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ASSOCIATION BETWEEN FIBRINOGEN LEVELS AND OTHER INFLAMMATORY PARAMETERS IN A COHORT OF PATIENT TREATED IN ICU LONGER THEN 7 DAYS
No full textIn summary, this retrospective observational study aimed to evaluate the potential of fibrinogen as a predictor of infection in patients who remain in the Intensive Care Unit (ICU) for longer than seven days. Our findings indicate that fibrinogen can not be reliably used as a predictor of infection development in this patient population. The data showed a significant correlation between fibrinogen and C-reactive protein (CRP), but no significant correlation was found between fibrinogen and leukocytes or procalcitonin (PCT). The small sample size of this study restricts the generalizability of the results. However, these findings provide a valuable foundation for further research. Future studies with a greater sample sizes are necessary to explore these relationships more comprehensively. Such research is crucial for developing better strategies to predict and manage infections in patients with prolonged ICU stays, ultimately improving patient outcomes in critical care settings
Congenital anomalies of the urinary bladder
No full textKongenitalne anomalije mokraćnog mjehura prirođene su rijetke anomalije uzrokovane kombinacijom genetskih poremećaja i djelovanja vanjskih čimbenika. Incidencija nastanka je najmanja od svih kongenitalnih anomalija mokraćnog sustava, a to je 1:50.000 živorođene djece, i čine 30% svih anomalija mokraćnog sustava. Prirođene anomalije mokraćnog mjehura mogu se dijagnosticirati prenatalno ili postnatalno unutar nekoliko sati od djetetova rođenja. Mogu biti izolirane ili nastajati u sklopu različitih sindroma. Najčešće anomalije koje nastaju jesu ekstrofija mokraćnog mjehura, divertikuli mokraćnog mjehura, neurogeni mjehur, megacistis sindrom i agenezija. Agenezija je vrlo rijetka anomalija često nespojiva sa životom. Osim agenezij, ostale anomalije češće se pojavljuju kod dječaka nego kod djevojčica.
Funkcija samog mokraćnog mjehura zahtjeva savršeno djelovanje neuralno – muskularno -hormonalnih podražaja koji uzrokuju pražnjenje i pohranu urina koja je glavna zadaća mokraćnog mjehura. Terapija ovih prethodno gore navedenih anomalija usmjerena je na kiruršku sanaciju anatomskih defekata u građi mokraćnog mjehura koji je zahvaćen prirođenom anomalijom s ciljem omogućavanja normalne pohrane urina, kontinencije urina i daljnjeg normalnog razvoja mokraćnog mjehura. Na taj način će se izbjeći kasnije infekcije urinarnog trakta, opstrukcije, inkontinencija mokraće i kronične upale kao moguća podloga za veću incidenciju nastanka malignih bolesti.Congenital anomalies of the urinary bladder are rare birth anomalies caused by a combination of genetic disorders and the action of external factors. The incidence of occurrence is the lowest of all congenital anomalies of the urinary system, which is 1:50:000 live births, although it accounts for 30% of all anomalies of the urinary system. Congenital anomalies of the urinary bladder can be diagnosed prenatally or postnatally within a few hours of the child's birth. They can be isolated or arise as part of different syndromes. The most common anomalies that occur are exstrophy of the urinary bladder, diverticula of the urinary bladder, neurogenic bladder, megacystis syndrome and agenesis, which is a very rare anomaly that often does not merge with life. Apart from agenesis, other anomalies appear more often in boys than in girls.
