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Progressive Muscle Weakness: Identifying Necrotizing Autoimmune Myopathy as a Rare Culprit
No full textStatin-induced necrotizing autoimmune myopathy (SINAM) is a rare but critical complication of statin therapy that leads to progressive muscle weakness. The complicated mechanisms underlying it make both diagnosis and treatment difficult. It is essential to recognize the condition early, especially in people who have had muscle problems treated with statins in the past. A 73-year-old woman arrived at the emergency department due to increasingly severe symmetrical muscle weakness accompanied by markedly elevated liver enzymes, creatine kinase (CK), and cardiac troponins. Although an acute cardiac event was ruled out, further tests indicated progressive myositis, necessitating hospitalization. A muscle biopsy subsequently confirmed myopathy with complement deposition, and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies were detected. With treatment that included corticosteroids, intravenous immunoglobulin, and rehabilitation, the patient showed remarkable improvement. This case undeniably highlights the critical importance of early detection of SINAM and intervention and emphasizes the absolute need for further research into causes and treatment strategies
The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross‐Sectional Study in 20 Countries in the WHO European Region
No full textBackground: Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth. Methods: We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions. Results: Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions. Discussion: This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity car
ASSESSMENT OF 10-YEAR CARDIOVASCULAR RISK IN THE ADULT POPULATION IN THE LIVNO AREA, BOSNIA AND HERZEGOVINA
No full textKardiovaskularne bolesti (KVB) vodeći su uzrok smrtnosti u svijetu, a prevalencija ovih bolesti raste, posebno u zemljama s niskim i srednjim prihodima. Procjena kardiovaskularnog rizika (KVR) ključna je za pravovremeno prepoznavanje rizika i intervenciju. Europsko kardiološko društvo preporučuje korištenje SCORE tablice za procjenu desetogodišnjeg KVR. Cilj istraživanja bio je procijeniti KVR u odrasloj populaciji Livna, Bosna i Hercegovina, korištenjem SCORE tablice. Istraživanje je obuhvatilo 50 ispitanika starijih od 40 godina, a rezultati su pokazali da muškarci imaju značajno viši prosječni KVR od žena (10,88% vs 7,06%). Također, stariji ispitanici (61-70 godina) imali su najviši KVR, dok mlađe skupine imaju niže vrijednosti. Obrazovna struktura nije imala značajan utjecaj na KVR. Zaključak naglašava potrebu za javnozdravstvenim preventivnim mjerama u Livnu.Cardiovascular diseases (CVD) are the leading cause of mortality worldwide, and the prevalence of these diseases is increasing, particularly in low- and middle-income countries. Cardiovascular risk (CVR) assessment is crucial for the timely identification of individuals at risk and intervention. The European Society of Cardiology recommends using the SCORE table to assess ten-year CVR. The aim of the study was to assess the CVR in the adult population of Livno, Bosnia and Herzegovina, using the SCORE table. The study included 50 participants aged over 40, and the results showed that men have significantly higher average CVR compared to women (10.88% vs. 7.06%). Furthermore, older participants (61-70 years) had the highest CVR, while younger age groups had lower values. Educational background did not significantly affect CVR. The conclusion highlights the need for public health preventive measures in Livno
Chronic kidney disease and menopausal health: An EMAS clinical guide
No full textKidney diseases are related to the aging process. Ovarian senescence and the loss of estrogen's renoprotective effects are directly associated with a decline in renal function and indirectly with an accumulation of cardiometabolic risk factors. The latter can predispose to the development of chronic kidney disease (CKD). Conversely, CKD diagnosed during reproductive life adversely affects ovarian function. Aim: To set out an individualized approach to menopause management in women with CKD. Materials and methods: Literature review and consensus of expert opinion. Summary recommendations: Menopause hormone therapy can be given to women with CKD. The regimen should be selected on the basis of patient preference and the individual's cardiovascular risk. The dose of hormonal and non-hormonal preparations should be adjusted in accordance with the patient's creatinine clearance. The management of a postmenopausal woman with CKD should focus on lifestyle advice as well as regular monitoring of the main cardiovascular risk factors and evaluation of bone mineral density. Tailored multidisciplinary advice should be given to women with comorbidities such as diabetes, dyslipidemia, and hypertension. Management of osteoporosis should be based on the severity of the CKD
