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The role of a nurse in a liver biopsy
No full textBiopsija jetre je invazivna metoda koja se koristi u dijagnostici bolesti jetre s ciljem utvrđivanja prirode bolesti (postavljanja dijagnoze) ili određivanja stupnja bolesti. Metoda je vrlo korisna i pouzdana te relativno jeftina, no invazivna i neugodna za pacijenta. Unatoč određenim rizicima za razvoj komplikacija, ova metoda je sigurna za pacijenta. Za uspješnost biopsije jetre, od izuzetne su važnosti specifična znanja i vještine liječnika i medicinske sestre, izvođača metode. Podjednako je važna i adekvatna psihička priprema bolesnika, gdje pored liječničke, posebno dolazi do izražaja uloga medicinske sestre. U ovom istraživanju, provedenom na Zavodu za gastroenterologiju KBC Split analizirani su trendovi i uspješnost biopsije jetre, njene komplikacije kao i uloga medicinske setsre pri ovoj pretrazi.
Cilj: Analizirati trendove izvođenja perkutane bopsije jetre, uspješnost ove metode te učestalost komplikacija u promatranom razdoblju (2020.—2022.). Daljnji cilj bio je usporediti rezultate biopsije s uputnom dijagnozom. Pored toga, analizirana je uloga medicinske setre u izvođenju ove metode.
Metode: Podaci su prikupljeni iz bolničkog informacijskog sustava (BIS), liječničkih otpusnih pisama kao i sestrinske dokumentacije. Podaci su obrađeni u aplikaciji Microsoft Excel te prikazani tabelarno i grafički.
Rezultati: Ukazuju na porast učestalosti izvođenja perkutane biopsije jetre tijekom promatranog razdoblja. Ciljana biopsija izvođena je češće od slijepe biopsije. Uspješnost biospije jetre je bila visoka a korelacija nalaza s uputnom dijagnozom značajna, dok je učestalost koplikacija ove metode bila niska.Liver biopsy is an invasive method used in diagnosing of liver diseses; its purpose being a determining of a nature of the disease (diagnosis establishing), or assessing of a degree of the disease. This method is highly useful and reliable and relatively inexpensive, but also invasive and unpleasant for the patient. Despite certain risks for complications, this is a generally safe method for the patient. A successful liver biopsy requires specific knowledges and skills of a doctor and a nurse who perform the procedure. Equally important is an adequate psychologic approach to the patient, and, beside the doctor's, there is an especially important role of the nurse in it. In this study, conducted at the Department of gastroenterology, University hospital Split, trends and successfulness of a liver biopsy as well as its complications were analyed, and the role of the nurse in this procedure was assessed.
Objective: To anlyze trends in percutaneous liver biopsy, its successfulness and complications rate in observed time period (2020.—2022.). Further aim was to compare biopsy resupts with initial diagnosis. Besides that, a role of the nurse in performing of the procedure was analyzed.
Methods: Data are collected from hospital information system (BIS), hospital dicharge letters and from nursing documatation. The data are processed in Microsoft Excel application and presented using tables and graphs.
Results: They indicate an increased freaquency of performing percutaneous liver biopsy during the observed period. A guided liver biopsy was performed more frequently than a blind biopsy. A successfulness of the liver biopsy was high and a correlation of biopsy results with initial diagnosis was significant, while complications rate was low
COMPARISON OF INTERVENTIONS IN PRE-COVID AND COVID PERIOD IN THE DEPARTMENT OF EMERGENCY MEDICINE OF SPLIT-DALMATIA COUNTY
No full textCilj: Cilj ovog rada je usporediti učestalost intervencija (pregleda) pacijenata koji su pod određenom prijemnom dijagnozom liječeni u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ) u godini prije (2019./2020.) i u godini za vrijeme (2020./2021.) pandemije COVID-19.
Materijali i metode: U ovo retrospektivno istraživanje uključeni su svi pacijenti liječeni u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ) od veljače 2019. do veljače 2021. godine. Podaci o dobi, spolu te prijemnoj dijagnozi pacijenata po MKB-10 klasifikaciji prikupljeni su iz informacijskog sustava e-Hitna.
