Veterinary medicine - Repository of PHD, master's thesis
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The role of adjunctive immunotherapy in the treatment of sepsis and septic shock
No full textSepsa je ozbiljno, po život opasno stanje koje nastaje kao posljedica nereguliranog i pretjerano izraženog imunološkog odgovora organizma na infekciju, pri čemu dolazi do oštećenja vlastitih tkiva i organa. Najteži oblik bolesti je septički šok, koji se definira kao trajno nizak krvni tlak unatoč adekvatnoj nadoknadi tekućine, a često je praćen disfunkcijom više organskih sustava zbog smanjene perfuzije i posljedične hipoksije. Liječenje sepse i septičkog šoka temelji se na brzoj dijagnostici, adekvatnoj i pravovremenoj primjeni antibiotika širokog spektra, nadoknadi tekućine, primjeni vazoaktivnih lijekova, potpori disanja te mnogim drugim mjerama intenzivne skrbi. Ipak, imunološki odgovor domaćina u sepsi često je disreguliran, što može rezultirati pretjeranom upalom ili dubokom imunosupresijom. U tom kontekstu razvijaju se pomoćni imunoterapeutici koji ciljano moduliraju imunološki odgovor s ciljem poboljšanja kliničkog ishoda, a sve više pažnje posvećuje se i pomoćnoj intravenskoj imunoterapiji. Među suvremenim pristupima ističe se i primjena ekstrakorporalnih metoda koje uklanjaju višak upalnih medijatora iz krvotoka, čime se smanjuje upalni odgovor i poboljšava mikrocirkulacija. Prema aktualnim istraživanjima i novoj kliničkoj praksi, sve se više koristi primjena intravenskih pripravaka obogaćenih imunoglobulinima, kao i drugih novih imunomodulatora. Pravovremeno prepoznavanje te multidisciplinarni pristup ključni su za smanjenje smrtnosti, dok razvoj novih imunomodulatornih terapija otvara mogućnosti za daljnje poboljšanje ishoda kod najtežih bolesnika. Posebna pažnja u ovom radu posvećena je suvremenim kliničkim ispitivanjima i izazovima u primjeni ovih terapija.Sepsis is a serious, life-threatening condition that arises as a result of a dysregulated and excessive immune response to infection, leading to damage of the body's own tissues and organs. The most severe form of the disease is septic shock, defined by persistently low blood pressure despite adequate fluid resuscitation, and is often accompanied by dysfunction of multiple organ systems due to reduced perfusion and consequent hypoxia. The treatment of sepsis and septic shock is based on rapid diagnosis, adequate and fast administration of broad-spectrum antibiotics, fluid replacement, the use of vasoactive drugs, respiratory support, and other intensive care measures. However, the host immune response in sepsis is often dysregulated, potentially resulting in intense inflammation or profound immunosuppression. In this context, adjunctive immunotherapeutics are being developed to specifically modulate the immune response with the goal of improving clinical outcomes, with increasing attention given to adjunctive intravenous immunotherapy. Among modern approaches, the use of extracorporeal methods that remove excess inflammatory mediators from the bloodstream is also prominent. According to current research and novel clinical practice, the use of intravenous immunoglobulin-enriched infusions and other new immunomodulators is becoming increasingly common. Early recognition and a multidisciplinary approach are crucial for reducing mortality, while the development of new immunomodulatory therapies offers further opportunities to improve outcomes in the most critically ill patients. This thesis places particular emphasis on recent clinical trials and the challenges associated with the implementation of these therapies
Pharmacotherapy of Peripheral Arterial Disease
No full textPeriferna arterijska bolest je globalni zdravstveni problem koji nastaje postupno i često ostaje neprepoznat sve do pojave intermitentnih klaudikacija. PAB nosi rizik od komplikacija kao što su infarkt miokarda, moždani udar i amputacija. Pravovremena dijagnoza i farmakoterapija nužni su za usporenje ateroskleroze i poboljšanje ishoda bolesti.
