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Effects of Music Therapy on Preterm Neonates and Their Parents
No full textMusic therapy (MT) is increasingly used in medicine. Even the youngest patients, premature infants, and their families can benefit from these interventions. This literature review highlights the physiological and developmental effects of MT on premature infants, exploring its influence on physiological stability, sleep, feeding, pain management and neurodevelopment, while, at the same time, elaborating on parental mental health and bonding. MT interventions adjusted to the NICU environment show promising outcomes on the regulation of infants' heart rates, reduction of pain and stress and facilitating neurobehavioral development. Furthermore, MT can reduce parental stress, anxiety, and depression and strengthen the bond between the parents and their infant.
Despite variable study designs and outcomes, MT is a valuable addition to neonatal care and should be implemented in NICUs to enhance the quality of life of the whole family
Advantages, disadvantages and limitations of local excision techniques for rectal tumors
No full textTehnike lokalne ekscizije za tumore rektuma privlačne su zbog smanjenog morbiditeta i
mortaliteta u usporedbi s radikalnom kirurgijom. Kako bi se postigli željeni rezultati potreban
je kvalitetan odabir pacijenata. Postoji nekoliko varijabli koje treba procijeniti prilikom
razmatranja pacijenta za lokalnu eksciziju. Ključne varijable uključuju karakteristike tumora kao
što su diferencijacija, prisutnost invazije limfovaskularnog sustava, položaj u rektumu, veličina
i klinički stadij. Lokalna ekscizija također se izvodi kod pacijenata koji nisu pogodni za velike
kirurške zahvate zbog medicinskih komorbiditeta ili kod onih s niskim lezijama koji snažno traže
očuvanje sfinktera, čak i ako tumori imaju "visokorizične" čimbenike ili su bili napredniji.
Potrebno je napomenuti da je odabir odgovarajućeg lokalnog modaliteta liječenja koji može
osigurati slobodne kirurške rubove i pravilna patohistološka evaluacija nakon ekscizije važan
dio izvođenja lokalne ekscizije. Obzirom da je riječ o relativno novim tehnikama u kirurgiji
rektuma, može se očekivati daljnji napredak svih navedenih tehnika.Techniques of local excision for rectal tumors are attractive due to reduced morbidity and
mortality compared to radical surgery. Achieving desired results requires careful patient
selection. There are several variables to consider when considering a patient for local excision.
Key variables include tumor characteristics such as differentiation, presence of lymphovascular
invasion, location in the rectum, size, and clinical stage. Local excision is also performed in
patients who are not suitable for major surgeries due to medical comorbidities or in those with
low lesions who strongly advocate for sphincter preservation, even if tumors have "high-risk"
factors or are more advanced. It is important to note that selecting the appropriate local
treatment modality that can ensure clear surgical margins and proper histopathological
evaluation after excision is an important part of performing local excision. Given that these are
relatively new techniques in rectal surgery, further advancement in all these techniques can
be expected
Modulation of the intestinal microbiota and the effectiveness of immunotherapy in the treatment of cancer - a review paper
No full textCrijevna mikrobiota važan je dio ljudskoga tijela čiji sastav može utjecati na djelotvornost imunoterapije. U zadnjih nekoliko godina, modulacija crijevne mikrobiote u cilju poboljšanja djelotvornosti imunoterapije postala je aktualna tema u znanstvenoj zajednici, ali postoji nedostatak istraživanja iz ovoga područja. U ovom diplomskom radu cilj je bio analizirati aktualnu literaturu vezanu uz modulaciju crijevne mikrobiote i djelotvornost imunoterapije u liječenju karcinoma. Analizirani su zasebno utjecaji AB, probiotika i prehrane te fekalne transplantacije. Iz osam aktualnih studija koje su proučile utjecaj AB na djelotvornost imunoterapije da se zaključiti da upotreba AB, pogotovo širokoga spektra i/ili u većoj količini, uzrokuje disbiozu crijevne mikrobiote zbog čega se djelotvornost imunoterapije može smanjiti. Pomoću pet aktualnih studija o probioticima i imunoterapiji, može