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No impact of steatotic liver disease on clinical outcomes in patients with essential thrombocythemia and polycythemia vera: A pilot study
No full textThe presence of steatotic liver disease (SLD) is associated with an increased cardiovascular risk in the general population. Chronic myeloproliferative neoplasms (MPNs), essential thrombocythemia (ET) and polycythemia vera (PV), are characterized by clonal myeloproliferation, chronic inflammatory state, and increased cardiovascular morbidity and mortality. The aim of this single-center study was to analyze clinical associations and the potential prognostic impact of SLD in ET and PV patients. We retrospectively included 108 patients (64 ET and 44 PV); median age was 70.5 years (range 21–92), 68 (63 %) were females, and the median follow-up time was 69 months. Baseline SLD presence was defined ultrasonographically and was detected in 25 (23.1 %) patients. There were no associations of SLD with any of the clinical and laboratory patient characterictics. Also, baseline ultrasonographic presence of SLD did not have an impact on future thrombotic, bleeding and disease transformation risk, nor patient survival. None of the patients experienced signs of liver failure during the follow-up. In conclusion, the presence of SLD in ET and PV patients does not seem to have major clinical implications. Therefore, patients may be advised about the generally harmless nature of SLD when occurring in the MPN context
Challenges of the Utilitarian Understanding of Religion
No full textPolazeći od pojma utilitarističkog razumijevanja religije, rad analizira odabrane suvremene teorije koje nastoje objasniti ljudsku religioznost, ističući temeljno pitanje tih pokušaja – pitanje o koristi religije u preživljavanju i reprodukciji pojedinca i društva. Razlog te usmjerenosti prepoznaje se u određenosti svih navedenih pokušaja evolucijskom teorijom. Nakon uvodne uspostave problematike utilitarističkog razumijevanja religije, u prvom koraku analiziraju se odabrane teorije koje razmatraju religiju kroz odnos pojedinac – društvo (šire utilitarističko razumijevanje religije), dok se u drugom koraku promatraju teorije koje polaze od ljudskih kognitivnih mehanizama te neuronske arhitekture i procesa (uže utilitarističko razumijevanje religije). Uz shvaćanje prednosti ovih pristupa, u zaključku se upozorava na ipak ograničeno razumijevanje religije i nužnost šireg zahvaćanja tog složenog i kompleksnog fenomena.Starting from the concept of the utilitarian understanding of religion, this paper analyzes selected contemporary theories that attempt to explain human religiosity, emphasizing that the main question of these attempts is the utility of religion for the survival and reproduction of the individual and society. The focus on this question is recognized as being influenced by evolutionary theory in all these attempts. After the introductory establishment of the issue of the utilitarian understanding of religion, the first step analyzes selected theories that examine religion in the context of the individual-society relationship (broader utilitarian understanding of religion), while the second step considers theories that start from human cognitive mechanisms and neural architecture / processes (narrow utilitarian understanding of religion). While understanding the advantages of these approaches, the conclusion points out the limited understanding of religion that these perspectives offer and the necessity of a broader approach to this complex and multifaceted concept
Open vertebroplasty for treating the metastatic compression fractures of the vertebral body and reducing pain syndrome
No full textObjectives: The aim of this study was to examine the efficacy of the operative procedure, open
vertebroplasty, by comparing and evaluating the clinical results before and after open vertebroplasty in the
treatment of vertebral fractures with spinal canal compression. Success of the surgery is defined by
increased or reduced pain intensity before and after the treatment, as assessed using the Visual Analogue
Scale (VAS).
Participants and methods: Data for the patients treated for vertebral fractures with open vertebroplasty
were retrospectively collected at the Institute for Orthopaedics of the Clinical Hospital Centre Osijek. The
analyzed data included: gender, duration of the illness, the intensity of pain before and after the treatment
(using the VAS), neurological status, radiological changes of the treated vertebral segment, before and after
the treatment, grade of vertebral fracture, and extracorporeal cement leakage from the vertebra body to the
surrounding tissue during the procedure.
