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Etiological factors in the development of bladder cancer
No full textKarcinom mokraćnog mjehura maligna je neoplazma najčešće nastala iz prijelaznog epitela. Četiri je puta češći kod muškaraca nego kod žena. Također, dvostruko je učestaliji u pripadnika bijele rase u odnosu na crnu rasu. Prosječna dob bolesnika s navedenom bolesti je 73 godine. Prema podacima Hrvatskog zavoda za javno zdravstvo za 2021. godinu rak mokraćnog mjehura četvrti je po učestalosti rak kod muškaraca u Republici Hrvatskoj s ukupno 836 bolesnika te godine. Etiološki čimbenici su najčešće okolišni: pušenje cigareta, profesionalno okruženje anilinskom bojama, infekcija HPV-om, infestacija Shistosomom, mokraćni kamenci, lijekovi poput ciklofosfamida itd. U manjem postotku nalazi se genetski uzrokovani karcinom mokraćnog mjehura, opet najčešće provociran okolišnim čimbenicima. Dijagnosticira se dobrom anamnezom, fizikalnim statusom s uključenim ultrazvukom, a zlatni standard je cistoskopija. Nakon toga u svih bolesnika treba učiniti transuretralnu resekciju tumora. Ona je ujedno i metoda izbora u pojedinih bolesnika. Liječenje se provodi kirurški, radioterapijom, kemoterapijom i imunoterapijom. Izbor načina liječenja je ovisno o TNM klasifikaciji, općem stanju pacijenta i patohistološkom nalazu.Bladder cancer is a malignant neoplasm arising usually from the transitional epithelium. It's four times more common in men than in women. It is also twice as common in Caucasians compared to blacks. The average age of patients with the mentioned disease is 73 years. According to data from the Croatian Institute of Public Health for the year 2021, bladder cancer is the fourth most common cancer in men in the Republic of Croatia with a total of 836 cases that year. Etiological factors are most often environmental: cigarette smoking, professional environment with aniline dyes, HPV infection, Schistosoma infestation, urinary stones, drugs such as cyclophosphamide, etc. In a smaller percentage, there is genetically caused bladder cancer, most often provoked by environmental factors. It is diagnosed with a good medical history, physical status with included ultrasound, and the gold standard is cystoscopy. The transurethral resection is performed in all patients. It is also the method of choice in certain cases. Treatment is carried out by surgery, radiotherapy, chemotherapy and immunotherapy. The choice of means of treatment depends on the TNM classification, the general condition of the patient and the pathohistological findings
THE IMPORTANCE OF EMOTIONAL INTELLIGENCE IN PATIENTS AND THEIR EFFECT ON POSTOPERATIVE WOUND HEALING
No full textThis paper explores the importance of Emotional Intelligence (EI) in patients and its relation to postoperative wound healing.
Wound healing is a tightly regulated and complex mechanism that plays a key role in patient care and is of medical as well as of economic interest. There are many local and systemic factors that can alter wound healing. For this paper stress as a direct influence on wound healing was of special importance, because alterations in the physiological stress responses seem to be the connection between psychological and physical states. Many immune cells are sensitive to stress hormones via cell surface receptors. In the mechanisms of wound healing an elevation in cortisol levels results in a decrease in proinflammatory and other cytokines important during the healing process. The stress axes of the body therefore bridge the gap between emotional and physical states and give an explanation of underlying mechanisms. EI is a concept that has its origin in the early 20th century and is of importance for social and other life functions. Emotional awareness, expression and regulation are linked to many psychological and somatic diseases. Since modern medicine is supposed to work based on a biopsychosocial level the EI of patients should not be neglected when it comes to patient care. Improving one’s EI and especially learning the habitual use of reappraisal could be a significant tool in patient care and should therefore be considered regularly in patient management
Intrauterine growth restriction – short-term and long-term consequences