Rezultati: Značajna razlika u učestalosti prijemnih dijagnoza u pre-COVID razdoblju u odnosu na COVID razdoblje na ukupnom uzorku od 214 862 ispitanika utvrđena je u razredima R00-R99 (Simptomi, znakovi i abnormalni klinički i laboratorijski nalazi, neklasificirani drugdje), S00-T98 (Ozljede, trovanja i određene druge posljedice s vanjskim uzrokom) te J00-J99 (Bolesti dišnog sustava) na razini značajnosti p<0,001. Nadalje značajna razlika utvrđena je u razredu I00-I99 (Bolesti cirkulacijskog sustava) na razini p=0,001 dok je razred H60-H95 (Bolesti uha i mastoidnih procesa) pokazao značajnost p=0,002. U pre-COVID razdoblju utvrđena je značajna razlika prema spolu, gdje su žene imale veći broj prijemnih dijagnoza u odnosu na muškarce, u razredima N00-N99 (Bolesti genitalno-urinarnog sustava) (p=0,001) te u razredu R00-R99 (p<0,001). U istom razdoblju muškarci su se značajno razlikovali od žena u razredu S00-T98 na razini p<0,001. U COVID razdoblju utvrđena je značajna razlika prema spolu, gdje su muškarci imali veći broj prijemnih dijagnoza u odnosu na žene, u razredu S00-T98 na razini p<0,001, dok su žene imale više prijemnih dijagnoza u razredima R00-R99 na razini p<0,001, I00-I99 na razini p=0,001 te N00-N99 (p=0,005).
Zaključci: Veći broj pacijenata zaprimljen je u ZHM SDŽ u godini koja je prethodila pandemiji nego u godini s pandemijom COVID-19. Iako je COVID-19 primarno bolest dišnog puta, više je pacijenata zaprimljeno pod tom prijemnom dijagnozom u godini prije pandemije COVID-19, što je vjerojatno razlog organizacije zdravstvenog sustava (direktan odlazak na COVID-19 prijeme) te sam učinak izolacije i samoizolacije (smanjen kontakt među ljudima). Pridržavanje načela zatvaranja također je vjerojatni čimbenik koji je doprinio značajnom smanjenju broja ozljeda i trovanja (prometne nesreće, traume, radne ozljede...).Summary:
Objective: The aim of this paper is to compare the frequency of interventions (examination) of patients who were treated at a certain admission diagnosis at the Department of Emergency Medicine of Split-Dalmatia County (ZHM SDŽ) in the year before (2019/2020) and in the year during (2020/2021) COVID-19 pandemic.
Materials and methods: This retrospective study included all patients treated at the Department of Emergency Medicine from February 2019 to February 2021. Data on age, sex and diagnosis of patients by ICD-10 classification were collected from medical program e-Hitna.
Results: A significant difference in the frequency of admission diagnoses in the pre-COVID period compared to the COVID period on a total sample of 214 862 subjects were found in classes R00-R99 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) , S00-T98 (Injuries, poisonings and certain other consequences with external cause) and J00-J99 (Respiratory diseases) at the level of significance p <0.001. Furthermore, a significant difference was found in class I00-I99 (Diseases of the circulatory system) at the level of p = 0.001 while class H60-H95 (Diseases of the ear and mastoid processes) showed a significance of p = 0.002. In the pre-COVID period, a significant gender difference was found, where women had a higher number of admission diagnoses than men in classes N00-N99 (Diseases of the genitourinary system) (p = 0.001) and in class R00-R99 (p <0.001). In the same period, men differed significantly from women in the S00-T98 class at the p <0.001 level. In the COVID period, a significant gender difference was found, where men had a higher number of admission diagnoses than women in class S00-T98 at the level of p <0.001, while women had more admission diagnoses in classes R00-R99 at the level of p <0.001, I00-I99 at p = 0.001 and N00-N99 (p = 0.005).
Conclusions: A larger number of patients were admitted to ZHM SDŽ in the year preceding the pandemic than in the year with the COVID-19 pandemic. Although COVID-19 is primarily a respiratory disease, more patients were admitted under this admission diagnosis in the year before the COVID-19 pandemic, which is probably due to organization of the health system (direct access to COVID-19 admissions) and the effect of isolation and self-isolation (less contact between people). Adherence to the principle of lockdown is also a likely factor that has contributed to a significant reduction in the number of injuries and poisonings (traffic accidents, trauma, work injuries...)
