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
The role of magnetic resonance imaging in the diagnosis of changes in dense glandular breast parenchyma
No full textGusti žljezdani parenhim dojke predstavlja značajan izazov u ranom otkrivanju raka dojke. Mamografija, osnovna dijagnostička metoda u programima ranog otkrivanja raka dojke, pokazuje smanjenu osjetljivost kod dojki gustog žljezdanog parenhima. Zbog toga se javlja potreba za korištenjem drugih dijagnostičkih metoda za potrebu probira žena s gustim žljezdanim parenhimom. Cilj ovog rada je analizirati ulogu magnetske rezonancije (MR) u ranom otkrivanju raka dojke kod žena s gustim žljezdanim parenhimom te usporediti učinkovitost s drugim dijagnostičkim metodama.
Digitalna tomosinteza u usporedbi s digitalnom mamografijom ima veću učinkovitost kod žena s gustim žljezdanim parenhimom, dok kombinacija ultrazvuka i mamografije značajno povećava osjetljivost probira, ali uz visoku stopu lažno pozitivnih rezultata. Osjetljivost kontrastne mamografije je 95%, a specifičnost 81%. S druge strane, magnetska rezonancija izdvaja se kao zlatni standard za dijagnostiku ove populacije zbog svoje visoke osjetljivosti i sposobnosti ranog otkrivanja malignih lezija, čak i kod vrlo gustog žljezdanog parenhima. Postoje čvrsti dokazi da MR u ovoj skupini žena povećava broj rano otkrivenih karcinoma dojke te da smanjuje mortalitet. Unatoč visokim troškovima probira MR-om, pokazalo se da je probir MR-om najisplativija metoda za probir žena s gustim žljezdanim parenhimom.
Europsko društvo za oslikavanje dojki (EUSOBI) izdalo je preporuku za korištenje MR-a kao dodatnu metodu probira kod žena s dojkama gustoće tip D. U slučaju nedostupnosti MR-a, EUSOBI preporučuje ultrazvuk u kombinaciji s mamografijom kao zamjensku metodu.Dense glandular breast parenchyma poses a significant challenge in the early detection of breast cancer. Mammography, the primary diagnostic method in early breast cancer detection programs, shows reduced sensitivity in women with dense glandular breast parenchyma. This highlights the need for the use of other diagnostic methods for screening women with dense glandular breast parenchyma. The aim is to analyze the role of magnetic resonance imaging (MRI) in the early detection of breast cancer in women with dense glandular breast parenchyma and to compare its effectiveness with other diagnostic methods.
Digital tomosynthesis and contrast-enhanced mammography have shown greater effectiveness in women with dense breasts compared to digital mammography. The combination of ultrasound and mammography significantly increases screening sensitivity, with a high rate of false positives. The sensitivity of contrast-enhanced mammography is 95%, and the specificity is 81%. On the other hand, MRI stands out as the gold standard for diagnosing this population due to its high sensitivity and ability to detect malignant lesions early, even in very dense glandular breast parenchyma. There is strong evidence that MRI increases the rate of early breast cancer detection and reduces mortality in this group of women. Despite the high costs of MRI screening, studies have shown that it is the most cost-effective method for screening women with dense glandular breast parenchyma.
The European Society of Breast Imaging (EUSOBI) has issued a recommendation for the use of MRI as an additional screening method for women with dense glandular breast parenchyma. In cases where MRI is unavailable, EUSOBI recommends ultrasound combined with mammography as an alternative method
Continuity of care for patients with heart failure in family medicine
No full textObiteljska medicina je medicinska disciplina koja se bavi najširim spektrom medicinskih stanja, a u središte pozornosti stavlja razvoj odnosa međusobnog povjerenja između liječnika i pacijenta. Ulogu i kompetencije obiteljskih liječnika definirala je Svjetska organizacija obiteljskih liječnika (WONCA).
