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Istodobni C. difficile kolitis i citomegalovirusna infekcija kao uzrok ustrajnog proljeva kod bolesnika s ne-Hodgkinovim limfomom nakon kondicioniranja baziranog na bendamustinu i autologne transplantacije krvotvornih matičnih stanica
No full textDiarrhea usually appears early following autologous hematopoietic stem cell transplantation
(ASCT) due to toxic mucosal damage and neutropenia. Infectious agents also cause diarrhea
in the post-transplantation period, with Clostridium difficile (C. difficile) being most common. In contrast,
cytomegalovirus (CMV) enterocolitis is extremely rare after ASCT. We report a case of a 55-year-old
male who underwent ASCT for non-Hodgkin lymphoma that was complicated by severe persistent
diarrhea resulting in significant hypovolemia and electrolyte imbalance. Prior to transplantation, the
patient received rituximab in combination with chemotherapy (R-CHOP/R-DHAP) followed by a
bendamustine-based conditioning regimen (BeEAM). After treatment with oral metronidazole, vancomycin
and fidaxomicin, diarrhea persisted despite undetectable C. difficile toxin, with elevation of hepatic
enzymes. Eventually, CMV infection was diagnosed by real-time polymerase chain reaction and treated
with ganciclovir and valganciclovir. Due to hypogammaglobulinemia following previous rituximab
treatment, CMV immunoglobulins were also administered. The patient’s condition gradually improved
with CMV DNA being undetectable in serum. This case shows that diarrhea may be caused by concurrent
infection with C. difficile and CMV after ASCT. Bendamustine-induced colitis and prior rituximab
treatment may have been additional risk factors in this patient. Therefore, more comprehensive workup
of diarrhea is needed in ASCT recipients treated with these agents.Proljev je česta komplikacija autologne transplantacije krvotvornih matičnih stanica (ATKMS), uzrokovan je različitim
infektivnim uzročnicima, a potpomognut toksičnim oštećenjem crijevne sluznice i neutropenijom. Clostridium difficile (C.
difficile) jedan je od najčešćih uzročnika proljeva, dok se citomegalovirusni (CMV) enterokolitis vrlo rijetko opisuje nakon
ATKMS. Prikazujemo slučaj 55-godišnjeg muškarca s razvojem teškog ustrajnog proljeva sa značajnom hipovolemijom i
poremećajem elektrolita nakon ATKMS zbog ne-Hodgkinovog limfoma. Prije transplantacije bolesnik je liječen rituksimabom
u kombinaciji s kemoterapijom (R-CHOP/R-DHAP), a u sklopu kondicioniranja dobio je bendamustin kao dio protokola
BeEAM. Nakon liječenja dokazane C. difficile infekcije metronidazolom per os, vankomicinom i fidaksomicinom proljev je i
dalje ustrajao unatoč negativnom toksinu C. difficile u stolici. Bolesnik je bio febrilan uz povišene jetrene enzime. Naposljetku,
lančanom reakcijom polimerazom u stvarnom vremenu dokazana je infekcija CMV koja je liječena ganciklovirom i
valganciklovirom. Zbog hipogamaglobulinemije nakon prethodnog liječenja rituksimabom primijenjeni su i CMV-specifični
imunoglobulini. Bolesnikovo stanje se postupno popravilo, a CMV DNA u serumu je postala nedetektabilna. Ovaj slučaj
pokazuje da proljev nakon ATKMS može biti uzrokovan usporednom infekcijom C. difficile i CMV-om. Oštećenje stijenke
crijeva kemoterapijom koja je sadržavala bendamustin (BeEAM) kao i prethodna primjena rituksimaba vjerojatno su
predstavljali dodatni rizični čimbenik. Stoga pojava proljeva kod takvih bolesnika zahtijeva sveobuhvatniju obradu
Vrijedna knjiga o Ruđeru Boškoviću - Stipe KUTLEŠA, Ruđer Bošković. Znanstvenik, književnik i diplomat, Dubrovnik, Ogranak Matice hrvatske u Dubrovniku, 2024, 268 str.