Falls in the Third Age of Life – Public Health Perspective and Challenges for the Future
No full textPadovi i ozljede u populaciji treće životne dobi predstavljaju veliki javnozdravstveni izazov kako u Hrvatskoj tako i u svijetu. Uzrokuju najveći broj hospitalizacija, dugotrajno bolničko liječenje i invalidnost te mogu voditi u smrtni ishod. Čak 30 % osoba starijih od 65 i 50 % osoba starijih od 80 godina iskuse barem jedan pad godišnje. U Hrvatskoj, u starijih od 65 godina 64,1 % hospitalizacija čine ozljede nastale kao posljedica pada, što ujedno predstavlja i vodeći uzrok smrti. Fizioterapijska prevencija padova i njihovih posljedica nezaobilazan je primjer integriranog procesa skrbi usmjerenog na osobu i zahtijeva brojniju radnu snagu i restrukturiranje usluga.Falls and fall-related injuries in the elderly population represent a major public health challenge both in Croatia and in the world. They cause the greatest number of hospitalizations, long-term hospital treatment, disability and can lead to death. As many as 30% of people over 65 and 50% of people over 80 experience at least one fall a year. In Croatia, in people over 65 years, 64.1% of hospitalizations are caused by injuries resulting from falls, which is also the leading cause of death. Physiotherapy prevention of falls and consequences is an unavoidable example of an integrated person-centred care process and requires a larger workforce and restructuring of services
The effect of shock wave therapy in relation to therapy of therapeutic ultrasound and laser for calcified shoulder tendinitis: research
No full textUvod i cilj istraživanja: Kalcificirajući tendinitis rotatorne manšete čest je poremećaj koji se očituje nakupljanjem kalcijeva hidroksipatita u području hvatišta tetiva za kost uz spontanu resorpciju kalcifikata i posljedično cijeljenje tetive. Za vrijeme odlaganja kalcijeva hidroksipatita bolesnik je uglavnom bez većih poteškoća. No za vrijeme resorpcije kalcifikata rame je izrazito bolno. Osim bolnosti kalcifikati dovode i do ograničenja pokreta u ramenu, a samim time utječu i na obavljanje svakodnevnih aktivnosti. Cilj ovog istraživanja bio je usporediti učinak različitih terapijskih metoda na poboljšanje funkcije i mišićne snage ramenog zgloba, povećanje opsega pokreta te smanjenje boli kod pacijenta sa simptomatskim kalcificirajućim tendinitisom u području ramena.
Ispitanici i metode: Istraživanjem je bilo obuhvaćeno 40 ispitanika s potvrđenom dijagnozom kalcificirajućeg tendinitisa m. supraspinatusa. Ispitanici su podijeljeni u skupine po 20 ispitanika, kontrolnu i eksperimentalnu. U kontrolnoj skupini se ispitanicima aplicirao terapijski ultrazvuk i laser (15 aplikacija terapijskim laserom i ultrazvukom) te su radili zadane izometričke vježbe snage. U eksperimentalnoj skupini se ispitanicima aplicirao udarni val (6 aplikacija) te su ispitanicima pokazane izometričke vježbe snage koje su trebali provoditi svakodnevno kod kuće.
Rezultati: Rezultati dobiveni u istraživanju pokazali su statistički značajnu razliku među promatranim metodama, pri čemu je terapija radijalnim udarnim valom dovela do značajnog povećanja opsega pokreta i smanjenja boli kod pacijenata u usporedbi s terapijom terapijskim ultrazvukom i terapijskim laserom.
Zaključak: Istraživanje je pokazalo kako je terapija radijalnim udarnim valom postigla bolje rezultate kod opsega pokreta ramenog zgloba i smanjenja bola od terapije ultrazvukom i laserom. Usporedbom ovog istraživanja s drugim sličnim studijama uočavaju se različiti pristupi primjeni radijalnog udarnog vala, koji se odnose na vremenske intervale korištenja, broj udaraca, gustoću energije i druge parametre, s ciljem postizanja što većeg opsega pokreta i smanjenja boli kod pacijenata. To nam govori kako je vrlo važno kroz ovakve studije i istraživanja ustanoviti koji su parametri, metode i pristup najučinkovitiji kako bi mogli propisati standarde koji će se zatim primjenjivati u liječenju kalcificirajuće tendiopatije.Introduction: Calcifying rotator cuff tendinitis is a common disorder characterized by the accumulation of calcium hydroxyapatite in the area of tendon attachment to bone, with spontaneous resorption of the calcifications and subsequent healing of the tendon. While the calcium hydroxyapatite is deposited, the patient generally has no major problems. However, during the resorption of the calcifications, the shoulder is extremely painful. In addition to pain, calcifications also lead to limited movement in the shoulder, which in turn affects the performance of daily activities. The aim of this study was to compare the effect of different therapeutic methods on improving the function and muscle strength of the shoulder joint, increasing the range of motion, and reducing pain in patients with symptomatic calcifying tendinitis in the shoulder area.