Dijagnoza se postavlja kliničkim pregledom te dijagnostičkim postupcima, među kojima je ankle-brachial index zlatni standard. Bolest se može klasificirati pomoću više sustava, uključujući Rutherford, Fontaine i TASC klasifikaciju. Epidemiološki podaci pokazuju da su rizični čimbenici pušenje, dijabetes, dislipidemija, hipertenzija i kronična bubrežna bolest. Liječenje se sastoji od farmakoterapije, endovaskularnih i kirurških zahvata. Prestanak pušenja, povećanje tjelesne aktivnosti i zdrava prehrana temelj su prevencije. Farmakoterapija uključuje antitrombocitne lijekove, statine, antihipertenzive te antidijabetike, a sve s ciljem usporenja ateroskleroze, povećanja perfuzije i smanjenja rizika neželjenih kardiovaskularnih događaja. Antitrombocitna terapija obično uključuje aspirin ili klopidogrel, dok se u bolesnika s visokim ishemijskim rizikom koristi i kombinacija s nižom dozom rivaroksabana. Posebno mjesto u terapiji imaju statini, koji značajno smanjuju razinu LDL kolesterola. Kod bolesnika s dijabetesom primjena SGLT-2 inhibitora i GLP-1 agonista ima kardiovaskularne i renoprotektivne učinke. U ovom radu su prikazane i uspoređene smjernice stručnih društava ESC, ESVS, ACC/AHA, CCS, EACTS koje su u velikoj mjeri slične, ali postoje ipak neznatne razlike u pristupu asimptomatskim bolesnicima i izboru terapije u slučaju pratećih komorbiditeta.
Unatoč svim terapijskim opcijama periferna arterijska bolest i dalje ostaje nedovoljno prepoznata bolest sve do pojave ozbiljnih komplikacija. Stoga je ključna prevencija, edukacije i rano liječenje pacijenata s većim rizikom bilo zbog pozitivne obiteljske anamneze ili nezdravog stila života, kako bi se poboljšala ukupna prognoza oboljelih.Peripheral arterial disease (PAD) is a global health problem that develops gradually and often remains undiagnosed until the onset of intermittent claudication. PAD carries the risk of complications such as myocardial infarction, stroke, and amputation. Timely diagnosis and pharmacotherapy are essential to slow the progression of atherosclerosis and improve disease outcomes.
Diagnosis is established through clinical examination and diagnostic procedures, among which the ankle-brachial index is the gold standard. The disease can be classified using several systems, including the Rutherford, Fontaine, and TASC classifications. Epidemiological data indicate that risk factors include smoking, diabetes, dyslipidemia, hypertension, and chronic kidney disease. Treatment consists of pharmacotherapy, endovascular, and surgical procedures. Smoking cessation, increased physical activity, and a healthy diet are the cornerstones of prevention. Pharmacotherapy includes antiplatelet agents, statins, antihypertensive drugs, and antidiabetic medications, all aimed at slowing atherosclerosis progression, improving perfusion, and reducing the risk of adverse cardiovascular events. Antiplatelet therapy typically involves aspirin or clopidogrel, while patients with a high ischemic risk may also receive a combination with a low dose of rivaroxaban. Statins play a particularly important role in therapy by significantly lowering LDL cholesterol levels. In diabetic patients, the use of SGLT-2 inhibitors and GLP-1 receptor agonists provides both cardiovascular and renoprotective benefits. This paper presents and compares the guidelines of professional societies such as ESC, ESVS, ACC/AHA, CCS, and EACTS, which are largely similar but show minor differences in the management of asymptomatic patients and therapy selection in the presence of comorbidities.
Despite the available therapeutic options, peripheral arterial disease remains underdiagnosed until the development of serious complications. Therefore, prevention, education, and early treatment of high-risk patients, whether due to a positive family history or unhealthy lifestyle, are crucial to improving the overall prognosis
Pathographies of the greats presented through psychodynamic analysis of historical figures
No full textPsihodinamskom analizom moguće je razmatrati unutarnja psihička zbivanja koja izazivaju pojavu narcističkih karakteristika u određenih ličnosti. Prema Kohutu i Kernbergu, veliku ulogu u formiranju narcističnog poremećaja ličnosti, ima rani odnos roditelja s djecom, često kroz manjak ili nedostatak emocionalnih interakcija. Iako je zdravo priznanje djetetovih uspjeha ključno u izgradnji samopouzdanja, pretjerano vrednovanje također ima utjecaj na nastanak narcizma. Obrambene reakcije kao kompenzacije podležeće unutarnje ranjivosti rezultiraju nastankom neke od dimenzija narcizma; grandiozne, ranjive ili maligne. Narcističke osobine u životima povijesnih ličnosti mogu svoje uzroke pronaći u najranijim odnosima, a posljedice su vidljive u političkim, vojnim i društvenim odlukama koje su utjecale na preoblikovanje brojnih ljudskih sudbina i povijesti.Through psychodynamic analysis, it is possible to examine the internal psychological processes that lead to the emergence of narcissistic traits in certain individuals. According to Kohut and Kernberg, early parent-child relationships play a significant role in the development of narcissistic personality disorder, often through a lack or absence of emotional interaction. While healthy recognition of a child’s achievements is crucial in building self-confidence, excessive praise can also contribute to the development of narcissism. Defensive reactions, as compensations for underlying inner vulnerability, result in the formation of certain dimensions of narcissism: grandiose, vulnerable, or malignant. Narcissistic traits in the lives of historical figures may find their origins in early relationships, and their consequences are evident in political, military, and social decisions that have shaped countless human destinies and the course of history
Polymyalgia Rheumatica
No full textPolimialgija reumatika je upalna reumatska bolest koja prvenstveno pogađa osobe starije od 50 godina, s većom učestalošću kod žena. Incidencija varira geografski, od 12,7/100.000 u Italiji do 112,6/100.000 u Norveškoj, s izraženim gradijentom prema sjevernoj hemisferi.