The function of the bladder itself requires the perfect action of neural – muscular - hormonal stimuli that cause emptying and storage of urine, which is the main task of the bladder. The therapy of these previously mentioned anomalies is also focused primarily on the surgical repair of anatomical defects in the structure of the urinary bladder that is affected by the congenital anomaly, enabling normal urine storage, urinary continence, the possibility of further normal development of the urinary bladder and care to avoid later infections of the urinary tract. obstructions, urinary incontinence and chronic inflammation as a possible basis for a higher incidence of malignant diseases
The role of diet in inflammatory bowel diseases
No full textThe review presents a focused examination of IBDs, primarily concentrating on CD and UC, encompassing their etiology, pathophysiology, clinical manifestations, diagnostic modalities, therapeutic strategies, and nutritional considerations. Etiologically, a complex interplay of genetic predisposition and environmental triggers are accountable for the rising global incidence of IBDs. Clinical manifestations vary but common symptoms include chronic diarrhea, abdominal pain, fatigue, and weight changes. Diagnosis entails a comprehensive evaluation including detailed clinical history, physical examination, laboratory assessment, and endoscopic investigation to differentiate between CD and UC accurately. Distinguishing features between CD and UC lie in their distinct patterns of inflammation and distribution within the gastrointestinal tract. Therapeutically, management of IBDs adopts a stepwise approach aimed at inducing and maintaining disease remission while minimizing complications. Treatment modalities encompass a range of pharmacological agents, including aminosalicylates, corticosteroids, and immunomodulators, tailored according to disease severity and response to therapy. Nutritional considerations play a pivotal role in the management of IBDs, with dietary factors exerting a significant influence on disease activity and progression. While Western diets rich in meats, sugars, and fats are associated with increased IBD risk, diets abundant in fiber, fruits, vegetables, and omega-3 PUFAs confer protective effects. Furthermore, malnutrition of various origins represents a common complication in IBDs. Nutritional assessment tools, alongside regular monitoring of biochemical parameters, aid in early detection and management of malnutrition. Nutritional interventions, especially enteral nutrition, play a vital role in achieving and maintaining disease remission, particularly in pediatric CD patients
Chronic inflammatory bowel disease in children in Clinical hospital centre Rijeka - retrospective study
No full textUvod: Upalne bolesti crijeva su kronične, imuno posredovane bolesti koje uključuju Crohnovu bolest, ulcerozni kolitis te neklasificiranu UBC. Najčešće se manifestiraju u adolescentnoj dobi. Klinički se očituju proljevom s primjesama krvi, abdominalnim bolovima te gubitkom tjelesne težine. Iako je incidencija UBC u posljednje vrijeme u porastu, pravovremenom dijagnozom i adekvatnom terapijom se postiže mirovanje bolesti i kvaliteta života pacijenata.
Cilj: Prikazati epidemiološka i klinička obilježja pacijenata oboljelih od UBC te analizirati dijagnostičku obradu u pacijenata s postavljenom sumnjom na UBC.
Metode: Retrospektivno istraživanje uključivalo je analizu medicinske dokumentacije 33 djece zaprimljene zbog sumnje na upalnu bolest crijeva te ukupno 15 hospitalizacija zbog egzacerbacije postojeće upalne bolesti crijeva na Klinici za pedijatriju KBC-a Rijeka u petogodišnjem razdoblju (01.01.2019.-31.12.2023.).
Rezultati: Medijan dobi zaprimljene djece sa sumnjom na UBC je 14 godina. Veći dio bila su muška djeca (56,7%) u odnosu na žensku djecu (43,3%). Najčešće zabilježeni simptomi UBC bili su proljevaste stolice, pojava krvi u stolici, abdominalna bol te gubitak tjelesne težine. Kod svih ispitanika dijagnoza je postavljena na temelju patohistološkog nalaza uzorka dobivenog biopsijom sluznice crijeva tijekom endoskopije. Od 15 hospitalizacija zbog pogoršanja osnovne bolesti, 80% je bilo zbog UK, a 20% zbog CB.
Zaključak: Zbog globalnog porasta incidencije UBC u djece, potrebna je pravovremena dijagnoza i odgovarajuća terapija kako bi se bolest uvela u remisiju i time održala kvaliteta života djece.Introduction: Inflammatory bowel diseases are chronic, immune-mediated diseases that include CB, UC and unclassified UBC. They are most often manifested in adolescence. Clinically, they are manifested by diarrhea with admixture of blood, abdominal pain and weight loss. Although the incidence of UBC has been on the rise recently, with timely diagnosis and adequate therapy, disease remission and patients' quality of life can be achieved.
Aim: To present the epidemiological and clinical characteristics of patients with UBC and to analyze the diagnostic work-up in patients with suspected UBC.
Methods: A retrospective study included an analysis of the medical records of 33 children admitted for suspected inflammatory bowel disease and a total of 15 hospitalizations due to exacerbation of existing inflammatory bowel disease at the Pediatric Clinic of KBC Rijeka in a five-year period (January 1, 2019-December 31, 2023).