Subjects and methods: The research included 40 subjects with a confirmed diagnosis of calcific tendinitis m. supraspinatus. The subjects were divided into groups of 20 subjects, control and experimental. In the control group, the subjects were treated with therapeutic ultrasound and laser (15 applications with therapeutic laser and ultrasound) and performed predetermined isometric strength exercises. In the experimental group, a shock wave was applied to the subjects (6 applications) and the subjects were shown isometric strength exercises that they were supposed to perform daily at home.
Results: The results obtained in the study showed a statistically significant difference between the observed methods, with radial shockwave therapy leading to a significant increase in range of motion and a decrease in pain in patients compared to therapeutic ultrasound and therapeutic laser therapy.
Conclusion: The study showed that radial shockwave therapy achieved better results in terms of shoulder range of motion and pain reduction than ultrasound and laser therapy. Comparing this study with other similar studies, different approaches to the application of radial shockwave are observed, which relate to the time intervals of use, the number of shocks, energy density and other parameters, with the aim of achieving the greatest possible range of motion and pain reduction in patients. This tells us that it is very important to establish through such studies and research which parameters, methods and approaches are the most effective in order to be able to prescribe standards that will then be applied in the treatment of calcific tendinopathy
Usage, knowledge and attitudes towards electronic cigarettes use among nursing students in Croatia: a cross-sectional study
No full textBackground: Evidence shows harmful effects of e-cigarettes on health. There is limited data on the use of e-cigarettes among nursing students. This study aimed to investigate the usage, knowledge, and attitudes towards e-cigarettes among nursing students in Croatia, as well as their views on the role of nurses in counseling patients and assisting with smoking cessation. Methods: This cross-sectional study was conducted via an online questionnaire among nursing students at 10 universities in Croatia in March/April 2024. Students were asked questions about socio-demographics, knowledge and attitudes towards e-cigarettes and their views on the role of nurses in counseling patients and assisting with smoking cessation. Results: The study included 1,039 participants; 89% were women, 43% were smokers; 53% used e-cigarettes and 76% used them for recreational purposes. 21% of participants agreed that e-cigarettes are an effective method for quitting smoking. More than half indicated that e-cigarettes could encourage non-smokers to start smoking. The majority (60%) reported that they had never received education on smoking cessation at university. Furthermore, 66% stated that they did not feel confident advising smokers about e-cigarettes. The majority (70%) considered physicians to be the most knowledgeable health experts to advise and educate users of e-cigarettes. There were no significant differences in attitudes between smokers and non-smokers on the use of e-cigarettes. Participants demonstrated insufficient knowledge about e-cigarettes. Non-smokers had more positive attitudes towards the role of nurses in combating smoking compared to smokers. Participants who had received education on smoking cessation were more willing to advise smokers and had clearer views on the risks and the importance of the nurse’s role in the quitting process compared to those who had not received such education. Smoking status and age were significant predictors of counseling confidence. Conclusion: The study found a high prevalence of smoking and e-cigarette use among Croatian nursing students, along with limited knowledge and generally negative attitudes towards e-cigarettes. It highlighted gaps in education regarding the health risks of e-cigarettes and the lack of practical skills needed to help smokers quit, suggesting that nursing programs should update their curricula to better prepare students in these areas
REHABILITATION OF ATHLETES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A review
