Veterinary medicine - Repository of PHD, master's thesis
Veterinary medicine - Repository of PHD, master's thesisNot a member yet
9490 research outputs found
Sort by
Electrocardiogram of the professional athletes
No full textSportska aktivnost može se podijeliti u profesionalnu, rekreacijsku i amatersku. Ovisno o vrsti
sportske aktivnosti, razlikuju se i promjene nastale na srcu. Vježbe se ugrubo kategoriziraju kao
primarno vježbe izdržljivosti (aerobne) ili vježbe snage (anaerobne) jer ove komponente
uglavnom imaju različit odgovor kardiovaskularnog sustava. Povećano opterećenje
prouzrokovano tjelesnom aktivnosti dovodi kako do fizioloških strukturalnih i
elektrofizioloških promjena na srcu, tako i do patoloških koje dovode sportaše u rizik od pojave
malignih aritmija i iznenadne srčane smrti. Pojam „sportsko srce“ odnosi se na niz strukturalnih
i fizioloških promjena koje su posljedica intenzivnih sportskih aktivnosti za koje se još uvijek
debatira jesu li u rangu fiziološke adapatacije kardiovaskularnog sustava. Kako bi se sportaše
na vrijeme zaštitilo od neželjenih posljedica, uveden je prednatjecateljski probir koji između
ostalog sadrži i snimanje 12-kanalnog elektrokardiografskog zapisa. Dobivene nalaze potrebno
je prema smjernicama Europskog kardiološkog društva klasificirati kao normalne, patološke ili
granične te ih tumačiti u okviru dobro uzete osobne i obiteljske anamneze te fizikalnog
pregleda. Pri uočavanju pozitivne anamneze, simptoma bolesti ili patoloških nalaza, potrebno
je sportaša uputiti na dodatnu dijagnostičku obradu u svrhu identifikacije srčane bolesti.
Posljedice za sportaša mogu biti privremena mjera zabrane bavljenja profesionalnim sportom
te potpuno udaljavanje od profesionalnih sportskih aktivnosti i prilagodba tjelesne aktivnosti
amaterskoj razini u ovisnosti o riziku kojeg nosi podležeća srčana bolest.Sports activity can be divided into professional, recreational, and amateur categories.
Depending on the type of sport, the changes that occur in the heart also vary. Exercises are
roughly categorized as primarily endurance exercises (aerobic) or strength exercises
(anaerobic) because these components generally have different cardiovascular responses.
Increased load caused by physical activity leads to both physiological structural and
electrophysiological changes in the heart, as well as pathological changes that put athletes at
risk for malignant arrhythmias and sudden cardiac death. The term "athlete's heart" refers to a
range of structural and physiological changes that result from intense physical activity, and
there is still debate about whether these changes are part of the physiological adaptation of the
cardiovascular system. In order to protect athletes from undesirable consequences in a timely
manner, pre-competition screening has been introduced, which includes, among other things, a
12-lead electrocardiogram. The findings obtained need to be classified according to the
guidelines of the European Society of Cardiology as normal, pathological, or borderline and
interpreted in the context of a thorough personal and family medical history and physical
examination. If a positive history, symptoms of disease, or pathological findings are observed,
the athlete should be referred for further diagnostic testing to identify any heart disease. The
consequences for the athlete may include a temporary ban from professional sports or complete
withdrawal from professional sports activities, with the adjustment of physical activity to an
amateur level depending on the risk posed by the underlying heart disease
Application of the Free Anterolateral Thigh Flap in Head and Neck Defect Reconstruction
No full textMaligni tumori glave i vrata predstavljaju posebno izazovno područje onkološke i rekonstruktivne kirurgije zbog visoke funkcionalne i estetske kompleksnosti ove regije. Strukture odgovorne za govor, gutanje, disanje i izražavanje emocija često su kompromitirane ablativnim zahvatima, a rekonstruktivni pristup mora omogućiti ne samo zatvaranje defekta, već i restauraciju funkcije i izgleda. U tom kontekstu, slobodni anterolateralni režanj natkoljenice (ALT) postao je jedan od najčešće korištenih mikrovaskularnih režnjeva u rekonstrukciji glave i vrata.