Zatajivanje srca je klinički sindrom čija je prevalencija u konstantnom porastu, što ga čini sve većim teretom zdravstvenih sustava diljem svijeta. Najčešće se dijeli prema ejekcijskoj frakciji na zatajivanje srca sa održanom ejekcijskom frakcijom (HFpEF), zatajivanje srca s umjereno reduciranom ejekcijskom frakcijom (HFmrEF) i zatajivanje srca s reduciranom ejekcijskom frakcijom (HFrEF). Rizični čimbenici isti su kao i kod većine kardiovaskularnih bolesti, a uključuju hipertenziju, pušenje, šećernu bolest, pretilost i nedostatak tjelesne aktivnosti.
Najčešći simptomi i znakovi uključuju zaduhu, ortopneju, umor, krepitacije pri auskultaciji pluća, edeme nogu i napunjene vratne vene. NYHA klasifikacija koristi se u kliničkom stupnjevanju bolesti. Glavne pretrage koje se koriste u dijagnostici uključuju radiogram srca i pluća, EKG, određivanje natriuretskih peptida u krvi i ehokardiografiju. Osnovu terapije čine ACE-i, ARB i β blokatori, dok se u simptomatskom liječenju najčešće koriste diuretici.
Uloga liječnika obiteljske medicine je prepoznati i kontinuirano pratiti progresiju i pojavu znakova i simptoma srčanog zatajivanja, provoditi model podjele skrbi za ovu vrstu kroničnih bolesnika, procijeniti potrebu za hospitalizacijom, modificirati terapiju te educirati pacijenta o specifičnostima liječenja zatajivanja srca.Family medicine is a medical discipline that deals with the widest range of medical conditions, placing emphasis on building a relationship of mutual trust between physician and patient. The roles and competencies of family physicians are defined by the World Organization of Family Doctors (WONCA).
Heart failure is a clinical syndrome with a prevalence that is constantly increasing, making it an ever-growing burden on healthcare systems worldwide. It is most commonly classified according to ejection fraction into heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF). The risk factors are the same as for most cardiovascular diseases and include hypertension, smoking, diabetes mellitus, obesity, and lack of physical activity.
The most common signs and symptoms include shortness of breath, orthopnea, fatigue, pulmonary crackles on auscultation, leg edema, and distended neck veins. The NYHA classification is used for clinical staging of the disease. Key diagnostic tests include chest radiography, ECG, measurement of natriuretic peptides in blood, and echocardiography. The cornerstone of therapy includes ACE inhibitors, ARBs, and beta-blockers, while diuretics are most commonly used for symptomatic treatment.
The role of the family physician is to assess continuously monitor the progression and appearance of signs and symptoms of heart failure, implement a care-sharing model for this type of chronic patients, assess the need for hospitalization, adjust treatment, and educate the patient on the specifics of heart failure management
Indications and Outcomes of Invasive Antenatal Diagnostics
No full textUVOD: Invazivna antenatalna dijagnostika, osobito amniocenteza, predstavlja zlatni standard za otkrivanje fetalnih kromosomskih abnormalnosti. Kontinuirano se nastoji optimizirati selekcija kliničkih indikacija za invazivnu prenatalnu dijagnostiku s ciljem maksimiziranja dijagnostičkog učinka uz istodobno smanjenje rizika i izbjegavanje nepotrebnih zahvata.
CILJ: Retrospektivno su analizirane kliničke i demografske indikacije za amniocentezu te učestalost i vrsta patoloških nalaza fetalnog kariograma u uzorku.
ISPITANICE I METODE: Izvršena je analiza podataka 118 amniocenteza izvedenih u razdoblju između 2022. i 2024. godine. U 14 slučajeva kariotip nije bio dostupan. 105 uzoraka uspješno je obrađeno. Indikacije su podijeljene u devet skupina (NIPT, kombinirani test, ultrazvuk, dob majke i dr.). Izračunati su udjeli abnormalnih kariograma, povezanost indikacija i nalaza, te pozitivna prediktivna vrijednost (PPV) probirnih testova. Sigurnost zahvata ocijenjena je učestalošću komplikacija.
