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Guidelines for the Management of Asthma Exacerbations in the Emergency Medicine
No full textTeške egzacerbacije astme danas su rijetke zahvaljujući primjeni inhalacijskih kortikosteroida koji su omogućili dobru kontrolu te bolesti. Međutim, kontrola astme u velikog broja astmatičara nije zadovoljavajuća, a smrtni slučajevi zbog akutnih egzacerbacija koje je trebalo spriječiti odgovarajućim liječenjem, bilježe se diljem svijeta. Kako bi se postigla dobra kontrola astme i spriječila teška i po život opasna egzacerbacija, preporučuje se upotreba Osobnog plana liječenja astme (OPLA) koji je opisan u hrvatskim smjernicama za liječenje astme 2023. Prema OPLA-i bolesnici sami procjenjuju stupanj kontrole svoje bolesti, a u slučaju gubitka kontrole imaju napisane precizne upute o mjerama samopomoći, odnosno o potrebi javljanja liječniku ili službi hitne pomoći. Blaga i umjerena egzacerbacija astme može se uspješno liječiti u izvanbolničkim ustanovama simptomatskom primjenom bronhodilatatora – „olakšivača“, uz obvezno pojačanje temeljnog protuupalnog liječenja (inhalacijski kortikosteroidi) s uvođenjem oralnih kortikosteroida ili bez njih. Teške i po život opasne egzacerbacije astme liječe se u bolničkoj hitnoj službi gdje se procjenjuje potreba za liječenjem na bolničkom odjelu ili jedinici intenzivnog liječenja. Egzacerbacije astme pokazatelj su rizika loših ishoda bolesti, te ih je stoga potrebno zabilježiti, a daljnje liječenje prilagoditi kako bi se spriječile u budućnosti.Severe exacerbations of asthma are rare today thanks to the use of inhaled corticosteroids, which have enabled good control of this disease. However, asthma control in many asthmatics is not satisfactory, and deaths due to acute exacerbations that should have been prevented by appropriate treatment are recorded worldwide. In order to achieve good asthma control and prevent a severe and life-threatening exacerbation, it is recommended to use the Personal Asthma Action Plan described in the Croatian guidelines for the treatment of asthma in 2023. According to the personal treatment plan, patients assess the degree of control of their asthma themselves, and in the event of loss of control, they have written precise instructions on self-help measures, i.e. on the need to contact a doctor or emergency services. Mild and moderate exacerbation of asthma can be successfully treated in outpatient facilities with the symptomatic use of bronchodilators, “relievers” with mandatory strengthening of the basic anti-inflammatory treatment (inhaled corticosteroids) with or without the introduction of oral corticosteroids. Severe and life-threatening asthma exacerbations are treated in the hospital emergency department where the need for hospitalization in a hospital ward or intensive care unit is assessed. Exacerbations of asthma are an indicator of the risk of bad outcomes of the disease, and therefore it is necessary to record them, and to adjust further treatment in order to prevent them in the future
IZVJEŠTAJ S GODIŠNJEG STRUČNOG SASTANKA HDFRM HLZ POVODOM OTVARANJA DJEČJEG ODJELA REHABILITACIJE ZAVODA ZA FRM, U NOVOM BOLNIČKOM KOMPLEKSU SUŠAK „ŽENA I DIJETE“ U KBC RIJEKA 8. 11. 2024. GODINE, UZ OBILJEŽAVANJE MEĐUNARODNOG DANA FIZIKALNE I REHABILITACIJSKE MEDICINE
No full textPredictive and Prognostic Values of Glycoprotein 96, Androgen Receptors, and Extranodal Extension in Sentinel Lymph Node-Positive Breast Cancer: An Immunohistochemical Retrospective Study
No full textObjectives: In this paper, we investigate the association of glycoprotein 96 (GP96) and androgen receptor (AR) expression with clinicopathological factors, additional axillary lymph node burden, and their potential role in predicting 5-year overall survival (OS) and disease-free survival (DFS) in breast cancer (BC) patients with sentinel lymph node (SLN) involvement. We also explore the prognostic value of the presence of extranodal extension (ENE) in SLN. Methods: We retrospectively enrolled 107 female patients with cT1-T2 invasive BC and positive SLN biopsy. GP96 and AR expression were immunohistochemically evaluated on tissue microarrays constructed from two 2 mm diameter cores of formalin-fixed paraffin-embedded tumor tissues from each