Results: The study included 23 patients, of whom 13 were females and ten were males. The difference
in pain before and after the surgery was statistically significant. All the patients complained of pain before
the surgery, and the pain intensity median was 8 (interquartile range 7, 5 to 9). However, after the surgery,
pain intensity decreased in all the patients, and the pain intensity median was 2.5 (interquartile range 2 to
3).
Conclusion: Improvement in clinical results of the treatment of vertebral metastatic fractures with
spinal stenosis with open vertebroplasty proves to be significant
Impact of Point-of-Care Laboratory Diagnostics on Emergency Department Processing Times During the COVID-19 Pandemic
No full textU Objedinjenom hitnom bolničkom prijamu (OHBP) Kliničkog bolničkog centra Rijeka 2020. godine uspostavljeno je molekularno testiranje kraj kreveta bolesnika (engl. Point-of-care polymerase chain reaction; POC-PCR) na teški akutni respiratorni sindrom koronavirus 2 (engl. Severe acute respiratory syndrome coronavirus 2; SARS-CoV-2). Uz bolesnike sa sumnjom na infekciju virusom SARS-CoV-2 redovito su testirani i zaposlenici. Ova studija analizira utjecaj POC-PCR-a na vrijeme obrade uzoraka, učinkovitost metode zbirnog testiranja te postotak lažno negativnih brzih antigenskih testova (BAT) u usporedbi s POC-PCR-om. Materijali i metode: Istraživanje je uključivalo bolesnike OHBP-a, hospitalizirane bolesnike i bolničko osoblje. Bolesnicima su uzeti brisevi orofarinksa i nazofarinksa. Osoblje je testirano zbirnim testiranjem (engl. “pooling”) koje uključuje do pet briseva nazofarinksa u istoj testnoj epruveti. PCR u stvarnom vremenu modificiran je u POC-PCR, a metode su izvođene s automatskom ekstrakcijom nukleinskih kiselina ili bez ekstrakcije. Visoko prioritetni slučajevi testirani su koristeći multipleks QIAstat-Dx SARS-CoV-2 respiratorni panel. Rezultati: Prije integracije POC-PCR laboratorija u OHBP, medijani potrebnog vremena od prikupljanja uzoraka do PCR rezultata iznosili su 74,29 i 8,35 sati. Nakon otvorenja POC-PCR laboratorija 2021. g. medijan se smanjio na 3,25 sati 2021. g., 2,30 sati 2022. g. te konačno dosegnuo 1,30 sati 2023. g. Također, od ukupno 1608 BAT-ova testiranih tijekom perioda od tri mjeseca, 3,4 % bilo je lažno negativno. Uvođenjem zbirnog testiranja brisevi bolničkog osoblja obrađeni su unutar 2,30 sati, a u slučaju pozitivnog testa, unutar šest sati od početka svake smjene. Najteže kategorije pacijenata testirane su multipleks PCR-om i rezultati pokazuju da SARS-CoV-2 prevladava, a slijede ga rinovirus/enterovirus i virusi influence. Zaključak: Integracija POC-PCR dijagnostike u OHBP-u značajno je ubrzala obradu uzoraka i pokazala učinkovitost zbirnog testiranja među bolničkim osobljem, čime se smanjuje pritisak na sustav hitne medicine i potiče daljnji razvitak POC-PCR laboratorija.Aim: In 2020 Emergency department (ED) in the Clinical hospital centre Rijeka established Point-of-care polymerase chain reaction (POC-PCR) testing for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to suspect cases, the ED also regularly tested hospital employees. To reduce the number of samples, employee’s swab samples were pooled for testing. This study aimed to analyse the impact of POC-PCR on diagnostic samples’ processing times, evaluated the efficacy of the pooling method among hospital personnel, and determined percentage of false-negative rapid antigen tests (RATs) in comparison with POC-PCR. Materials and Methods: The study included ED patients, hospitalized patients, and hospital personnel. Patients