se uvidjeti da bi disbiozu mogli popraviti probiotici i tako utjecati na poboljšanje imunoterapije, no upotreba komercijalnih probiotika bez dokaza disbioze u crijevima nije još dovoljno ispitana kako bi joj se potvrdila sigurnost za pacijente s karcinomom koji se liječe imunoterapijom. Prehrana koja se sastoji od dovoljne količine vlakana preporučljiva je od strane četiri aktualne studije o utjecaju prehrane s višom količinom vlakana i djelotvornosti imunoterapije. Prema dvije studije, dijeta s višim udjelom soli pozitivno korelira sa uspješnosti imunoterapije. Fekalna transplantacija je prema trima jedinim ljudskim studijama sigurna i realna adjuvantna opcija za liječenje pacijenata s karcinomom uz imunoterapiju, ali je potrebno standardizirati protokole liječenja i uspostaviti još kliničkih dokaza o uspješnosti ovakve vrste liječenja. Modulacijom sastava mikrobiote uistinu se može promijeniti djelotvornost imunoterapije, ali u budućnosti treba organizirati više studija na ljudima koje bi precizno odredile točne vrste i postupke modulacije mikrobiote i istražile ih detaljnijeThe intestinal microbiota is an important part of the human body and its composition can affect the effectiveness of immunotherapy. In the last few years, the modulation of intestinal microbiota in order to improve the effectiveness of immunotherapy has become a current topic in the scientific community, but there is a lack of research in this area. In this thesis, the goal was to analyze the current literature related to the modulation of intestinal microbiota and the effectiveness of immunotherapy in the treatment of cancer. The effects of antibiotics, probiotics, diet and faecal microbial transplantation were analyzed separately. From eight current studies that studied the influence of antibiotics on the effectiveness of immunotherapy, it was concluded that the use of antibiotics, especially broad-spectrum and/or use of antibiotics in larger quantities, causes dysbiosis of the intestinal microbiota, which can reduce the effectiveness of immunotherapy. Using five current studies on probiotics and immunotherapy, it can be seen that dysbiosis could be repaired by probiotics and thus affect the improvement of immunotherapy, but the use of commercial probiotics without evidence of intestinal dysbiosis has not yet been sufficiently tested to confirm its safety for cancer patients who are treated with immunotherapy. A diet consisting of a sufficient amount of fiber is recommended by four current studies on the impact of a diet with a higher amount of fiber and the effectiveness of immunotherapy. According to two studies, a diet with a higher salt content positively correlates with the success of immunotherapy. According to the only three human studies, fecal transplantation is a safe and realistic adjuvant option for the treatment of cancer patients with immunotherapy, but it is necessary to standardize treatment protocols and establish more clinical evidence of the success of this type of treatment. Modulating the composition of the microbiota can indeed change the effectiveness of immunotherapy, but in the future, more human studies should be organized to precisely determine the exact types and procedures of microbiota modulation and investigate them in more detail
Spleen diseases and injuries in childhood
No full textSlezena je najveći organ limfnog sustava u ljudskom tijelu. Nalazi se intraperitonealno u gornjem lijevom kvadrantu. Njezina duljina se mijenja ovisno o starosti djetata, s time da svoju najveću duljinu dosegne s 14 godina. Glavne funkcije su: Hematopoeza, imunološka funkcija, funkcija depoa, metabolička funkcija i filtracija krvnih stanica. Patološka stanja dijelimo na bolesti (kongenitalne ili stečene) i ozljede. Kongenitalne bolesti su asplenija, polisplenija, akcesorna slezena i lutajuća slezena, dok su stečene bolesti benigne bolesti (nasljedna sferocitoza, hemoglobinopatije i idiopatska trombocitopenična purpura), maligne bolesti (limfomi i leukemije), benigni ili maligni tumori, ciste ili infekcije. Glavna moguća ozljeda slezene je ruptura nastala zbog traume, ijatrogeno ili spontano, s time da je slezena najčešći ozljeđeni intraabdominalni organ kod tupe traume (uglavnom prometne nesreće). Moguće metode liječenja kod bolesti i ozljeda slezene su konzervativna i