Bismarck's model of public health financing
No full textČesto se zdravstveni sustavi opisuju prema njihovom prevladavajućem izvoru financiranja (npr. „Bismarckovi“ sustavi socijalnog zdravstvenog osiguranja, opći sustavi „Beveridge“ koji se financiraju iz poreza). Funkcioniranje zdravstva ovisi uglavnom o razini i načinu financiranja. Zemlje biraju između različitih modela. Svrha ovog rada je prikazati različite modele financiranja zdravstvene zaštite, s posebnim osvrtom na Bismarckov, Beveridgeov i američki model, kao vodećim modelima financiranja zdravstva. Na temelju literature i vlastitih razmišljanja autora, u zaključku su dati prijedlozi kako bi se spomenuti modeli poboljšali koristeći najbolje od svakog.Often, health systems are described by their prevailing source of funding (e.g., "Bismarck" social security systems, tax-funded general "Beveridge" systems). The functioning of health care depends mainly on the level and method of funding. Countries choose from different models. The purpose of this paper is to present different models of health care financing, with special reference to Bismarck', Beveridge's and American models, as leading models of health care financing. Based on the literature and the author's own reflections, suggestions were made in conclusion to improve the models using the best of each
Panel reactive HLA antibodies in patients on kidney transplant waiting list
No full textU uvodnom dijelu ovoga rada govorimo o bubregu i njegovoj anatomskoj građi. Nažalost zbog bolesti
bubrega i njegove insuficijencije često dolazi do potrebe za transplantacijom bubrega. Na samu
transplantaciju utječu mnogi faktori među kojima glavnu ulogu ima podudarnost u HLA sustavu tkivne
snošljivosti između darivatelja i primatelja organa.
Cilj ovoga rada bio je testirati serume tri pacijenta kako bi odredili prisutnost ili odsutnost antitijela u
serumima. Zavod za transfuziju KBC-a Split bio je mjesto obavljanja istraživanja na uzorcima seruma
pacijenata koji se nalaze na listi čekanja za transplantaciju bubrega.
Metode koje smo koristili u istraživanju je test mikrolimfocitotoksičnosti - citotoksičnost ovisna o
komplementu (CDC).
Rezultati su pokazali da je pacijent br. 1 reagirao sa svim osobama na probiru te da se radi od visoko
senzibiliziranom događaju. Kod pacijenta br. 2 kod kojeg je utvrđena senzibilizacija otkrivena je specifičnost
za antigen HLA-A2 i HLA-A24 te pacijent br. 3 kod kojeg nije dokazana prisutnost antitijela.
Uz ispravne i aktualizirane podatke o mogućim senzibilizirajućim događajima, rezultati redovnih probira
ključni su pri definiranju imunološkog statusa primatelja i omogućavaju optimalnu pretragu za potencijalnim
donorom organa.Introductory part of this thesis provides short description of kidney anatomy and pathogenesis of kidney
diseases. Unfortunately, kidney pathogenic states often lead to insufficiency, with kidney transplant as the
most desirable way of treating the disease. One of the most important factors for successful kidney transplant
and graft longevity is the best possible HLA system compatibility between organ donor and recipient.
The objective of this research was to test serums of 3 patients and determine presence or absence of HLA
antibodies in given samples. Blood samples from patients were provided by Division of Transfusion Medicine
(University hospital center Split), while all the tests were performed in Tissue Typing Laboratory.
Method used for HLA antibody detection in this research was mikrolimfocitotoxicity (CDC) test.
Research results showed that out of three tested patients, one was highly sensitized (against all samples
provided for lymphocyte panel), second patient was sensitized specifically to HLA-A2 and HLA-A24(9)
antigens, while in the last patient no HLA antibodies were detected.
Along with correct and updated data on possible sensitizing events, the results of regular screenings are
crucial in defining the recipient's immune status and enable an optimal search for a potential organ dono
Physiotherapy for osteoarthritis of hand
No full text: Osteoartritis šaka je kronična, progresivna degenerativna bolest zglobova šaka kojoj je osnovni uzrok propadanje zglobne hrskavice. Povezan je s boli, smanjenom snagom stiska, gubitkom opsega pokreta i ukočenošću zglobova, što dovodi do poremećaja funkcije šake i poteškoća u obavljanju svakodnevnih aktivnosti.
Smjernice za liječenje OA naglašavaju važnost nefarmakoloških mjera, poput fizikalne terapije, primjene ortoza i edukacije pacijenata, u smanjenju boli, poboljšanju pokretljivosti i povećanju funkcionalnosti zahvaćenih zglobova te poboljšanju kvalitete života. Nefarmakološke mjere preporučuju se kao prva linija liječenja ili kao dio sveobuhvatnog plana liječenja koji se kombinira s farmakološkim modalitetima. Ovi pristupi podržani su znanstvenim dokazima i smatraju se sigurnima i učinkovitima za upravljanje simptomima i poboljšanje funkcionalnosti kod pacijenata s OA. Prema sadašnjim saznanjima temeljenim na dokazima, postoje umjereni do visoki dokazi koji podupiru edukaciju o zaštiti zglobova, tjelovježbu, lokalnu primjenu toplinskih procedura i uporabu ortoza u OA šake, dok postoje niski dokazi za magnetoterapiju, elektroterapiju i akupunkturu.