ALT režanj temelji se na perforatorima lateralne cirkumfleksne femoralne arterije (LCFA), a njegova neurovaskularna anatomija omogućuje veliku fleksibilnost. Različite anatomske varijacije perforatora utječu na planiranje disekcije i podizanja režnja. Razvijene su brojne varijacije ALT režnja koje dodatno proširuju njegovu primjenu i omogućuju bolju prilagodbu prema vrsti, lokalizaciji i složenosti defekta. Fascia lata režanj (fALT) koristi se za rekonstrukciju sluzničkih defekata, osobito kada je poželjan tanak, elastičan i avaskularan pokrov, bez prenošenja kožnih folikula. Suprafascijalni ALT predstavlja tanju varijantu klasičnog režnja, kod koje se kožni pokrov podiže iznad fascije, čime se postiže bolji estetski rezultat i smanjuje debljina režnja, što je osobito važno u intraoralnim rekonstrukcijama. “Sendvič” ALT (sALT) kombinira dvije ili više slojeva potkožnog masnog tkiva i fascije u konfiguraciji koja omogućuje dodatnu čvrstoću i volumen tamo gdje je potreban veći strukturalni otpor, npr. kod rekonstrukcije višeplanih defekata. ALT režanj s uključenjem mišića vastus lateralis koristi se kada je potrebno dodatno mišićno tkivo za popunjavanje dubokih ili kontaminiranih defekata, čime se poboljšava vaskularizacija rekonstruiranog područja i otpornost na infekcije. Konačno, kimerični ALT režnjevi sadrže više zasebno vaskulariziranih komponenti (koža, fascija, mišić) koje su neovisno pokretljive, ali dijele zajedničku vaskularnu peteljku, što omogućuje preciznu rekonstrukciju složenih trodimenzionalnih defekata s više rekonstruktivnih ciljeva unutar istog zahvata.U kliničkoj praksi, ALT režanj koristi se za pokrivanje defekata usne šupljine, jezika, orofarinksa, srednjeg lica te kože i potkožja lica i vrata. Njegova debljina i volumen mogu se individualno prilagoditi potrebama defekta.
Zahvaljujući dugoj vaskularnoj peteljci, mogućnosti oblikovanja volumena i prisutnosti fascije late, ALT režanj je posebno pogodan i za rekonstrukciju baze lubanje, srednjeg lica i vlasišta. Osim izvrsne funkcionalne rehabilitacije, ovaj režanj omogućuje i estetski zadovoljavajuće rezultate bez potrebe za dodatnim venskim presadcima.Malignant tumors of the head and neck present a particularly challenging area in oncologic and reconstructive surgery due to the high functional and aesthetic complexity of this region. Structures responsible for speech, swallowing, breathing, and emotional expression are often compromised by ablative procedures, and reconstructive approaches must provide not only defect closure but also restoration of function and appearance. In this context, the free anterolateral thigh (ALT) flap has become one of the most commonly used microsurgical flaps in head and neck reconstruction.
The ALT flap is based on perforators of the lateral circumflex femoral artery (LCFA), and its neurovascular anatomy allows great versatility. Various anatomical variations of the perforators influence the planning of flap dissection and elevation. Numerous ALT flap modifications have been developed to further expand its applications and enable better customization according to the type, location, and complexity of the defect. The fascia lata flap (fALT) is used for mucosal defect reconstruction, especially when a thin, elastic, and avascular coverage without skin follicles transfer is desired. The suprafascial ALT represents a thinner variant of the classic flap, in which the skin paddle is elevated above the fascia, resulting in improved aesthetic outcomes and reduced flap thickness, particularly important in intraoral reconstructions. The “sandwich” ALT (sALT) combines two or more layers of subcutaneous fat and fascia in a configuration that provides additional strength and volume where greater structural support is needed, such as in multilayer defect reconstruction. The ALT flap including the vastus lateralis muscle is employed when additional muscle tissue is required to fill deep or contaminated defects, improving vascularization of the reconstructed area and resistance to infection. Finally, chimeric ALT flaps consist of multiple independently movable components (skin, fascia, muscle) sharing a common vascular pedicle, allowing precise reconstruction of complex three-dimensional defects with multiple reconstructive goals within a single procedure.
In clinical practice, the ALT flap is used to cover defects of the oral cavity, tongue, oropharynx, midface, as well as skin and subcutaneous tissue of the face and neck. Its thickness and volume can be individually tailored to the defect’s needs.