Etiologija nije potpuno razjašnjena, ali uključuje kombinaciju genetskih (HLA-DR4) i okolišnih čimbenika. Patofiziološki, karakterizira je sinovijalna i periartikularna upala, s infiltracijom leukocita i vaskularnom proliferacijom. Važnu ulogu imaju T-stanice, IL-6 i drugi upalni medijatori.
Klinički se manifestira simetričnom boli i ukočenošću ramenog i zdjeličnog pojasa, najizraženijom ujutro i nakon mirovanja. Simptomi značajno utječu na svakodnevne aktivnosti. Sistemski znakovi poput umora i subfebrilnosti prisutni su u polovice pacijenata.
Dijagnoza se temelji na kliničkoj slici, povišenim upalnim parametrima (SE, CRP) i brzom odgovoru na glukokortikoide. Slikovne metode (ultrazvuk, MR, PET-CT) pomažu u potvrdi dijagnoze i isključenju drugih stanja.
Diferencijalno-dijagnostički najvažnije je isključiti reumatoidni artritis, miozitis, maligne bolesti i druge upalne reumatske bolesti.
Liječenje se primarno provodi glukokortikoidima (prednizon 12,5-25 mg/dan) uz postupno smanjivanje doze tijekom minimalno 12 mjeseci. Metotreksat se može dodati kod visokog rizika od recidiva. Potrebno je redovito praćenje aktivnosti bolesti i nuspojava terapije.
Najčešći komorbiditeti su kardiovaskularne bolesti, dok je povezanost s malignitetima kontroverzna. Unatoč većem teretu komorbiditeta, Polimialgija reumatika ne utječe značajno na očekivani životni vijek, vjerojatno zbog redovitog medicinskog praćenja koje omogućuje rano otkrivanje i liječenje pridruženih bolesti.Polymyalgia rheumatica is an inflammatory rheumatic disease primarily affecting people over 50 years of age, with higher frequency in women. The incidence varies geographically, from 12.7/100,000 in Italy to 112.6/100,000 in Norway, with a pronounced gradient towards the northern hemisphere.
The etiology is not fully understood but involves a combination of genetic (HLA-DR4) and environmental factors. Pathophysiologically, it is characterized by synovial and periarticular inflammation, with leukocyte infiltration and vascular proliferation. T-cells, IL-6, and other inflammatory mediators play important roles.
Clinically, it manifests with symmetric pain and stiffness of the shoulder and pelvic girdle, most pronounced in the morning and after rest. Symptoms significantly impact daily activities. Systemic signs such as fatigue and low-grade fever are present in half of the patients.
Diagnosis is based on clinical presentation, elevated inflammatory parameters (ESR, CRP), and rapid response to glucocorticoids. Imaging methods (ultrasound, MRI, PET-CT) help confirm the diagnosis and exclude other conditions.
Differential diagnosis most importantly requires excluding rheumatoid arthritis, myositis, malignancies, and other inflammatory rheumatic diseases.
Treatment primarily consists of glucocorticoids (prednisone 12.5-25 mg/day) with gradual dose reduction over a minimum of 12 months. Methotrexate may be added in cases with high risk of relapse. Regular monitoring of disease activity and therapy side effects is necessary.
