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The role of moral injury in modulating symptoms of complex PTSD in veterans undergoing long-term treatment
No full textKPTSP sve se češće prepoznaje kao zaseban klinički entitet koji nastaje nakon dugotrajne, ponavljajuće traume, osobito one interpersonalne prirode. Moralna ozljeda, definirana kao duboko psihološko i egzistencijalno ranjavanje koje nastaje nakon kršenja osobnih moralnih vrijednosti, pokazuje se kao važan faktor u razumijevanju težine i otpornosti simptoma kPTSP-a. Cilj ovog istraživanja bio je ispitati povezanost moralne ozljede sa simptomima kPTSP-a kod veterana Domovinskog rata uključenih u višegodišnje psihijatrijsko liječenje. U istraživanju je sudjelovalo 62 veterana s dijagnozom kPTSP-a prema MKB-11 kriterijima. Rezultati su pokazali da postoji snažna povezanost moralne ozljede sa simptomima poremećaja u samoorganizaciji, osobito s afektivnom disregulacijom, negativnom slikom o sebi i poteškoćama u interpersonalnom funkcioniranju. Također je utvrđeno da veterani koji su osobno sudjelovali u moralno konfliktima događajima pokazuju višu razinu srama i ukupne moralne ozljede. Sociodemografski čimbenici nisu se pokazali značajnima u predviđanju intenziteta simptoma. Dobiveni nalazi ukazuju na potrebu za integracijom moralne dimenzije traume u dijagnostički i terapijski pristup kompleksnom PTSP-u te upućuju na važnost razmatranja moralne ozljede kao ključnog kliničkog i teorijskog konstrukta u razumijevanju ratne psihotraume.Complex posttraumatic stress disorder (CPTSD) is increasingly recognized as a distinct clinical entity arising from prolonged and repetitive trauma, particularly of interpersonal nature. Moral injury, defined as a deep psychological and existential wound resulting from the violation of one’s moral values, has emerged as a significant factor in understanding the severity and persistence of CPTSD symptoms. The aim of this study was to examine the association between moral injury and CPTSD symptoms among Croatian Homeland War veterans undergoing long-term psychiatric treatment. The study included 62 veterans diagnosed with CPTSD according to ICD-11 criteria. Findings revealed a strong association between moral injury and disturbances in self-organization, particularly affective dysregulation, negative self-concept, and relational difficulties. Veterans who reported having personally committed or omitted morally injurious acts exhibited significantly higher levels of shame and overall moral injury. Sociodemographic variables were not significant predictors of symptom severity. These findings underscore the importance of integrating the moral dimension of trauma into the diagnostic and therapeutic framework of CPTSD and highlight moral injury as a central clinical and conceptual construct in the understanding of war-related trauma
The Impact of Isotonic Seawater on Subjective and Objective Nose Patency in Athletes: A Randomized Controlled Trial
No full textBackground/Objectives: Nasal irrigation with isotonic seawater is a known and oft-used treatment for nasal obstruction in patients with acute and chronic nasal inflammatory disease undergoing therapy with intranasal corticosteroids and antihistamine drugs. Nasal patency in healthy athletes is extremely important; however, to date, the effect of isotonic solutions for nasal irrigation in healthy athletes has not been tested. This randomized controlled trial aimed to investigate the potential synergy of physical exercise and nasal isotonic seawater on airflow and the subjective assessment of nasal patency in healthy, high-level athletes. Methods: The intervention group included 33 healthy athletes who used an isotonic seawater nasal spray daily, with a control group including 31 healthy athletes who did not use any sprays; both groups underwent identical seven-day training periods. The primary outcome measures were subjective NOSE questionnaire scores and secondary peak nasal inspiratory flow (PNIF) measures, while anthropometric and demographic variables were covariates. Results: A significant decrease in subjective nasal resistance scores was observed in the intervention group compared to the control group (binary logistic regression model, p = 0.006, RR 7.695), both in the first and second measurement interval. This effect increased with time (Friedman’s two-way analysis of variance, p < 0.001). Peak nasal inspiratory flow is positively affected by exercise but not by isotonic seawater spray intervention. Conclusions: The effects of nasal isotonic seawater irrigation during intense athletic training are beneficial on subjective nasal patency in the short term, while the effects on objective nasal patency are less clear
ADAR1 p150 prevents HSV-1 from triggering PKR/eIF2α-mediated translational arrest and is required for efficient viral replication