Thanks to its long vascular pedicle, volume adjustability, and the presence of fascia lata, the ALT flap is also particularly suitable for reconstruction of the skull base, midface, and scalp. In addition to excellent functional rehabilitation, this flap achieves aesthetically satisfactory results without the need for additional venous grafts
Trends in aesthetic facial surgery in the last decade
No full textEstetska kirurgija lica u posljednjem desetljeću postaje sve popularnija. Ne samo da raste broj zahvata nego se razvijaju i raznovrsniji pristupi prema pacijentima. Sve veći broj ljudi odlučuje se na estetske zahvate ne samo radi fizičkih promjena, već i zbog želje za očuvanjem svježeg, mladolikog izgleda i jačanja samopouzdanja. Osim tradicionalnih kirurških metoda, danas su dostupne i brojne minimalno invazivne tehnike koje omogućuju brži oporavak i suptilnije rezultate. Promjene u društvenim normama, utjecaj društvenih mreža i globalizacija ideala ljepote značajno su utjecali na percepciju fizičkog izgleda. Estetski zahvati sve su dostupniji i prihvaćeniji, a očekivanja pacijenata mijenjaju se od dramatičnih transformacija prema prirodnijem izgledu koji odražava individualne crte lica. Zanimljivo je da pacijenti danas sve češće dolaze s vrlo konkretnim željama, često potaknutima prizorima s interneta, ali ujedno traže i savjete stručnjaka o tome što je realno i estetski održivo. Upravo zato raste važnost individualiziranog pristupa, gdje se estetski zahvati prilagođavaju osobinama pacijenta, a ne univerzalnim idealima ljepote. Cilj ovog rada je analizirati glavne trendove u estetskoj kirurgiji lica, s naglaskom na promjene u preferencijama pacijenata. Kroz pregled najčešće izvođenih zahvata i utjecaja društvenih faktora, rad nastoji rasvijetliti kako su se estetski standardi i očekivanja korisnika promijenili u suvremenom kontekstu. Rad se sastoji od teorijskog pregleda najčešćih estetskih zahvata lica, analize novijih trendova i usporedbe preferencija pacijenata kroz dostupne podatke i literaturu. Poseban naglasak stavljen je na metode kao što su facelifting, rinoplastika, blefaroplastika te primjenu botulinum toksina i dermalnih filera.Facial aesthetic surgery has become increasingly popular over the past decade. Not only has the number of procedures risen, but more diverse and individualized approaches to patients have also developed. An increasing number of individuals now pursue aesthetic procedures not solely for physical alterations, but also to maintain a fresh, youthful appearance and to enhance self-confidence. In addition to traditional surgical methods, a wide range of minimally invasive techniques are now available, offering faster recovery and more subtle results. Shifts in social norms, the influence of social media, and the globalization of beauty ideals have significantly shaped perceptions of physical appearance. Aesthetic procedures are becoming more accessible and socially accepted, and patients expectations have shifted from dramatic transformations to more natural outcomes that highlight individual facial features. Interestingly, patients today often arrive with very specific requests, frequently inspired by images found online, but they also seek expert advice on what is realistic and aesthetically appropriate. This has reinforced the importance of personalized approach, where treatments are tailored to the individual characteristics of the patient rather than universal beauty standards. The aim of this thesis is to analyze the main trends in facial aesthetic surgery, with particular focus on changing patient preferences. Through a review of the most commonly performed procedures and the influence of social factors, the paper aims to shed light on how aesthetic standards and user expectations have evolved in a modern context. The thesis consists of a theoretical overview of the most common facial procedures, an analysis of current trends, and a comparison of patient preferences based on available data and literature. Special attention is given to techniques such as facelifting, rhinoplasty, blepharoplasty, and the use of botulinum toxin and dermal fillers
Regional differences in expression of molecular markers during formation of the expanded subplate zone in the human fetal cerebral cortex
