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Depression and Suicidality During Pregnancy
No full textBackground: Pregnant women experience a set of biological and psychological disturbances. The aim of this study was to assess the appearance of depressive symptoms and suicidal thoughts in pregnant women during the third trimester of pregnancy.
Subjects and methods: A total of 110 pregnant women were included in the study. All of them filled out an anonymous questionnaire about sociodemographic data, Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).
Results: Study participants were between 18-46 years of age. 45.45% of the pregnant women were between 37 and 39 weeks pregnant. According to the EPDS, the risk for perinatal depression was observed in 29 (23.36%) pregnant women: 15 (13.64%) of them had a total score on EPDS from 10-12, and 14 (12.72%) had a total score of 13-20. A higher score on both Beck scales was characteristic for pregnant women with a higher risk for the development of perinatal depression based on the results on EPDS. The prevalence of suicidal thoughts was 2.73%.
Conclusions: Perinatal depression is a state which should be given more attention. The recognition of perinatal depression during pregnancy allows health medical workers to observe pregnant women at risk and then to make preventive and clinical interventions. The risk for perinatal depression is higher in pregnant women with more expressed depressive and anxiety symptoms. Pregnant women with suicidal thoughts are more anxious and depressed
Association of Wnt Inhibitors, Bone Mineral Density and Lifestyle Parameters in Women with Breast Cancer Treated with Anastrozole Therapy
No full textAIM: To determine the levels of Wnt inhibitors in patients treated with aromatase inhibitors (AIs) prior to therapy and to investigate their association with bone mineral density (BMD) and lifestyle parameters.
METHODS: 137 breast cancer patients were divided into a group treated with 1 mg of anastrozole and a group w/o anastrozole therapy. Serum concentrations of sclerostin and dickkopf1 (DKK1) were measured by ELISA. BMD was measured by dual-energy X-ray absorptiometry (DXA). Lifestyle factors were investigated by a self-reported questionnaire.
RESULTS: Sclerostin was significantly higher in the AI-treated group (31.8 pmol/L vs. 24.1 pmol/L; p < 0.001), whereas DKK1 was significantly lower in the AI-treated group (24.3 pmol/L vs. 26.02 pmol/L; p < 0.001). Total hip and femoral neck BMD were significantly lower in the AI-treated group.
CONCLUSION: AI treatment was associated with increased levels of sclerostin and decreased levels of DKK1
Partial Resection of the Urinary Bladder in Swine and Sheep and Replacement of the Resected Segment by Biologically Inert Patches
No full textThis study was performed to examine the adequacy of biological inert patches as a substitute material for the construction of urinary bladder replacement tissue. An animal model experiment was conducted in six sheep and six swine. In all animals partial resection of the urinary bladder was performed; round or oval-shaped, 5–6 cm in diameter. Patches of the same shape, 4–5 cm in diameter were used. Two types of patches, polytetrafluorethylene and small intestinal submucosa were tested in the experiment, sewn with an absorbable 4-0 polydioxanone suture. Following 16 weeks the animals were euthanized followed by autopsy and histologic analysis. All animals showed evidence of bladder regeneration at the replaced segment. The patches were found to be contracted to 12–20 mm in length and 8–10 mm in width, attached to the bladder mucosa with their smaller base and protruding into the bladder lumen. In some animals, no shrunk patches were found, suggesting they had been passed out by urine. Histologically, fibrous tissue completely replacing the substitute tissue was identified with endothelial-lined luminal surface and submucosal and serosal ingrowth of new blood vessels. The replacement tissue showed no evidence of muscle layer ingrowth. Bladder capacity was also measured and no significant decrease was recorded. Our experiment demonstrated the formation of replacement tissue at the site of graft implantation, which allows the resection of a larger portion of bladder without decreasing its capacity and thus constitutes a very good method for surgical treatment of urinary bladder tumours and other defects
What is Safe Enough - Asthma in Pregnancy - a Review of Current Literature and Recommendations
No full textBACKGROUND: Although asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.
MAIN BODY: The main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.
CONCLUSION: There is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy
Acute Exhaustive Rowing Exercise Reduces skin Microvascular Dilator Function in Young Adult Rowing Athletes
No full textPURPOSE: The effect of acute exhaustive exercise session on skin microvascular reactivity was assessed in professional rowers and sedentary subjects. A potential involvement of altered hemodynamic parameters and/or oxidative stress level in the regulation of skin microvascular blood flow by acute exercise were determined.
METHODS: Anthropometric, biochemical, and hemodynamic parameters were measured in 18 young healthy sedentary men and 20 professional rowers who underwent a single acute exercise session. Post-occlusive reactive hyperemia (PORH), endothelium-dependent acetylcholine (ACh), and endothelium-independent sodium nitroprusside (SNP) microvascular responses were assessed by laser Doppler flowmetry in skin microcirculation before and after acute exercise. Serum lipid peroxidation products and plasma antioxidant capacity were measured using spectrophotometry.
