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Obesity: risk factor and predictor of osteoarthritis
No full textOsteoartritis (OA) najčešća je zglobna bolest razvijenog svijeta i glavni je uzrok kronične onesposobljenosti, većinom kao posljedica OA koljena i/ili kuka. Unatoč neprepoznavanju točnog uzroka više je studija pokazalo da je prekomjerna tjelesna težina jedan od najvažnijih čimbenika rizika, a i prediktor je progresije OA ponajprije koljenskog zgloba, u manjoj mjeri zgloba kuka. Odnos indeksa tjelesne mase (BMI) i OA koljena uglavnom je linearan, a značajni su trajanje povećanog opterećenja i dobivanje na tjelesnoj težini. Studije povezanost debljine i OA šaka su kontradiktorne, dok se čini da je gradijent rizika između tjelesne težine i OA kuka negdje između onog za koljena i šake. Onesposobljenost se može značajno ublažiti ako se tjelesna težina smanji za više od 5,1%. Dvadeset sedam posto slučajeva ugradnje endoproteze kuka i 69% endoproteze koljena može se pripisati debljini. Nefarmakološko liječenje OA uključuje i liječenje debljine.Osteoarthritis (OA) is the most common articular disease of the developed world and a leading cause of chronic disability, mostly as a consequence of the knee OA and/or hip OA. In spite of misrecognition of the exact cause, a number of studies have shown that obesity represents one of the most important risk factors and it is also a predictor for progression of OA, especially of a knee joint and less of the hip joint. Relationship between body mass index (BMI) and OA of the knee is mainly linear, and duration of increased joint loading or gaining weight is also significant. Studies about obesity and hand OA are contradictory. Risk gradient for BMI and the hip OA is somewhere between the knee and the hand gradient. Disability may be significantly relieved if a body weight is decreased for more than 5.1%. Twenty seven percent of cases of hip arthroplasty and 69% knee arthroplasty may be attributed to obesity. Nonpharmacologic treatment of OA includes treatment of obesity
Chronic leg ulcer - etiology, treatment and reconstruction
No full textNajčešći uzrok kroničnog vrijeda potkoljenice je kronična venska insuficijencija i periferna arterijska bolest. Kronična venska insuficijencija podrazumijeva valvularnu inkompetenciju s opstrukcijom venskog odtoka ili bez nje, koja zahvaća površinski ili duboki venski sustav zajedno s perforantnim venama. Periferna arterijska bolest je opstruktivno-okluzivna bolest donjih ekstremiteta koja značajno reducira normalan protok krvi. Oba patološka supstrata dovode do promjena mikrocirkulacije s posljedičnim kroničnim potkoljeničnim vrijedom. Razumijevanje patofiziologije koja dovodi do pojave vrijeda potkoljenice čini okosnicu liječenja bez obzira na etiološki čimbenik. Atraumatski striping površinskih vena uz mikroflebektomiju standardni je postupak liječenja kronične venske insuficijencije. Okluzijski postupci kao što su RFA, EVLT, te endoskopsko podvezivanje perforantnih vena (SEPS) &ine novije zahvate na površinskom venskom sustavu. Dobrom selekcijom bolesnika i pravilnim odabirom supraingvinalnih i infraingvinalnih oblika revaskularizacije moguće je postići višegodišnju prohodnost revaskulariziranih krvnih žila. Uz poznavanje dijagnostike i odgovarajućeg kirurškog liječenja uzroka vrijeda potrebno je i poznavanje rekonstrukcijskih modaliteta defekta koji nastaje nakon obavezno učinjenog debridmana. U obzir dolazi pokrivanje defekta slobodnim kožnim transplantatom, lokalnim fasciokutanim i mišićnim režnjevima, kao i slobodnim fasciokutanim, kutanim i mišićno-kutanim odnosno mišićnim režnjevima. Postoje i drugi oblici tretiranja defekata primjenom negativnog tlaka, posebnih obloga, hiperbarične oksigenoterapije kao i primjene zamjenskih oblika kožnog pokrova.The leading causes of chronic leg ulcers are chronic venous insufficiency and peripheral arterial disease. Chronic venous insufficiency is based on superficial or deep venous system dysfunction with valvular incompetency. Peripheral arterial disease is obstructive arterial disease of lower extremities reducing normal arterial flow. Both chronic venous insufficiency and peripheral arterial disease have functional derangements associated with chronic ulcer formation. Understanding of the ulcer formation