patient. ENE in SLN was measured in the highest (HD-ENE) and widest diameter (WD-ENE). Relative GP96 gene expression was determined using real-time quantitative PCR. Results: The analysis revealed ENE in SLN as the strongest predictive factor for non-SLN metastases. Patients with WD-ENE > HD-ENE had a higher risk of non-SLN metastases and worse DFS compared to those with WD-ENE ≤ HD-ENE. High GP96 expression was associated with a greater relative risk for locoregional recurrence but showed no significant impact on OS or DFS. Histological grade 3, extensive intraductal component (EIC), higher lymph node ratio (LNR), and negative AR were associated with worse DFS, while age, histological grade 3, EIC, and higher LNR were independent predictors of OS. GP96 mRNA levels were elevated in BC tissue compared to normal breast tissue. Conclusions: ENE in SLN is the strongest predictor of non-SLN involvement and could also have prognostic significance. While GP96 expression does not influence survival outcomes, AR expression could be used as a valuable biomarker in the follow-up of BC patients
Identification of urine biomarkers of endometriosis—Protein mass spectrometry
No full textIntroduction: Endometriosis is a chronic inflammatory disease that leads to a series of pathological reactions. The basis is a changed proinflammatory activated immune system, which results in more pronounced oxidative stress, disturbed function of proteolysis and cell apoptosis. These processes are crucial in the development of the disease because their dysfunctional activities cause the progression of the disease. It is believed that the proteins excreted in the urine interact with each other and promote pathological processes in endometriosis. Methods: We analyzed the urine proteome of patients and aimed to detect a potential protein biomarker for endometriosis in the urine proteome. We collected urine samples from 16 patients with endometriosis and 16 patients in the control group with functional ovarian cysts. The diagnosis for all patients was confirmed through pathohistological analysis. After the preanalytical preparation of the urine, chromatography and mass spectrometry (LC-MS/MS) used the technology of urine proteome analysis. Results: The main finding was a significantly different concentration of 14 proteins in the urine samples. We recorded a considerably higher concentration of proteins that have a significant role in activating the immune system (SELL), iron metabolism (HAMP) and cell apoptosis (CHGA) in endometriosis compared to controls. Proteins having an antioxidant function (SOD1) and a role in proteolysis of the extracellular matrix (MMP-9) were significantly reduced in endometriosis compared to controls. Conclusion: Consistent with the known pathogenesis of endometriosis, the study results complement the pathological responses that occur with disease progression
The effect of fluid therapy on endothelial dysfunction in critically ill patients
No full textTerapije intravenskim tekućinama primjenjuju se dulje od stotinu godina te predstavljaju jedan od najčešće provođenih postupaka u medicini, osobito u životno ugroženih bolesnika. Postojeća znanstvena saznanja ukazuju na različit utjecaj intravenskih tekućina na endotel i endotelni glikokaliks (EG): s jedne strane određene otopine koje se koriste u resuscitaciji mogu doprinijeti regeneraciji integriteta EG-a i poboljšanju mikrocirkulacije te boljoj oksigenaciji stanica i tkiva, dok s druge strane određene otopine mogu pridonijeti razvoju endotelne disfunkcije te oštećenju EG-a. Izrazito je važno poznavanje kompleksnosti mehanizama upravljanja intravenskom terapijom tekućinama budući da neodgovarajuća primjena ovog postupka može doprinijeti i nepovoljnom ishodu kod životno ugroženih bolesnika. Prilagođen i individualiziran pristup intravenskoj terapiji tekućinama, vođen neprekidnim praćenjem hemodinamike uz osobit fokus na karakteristike svakog bolesnika, ključan je u optimizaciji funkcije endotela te u konačnici poboljšanju ishoda intenzivnog liječenja. Cilj ovoga preglednog rada jest prikazati dosadašnja saznanja o molekularnim mehanizmima, ali i kliničkim saznanjima o utjecaju terapije intavenskim tekućinama na endotel i EG. Razumijevanje složenih interakcija između intravenske