No full textIntrauterini zastoj rasta fetusa (engl. Intrauterine growth restriction, IUGR) javlja se u do 10 % trudnoća te je uzrok perinatalnog morbiditeta i mortaliteta. Definiran je kao fetalna masa ispod 10. percentila za odgovarajuću gestacijsku dob. Etiologija IUGR-a je multifaktorijalna i uključuje genetske faktore, placentarnu insuficijenciju, majčine bolesti te infekcije. Najčešća se etiologija ipak veže uz smanjen uteroplacentarni prijenos hranjivih tvari i kisika. Nepovoljnim se intrauterinim uvjetima fetus prilagođava promjenama u kardiovaskularnom, metaboličkom i endokrinom sustavu. Fetalni zastoj rasta često uzrokuje prijevremeni porođaj, stoga za posljedicu imamo prematurno novorođenče koje je većoj opasnosti za razvoj ranih neonatalnih komplikacija poput perinatalne asfiksije, hipotermije, hipoglikemije, hipokalcemije, policitemije, žutice, poteškoća s hranjenjem te nekrotizirajućeg enterokolitisa. IUGR i nedonošenost sinergistički djeluju na težinu ranog kliničkog tijeka, ali i daljnjeg rasta i razvoja, posebice kada je riječ o psihomotornom i kognitivnom razvoju. Epigenetske promjene nastale prenatalno, prema Barkerovoj hipotezi fetalnog programiranja čine podlogu za razvoj kroničnih bolesti poput kardiovaskularnih, metaboličkih, bubrežnih te neuroloških bolesti tijekom života. IUGR predstavlja ozbiljan javnozdravstveni problem koji podrazumijeva nedovoljni rast fetusa u maternici s komplikacijama koje ne završavaju s tijekom neonatalnog razdoblja, nego se nastavljaju tijekom djetinjstva u odraslu dob te mogu imati trajni utjecaj na zdravlje djeteta i odrasle osobe.Intrauterine growth restriction (IUGR) occurs in up to 10 percent of pregnancies and is the cause of perinatal morbidity and mortality. IUGR is defined as fetal mass below the 10th percentile for the appropriate gestational age. The etiology of IUGR is multifactorial and includes genetic factors, placental insufficiency, maternal diseases, and infections. However, the most common etiology is related to reduced uteroplacental transfer of nutrients and oxygen. Under unfavorable intrauterine conditions, the fetus adapts to changes in the cardiovascular, metabolic, and endocrine systems. Fetal growth arrest often causes premature birth, so the result is a premature newborn. Prematurity is a risky condition in itself, and such newborns are at greater risk of developing early neonatal complications such as perinatal asphyxia, hypothermia, hypoglycemia, hypocalcemia, polycythemia, jaundice, feeding difficulties and necrotizing enterocolitis. IUGR and prematurity act synergistically on the severity of the early clinical course, but also on further growth and development, especially when it comes to psychomotor and cognitive development. According to Barker's hypothesis of fetal programming, epigenetic changes created prenatally form the basis for the development of chronic diseases, such as cardiovascular, metabolic, renal and neurological diseases during life. IUGR represents a serious public health problem that implies insufficient growth of the fetus in the mother, with complications that do not end during the neonatal period, but continue during childhood and adulthood, and can have a lasting impact on the health of the child and adult
OVARIAN RESERVE IN PATIENTS WITH HYPERRESPONSE FOLLOWING GONADOTROPHIN STIMULATION
No full textAim: To investigate the relationship between markers of ovarian reserve, associated endocrinopathies and increased ovarian response in patients undergoing gonadotrophin stimulation during in vitro fertilization procedures.
Methods: A retrospective analysis of medical records from infertile female patients with preserved or high ovarian reserve and 10 or more oocytes retrieved in a single IVF cycle was done. Analysed data included ovarian reserve markers and associated endocrinopathies.
Results: The mean age of participants was 35.5 years (±4.58), with 62% treated after the age of 35. AMH values showed broad distribution in oocyte number, with OHSS identified in 3 participants in the middle AMH category. No clear age-related trend in AMH concentration was observed. PCOS prevalence was low (3%) among the study group, while autoimmune thyroiditis (22%) and hyperprolactinemia (9%) were more common. Endocrinopathies were most frequent in the middle AMH category.