pathophysiology is a basis for appropriate treatment and healing. Atraumatic stripping of superficial vein and microphlebectomy is a standard treatment for superficial venous insufficiency followed by endovenous radiofrequency ablation (REA), endovenous laser ablation treatment (EVLT) and subfascial endovascular perforator stripping (SEPS). A significant patency rate of revascularized arteries can be achieved by good selection of suprainguinal and infrainguinal revascularization modalities. With all the diagnostic modalities available, proper patient selection for the appropriate sur- gical treatment can be made, considering a host of knowledgeable reconstructive possibilities that follow after adequate surgical debridement. These include split thickness skin graft, local fasciocutaneous and muscle flaps, and fasciocutaneous, cutaneous and muscle free flaps as well. Other modalities of treatment include topical negative pressure treatments, special dressings, hyperbaric oxygen therapy and advanced tissue replacement possibilities
Život s reumatologijom: knjiga uputa i savjeta svima onima koji se žele baviti reumatologijom, granom medicine koja sve više osvaja svijet
Get PDFInfluence of ATII Blockers and Calcium Channel Blockers on Renal Vascular Resistance in Patients with Essential Hypertension
No full textDoppler can evaluate renal vascular resistance, and resistance index (RI) highly correlates with blood pressure and renal function in various pathological conditions. Purpose of the study was to measure and compare renal Doppler indices in patients with newly-diagnosed essential hypertension (EH) and in healthy subjects; to determine changes of Doppler indices in patients after six-months monotherapy with either the AT II blocker (valsartane) or calcium channel blocker (niphedipine); to determine which drug has better renoprotective effect. 65 healthy controls were examined, as well as 69 patients with the newly-diagnosed EH, without signs of the target organ damage. Duplex Doppler US of interlobar intrarenal arteries was performed, and RI, acceleration index (AI) and acceleration time (AT) measured. Antihypertensive monotherapy was performed with vaslartane in 34 patients and with niphedipine in 35 patients. Doppler was repeated after the six-months therapy. RI in patients with the 1. stage of EH is significantly higher compared to the controls (p<0.001), and significantly lower compared to the stage 2. of EH (p<0.001). The significant decrease of systolic (p<0.001) and dyastolic blood pressure (BP) (p<0.001) was noted after the therapy. RI in healthy examinees (RI=0.59±0.023) is significantly lower than in EH (RI=0.66±0.26) (p<0.001), while AI is significantly higher (p<0.001), and AT is significantly lower (p<0.001). In patients treated with valsartane and those treated with niphedipine, the RIs are significantly lower than before (p<0.001), while AIs were significantly higher, and ATs were significantly lower after the therapy after the therapy with both drugs. RIs in patients treated with valsartane (RI = 0.615 ± 0.036) are significantly lower than RIs of patients treated with niphedipine (RI=0.642±0.030) (p<0.01) after therapy. Regression analysis for the predictive values of RI, AT, AI in relation to the age-standardized values of systolic and diastolic BP of healthy examinees and patients with hypertension has demonstrated that RI is the strongest and statistically significant predictor in all groups of examinees. Six-months monotherapy of EH with valsartane or with niphedipine is equally efficient in the decrease of the blood pressure, but valsartane has more favourable effect on kidney. Resistance index measured in intrarenal arteries is the best parameter of Doppler spectrum in the evaluation of the effects of antihypertensive therapy on the kidney
The reliability and validity of a croatian version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with ankylosing spondylitis
No full textCilj rada je bio utvrditi pouzdanost i valjanost hrvatske inačice Bath funkcijskog indeksa za ankilozantni spondilitis (Bath Ankylosing Spondylitis Functional indeksa - BASFI) i Bath indeksa aktivnosti bolesti za ankilozantni spondilitis (Bath Ankylosing Spondylitis Disease Activity indeksa - BASDAI) u bolesnika s ankilozantnim spondilitisom (AS).