The most common comorbidities are cardiovascular diseases, while the association with malignancies is controversial. Despite a higher comorbidity burden, Polymialgia rheumatica does not significantly affect life expectancy, likely due to regular medical monitoring that enables early detection and treatment of associated conditions
Significance of intraoperative findings in revision tympanomastoidectomy
No full textTimpanomastoidektomija predstavlja kirurški zahvat usmjeren na liječenje patologija srednjeg uha, osobito kronične upale, kolesteatoma te drugih destruktivnih procesa koji zahvaćaju šupljine srednjeg uha i mastoida. Razlikuje se primarna timpanomastoidektomija, koja se odnosi na prvi kirurški zahvat kojim se pristupa srednjem uhu i mastoidnom nastavku, i revizijska timpanostoidektomija, koja se provodi kada je potrebna daljnja intervencija zbog recidiva bolesti, komplikacija ili neuspjeha primarne operacije. Osnovna podjela timpanomastoidektomija uključuje pristupe s očuvanjem stražnjeg zida zvukovoda (CWU) i pristupe s njegovim uklanjanjem (CWD). Unatoč temeljitoj preoperativnoj evaluaciji, nije moguće sa sigurnošću predvidjeti sve komponente bolesti. Zbog toga se tijekom zahvata može pojaviti potreba za intraoperativnom procjenom i prilagodbom prethodno planiranog kirurškog postupka. Kombinacija kompjuterizirane tomografije (CT) i magnetske rezonancije (MR), naročito s difuzijski ponderiranim sekvencama (DWI), omogućuje vrlo preciznu procjenu proširenosti bolesti i detekciju rezidualnih ili recidivnih lezija. Recidivi se najčešće javljaju zbog zaostalih patoloških stanica u teško dostupnim regijama što ukazuje na važnost temeljite intraoperativne procjene i kirurškog pristupa tim lokalizacijama. Povezivanje mjesta recidiva bolesti s ishodima sluha ima važnu prognostičku vrijednost jer je postoperativno poboljšanje sluha pod izravnim utjecajem mjesta recidiva. Pažljivo kirurško planiranje, temeljeno na ekstrapoliranim podacima o svim anatomskim rizičnim točkama, ključno je za smanjenje potrebe za dodatnim revizijskim zahvatima.Tympanomastoidectomy is a group of surgical procedures used to treat middle ear diseases, particularly in cases of chronic inflammation, cholesteatoma, and other destructive processes affecting the middle ear and mastoid cavities. It includes primary tympanomastoidectomy, which refers to the initial surgical procedure to access the middle ear and mastoid, and revision tympanomastoidectomy, which is performed when further intervention is needed due to disease recurrence, complications or failure of the initial operation. Tympanomastoidectomy is typically classified into two main approaches, approaches with preservation of the posterior wall of the auditory canal (CWU) and approaches with its removal (CWD). Despite a thorough preoperative evaluation, it is not always possible to fully anticipate the extent and nature of the disease. Therefore, intraoperative assessment and modifications to the surgical plan may be necessary during the procedure. The combination of computed tomography (CT) and magnetic resonance imaging (MR), especially with diffusion-weighted sequences (DWI), allows for detailed evaluation of the disease extent and detection of residual or recurrent lesions. Recurrences most often occur due to residual pathological cells in difficult-to-reach regions, highlighting the importance of thorough intraoperative assessment and surgical approach to these locations. The location of disease recurrence has prognostic significance, as postoperative hearing improvement is directly influenced by the site of recurrence. Careful surgical planning, based on extrapolated data on anatomical risk points, is essential for minimizing the need for further revision procedures and achieving better clinical outcomes
Pain and dysmaturation of brain in preterm infants
No full textBol u neonatalnom razdoblju danas predstavlja značajno kliničko i znanstveno područje interesa u neonatalnoj medicini. Zbog nemogućnosti verbalnog izražavanja, nezrele percepcije okoline, drukčijeg obrasca ponašanja i sveukupne nezrelosti smatralo se