Get PDFSearch for Home in the Prose Works of Sophia Yablonska
No full textRad je posvećen analizi motiva doma u prozi Sofije Jablons’ke kao utjelovljenja ideje ukorjenjivanja u modernoj kulturi XX. stoljeća. Na temelju putopisne proze objavljene 30-ih godina XX. stoljeća razmatra se dinamika predodžbi o domu kao mjestu osobne i zajedničke samoidentifikacije te kao izrazu pripadnosti i povezanosti. Pritom se putovanje tumači kao put povratka i pronalaska, kao kretanje ne samo kroz raznolik kulturni prostor već i kroz povijesno vrijeme radikalnih događaja koji status putnika mogu promijeniti u status prognanika, bjegunca, emigranta.The article analyses the image of “home” in the prose of Sophia Yablonska as the embodiment of the idea of the need for roots in the modern culture of the 20th century. Based on travelogues published in the 1930s, it explores the dynamics of the idea of home as a space of both personal and collective self-identification, and as a kind of message of involvement and belonging. At the same time, the journey is interpreted as a path of return and discovery, a movement not only in a heterogeneous cultural space, but also in the historical time of radical events capable of changing the status of the traveller to the status of an exile, fugitive, and emigrant
Arterial Hypertension: From Definition to Diagnosis
Get PDFArterijska hipertenzija predstavlja vodeći i potencijalno reverzibilan čimbenik rizika za kardiovaskularni morbiditet i mortalitet u Hrvatskoj i globalno. Prema najnovijim podacima EH-UH 2 studije, prevalencija arterijske hipertenzije u odrasloj populaciji Hrvatske iznosi 50,9 %, što upućuje na pogoršanje u odnosu na ranije epidemiološke podatke. U kontekstu kardio-reno-metaboličke prevencije, imperativ je pravovremeno prepoznavanje, klasifikacija i optimalno liječenje arterijske hipertenzije prema suvremenim smjernicama. Dijagnoza arterijske hipertenzije temelji se na ponovljenim pravilno provedenim mjerenjima arterijskoga tlaka u ambulantnim i izvanambulantnim, tj. kućnim uvjetima. Posebnu važnost imaju kućno (MATS) i 24-satno kontinuirano mjerenje arterijskoga tlaka (KMAT) u identifikaciji hipertenzije bijele kute i maskirne hipertenzije. Validirani oscilometrijski uređaji, pravilna tehnika mjerenja i odgovarajuća veličina orukvice temelj su preciznog dijagnosticiranja arterijske hipertenzije. Procjena ukupnoga kardiovaskularnog rizika individualizira se uporabom alata SCORE2/SCORE2-OP, a dodatnu stratifikaciju omogućuje identifikacija oštećenja ciljnih organa (HMOD), uključujući hipertrofiju lijeve klijetke, albuminuriju, snižen eGFR, povećanu debljinu intime-medije karotida te povišenu krutost arterija (PWV). HMOD ima dijagnostičku, prognostičku i terapijsku vrijednost te omogućuje precizniju evaluaciju terapijskoga odgovora. Kod sumnje na sekundarnu hipertenziju – osobito u mlađih bolesnika, kod iznenadnoga pogoršanja kontrole ili rezistencije na terapiju – preporučuje se ciljana dijagnostička obrada usmjerena na endokrine, renovaskularne i druge etiologije. U dijagnostičkom algoritmu nužna je integracija anamnestičkih podataka, fizikalnog pregleda, laboratorijske i slikovne dijagnostike. Značajnu ulogu u ranom otkrivanju arterijske hipertenzije imaju javnozdravstvene intervencije i nacionalni programi probira, kao i kontinuirana edukacija zdravstvenih radnika o pravilnom praćenju, mjerenju i interpretaciji vrijednosti arterijskoga tlaka. Sveobuhvatan i multidisciplinaran pristup nužan je za smanjenje tereta arterijske hipertenzije na populacijskoj razini.Arterial hypertension is the leading and potentially reversible risk factor for cardiovascular morbidity and mortality in Croatia and the world. According to the latest data from the nationwide EH-UH 2 study, the prevalence of hypertension in the adult population of Croatia is 50.9%, indicating an increase compared to previous epidemiological data. In the context of cardio-renal-metabolic prevention, timely recognition, classification, and optimal treatment of hypertension according to the current guidelines is an imperative. The diagnosis of arterial hypertension is based on repeated, properly conducted blood pressure measurements in office and out-of-office settings. Home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) are particularly important in identifying white-coat hypertension and masked hypertension. Validated oscillometric devices, proper measurement technique, and appropriate