No full textU doktorskoj disertaciji prikazane su regionalne citoarhitektonske razlike između čeone, tjemene, zatiljne i cingularne moždane kore u fazi ekspanzije i stvaranja subplate zone (od 13. do 15. TNZ). Pomoću imunohistokemijskih metoda na prenatalnom postmortalnom tkivu mozga čovjeka praćena je dinamika ekspresije molekularnih biljega. Rezultati su pokazali kako regionalne razlike između pojedinih izokortikalnih regija fetalne moždane kore čovjeka postaju vidljive rano tijekom prenatalnog razvoja, a postaju najistaknutije upravo tijekom razdoblja formiranja SP-a. Proces stvaranja SP-a iz dubokog dijela KP prikazan je biljegom SP neurona TBR1. Pokazano je i kako je obrazac formiranja SP-a važan kriterij za diferenciranje dorzalne izokortikalne i ventralne mezokortikalne cingularne moždane kore u ranom fetalnom razdoblju. Nadalje, karakteristike rane diferencijacije mezokortikalne cingularne moždane kore su: proširenje MZ, suženje KP i SVZ. Jedna od glavnih karakteristika mezokortikalnog dijela cingularne moždane kore je nepotpuna ekspanzija SP-a, a navedeno je prikazano pomoću biljega projekcijskih neurona. Analiza ranog razvoja cingularne moždane kore važna je radi njezine uloge u stvaranju ranih neuralnih krugova uključenih u ponašanje i emocije. Nadalje,
poznavanje regionalnog razvoja bitno je za razumijevanje arealne diferencijacije i kasnije funkcionalne specifikacije moždane kore što je preduvjet za razumijevanje neurorazvojnih poremećaja.In the doctoral thesis, regional cytoarchitectonic differences between the frontal, parietal, occipital, and cingulate cortex were analyzed in the the subplate formation phase (13 to 15 PCW). Immunohistochemical methods were used on prenatal postmortem human brain tissue to analyze the molecular markers` expression pattern dynamics. The results showed that
regional differences between isocortical regions of the human fetal cortex become visible early during prenatal development, and are most prominent during the SP formation period. The SP formation process is shown with the SP neuron marker TBR1. Additionally, we showed that the SP formation pattern is an important criterion for differentiating the dorsal isocortical and ventral mesocortical cingulate cortex in the early fetal period. Furthermore, the early mesocortical cingulate cortex is characterized by the widening of the MZ and the narrowing of the CP and SVZ. One of the main characteristics of the mesocortical part of the cingulate cortex is an incomplete SP expansion, and this is shown in the results using projection neuron markers. The early cingulate cortex development analysis is important because of its involvement in the formation of early neural circuits involved in behavior and emotions. Furthermore, analysis of regional differences is essential for understanding areal differentiation and later functional specification of the cerebral cortex, which is a prerequisite for understanding diverse neurodevelopmental disorders
Prediction of periventricular leukomalacia and intracranial haemorrhage in preterm infants using cerebral near-infrared spectroscopy
No full textPrijevremno rođenje značajno povećava rizik nastanka cerebralnih krvarenja i ozljeda bijele tvari mozga. NIRS tehnologija omogućuje kontinuirano praćenje dostave i potrošnje kisika u tkivu mozga u stvarnom vremenu, pružajući indirektan uvid u stanje cerebralne hemodinamike i autoregulacije, čiji poremećaji nerijetko prethode nastanku ozljeda mozga u nedonoščadi. Osnovni cilj ovog rada bio je istražiti utjecaj promjena cerebralne oksigenacije (rScO2) mjerenih pomoću NIRS-a tijekom prva tri dana života, na razvoj ozljeda mozga vrlo nezrele nedonoščadi. U razdoblju od 2018. do 2022. godine provedeno je prospektivno istraživanje koje je obuhvatilo 81 nedonošče gestacijske dobi manje od 32 tjedna (s medijanom od 30.1 tjedan i rodnom masom 1345 g). Ozljede mozga definirane su na temelju nalaza magnetske rezonancije u terminskoj dobi.
Uredan nalaz MR-a mozga imala su 32 (39.5%) ispitanika, dok je u 49 (60.5%) dijagnosticirana jedna ili više ozljeda mozga. Trideset i dvoje (39.5%) ispitanika imalo je izolirane ozljede: 17 ispitanika imalo je IVK, 12 ispitanika ozljedu bijele tvari, a u troje je nađeno krvarenje u malom mozgu. Višestruke ozljede je imalo 17 (21%) ispitanika. Sve su ozljede bile blage naravi, kategorizirane kao I. i II. stupanj IVK-a tj. I i II. stupanj ozljeda bijele tvari. Nije bilo značajnih razlika u demografskim karakteristikama ni glavnim komorbiditetima prematuriteta između ispitanika s ozljedama mozga i onih bez njih.