No full textOzljeda prednjeg križnog ligamenta vrlo je česta kod sportaša koji se bave sportovima koji zahtijevaju kontinuirane promjene smjera, skokove ili kontakte s drugim igračima. Rekonstrukcija prednjeg križnog ligamenta jedini je način liječenja ozljede kod sportaša koji teže povratku na sportske terene. Cilj rada bio je istražiti temeljne parametre kvalitetne rehabilitacije koji uključuju optimalan odabir presatka, učinkovito provedenu predoperativnu rehabilitaciju, višefaznu rehabilitaciju s implementiranim neuromuskularnim treningom, treningom snaženja te psihološkom pripremom sportaša. Prijevremeni povratak sportu značajno povećava mogućnost nastanka ponovne ozljede prednjeg križnog ligamenta. Stoga je poseban naglasak stavljen na kvalitetno provedenu procjenu funkcionalnih sposobnosti, ističući provedbu testa vertikalnog skoka kao temelja svake procjene. Također, implementacija preventivnih programa u zagrijavanje sportaša, posebice FIFA 11+ programa, značajno utječe na smanjenje nastanka nove ili ponovne ozljede. Zaključno, uspješna rehabilitacija sportaša zahtijeva individualizirani pristup temeljen na suvremenoj znanstvenoj podlozi, uz zadovoljavanje jasno postavljenih psihofizičkih i biomehaničkih ciljevaAnterior cruciate ligament injury is very common in athletes who engage in sports activities that require continuous changes of direction, jumping or contact with other players. Anterior cruciate ligament reconstruction is the only way to treat the injury in athletes who are striving to return to the sports field. The aim of the study was to investigate the basic parameters of quality rehabilitation, which include optimal graft selection, effectively implemented preoperative rehabilitation, multi-phase rehabilitation with implemented neuromuscular training, strength training and psychological preparation of the athlete. Premature return to sport significantly increases the possibility of re-injury of the anterior cruciate ligament. Therefore, special emphasis is placed on a quality assessment of functional abilities, emphasizing the implementation of the vertical jump test as the basis of each assessment. Also, the implementation of preventive programs in the warm-up of athletes, especially the FIFA 11+ program, significantly affects the reduction of the occurrence of new or repeated injuries. In conclusion, successful rehabilitation of athletes requires an individualized approach based on modern scientific evidence, while meeting clearly set psychophysical and biomechanical goals
The Role of CT Diagnostics in Patients With Subdural Hematomas
No full textKompjuterizirana tomografija (CT) predstavlja ključnu neinvazivnu radiološku metodu u suvremenoj medicini, osobito u dijagnostici traumatskih ozljeda glave s naglaskom na intrakranijalna krvarenja. CT zbog svoje brzine i preciznosti omogućuje otkrivanje prijeloma, različitih oblika krvarenja te drugih znakova ozljeda glave, što ga čini zlatnim alatom u hitnim kliničkim stanjima. Ozljede glave predstavljaju značajan javnozdravstveni problem, s visokim udjelom morbiditeta i mortaliteta, a među njima je subduralni hematom (SDH) jedan od najčešćih, a ujedno i po život ozbiljnih oblika intrakranijalnog krvarenja. SDH nastaje nakupljanjem krvi između dure i arahnoideje, najčešće uslijed traume, a može biti akutni, subakutni ili kronični, ovisno o vremenu nastanka. Klinička važnost SDH-a proizlazi iz mogućnosti razvoja hernijacije mozga i drugih ozbiljnih komplikacija, kao što su udružene ozljede i/ili frakture.
Ovaj rad retrospektivno analizira više parametara u bolesnika kojima je pomoću CT uređaja dijagnosticiran traumatski subduralnim hematomom, koji su obrađeni na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju u KBC-u Rijeka u razdoblju od 1. siječnja 2024. do 31. prosinca 2024. godine. U istraživanje je bilo uključeno ukupno 168 bolesnika, a podaci su anonimno prikupljeni iz medicinske dokumentacije i radiološke arhive. Istraživanjem su analizirane ključne karakteristike bolesnika, uključujući dob, spol tip i širinu hematoma, lokalizaciju, prisutnost hernijacije mozga. Također, obrađeni su i podatci o prisutnosti udruženih ozljeda i/ili fraktura.
Rezultati istraživanja pokazuju da su većinu ispitanika u ovom istraživanju činili muškarci te da je prosječna dob 67 godina. Najčešći oblik bio je akutni subduralni hematom, dok su subakutni i kronični oblici bili znatno rjeđi. U velikom broju slučajeva širina hematoma bila je do 10 mm. Hernijacija mozga znatno se češće javljala u skupini bolesnika sa hematomom ≥10 mm . Uz subduralni hematom, kod mnogih bolesnika zabilježene su i udružene ozljede te frakture, što dodatno potvrđuje težinu njihovog zdravstvenog stanja.Computed tomography (CT) represents a key non-invasive radiological method in modern medicine, especially in the diagnosis of traumatic head injuries with an emphasis on intracranial hemorrhages. Due to its speed and precision, CT enables the detection of fractures, various types of hemorrhages, and other signs of head injuries, making it a gold standard tool in emergency clinical situations. Head injuries represent a significant public health problem, with a high proportion of morbidity and mortality, among which subdural hematoma (SDH) is one of the most common and life-threatening forms of intracranial hemorrhage. SDH occurs as an accumulation of blood between the dura mater and the arachnoid, most often as a result of trauma, and can be classified as acute, subacute, or chronic, depending on the time of onset. The clinical significance of SDH arises from the possibility of brain herniation and other serious complications, such as associated injuries and/or fractures.