Ograničeni broj visokokvalitetnih randomiziranih studija o nefarmakološkim modalitetima liječenja ograničava međunarodne smjernice u pružanju preporuka s jakim dokazima o učinkovitosti pojedinih nefarmakoloških mjera u liječenju OA šaka. Osim toga, nedostaju preporuke o optimalnom intenzitetu i trajanju vježbanja, što zahtijeva daljnja istraživanja visoke metodološke kvalitete kako bi se postigao konsenzus o ovom pitanju.Osteoarthritis of the hands is a chronic, progressive degenerative disease of the joints of the hands, the main cause of which is the deterioration of joint cartilage. It is associated with pain, reduced grip strength, loss of range of motion, and joint stiffness, leading to impaired hand function and difficulty in performing daily activities.
Guidelines for the treatment of OA emphasize the importance of non-pharmacological measures, such as physical therapy, use of orthoses and patient education, in reducing pain, improving mobility and increasing functionality of the affected joints and therefore improving quality of life. Non-pharmacological measures are recommended as first-line treatment or as part of a comprehensive treatment plan that is combined with pharmacological modalities. These approaches are supported by scientific evidence and are considered safe and effective for managing symptoms and improving functionality in patients with hand OA. According to the current evidence-based knowledge, there is moderate to high evidence supporting joint protection education, exercise, topical application of thermal procedures and the use of orthoses in hand OA, while there is low evidence for magnetotherapy, electrotherapy and acupuncture. The limited number of high-quality randomized studies on non-pharmacological treatment modalities limits international guidelines in providing recommendations with strong evidence for the effectiveness of individual non-pharmacological measures in the treatment of hand OA. In addition, there is a lack of recommendations on the optimal intensity and duration of exercise, which requires further research of high methodological quality to reach a consensus on this issue
Prevalence and types of decompression illness in divers from 2010 to 2020
No full textCilj: Glavni je cilj istraživanja prikazati prevalenciju i tipove dekompresijske bolesti na Zavodu za pomorsku, podvodnu, hiperbaričnu medicinu u Splitu od 2010. do 2020. godine. Specifični su ciljevi istraživanja prikazati podatke o roniocima prema broju intervencija, tipu dekompresijske bolesti, dubini zarona, ishodu liječenja te sociodemografskim podacima (spolu, dobi i nacionalnost), ispitati razlike u tipovima dekompresijske bolesti u odnosu na dubine zarona, spol i dob te ispitati povezanost dubine zarona i ishoda liječenja.
Metode i ispitanici: Provedena je retrospektivna analiza medicinske dokumentacije od 2010. do 2020. godine s obzirom na dekompresijsku bolest. Varijable su opisane frekvencijama i postocima. Prilikom testiranja odnosa određenih pokazatelja i sociodemografskih značajki ispitanika korišten je Hi-kvadrat test. Kao razina značajnosti korištena je vrijednost od 5 % (p<0,05). U istraživanju je sudjelovao 141 pacijent koji se u tom razdoblju liječio od dekompresijske bolesti na Zavodu za pomorsku, podvodnu, hiperbaričnu medicinu u Splitu.
Rezultati: Broj intervencija u promatranom razdoblju porastao je za više od tri puta. Pokazalo se da je tip 2 dekompresijske bolesti tri puta češći od tipa 1 dekompresijske bolesti. Većina ispitanih pacijenata (63,1 %) ronila je na dubinama do 40 metara. Najčešći ishod bolesti (u 94,2 % slučajeva) bilo je izlječenje. Većina ispitanih ronilaca (njih 80,9 %) bili su muškarci, pacijenti u dobi od 41 godine i više (80,1 %) te hrvatski državljani (34,8 %). Utvrđena je statistički značajna razlika između tipa dekompresijske bolesti s obzirom na dob ispitanika. Razlike između dubine zarona i spola pacijenata i tipa dekompresijske bolesti nije utvrđena. Dokazana je statistički značajna povezanost između dubine zarona pacijenata i ishoda liječenja dekompresijske bolesti.