Najvažniji rezultat ovog istraživanja je da su četiri varijable cerebralne oksigenacije, veća varijabilnost rScO2 (rScO2VAR), viša standardna devijacija rScO2 (rScO2SD), niža prosječna rScO2 (rScO2PROSJEK) te dulje vrijeme provedeno s rScO2 ispod 60% (rScO2%<60%) tijekom prva tri dana života značajno povezane s nalazom ozljeda mozga na MR-u u terminskoj dobi. Slični
rezultati su dobiveni i u logističkoj regresijskoj analizi, prilagođenoj za GD i rodnu masu. Iako nisu sve varijable u multivarijatnoj analizi pokazale statističku značajnost, varijabla koja odražava varijabilnost cerebralne oksigenacije (rScO2VAR,) dosljedno je bila povezana s nalazom ozljeda mozga na MR-u u terminskoj dobi.
Istraživanje je pokazalo da varijabilnost cerebralne oksigenacije, kao indirektni pokazatelj poremećaja autoregulacije u ranom razdoblju nakon rođenja, predstavlja značajan rizični čimbenik za razvoj ozljeda mozga u vrlo nezrele nedonoščadi. Istraživanje je postavilo temelje za buduća istraživanja usmjerena na proučavanje autoregulacije cerebralnog protoka tijekom ranog postnatalnog razdoblja, s ciljem razvoja ranih terapijskih intervencija koje bi stabilizirale cerebralnu oksigenaciju, smanjile rizik od cerebralnih oštećenja i poboljšale dugoročne neurorazvojne ishode.Premature birth significantly increases the risk of cerebral hemorrhages and white matter brain injuries. NIRS technology allows continuous monitoring of oxygen delivery and consumption in brain tissue in real-time, providing indirect insight into cerebral hemodynamics and autoregulation, whose disturbances often precede the occurrence of brain injuries in preterm infants. The primary goal of this study was to investigate the impact of changes in cerebral oxygenation (rScO2) measured by NIRS during the first three days of life on the development of brain injuries in preterm infants.
Between 2018 and 2022, a prospective study was conducted involving 81 preterm infants with a gestational age of less than 32 weeks (with a median of 30.1 weeks and a birth weight of 1345 g). Brain injuries were defined based on magnetic resonance imaging (MRI) findings at term-equivalent age.
Normal MRI findings were observed in 32 (39.5%) patients, while 49 (60.5%) were diagnosed with one or more brain injuries. Thirty-two (39.5%) patients had isolated injuries: 17 patients had intraventricular hemorrhage (IVH), 12 patients had white matter injuries, and in three cases, cerebellar hemorrhage was found. Seventeen (21%) patients had multiple injuries. All injuries were mild, categorized as grade I and II IVH, or grade I and II white matter injuries. There were no significant differences in demographic characteristics or major comorbidities of prematurity between patients with brain injuries and those without.
The most important result of this study is that four cerebral oxygenation variables—greater
variability in rScO2 (rScO2VAR), higher standard deviation of rScO2 (rScO2SD), lower average rScO2 (rScO2MEAN), and longer time spent with rScO2 below 60% (rScO2%<60%) during the first three days of life—were significantly associated with brain injury findings on MRI at termequivalent age. Similar results were obtained in logistic regression analysis, adjusted for gestational age and birth weight. Although not all variables showed statistical significance in multivariate analysis, the variable reflecting variability in cerebral oxygenation (rScO2VAR) was consistently associated with brain injury findings on MRI at term-equivalent age.
The study demonstrated that variability in cerebral oxygenation, as an indirect indicator of autoregulation disturbances in the early postnatal period, represents a significant risk factor for brain injuries in very immature preterm infants. The research laid the foundation for future studies focused on investigating cerebral blood flow autoregulation during the early postnatal period, with the aim of developing early therapeutic interventions that would stabilize cerebral oxygenation, reduce the risk of cerebral damage, and improve long-term neurodevelopmental outcomes
Pathogenic cryptic variants detectable through exome data reanalysis significantly increase the diagnostic yield in Joubert syndrome
No full textJoubert syndrome (JS) is a genetically heterogeneous neurodevelopmental ciliopathy. Despite exome sequencing (ES), several patients remain undiagnosed. This study aims to increase the diagnostic yield by uncovering cryptic variants through targeted ES reanalysis. We first focused on 26 patients in whom ES only disclosed heterozygous pathogenic coding variants in a JS gene. We reanalyzed raw ES data searching for copy number variants (CNVs) and intronic variants affecting splicing. We validated CNVs through real-time PCR or chromosomal microarray, and splicing variants through RT-PCR or minigenes. Cryptic variants were then searched in additional 44 ES-negative JS individuals. We identified cryptic "second hits" in 14 of 26 children (54%) and biallelic cryptic variants in 3 of 44 (7%), reaching a definite diagnosis in 17 of 70 (overall diagnostic gain 24%). We show that CNVs and intronic splicing variants are a common mutational mechanism in JS; more importantly, we demonstrate that a significant proportion of such variants can be disclosed simply through a focused reanalysis of available ES data, with a significantly increase of the diagnostic yield especially among patients previously found to carry heterozygous coding variants in the KIAA0586, CC2D2A and CPLANE1 genes
Should we treat macular oedema in nonarteritic anterior ischemic optic neuropathy with anti-VEGF intravitreal therapy?