da novorođenčad, osobito nedonoščad, ne doživljava bol te da ju nije potrebno ublažavati pri izvođenju invazivnih procedura. Danas ipak znamo da novorođenčad, posebice nedonoščad, doista osjeća bol, štoviše često intenzivnije nego odrasli. U trenutku rođenja, središnji živčani sustav nedonoščeta ima specifičnu ranjivost i podložnost razvojnim poremećajima pod utjecajem različitih štetnih podražaja poput boli. Rano i učestalo izlaganje bolnim iskustvima može rezultirati patološkim entitetom poznatim kao dismaturacija mozga, čije se posljedice mogu pratiti kroz djetinjstvo sve do odrasle dobi. Najčešće dugoročne posljedice dismaturacije mozga uključuju poremećaje kognitivnih funkcija, koji se mogu kvanitficirati standardiziranim testovima poput IQ-a. Iako još uvijek nedostaje specifičnih znanstvenih istraživanja na temu dismaturacije mozga, novija istraživanja i longitudinalno praćenje razvoja nedonoščadi pružaju važne spoznaje o utjecaju boli na razvoj mozga. Budući da je riječ o boli izazvanoj vanjskim podražajima, posebna se pozornost posvećuje mogućnostima prevencije dismaturacije mozga primjenom farmakoloških i nefarmakoloških metoda. Među farmakološkim sredstvima i dalje se najčešće primjenjuju benzodiazepini i opioidni analgetici, iako se sve veći interes usmjerava prema α2 agonistu deksmedetomidinu, zbog njegovih minimalnih nuspojava u usporedbi s tradicionalnim i najčešće korištenim analgeticima. Pri izvođenju manje bolnih procedura poput venepunkcije, sve se češće koriste i oralne otopine šećera, čiji analgetski učinak još nije potpuno razriješen. Nefarmakološki pristupi, osobito oni usmjereni na prilagodbu okolišnih podražaja, fizičku blizinu roditelja te individualiziranu njegu, također imaju važnu ulogu u prevenciji boli i očuvanju neurološke stabilnosti. Ove mjere integrirane su u razvojno potporni program Newborn Individualized Developmental Care and Assessment Program (NIDCAP).Although once a neglected field, neonatal pain is today a subject of growing interest in both clinical practice and scientific research within neonatal medicine. Due to the inability to verbally express emotions, immature perception of the environment, different behavioral patterns, and overall physiological immaturity, it was once believed that newborns do not
experience pain and that pain management was unnecessary during invasive procedures. However, we now know that newborns, especially preterm infants, do experience pain, and in fact, may perceive it more intensely than adults.
Moreover, the central nervous system at birth is structurally and fuctionally immature, making it particularly vulnerable to developmental disruption under the influence of various harmful stimuli such as pain. Early and repeated exposure to painful stimuli can result in a pathological entity known as brain dysmaturation, with consequences that may persist into school age and beyond. The most common long-term effects of brain dysmaturation involve impairements in cognitive functions, which can be quantified using IQ tests. Although specific scientific data on brain dysmaturation remain limited, recent studies and
longitudinal follow-ups of preterm infants have significantly contributed to our empirical understanding of pain-induced neurodevelopmental outcomes. As this type of pain is externally induced, both pharmacological and non-pharmacological
strategies are being explored to prevent or mitigate brain dysmaturation. Among pharmacological options, benzodiazepines and opioid analgesics remain the most commonly used, although increasing attention is being given to the use of the α2-agonist dexmedetomidine, due to its minimal side effects compared to the two previously mentioned. The use of oral sugar solutions, which reduce pain through a mechanism that is still not fully understood, is also considered effective, particularly for less invasive procedures such as venipuncture. In addition to pharmacological management, non-pharmacologic approaches are equally important and should not be overlooked. These include modification of environmental stimuli, skin-to-skin contact, parental presence, and various other interventions integrated into the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)
Biomarkers in Chronic Spontaneous Urticaria
No full textKronična spontana urtikarija (KSU) bolest je obilježena spontanom pojavom urtika i angioedema u trajanju duljem od šest tjedana. Kompleksna etiopatogeneza i heterogena klinička slika tipične su značajke ove bolesti. Obzirom da se dijagnoza KSU postavlja klinički, nameće se potreba za identifikacijom bioloških markera čime bi se znatno unaprijedila dijagnostika bolesti te objektivizirala procjena njene aktivnosti i odgovor na terapiju. Cilj ovog rada je predstaviti i sistematizirati sve do sada poznate biološke markere KSU te se osvrnuti na njihov prognostički i dijagnostički značaj. Prema kliničkoj uporabi dijele se na biološke markere korisne u procijeni aktivnosti i težine bolesti te na prediktivne markere odgovora na terapiju. Prvoj skupini pripadaju klinički, serumski i stanični pokazatelji, od kojih su najviše istraženi upravo serumski. Najčešće mjereni jesu ukupna razina IgE, anti-TPO-IgG te C-reaktivni