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Clinical evaluation and treatment of patients with papillary renal cell carcinoma
No full textZbog slučajnih otkrića malih bubrežnih tvorbi tijekom abdominalnih pregleda, učestalost raka bubrega danas je u porastu. Papilarni karcinom bubrežnih stanica (pRCC) je drugi najčešći tip karcinoma bubrega. U početnim fazama mnogi pacijenti nemaju simptome, no kasnije mogu imati bolove u lumbalnoj regiji, hematuriju, gubitak težine, noćno znojenje i druge simptome. Rizični čimbenici uključuju pušenje, hipertenziju, pretilost i obiteljsku povijest raka te različite stadije bubrežne disfunkcije. Morfološka klasifikacija pRCC-a je izazovna zbog postojanja mješovitih tumora tipa 1 i 2. PRCC1 povezan je s prekomjernom ekspresijom MET gena i obično ima indolentan tijek. S druge strane, tip 2 manje je povezan s MET mutacijama i ima lošiju prognozu. S obzirom na češće otkrivanje manjih tumora, preferiraju se nefron-poštedne operacije. Parcijalna nefrektomija je preporučena metoda za lokalizirani pRCC. Kod metastatskog pRCC-a prognoza je lošija. Terapija citokinima pokazala se manje učinkovitom pa je imunoterapija zamijenjena ciljanim lijekovima poput cabozantiniba, koji se sada preporučuje kao terapija prvog izbora. Kombinacija lenvatiniba i pembrolizumaba, te cabozantiniba i nivolumaba, pokazale su visoku učinkovitost, a pembrolizumab je doveo do dugoročnog preživljenja kod određenih pacijenata. EAU smjernice za 2025. godinu preporučuju cabozantinib, dok se imunoterapijske kombinacije mogu razmotriti u specifičnim slučajevima, osobito kod pacijenata s MET-alteracijama i dobrom općom prognozom. U ovome radu su prikazane postojeće spoznaje o pRCC-u te specifičnosti u odnosu na druge podtipove RCC-a.Due to the incidental discovery of small renal masses during abdominal examinations, the incidence of kidney cancer is increasing. Papillary renal cell carcinoma (pRCC) is the second most common type of kidney cancer. In the early stages, many patients are asymptomatic, but later they may present with lower back pain, hematuria, weight loss, night sweats, and other symptoms. Risk factors include smoking, hypertension, obesity, and a family history of cancer, as well as varying degrees of renal dysfunction. Morphological classification of pRCC is challenging due to the existence of mixed types 1 and 2 tumors. PRCC1 is associated with overexpression of the MET gene and usually has an indolent course. On the other hand, type 2 is less associated with MET mutations and has a worse prognosis. Given the more frequent detection of smaller tumors, nephron-sparing surgeries are preferred. Partial nephrectomy is the recommended method for localized pRCC. Metastatic pRCC has a worse prognosis. Cytokine therapy proved less effective, so immunotherapy was replaced by targeted drugs such as cabozantinib, which is now recommended as first-line therapy. The combination of lenvatinib and pembrolizumab, and cabozantinib and nivolumab, have shown high efficacy, with pembrolizumab leading to long-term survival in certain patients. The 2025 EAU guidelines recommend cabozantinib, while immunotherapy combinations may be considered in specific cases, especially in patients with MET-alterations and a good overall prognosis. This paper presents the current knowledge about pRCC and its specificities in relation to other subtypes of RCC
Comparison of the Use of Long-Acting and Oral Antipsychotics in the Treatment of the First Psychotic Episode at the Emergency Department of Psychiatry in the Clinical Hospital Rijeka in the Period 2020–2024 and the Rate of Relapse
No full textPrva psihotična epizoda predstavlja kritičnu prekretnicu u liječenju psihotičnih poremećaja, budući da rana i optimalna antipsihotička intervencija može dugoročno poboljšati kliničke ishode te smanjiti učestalost relapsa. U uvodnom dijelu rada razmotreni su psihotični poremećaji te njihova etiologija i dijagnostika s naglaskom na akutne psihotične poremećaje, mehanizmi djelovanja antipsihotika, izazovi vezani uz adherenciju kod peroralnih pripravaka i komplikacije nepravilnog uzimanja lijekova, kao i prednosti dugodjelujućih formulacija koje pružaju stabilniju razinu lijeka u plazmi i smanjuju fluktuacije koncentracije. Pregled literature naglašava važnost prilagodbe terapije profilu nuspojava i farmakokinetičkim svojstvima, pri čemu dugodjelujuće injekcije omogućuju veću kontrolu tretmana i potencijalno poboljšavaju kvalitetu života bolesnika. Ciljevi su bili retrospektivno ispitati razlike u primjeni