U istraživanju su sudjelovali bolesnici s potvrđenom dijagnozom AS-a i to 52 bolesnika za ocjenu BASFI, a 48 bolesnika za ocjenu BASDAI upitnika. Prijevod upitnika je napravljen prema međunarodno prihvaćenim smjernicama. Za ocjenu pouzdanosti bolesnici su ispunili upitnik sljedeći dan. U cilju ocjene valjanosti upotrijebljeni su sljedeći parametri: pokretljivost kralježnice u sagitalnoj ravnini, indeks disanja, sedimentacija eritrocita, vrijednost serumskog C-reaktivnog proteina, jačina boli i bolesnikova globalna ocjena. Osim deskriptivne statistike, u statističkoj analizi je korišten Spearmanov rho koeficijent korelacije.
Korelacija između rezultata BASFI i BASDAI upitnika je bila 0,621. Srednja vrijednost za BASFI u dva navrata (unutar 24 sata) bila je 4,82±2,67 odnosno 4,88±2,52 (r=0,961; p<0,01), dok je za BASDAI iznosila 5,46±2,30 odnosno 5,32±2,19 (r=0,959; p<0,01). Indeks stabilnosti za oba upitnika bio je 0,98. Visoka korelacija je utvrđena za svako ponovljeno pitanje BASFI i BASDAI upitnika. Za oba upitnika kongruentna valjanost je pokazala najbolju korelaciju s pokretljivosti vratne i prsne kralježnice. Također, nađena je korelacija BASFI vrijednosti sa pokretljivosti slabinske kralježnice i BASDAI sa stupnjem boli.
Naši nalazi pokazuju da je hrvatska inačica BASFI i BASDAI upitnika pouzdana i valjana. Stoga, može se koristiti u kliničkim istraživanjima, kao i u kliničkoj praksi.The aim of the study was to investigate the reliability and the validity of the Croatian version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in patients with ankylosing spondylitis (AS).
Patients with established diagnosis of AS participated in the study. Fifty-two and 48 patients were included for the evaluation of BASFI and BASDAI, respectively. For translation international translation steps were followed. For reliability patients recompleted both indices on the following day. To assess validity following parameters were obtained: spinal mobility in sagittal plane, chest expansion index, erythrocyte sedimentation rate, serum C-reactive protein, level of pain and patient’s global health. Apart from descriptive statistics Spearman’s rho coefficient was used.
Correlation between BASFI and BASDAI score was 0.621. The mean BASFI scores on two occasions (within 24 hours) were 4.82±2.67 versus 4.88±2.52 (r=0.961; p<0.01), and for BASDAI scores were 5.46±2.30 versus 5.32±2.19, respectively (r=0.959; p<0.01). Stability index for both indices was 0.98. High correlation was found for each repeated question of BASFI and BASDAI. For both indices congruent validity demonstrated the best correlation with cervical and thoracic mobility. Also, the correlation was observed for BASFI with spinal mobility in lumbar region and with chest expansion index, and for BASDAI with the level of pain.
Our findings indicate that Croatian version of BASFI and BASDAI is reliable and valid. Therefore, it can be used in clinical research as well as in clinical practice
Combined megaloblastic and immunohemolytic anemia associated - case report
No full textA 55-year-old female with a history of psychosis and rheumatoid arthritis was admitted to the hospital for fatigue and dizziness. At admission, macrocytic anemia, high serum lactic acid dehydrogenase (LDH) and gastrin concentrations, decreased serum vitamin B concentration, with macroovalocytes and poikilocytes in peripheral blood smear suggested the diagnosis of pernicious anemia. Indirect antiglobulin test (IAT) was negative. Surprisingly, treatment by vitamin B and folic acid administered for two weeks was ineffective and followed by transitory worsening of hemoglobin concentration on day 8. Repeat direct antiglobulin test (DAT) and IAT were positive. This immunotransfusion conversion, suggesting the presence of autoimmune hemolytic anemia, could be explained by change in the macroblastic erythrocyte population, i.e. emerging red cells with completely exposed membrane antigens due to vitamin B treatment and/or higher degree of dysregulation of the lymphocyte clone secreting erythrocyte autoantibodies. We proposed the coexistence of pernicious and autoimmune hemolytic anemia; therefore, methylprednisolone was added to vitamin B treatment. This therapy successfully improved hemoglobin and erythrocyte concentration. Although megaloblastic-pernicious anemia is a common disease, association of pernicious and autoimmune hemolytic anemia with two mechanisms of hemolysis (ineffective erythropoiesis and immune mechanism) is a rare condition, with only several dozens of cases described so far