protein, s obzirom da postoji najsnažnija utvrđena povezanost njih s aktivnosti i težinom KSU. Neki od prikazanih bioloških markera odlični su pokazatelji odgovora na terapiju, naročito D-dimeri te test autolognim serumom (engl. Autologous serum skin test, ASST). Iako većina prikazanih bioloških markera pokazuje obećavajuće rezultate, mnogi se ne koriste u kliničkoj praksi zbog ograničavajućih čimbenika poput njihove nespecifičnosti te nedostatka standardizacije referentnih vrijednosti, ali i zbog prirode same bolesti. Potrebna su daljnja istraživanja koja bi opravdala korištenje spomenutih bioloških markera u rutinskom radu, čime bi se znatno unaprijedila dijagnostika i praćenje kronične spontane urtikarije.Chronic spontaneous urticaria (CSU) is a disease characterized by the spontaneous appearance of hives and/or angioedema lasting longer than six weeks. Complex etiopathogenesis and heterogeneous clinical presentation are characteristic clinical features of this disease. Given that the diagnosis of CSU is made clinically, there is a need to identify biological markers, which would significantly improve the diagnostics of the disease and make the assessment of its activity and response to therapy more objective. The aim of this paper is to present and systematize all known biological markers of CSU so far and to review their prognostic and diagnostic significance. According to their clinical use, they are divided into biomarkers useful in assessing the activity and severity of the disease and predictive markers of response to therapy. The first group includes clinical, serum and cellular indicators, of which serum indicators have been most extensively studied. The most commonly measured are total IgE levels, anti-TPO-IgG and C-reactive protein because of their strongly established connection with the activity and severity of CSU. Some of the presented biomarkers are excellent indicators of response to therapy, especially D-dimers and autologous serum skin test (ASST). Although most of the presented biomarkers show promise, they are not widely used in clinical practice due to limiting factors such as their non-specificity and lack of standardization of reference values, but also due to the nature of the disease itself. Further research is needed to justify the use of the mentioned biological markers in routine clinical practice, which would significantly improve the diagnosis and monitoring of chronic spontaneous urticaria
The gut microbiota and inflammatory bowel disease
No full textUpalne bolesti crijeva zbog svoje kompleksne patofiziologije predstavljaju veliki izazov moderne medicine. Sve veći broj ljudi, poglavito u urbanim sredinama, obolijeva od UBC-a. Ulcerozni kolitis i Crohnova bolest iako dijele mnoge kliničke i histopatološke značajke, različiti su entiteti koji zahtjevaju zasebni terapijski pristup. U nastanku UBC-a isprepliću se utjecaj genetike, okolišnih čimbenika, imunološkog odgovora i crijevne mikrobiote. Disbioza kao poremećaj ravnoteže između komenzalnih i patogenih mikroorganizama se sve češće prepoznaje kao važan čimbenik u patogenezi bolesti. Klinička slika uključuje proljev, abdominalnu bol, gubitak tjelesne mase, umor i niz ekstraintestinalnih manifestacija. Dijagnoza se postavlja temeljem kliničkih, laboratorijskih, endoskopskih i histoloških nalaza. Terapija uključuje 5-aminosalicilate, kortikosteroide, imunomodulatore, biološke lijekove i novije terapije poput JAK inhibitora i anti-IL-23 antitijela. Kirurško liječenje ostaje nužno u određenim slučajevima, osobito kod komplikacija ili rezistencije na farmakološko liječenje. Sve se više proučava i uloga transplantacije fekalne mikrobiote kao potencijalnog oblika personalizirane terapije. Budućnost liječenja UBC-a usmjerena je prema personaliziranom pristupu, temeljitoj klasifikaciji bolesnika i individualiziranom određivanju terapije. Crijevna sluznica ima ključnu ulogu u imunološkoj obrani, a narušavanje njezine funkcije može rezultirati kroničnom upalom. U novije vrijeme epigenetski mehanizmi, mikroRNA i terapije temeljene na oligonukleotidima dodatno se istražuju kao ciljni oblici liječenja. Prevencija komplikacija i održavanje kvalitete života pacijenata ostaju primarni ciljevi liječenja.Inflammatory bowel diseases due to their complex pathophysiology, represent a major challenge in modern medicine. An increasing number of individuals, particularly in urban areas, are being diagnosed with IBD. Although UC and CD share many clinical and histopathological features, they are distinct entities that require separate therapeutic strategies. The pathogenesis of IBD is multifactorial involving genetic