dugodjelujućih naspram peroralnih antipsihotika i povezanost s relapsom te utjecaj spola na izbor i opću primjenu antipsihotika kod pacijenata s prvom psihotičnom epizodom. Kod 369 bolesnika hospitaliziranih na Zavodu za urgentnu psihijatriju KBC Rijeka u razdoblju od 2020. do 2024. godine, 72 % je primilo peroralne antipsihotike, a 28 % dugodjelujuće formulacije. Rezultati su pokazali ukupnu stopu relapsa od 22,8 %, bez statistički značajne razlike između oralne (24,1 %) i dugodjelujuće terapije (19,4 %), niti unutar spolnih podskupina. Žene su češće liječene dugodjelujućim aripiprazolom i peroralnim pripravcima, dok su muškarci češće primali dugodjelujuće pripravke općenito, a uz dugodjelujući aripiprazol primali su i dugodjelujući paliperidon, haloperidol i flufenazin. Rasprava ukazuje na prednosti dugodjelujućih antipsihotika u poboljšanju adherencije i moguće smanjenje relapsa, uz ograničenja retrospektivnog dizajna, heterogenosti uzorka i neujednačenog praćenja. Zaključci podupiru potrebu za prospektivnim, multicentričnim studijama s ujednačenim i produljenim praćenjem.The first psychotic episode represents a pivotal turning point in the management of psychotic disorders, given that early and optimal antipsychotic intervention can enhance long-term clinical outcomes and reduce relapse frequency. The introduction of this study examines psychotic disorders, their etiology, and diagnostic approaches, with a particular focus on acute psychotic disorders. It also explores the mechanisms of action of antipsychotics, challenges related to adherence with oral formulations, improper medication intake complications, and the advantages of long-acting injectable formulations that provide more stable plasma drug levels and minimize concentration fluctuations. A literature review emphasizes the importance of tailoring therapy to side effect profiles and pharmacokinetic properties, highlighting that long-acting antipsychotics offer greater treatment control and may improve patients' quality of life. The study aimed to retrospectively assess differences in the use of long-acting versus oral antipsychotics, their association with relapse rates, and the influence of sex on the selection and overall application of antipsychotics in patients experiencing their first psychotic episode. Among 369 patients hospitalized at the Department of Emergency Psychiatry, Clinical Hospital Center Rijeka, between 2020 and 2024, 72% received oral antipsychotics, while 28% were administered long-acting formulations. The overall relapse rate was 22.8%, with no statistically significant difference between oral (24.1%) and long-acting therapy (19.4%), nor within sex subgroups. Female patients were more frequently treated with long-acting aripiprazole and oral formulations, whereas male patients more commonly received long-acting formulations in general, including long-acting aripiprazole, paliperidone, haloperidol, and fluphenazine. The discussion highlights the benefits of long-acting antipsychotics in enhancing adherence and potentially reducing relapse rates, while acknowledging limitations such as the retrospective study design, sample heterogeneity, and inconsistent follow-up. The conclusions support the need for prospective, multicenter studies with standardized and extended follow-up periods
The role of professional ethics in pharmacy management: challenges and solutions
No full textUpravljanje ljekarnama u suvremenom zdravstvenom sustavu suočeno je s brojnim izazovima koji nadilaze operativno poslovanje, a jedan od ključnih aspekata predstavlja profesionalna etika. Etika u ljekarničkoj praksi ne utječe samo na kvalitetu pružanja zdravstvenih usluga, već i na povjerenje pacijenata, zadovoljstvo zaposlenika te ugled same ustanove. U kontekstu povećanih zahtjeva tržišta, pritisaka vezanih uz financijsku isplativost te očekivanja zajednice, profesionalna etika postaje temelj održivog i odgovornog poslovanja u ljekarništvu. Ljekarne su mjesta gdje se svakodnevno susreću interesi pacijenata, zdravstvenih djelatnika i menadžmenta, što otvara prostor za različite etičke dileme i izazove. Cilj istraživanja bio je ispitati kako zaposlenici i korisnici ljekarni percipiraju etičke norme u svakodnevnom poslovanju, koliko su zaposlenici osposobljeni za prepoznavanje i rješavanje etičkih dilema, te u kojoj mjeri menadžment podržava i provodi etičke vrijednosti u okviru organizacijskog upravljanja. Istraživanje je provedeno na području Bjelovarsko-bilogorske županije putem anketnog upitnika na uzorku zaposlenika i