Zaključci: Vrlo je visoki postotak izlječenja dekompresijske bolesti jer je zdravstveni tim obučen, stručan i reagira pravovremeno zbog pripravnosti. Međutim, prilikom ronilačkih incidenata nužan je što raniji dolazak do Zavoda i početak liječenja.Objective: The main objective of the research is to show the prevalence and types of decompression sickness at the Institute for Maritime, Underwater, Hyperbaric Medicine in Split from 2010 to 2020. The specific objectives of the research are to present data on divers according to the number of interventions, type of decompression sickness, depth of dive, outcome of treatment and sociodemographic data (gender, age and nationality), to examine differences in types of decompression sickness in relation to diving depth, gender and age, and to examine the connection diving depth and treatment outcomes.
Methods and subjects: A retrospective analysis of medical records from 2010 to 2020 was conducted with regard to decompression sickness. Variables described by frequencies and percentages. When testing the connection between certain indicators and the socio-demographic features of the respondents, the Chi-square test was used. A value of 5% (p<0.05) was used as the level of significance. In the research 141 patients were treated for decompression sickness at the Institute for Maritime, Underwater, Hyperbaric Medicine in Split.
Results: The number of interventions in the observed period increased by more than three times. Type 2 decompression sickness has been shown to be three times more common than type 1 decompression sickness. The majority of examined patients (63.1%) dived at depths of up to 40 meters. The most common outcome of the disease (in 94.2% of cases) was cure. Most of the examined divers (80.9%) were men, patients aged 41 and over (80.1%) and Croatian citizens (34.8%). A statistically significant difference was found between the type of decompression sickness with regard to the age of the subjects. Differences between the depth of the dive and the gender of the patients and the type of decompression sickness were not determined. A statistically significant correlation between the depth of the patient's dive and the outcome of the treatment of decompression sickness was proven.
Conclusions: There is a very high percentage of cure of decompression sickness because the medical team is trained, professional and reacts in a timely manner due to preparedness. However, in case of diving incidents, it is necessary to arrive at the Institute as early as possible and start treatment
The effect of work stressors on the job satisfaction in surgical team members of KBC Split
No full textUvod: Najvažniji čimbenici koji se javljaju svakodnevno, a važni su za funkcioniranje kirurškog tima su radni
stresori: psihološki, fizički, emocionalni, financijski, organizacijski, uzrokovani izostankom edukacije, lošim
međuljudskim odnosima i komunikacijom.
Cilj istraživanja: Istraživanje se bavi utjecajem radnih stresora na razinu zadovoljstva poslom
Ispitanici i metode: U istraživačkom radu sudjelovala su 251 zdravstvena djelatnika iz kirurških timova
zavoda/klinika KBC-a Split. Istraživanje je provedeno anonimnom anketom sa 78 tvrdnji, a ispitanici su imali
ponuđenih pet odgovora (1-u potpunosti se ne slažem do 5- u potpunosti se slažem).
Rezultati: Prosječna razina zadovoljstva je: rad u kirurškom timu (M=2,89), prisutnost emocionalnih stresora
(M=2,68), stresori uzrokovani međuljudskim odnosima i komunikacijom (M=2,62), financijski stresori
(M=4,07) koji ukazuju na visoku razinu stresa. Prosječne razine su: fizičkih stresora (M=3), nedostatkom
edukacije (M=2,91) te psiholoških stresora (M=3,16). Najzadovoljniji su specijalizanti anestezije (M=3,98), a
najmanje operacijske sestre/tehničari. Osoblje koje radi smjenski rad u odnosu na osoblje koje radi dežurstva i
rad po pozivu su zadovoljnije poslom (t=2,44; P=0,015). Sociodemografske varijable tumače 3% varijance
zavisne varijable zadovoljstva radom u kirurškom timu, a uvođenjem varijabli stresora protumačenost raste za
42 postotna boda na 45% varijance. Procijenjeni model koji sadržava sociodemografske varijable i varijable
stresa su statistički značajni (F=30,53; P<0,001). Prema procijenjenom modelu muškarci su manje zadovoljni
organizacijom i vođenjem u kirurškom timu (P=0,016), a uvođenjem stresora statistički je značajan negativan
utjecaj stresora međuljudskih odnosa (P<0,001), pri čemu financijski stresori (P<0,001), fizički
stresori/fiziološke promjene (P=0,045) i stresori nedostane edukacije (P<0,001) umanjuju zadovoljstvo radom
u kirurškom timu. Najveća protumačenost zadovoljstva organizacijom i vođenjem uz korigiran efekt ostalih
nezavisnih varijabli je utvrđena kod stresora međuljudskih odnosa i komunikacije (8,41%), te od strane stresora
nedostatne edukacije (5,29%).