predisposition, environmental influences, immune system dysregulation, and alterations in the gut microbiota. Dysbiosis an imbalance between commensal and pathogenic microorganisms is increasingly recognized as a key contributor to disease development. IBD presents with diarrhea, abdominal pain, weight loss, fatigue, and a range of extraintestinal manifestations. Diagnosis relies on a combination of clinical evaluation, laboratory findings, endoscopic visualization, and histological assessment. Treatment options include 5-aminosalicylates, corticosteroids, immunomodulators, biologics, and JAK inhibitors and anti-IL-23 antibodies. Surgical intervention remains necessary in some cases, particularly when complications arise or in patients who are refractory to medical therapy. Fecal microbiota transplantation is also being actively explored as a promising approach in the future. The future of IBD treatment lies in individualized strategies and targeted therapy. The mucosal barrier is essential for immune defense, and its disruption leads to chronic inflammation. Epigenetics, microRNAs, and oligonucleotides represent emerging targeted treatment options. The primary goals of therapy are the prevention of complications and the improvement of patients' quality of life
Locomotor system injuries in combat sports
No full textBorilački sportovi imaju bogatu povijest te su danas vrlo popularni izbor rekreacije amaterskih sportaša ili profesionalnih natjecatelja. Iako su svi borilački sportovi različiti prema načinu korištenja tijela za borbu i pravilima, mogu se podijeliti s obzirom na prevladavanje hrvačkog ili udaračkog stila. U udaračkim stilovima cilj je udariti protivnika šakom ili nogom u određeno područje, dok je u hrvačkom stilu poanta obariti ili imobilizirati drugog borca. Iako postoji mnoštvo različitih borilačkih sportova, na ljetnim Olimpijskim igrama za sada su samo njih četiri u stalnom programu, a to su od hrvačkih stilova hrvanje i judo te od udaračkih stilova taekwondo i boks. Oba stila borilačkih sportova karakterizira fizička borba s direktnim kontaktom koja može dovesti do ozljeda lokomotornog sustava. Tip ozljede ovisi o sili koja je izazvala ozljedu te mehanizmu ozljede, odnosno direktnim ili indirektnim mehanizmom. Najveću važnost ozljeda donose prijelomi i iščašenja zglobova zbog dugotrajnog oporavka i rehabilitacije. Na mjesto nastanka ozljede utječe stil borbe te je u borilačkim sportovima s udarcima uočeno više ozljeda na distalnim dijelovima ekstremiteta, a kod hrvačkih borilačkih sportova primijećena je veća učestalost ozljeda na proksimalnim zglobovima ekstremiteta. Pod distalne dijelove udova podrazumijevamo gležanj i stopalo kod donjeg uda, a šaku i prste kod gornjeg uda. U taekwondou je zabilježena visoka incidencija uganuća gležnja te prijeloma metatarzalnih kostiju i kostiju članaka prstiju stopala. Zatim je u boksu zapažen veći postotak ozljeda šaka, točnije prijeloma metakarpalnih kostiju od kojih je prijelom vrata pete metakarpalne kosti karakterističan za boksače. U hrvanju i judu, najveću učestalost ozljeda bilježe dislokacije ramena te ozljede meniska i ligamentarnog aparata koljena. Uganuća i iščašenja se većinom liječe konzervativno, prema RICE protokolu, odnosno repozicijom i imobilizacijom zgloba, a pristupa se operaciji kada je potrebna rekonstrukcija ozlijeđenog ligamenta ili je prisutan podležeći prijelom kosti. Prijelomi kosti se također liječe konzervativno imobilizacijom s redukcijom opterećenja kada su minimalno dislocirani i stabilni, ali je kirurško liječenje potrebno u nestabilnih i pomaknutih prijeloma.Combat sports have a rich history, and today they are a very popular choice of recreation for amateur athletes or professional competitors. Although each combat sport differs in terms of how the body is used in combat and specific rules, they can generally be categorized based on whether they predominantly involve grappling or striking techniques. In striking styles, the objective is to hit the opponent with fists or legs to designated areas, whereas in grappling styles, the goal is to take down or immobilize the opponent. Despite the wide variety of combat sports, only four are currently included in the official program of the Summer Olympic Games: wrestling and judo (grappling styles), and taekwondo and boxing (striking styles). Both styles are characterized by physical combat with direct contact, which can lead to injuries of the locomotor system. The type of injury depends on the force involved and the injury mechanism, either direct or indirect. The most serious injuries include bone fractures and joint dislocations due to the prolonged recovery and