korisnika ljekarni. Podaci su obrađeni i analizirani pomoću deskriptivne statistike i osnovnih korelacijskih analiza. Upitnik je sadržavao tvrdnje koje su ispitivale percipiranu prisutnost etike u poslovanju, ulogu menadžmenta, učestalost etičkih dilema, kao i potrebu za dodatnim edukacijama. Rezultati istraživanja pokazuju kako većina zaposlenika smatra da profesionalna etika ima važnu ulogu u svakodnevnom radu, ali ističu da u njihovim ustanovama često nedostaje formaliziranih etičkih smjernica i edukacija. Nadalje, značajan udio ispitanika navodi da ne dobiva sustavnu podršku menadžmenta kada se nađu u etički složenim situacijama. S druge strane, korisnici ljekarni prepoznaju važnost etičnog ponašanja zaposlenika i smatraju da ono izravno utječe na njihovo povjerenje i zadovoljstvo. No, gotovo polovica korisnika uočava razlike u pristupu i razini etičnosti među različitim ljekarnama, što upućuje na nedostatak standardiziranih praksi. Zaposlenici izražavaju visoku razinu interesa za edukacije vezane uz profesionalnu etiku, a osobito ističu potrebu za praktičnim smjernicama u rješavanju etičkih dilema te veću uključenost stručnih tijela i vodstva u etička pitanja. Osim toga, rezultati pokazuju da zaposlenici koji smatraju da njihova ljekarna promovira etičke vrijednosti, iskazuju i veći osjećaj profesionalnog zadovoljstva. Zaključno, istraživanje ukazuje na potrebu sustavnog uvođenja etičkih normi u upravljanje ljekarnama, uključujući edukacije, razvoj internih etičkih protokola i jačanje etičkog liderstva menadžera. Etičko ponašanje ne smije biti prepušteno samo individualnoj savjesti zaposlenika, već mora biti integrirano u organizacijsku kulturu i upravljačke strategije ljekarni
Effects of Implementing an ICU Discharge Readiness Checklist on Patient Safety Culture: A Quasi-Experimental Research Study
No full textBackground: Discharging patients from intensive care units (ICUs) poses significant risks for adverse events (AEs), contributing to hospital morbidity and mortality. To mitigate premature transitioning, an ICU discharge readiness checklist (ICU-DRC) was developed. Enhanced patient safety culture (PSC) is crucial for reducing AEs and improving outcomes. Given the pressing need to enhance PSC in ICUs, this study evaluates the impact of ICU-DRC implementation on PSC, aiming to address a critical gap in quality improvement. Methods: A prospective quasi-experimental study assessed PSC before and after a year-long ICU-DRC intervention at Merkur Clinical Hospital in Zagreb, Croatia. Healthcare providers from two distinct ICUs participated voluntarily in the Hospital Survey on Patient Safety Culture. The surgical ICU, where the intervention was applied, employed 106 providers, while the medical ICU, which did not implement the intervention, had 42 providers. Results: Initial response rates were 58% for the intervention group and 45% for the control group, with post-intervention rates of 53% and 48%, respectively. The ICU-DRC was utilized with a fidelity of 65.7%. Due to the non-normal distribution found for most variables, non-parametric analytical procedures were applied. In baseline measurements, the control group outperformed the intervention group in three out of fourteen PSC dimensions. Post-intervention, PSC scores in the intervention group significantly improved in one dimension, whereas three dimensions in the control group showed significant declines, resulting in superior PSC outcomes for four dimensions in the intervention group during the second measurement. Conclusions: Applying the ICU-DRC as an isolated safety intervention aimed at optimizing ICU patient throughput resulted in observable patterns of improvement in several PSC dimensions, with statistically significant changes in specific areas
Environmental aspects of sea pollution with oils from ships
No full textU ovom radu se objašnjavaju ekološki aspekti onečišćenja mora uljem ujedno se tumači i sastav ulja i njegove glavne karakteristike. Onečišćenje mora uljem predstavlja ozbiljan ekološki problem koji nastaje kao rezultat nekontroliranog ispuštanja nafte ili naftnih derivata u morski okoliš. Ovakva onečišćenja mogu imati ozbiljne posljedice na morski ekosustav, ugrožavajući morske organizme, ptice, biljke i ukupnu biološku raznolikost. Opisuju se i navode glavne međunarodne organizacije i propisi u slučaju onečišćenja mora uljem. Temeljna tema diplomskog rada je sama konstrukcija tankera koji mora biti građen po svim zakonima i pravilima konvencija i klasifikacijskim društava koje se brinu o sigurnosti