REZULTATI: U većini analiziranih uzoraka (82/105; 78,1%) kariotip je bio uredan, a 21,9% (23/105) njih bilo je patološko. Trisomija 21 bila je najčešća aberacija (13/105; 12,38% ukupnih uzoraka, 56,52% patoloških). Najveći postotak patoloških nalaza zabilježen je kod indikacije NIPT (48,0%; p < 0,001). PPV NIPT-a iznosio je 48,0%, ultrazvuka 23,5%, kombiniranog testa 10,0%, a trostruki test nije potvrdio nijedan nalaz (PPV 0%). Komplikacije nakon zahvata nisu zabilježene.
ZAKLJUČAK: Indikacije temeljene na pozitivnom NIPT-u i patološkom ultrazvučnom nalazu dovode do značajno većeg udjela patoloških kariograma, dok indikacija isključivo prema dobi pokazuje slabiju povezanost s otkrivenim anomalijama. Visoka PPV NIPT-a i odsutnost komplikacija potvrđuju kliničku vrijednost i sigurnost selektivne primjene amniocenteze. Nadalje, rezultati podupiru uvođenje NIPT-a kao prvog probirnog testa uz obaveznu potvrdu pozitivnih nalaza invazivnom dijagnostikom.INTRODUCTION: Invasive antenatal diagnostics, particularly amniocentesis, represent the gold standard for detecting fetal chromosomal abnormalities. Continuous efforts are made to optimize the selection of clinical indications for invasive prenatal diagnostics in order to maximize diagnostic yield while minimizing risk and avoiding unnecessary procedures.
OBJECTIVE: Clinical and demographic indications for amniocentesis, as well as the frequency and types of abnormal findings in fetal karyotyping, were retrospectively analyzed within the study sample.
PATIENTS AND METHODS: Data from 118 amniocentesis procedures performed between 2022 and 2024 were analyzed. In 14 cases, karyotype results were unavailable. A total of 105 samples were successfully processed. Indications were categorized into nine groups (NIPT, combined test, ultrasound, maternal age, etc.). The proportions of abnormal karyotypes, correlation between indications and findings, and the positive predictive value (PPV) of screening tests were calculated. The safety of the procedure was assessed based on the incidence of complications.
RESULTS: A normal karyotype was found in 78.1% of samples (82/105), while 21.9% (23/105) were pathological. Trisomy 21 was the most frequent chromosomal aberration (13/105; 12.38% of total samples, 56.52% of pathological findings). The highest percentage of pathological findings was recorded in the NIPT indication group (48.0%; p < 0.001). The PPV for NIPT was 48.0%, for ultrasound 23.5%, for the combined test 10.0%, and no abnormalities were confirmed by the triple test (PPV 0%). No complications were recorded following the procedure.
CONCLUSION: Indications based on a positive NIPT or abnormal ultrasound findings result in a significantly higher proportion of pathological karyotypes, whereas maternal age alone shows weaker correlation with detected anomalies. The high PPV of NIPT and the absence of complications confirm the clinical value and safety of selective amniocentesis. Furthermore, the results support the implementation of NIPT as a first-tier screening test, with mandatory confirmation of positive results through invasive diagnostics
Volume and pressure overload of the heart
No full textVolumno i tlačno opterećenje srca predstavljaju temeljne oblike hemodinamskog stresa koji uzrokuju različite strukturne, funkcionalne i molekularne promjene u miokardu. Tlačno opterećenje nastaje pri kroničnom povećanju naknadnog opterećenja, što se može vidjeti kod arterijske hipertenzije ili aortne stenoze. Rezultira koncentričnom hipertrofijom, pri čemu dolazi do zadebljanja stijenke bez širenja volumena srčane šupljine. Na staničnoj razini, karakteristično je paralelno dodavanje sarkomera, smanjena popustljivost miokarda, fibroza i poremećena regulacija kalcija. Tijekom vremena, ti mehanizmi dovode do dijastoličke disfunkcije, a naposljetku i do srčanog zatajenja. Volumno opterećenje nastaje zbog povećanog venskog priljeva ili regurgitacije zalistaka, što povećava dijastolički volumen i rezultira ekscentričnom hipertrofijom. U