Results: The median age of children admitted with suspected UBC is 14 years. The majority were male children (56.7%) compared to female children (43.3%). The most frequently recorded symptoms of UBC were diarrheal stools, the appearance of blood in the stool, abdominal pain and weight loss. In all subjects, the diagnosis was established on the basis of the pathohistological findings of the sample obtained by biopsy of the intestinal mucosa during endoscopy. Of the 15 hospitalizations due to worsening of the underlying disease, 80% were due to UK, and 20% were due to CB.
Conclusion: Due to the global increase in the incidence of UBC in children, timely diagnosis and appropriate therapy are needed to put the disease into remission and thereby maintain the quality of life of children
Sexual differentiation disorder - Gonadal dysgenesis
No full textGonadna disgeneza je specifičan podskup poremećaja spolnog razvoja, obuhvaćajući različite genetičke i fenotipske varijacije. Fokusirajući se na potpunu i parcijalnu gonadnu disgenezu, ovaj rad analizira njihove kliničke prezentacije, genetičke uzroke i moguće komplikacije. Pregledom literature obrađeni su mehanizmi razvoja ovih poremećaja, dijagnostički postupci i pristupi liječenju.
Gonadna disgeneza proizlazi iz genetičkih promjena koje uzrokuju oštećenje razvoja gonada, rezultirajući potpunim ili djelomičnim poremećajem. Rad identificira najčešće oblike gonadne disgeneze kao što su 46,XY Swyer sindrom, 45,X/46,XY mozaicizam, Kallmann sindrom i Turner sindrom. Kroz analizu mehanizama spolne diferencijacije, raspravlja se o razvoju unutarnjih i vanjskih spolnih organa te njihovoj disfunkciji kod pacijenata s gonadnom disgenezom.
Dijagnostika gonadne disgeneze zahtijeva integrirani pristup koji uključuje kliničke, laboratorijske, genetičke i slikovne postupke. Kroz detaljnu anamnezu, klinički pregled i laboratorijske testove, utvrđuje se prisutnost hipogonadizma i identificiraju specifični tipovi poremećaja. Genetičke analize i radiološke pretrage dodatno pružaju informacije o uzrocima i fenotipskim varijacijama poremećaja.
Posebna pažnja posvećena je prenatalnoj dijagnostici i prepoznavanju atipičnih znakova koji ukazuju na gonadnu disgenezu. Sve ove varijante gonadne disgeneze zahtijevaju cjeloživotno praćenje i prilagođeni pristup liječenju radi osiguranja najbolje moguće kvalitete života za pacijente.Gonadal dysgenesis has been investigated as a specific subset of disorders of sexual development, encompassing various genetic and phenotypic variations. Focusing on complete and partial gonadal dysgenesis, this paper analyzes their clinical presentations, genetic causes, and potential complications. Reviewing the literature, mechanisms of these disorders' development, diagnostic procedures, and treatment approaches are addressed.
Gonadal dysgenesis arises from genetic changes that impair gonadal development, resulting in complete or partial disorders. The paper identifies the most common forms of gonadal dysgenesis such as 46,XY Swyer syndrome, 45,X/46,XY mosaicism, Kallmann syndrome, and Turner syndrome, highlighting their genetic and phenotypic differences. Through an analysis of mechanisms of sexual differentiation, the development of internal and external genitalia and their dysfunction in patients with gonadal dysgenesis are discussed.
The diagnosis of gonadal dysgenesis requires an integrated approach involving clinical, laboratory, genetic, and imaging procedures. Through detailed medical history, clinical examination, and laboratory tests, the presence of hypogonadism is determined, and specific types of disorders are identified. Genetic analyses and radiological examinations further provide information on the causes and phenotypic variations of the disorder.
Special attention is given to prenatal diagnosis and recognition of atypical signs indicating gonadal dysgenesis. All these variants of gonadal dysgenesis require lifelong monitoring and a tailored approach to treatment to ensure the best possible quality of life for patients
Complex revascularization of supra-aortic branches
No full textRevaskularizacija supraaortnih grana predstavlja kritičan aspekt vaskularne kirurgije i to rješavajući složene patologije koje uključuju arterije koje opskrbljuju krvlju glavu i gornje ekstremitete. Ovaj rad daje pregled trenutnog stanja složenih revaskularizacijskih postupaka.