u plovidbi i sprječavanju onečišćenja mora.This work explains the ecological aspects of oil pollution in the sea while also interpreting the composition of oil and its main characteristics. Oil pollution in the sea represents a serious environmental problem that arises as a result of uncontrolled release of oil or oil derivatives into the marine environment. Such pollution can have severe consequences on the marine ecosystem, endangering marine organisms, birds, plants, and overall biodiversity. The main international organizations and regulations in the case of oil pollution in the sea are described and referenced. The central theme of the graduation thesis is the construction of oil tankers, which must be built in accordance with all laws, conventions, and classification societies that ensure safety in navigation and prevention of sea pollution
Disease Characteristics and Treatment Outcomes of Myeloma Patients Under 50 Years of Age: An Analysis of the Balkan Myeloma Study Group
No full textYounger multiple myeloma (MM) patients, representing 10% of cases, show distinct clinical features, including lower anemia and renal impairment rates but higher lytic bone disease and adverse cytogenetics. Retrospective analysis reveals better complete response and survival outcomes, with median OS exceeding 15 years. Key prognostic factors include anemia and high-risk cytogenetics, while autologous stem cell transplantation significantly improves outcomes, highlighting the importance of tailored, intensive treatment strategies. Background: Multiple myeloma (MM) is predominantly a disease of the elderly, but approximately 10% of patients are younger than 50 years at diagnosis. Methods: This study aimed to investigate the clinical characteristics, treatment outcomes, and prognostic factors in younger MM patients using retrospective data from the Balkan Myeloma Study Group registry. Results: A total of 350 patients under 50 years old were included, comprising 10.4% of the overall cohort. The study found that younger patients had lower rates of renal impairment and anemia but a higher incidence of lytic bone disease and adverse cytogenetics. Treatment regimens, including proteasome inhibitors and immunomodulatory agents, were comparable between younger and older patients, but younger patients had significantly better complete response rates and overall survival (OS). The 5- and 10-year OS rates were 76% and 64%, respectively, with a projected median OS exceeding 15 years. Factors such as anemia, hypercalcemia, and high-risk cytogenetics were associated with worse survival outcomes. Autologous stem cell transplantation (ASCT) emerged as a key contributo
Circular waste management model based on the example of the sorting plant of the municipal company Eko-Murvica d.o.o.
No full textDruštvo postaje svjesno promjena na planetu te kako problemi poput globalnog zatopljenja i nejednakosti postaju izraženiji. To utječe na svijest o tome što će generacije današnjice ostaviti budućim generacijama. Ovi izazovi zahtijevaju nove pristupe u osiguravanju ravnoteže između ekonomskog rasta, društvenog blagostanja i zaštite okoliša. Države članice Ujedinjenih naroda usvojile su program održivog razvoja sa svrhom zaštite planeta i poboljšanja kvalitete života. Zakonom o gospodarenju otpadom propisuju se mjere za ostvarenje ciljeva Europskog zelenog plana i Akcijskog plana za kružno gospodarstvo. Kružnim gospodarenjem otpadom resursi se vraćaju u ponovnu upotrebu, a proces je uspješan uz selektivno sortiranje frakcija prikladnih za oporabu putem sortirnica. Poduzeće Eko-Murvica d.o.o. zbog nepostojanja uvjeta za manipulaciju miješanim komunalnim otpadom ima visoke troškove zbrinjavanja. Oni će i u budućnosti opterećivati lokalne proračune, poslovanje i korisnike, ne izgrade li se održivi sustavi. Osim toga, sadašnji sustav negativno utječe na okoliš, što nije u skladu s društveno odgovornim poslovanjem. Ovim radom analizira se utjecaj projekta izgradnje sortirnice na održivo gospodarenje otpadom poduzeća Eko-Murvica d.o.o., uključujući pozitivne učinke na okoliš, financije i društvo
The forgotten third: understanding the ACL femoral insertion and lateral intercondylar ridge extension onto the notch roof
No full textPurpose This study assesses the positioning of the lateral intercondylar ridge (LIR) and the anterior cruciate ligament (ACL)
femoral insertion area (FIA) in relation to the femoral notch roof and the lateral notch wall and examines its correlation with
the width of the posterior notch outlet.