tom slučaju dolazi do serijskog dodavanja sarkomera, ventrikularne dilatacije i početno očuvane kontraktilnosti. Međutim, prolongirano opterećenje dovodi do smanjene kontrakcijske učinkovitosti, disfunkcije mitohondrija, promjena u izvanstaničnom matriksu i, u konačnici, sistoličkog zatajenja. U ovom radu prikazani su fiziološki mehanizmi odgovora miokarda na opterećenje, uključujući Frank-Starlingov zakon, Laplaceov zakon i molekularne puteve signalizacije. Također se obrađuju dijagnostički alati poput ehokardiografije, biomarkera i slikovnih metoda, koji omogućuju razlikovanje tipova opterećenja i praćenje progresije bolesti. Razumijevanje razlika u patofiziologiji volumnog i tlačnog opterećenja ključno je za pravovremenu dijagnozu, prognozu i terapijsko usmjerenje bolesnika sa srčanom bolesti.Volume and pressure overload of the heart represent fundamental forms of hemodynamic stress that lead to various structural, functional and molecular changes in the myocardium. Pressure overload occurs due to chronically increased
afterload, as seen in conditions such as arterial hypertension or aortic stenosis. It results in concentric hypertrohy, characterized by thickening of the ventricular wall without dilation of the chamber. At the cellular level, it involves parallel addition of the sarcomeres, reduced myocardial compliance, fibrosis and discrupted calcium regulation. Over time, these mechanisms lead to diastolic dysfunction and ultimatively to heart failure. Volume overload arises from increased venous return or, perhaps, valvular regurgitation, which increases end-diastolic volume and results in eccentric hypertrophy. In this case, sarcomeres are added in series, leading to ventricular dilation and initially preserved contractility. However, prolonged overload decreases contractile efficiency, causes mitochondrial dysfunction, extracellular matrix remodeling, and eventually leads to systolic heart failure. This thesis presents the physiological mechanisms of myocardial adaptation to overload, including the Frank-Starling law, Laplace’s law and molecular signaling pathways. It also discusses diagnostic tools such as echocardiography, biomarkers and imaging techniques, which enable differentiation between types of overload and tracking
disease progression. Understanding the patophysiological differences between volume and pressure overload is essential for timely diagnosis, prognosis and treatment planning in patients with cardiac disease
Respiratory manifestations in children with inherited metabolic diseases
No full textNasljedne metaboličke bolesti su monogenske bolesti uzrokovane patogenim
varijantama u genima koji kodiraju enzime i transportne proteine nužne za neometano
odvijanje metaboličkih procesa u organizmu. Budući da je riječ o bolestima koje najčešće
zahvaćaju više organskih sustava, među njima se ističe respiratorni sustav kao jedan od vodećih
uzroka morbiditeta i mortaliteta.
Respiratorni simptomi u okviru ovih bolesti vrlo su raznoliki i ovise o specifičnom
mehanizmu nastanka i vrsti supstrata koji se nakuplja u podležećoj bolesti. Mogu zahvaćati
plućni parenhim, dišne putove ili pak respiratornu muskulaturu, bilo kao dio kliničke slike na
početku bolesti ili kao kasna komplikacija. Akutni respiratorni simptomi mogu potaknuti
dekompenzaciju podležeće metaboličke bolesti, dovodeći do daljnje progresije bolesti i
respiratornog zatajenja. Time nerijetko dovode do učestalijih hospitalizacija i značajno
povećavaju ukupne troškove liječenja. U ovom radu bit će prikazane najčešće nasljedne
metaboličke bolesti koje u svojoj kliničkoj slici uključuju respiratorne simptome. Bolesti su
grupirane prema dominantnoj zahvaćenosti na one koje zahvaćaju plućni parenhim, zatim one
koje se očituju plućnom hipertenzijom, one koje zahvaćaju pretežito gornje dišne puteve te one
koje narušavaju funkciju respiratorne muskulature. Na kraju će biti prikazane i one koje
zahvaćaju središnji i periferni živčani sustav te time neizravno utječu na funkciju disanja.