kirurška. Konzervativno liječenje uključuje mirovanje, nadoknadu tekućine, transfuziju krvi i redovite kontrole. Pri kirurškoj metodi splenektomije, slezena se odstranjuje. Splenektomija može biti totalna, parcijalna i subtotalna, te otvorena ili laparoskopska. Zbog imunološke važnosti slezene kod djece se nastoji provoditi poštedna metoda da bi se moglo očuvati što više parenhima, osim ako je dijete životno ugroženo ili nema drugog rješenja nego napraviti totalnu splenektomiju. Neovisno o kojem se zahvatu radi mogu nastati rane komplikacije kao što su krvarenja, tromboembolije, plućne komplikacije, infektivne komplikacije i komplikacije intraoperacijskih susjednih organa i kasne komplikacije kao što je postsplenektomična sepsa. Zbog navedenih komplikacija je perioperativna skrb izrazito bitna. Uključuje cjepivo, antibiotik i tromboprofilaksu.The spleen is the largest organ of the lymphatic system in the human body. It is located intraperitoneally in the upper left quadrant. Its length changes depending on the age of the child, reaching its maximum length at the age of 14. The main functions are hematopoiesis, immunological function, depot function, metabolic function, and filtration of blood cells. Pathological conditions are divided into diseases (congenital or acquired) and injuries. Congenital diseases are asplenia, polysplenia, accessory spleen and wandering spleen, while acquired diseases are benign diseases (hereditary spherocytosis, hemoglobinopathies and idiopathic thrombocytopenic purpura), malignant diseases (lymphomas and leukemias), benign or malignant tumors, cysts or infections. The main possible injury of the spleen is a rupture caused by trauma, iatrogenic or accidental, with the spleen being the most frequently injured intra-abdominal organ in blunt trauma (mainly traffic accidents). Possible methods of treatment for diseases and injuries of the spleen are conservative and surgical. Conservative treatment includes rest, fluid replacement, blood transfusion and regular controls. In splenectomy, which is a surgical method, the spleen is removed. It can be total, partial, and subtotal; open or laparoscopic. Due to the immunological importance of the spleen in children, a sparing method should be chosen to preserve as much of the parenchyma as possible, unless the child is life-threatening or there is no other solution but to perform a total splenectomy. Regardless of the procedure, early complications like bleeding, thromboembolism, pulmonary complications, infectious complications, complications of intraoperative adjacent organs and late complications like post-splenectomy sepsis can occur. Due to the mentioned complications, perioperative care is extremely important. It includes vaccine, antibiotic and thromboprophylaxis
Physical activity for curing back pain
No full textKrižobolja predstavlja značajan zdravstveni problem koje značajno utječe na kvalitetu života pojedinaca ali predstavlja i značajan ekonomski teret kako za bolesnika tako i za društvo u cjelini. U ovom radu istaknuta je učinkovitost različitih vrsta fizičkih aktivnosti u ublažavanju boli u leđima i poboljšanju općeg blagostanja. Medicinske vježbe u vodi, vježbe stabilizacije, McKenziejeva metoda, joga, tai chi, pilates, treninzi istezanja, trening snage i aerobne vježbe su se pokazale učinkovite po pitanju smanjenja boli, poboljšanja fleksibilnosti i unaprjeđenja kvalitete života bolesnika s križoboljom. Prilagođavanje terapijskog pristupa individualnim potrebama i preferencijama bolesnika je ključno za postizanje optimalnih rezultata. Uključivanje tjelesne aktivnosti u svakodnevnu rutinu može predstavljati održivo, dugoročno rješenje za kontrolu križobolje i sprječavanje njezinih recidiva. Daljnja istraživanja su potrebna kako bi se unaprijedila i proširila postojeća znanja omogućujući da primjeri dobre prakse temeljeni na dokazima budu dostupni i primjenjivi različitim populacijama u različitim dohodovnim okruženjima. Promicanjem tjelesne aktivnosti kao značajne komponente liječenja križobolje, može se povećati i svijest javnosti, potaknuti zdraviji stilovi života i unaprijediti sveukupne zdravstvene ishode.Back pain represents a significant health problem that significantly affects the quality of life of individuals, but also represents a significant economic burden both for the