cuff size are the foundation of accurate diagnosis of arterial hypertension. The assessment of total cardiovascular risk is individualized using the SCORE2/SCORE2-OP tools, and additional stratification is enabled by identifying hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy, albuminuria, reduced eGFR, increased carotid intima-media thickness, and elevated arterial stiffness-pulse wave velocity (PWV). HMOD has diagnostic, prognostic, and therapeutic value and allows for a more precise evaluation of therapeutic response. In cases of suspected secondary hypertension—especially in younger subjects, with sudden worsening of control or therapy resistance—targeted diagnostic evaluation is recommended, focusing on endocrine, renovascular, and other causes. The diagnostic algorithm requires integration of medical history (anamnesis), physical examination, laboratory, and imaging diagnostics. Public health interventions and national screening programs play a significant role in the early detection of hypertension, as does the continuous education of healthcare professionals on proper monitoring, measurement, and interpretation of blood pressure values. A comprehensive and multidisciplinary approach is essential to reduce the burden of hypertension at the population level
Treating Type II Diabetes
Get PDFU Hrvatskoj, kao i u svijetu, posljednjih se godina bilježi porast incidencije i prevalencije šećerne bolesti tipa 2. Poznata je činjenica da gotovo 50 % osoba oboljelih od šećerne bolesti ne postiže ciljeve liječenja, u pogledu kontrole glikemije, a kao mogući uzroci navode se kašnjenje u postavljanju dijagnoze te klinička inercija. Liječenje osoba oboljelih od šećerne bolesti tipa 2 sastoji se od primjene nefarmakoloških mjera liječenja i primjeni farmakoterapije. Novije skupine antihiperglikemika omogućuju povrh postizanja optimalne kontrole glikemije kardiovaskularnu i renalnu protekciju. Cilj liječenja šećerne bolesti nije samo postizanje dobre glukoregulacije već i sprječavanje i/ili usporavanje razvoja akutnih i kroničnih komplikacija bolesti te poboljšanje kvalitete života oboljelih osoba.In Croatia, as well as in the world, there has been an increase in the incidence and prevalence of type 2 diabetes in recent years. It is a well-known fact that nearly 50% of individuals with diabetes do not achieve treatment goals regarding glycemic control, with possible causes including delays in diagnosis and clinical inertia. Treating individuals with type 2 diabetes involves the implementation of non-pharmacological treatment measures and pharmacotherapy. Newer classes of antihyperglycemic agents allow not only for optimal glycemic control but also for cardiovascular and renal protection. The goal of diabetes treatment is not only to achieve good glycoregulation but also to prevent and/or slow down the development of acute and chronic complications of the disease and to improve the quality of life of affected individuals
Ovarian Hemangioma Mimicking Ovarian Carcinoma
No full textCilj ovog rada je prikazati dijagnostički i terapijski pristup hemangiomu jajnika (HJ), koji predstavlja rijetkost u ginekološkoj praksi, s manje od 60 slučajeva zabilježenih u dostupnoj medicinskoj literaturi. Pacijentica u dobi od 67 godina upućena je u našu ambulantu zbog morfološki suspektnih i progresivno rastućih cističnih tvorbi na lijevom jajniku. Transvaginalnim ultrazvukom utvrđene su solidno-cistične promjene veličine 4,45 × 5,15 × 4,52 cm, pri čemu je najveća cistična komponenta iznosila 2,31 × 1,75 cm, bez značajnog protoka na kolor dopleru. Dodatno, zabilježena je povišena razina tumorskog biljega CA-125 (45,2 U/mL). Indicirana je dijagnostičko-terapijska laparoskopska operacija. Tijekom laparoskopije uočena je cistična tumorska tvorba veličine približno 5 cm u području lijevog adneksa, glatke vanjske ovojnice, ali izraženoga vaskularnog crteža. Nadalje, uz lateralni rub ileocekalnog spoja na parijetalnom peritoneumu identificirana je još jedna tumorska tvorba veličine oko 2 cm, morfološki slična prethodno opisanoj. Uzeti su citološki uzorci slobodne tekućine iz Douglasova prostora i sadržaja ciste. Učinjena je obostrana adneksektomija te ekscizija parijetalne peritonealne tvorbe. Histopatološkom analizom obje su tvorbe potvrđene kao hemangiomi. Unatoč povišenim vrijednostima CA-125, ultrazvučnim nalazima koji sugeriraju druge patologije i intraoperativnom nalazu peritonealnih masa, hemangiom jajnika