Napredak u tehnikama snimanja, perioperativnom liječenju i kirurškoj opremi značajno je poboljšao preciznost i sigurnost revaskularizacije supraaortalnih grana. Integracija endovaskularnih pristupa, poput angioplastike i postavljanja stenta, uz tradicionalne otvorene kirurške metode, proširila je oruđe liječenja za raznolik raspon vaskularnih patologija.
Međutim, i dalje postoje izazovi, uključujući složenost odabira pacijenata, optimalan izbor tehnike revaskularizacije i liječenje perioperativnih komplikacija. Čimbenici specifični za pacijenta, kao što su anatomske varijacije, komorbiditeti i prisutnost složenih lezija, zahtijevaju prilagođeni pristup za postizanje optimalnih ishoda. Usklađivanje potencijalnih rizika i dobrobiti različitih strategija revaskularizacije ostaje složen proces donošenja odluka.Revascularization of the supraaortic branches represents a critical aspect of vascular surgery, solving complex pathologies involving the arteries that supply blood to the head and upper extremities. This paper provides an overview of the current state of complex revascularization procedures.
Advances in imaging techniques, perioperative management, and surgical equipment have significantly improved the precision and safety of supraaortic branch revascularization. The integration of endovascular approaches, such as angioplasty and stenting, in addition to traditional open surgical methods, has expanded the treatment tools for a diverse range of vascular pathologies.
However, challenges remain, including the intricacies of patient selection, optimal choice of revascularization technique, and management of perioperative complications. Patient-specific factors, such as anatomic variations, comorbidities, and the presence of complex lesions, require a tailored approach to achieve optimal outcomes. Balancing the potential risks and benefits of different revascularization strategies remains a complex decision-making process
Clinical and therapeutic features of operated patients with kidney cancer
No full textProvedena je retrospektivna evaluacija medicinske dokumentacije pacijenata s karcinomom bubrega operiranih u Kliničkom bolničkom centru Rijeka na Klinici za urologiju u razdoblju od 1.1.2021. do 31.12.2022. godine. Prikupljeni su i obrađeni sljedeći podaci pacijenata: dob, spol, vrsta operacije, koji bubreg je operiran, patohistološki tip tumora, veličina tumora, simptomi i znakovi prilikom postavljanja dijagnoze, laboratorijske vrijednosti hemoglobina, kreatinina i ureje, izvršenost slikovnih pretraga, prisutnost metastaza, postoperacijske komplikacije i njihovo liječenje. Svrha ovog rada jest prikazati kliničke i terapijske značajke operiranih bolesnika s karcinomom bubrega u dvogodišnjem razdoblju. Naglasak je stavljen na kliničku sliku i kirurško liječenje pacijenata
Diabetic retinopathy and modern therapeutic approach
No full textDijabetička retinopatija je vodeća komplikacija dijabetesa melitusa i glavni uzrok sljepoće kod odraslih osoba u radnoj dobi. DR nastaje kao rezultat dugotrajne hiperglikemije, koja dovodi do oštećenja krvnih žila mrežnice kroz složene patofiziološke mehanizme, uključujući mikrovaskularne promjene, upalu i neurodegeneraciju.
Dijabetička retinopatija se klinički dijeli na neproliferacijsku i proliferacijsku fazu. NPDR karakterizira povećana propusnost i okluzija kapilara, što može dovesti do mikroaneurizmi, krvarenja i tvrdih eksudata. PDR je ozbiljnija i uključuje stvaranje novih, abnormalnih krvnih žila koje mogu uzrokovati ozbiljne komplikacije poput odvajanja retine i teškog gubitka vida.
Glavni faktori rizika za razvoj DR uključuju trajanje dijabetesa, visoke razine HbA1c, povišeni krvni tlak i serumskih lipida. Prevencija je usmjerena na strogu kontrolu šećera u krvi, krvnog tlaka i lipidnih profila, kao i na redovite oftalmološke preglede kako bi se rano otkrile promjene na mrežnici.