patient and for society as a whole. This paper highlights the effectiveness of different types of physical activities in alleviating back pain and improving general well-being. Medical exercises in water, stabilization exercises, the McKenzie method, yoga, tai chi, pilates, stretching exercises, strength training and aerobic exercises have been shown to be effective in reducing pain, improving flexibility and improving the quality of life of patients with back pain. Adapting the therapeutic approach to the individual needs and preferences of the patient is key to achieving optimal results. Incorporating physical activity into your daily routine can be a sustainable, long-term solution to control low back pain and prevent recurrences. Further research is needed to advance and extend existing knowledge enabling evidence-based examples of good practice to be available and applicable to different populations in different access settings. By promoting physical activity as a significant component of back pain treatment, public awareness can be increased, healthy lifestyles can be improved, and overall health outcomes can be improved
SHOULDER INSTABILITY
No full textShoulder instability, particularly of the glenohumeral joint, is common in nowadays medicine, ranging from minor subluxations to complete dislocations caused by trauma or hereditary factors. Anterior dislocations are the most prevalent, often necessitating surgical intervention for associated Bankart lesions. The incidence of traumatic shoulder instability is 1.7% in the general population, with significant recurrence rates. Multidirectional instability (MDI) is notable in patients with hypermobility conditions, increasing the risk of recurrent instability. The shoulder's stability depends on its complex anatomy, including ligaments, muscles, and neurovascular structures. The Stanmore Instability Classification helps categorize instability into structural and non-structural types. Imaging techniques such as MRI and MR arthrography are crucial for diagnosing ligamentous and labral injuries, but they are also essential for planning surgical repairs. Treatment involves both conservative rehabilitations, focusing on muscle strengthening and proprioception, and surgical interventions like Bankart repair and capsular shift, depending on the instability's type and severity. Effective management requires a comprehensive understanding of the shoulder's anatomy, accurate diagnosis, and individualized treatment plans to restore function and prevent recurrence. It is important to note that each patient must be viewed as an individual. Every information given in this thesis is retrospective statistics. The appropriate treatment and care must be provided for each patient individually
GiOPARK Project: The Genetic Study of Parkinson’s Disease in the Croatian Population
No full textParkinson’s disease is a neurological disorder that affects motor function, autonomic functions, and cognitive abilities. It is likely that both genetic and environmental factors, along with age, contribute to the cause. However, there is no comprehensive guideline for genetic testing for Parkinson’s disease, and more research is needed to understand genetic variations in different populations. There has been no research on the genetic background of Parkinson’s disease in Croatia so far. Therefore, with the GiOPARK project, we aimed to investigate the genetic variants responsible for Parkinson’s disease in 153 Croatian patients with early onset, familial onset, and sporadic late-onset using whole-exome sequencing, along with multiplex ligation-dependent probe amplification and Sanger sequencing in select patients. We found causative variants in 7.84% of the patients, with GBA being the most common gene (4.58%), followed by PRKN (1.96%), ITM2B (0.65%), and MAPT (0.65%). Moreover, variants of uncertain significance were identified in 26.14% of the patients. The causative variants were found in all three subgroups, indicating that genetic factors play a role in all the analyzed Parkinson’s disease subtypes. This study emphasizes the need for more inclusive research and improved guidelines to better understand the genetic basis of Parkinson’s disease and facilitate more effective clinical management
Medicolegal relevance of the transient loss of consciousness