Conclusion: This research indicates that a significant proportion of stimulated IVF patients with preserved/high ovarian reserve are of older reproductive age. A negative correlation between age and the number of oocytes retrieved was observed. Concentrations of AMH varied significantly, suggesting they are not strictly age dependent. Autoimmune thyroiditis was the most common endocrinopathy, while PCOS was rare. These results highlight the complexity of factors influencing IVF outcomes and indicate the need for further research
8th Congress of Emergency Medicine, March 22nd - 24th, 2024 Rijeka, Croatia : Abstract book
No full textThe Sisters of Charity of Saint Vincent de Paul as Pioneers of Nursing in Rijeka and Health Activities of their Province of »The Mother of Good Counsel«
No full textSkrb za bolesne i potrebite stara je koliko i umijeće liječenja. Međutim, sve do modernog doba skrb za bolesne bila je obilježena više karitativnim pristupom bez propisanih standarda i sustavne organizacije edukacije osoba koje su skrb provodile. U radu će se prikazati rad i djelovanje sestara milosrdnica sv. Vinka Paulskog od druge polovice 19. stoljeća do današnjih dana i njihov doprinos razvoju zdravstvene zaštite u Rijeci. Izvršena je analiza dosad neistraženih primarnih arhivskih izvora, provedeni su polustrukturirani intervjui i pregled dostupne literature koja se bavi djelovanjem ovoga reda. Sestre milosrdnice su značajno utjecale na unaprjeđivanje skrb i organizacije rada u zdravstvenim ustanovama u Hrvatskoj od druge polovice 19. stoljeća. Rasvjetljavanje njihovog djelovanje u sklopu zdravstvenih i socijalnih ustanova u Rijeci, koja je bila pod utjecajem različitih povijesnih događanja, nezaobilazna je tema u razumijevanje povijesnog razvoja sestrinstva na našim područjima.Caring for the sick and needy is as old as it is easier to treat them. Until modern times, however, nursing was characterised by a rather charitable approach without prescribed standards and a systematic organisation of the training of the people who carried it out. The article presents the work and activities of »The Sisters of Charity of Saint Vincent de Paul from the second half of the 19th century to the present day and their contribution to the development of healthcare in Rijeka. An analysis of previously unexplored primary archival sources, semi-structured interviews and a review of the available literature on the activities of this order were conducted. The Sisters of Charity had a significant influence on the improvement of care and the organisation of work in health care institutions in Croatia from the second half of the 19th century. The information about their activities in the health and social care institutions in Rijeka, which was influenced by various historical events, is an unavoidable topic for understanding the historical development of nursing in our region
Ozone Therapy in Medicine and Dentistry
No full textCilj je ovog preglednog rada prikazati sažetak trenutnog stanja primjene terapije ozonom u medicini i dentalnoj medicini na temelju pretraživanja znanstvenih članaka i kliničkih studija. Pretraživanjem tražilice PubMed uočen je značajan porast broja kliničkih istraživanja u periodu od 2015. do danas, a posebno u posljednje tri godine, što ukazuje na sve veći interes za kliničku primjenu. Tome pridonosi razvoj sigurnih uređaja i načina uporabe. Ozon je otkriven prije više od stotinu godina i od tada se široko koristi u mnogim područjima uključujući mnoge grane medicine. Mnogobrojne studije dokazale su pozitivan učinak ozona na antioksidativni kapacitet, kao i na modulacije u vaskularnom, hematološkom i imunološkom sustavu, ali i njegovu efikasnost ako se primjenjuje kao adjuvans u konvencionalnim terapijama. Snažan oksidacijski učinak ozona omogućava suzbijanje gotovo svih mikroorganizama, zbog čega ozon ima baktericidna, virucidna i fungicidna svojstva. Međutim, unatoč korisnim učincima koji mu omogućuju široku primjenu u medicini, primjena u dentalnoj medicini nije pokazala očekivanu učinkovitost. Lokalna primjena ozona, kao antimikrobnog sredstva za nekirurško liječenje parodontne bolesti, dobar je alat potpore parodontnoj terapiji.The aim of this review is to provide an overview of the status of the use of ozone therapy in medicine and dentistry, based on a search for scientific articles and clinical studies. A search in the PubMed search engine revealed a positive trend, namely a significant increase in clinical research in the period from 2015. to date, especially in the last three years, indicating an increasing interest in clinical application. The development of safe devices and application methods contributes to this. Ozone was discovered over a hundred years ago and has since been used in many areas, including medicine. Numerous studies have demonstrated the positive effect of ozone on antioxidant capacity and on modulations in the vascular, haematological and immunological systems, as well as its effectiveness as an adjunct to conventional therapies. The strong oxidising effect of ozone enables the suppression of almost all microorganisms, which is why ozone exhibits bactericidal, virucidal and fungicidal properties. However, despite the positive effects that enable its broad application in medicine, the use of ozone in dentistry has not shown the expected effectiveness. The local application of ozone as an antimicrobial agent for the non-surgical treatment of periodontal diseases is a good tool to support periodontal therapy