Zaključak: Učestalost emocionalnih stresora uzrokovanih lošim međuljudskim odnosima i komunikacijom,
nedostatnom edukacijom, fizičkih i psiholoških stresora izražena je u umjerenom stupnju. Najnezadovoljnije
su operacijske sestre/tehničari, najzadovoljniji specijalizanti anestezije. Veće zadovoljstvo je među osobljem
koje radi smjenski rad u odnosu na one koji rade dulje. Veza između sociodemografskih čimbenika i radnih
stresora sa zadovoljstvom radom ukazuje da sociodemografske varijable tumače 3% varijance zadovoljstva
radom, dok uvođenjem varijabli stresora protumačenost raste na 45%.Introduction: The most important factors that occur on a daily basis, and are important for the functioning of
the surgical team, are work stressors: psychological, physical, emotional, financial, organizational, caused by
the lack of education, poor interpersonal relationships and communication.
Research objective: The research deals with the impact of work stressors on the level of job satisfaction
Subjects and methods: 251 health professionals from surgical teams of the Institutes/Clinics of the University
Hospital Center Split participated in the research work. The research was conducted by an anonymous survey
with 78 statements, and the respondents were offered five answers (1-strongly disagree to 5-strongly agree).
Results: The average level of satisfaction is: working in the surgical team (M = 2.89), the presence of emotional
stressors (M = 2.68), stressors caused by interpersonal relationships and communication (M = 2.62), financial
stressors (M = 4.07) indicating a high level of stress. Average levels are: physical stressors (M = 3), lack of
education (M = 2.91) and psychological stressors (M = 3.16). The most satisfied are anesthesia residents (M =
3.98), and the least are operating nurses/technicians. Staff who work shifts compared to on-call and on-call staff
are more satisfied with their jobs (t=2.44; P=0.015). Sociodemographic variables interpret 3% of the variance
of the dependent variable of job satisfaction in the surgical team, and with the introduction of stressor variables,
the interpretation increases by 42 percentage points to 45% of the variance. The estimated model containing
sociodemographic variables and stress variables are statistically significant (F=30.53; P<0.001). According to
the estimated model, men are less satisfied with the organization and leadership in the surgical team (P=0.016),
and the introduction of stressors has a statistically significant negative impact of interpersonal relationship
stressors (P<0.001), with financial stressors (P<0.001), physical stressors/physiological changes (P=0.045) and
stressors of lack of education (P<0.001) reducing satisfaction with work in the surgical team. The highest
interpretation of satisfaction with organization and leadership with the corrected effect of other independent
variables was found in stressors of interpersonal relationships and communication (8.41%), and by stressors of
insufficient education (5.29%).Conclusion: The frequency of emotional stressors caused by poor interpersonal
relationships and communication, insufficient education, physical and psychological stressors is expressed in a
moderate degree. The most dissatisfied are the operating nurses/technicians, the most satisfied anesthesia
residents. Greater satisfaction is among staff who work shifts compared to those who work longer. The
relationship between sociodemographic factors and work stressors with job satisfaction indicates that
sociodemographic variables interpret 3% of the variance of job satisfaction, while with the introduction of
stressor variables, the interpretation increases to 45%
Association between HLA variants and Crohn's disease (family study)
No full text: Sustav HLA (engl. H uman L eukocyte A ntigen) je glavni sustav tkivne snošljivosti kod čovjeka. Geni
sustava HLA nalaze se na kraćem kraku kromosoma 6 te se dijele na 3 razreda s pripadajućim lokusima. Razred I
čine lokusi: HLA A, HLA B, HLA Cw i dok gene razreda II čine lokusi HLA DR, HLA DQ, HLA DP. Osobitosti
ovog najsloženijeg genetskog sustava su izraziti polimorfizam, neravnoteža udruživanja, segregacija gena,
crossing over, populacijska specifičnost. Antigeni sustava HLA smatraju se značajnim čimbeni kom u
imunološkom odgovoru te obrani o rganizma. Najznačajniji su faktori u transplantaciji organa kao i u transplantaciji
krvotvornih matičnih stanica, u populacijskoj genetici te sudskoj medicini. Značaj sustava HLA očituje se u
povezanosti s bolestima tj. genetskoj predispoziciji za autoimune bolesti od kojih je najveća povezanost pokazana
s reumatološkim (reumatoidni artritis, psorijatični artritis, ankilozantni spondilitis), gastroenterološkim bo lestima
(celijakija, ulcerozni kolitis, Crohnova bolest) i endokrinološkim bolestima (diabetes m ellitus, Hashimotova
bolest). Cilj ovog rada bio je istražiti povezanost gena HLA s Crohnovom bolešću i time utvrditi njihovu važnost
u dijagnostici i utjecaj na razvoj ove bolesti. Crohnova bolest je kronična, upalna autoimuna bolest crijeva
nepoznate eti ologije koja se očituje različitom skupinom simptoma. Osim genetskih faktora, smatra se da neki
okolišni čimbenici utječu na razvoje bolesti zajedno sa životnim navikama i stresom. U ovom radu prikazana je
obiteljska studija pacijentice s Crohnovom bolesti i članova obitelji, kojima smo molekularnom metodom
PCRSSO (engl. P olymerase C hain R eaction S equence S pecific O ligonucleotides ) odredili alele razreda I i II.