potrebno je uključiti u diferencijalnu dijagnozu cističnih i solidnih tvorbi jajnika. Konačna dijagnoza moguća je isključivo histopatološkom verifikacijom.This paper aims to give a diagnostic and therapeutic approach to ovarian hemangioma (OH), as a rarity in gynecological practice, with less than 60 cases reported in available medical literature. A 67-year-old female patient was referred to our clinic due to morphologically suspicious and progressively growing cystic formations to the left ovary. Transvaginal ultrasound revealed solid-cystic changes measuring 4.45 × 5.15 × 4.52 cm, the largest cystic component being 2.31 × 1.75 cm, but without significant flow on the color Doppler. Additionally, an elevated level of tumor marker CA-125 (45.2 U/mL) was noted. Diagnostic and therapeutic laparoscopic surgery was indicated. During the laparoscopy, a cystic tumor formation of approximately 5 cm was visible in the area of the left adnexa, with a smooth outer membrane but with pronounced vascular pattern. Furthermore, another tumor mass measuring approximately 2 cm was identified along the lateral edge of the ileocecal junction on the parietal peritoneum, morphologically similar to the one described above. Cytological samples of free fluid were taken from the Douglas space and cyst contents. Also performed were a bilateral adnexectomy and excision of the parietal peritoneal mass. Histopathological analysis confirmed both masses as hemangiomas. Despite elevated CA-125 values, ultrasound findings suggesting other pathologies and intraoperative peritoneal masses, ovarian hemangioma should be included in the differential diagnosis of cystic and solid ovarian masses. A final diagnosis is possible only through histopathological verification
Comparison of lipophilic and size-exclusion membranes: creating sink conditions with cyclodextrin
Get PDFBackground and purpose: The effective transport of an active pharmaceutical ingredient across various membrane systems is critical for enhancing its bioavailability, especially in formulations involving solubilizing agents. This study aims to investigate the permeability differences of carvedilol between lipophilic (organic solvent) and size-exclusion membranes in the presence of 2-hydroxypropyl-beta-cyclodextrin in just the acceptor compartment or both sides of the membrane using in vitro side-by-side diffusion cell assays. Experimental approach: Cyclodextrins (CDs) on the acceptor side significantly improved flux and permeability for the lipophilic membrane. In contrast, with size-exclusion membranes that allow the permeation of CDs and their complexes, the benefits of sink conditions were completely diminished. When the same amount of CD was introduced on both sides, the negative effect of CD on the donor side surpassed the positive sink effects on the acceptor side, resulting in reduced flux and permeability across all membrane types. Key results: A novel aspect of this work is the assessment of the applicability of a previously described general mathematical equation for sink conditions. Findings indicated that the supersaturation ratio between donor and acceptor compartments serves as the primary driving force of the membrane transport. For the lipophilic membrane, CDs on the acceptor side not only influenced the driving force of the transport by enhancing the solubility of carvedilol in the acceptor compartment but also altered the proportionality coefficient, hence modifying the apparent thickness of the unstirred water layer. The impact was not observed with size-exclusion membranes. The applicability of the mathematical model was additionally evaluated for CD placed on both sides of the membrane. Conclusion: The model effectively describes the impact of CD placed on the donor side when the solid membrane permits only the drug’s permeation, as in the case of a lipophilic membrane, where the solubilizing additive cannot pass through. It is also applicable when the solubilizing additive permeates slowly and has minimal influence on transport, such as with a size-exclusion membrane with a 1 kDa molecular weight cut-off. The model remains suitable if the additive is small enough in hydrodynamic size to permeate the membrane, but no concentration gradient exists to drive its transport, for example, with a 6 kDa size-exclusion membrane containing the same CD concentration on both sides of the membrane
Romski dječji brakovi u Srbiji: Tradicija ili ne?
