Examining the impact and implementation of the ENabling VISions And Growing Expectations (ENVISAGE) program in Croatia: a discourse analysis pilot study.

Purpose: To explore the impact of the online ENVISAGE program for parents of children with neurodevelopmental disabilities (NDD) on parents' perception of , their , and their , as well as to explore experiences of participating in the program in Croatia.

Methods: In this before-after discourse analysis study, participants took part in the five-week ENVISAGE program. There were two semi-structured interviews for each participant: within one month before and after participating in the program.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery.

[Exercise program for chronic low back pain based on common clinical characteristics of patients].

Aims: 1. To determine which clinical characteristics are common in patients with chronic low back pain (CLBP) and 2. To present an exercise program for CLBP composed on the basis of the common clinical characteristics of patients.

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans.

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction and psychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent-child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent-child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N = 122) and non-PTSD veteran adolescent offspring (N = 122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area.

[Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine].

Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis.

[Piriformis muscle syndrome: etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].

The term 'piriformis syndrome' (PS), introduced by Robinson in 1947, implies a group of signs and symptoms caused by piriformis muscle (PM) disorders. Since PM disorders lead to irritation/compression of the anatomic structures passing under its belly, the main clinical PS signs and symptoms are actually the clinical signs and symptoms of irritation/ compression of neural and vascular structures passing through the infrapiriform foramen: sciatic nerve/SN, inferior gluteal nerve, posterior femoral cutaneous nerve, pudendal nerve, inferior gluteal artery and vein and inferior pudendal artery and vein. The clinical picture is usually dominated by signs and symptoms of irritation/compression of SN (SN irritation --> low back and buttock pain, sciatica,paresthesias in distribution of SN; SN compression --> low back and buttock pain,sciatica, paresthesias and neurologic deficit in distribution of SN).

Adherence to pharmacological treatment of chronic nonmalignant pain in individuals aged 65 and older.

Background: Medication nonadherence is a frequent problem in the treatment of chronic conditions.

Objective: To study the adherence to pharmacological treatment of chronic nonmalignant pain, as well as factors and patient attitudes related to nonadherence in patients aged ≥65 years.

Methods: The cross-sectional study was conducted with a self-administered questionnaire among 100 patients aged ≥65 years by five family physicians at the Health Care Centre Mostar, Bosnia and Herzegovina.

[Coccygodynia: etiology, pathogenesis, clinical characteristics, diagnosis and therapy].

The term 'coccygodynia' means the pain in the tailbone area (os coccygis; coccyx). Due to the sitting intolerance, coccygodynia can significantly disturb the quality of life. Coccygeal disorders that could be manifested in coccygodynia are injuries (fracture, subluxation, luxation), abnormal mobility (hypermobility, anterior and posterior subluxation or luxation of the coccyx), disc degeneration at sacrococcygeal (SC) and intercoccygeal (IC) segments, coccygeal spicule (bony excrescence), osteomyelitis and tumors.

[Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints].

Disorders of lumbosacral (LS) facet joints are manifested by low back pain with or without referred leg pain and decreased mobility of the LS spine (LS facet syndrome). The most frequent causes of LS facet syndrome are functional disorders (functional blockade or dysfunction of facet joint=reversible restriction of facet joint movements caused by meniscoid entrapment) and degenerative changes of facet joints while the others are less frequent (spondyloarthropathies, infection, tuberculosis, synovial cyst, injury). Although it has been proven that the facet joints are one of the most frequent sources of chronic low back pain (15-45%), the fact is that the facet syndrome has been frequently overlooked in patients with chronic low back pain.

[Vertebrobasilar insufficiency and obstructive sleep apnea].

The aim of this article is to point to correlation between vertebrobasilar insufficiency (VBI) and obstructive sleep apnea (OSA) that has not been perceived sufficiently till now. Namely, in the voluminous literature about sleep-disordered breathing, VBI has been cited only as one of the possible causes of central and mixed sleep apnea. However, according to our clinical observation, VBI could be one of the most important factors in etiopathogenesis of OSA.

[Congenital hypoplasia of the lower portion of the left psoas muscle].

We are presenting a case of a 58-year-old-male patient with a congenital hypoplasia of the lower portion of his left psoas muscle. This rare anomaly, which should be differentiated from other pathological conditions (destructive processes, tumors, metastases, inactivate atrophy), was discovered during the MRI examination of his lumbosacral (LS) spine which the patient underwent due to deterioration of chronic low back pain. His right psoas muscle was hypertrophic.

Clinical experiences in treating PTSD patients by combining individual and group psychotherapy.

PTSD is a complex psychobiological disorder that causes disfunctionality in many areas. In treating PTSD different models have been applied, however, no general consensus on the method of treatment has yet been achieved. At the Clinic for Psychological Medicine we have developed the model of combined treatment for PTSD patients that involves outpatient individual psychotherapy, psychopharmacotherapy and group psychotherapeutic techniques introduced within repeated day-hospital treatments.

Retinal function in patients with serpiginous choroiditis: a microperimetry study.

Purpose: To investigate fixation pattern and retinal sensitivity in patients with serpiginous choroiditis (SC).

Methods: Twenty-eight eyes (14 patients) with SC were evaluated. Best-corrected visual acuity, color fundus photography, fundus autofluorescence, and fluorescein and indocyanine green angiography were performed.