No full textAdenosine deaminase acting on dsRNA 1 (ADAR1) catalyzes the deamination of adenosines to inosines in double-stranded RNAs (dsRNA) and regulates innate immunity by preventing the hyperactivation of cytosolic dsRNA sensors such as MDA5, PKR or ZBP1. ADAR1 has been shown to exert pro- and antiviral, editing-dependent and editing-independent functions in viral infections, but little is known about its function in herpesvirus replication. We now demonstrate that herpes simplex virus 1 (HSV-1) hyperactivates PKR in the absence of ADAR1, resulting in eIF2α mediated translational arrest and reduced viral replication. Silencing of PKR or inhibition of its downstream effectors by viral (ICP34.5) or pharmacological (ISRIB) inhibitors rescues viral replication in ADAR1-deficient cells. Upon infection, ADAR1 p150 interacts with PKR and prevents its hyperactivation. Our findings demonstrate that ADAR1 is an important proviral factor that raises the activation threshold for sensors of innate immunity
Ascites in a Family Medicine Practice – The Importance of Ultrasound Application
No full textCilj ovoga rada je prikazati slučaj bolesnice s kliničkom prezentacijom ascitesa kao znaka novotvorina jajnika, s naglaskom na važnost korištenja orijentacijskog ultrazvuka u ordinacijama obiteljske medicine. 72-godišnja bolesnica javlja se u ordinaciju obiteljske medicine zbog bolova u abdomenu unazad tri dana. Posljednjih mjesec dana primijetila je povećanje opsega trbuha i započela s dijetnom prehranom. Inače boluje od arterijske hipertenzije, kroničnoga bubrežnog zatajenja te ima hijatalnu herniju. Obiteljska anamneza je bez osobitosti. Prilikom fizikalnog pregleda abdomen je iznad razine toraksa, napete stijenke, bezbolan na palpaciju. Peristaltika je čujna, a koža i sluznice prokrvljene. Učine se laboratorijske pretrage u kojima se izdvaja povišen CRP. Učini se ultrazvuk abdomena koji pokazuje masivni ascites. Ne uspijeva se prikazati prostor male zdjelice te se hitno upućuje na odjel gastroenterologije. Daljnja obrada bolničkih specijalista uključuje CT abdomena i zdjelice, RTG grudnih organa, EGDS i kolonoskopiju. Indicira se analiza ascitesa te tumorski markeri i serumski albumini. Biokemijskom analizom ascitesa zaključuje se da je sadržaj tipa eksudata. U laboratorijskom nalazu povišene su razine CEA i CA 19-9. CT abdomena i zdjelice pokazuje u području zdjelice cističnu ekspanzivnu tvorbu sa septama i manjom solidnom komponentom koja ima polazište od desnog jajnika te ispunjava cijeli abdomen, što prvenstveno odgovara ovarijalnom seroznom cistadenomu. Nalazi ostalih dijagnostičkih postupaka bili su uredni. Bolesnica je upućena na daljnje kirurško liječenje na odjel ginekologije. Novotvorine jajnika imaju nespecifične simptome. Uz redovite ginekološke preglede, treba istaknuti važnost temeljite anamneze i fizikalnog pregleda u ordinacijama obiteljske medicine te potrebu da se poveća dostupnost ultrazvučnih pregleda u ordinacijama obiteljske medicine.The aim of this paper is to present the case of a patient with the clinical presentation of ascites as a sign of ovarian neoplasms, emphasizing the importance of using point-of-care ultrasound in family medicine practices. The 72-year-old female patient visited the family medicine office because of abdominal pain for the past three days. In the last month, she noticed an increase in the growth of her stomach and started a diet. She has a hiatal hernia, chronic renal failure and arterial hypertension. The family history is unremarkable. During the physical examination the abdomen was above the level of the thorax, the wall was taut, painless. Peristalsis was audible, and the skin and mucous membranes were well perfused. Following laboratory testing, an increased CRP was identified. Abdominal ultrasound was performed which showed massive ascites. It was not possible to display the area of the lesser pelvis. The patient was urgently referred to the gastroenterology department. CT scans of the abdomen and pelvis, X-ray of chest organs, EGDS, and colonoscopy were performed. Ascites analysis, tumor markers, and serum albumins test were indicated. Biochemical analysis of ascites concluded that the content was of the exudate type. CEA and CA 19-9 levels were elevated. CT scans of the abdomen and pelvis showed a cystic expansion formation in the pelvic region with septa and a smaller solid component that originated from the right ovary and filled the entire abdomen, which primarily corresponded to an ovarian serous cystadenoma. Other diagnostic procedures were normal. The patient was sent to the gynecology department for further surgical treatment. The symptoms of ovarian neoplasms are nonspecific. In addition to routine gynecological examinations, family medicine offices should emphasize the value of a comprehensive physical examination and history, as well as the necessity of expanding the availability of ultrasound examinations