Rezultati ovoga istraživanja su pokazali da sestra koja boluje od Crohnove bolesti nosi haplotip HLA C*04,
DRB*16, DQA1*01, DQB1*05 koji je naslijedila od oca.: The human leukocyte antigen (HLA) system (the major histocompatibility system [MHC] in humans)
is the main system of tissue tolerance in humans. The genes controlling expression of HLA system molecules are
located on chromosome 6 and are divided into 3 classes. Class I is made up of loci: HLA A, HLA B, HLA Cw
while class II consists of HLA DR, HLA DQ and HLA DP loci. Main characteristics of this most complex genetic
system in humans are extreme gene polymorphism, linkeage disequilibrium, gene segregation, crossing over and
population specificity. HLA antigens are one of the most significant factors in solid organ transplantation as well
as hematopoieti c stem cell transplantation. Another major importance of HLA system is shown in clinical
diagnostics specific HLA alelles are linked to autoimmune disorders, with the greatest association shown between
rheumatic (rheumatoid arthritis, psoriatic arthritis , ankylosing spondylitis), gastrointestinal (celiac disease,
ulcerative colitis, Crohn's disease) and endocrine diseases (diabetes mellitus, Hashimoto's disease). The aim of this
paper was to investigate the association of HLA genes with Crohn's disease an d thereby determine their importance
in disease diagnostics and influence on the development of this disease. Chron's disease is a chronic, inflammatory
autoimmune bowel disease of unknown etiology which is manifested by a different group of symptoms. Othe r than
genetic factors, it is believed that some environmental factors influence the development of the disease together
with lifestyle habits and stress. This paper presents a family study of a patient with Crohn's disease and family
members where class I and II alelles were determined with PCR SSO (engl. P olymerase C hain R eaction S equence
S pecific O ligonucleotides) method. The results of this research showed that the sister suffering from Crohn's
disease carries the haplotype HLA C*04, DRB*16, DQA1*01, DQB1*05 inherited from her father.
Keywords
Effectiveness of physiotherapy interventions to reduce spasticity in patients with multiple sclerosis
No full textSpazam mišića je čest neurološki simptom kod pacijenata s multiplom sklerozom, obilježen nevoljnim, brzim i
ponekad bolnim grčevima mišića koji mogu značajno otežati svakodnevno kretanje i funkcioniranje. Liječenje
spastičnosti kod ovih pacijenata zahtijeva sveobuhvatan pristup koji uključuje različite terapijske modalitete.
Fizioterapijske intervencije igraju ključnu ulogu u upravljanju spastičnošću kod multiple skleroze. Usmjerene su na
poboljšanje funkcionalne sposobnosti, smanjenje boli, povećanje opsega pokreta te poboljšanje kvalitete života.
Fizioterapijske intervencije obuhvaćaju širok spektar tehnika kao što su kineziterapija, hidroterapija,
krio/termoterapija, udarni val, terapijski ultrazvuk, terapija vibracijama, robotika, biofeedback, pravilno
pozicioniranje, upotreba ortotike, istezanje, manualne tehnike te specijalizirani pristupi poput Bobath i Vojta terapije
te proprioceptivne neuromuskularne facilitacije. Učinkovitost ovih intervencija može varirati ovisno o individualnim
karakteristikama pacijenta i stadiju bolesti. Stoga je ključno da se svaki pacijent procjenjuje i tretira individualno, uz
personalizirani plan rehabilitacije koji će najbolje odgovarati njegovim specifičnim potrebama i ciljevima liječenja.