underwent oropharyngeal and nasopharyngeal swabbing. Personnel were screened using the pooling method, combining up to five swabs per test tube. Real time PCR (RT-PCR) was modified to POC-PCR, with or without automated nucleic acid extraction. High-priority patients were tested using the Multiplex PCR QIAstat-Dx Respiratory SARS-CoV-2 Panel. Results: Before the POC-PCR laboratory was established, the median processing times from sample collection to PCR results were 74.29 and 8.35 hours, respectively. Following the establishment of the POC-PCR laboratory in 2021, the median further reduced to 3.25 hours in September 2021, 2.30 hours in September 2022, and eventually reached 1.30 hours in September 2023. Additionally, out of the total 1608 RATs conducted over a 3-month period, 3.4% were false negatives. The pooling method allowed hospital staff samples to be analysed within 2.30 hours, or in the case of a positive pool, within 6 hours of each shift. Multiplex PCR for severe ED patients showed predominant SARS-CoV-2, followed by Rhinovirus/Enterovirus, Influenza, and other Coronaviruses. Conclusion: POC-PCR integration in the ED has significantly reduced time to diagnoses and proved the efficacy of the pooling method, easing the burden on ED and paving the way for further POC-PCR laboratory development
Healing of apical periodontitis after nonsurgical endodontic treatment : the impact of diabetes mellitus and tobacco smoking : doctoral thesis
No full textCiljevi: Procijeniti i usporediti cijeljenje periapikalne kosti u pušača i nepušača nakon
endodontskog liječenja te ispitati povezanost intenziteta i trajanje navike pušenja s brzinom
cijeljenja apikalnog parodontitisa (AP). Također, procijeniti i usporediti cijeljenje AP u
oboljelih od šećerne bolesti tip II (ŠB II) i zdravih pacijenata te ispitati povezanost
koncentracije glikiranog hemoglobina s brzinom cijeljenja AP.
Ispitanici i metode: Uključeni su punoljetni pacijenti s radiološkom dijagnozom AP i zubima
koji nisu prethodno endodontski liječeni. Formirane su skupine pušači i nepušači te oboljeli od
ŠB II i zdravi ispitanici upareni po dobi i spolu. Praćenje cijeljenja AP provodilo se izradom
periapikalnih snimaka odmah nakon završetka liječenja te na kontrolnim pregledima nakon 6 i
12 mjeseci. Periapikalni status zuba procijenjen je pomoću periapikalnog indeksa (PAI).
Prikupljeni su podaci o navici pušenja i socioekonomskom statusu te je izračunat indeks
pušenja. Stupanj glikemijske kontrole je određen pomoću glikiranog hemoglobina (HbA1c).
Rezultati: Uočena je viša stopa cijeljenja u skupini nepušača (90,9%) nego u pušača (58,2 %)
nakon 12 mjeseci (χ
2=13,846; P<0,001). Regresijska analiza je prikazala da se rizik od
izostanka cijeljenja AP značajno povećava s porastom vrijednosti indeksa pušenja i to 7,66
puta za indeks pušenja < 400 (OR =7,66; 95% CI: 2,51-23,28; P < 0,001) i 9,65 puta za indeks
pušenja 400 do 799 (OR = 9,65; 95% CI: 1,45-64,14; P = 0,019). Uočena je značajno veća
stopa cijeljenja u kontrolnoj skupini (66,6%) nakon 6 mjeseci u odnosu na skupinu oboljelih
od ŠB II (33,3%; χ
2= 4,857; P=0,0275). Žene su imale 3,92 puta veći rizik od izostajanja
cijeljenja AP u usporedbi s muškarcima (OR= 3,92; 95% CI: 1,04-14,79; P=0,043). Ispitanici
koji boluju od ŠB IIsu imali 4,27 puta veći rizik za izostajanjem cijeljenja AP nakon 12 mjeseci
u usporedbi sa zdravim ispitanicima (OR=4,27; 95% CI: 1,18-15,50; P=0,027). Ispitanici s
višim prihodima su imali 5,39 puta povećani rizik za izostanak cijeljenja AP u odnosu na
ispitanike s manjim prihodima (OR=5,39; 95% CI=1,33-21,89; P=0,018).