Liječenje DR uključuje nekoliko pristupa. Laserska fotokoagulacija koristi se za zatvaranje curenja iz krvnih žila i sprječavanje stvaranja novih abnormalnih žila. Intravitrealne injekcije anti-VEGF lijekova smanjuju upalu i patološku angiogenezu. U težim slučajevima može biti potrebna vitreoretinalna kirurgija kako bi se uklonila krvarenja iz staklastog tijela ili popravilo odvajanje mrežnice.
Usprkos trenutnim terapijama, mnogi pacijenti ne doživljavaju poboljšanje, što zahtijeva daljnji razvoj novih terapijskih metoda. Buduća istraživanja trebala bi se usmjeriti na razumijevanje molekularnih mehanizama bolesti, kao i na razvoj regenerativnih terapija, kao što je transplantacija matičnih stanica, koje bi mogle pružiti mogućnost obnavljanja oštećene mrežnice.
Sveobuhvatan pristup uključuje prevenciju, rano otkrivanje i napredne terapijske metode kako bi se smanjila učestalost i ozbiljnost dijabetičke retinopatije i poboljšala kvaliteta života pacijenata s dijabetesom.Diabetic retinopathy is a leading complication of diabetes mellitus and the main cause of blindness among working-age adults. DR results from prolonged hyperglycemia, which leads to damage to the retinal blood vessels through complex pathophysiological mechanisms, including microvascular changes, inflammation, and neurodegeneration.
Diabetic retinopathy is clinically divided into non-proliferative and proliferative stages. NPDR is characterized by increased capillary permeability and occlusion, which can lead to microaneurysms, hemorrhages, and hard exudates. PDR is more severe and involves the formation of new, abnormal blood vessels that can cause serious complications such as retinal detachment and severe vision loss.
The main risk factors for developing DR include the duration of diabetes, high levels of HbA1c, elevated blood pressure, and serum lipids. Prevention focuses on strict control of blood sugar levels, blood pressure, and lipid profiles, as well as regular ophthalmological examinations to detect retinal changes early.
Treatment of DR includes several approaches. Laser photocoagulation is used to seal leaking blood vessels and prevent the formation of new abnormal vessels. Intravitreous injections of anti-VEGF drugs reduce inflammation and pathological angiogenesis. In more severe cases, vitreoretinal surgery may be necessary to remove vitreous hemorrhages or repair retinal detachments.
Despite current therapies, many patients do not experience improvement, highlighting the need for further development of new therapeutic methods. Future research should focus on understanding the molecular mechanisms of the disease, as well as developing regenerative therapies, such as stem cell transplantation, which could offer the possibility of restoring damaged retinas.
A comprehensive approach includes prevention, early detection, and advanced therapeutic methods to reduce the incidence and severity of diabetic retinopathy and improve the quality of life for patients with diabetes
Dijagnostika i liječenje infektivnog endokarditisa - iskustva iz Klinike za infektivne bolesti Kliničkog bolničkog centra Rijeka u 10-godišnjem periodu
No full textInfective endocarditis is a disease whose incidence is rising in patients of all ages; with male gender predominance of 2:1 ratio. Degenerative valvular diseases, an increase in the number of artificial valve procedures and a higher rate of nosocomial infections have led to the increase in the average age of patients with IE. IE is associated with high morbidity and mortality and, if left untreated, IE is considered to be always fatal. In recognizing this disease, the most important is to diagnose it on the basis of history and clinical examination. Modified Duke Criteria are generally accepted and applied in diagnostics today, even though they show low sensitivity without using imaging methods. Treatment of patients requires the joint involvement of infectious disease specialists, microbiologists and cardiologists, cardiac imaging experts and cardiac surgeons. Antimicrobial therapy is used in all cases due to the nature of infective agents; surgery is becoming the backbone in reducing mortality being used in up to 50% of patients. Adherence to therapeutic guidelines and indications for surgery can significantly improve the survival and quality of life of these patients.Infektivni endokarditis bolest je čija je incidencija u porastu u bolesnika svih dobnih skupina; s dominacijom muškog spola u omjeru 2:1. Degenerativne valvularne