Zbog širokog spektra kliničkih manifestacija, osobito je važno pravodobno prepoznati
osnovni metabolički poremećaj i odmah započeti odgovarajuće liječenje, kako same bolesti
tako i njenih respiratornih komplikacija. Moderna terapijska rješenja, poput enzimskog
nadomjesnog liječenja, pokazala su značajan terapijski potencijal, mijenjajući prirodni tijek
bolesti, a u pojedinim slučajevima dovodeći i do potpunog kliničkog oporavka. Međutim, s
produljenjem preživljenja i promjenom fenotipskih obilježja, javljaju se novi izazovi koji
zahtjevaju razvitak novih modaliteta liječenja i prilagodbu postojećih terapijskih opcija.Inherited metabolic diseases are monogenic disorders caused by pathogenic variants in
genes encoding enzymes and transport proteins essential for normal metabolic processes in the
human body. Since these diseases often affect multiple organ systems, the respiratory system
stands out as one of the leading causes of morbidity and mortality.
Respiratory symptoms in these diseases are highly variable and depend on the underlying
pathophysiological mechanism and the specific type of accumulated substrate. They may
involve the pulmonary parenchyma, airways, or respiratory musculature, either as an early
manifestation or as a late complication. Acute respiratory symptoms may precipitate
decompensation of the underlying metabolic disorder, leading to further disease progression
and respiratory failure. Consequently, these symptoms result in more frequent hospitalizations
and significantly increase the overall treatment costs. This review will discuss the most
common inherited metabolic diseases that present with respiratory symptoms. The diseases are
grouped according to the predominant site of involvement into those affecting the pulmonary
parenchyma, those manifesting as pulmonary hypertension, those primarily involving the upper
airways, and those impairing the function of respiratory muscles. Finally, diseases affecting
the central and peripheral nervous system, which indirectly influence respiratory function, will
also be addressed.
Due to the wide spectrum of clinical manifestations, early recognition of the underlying
metabolic disorder and prompt initiation of appropriate therapy, for both the primary disease
and its respiratory complications, is of utmost importance. Modern therapeutic approaches,
such as enzyme replacement therapy, have shown considerable potential by altering the natural
course of disease and, in some cases, achieving complete clinical resolution. However, as
survival improves and phenotypic presentation changes, new challenges are emerging that
demand further development and adaptation of treatment strategies
Advantages and disadvantages of ursodeoxycholic acid use in pregnancy
No full textUrsodeoksikolatna kiselina (UDCA) je žučna kiselina (ŽK) koja se sve češće
primjenjuje u liječenju kolestatskih bolesti jetre, osobito tijekom trudnoće, iako se tada
koristi izvan uvjeta odobrenja za stavljanje u promet (off label primjena). Najčešća
indikacija za njezinu primjenu u trudnoći je intrahepatička kolestaza trudnoće (IKT),
stanje koje može dovesti do ozbiljnih fetalnih komplikacija poput prijevremenog
porođaja, fetalne patnje ili intrauterine smrti. Osim toga, UDCA se koristi i kod
trudnica s kroničnim bolestima jetre poput primarnog bilijarnog kolangitisa (PBC) i
primarnog sklerozirajućeg kolangitisa (PSK), iako su klinički podaci o učinkovitosti u
tim slučajevima još uvijek ograničeni. UDCA djeluje koleretički, citoprotektivno i
imunomodulatorno. Njezina primjena smanjuje koncentraciju toksičnih ŽK,
normalizira biokemijske jetrene parametre, ublažava svrbež te potencijalno
poboljšava perinatalni ishod. Dok je učinkovitost UDCA u liječenju IKT-a relativno
dobro dokumentirana, njezina uloga kod PBC-a i PSK-a tijekom trudnoće još uvijek
se istražuje. Kod PBC-a, UDCA može stabilizirati bolest i prevenirati pogoršanja,
osobito nakon porođaja, dok kod PSK-a podaci o djelotvornosti variraju, a visoke
doze lijeka mogu rezultirati negativnim posljedicama. Iako se UDCA općenito smatra
sigurnom za primjenu u trudnoći, ograničena dostupnost prospektivnih kliničkih
ispitivanja nameće potrebu za individualnim pristupom. Nuspojave su rijetke i u
pravilu blagog intenziteta, pri čemu je proljev najčešće zabilježena reakcija. Cilj ovog
rada bio je prikazati mehanizam djelovanja, indikacije, kliničku učinkovitost te
sigurnost UDCA u trudnoći, uz kritičku analizu njezinih terapijskih potencijala i
ograničenja.Ursodeoxycholic acid (UDCA) is a bile acid increasingly used in managing cholestatic
liver diseases, especially during pregnancy, although such use is outside of the terms
of marketing authorization (off-label use). Its most common application is in the
treatment of intrahepatic cholestasis of pregnancy (ICP), a condition that poses
serious risks to the fetus, including preterm birth, fetal distress, and stillbirth.
