary cancer totalled 61.9, 56.4, 66.4 and 60.8 years, respectively, while the median ages at death from these cancers were 68.7, 65.7, 70.3 and 67.6 years, respectively. During the entire 9-year period, the average length of stay in hospital due to breast, cervix uteri, corpus uteri and ovary cancer were 12.1, 14.8, 18.5 and 11.3 days, respectively. The length of stay in hospital decreased for all but for ovary cancer. Implementation and consolidation of women's awareness of these cancers and relating early diagnostic activities within the OBC population seem to be the most effective ways to reduce the appertaining risks and thus to encourage changes in the lifestyle.