Hrvoje Lalić

A case report of occupational middle ear tuberculosis in a nurse.

A Case Report of Occupational Middle Ear Tuberculosis in a Nurse This article presents a case of a 40-year-old female patient with a right-side middle ear tuberculosis. The patient was a nurse, who had worked at the Department of Pulmology, Clinical Hospital Rijeka for 17 years. The cause was infection with Mycobacterium tuberculosis while she assisted in bronchoscopy. The patient was referred to occupational medicine (OM) for confirmation of occupational disease immediately after surgery. The disease was confirmed as occupational by the Croatian Institute for Health Insurance of Health Protection at Work. During surgery a sample was taken for microbiological analysis. We did initial and control multislice computed tomography (MSCT) and control magnetic resonance imaging (MRI) of temporal bones 6 months after the surgery. The initial MSCT showed total mastoid cell shadowing without destruction, while the control image showed almost full recovery save for a few remaining shadowed cells. Adequately taken occupational history by an OM specialist can significantly shorten the time to diagnosis of a rare occupational illness that is often manifested by non-specific symptoms. Profesionalna tuberkuloza srednjeg uha u medicinske sestre: prikaz slučaja Tuberkuloza srednjeg uha kao primarna bolest je rijetka. U ovom radu prikazana je 40-godišnja pacijentica, medicinska sestra, koja je radila 17 godina na Odjelu za pulmologiju Kliničkoga bolničkog centra u Rijeci, u Hrvatskoj, i oboljela je od desnostrane tuberkulozne upale srednjeg uha. Razlog je bio kontakt s Mycobacterium tuberculosis za vrijeme asistiranja kod bronhoskopije. Cilj je rada upozoravanje na važnost medicine rada koja je odmah nakon primitka pacijentice započela proces priznavanja profesionalne bolesti. Nakon dobivanja suglasnosti Hrvatskog zavoda za zdravstveno osiguranje zaštite zdravlja na radu pacijentica je dobila status profesionalno oboljele osobe i sva prava koja joj iz toga proizlaze. Za vrijeme operacije srednjeg uha uzet je obrisak na mikrobiološku analizu. Učinjena je inicijalna i kontrolna višeslojna kompjutorizirana tomografija (MSCT) te magnetska rezonancija (MR) temporalnih kostiju nakon 6 mjeseci liječenja. Mikrobiološka analiza bila je pozitivna na M. tuberculosis. Inicijalni MSCT pokazao je potpuno zasjenjenje celula mastoida bez destrukcije, a kontrolna snimka gotovo potpunu sanaciju sa zasjenjenjem tek pokoje celule, dok MR pokazuje porast signala kod malobrojnih celula. Dobro uzeta radna anamneza od strane medicine rada može znatno skratiti vrijeme dijagnosticiranja rijetkih profesionalnih bolesti, koje često imaju nespecifične simptome. Nadalje, pokretanje postupka te priznavanje profesionalne bolesti značajno je za adekvatni status i liječenje osoba oboljelih na radu.

Discrepancies in the evaluation of incapacity for work in a patient with epidermolysis bullosa acquisita between public pension fund and occupational medicine expert raise the issue of competencies

Abstrat A 50-year-old female patient suffering from a severe form of epidermolysis bullosa acquisita (EBA) took legal action against the Croatian Pension Insurance Institute (CPII) in an attempt to overturn their assessment that she was no longer capable of working as a seamstress but still capable of doing administrative jobs. Her claim was that she was not capable of doing any job at all. She was first diagnosed EBA in 2000, and the disease progressed slowly with intermittent remissions. In 2012, skin erosions appeared on her feet, followed by the loss of all toenails and lesions and infiltrations on the tongue and oral mucosa. Her whole body was covered in oozing wounds, she was in pain, and parts of her skin would stick to fabric while changing clothes or bandages. The most recent findings showed oesophageal stricture. She can consume only liquid food and is on the waiting list for receiving a feeding tube. The occupational health expert witness confirmed that the patient was generally incapable of work and was fighting her life. The judge and CPII lawyers fully accepted this report and the earlier assessment was overturned. To avoid incompetent assessments of working (in)capacity in the future, CPII and similar institutions should engage occupational medicine specialists to work in their assessment teams.

Jesu li psiholozi i psihijatri koji ocjenjuju radnu sposobnost dio problema ili rješenja problema

Abstract Three sets of flavonoid derivatives (N=32, 40, and 74) and logarithms of their dissociation constants (log Kd) that describe flavonoid affinity toward P-glycoprotein were modelled using six connectivity indices. The best results were obtained with the zero-order valence molecular connectivity index (0χv) for all three sets. Standard errors of the calibration models were around 0.3, and of the constants from the test sets even a little lower, 0.22 and 0.24. Despite using only one descriptor, our model proved better in internal (cross-validation) and especially in external (test set) statistics than much more demanding methods used in previous 3D QSAR modelling.

Are psychologists and psychiatrists assessing work capacity part of the problem or solution

Abstract The aim of this case study was to emphasise the importance of coordination between the members of occupational medicine teams who assess work capacity in persons whose jobs may involve responsibility for other people’s safety and health. We have picked out four cases - three visiting nurses and one applicant for driving and firearms licence extension - where psychiatrists/psychologists and occupational health specialist disagreed in their assessment entirely. These cases illustrate how psychologists and psychiatrists tend to support patients’ wishes to either remain at their workplace or take disability retirement, whereas occupational health specialists take a different, less easy course, relying on the medical condition of the patient, specific job requirements, and broader implications for public safety. It appears that this is not a problem only in Croatia, but in a number of developed countries as well. This problem calls for additional training of all members of a work capacity assessment team.