RESULTS: At baseline, rowers had significantly lower diastolic blood pressure (DBP) and heart rate (HR), and higher stroke volume (SV), PORH, and endothelium-dependent vasodilation than sedentary. Acute exercise caused a significant increase in systolic blood pressure, DBP, HR, and SV and a decrease in total peripheral resistance in both groups. Acute exercise induced a significant impairment in PORH and ACh-induced response in rowers, but not in sedentary, whereas the SNP-induced vasodilation was not affected by acute exercise in any group. Antioxidant capacity significantly increased only in sedentary after acute exercise.
CONCLUSION: Single acute exercise session impaired microvascular reactivity and endothelial function in rowers but not in sedentary, possibly due to (1) more rowing grades and higher exercise intensity achieved by rowers; (2) a higher increase in arterial pressure in rowers than in sedentary men; and (3) a lower antioxidant capacity in rowers
A Novel PGAP3 Mutation in a Croatian boy with Brachytelephalangy and a Thin Corpus Callosum
No full textBiallelic mutations in the post-GPI attachment to proteins 3 (PGAP3) gene cause hyperphosphatasia with mental retardation syndrome 4 (HPMRS4), which is characterized by elevated serum alkaline phosphatase, severe psychomotor developmental delay, seizures, and facial dysmorphism. To date, 15 PGAP3 mutations have been reported in humans. Here we report a novel homozygous PGAP3 mutation (c.314C>A, p.Pro105Gln) in a Croatian patient and fully describe the clinical features
Učinkovitost liječenja niskoenergetskim laserom u sindromu pekućih usta – probno istraživanje
No full textThe aim of this clinical study was to compare low-level laser therapy (LLLT) switched on and switched off in the treatment of burning mouth syndrome (BMS). BMS is a debilitating condition for patients and highly demanding for physicians, characterized by burning symptoms in the oral cavity. Despite extensive research, so far only cognitive behavioral therapy and clonazepam have been proven successful for its treatment in randomized controlled trials. Forty-four patients with BMS were randomly assigned to the study laser group (LLLT) or the sham laser group. LLLT was performed with the GaAlAs laser (830 nm) used in non-contact mode on the site in the mouth where burning symptoms were present; study patients received 10 sessions (10 days). Each participant fi lled out the visual analog scale (VAS) and oral health impact on the quality of life scale (OHIP-CRO 14) before and after either therapy protocol. Th ere were no signifi cant diff erences between the groups before and after LLLT (switched on and off ) in the quality of life (OHIP CRO 14 scores) (p>0.05). There was signifi cant decrease in pain symptoms (VAS) in both LLLT switched on and LLLT switched off groups (p0,05). Utvrđeno je značajno smanjenje simptoma boli (VAS) u objema skupinama liječenim laserom (upaljen i ugašen) (p<0,05). Upaljen i ugašen laser je doveo do smanjenja simptoma boli u bolesnika s SPU, doduše, niti jedan način liječenja laserom (upaljen ili ugašen) nije doveo do poboljšanja rezultata utjecaja oralnog zdravlja na kvalitetu života
Utječe li anestezijska tehnika na arterijski tlak i regionalnu moždanu perfuziju tijekom artroskopije ramena u sjedećem položaju?
No full textThis study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.Cilj ovoga istraživanja je bio ispitati povezanost postavljanja bolesnika u sjedeći položaj (engl. beach chair position, BCP) i vrste anestezijske tehnike s posljedičnim promjenama arterijskog tlaka i srčanih otkucaja, kao i njihovog utjecaja na regionalnu moždanu perfuziju tijekom artroskopije ramena. U studiju je bilo uključeno 60 bolesnika: prvu skupinu činilo je 30 bolesnika kod kojih je operacijski zahvat izveden u općoj anesteziji (OA) koji su bili mehanički ventilirani, a drugu skupinu 30 bolesnika kod kojih je operacijski zahvat izveden uz interskalenski blok (ISB) i spontano disanje. U 12 prethodno definiranih točaka tijekom perioperacijskog razdoblja mjerio se neinvazivno arterijski tlak, srčani otkucaji, periferna zasićenost kisikom i regionalna moždana zasićenost kisikom. Bolesnici u skupini OA imali su značajno niže vrijednosti srednjeg arterijskog tlaka i srčanih otkucaja u odnosu na bolesnike u skupini ISB tijekom BCP (p<0,001). Promjene srednjeg arterijskog tlaka i regionalne moždane zasićenosti kisikom za obje moždane hemisfere korelirale su samo u 10. minuti nakon postavljanja bolesnika u BCP kod skupine OA (desna p=0,004, lijeva p=0,003). Ova korelacija nije zabilježena kod bolesnika skupine ISB ni u jednoj od mjerenih točaka. Moždani desaturacijski događaji su zabilježeni u objema skupinama, ali nisu bili statistički značajni. Rezultati ovoga istraživanja ukazuju na to da je OA očuvala regionalnu moždanu zasićenost kisikom unutar sigurnog raspona u usporedbi sa skupinom ISB tijekom BCP, unatoč značajnim promjenama arterijskog tlaka i srčanih otkucaja
Protective Effect of Blepharospasm on the Anterior Segment of the Eye