Additionally, UDCA is used in pregnant women with chronic hepatic conditions such
as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), though
data supporting these indications remain limited. UDCA exerts choleretic,
cytoprotective, and immunomodulatory effects. Its administration helps reduce serum
bile acid levels, improves liver enzyme profiles, alleviates pruritus, and may
contribute to improved perinatal outcomes. While its effectiveness in ICP is well
supported by clinical studies, evidence regarding its role in PBC and PSC during
pregnancy is still emerging. In PBC, UDCA is believed to stabilize liver function and
reduce disease exacerbations, especially in the postpartum period. For PSC, the
data are more controversial; although some studies show biochemical improvement,
others suggest no benefit or even adverse outcomes when high doses are used.
Although UDCA is generally regarded as safe for use during pregnancy, the absence
of large-scale clinical trials necessitates an individualized therapeutic approach.
Adverse effects are uncommon and generally mild, with diarrhea being the most
frequently reported. The aim of this thesis was to explore UDCA’s mechanism of
action, clinical indications, therapeutic efficacy, and safety in pregnancy, while
determining the advantages and limitations of its use in obstetric hepatology
Prevention and treatment of patients with heart failure in family medicine
No full textZatajivanje srca predstavlja složeni klinički sindrom uzrokovan strukturnim i/ili funkcijskim poremećajima srca koji rezultiraju povišenim intrakardijalnim tlakovima i/ili smanjenim srčanim minutnim volumenom. Najčešće se prezentira relapsno-remitirajućim tijekom s naizmjeničnim razdobljima stabilnosti i epizodama dekompenzacije, a od simptoma i znakova bolesti najčešći su zaduha, zamor, periferni edemi i anoreksija. Globalna je prevalencija zatajivanja srca u porastu, najviše kao posljedica starenja stanovništva, a također se bilježi porast prevalencije rizičnih čimbenika. Najčešći su uzroci u Hrvatskoj i svijetu ishemijska bolest srca i arterijska hipertenzija. Osnovni dijagnostički algoritam obuhvaća postavljanje sumnje na zatajivanje srca na temelju tipičnih simptoma i znakova bolesti, elektrokardiografiju, mjerenje koncentracija natriuretskih peptida u plazmi i ehokardiografiju. Liječenje bolesnika sa reduciranom ejekcijskom frakcijom uključuje primjenu ACE inhibitora ili kombinacije sakubitril/valsartana, blokatora β-adrenergičkih receptora, mineralokortikoidnih antagonista i SGLT2 inhibitora, uz primjenu diuretika u bolesnika s kongestijom. Terapijske su opcije u bolesnika s blago reduciranom i očuvanom ejekcijskom frakcijom ograničene, pri čemu su SGLT2 inhibitori preporučeni s najvišom razinom dokaza kao oblik lijekova koji modificiraju bolest. Od općih se mjera prevencije preporučuju prije svega, modifikacija prehrambenih navika, implementacija redovite tjelesne aktivnosti, prestanak pušenja i kontrola konzumacija alkohola. Od farmakološke terapije učinkoviti su se u prevenciji pokazali antihiperzenzivi, statini i SGLT2 inhibitori. Uz to, neophodno je praćenje i kontrola glikemije. U tom kontekstu, liječnik obiteljske medicine ima središnju ulogu u provođenju preventivnih mjera, ranom prepoznavanju bolesti i dugoročnoj skrbi za bolesnika. Praksa obiteljskog liječnika u skrbi bolesnika sa zatajivanjem srca treba biti usmjerena na identifikaciju bolesnika pod rizikom, prepoznavanje tipičnih simptoma i znakova u ranoj fazi bolesti, provođenje dijagnostičkih postupaka, započinjanje terapije i koordinaciju odnosa između obiteljskog liječnika i drugih specijalista u skrbi za bolesnika sa zatajivanjem srca.Heart failure represents a complex clinical syndrome caused by structural and/or functional abnormalities of the heart, resulting in elevated intracardiac