Zaključak: Uočena je povezanost povećanog intenziteta pušenja s izostankom cijeljenja AP.
Cijeljenje AP je bilo usporeno u oboljelih od ŠB II u odnosu na kontrolnu skupinu, međutim
ne i kompromitirano. Potrebne su redovite kontrole kako bi se nadzirao proces cijeljenja
periapikalnih lezija.Objectives: To assess and compare the healing of periapical bone in smokers and nonsmokers
after nonsurgical endodontic treatment and to analyze the association of intensity and smoking
duration with the healing rate of apical periodontitis (AP). Also, to assess and compare the
healing of AP in patients with diabetes mellitus type II (DM II) and healthy controls and to test
the association of glycemic control with the healing rate of AP.
Patients and methods: Adult patients with a radiographically confirmed diagnosis of AP were
included in the study. Only previously untreated teeth were included in the sample. Groups of
smokers and nonsmokers, patients with DM II, and healthy control groups were formed and
matched according to age and gender. Healing of AP was monitored using periapical
radiographs taken after root canal treatment, and at recalls after 6 and 12 months. The periapical
status of teeth was assessed using a periapical index score (PAI). Data on smoking intensity
and duration and socioeconomic status were collected and a smoking index was calculated.
Glycemic control was assessed using glycated haemoglobin (HbA1c).
Results: A significantly higher healing rate was observed in the control group than in smokers
(90,9% vs 58,2; χ2=13,846; P<0,001). The logistic regression analysis observed that an increase
in the value of the smoking index increases the risk of AP persistence 7,66 times for smoking
index < 400 (OR =7,66; 95%; CI: 2,51-23,28; P < 0,001) and 9,65 times for smoking index
400 to 799 (OR = 9,65; 95% CI: 1,45-64,14; P = 0,019). A significantly higher healing rate
was observed in the control group than in patients with DM II (66,6 vs 33,3%; χ2= 4,857;
P=0,0275) at 6 months follow-up. Female gender was associated with an increased risk of AP
persistence compared to men (OR= 3,92; 95% CI: 1,04-14,79; P=0,043). Patients with DM II
had a 4,27 greater risk of AP persistence after 12 months in comparison to the control group
(OR=4,27; 95% CI: 1,18-15,50; P=0,027). Participants with a higher income had a 5,39 greater
risk of AP persistence compared to participants with a lower income (OR=5,39; 95% CI=1,33-
21,89; P=0,018).
Conclusion: An association between increased smoking intensity and AP persistence was
observed. Healing of AP was delayed in patients with DM II, however not compromised.
Regular follow-ups are needed to monitor the healing process of periapical lesions
Analysis of Axillary Lymph Nodes in Breast Cancer Patients with Positive Sentinel Lymph Node Biopsy
No full textObjective: To determine the prevalence of positive non-sentinel nodes (non-SLN) after axillary dissection for positive sentinel lymph node (SLN) and the relationship between occurrence of positive non-SLNs and penetration of the sentinel's capsule by malignant cells, as well as grade and molecular subtype of the breast cancer.
Methods: An analysis was performed of a total of 77 patients with a positive SLN from a fiveyear period. Patients were categorized according to the following criteria: positivity of non-SLN, invasion of SLN capsule, tumour grade, T stage and molecular subtype.
Results: In over 65% of patients, non-SLN were negative for metastases despite a positive SLN. A statistically significant correlation was observed between SLN capsule penetration and positive non-SLN metastases (p < 0.001). It was also observed that non-SLN metastases are more commonly positive in patients with a high tumour grade, high T stage, and HER2-positive and triple-negative tumours.