No full textCilj rada bio je odrediti ulogu blefarospazma kao zaštitnog čimbenika prednjeg segmenta oka usporedbom stupnja blefarospazma i promjenama prednjeg segmenta oka. Rad je uključivao 60 žena starijih od 40 godina s kliničkom slikom blefarospazma podijeljenih u dvije skupine. Prvu skupinu činile su bolesnice s I. i II. stupnjem blefarospazma kod kojih su dominirali simptomi suhog oka, a drugu skupinu činile su bolesnice III. i IV. stupnja blefarospazma kod kojih je bila potrebna interventna terapija (sve bolesnice su bile liječene botulin toksinom tipa A). Za bojanje okularne površine radi otkrivanja kornealnih epitelnih defekata rabio se fluorescein. Bojanje kornealnih epitelnih defekata fluoresceinom bilo je statistički značajno manje u intervencijskoj skupini. Usporedba rezultata između promatranih skupina ukazala je na to da izraženi blefarospazam ima zaštitnu ulogu na površinu oka.The aim of the study was to determine the role of blepharospasm as a protective factor for the anterior segment of the eye by comparing the degree of blepharospasm and changes of the anterior segment structures. The study included sixty female patients older than forty years with the clinical diagnosis of blepharospasm. They were divided into two groups; the first group consisted of patients with stage I and II of blepharospasm with dominant dry eye symptoms, and the second group consisted of patients with stage III and IV of blepharospasm who required interventional therapy (all patients in this study were treated with botulinum toxin type A). Staining of ocular surface with vital dyes such as fluorescein was used to determine ocular surface defects. Fluorescein stains the corneal epithelial defects, which were statistically less pronounced in the interventional group. In conclusion, comparison of the results between the two groups of patients may implicate that advanced blepharospasm has a protective effect on ocular surface
Mjerenje kvalitete zdravstvene skrbi – paradigma MEDQUAL
No full textMedical activity is assumed to be service activity the effects of which can be measured. The SERVQUAL scale was used as a starting point for our research, which resulted in a new, adopted scale called MEDQUAL. The MEDQUAL scale aims to measure the quality of healthcare provided by medical staff of one hospital department instead of the overall quality of hospital services or parts of services on which medical staff in one department has no influence. The study was conducted in a clinical hospital department in Croatia and included 300 respondents (169 patients and 131 medical staff members). The MEDQUAL scale, designed and tested in the study, showed high reliability in all established dimensions, i.e. trust in doctors (Cronbach’s Alpha 0.923), nursing professionalism (0.913), medical professionalism (0.938), and departmental organization (0.810). The scale proposed evaluates both patient satisfaction with the quality of healthcare received and medical staff satisfaction with the quality of healthcare provided. The results were comparable to the groups of respondents, departments, and institutions with potential longitudinal studies of this phenomenon. MEDQUAL is a simple, repeatable and cost-eff ective scale, applicable to almost all departments and used for measuring the quality of healthcare services both provided and received, the aim of which is to contribute to the assessment of healthcare quality and its improvement.Polazišna pretpostavka rada bila je da je medicinska djelatnost uslužna djelatnost učinke koje je moguće mjeriti kao i u drugim uslužnim djelatnostima. Istraživanjem izgrađenih i testiranih mjernih instrumenata za ocjenu kvalitete uslužnih djelatnosti izabran je mjerni instrument SERQUAL te je adaptiran u MEDQUAL. Mjerni instrument MEDQUAL ima za cilj mjerenje kvalitete pojedinačne medicinske usluge odnosno kvalitete medicinske usluge medicinskog osoblja jednog bolničkog odjela umjesto kvalitete cjelokupne bolničke usluge ili dijelova usluge na koje osoblje ne može utjecati, jer je ranije određeno drugim čimbenicima. Istraživanje je provedeno na jednom odjelu klinike u Republici Hrvatskoj u kojem je sudjelovalo 300 ispitanika (169 bolesnika i 131 član medicinskog osoblja). Istraživanjem je izrađen i testiran mjerni instrument MEDQUAL visoke pouzdanosti na svim utvrđenim dimenzijama: povjerenje u liječnika (C. alfa 0,923), profesionalnost medicinskih sestara (0,913), profesionalnost liječnika (0,938) te organizacija klinike (0,810). Temeljna odlika predloženog mjernog instrumenta ogleda se u mogućnosti istodobne ocjene zadovoljstva kvalitetom pružene i primljene medicinske usluge rezultata usporedivih prema skupinama ispitanika, odjelima, ustanovama s potencijalom longitudinalnog praćenja ovog fenomena. MEDQUAL je jednostavan, primjenjiv na sve odjele, učinkovit i ponovljiv mjerni instrument za mjerenje kvalitete pružene/primljene medicinske usluge, koji ima svoje mjesto u procjeni kvalitete medicinske usluge kao i u njenom poboljšanju