Remimazolam and Esketamine for CT-Guided Aortic Graft Infection Drainage in a Patient with Severe Systematic Comorbidities: A Case Report
No full textBackground/Objectives: The management of patients with severe systemic comorbidities undergoing radiologic interventional procedures presents a significant challenge for anesthesiologists. Selecting an appropriate combination of anesthetic drugs is crucial to ensure a safe, painless procedure, facilitate rapid recovery, and minimalize complications. Here, we present a case of a 68-year-old female patient of ASA V status with a history of diabetes, coronary artery disease, and severe chronic obstructive pulmonary disease due to lung emphysema and dependence on a home oxygenator, requiring sedation for CT-guided percutaneous drainage of the aortic graft infection. Methods: After on-site emergent patient preparation and several position adjustments, sedation was initiated and maintained using continuous infusions of remimazolam and esketamine. Results: Throughout the procedure, the patient remained sedated, comfortable, and free of unwanted movements. The patient was hemodynamically stable and maintained oxygen saturation between 92 and 96%. Conclusions: In our opinion, the combination of remimazolam and esketamine demonstrated an effective and safe profile for procedural sedation. This approach holds the potential to influence standard operating protocols, particularly for patients with severe and multiple comorbidities requiring personalized anesthetic management
Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact
No full textABSTRACT Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low‐molecular‐weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non‐inferior to LMWH for all‐cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of 110,431,241 for U.S. healthcare stakeholders, and 56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost‐effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk
The use of continuous glucose monitoring in people living with obesity, intermediate hyperglycemia or type 2 diabetes
No full textA global trend towards increased obesity, intermediate hyperglycemia (previously termed prediabetes) and type 2 diabetes, has prompted a range of international initiatives to proactively raise awareness and provide action-driven recommendations to prevent and manage these linked disease states. One approach, that has shown success in managing people already diagnosed with type 2 diabetes mellitus, is to use continuous glucose monitoring (CGM) devices to help them manage their chronic condition through understanding and treating their daily glucose fluctuations, in assocation with glucose-lowering medications, including insulin. However, much of the burden of type 2 diabetes mellitus is founded in the delayed detection both of type 2 diabetes mellitus itself, and the intermediate hyperglycemia that precedes it. In this review, we provide evidence that using CGM technology in people at-risk of intermediate hyperglycemia or type 2 diabetes mellitus can significantly improve the rate and timing of detection of dysglycemia. Earlier detection allows intervention, including through continued use of CGM to guide changes to diet and lifestyle, that can delay or prevent harmful progression of early dysglycemia. Although further research is needed to fully understand the cost-effectiveness of this intervention in people at-risk or with early dysglycemia, the proposition for use of CGM technology is clear
Chemical Composition, Quality, and Bioactivity of Laurus nobilis L. Hydrosols from the Adriatic Regions of Croatia: Implications for Dermatological Applications
No full textLaurus nobilis L., Lauraceae, bay laurel, has been traditionally used for its various therapeutic properties, and in recent years has been gaining interest for its potential applications in skincare products. However, the biological effects of bay laurel, particularly its hydrosols, a water fraction obtained during essential oil production, remain unexplored. The objective of this study was to identify the volatile compounds in L. nobilis hydrosols (LnHYs) from different coastal regions of Croatia (north, middle, and south Adriatic) and to evaluate their potential safety and efficacy for dermatological applications. Upon isolating LnHYs using microwave-assisted extraction, LnHY volatiles were identified and quantified using gas chromatography and mass spectrometry. Oxygenated monoterpenes were the dominant compounds in all LnHYs (61.72–97.00%), with 1,8-cineole being the most abundant component (52.25–81.89%). The