Nitric Oxide Synthesis in Placenta is Increased in Intrauterine Growth Restriction and Fetal Hypoxia
No full textIn order to study the possible role of nitric oxide (NO) in the human placenta, we measured the concentration of its stable Metabolite nitrite (NO₂ –) in the placentas of women with normal pregnancies and those from pregnancies complicated by Intrauterine growth restriction (IUGR) with or without fetal hypoxia. We have measured nitrites by the Griess reaction in 15 placentas from IUGR pregnancies and 12 controls. Cerebroumbilical ratio (C:U) was recorded by color Doppler ultrasound and values below 1 were considered to be a predictor for fetal hypoxia. NO₂ – levels measured in pathological placentas were increased for at least 93 % as compared to control. Subjects from pregnancies complicated by IUGR and fetal hypoxia had increased NO₂ – as compared to the placentas from pregnancies with IUGR and normal fetal oxygenation. NO production in placenta is increased in pregnancies with IUGR. This effect is more pronounced in those with compromised fetal oxygenation
Dental extractions in patients taking anticoagulant therapy
No full textBolesnici koji imaju određenu oralnu antikoagulantnu terapiju zbog prevencije ili liječenja kardiovaskularnih bolesti, česti su pacijenti u stomatološkim ambulantama te se uglavnom neodgovarajuće tretiraju ili čak upućuju oralnom kirurgu i za jednostavne zahvate. Nakon ekstrakcije teoretski postoji minimalan rizik od produljenog krvarenja, no prekidom terapije rizik može biti znatno veći zbog moguće trombembolije. Vađenje zuba može se obaviti bez prekida protuzgrušavajuće terapije, ako se primijene lokalne mjere hemostaze pomoću želatinoznih spužvi, šavovima i/ili ispiranjem usne šupljine traneksamičnom kiselinom, što sprječava produženo krvarenje. U istraživanju je sudjelovalo 16 pacijenata na oralnoj kumarinskoj antikoagulantnoj terapiji kod kojih je bilo potrebno obaviti ekstrakciju zuba i zaostalih korijenova. Bili su raspoređeni u tri skupine prema vrijednosti protrombinskog vremena (PV-a) izraženog kao INR (International Normalized Ratio). Produljeno postekstrakcijsko krvarenje spriječeno je želatinoznom spužvom (Gelatamp®) i 4,8-postotnom vodenom otopinom traneksamične kiseline (Cyklokapron®) koja se koristila za ispiranje usne šupljine. Od ukupno 16 ispitanika s prosječnim vremenom krvarenja od 3,75 ± 1,05 min i terapeutskim vrijednostima INR-a (≤ 3,0), te primjenom mjera lokalne hemostaze, samo je dvoje naknadno krvarilo, što je zaustavljeno postavljanjem šavova.Patients who are taking oral anticoagulation therapy to prevent or treat their cardiovascular diseases, are often patients in dental offices. Usually, there are incongruously treated, or sent for simple interventions or dental procedures to oral surgeon. There is a theoretical risk of bleeding after dental surgery in patients at therapeutic levels of anticoagulation, however it is minimal, and may be greatly outweighed by the risk of thromboembolism upon anticoagulant therapy withdrawal. Thus, dental extractions can be performed without modification or interruption of oral anticoagulant therapy. In most patients local hemostasis with gelatin sponge, sutures and/or mouthwash with tranexamic acid is sufficient to prevent postoperative bleeding. Sixteen patients taking oral coumarin anticoagulant therapy and undergoing dental extractions took part in this study. Three groups of patients were performed according to therapeutic prothrombin time which was declared as International Normalization Ratio (INR). Extensively postoperative bleeding was prevented with gelatine sponge (Gelatamp ®) and 4.8 % tranexamic acid mouthwash (Cyklokapron®). Among sixteen patients with average bleeding time of 3.75 ± 1.05 minutes and INR values inside therapeutic range (<3.0), only two of them had short episodes of delayed bleeding. It was stopped by placing a suture over extraction wound
Main Function for Hospital Libraries