pressures and/or reduced cardiac output. The condition most commonly manifests with a relapsing-remitting course, characterized by alternating periods of stability and episodes of decompensation. Among the most frequent symptoms and signs of the disease are dyspnea, fatigue, peripheral edema, and anorexia. The global prevalence of heart failure is increasing, primarily as a consequence of population aging, accompanied by a rising prevalence of associated risk factors. The most common causes of heart failure in both Croatia and worldwide are ischemic heart disease and arterial hypertension. The fundamental diagnostic algorithm includes establishing a clinical suspicion of heart failure based on typical symptoms and signs, electrocardiography, measurement of plasma natriuretic peptide concentrations, and echocardiography. The treatment of patients with reduced ejection fraction comprises the use of angiotensin-converting enzyme (ACE) inhibitors or the sacubitril/valsartan combination, β-adrenergic receptor blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 (SGLT2) inhibitors, alongside the administration of diuretics in patients presenting with congestion. Therapeutic options for patients with mildly reduced or preserved ejection fraction are limited, with SGLT2 inhibitors recommended at the highest level of evidence as disease-modifying agents. General preventive measures primarily include dietary modification, the implementation of regular physical activity, smoking cessation, and the regulation of alcohol consumption. Among pharmacological therapies, antihypertensive agents, statins, and SGLT2 inhibitors have demonstrated efficacy in prevention. In addition, it is essential to ensure glycemic monitoring and control. Within this context, the family physician plays a central role in the implementation of preventive measures, the early detection of the disease, and the long-term care of patients. The practice of the family physician in managing patients with heart failure should focus on identifying at-risk individuals, recognizing typical symptoms and signs at an early stage of the disease, conducting diagnostic procedures, initiating appropriate therapy, and coordinating the care of the patient in collaboration with other medical specialists
Skin changes caused by environmental factors
No full textKoža je neprestano izložena djelovanju okolišnih čimbenika koji mogu uzrokovati širok spektar promjena, od prolaznih iritacija do kroničnih upalnih bolesti i zloćudnih novotvorina. Među fizikalnim okolišnim čimbenicima osobito se ističe ultraljubičasto zračenje, u čijem je djelovanju na kožu oksidativni stres jedan od ključnih, ali ne i jedini mehanizam. Ultraljubičasto zračenje može uzrokovati akutne promjene, poput solarnog eritema, te kronične promjene, u koje se ubrajaju fotostarenje, aktinična keratoza, lentigo solaris, ali i zloćudne novotvorine, uključujući bazocelularni i planocelularni karcinom te melanom. Abnormalne kožne reakcije na ultraljubičasto zračenje nazivaju se fotodermatozama. Ionizirajuće zračenje može rezultirati akutnim i kroničnim radiodermatitisom. Temperatura je također važan fizikalni čimbenik koji djeluje na kožu. Toplina može izazvati promjene poput milijarije, erythema ab igne, toplinske urtikarije i opeklina, dok hladnoća može dovesti do suhoće kože, perinioze, hladnoćom izazvane urtikarije te ozeblina. Centralnu ulogu među kemijskim čimbenicima ima onečišćenje zraka, koje također doprinosi oksidativnom stresu, čime podupire preuranjeno starenje kože te sudjeluje u nastanku i pogoršanju kožnih bolesti poput akne, atopijskog dermatitisa, psorijaze i alopecije. Izloženost toksičnim kemikalijama može uzrokovati i specifične promjene poput klorakne. Kontaktni dermatitis, iritativni i alergijski, često je povezan s izlaganjem kemijskim, a rjeđe