bolesti, povećanje broja kirurških zahvata na zalistcima i veća stopa nozokomijalnih infekcija doveli su do porasta prosječne dobi bolesnika koji oboljevaju od infektivnog endokarditisa. Infektivni endokarditis povezan je s visokim morbiditetom i mortalitetom te, ako se pravovremeno ne liječi, smatra se uvijek fatalnim. U prepoznavanju ove bolesti najvažnije je dijagnosticirati je na temelju anamneze i kliničkog pregleda. Modificirani Dukeovi kriteriji danas su općenito prihvaćeni i primjenjuju se u dijagnostici, iako pokazuju nisku osjetljivost bez korištenja slikovnih metoda. Liječenje bolesnika zahtijeva zajednički angažman infektologa, mikrobiologa, kardiologa te kardiokirurga. Antimikrobna terapija koristi se u svim slučajevima zbog prirode uzročnika infekcije; kirurgija postaje okosnica u smanjenju smrtnosti i koristi se u do 50% pacijenata. Pridržavanje terapijskih smjernica i indikacija za operaciju može značajno poboljšati preživljenje i kvalitetu života ovih bolesnika
The Vaginal Microbiome in Health and Disease
No full textThere are different compositions characterizing a healthy vaginal microbiota, typically characterized by a dominance of Lactobacilli and an acidic pH milieu, constituting the primary barrier against pathogenic intrusion. Even subtle perturbations can precipitate various clinical presentations or adverse obstetric outcomes. The vaginal microbial balance (VMB) is intricately modulated by multifaceted factors, encompassing the woman's age, hormonal milieu, lifestyle choices, prior infections and treatments, as well as the influence of probiotics, among others. Hence, it exhibits dynamic temporal fluctuations rather than static stability.
This discourse delves into three prevalent clinical entities incited by dysbiosis, namely Bacterial Vaginosis (BV), Vulvovaginal Candidiasis (VVC), and Trichomoniasis, each attributed to bacterial, fungal, and protozoal pathogens, respectively. Beyond hallmark symptoms such as malodor, pruritus, and increased vaginal discharge, these maladies pose obstetric complications and heighten susceptibility to sexually transmitted diseases (STDs) and urogenital afflictions during gestation. Treatment modalities entail aggressive measures, often entailing systemic antibiotics, inadvertently affecting both pathogenic and commensal flora, thus disrupting the delicate equilibrium and fostering recurrence.
In mitigating such recurrences, probiotics emerge as pivotal adjuncts, comprising non-pathogenic, symbiotic microorganisms beneficial to the host. While strides have been made in ameliorating reinfection rates and optimizing therapeutic outcomes, extensive research endeavors remain imperative to pinpoint the ideal bacterial strains, thereby furnishing patients with enhanced therapeutic regimens.There are different compositions characterizing a healthy vaginal microbiota, typically characterized by a dominance of Lactobacilli and an acidic pH milieu, constituting the primary barrier against pathogenic intrusion. Even subtle perturbations can precipitate various clinical presentations or adverse obstetric outcomes. The vaginal microbial balance (VMB) is intricately modulated by multifaceted factors, encompassing the woman's age, hormonal milieu, lifestyle choices, prior infections and treatments, as well as the influence of probiotics, among others. Hence, it exhibits dynamic temporal fluctuations rather than static stability.
This discourse delves into three prevalent clinical entities incited by dysbiosis, namely Bacterial Vaginosis (BV), Vulvovaginal Candidiasis (VVC), and Trichomoniasis, each attributed to bacterial, fungal, and protozoal pathogens, respectively. Beyond hallmark symptoms such as malodor, pruritus, and increased vaginal discharge, these maladies pose obstetric complications and heighten susceptibility to sexually transmitted diseases (STDs) and urogenital afflictions during gestation. Treatment modalities entail aggressive measures, often entailing systemic antibiotics, inadvertently affecting both pathogenic and commensal flora, thus disrupting the delicate equilibrium and fostering recurrence.
In mitigating such recurrences, probiotics emerge as pivotal adjuncts, comprising non-pathogenic, symbiotic microorganisms beneficial to the host. While strides have been made in ameliorating reinfection rates and optimizing therapeutic outcomes, extensive research endeavors remain imperative to pinpoint the ideal bacterial strains, thereby furnishing patients with enhanced therapeutic regimens