Conclusion: Non-SLN metastases are generally found in patients with SLN capsule penetration by malignant cells, in those with poorly differentiated tumours (high grade), and in those with high T stage, as well as in triple-negative and HER2-positive tumours. Based on these findings, such patients should undergo axillary dissection due to an increased risk of non-SLN metastases
Kant’s Critique of Pure Moral Interest
No full textAutor u radu polazi od temeljnih odrednica interesa uma i nagnuća u kontekstu čovjekova odredbenog razloga djelovanja s posebnim osvrtom na pitanje čistog moralnog interesa. Temeljna je, pritom, pretpostavka shvaćanje da osjetilnost određuje ono što je ugodno i obećava osjetilnu ugodu, a um ističe ono što je dobro. Budući da svako određenje volje može nastupiti samo na jedan od ova dva načina jasno je kako svako htijenje ima interes kao osnovu. U okviru tih razmatranja rad ukazuje na probleme koji su vezani uz poteškoće razjašnjenja čistog moralnog interesa da adekvatno izrazi obvezatnost kategoričkog imperativa s obzirom na štovanje moralnog zakona. U zaključku se naglašava da se potencijalni moralni sukob između interesa nagnuća i interesa uma odnosi jedino na subjekta koji odabire osjetilno pokretalo kao moguće određenje svojega djelovanja, a ne moralni zakon kao takav.In this paper, the author explores the foundational determinants of interests of reason and interests of inclination within the framework of the determining principle of action. Special attention is given to the concept of pure moral interest. The underlying assumption is the recognition that sensibility dictates what is pleasurable and promises sensory delight, while reason discerns what is morally good. Since every determination of the will arises through one of these two ways, it becomes clear that every act of the will is rooted in an interest. In this context, the paper addresses the challenges of elucidating pure moral interest in order to adequately express the obligation of the categorical imperative to respect the moral law. The conclusion emphasizes that the potential moral conflict between the interests of inclination and those of reason concerns only the individual who chooses the sensory incentive as a potential determinant of their actions, and does not pose a challenge to the moral law itself
Dataset DIABOLYC
No full textZavršni skup podataka sadržava informacije o metodologiji istraživanja i eksperimentalnih pokusa, pojedinostima analiza i sve neophodne informacije o korištenim materijalima u istraživanju.· tekstualni dokument s pojedinostima uvjeta i postupaka provedenih eksperimenata (eksperimentalni protokol)
· dokument s tablicom korištenih materijala (reagencija i antitijela
Hyperparathyreoidism After Kidney Transplantation
No full textNakon uspješne transplantacije bubrega dolazi do oporavka egzokrine i endokrine funkcije bubrega. Vrijednosti serumske koncentracije kalcija, fosfata, paraireoidnog hormona (PTH), čimbenika rasta fibroblasta 23 i vitamina D se normaliziraju. Zbog toga bi trebale uslijediti pozitivne promjene u koštanom metabolizmu. Kod dijela bolesnika, unatoč uspješnoj transplantaciji, ostaju poremećaji u koštanom metabolizmu. Učestalost hiperparatireoidizma (HPT) nakon prve godine od transplantacije bubrega kreće se od 10 do 50 %. Trajanje dijalize i stupanj hiperplazije paratireoidnih žlijezda čimbenici su rizika za razvoj poslijetransplantacijskog HPT-a. Liječenje poslijetransplantacijskog HPT-a uključuje terapiju vitaminom D, analozima vitamina D, kalcimemeticima i paratireidektomija.After successful kidney transplantation, the recovery of exocrine and endocrine kidney function occurs. Serum calcium, parathyroid hormone (PTH) phosphate, fibroblast growth factor 23 (FGF-23) and vitamin D values normalize. Therefore, positive changes in bone metabolism improve bone quality, reducing the frequency of fractures and vascular calcifications. In some patients, despite successful transplantation, disorders in bone metabolism remain. The incidence of hyperparathyroidism (HPT) after the first year of kidney transplantation ranges from 10-50%. The duration of dialysis and the degree of hyperplasia of the parathyroid glands are risk factors for the development of posttransplant HPT. The treatment of posttransplant HPT includes vitamin D therapy, vitamin D analogs, calcimimetics and parathyroidectomy (PTX)