This study retrospectively analyzes several parameters in patients diagnosed with traumatic subdural hematoma by CT, who were treated at the Clinical Department of Diagnostic and Interventional Radiology at the University Hospital Center Rijeka from January 1, 2024, to December 31, 2024. The study included a total of 168 patients, and the data were collected anonymously from medical records and the radiological archive. The research analyzed key patient characteristics, including age, sex, type and width of hematoma, localization, and the presence of brain herniation. Additionally, data on the presence of associated injuries and/or fractures were also processed.
The research results show that the majority of participants in this study were men, with an average age of 67 years. The most common type was acute subdural hematoma, while subacute and chronic forms were significantly less frequent. In a large number of cases, the hematoma width was up to 10 mm. Brain herniation occurred significantly more often in the group of patients with hematomas ≥10 mm. In addition to subdural hematoma, many patients also had associated injuries and fractures, further confirming the severity of their medical condition
DIETARY INTERVENTIONS IN CHILDREN WITH ATTENTION AND HYPERACTIVITY DISORDER AND THE POTENTIAL OF THE MEDITERRANEAN DIET IN SYMPTOM CONTROL
No full textPoremećaj pažnje i hiperaktivnosti jedan je od najčešćih neurorazvojnih poremećaja kod djece i adolescenata. Poremećaj je obilježen simptomima nepažnje, hiperaktivnosti i impulzivnosti. Osim navedenih simptoma, djeca s ADHD-om imaju dodatne poteškoće u školskom uspjehu, socijalnim odnosima i spavanju. Poremećaj ADHD-a je nasljednog podrijetla, okolišni čimbenici, uključujući prehranu, značajno doprinose razvoju poremećaja i pogoršanju simptoma. Novija istraživanja sve više upućuju na povezanost prehrambenih navika i statusa nutrijenata s pojavom ovog poremećaja. Istraživanja pokazuju da djeca s dijagnozom ADHD poremećaja imaju nedostatak esencijalnih nutrijenata poput magnezija, cinka, željeza, selena i omega-3 masnih kiselina. Mediteranska prehrana, bogata voćem, povrćem, cjelovitim žitaricama, maslinovim uljem i omega-3 masnim kiselinama, pokazala je negativnu korelaciju s pojavom ADHD poremećaja, te povoljan učinak na regulaciju oksidativnog stresa i upalnih procesa koji su uključeni u patofiziologiju poremećaja. Važnu ulogu u razvoju poremećaja ima i odnos između crijevnog mikrobioma i središnjeg živčanog sustava. Promjene u prehrambenom obrascu utječu na sastav mikrobioma što pridonosi razvoju poremećaja. S obzirom na brojne nuspojave farmakološke terapije, prehrambene intervencije, osobito obrazac mediteranske prehrane, predstavljaju potencijalnu alternativu za liječenje ADHD poremećaja.
Cilj ovog preglednog rada je pregled znanstvene i stručne literature, te novih spoznaja o povezanosti prehrane i ADHD poremećaja. Naglasak je na obrazac mediteranske prehrane kao moguću strategiju za ublažavanje simptoma i manje potrebe za farmakološkom terapijom kod djece i mladih u dobi od 1 do 18 godina.Attention deficit hyperactivity disorder is one of the most common neurodevelopmental disorders in children and adolescents. The disorder is characterized by symptoms of inattention, hyperactivity, and impulsivity. In addition to the above symptoms, children with ADHD have additional difficulties in school performance, social relationships, and sleep. ADHD is hereditary, and environmental factors, including diet, significantly contribute to the development of the disorder and the worsening of symptoms. Recent research increasingly suggests a connection between dietary habits and nutritional status and the occurrence of this disorder. Research shows that children diagnosed with ADHD are deficient in essential nutrients such as magnesium, zinc, iron, selenium, and omega-3 fatty acids. The Mediterranean diet, rich in fruits, vegetables, whole grains, olive oil, and omega-3 fatty acids, has shown a negative correlation with the occurrence of ADHD, and a favorable effect on the regulation of oxidative stress and inflammatory processes that are involved in the pathophysiology of the disorder. The relationship between the gut microbiome and the central nervous system also plays an important role in the development of the disorder. Changes in dietary patterns affect the composition of the microbiome, which contributes to the development of the disorder. Given the numerous side effects of pharmacological therapy, nutritional interventions, especially the Mediterranean dietary pattern, represent a potential alternative for the treatment of ADHD disorders.
The aim of this review is to review scientific and professional literature, as well as new insights into the association between diet and ADHD disorders. The emphasis is on the Mediterranean dietary pattern as a possible strategy for symptom relief and reduced need for pharmacological therapy in children and adolescents aged 1 to 18 years