No full textAccording to the UNICEF data from 2019, in the general population of women in Serbia aged 20 to 49 who have been married or are living in a common-law marriage, 7.9% entered their first union before the age of 18. Among their peers from Roma communities, this percentage is as high as 57.2% (UNICEF, 2020: 396).
Marriage among adolescent girls and boys, who are physically and psychosocially immature, uneducated, and economically dependent, can no longer be justified by the specific customs and traditions of a community. Understanding and combating this cultural practice requires an explicit public articulation of its harmful nature, particularly because this practice is forbidden by the Serbian legislative system and is a violation of universal human rights.
The persistence of the practice of the early marriage of Roma girls in the twenty-first century, a phenomenon with multiple harmful consequences for the Roma population, only confirms its complex and multidimensional nature and the necessity of considering it in interaction with numerous social factors, such as poverty, unemployment, education, social norms, customs and gender roles in the community, lack of efficiency among institutions and policy instruments, etc. This paper offers the concept of a marginalized environment as an explanatory framework within which the practice of child marriage among the Roma in Serbia has been functioning and been perpetuated (UNICEF, 2017).
By means of measures aimed to protect Roma children from all forms of neglect, violence, and abuse (formulating and implementing appropriate legal solutions, raising social awareness and providing alternatives to at risk children and their families), state authorities would significantly contribute to reducing existing prejudices against the Roma and empowering members of the Roma community in Serbia for more successful inclusion into Serbian society.Prema podacima UNICEF-a iz 2019. godine, u općoj populaciji žena, starosti od 20
do 49 godina, koje su ikada bile u braku ili vanbračnoj zajednici, 7,9 % je u prvu
zajednicu stupilo prije 18. godine. Među njihovim vršnjakinjama iz romskih naselja,
ovaj postotak bio je čak 57,2 % (UNICEF, 2020, str. 396)!
Udaja ili ženidba osoba na pragu puberteta, fizički i psihosocijalno nezrelih, slabo
obrazovanih i ekonomski zavisnih, ne smiju se više opravdavati specifičnošću
običaja i tradicijom jedne nacionalne zajednice, već zahtijevaju izričitu javnu artikulaciju
njihove neprihvatljivosti, jer su u suprotnosti s postojećim zakonodavnim
sustavom i proklamiranim univerzalnim ljudskim pravima.
Opstanak prakse rane udaje romskih djevojčica u dvadeset i prvom stoljeću, fenomena
s višestruko štetnim posljedicama po romsku populaciju, samo potvrđuje
njegovu složenu i višedimenzionalnu prirodu i neophodnost sagledavanja u interakciji
s brojnim socijalnim čimbenicima kao što su siromaštvo, nezaposlenost, obrazovanje,
sustav vrijednosti, norme, običaji i rodne uloge u zajednici, neefikasnost
nadležnih institucija i instrumenata javne politike i dr. Stoga se u radu polazi od
koncepta marginaliziranog okruženja kao eksplanatornog okvira unutar kojega funkcionira
i reproducira se praksa dječjih brakova u romskim zajednicama, u Srbiji
(UNICEF, 2017).