Multidisciplinarni pristup, koji kombinira različite terapijske modalitete, pruža najbolje izglede za smanjenje
spastičnosti i značajno poboljšanje kvalitete života pacijenata s multiplom sklerozom.Muscle spasticity is a common neurological symptom in patients with multiple sclerosis, characterized by
involuntary, rapid and sometimes painful muscle spasms that can make daily movement and functioning significantly
more difficult. Treatment of spasticity in these patients requires a comprehensive approach that includes various
therapeutic modalities. Physiotherapy interventions play a key role in the management of spasticity in multiple
sclerosis. They are aimed at improving functional ability, reducing pain, increasing range of motion and improving
quality of life.
Physiotherapy interventions include a wide range of techniques such as kinesitherapy, hydrotherapy,
cryo/thermotherapy, shock wave, therapeutic ultrasound, vibration therapy, robotics, biofeedback, correct
positioning, use of orthotics, stretching, manual techniques and specialized approaches such as Bobath, Vojta therapy
and proprioceptive neuromuscular facilitation. The effectiveness of these interventions may vary depending on the
individual characteristics of the patient and the stage of the disease. It is therefore crucial that each patient is assessed
and treated individually, with a personalized rehabilitation plan that will best suit their specific needs and goals. A
multidisciplinary approach that combines different therapeutic modalities offers the best prospects for reducing
spasticity and significantly improving the quality of life of patients with multiple sclerosis
Association between HLA class I and II variants and pathogenesis of psoriatic arthritis
No full textCilj: Cilj rada je uočiti razlike u zastupljenosti alela kod pacijenata s psorijatičnim artritisom u usporedbi s kontrolnom skupinom te prikazati alele koji se pojavljuju s većom učestalošću kod ispitanika sa PsA.
Materijali i metode: Zbog nepostojanja definitivnih laboratorijskih testova za psorijatični artritis, tipizacija HLA pokazala se od velike koristi s obzirom na asocijaciju PsA s pojedinim alelima sustava HLA. Za određivanje alela lokusa HLA korištene su molekularne metode (PCR-SSO, PCR-SSP) u rutinskom radu na 105 pacijenata poslanih od strane reumatologa.
Rezultati: Usporedbom učestalosti alela lokusa HLA kod pacijenata sa PsA u odnosu na kontrolnu skupinu uočena je povećana učestalost alela HLA-A*32 i HLA-A*02 kod pacijenata. Aleli HLA-B*08, HLA-B*13 i HLA-B*57 pokazuju statistički značajnu učestalost kod pacijenata sa PsA, dok se najučestalijim alelom pokazao alel HLA-C*06 i predstavlja faktor rizika za psorijatični artritis. Različiti rezultati u zastupljenosti alela HLA-DRB1 lokusa mogu biti relevantni za modulaciju kliničke ekspresije.
Zaključak: PsA je klinički heterogena bolest. Dobiveni rezultati ukazuju na složenost sustava HLA koja nije samo temelj i glavna karika u području transplantacijske medicine već zahvaljujući najnovijim metodama molekularne biologije (PCR, NGS) i glavno polazište u određivanju genske predispozicije za niz bolesti. Još uvijek postoji potreba za daljnjim i većim genetskim studijama, unutar i izvan HLA regije, kako bi se došlo do čvršćih zaključaka u vezi psorijatičnog artritisa.Objectives: The aim of the work is to observe the differences in the representation of alleles in patients with psoriatic arthritis compared to the control group and to show the alleles that appear with greater frequency in subjects with PsA.
Material and methods: Due to the lack of definitive laboratory tests for psoriatic arthritis, HLA typing has proven to be of great use considering the association of PsA with certain alleles of the HLA system. To determine the alleles of the HLA locus, molecular methods (PCR-SSO, PCR-SSP) were used in routine work on 105 patients referred by a rheumatologist.
Results: By comparing the frequency of HLA locus alleles in patients with PsA compared to the control group, an increased frequency of HLA-A*32 and HLA-A*02 alleles was observed in patients. The HLA-B*08, HLA-B*13 and HLA-B*57 alleles show a statistically significant frequency in patients with PsA, while the most frequent allele was the HLA-C*06 allele and represents a risk factor for psoriatic arthritis. Different results in the allele representation of the HLA-DRB1 locus may be relevant for the modulation of clinical expression.
Conclusion: PsA is a clinically heterogeneous disease. The obtained results indicate the complexity of the HLA system, which is not only the foundation and the main link in the field of transplant medicine, but thanks to the latest methods of molecular biology (PCR, NGS) and the main starting point in determining the genetic predisposition for several diseases. There is still a need for further and larger genetic studies, within and beyond the HLA region, to reach firmer conclusions regarding psoriatic arthritis