No full textNearteritička prednja ishemijska optička neuropatija (NA-AION) je najčešći oblik ishemijske optičke neuropatije. Makularni edem (ME) kod NA-AION nije opisan kao dio uobičajene kliničke slike. Međutim, pojavom optičke koherentne tomografije (OCT) pokazano je da se isti može pojaviti čak u 10-46,7 % slučajeva. Stoga smo ovim preglednim radom htjeli upozoriti na njegovu pojavnost kod NA-AION kako nas ona u kliničkoj praksi ne bi dovela do krive dijagnoze i neprimjerenog liječenja. Dostupna stručna literatura identificira dva terapijska smjera, terapijsku intervenciju na rezoluciju makularnog edema zbog pozitivnog utjecaja na oporavak vidne oštrine ili praćenje bez intervencije jer je bolest potencijalno samo ograničavajuća. Unatoč kliničkim iskustvima u navedenim radovima nema jedinstvenog stava kako pristupiti liječenju opisanog entiteta. Mi sugeriramo individualiziran terapijski pristup uz temeljitu analizu koristi liječenja za bolesnika i eventualnog rizika prije same intervencije.Nonarteritic anterior ischemic optic neuropathy (NA-AION) is the most common type of ischemic optic neuropathy. Macular edema (ME) in NA-AION is not described as a part of the natural history of NA-AION. However, with the introduction of optical coherence tomography (OCT) it was shown that macular edema may occur in 10 - 46,7% of NA-AION cases. Thus, with this rewiew we wanted to raise awarenes of this entity so its occurrence does not confuse us in our clinical practice to other diseases and leads us to unnecessary treatment. Up to date literature identifies two treatment directions, therapeutic intervention toward resolution of macular edema because of its positive effect on visual acuity or monitoring with no therapy since the disease is self limmiting. Inspite clinical experience, there is no uniqe opinion on how to treat these cases. We are suggesting individual approach with thorough analysis of the benefit for the patient and potential treatment risk
Malnutrition and sarcopenia in postoperative course after visceral surgery
No full textMalnutricija i sarkopenija su klinička stanja koja značajno utječu na metabolizam i imunološki sustav pojedinca. Malnutricija podrazumijeva nedostatan unos ili apsorpciju nutrijenata, dok sarkopenija označava gubitak mišićne mase i snage. Njihovo međusobno preklapanje dodatno povećava klinički rizik. Prevalencija je u općoj populacija visoka, među hospitaliziranim bolesnicima, poglavito onih s malignim bolestima probavnog sustava, bilježe se još više vrijednosti. Oba stanja negativno utječu na sposobnost organizma da reagira na fiziološki stres izazvan operacijskim zahvatom. Operacijski zahvati utječu na integritet organizma uzrokujući imunološke i metaboličke promjene koje uključuju katabolizam, inzulinsku rezistenciju, sistemsku upalu i imunosupresiju.
Malnutricija i sarkopenija u prijeoperaicjskom periodu utječu na tijek liječenja i oporavak bolesnika. Pod većim su rizikom od razvoja postoperacijskih komplikacija, infekcija i otežanog cijeljenja rana, vrijeme hospitalizacije im je produženo, viša je stopa mortaliteta i trošak liječenja je veći.