Mjerama zaštite romske djece iz svih gledišta zloupotrebe, nasilja i zlostavljanja
(formuliranje i primjena odgovarajućih zakonskih rješenja, promjena društvene
svijesti i osiguravanje alternative djeci u potencijalnoj opasnosti/riziku i njihovim
porodicama) državni organi bi značajno doprinijeli smanjenju postojećih predrasuda
prema Romima i omogućili pripadnicima romske zajednice u Srbiji uspješnije
uključivanje u društvene tijekove
Le démonique et ses modes chez Kierkegaard. Avec une discussion sur la souffrance ineffable dans les troubles mentaux
No full textKierkegaard’s demonic theory offers a critical framework for analysing ineffable suffering in mental disorders. The demonic manifests as anxiety toward the Good, where temporal totality becomes perceived as suffering’s source through a sin-redemption spiral. This process involuntarily excludes sufferers from universal discourse by fixating on sin while resisting redemption. Our examination reveals two volitional paradoxes producing four archetypes: Satan’s absolute defiance, Abraham’s sacrificial suspension, Antigone’s silent devotion, and the Merman’s existential ambiguity. Through analysing their immediacy/mediacy and possibility/necessity dialectics, we demonstrate how Abraham and Antigone’s failed transcendence patterns form the demonic’s essential movement. Their paradoxical evasion of Merman-mode despair ultimately propels Satanic actualization – an endless antagonism with universality achieved through ineffable psychoanalytic perversity. This perpetual motion sustains suffering by paradoxically avoiding its apparent culmination.Kierkegaardova teorija demonskog nudi kritički okvir za analizu neizrecive patnje u mentalnim poremećajima. Demonsko se očituje kao tjeskoba pred Dobrim, gdje se vremenska totalnost percipira kao izvor patnje kroz spiralu grijeha i iskupljenja. Taj proces nehotice isključuje patnike iz univerzalnog diskursa usmjeravanjem na grijeh uz istodobno odbijanje iskupljenja. Naše istraživanje otkriva dva voljna paradoksa koja proizvode četiri arhetipa: Sotonino apsolutno prkošenje, Abrahamovu žrtvenu suspenziju, Antigoninu tihu odanost i Mermanovu egzistencijalnu dvosmislenost. Analizom njihovih dijalektika neposrednosti/posrednosti i mogućnosti/nuž- nosti pokazujemo kako obrasci neuspjele transcendencije Abrahama i Antigone oblikuju bitni pokret demonskog. Njihovo paradoksalno izbjegavanje Mermanova modusa očaja naposljetku potiče sotonističku aktualizaciju – beskonačno neprijateljstvo s univerzalnošću ostvareno kroz neizrecivu psihoanalitičku perverziju. Taj vječni pokret održava patnju paradoksalnim izbjegavanjem njezina prividnog dovršenja.Kierkegaards Theorie des Dämonischen bietet einen kritischen Bezugsrahmen zur Analyse des unaussprechlichen Leidens bei psychischen Störungen. Das Dämonische offenbart sich als Angst vor dem Guten, wobei die zeitliche Totalität durch eine Sünde-Erlösung-Spirale als Ursprung des Leidens erfahren wird. Dieser Prozess schließt die Leidenden unwillentlich vom universellen Diskurs aus, indem er die Aufmerksamkeit auf die Sünde fixiert und die Erlösung verweigert. Unsere Untersuchung legt zwei willensbezogene Paradoxien offen, aus denen vier Archetypen hervorgehen: Satans absolute Auflehnung, Abrahams Opfer-Suspension, Antigones schweigende Hingabe und die existenzielle Zweideutigkeit des Meermannes. Durch die Analyse ihrer Dialektik von Unmittelbarkeit/Mittelbarkeit sowie Möglichkeit/Notwendigkeit zeigen wir, wie die gescheiterten Transzendenzmuster von Abraham und Antigone die wesentliche Bewegung des Dämonischen bilden. Deren paradoxe Umgehung der Verzweiflung im Meermann-Modus treibt letztlich die satanische Aktualisierung voran – einen endlosen Widerstreit mit dem Universellen, vollzogen in unaussprechlicher psychoanalytischer Verkehrtheit. Diese unablässige Bewegung erhält das Leiden aufrecht, indem sie sich dessen scheinbarer Vollendung paradoxerweise entzieht.La théorie du démonique chez Kierkegaard offre un cadre critique pour analyser la souffrance ineffable dans les troubles mentaux. Le démonique se manifeste comme une angoisse face au Bien, où la totalité temporelle est perçue comme la source de la souffrance à travers une spirale péché-rédemption. Ce processus exclut involontairement les souffrants du discours universel en fixant leur attention sur le péché tout en résistant à la rédemption. Notre analyse révèle deux paradoxes volitionnels donnant naissance à quatre archétypes : la défiance absolue de Satan, la suspension sacrificielle d’Abraham, la dévotion silencieuse d’Antigone et l’ambiguïté existentielle du Triton. En examinant leurs dialectiques immédiat/medié et possible/nécessaire, nous montrons comment les schémas de transcendance échouée d’Abraham et d’Antigone constituent le mouvement essentiel du démonique. Leur évitement paradoxal du désespoir à la manière du Triton propulse finalement la réalisation satanique – un antagonisme sans fin avec l’universel, accompli par une perversion psychanalytique ineffable. Ce mouvement perpétuel entretient la souffrance en évitant paradoxalement son aboutissement apparent