physical and chemical parameters of LnHYs were investigated to assess their purity and quality. Biological activity (cytotoxicity and wound-healing effect) was tested on the human keratinocyte cell line (HaCaT), selected as the experimental model due to its relevance to skin biology. Additionally, contents of polyphenolic substances, antioxidative effects using the Oxygen Radical Absorbance Capacity (ORAC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods, and the antimicrobial activity of LnHYs toward five skin microorganisms were determined. All tested hydrosols showed similar biological activity, with only minor differences. Cytotoxicity studies indicated the safety of the dermatological application of LnHYs, and the results of the wound-healing assay showed their neutral to mildly positive effect. Considering the growing use of bay laurel preparations in pharmaceutical and cosmetic applications, extensive studies on their biological activity, quality, and safety are essential to either support or regulate their use in humans
Multi-antigen serology and a diagnostic algorithm for the detection of arbovirus infections as novel tools for arbovirus preparedness in southeast Europe (MERMAIDS-ARBO): a prospective observational study
No full textUltrasound - guided renal mass biopsy during the surgery due to histological evaluation
No full textUltrazvučno vođena perioperacijska biopsija tumora bubrega sve više zauzima značajno mjesto u dijagnostičkom i terapijskom algoritmu uroloških malignoma. S obzirom na činjenicu da tumori bubrega dugo ostaju asimptomatski zbog retroperitonealnog položaja bubrega, bolest se u velikom broju slučajeva otkriva slučajno, najčešće tijekom rutinskih slikovnih pretraga. Upravo zbog sve veće primjene ultrazvuka u sklopu preventivnih pregleda i evaluacije nespecifičnih abdominalnih tegoba, bilježi se porast broja slučajeva otkrivenih u ranom, često lokaliziranom stadiju bolesti. Oko 90 % svih primarnih tumora bubrega pripada skupini RCC-a, a najčešći histološki podtip je svijetlostanični karcinom, koji ujedno pokazuje i najveći metastatski potencijal. Preostalih 10% čine različiti benigni tumori, poput onkocitoma i angiomiolipoma, kao i rijetki maligni entiteti poput sarkoma. U diferencijaciji između benignih i malignih lezija, poglavito kod manjih, incidentalno otkrivenih masa, ultrazvučno vođena biopsija predstavlja ključan dijagnostički korak. Perioperacijska (ex tempore) biopsija omogućuje brzo uzimanje uzorka tumorskog tkiva u stvarnom vremenu, najčešće neposredno prije ili tijekom operacije, čime se omogućuje personalizacija liječenja i pravovremeno donošenje odluke o daljnjem kirurškom liječenju. Ultrazvukom vođena biopsija pokazala se sigurnom, učinkovitom i minimalno invazivnom metodom visoke dijagnostičke vrijednosti. Njezina sve šira primjena potvrđuje njezinu važnost u suvremenoj onkologiji, osobito u kontekstu ranog otkrivanja, precizne klasifikacije tumora i donošenja optimalnih terapijskih odluka. S obzirom na rastuću incidenciju tumora bubrega te njihovu često tiho kliničko ponašanje, važno je dodatno naglašavati vrijednost ultrazvuka i biopsije u ranom otkrivanju i racionalnom vođenju liječenja ovih bolesnika.Ultrasound-guided perioperative biopsy of renal tumors is becoming an increasingly valuable tool in both the diagnosis and management of urological cancers. Because of their retroperitoneal location, kidney tumors often remain undetected until they are discovered incidentally during imaging for unrelated issues. With the growing use of ultrasound in routine health screenings, more renal masses are being identified at an early, localized stage. About 90% of kidney tumors originate as RCC, with clear cell carcinoma being the most common and also the most prone to metastasis. The remaining 10% includes benign lesions like oncocytomas and angiomyolipomas, along with rare malignant forms such as sarcomas. Distinguishing between benign and malignant tumors, especially when dealing with small, incidentally found masses, is vital for determining appropriate treatment. Ultrasound-guided biopsy during the perioperative period offers real-time tissue sampling either just before or during surgery, enabling surgeons to make immediate, informed decisions. This technique supports a more personalized therapeutic approach and has proven to be safe, minimally invasive, and highly accurate in terms of diagnosis. As kidney tumors are often asymptomatic and being diagnosed more frequently due to improved screening, the role of image-guided biopsy is becoming more central in modern oncological practice. It plays a critical part in early detection, precise tumor classification, and the selection of the most effective treatment strategies, thereby improving outcomes and ensuring more targeted patient care