S obzirom na negativne posljedice malnutricije i sarkopenije, osobito u bolesnika podvrgnutih abdominalnim operacijskim zahvatima, iznimna važnost pridaje se ranom prepoznavanju malnutricije i sarkopenije i pravovremenom uvođenju ciljane nutritivne i rehabilitacijske podrške. Ovakav pristup u perioperacijskoj skrb može značajno poboljšati ishode liječenja, smanjiti stopu komplikacija, te skratiti vrijeme hospitalizacije. Potrebna je veća svijest među zdravstvenim djelatnicima i uvođenje standardiziranih protokola skrbi kako bi se ovim stanjima pristupilo pravodobno, stručno i sveobuhvatno.Malnutrition and sarcopenia are clinical conditions that significantly affect metabolism and immune system of an individual. Malnutrition refers to insufficient intake or absorption of nutrients, while sarcopenia denotes the loss of muscle mass and strength. The coexistence of these conditions further increases clinical risk. Their prevalence is high in the general population, and higher among hospitalized patients including those undergoing abdominal surgical procedures. Both conditions negatively impact the body's ability to cope with the physiological stress induced by surgery. Surgical procedures additionally compromise the integrity of organism by triggering immunological and metabolic alterations, including catabolism, insulin resistance, systemic inflammation, and immunosuppression.
Patients who present with malnutrition and sarcopenia in the preoperative period experience an even more pronounced adverse response to surgical trauma. They are at higher risk of developing postoperative complications, infections, impaired wound healing, prolonged hospital stays, and increased mortality and treatment costs.
According to negative consequences of malnutrition and sarcopenia, particularly in patients undergoing abdominal surgery, early identification and timely implementation of targeted nutritional support and rehabilitation are of paramount importance. Such approach within perioperative care can significantly improve treatment outcomes, reduce complication rates, and shorten hospitalization duration. Increased awareness among healthcare professionals and the establishment of standardized care protocols are essential to ensure these conditions are managed promptly, effectively, and comprehensively
Comparison of the management of patients with ST-elevation myocardial infarction before and during the COVID-19 pandemic
No full textPandemija bolesti COVID-19 značajno je utjecala na organizaciju zdravstvene skrbi i pristup hitnim medicinskim uslugama. Cilj ovog retrospektivnog istraživanja bio je usporediti kliničke karakteristike, ključna vremena do terapije i ishode bolesnika sa STEMI-jem liječenih u Kliničkom bolničkom centru Zagreb tijekom šest mjeseci prije i šest mjeseci nakon proglašenja COVID-19 pandemije.
U analizu je uključeno ukupno 186 bolesnika: 105 iz pandemijske i 81 iz predpandemijske kohorte. Medijan dobi bio je sličan među skupinama (pandemijska: 66 godina; predpandemijska: 64 godine), a muškarci su činili većinu u obje skupine (63% naprema 64%). Najčešći rizični čimbenik bila je arterijska hipertenzija (61,9% pandemijska naprema 74,1% predpandemijska skupina). Dislipidemija, dijabetes tipa 2 i pušenje bili su prisutni kod sličnog udjela bolesnika u obje skupine. Ključna vremena do reperfuzijskog liječenja produljena su tijekom pandemije: medijan vremena od pojave boli do prvog medicinskog kontakta bio je 180 minuta (IQR 90–360) u pandemijskoj, naspram 120 minuta (IQR 60–210) u predpandemijskoj skupini. Medijan "door-to-balloon" vremena iznosio je 67,5 minuta (IQR 41–101) za pandemijsku, a 52 minute (IQR 30–86) za predpandemijsku skupinu.
Unutarbolnička smrtnost bila je viša u pandemijskoj skupini (3,8% naprema 1,2%), iako ta razlika nije bila statistički značajna. Rezultati sugeriraju da je pandemija dovela do produljenja vremena do liječenja i trenda povećane smrtnosti, što naglašava važnost pravovremenog pristupa hitnoj kardiološkoj skrbi čak i u kriznim uvjetima.The COVID-19 pandemic profoundly disrupted the organization of healthcare systems and access to emergency medical services. This retrospective study aimed to compare clinical characteristics, key treatment delays, and in-hospital mortality of STEMI patients treated at University Hospital Centre Zagreb during the six months before and six months after COVID-19 pandemic.
A total of 186 patients were included: 105 in the pandemic cohort and 81 in the pre-pandemic cohort. The median age was similar between groups (pandemic: 66 years; pre-pandemic: 64 years), with a predominance of male patients in both groups (63% vs 64%). The most frequent risk factor was arterial hypertension (61.9% in the pandemic vs 74.1% in the pre-pandemic group), while the prevalence of dyslipidemia, diabetes mellitus type 2 and smoking was comparable between the groups. Key treatment times were prolonged during the pandemic: the median time from symptom onset to first medical contact was 180 minutes (IQR 90–360) for the pandemic cohort, compared to 120 minutes (IQR 60–210) in the pre-pandemic group. The median door-to-balloon time was 67.5 minutes (IQR 41–101) and 52 minutes (IQR 30–86) in pandemic and pre-pandemic group, respectively.