No full textTransient and hardly traceable signs of diminished consciousness might be the only signs that are apparent and reported during the scrutinous care of intensive care unit (ICU) staff. Unfortunately, most transient loss of consciousness (TLoC) episodes occur elsewhere. This review aims to help recognize TLoC and identify situations when these conditions mean that certain legal privileges should be held. With this aim, the current literature was scoped for conceptualizing consciousness, its alterations, and loss as regarded in the legal system. This review was partly inceptive for increasing the use of unconsciousness as a defense against criminal charges. This paper tackles working ability and the legal liability of individuals suffering from TLoC. What has been most discussed is so-called syncope—a TLoC without actual focal neurological deficit which occurs due to hypoperfusion of the brain. Therefore, it is a symptom of the nervous system indicating a cardiovascular condition. Unlike stroke or transient ischemic attack (TIA), hypoperfusion affects the entire brain. The sudden loss of consciousness in everyday workplace situations can lead to dangerous situations. Likewise, as a result of avoiding these situations, being aware of the possible loss of consciousness can preclude a patient from performing the duties of occupation—or any activity
Amylin, Another Important Neuroendocrine Hormone for the Treatment of Diabesity
No full textDiabetes mellitus is a devastating chronic metabolic disease. Since the majority of type 2 diabetes mellitus patients are overweight or obese, a novel term—diabesity—has emerged. The gut–brain axis plays a critical function in maintaining glucose and energy homeostasis and involves a variety of peptides. Amylin is a neuroendocrine anorexigenic polypeptide hormone, which is co-secreted with insulin from β-cells of the pancreas in response to food consumption. Aside from its effect on glucose homeostasis, amylin inhibits homeostatic and hedonic feeding, induces satiety, and decreases body weight. In this narrative review, we summarized the current evidence and ongoing studies on the mechanism of action, clinical pharmacology, and applications of amylin and its analogs, pramlintide and cagrilintide, in the field of diabetology, endocrinology, and metabolism disorders, such as obesity
Management of long bone fractures and traumatic hip dislocations in paediatric patients: study protocol for a prospective global multicentre observational cohort registry
No full textABSTRACT
Introduction Management controversy and clinical
equipoise exist in treatments of long bone fractures
and traumatic hip dislocation in paediatric patients
due to the lack of high-quality clinical evidence. This
protocol describes the effort of a large prospective global
multicentre cohort study (registry) aiming at providing
quality data to assist evidence-based treatment decisionmaking.
Methods and analysis Eligible paediatric patients
(N=750–1000) with open physes suffering from proximal
humerus fractures, distal humerus fractures, proximal
radius fractures, forearm shaft fractures, traumatic
hip dislocations, femoral neck fractures or tibial shaft
fractures will be recruited over a period of 24–36
months. Hospitalisation and treatment details (including
materials and implants) will be captured in a cloudbased, searchable database. Outcome measures include
radiographic assessments, clinical outcomes (such as
range of motion, limb length discrepancies and implant
removal), patient-reported outcomes (Patient Reported
Outcomes Of Fracture, Patient-Reported Outcomes
Measurement Information System (PROMIS) and EuroQol5D (EQ-5D-Y)) and adverse events.
Aside from descriptive statistics on patient demographics,
baseline characteristics, types of fractures and adverse
event rates, research questions will be formulated based
on data availability and quality. A statistical analysis plan
will be prepared before the statistical analysis.
Ethics and dissemination Ethics approval will be
obtained before patients are enrolled at each participating
site. Patient enrolment will follow an informed consent
process approved by the responsible ethics committee.
Peer-reviewed publication is planned to disseminate the
study results.
Trial registration number NCT04207892