rehabilitation they require. The combat style influences the location of injuries. In striking sports, more injuries are observed in the distal parts of the limbs, while grappling sports tend to result in more frequent injuries to the proximal joints of the limbs. The distal parts of the limbs include the ankle and foot in the lower extremity, and the hand and fingers in the upper extremity. In taekwondo, a high incidence of ankle sprains and fractures of the metatarsal bones and toe phalanges has been recorded. In boxing, a higher percentage of hand injuries has been observed, specifically fractures of the metacarpal bones, with the fracture of the fifth metacarpal neck being particularly characteristic. In wrestling and judo, the most common injuries include shoulder dislocations as well as meniscal and ligament injuries of the knee. Sprains are typically treated conservatively using the RICE protocol, while dislocations are managed through joint reduction and immobilization. Surgery is indicated when ligament reconstruction is required or when an underlying bone fracture is present. Bone fractures are also commonly treated conservatively through immobilization and load reduction if they are minimally displaced and stable, whereas surgical treatment is necessary for unstable and displaced fractures
A Modern Perspective on the Neurosurgical Treatment of Glioblastoma
No full textGlioblastom predstavlja najčešći i najzloćudniji primarni tumor središnjeg živčanog sustava kod odraslih, karakteriziran brzim rastom, izraženom infiltrativnošću i visokom stopom recidiva. Riječ je o gliomu gradusa IV prema Svjetskoj zdravstvenoj organizaciji, s vrlo nepovoljnom prognozom unatoč multimodalnom pristupu liječenju. Medijan preživljenja, čak i uz optimalnu terapiju, obično je u rasponu od oko 12 do 16 mjeseci. Biološka kompleksnost i heterogenost tumora predstavljaju veliki izazov u planiranju i provedbi liječenja. Temelj terapijskog pristupa glioblastomu čini kombinacija neurokirurške resekcije, radioterapije i kemoterapije. Osnovni je princip neurokirurške resekcije maksimalna sigurna resekcija koja se temelji na odstranjivanju što većeg volumena tumora uz uvjet očuvanja neuroloških funkcija i kvalitete života pacijenta.
Intraoperativne tehnologije omogućuju preciznu identifikaciju granica tumora u realnom vremenu, čime se značajno povećava sigurnost i učinkovitost resekcije. Njihova primjena ključna je za postizanje maksimalne sigurne resekcije jer smanjuje rizik od oštećenja funkcionalno važnih područja mozga. Time se omogućuje ostvarivanje većeg opsega resekcije, koji je povezan s poboljšanjem ukupnog preživljenja. Iako veći opseg resekcije dokazano doprinosi povoljnijem kliničkom ishodu, postoperativni rezidualni volumen tumora snažniji je i pouzdaniji neovisni prognostički čimbenik. Manji rezidualni volumen tumora dosljedno se povezuje s produljenjem ukupnog i progresijom slobodnog preživljenja te boljim odgovorom na adjuvantne terapijske modalitete.Glioblastoma is the most common and most malignant primary tumor of the central nervous system in adults, characterized by rapid growth, extensive infiltration, and a high recurrence rate. It is classified as a grade IV glioma according to the World Health Organization and is associated with a very poor prognosis despite a multimodal treatment approach. The median survival, even with optimal therapy, is typically between 12 and 16 months. The biological complexity and heterogeneity of the tumor present significant challenges in treatment planning and implementation. The cornerstone of glioblastoma therapy is a combination of neurosurgical resection, radiotherapy, and chemotherapy. The fundamental principle of neurosurgical treatment is maximal safe resection, which aims to remove as much tumor volume as possible while preserving neurological function and the patient’s quality of life. Intraoperative technologies enable accurate real-time identification of tumor boundaries, significantly improving the safety and effectiveness of the procedure. Their use is essential for achieving maximal safe resection, as they reduce the risk of damaging eloquent brain regions. This allows for a greater degree of resection, which is associated with improved overall survival. Although a greater extent of resection has been shown to contribute to more favorable clinical outcomes, the postoperative residual tumor volume is considered a stronger and more reliable independent prognostic factor. A smaller residual tumor volume is consistently associated with prolonged overall and progression-free survival, as well as a better response to adjuvant therapeutic modalities