Get PDFBolničke knjižnice su specijalne medicinske knjižnice u sastavu zdravstvenih ustanova (bolnica ili kliničkih ustanova) ili biomedicinskih instituta i zavoda. U skupinu medicinskih knjižnica ubrajaju se i visokoškolske knjižnice u sastavu biomedicinskih fakulteta. Danas u Hrvatskoj djeluje 28 specijalnih medicinskih knjižnica te 8 visokoškolskih biomedicinskih knjižnica. Autorica se osvrće na fond i vrste korisnika ovih knjižnica, te navodi razloge i primjere iz prakse, koji pokazuju zbog čega je za ovu vrstu knjižnica potrebna dobro organizirana matična služba. Između ostalog, to su pitanje otpisa i revizije građe, organizacija depozitarne knjižnice za stariju tiskanu građu, prikupljanje podataka za skupni katalog na razini Hrvatske, informatizacija i zajednički knjižnični program, stalno stručno usavršavanje knjižničara, status knjižničara u zdravstvenoj ustanovi, donošenje standarda za specijalne knjižnice, itd. Potrebe ovih knjižnica u smislu matične djelatnosti slične su potrebama visokoškolskih knjižnica - na prvoj razini matičnu djelatnost treba obavljati Nacionalna i sveučilišna knjižnica (NSK), a na drugoj razini matična se služba treba organizirati pri sveučilišnim knjižnicama (za područje Zagrebačkog sveučilišta pri NSK) - dakle, u skladu s čl.18 Pravilnika o matičnoj djelatnosti knjižnica u RH te čl. 31 Zakona o knjižnicama.Hospital libraries are special medical libraries located in health institutions (hospitals and university hospitals) or biomedical institutes. The group of medical libraries also comprises academic biomedical libraries affiliated with higher-education institutions in the field of biomedicine. At present, there are 28 special medical libraries and 8 academic biomedical libraries in Croatia. The author refers to collections and users of hospital libraries, and gives examples from daily practice that clearly show the need for a well-organized research and development center at both the local and national level. Among other reasons, such a research and development center is necessary due to the following: stocktaking and "writing off" of library items, organization of depositary library for older print collections, collection of data for union catalog(s) at the national level, networking and integrated information library system, continuous postgraduate education of librarians, position of librarians in health institutions, updating of standards for special libraries, etc. The requirements of hospital libraries with regard to research and development center are similar to those expressed by academic libraries in the field of biomedicine. The National and University Library in Zagreb should take care of research and development at the first (national) level, whereas at the second (regional) level this task should be fulfilled by university Iibraries (for the region of the Zagreb University, the National and University Library should fulfill this task at both levels). In other words, research and development center for special libraries should be organized in accordance to the Article 18 of the Regulations on Research and Development of Libraries in Croatia and the Article 31 of the Act on Libraries
Guidelines for prevention, control and treatment of infections caused by methicillin-resistant Staphylococcus Aureus (MRSA)
No full textMeticilin-rezistentni Staphylococus aureus (MRSA) važan je bolnički patogen u čitavom svijetu, pa i u Republici Hrvatskoj. Stoga se pristupilo izradi smjernica, kojih je svrha smanjiti broj bolesnika inficiranih/koloniziranih sojevima MRSA u zdravstvenim ustanovama i domovima za starije i nemoćne osobe u Republici Hrvatskoj, te na taj način smanjiti morbiditet i mortalitet koji uzrokuje ova bakterija. Interdisciplinarni tim stručnjaka načinio je Smjernice, koristeći se internacionalnim publikacijama i smjernicama koje govore o prevenciji i kontroli MRSA te liječenju i laboratorijskoj dijagnostici MRSA. Snaga preporuka određena je metodologijom CDC/HICPAC, a kategorizirane su na temelju postojeći znanstvenih podataka, teoretske logične podloge, primjenjivosti i ekonomskog utjecaja. Nakon široke rasprave u stručnim društvima Smjernice su prihvaćene. Preporuke Smjernica obuhvaćaju postupke prevencije širenja MRSA, ulogu uprave bolnica u prevenciji, racionalnu primjenu antibiotika, postupak pri epidemiji, liječenje infekcija koje uzrokuje te je ukratko opisan problem izvanbolnički stečenog MRSA; na kraju su dodani formulari za bolnički izvid, algoritmi dijagnostike MRSA-infekcija, obavijest za bolesnike i formular za nacionalno praćenje MRSA.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and in Croatia as well. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. Guidelines include recommendations for measures in prevention of MRSA spread, role of hospital management, rational use of antibiotics, measures in a case of outbreak, treatment of infections and brief review of community-acquired MRSA. At the end, appendices concerning hospital audit, algorithms of laboratory diagnosis, patient information and form for national MRSA surveillance were added