Retropharyngeal abscess is acute suppurative infection of the retropharyngeal space. Most commonly it occurs in children younger than four years of age having history of streptoccocal pharyngitis. Clinical presentation similar to epiglottitis or foreign body aspiration makes distinguishing issues so the diagnosis of retropharyngeal abscess can initially be missled. Here we are illustrating four month old female infant with incipient presentation that clinically resembles epiglottitis. After the initial management in the intensive care unit clinical work-up was continued with multidysciplinary collaboration and the diagnosis of retropharyngeal abscess was given, treated both surgically and conservatively. Postoperative intensive care was then continued with subsequent clinical and biochemical improvement. This case demonstrates the need for broad thinking when dealing with affebrile child being respiratory distressed and during diagnostic work-up of a patient having fever of unknown origin.

Aim To investigate the prevalence of burnout syndrome among physicians of all specialties, including residents and non-specialists, on a national level in Croatia. Methods This cross-sectional study, conducted in October 2017, used anonymous online survey based on the Maslach Burnout Inventory Human Services Survey. The Croatian version of the inventory was assessed for acceptability, factorial validity, and reliability. Key dimensions of burnout – emotional exhaustion, depersonalization, and lack of personal accomplishment were assessed. Respondents scoring high for emotional exhaustion or depersonalization were defined as burned-out. Results The response rate was 18% (2557/14 427). Respondents’ median age was 41 years (range 25-80), and 68% (1737/2557) were women. Good sampling adequacy and scale reliability were confirmed. Factorial validity suggested the presence of three overall factors, and no items were eliminated. Sixty-three percent of physicians were burned-out. High score on emotional exhaustion, depersonalization, and reduced personal accomplishment were found in 58%, 29%, and 52% of respondents, respectively. As many as 16% of the respondents simultaneously experienced high levels of all three burnout dimensions. Multivariate logistic regression analysis revealed that residents and physicians in tertiary or primary care were at an increased risk of burnout, while physicians working in institutes were at a decreased risk. Conclusion Active national measures are needed to reduce the high prevalence of burnout among Croatian physicians.

Background Accelerated idioventricular rhythm (AIVR) is a wide QRS complex dysrhythmia that, as far as pediatric population is concerned, occurs mostly in children with underlying systemic or heart disease. Its clinical course is thought to be typically benign in otherwise healthy children and treatment to be completely needless. Existing guidelines/recommendations are based entirely on cases that had low daily burden of AIVR, and those referring to treatment itself are very unspecific. Pharmacologic therapy has been mostly unsuccessful and catheter ablation as a way of treatment has been only sporadically reported. This article is a case report with a literature review that aims to practically separate the age groups into newborn and older children and to emphasize the different clinical outcomes of children with occasional and frequent AIVR. There are only a few cases so far describing undesirable outcomes of this condition, and most of these patients had high daily burden of AIVR. To be more specific, among 38 healthy children older than 1 year reported in total, 6 had undesirable outcomes, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy/heart failure. Case presentation An 11-year-old boy had been referred to our center for a workup of incidentally discovered wide-complex arrhythmia. He was asymptomatic, with no underlying cardiac or systemic diseases. Continuous heart rate monitoring detected AIVR during most time of monitoring. In 24-h Holter-ECG, wide QRS complexes accounted for 73%. With parental consent, we conducted an electrophysiological study accompanied by radiofrequent ablation of ectopic focus, which lead to an instantaneous sinus rhythm that continued during the entire follow-up. Conclusion AIVR is a rare dysrhythmia in the pediatric population, typically considered benign. Nevertheless, more than a few cases evidence its harmful potential, short-term in terms of developing malignant arrhythmia or long-term in terms of developing cardiomyopathy. Gathering more knowledge and experience along with conducting further studies is essential for the enhancement of understanding this condition, and selecting potentially vulnerable patients as well as their treatment.

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sample values. The patient had reccurent problems with social functioning, which manifested as intermittent palpitations, precordial sensations, and a prolonged episode of large amplitude incontrollable tremor for which he was hospitalized once again after the second episode of pancreatitis. Conclusion The presented cases show the possible extent of extrapulmonary illness caused by Mycoplasma pneumoniae in children. Judging by these cases, autoimmune mechanisms and also genetic factors seem to play an important role in the infection of a specific organ by M. pneumoniae.