In-hospital mortality was higher in the pandemic group (3.8% vs 1.2%), although this difference was not statistically significant. These results suggest the pandemic led to longer treatment delays and a trend toward increased mortality, highlighting the importance of maintaining timely access to acute cardiac care even under global medical crisis
Atypical presentations of Alzheimer’s disease
No full textAlzheimerova bolest (AD) predstavlja najčešći uzrok demencije, a radi se o sporo napredujućoj neurodegenerativnoj bolesti koja se najčešće pojavljuje u osoba starije životne dobi. Na patološkoj razini, bolest je karakterizirana značajnom atrofijom korteksa, nakupljanjem amiloidnih plakova i neurofibrilarnih spletova. Najčešće započinje poteškoćama u epizodičkom pamćenju (amnestički oblik), a kako bolest napreduje dolazi do sve većeg zahvaćanja i pogoršanja i drugih kognitivnih funkcija uz progresivno smanjenje funkcionalnih sposobnosti. Osim ove najčešće, tipične prezentacije AD-a, u kliničkoj praksi susreću se i rjeđi oblici, odnosno atipične prezentacije. Atipični slučajevi karakterizirani su početkom bolesti u mlađoj dobi, odnosno prije 65. godine života te inicijalnim neamnestičkim kognitivnim oštećenjem, uključujući jezičnu, vizualnu, izvršnu, bihevioralnu i motoričku domenu. U atipične fenotipe ubrajaju se logopenična varijanta primarne progresivne afazije, posteriorna kortikalna atrofija, kortikobazalni sindrom te disegzekutivna i bihevioralna varijanta AD-a. Zbog kliničkih karakteristika ovih rijetkih oblika AD-a, atipične varijante često ostaju neprepoznate ili se dijagnoze postavljaju sa zakašnjenjem, što odgađa početak liječenja i sprječavanja progresije bolesti. Razvoj in vivo biomarkera za detekciju patologije Alzheimerove bolesti unaprijedio je sposobnost pravovremene dijagnoze ovih oblika AD-a. Atipične varijante AD-a liječe se slično kao i tipični oblici, što uključuje farmakološke i nefarmakološke metode s pomoću kojih se nastoji ublažiti simptome i usporiti daljnje napredovanje bolesti te tako poboljšati kvaliteta života oboljelih. Zbog karakterističnih kliničkih obilježja i rane dobi početka atipičnih oblika AD-a, poseban izazov predstavljaju sigurnost i skrb za oboljele, zbog čega su rano pravno i socijalno planiranje i podrška ključni kako bi se osigurala sigurnost.Alzheimer's disease (AD) is the most common cause of dementia. It is a slowly progressing neurodegenerative disease that most often occurs in the elderly. Pathologically, the disease is characterized by significant atrophy of the cortex, accompanied by the accumulation of amyloid plaques and neurofibrillary tangles. It usually starts with episodic memory difficulties (amnestic type), and as the disease progresses, there is an increasing deterioration in memory and other cognitive functions with a corresponding decrease in functional abilities. In addition to this most common, typical presentation of AD, in clinical practice rarer forms can be observed, i.e. atypical presentations. Atypical cases are characterized by the onset of the disease at a younger age, i.e. before the age of 65, and by initial non-amnestic cognitive impairment, affecting the language, visual, executive, behavioral and motor cognitive domains. Atypical phenotypes include the logopenic variant of primary progressive aphasia, posterior cortical atrophy, corticobasal syndrome, and the dysexecutive and behavioral variants. Due to clinical characteristics of these rare forms of AD, atypical variants often go unrecognized or with delayed diagnosis, which postpones the start of treatment and prevention of disease progression. The development of in vivo biomarkers for the detection of the pathology of Alzheimer's disease has improved the ability to diagnose these forms of AD timely. Treatment of atypical variants of AD is similar to typical variants, and include pharmacological and non-pharmacological methods that aim to alleviate symptoms and slow down further progression of the disease, thus improving the quality of life of AD patients. Due to the characteristic clinical features of atypical forms of AD, safety and care for these patients pose a particular challenge, which is why early legal and social planning and support are essential to ensure safety