[Influence of manual therapy of cervical spine on typical trigeminal neuralgia: a case report].

This article presents the case of a 43-year-old female patient with pain in the cervical spine area and a typical trigeminal neuralgia (TN; French name "tic douloureux") in the receptive field of the second and the third branches of the left trigeminal nerve. The patient came to our medical practice for a manual therapy of the cervical spine as the application of the standard therapy had not given her any pain reduction in the cervical spine area. As the result of the manual therapy of the cervical spine (nonspecific traction mobilization, specific or segmental mobilization, manipulation), not only a significant pain reduction in the cervical spine area occurred but also a complete cessation of TN.

[Dysmenorrhea induced by lumbosacral spine disorders. Pathogenesis, diagnosis and therapy with special emphasis on spinal manipulative therapy].

Dysmenorrhea (painful menstruation), which can be primary or secondary, is a common gynecological problem. Primary dysmenorrhea (normal gynecological finding) is caused by increased production of uterine prostaglandins. Namely, under the influence of hormonal changes and vegetative factors at the end of a menstrual cycle, in numerous girls and women with a normal gynecological finding, vasoconstriction in small uterine arteries and endometrial ischemia occur, resulting in excessive prostaglandins synthesis in endometrial cells.

[Iliopsoas muscle syndrome. Functional disorders: shortening, spasm and weakness of a structurally unchanged muscle].

Functional (non-organic) disorders of the iliopsoas muscle (IPM), i.e. the shortening, spasm and weakness of the structurally unchanged IPM, can be manifested as abdominal and/or pelvic pain, pain in areas of the thoracolumbar (ThL) and lumbosacral (LS) spine, sacroiliac (SI) joint, hip, groin and anterior thigh on the side of the affected muscle as well as gait disturbances (iliopsoas muscle syndrome).

[Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment c6-c7: a case report].

This article presents the case of a 41-year-old female physician complaining about frequent chest pain attacks and breathing difficulties. Disorders started six months previously after inexpert manipulation of the thoracic spine performed by a physiotherapist while massaging the patient's back. Numerous diagnostic examinations (CT of the thorax, MRI of the thoracic spine, esophagography, cardiological examination, pulmological examination) did not explain the cause of subjective symptoms.

[Cervicogenic headache: etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy].

The term "cervicogenic headache" (CH) implies a chronic hemicranial pain syndrome caused by upper cervical spine disorders. According to the clinical researches, in 15-20% of the patients with chronic unilateral headache, it is the case of the headache of cervical origin. The sources of the referred pain manifested as CH are the disorders of anatomical structures innervated by the first three cervical spinal nerves and/or direct irritation/lesion of these nerves (spinal nerves C1-C3, intervertebral/i.

[Severe chronic illness and liaison psychiatry].

The paper reviews three cases treated for somatic diseases on the clinical wards for dialysis, haematology and gynaecology. Patients suffereing from somatic diseases often have psychological disturbances, too. As a connection between somatic and psychological, a relatively new branch of psychiatry developed - liaison psychiatry.

[Vertebrogenic chest pain--"pseudoangina pectoris": etiopathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].

Vertebrogenic pain localised in the anterior thorax can imitate anginal pain ("pseudoangina pectoris"). The most common causes of vertebrogenic chest pain are segmental dysfunction and degenerative changes at the level of the lower cervical and upper middle thoracic spine. Segmental dysfunction is a source of pseudoradicular pain, and degenerative changes, before all disc hernia and dorsal osteophytes which are compressing corresponding nerve roots, are the sources of radicular pain which irradiates in the chest.

[Cervicogenic proprioceptive vertigo: etiopathogenesis, clinical manifestations, diagnosis and therapy with special emphasis on manual therapy].

Cervical proprioceptive system (CPS) consisting of mechanoreceptors of cervical intervertebral joints, mechanoreceptors of neck muscles and ligament's insertions, muscle spindles located in deep short muscles of cervical spine and sensitive fibers connecting neck's proprioceptors with neurons of cornu posteriori of spinal cord, plays an essential part in maintaining bodily balance. CPS, via tractus spinovestibularis, is connected to vestibular nuclei. Clinical and neurophysiological studies have shown that functional disorders and/or organic lesions of CPS cause identical symptoms as vestibular diseases: vertigo, nystagmus and balance disorders.

[Lumbar disc herniation. Reposition effect of rotational manipulation: a case report].

In a 38-year old patient affected by acute radicular syndrome magnetic resonance imaging (MRI), diagnosed a large dorso-medial herniation at L4/L5 segment. Upon application of the usual conservative therapy, during 3.5 months of conservative treatment, no clinical improvement was achieved.

[The sacroiliac joint dysfunction: clinical manifestations, diagnostics and manual therapy].

Sacroiliac joint dysfunction is one of the proved causes of sacroiliac joint syndrome. We are talking about the restricted mobility of sacrum opposite to ilium the type of "reversible blockage of movement". Main characteristics of dysfunction are as follows: restricted "joint play", referred pain, normal radiological finding, normal lab results and disappearance of clinical symptoms after deblocking of articular bodies.

[Blue color vision as a sign of digitalis poisoning].

The paper deals with the course of the illness in a 66 years old male, who had taken an amount of 0.2 mg of medigoxin for an unknown period of time, because of chronic heart failure due to atherosclerotic heart disease and chronic atrial fibrillation. He have had a cholelithiasis also and reduced renal reserve.