terapije tekućinom i funkcije endotela može doprinijeti učinkovitijem liječenju životno ugroženih bolesnika te naposljetku boljem ishodu liječenja.Intravenous fluid therapies have been utilized for over a century and represent one of the most commonly performed procedures in medicine, particularly in critically ill patients. Current scientific knowledge points to the diverse effects of intravenous fluids on the endothelium and endothelial glycocalyx (EG): on the one hand, certain fluids used in resuscitation can contribute to EG integrity regeneration and improve microcirculation and tissue oxygenation, while on the other hand, specific fluids may contribute to the development of endothelial dysfunction and EG damage. Understanding the complexity of intravenous fluid therapy management is crucial as inappropriate administration of this procedure can lead to unfavorable outcomes in critically ill patients. A tailored and individualized approach to rehydration, guided by continuous hemodynamic monitoring with a particular
focus on patient characteristics, is essential in optimizing endothelial function and ultimately, improving intensive care outcomes. The aim of this review is to present existing knowledge on the molecular mechanisms as well as clinical findings regarding the impact of intravenous fluid therapy on the endothelium and EG. Understanding the intricate interactions between intravenous fluid therapy and endothelial function can contribute to more effective care for critically ill patients and ultimately lead to better treatment outcomes
Exosome-Derived microRNAs: Bridging the Gap Between Obesity and Type 2 Diabetes in Diagnosis and Treatment
No full textObesity and type 2 diabetes represent global public health challenges that are continuously growing at an alarming rate. The etiology of obesity is complex and multifactorial, with a substantial interplay between behavioral, biological, and environmental factors. Dysregulation of immunometabolism through chronic low-intensity inflammation in obesity has long been recognized as the main driver of insulin resistance and the development of type 2 diabetes. However, the intricate mechanisms underlying these alterations have yet to be fully elucidated. Exosomes are extracellular vesicles that carry biomolecules including various types of RNA molecules. Of particular importance are microRNAs (miRNAs), known as modulators of gene expression whose altered expression is observed in various pathophysiological conditions. Recent research suggests that exosome-derived miRNAs, such as miR-155, miR-27a, and miR-29, play an essential role in the regulation of inflammatory processes, while miR-122 and miR-192 are associated with metabolic dysfunction. These and many other miRNAs influence signaling pathways that are critical for maintaining insulin sensitivity, thereby contributing to the development of insulin resistance in individuals with obesity. Hence, there is a growing interest in the potential of exosomes and miRNAs as biomarkers for the early detection of insulin resistance and other obesity-related complications, as well as promising therapeutic targets or next-generation drug delivery carriers. This review provides a comprehensive overview of the interplay between exosome-derived miRNA, obesity, and type 2 diabetes and summarizes the latest findings in exosome biology
Cervical cancer prevention and human papillomavirus vaccination campaigns in Croatia
No full textRak vrata maternice je vrsta raka na koju se može djelovati mjerama primarne (edukacija i informiranje o odgovornom spolnom ponašanju i cijepljenje protiv humanog papilomavirusa – glavnog uzročnika navedenog raka) i sekundarne prevencije (test probira i liječenje prekanceroznih lezija). U cilju osvješćivanja i educiranja vulnerabilnih skupina (žene, mladi) o mogućnostima prevencije raka vrata maternice provode se diljem svijeta, pa tako i u Hrvatskoj, brojne javnozdravstvene kampanje kako bi se pravodobno djelovalo na smanjivanje rizika obolijevanja. Pritom je važno kontinuirano provoditi edukativno-promotivne aktivnosti ne samo tradicionalnim načinima promicanja zdravlja (letci, priručnici, javna predavanja i skupovi), već i u skladu s novim trendovima (videomaterijali, mrežne stranice, online