Disease Activity, Inflammation Markers, and Quality of Life Are Associated with Muscle Strength in Croatian Rheumatoid Arthritis Patients—A National-Based Study
No full textBackground and Objectives: Rheumatoid arthritis (RA) patients experience sarcopenia and decreased muscle mass and handgrip strength, leading to decreased quality of life and disability. The prevalence of RA varies across regions. This study aimed to evaluate the factors associated with RA in Croatian regional centres and explore correlations between clinical parameters and muscle strength. Materials and Methods: Included in this study were 267 stable RA patients from four Croatian clinical centres. The patients’ mean age was 60.4 ± 12.0 years, with 12.7% of them being male. For each study participant, information was gathered on their anthropometric characteristics, clinical and laboratory indicators, quality of life, disease activity, and sociodemographics. Results: The main results showed that in the female RA participants, the significant positive predictors are weight, height, exercise, VAS, and haemoglobin level. The negative predictors are the use of conventional synthetic disease-modifying anti-rheumatic drugs, the use of biological disease-modifying anti-rheumatic drugs, the number of tender joints, the number of swollen joints, the estimated sedimentation rate, the C-reactive protein, the disease activity score, the parameters of the EQ5D, and being prescribed with three or more medications. In the male RA participants, significant predictors of muscle strength are only weight, height, and anxiety/depression difficulties, according to the EQ5D. Conclusions: This study showed correlations between muscle strength and the parameters of disease activity, inflammation parameters, health-related quality of life, therapy, and exercise in the female RA participants in Croatia
The effect of sampling frequency and spatial and temporal variation in the density of fecal indicator bacteria on the assessment of coastal bathing water quality
No full textThe time and location of sampling as well as the number of samples per season can influence a reliable
assessment of bathing water quality. In this study, we investigated the spatio-temporal variation of fecal indicator bacteria (FIB) density and the effects of FIB variability and sampling frequency on the assessment of a single
sample and the annual and final assessment of coastal bathing water quality. Increasing the number of samples
from 10 to 20 per bathing season had a significant impact on bathing water quality assessment at sites where
water quality fluctuations had previously been observed, resulting in a change in water quality to a lower
category in 36 % of annual and 54 % of final assessments, suggesting that the minimum number of samples per
season should be increased at such sites. Increasing the number of samples at sites assessed as excellent over a
longer period had no impact on water quality assessment.
Spatial and temporal variations in FIB density were significant at a considerable number of sites both in the
single sample assessment and in the annual and final assessment. Bathing water quality was spatially unrepresentative at a quarter of the sites analyzed and temporally unrepresentative at a fifth, as there was at least one
additional point with a lower bathing water quality than the official sampling point or the bathing water quality
was lower in the afternoon than in the morning.
When revising the current recreational water quality regulations, the impact of sampling frequency of and of
spatio-temporal variation of FIB density on the relevance of bathing water quality assessment at sites subjected to
pollution needs to be seriously considered
Advanced Treatment of Refractory Congestive Heart Failure by Peritoneal Ultrafiltration with Icodextrin in Patients without End-Stage Renal Disease
No full textIn patients with Congestive Heart Failure (CHF), neurohormonal activation leads to fluid overload that can be treated with high doses of furosemide unless diuretic resistance and hyponatremia develop. End-stage CHF, including patients with normal or slightly deteriorated kidney function, can resist medical treatment. In some cases of refractory CHF, ultrafiltration (UF) is required. To manage a refractory CHF population, extracorporeal UF is commonly used as an emergency treatment, but peritoneal UF should be considered a follow-up therapy option. This method offers potential advantages over extracorporeal therapies, including better preservation of residual renal function, tighter control of sodium balance, less neurohumoral activation, and the possibility of daily treatment in the home environment. Using glucose as an osmotic agent leads to the deterioration of the peritoneal membrane. The UF properties of icodextrin depend on the dwell time, whereby the maximum effect of icodextrin concerning glucose is achieved at a prolonged dwell time. Icodextrin may offer improved peritoneal membrane biocompatibility compared with conventional glucose-based dialysates by decreasing glucose exposure, iso-osmolarity, and reduced carbonyl stress. The proper anesthesia technique and surgical approach for peritoneal dialysis (PD) catheter placement in CHF patients must be based on the patient’s characteristics, available equipment, and surgeon’s experience. An open procedure using a transversus abdominis plane block for PD catheter placement in patients with CHF is strongly recommended