Method 45 dried femurs underwent 3D scanning. A cutting plane was established to divide the intercondylar roof from the
condylar wall based on three points. The length of the LIR on the roof and wall were measured, along with the distances from
key landmarks. The total ACL-FIA and the areas on the roof and wall of the intercondylar notch were measured.
Results A significant correlation was found between the LIR position on the roof and the width of the notch. LIR averaged
16.18 mm, with 30.86% on the roof, while ACL-FIA averaged 134.19 mm², with 31.55% on the roof. The width of the
posterior notch outlet was averaged at 24.34 mm. The distance between the most proximal part of the LIR and the posterior
intercondylar line averaged 4.87 mm and 12.46 mm to the most proximal and deepest point of the cartilage border of the
lateral femoral condyle.
Conclusion This study confirms that approximately 30% of the LIR and ACL-FIA extend to the intercondylar notch roof,
with a significant moderate positive correlation with the width of the posterior notch outlet. These findings highlight the
need to consider the notch roof in the placement of the femoral tunnel for improved anatomical reconstruction of the ACL
Gledati svijet kako se kreće. Kratka proza Osvalda Ramousa
No full textKnjiga nudi uvid u kratku prozu Osvalda Ramousa, jednog od najznačajnijih riječkih književnika na talijanskom jeziku 20. stoljeća. Kroz tematski i kontekstualni pregled njegovih pripovijetki, djelo otkriva slojevitost Ramousova opusa kao i svu složenost njegova pripovijedanja kroz koje promišlja o položaju suvremenog čovjeka, njegovim unutarnjim sukobima i fragmentacijama, ali i o ulozi umjetnosti kao mosta između realnog i imaginarnog
Authenticity assessment of honeydew honey based on phytochemical profile
No full textConsidering the health-beneficial properties of honeydew honey and difficulties in its authenticity assessment, a high-performance thin-layer chromatography (HPTLC) fingerprint method in combination with multivariate analysis was developed, in order to relate phenolic profiles of selected honey samples to their verified botanical origin and biological activity. The HPTLC chromatograms were obtained using two derivatization reagents, vanillin-sulfuric acid and 2,2-diphenyl-1-picrylhydrazyl (DPPH) solution. Phenolic profiles of samples indicated the uniformity within each honey variety, but also variability among different botanical origin. Chemometric evaluation, including principal component analysis and partial least squares discriminant analysis, hyphenated with chromatographic method provided a discriminative and predictive methodology for classification of Hungarian oak, Evergreen oak, Montpellier maple and Silver fir honey samples. The analysis highlighted the significance of specific phenolic compounds (e.g., RF = 0.31, 0.41, 0.51) for distinguishing the samples, underscoring the potential for accurate botanical authentication of samples, particularly Hungarian oak honey, based on its chemical profile. The HPTLC-DPPH method demonstrated a high potential for differentiating samples based on antioxidant activity, offering an efficient alternative to other techniques for antioxidant activity determination. PLS-DA models successfully predicted the botanical origin of Quercus spp., Evergreen oak and Hungarian oak. This approach can be useful for ensuring the quality control of honeydew honey products, providing an efficient and resource-saving alternative to more advanced analytical techniques. Additionally, caffeic acid emerged as the most potent antioxidant across the selected honeydew honey varieties. This highlights the potential of caffeic acid as a key bioactive compound contributing to the health-promoting properties of honeydew honey