tečajevi, mobilne aplikacije, uključivanje influencera). U ovom radu je prikazan dio javnozdravstvenih kampanja i provedenih edukativno-promotivnih aktivnosti u Hrvatskoj u razdoblju od 2007. do 2023. godine, izdvojenih kao primjera dobre prakse. Prikazane kampanje uključile su intersektorsku suradnju (zdravstveni sektor i civilno društvo), dobru međusobnu koordinaciju, multidisciplinarni i integrirani pristup te racionalno korištenje svih resursa. Ovakav pristup rezultirao je učinkovitim, prepoznatljivim i kvalitetnim kampanjama. Osim javnozdravstvenih kampanja, u cilju povećanja broja cijepljenih protiv humanog papilomavirusa u Zagrebu su otvorena i dva punkta za cijepljenje mladih do 25 godina, gdje je omogućeno besplatno cijepljenje bez naručivanja, kao i savjetovanje o spolnom zdravlju, a sve u cilju povećanja obuhvata cijepljenjem. Također, naglašeni su neki od ključnih izazova za daljnje unaprjeđenje edukativno-promotivnih aktivnosti javnozdravstvenih kampanja, a koji uključuju mogućnost i održivost kontinuiranog provođenja, praćenja, evaluacije te budućeg poboljšanja kvalitete provedbe. Javnozdravstvene kampanje nužno je stalno prilagođavati na temelju rezultata evaluacije, sukladno obilježjima epidemioloških podataka i zdravstvenih potreba ciljane populacije.Cervical cancer is a type of cancer that can be affected by measures of primary (education and informing about responsible sexual behavior and vaccination against human papillomavirus – the main cause of this cancer) and secondary prevention (a screening test and the precancerous lesions treatment). To raise awareness and educate vulnerable groups (women, youth) on the possibilities of cervical cancer prevention, numerous public health promotional activities are carried out worldwide, including Croatia, for the risk of cancer to be timely reduced. Health promotion activities need to be implemented not only via traditional methods of health promotion (leaflets, manuals, public lectures, and meetings), but following new trends as well (video materials, websites, online courses, mobile applications, inclusion of influencers). This paper presents a part of the health promotion campaigns and activities carried out in Croatia during the period 2007–2023, showing an example of good
practice. Presented campaigns included inter-sectoral collaboration (health sector and civil society), good mutual coordination, multidisciplinary and integrated approach, and rational use of all resources. This approach resulted in efficient, recognizable, and quality campaigns. In addition to public health campaigns, as to increase the number of people vaccinated against the human papillomavirus, two vaccination points for youth up to 25 years of age were opened in Zagreb, with available free vaccination and no appointment needed, as well as counselling on sexual health, with the aim of increasing vaccination coverage. Also, the key challenges for further improvement of educational and promotional activities of health promotion campaigns are emphasized: the possibility and sustainability of continuous implementation, monitoring, evaluation, and future improvement of the quality of
implementation. Health promotion campaigns should be constantly adjusted based on evaluation results, in accordance with the characteristics of epidemiological data and the health needs of target population
Effectiveness of Bobath Therapy vs. Conventional Medical Gymnastics in Psycho-Social and Cognitive Status Improvement in Children with Mild Neurodevelopmental Delay: A Randomized Double-Blinded Prospective Cohort Study
No full textBackground/Objectives: The main objective of this research was to compare the Bobath concept and conventional medical gymnastics in psycho-social and cognitive habilitation of infants with mild neurodevelopmental delay, and determine whether there is a difference in their effectiveness. Methods: The study included 100 children up to 3 months of age who were diagnosed with a mild neuromotor disorder based on clinical examination, the Münich Functional Developmental Diagnostic Test for the first year of life, and the Ages and Stages questionnaire. The respondents were randomized into two groups, habilitated according to the Bobath concept or conventional medical gymnastics. The observed parameters were problem-solving skills, communication skills, and the infants’ psycho-social status. Results: The Ages and Stages questionnaire revealed no significant differences between the two concepts. The Munich Diagnostic Test revealed different starting values in speech and socialization delay, but the treatment outcomes showed significant improvement in both cohorts. There were also no significant differences in the guardians’ opinions on therapeutic effectiveness. Conclusions: This study demonstrated that there is no difference in effectiveness between the two tested habilitation programs in mild neurodevelopmental delay treatment in infants after six months of therapy, laying the foundation for a professional consensus
HIPOHONDRIJA KAO RASTRESENOST UMA UNUTAR KANTOVE TRANSCENDENTALNE FILOZOFIJE
No full textThe primary aim of this paper will be to understand hypochondria as a philosophical problem, rather than a medical-psychological one, since there is a significant difference between the modern (medical-psychological in the true sense of the word) understanding of hypochondria and all earlier anthropological, philosophical, and physiological understandings, including that of Kant. Kant's interpretation of hypochondria, as a mental illness, highlights an interesting dichotomy between actual bodily sensations and distorted perception. The hypochondriac experiences real physical sensations but interprets them in a way that is not grounded in actuality. Kant argues that these sensations result from the (lack of) attention the hypochondriac gives to certain physical signals. On the other hand, if one were to focus their attention on something else or engage in activities that distract their thoughts from pathological feelings, the feelings could diminish, and with enough composure, even disappear entirely. One of the key problems with hypochondria is that rational arguments often cannot change the beliefs of a person who feels symptoms in their body and mind. In order for a person to regain control over themselves, Kant turns to the principles of moral and philosophical dietetics. Therefore, this paper will specifically follow two aspects: Kant's scattered analysis of hypochondria and its transcendental philosophical assumptions. Conclusions from transcendental philosophy should help in overcoming hypochondriac whims.Osnovni cilj ovoga rada bit će razumijevanje hipohondrije kao filozofijskog problema, a ne medicinsko-psihološkog, s obzirom na to da postoji bitna razlika između modernog (medicinsko-psihološkog u pravom smislu riječi) razumijevanja hipohondrije i svih ranijih antropološko-filozofsko-fizioloških razumijevanja, pa tako i onoga Kantova. Kantova interpretacija hipohondrije, kao duševne bolesti, ističe zanimljivu dihotomiju između stvarnih tjelesnih osjeta i iskrivljene percepcije. Hipohondar doživljava stvarne fizičke osjete, ali ih interpretira na način koji nije utemeljen u realnosti. Kant tvrdi da su ti osjeti rezultat (ne)pažnje koju hipohondar pridaje određenim fizičkim signalima. S druge strane, ako bi svoju pažnju usmjerio na nešto drugo ili se zaokupio nečim što mu odvlači misli od boležljivih osjećaja, osjećaji bi mogli oslabjeti, a uz dovoljno sabranosti, čak i potpuno nestati. Jedan od ključnih problema s hipohondrijom jest taj što umni argumenti često ne mogu promijeniti uvjerenja osobe koja osjeća simptome u svome tijelu i svome duhu. Da bi ljudsko biće ponovno zadobilo kontrolu nad samim sobom, Kant se okreće načelima moralne i filozofijske dijetetike. Stoga će se u ovom radu posebno pratiti dva aspekta: Kantova raštrkana analiza hipohondrije i njezine transcendentalno-filozofske pretpostavke. Zaključci iz transcendentalne filozofije trebali bi pomoći u svladavanju hipohondrijske mušičavosti
Identifikacija cirkulirajućih biomarkera neurološkog oporavka u bolesnika s ozljedom mozga: plan upravljanja istraživačkim podacima
No full textPrikupljat će se, obrađivati i ponovno koristiti podaci o bolesnicima s traumatskom ozljedom mozga i podaci o njihovim uzorcima likvora. Stvarat će se, obrađivati i ponovno koristiti podaci analiza kliničkih uzoraka dobivenih putem metoda za analizu izvanstaničnih vezikula, proteina i RNA. Podaci će biti u digitalni u obliku slikovnih, excel i doc datoteka