i fizikalnim agensima.The skin is continuously exposed to environmental factors that can induce a wide range of changes, from transient irritation to chronic inflammatory conditions and malignant neoplasms. Among physical environmental agents, ultraviolet (UV) radiation is particularly significant, with oxidative stress being one of the key mechanisms of its action, but not the only one. UV radiation may cause acute effects, such as solar erythema, as well as chronic changes including photoaging, actinic keratosis, solar lentigo, and malignant neoplasms such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Abnormal skin responses to UV radiation are known as photodermatoses. Ionizing radiation can result in both acute and chronic radiodermatitis. Temperature is another important physical factor affecting the skin. Heat may lead to conditions such as miliaria, erythema ab igne, heat-induced urticaria, and burns, while cold exposure may result in skin dryness, perniosis, cold-induced urticaria, and frostbite. Air pollution plays a central role among chemical agents by contributing to oxidative stress, thereby accelerating skin aging and exacerbating or triggering conditions such as acne, atopic dermatitis, psoriasis, and alopecia. Exposure to toxic chemicals can also lead to specific conditions, such as chloracne. Contact dermatitis, both irritant and allergic, is frequently associated with exposure to chemical agents and, less commonly, with physical agents
Diabetic retinopathy in pregnancy
No full textDijabetička retinopatija (DR) jedna je od najčešćih mikrovaskularnih komplikacija
šećerne bolesti. Predstavlja vodeći uzrok sljepoće u radno aktivnoj populaciji.
Trudnoća dodatno povećava rizik nastanka i progresije DR-a zbog brojnih fizioloških i
hormonskih promjena koje nepovoljno djeluju na krvno-retinalnu barijeru. U ovom
radu prikazani su patofiziološki mehanizmi DR-a, dijagnostičke metode i mogućnosti
liječenja, s posebnim naglaskom na tijek bolesti tijekom trudnoće te na izazove i
specifičnosti koje to razdoblje nosi za žene s dijabetesom. Analizom relevantne
literature i važećih kliničkih smjernica istaknuta je važnost pravodobnog probira i
individualiziranog praćenja trudnica s dijabetesom, osobito onih s dijabetesom tipa 1.
Posebna se pažnja posvećuje rizičnim čimbenicima progresije bolesti, među kojima
su najvažniji trajanje dijabetesa prije trudnoće, početna težina retinopatije i
neadekvatna glikemijska kontrola. Opisane su terapijske mogućnosti koje se
smatraju sigurnima tijekom trudnoće, poput laserske fotokoagulacije, dok je primjena
anti-VEGF terapije rezervirana za iznimne slučajeve. Kirurški zahvati uglavnom se
odgađaju za postporođajno razdoblje, osim u hitnim situacijama. U završnom dijelu
rada razmatra se utjecaj DR-a na ishod trudnoće, izbor načina poroda i važnost
praćenja u postporođajnom razdoblju, s obzirom na mogućnost pogoršanja bolesti,
osobito u prvim tjednima nakon poroda.Diabetic retinopathy (DR) is one of the most common microvascular complications of
diabetes mellitus and a leading cause of blindness in the working-age population.
Pregnancy introduces numerous complex physiological changes that can
compromise the blood-retinal barrier, thereby increasing the risk of onset and
progression of DR. This review article presents the pathophysiological mechanisms
of DR, along with diagnostic and treatment methods, emphasizing how pregnancy
affects the course of the disease and the specific challenges it brings for women with
diabetes. Through analysis of relevant literature and clinical guidelines, the
importance of early screening and individualized monitoring of pregnant women with
diabetes is brought to attention, especially in those with type 1 diabetes. Special
attention is given to risk factors for progression, particularly the duration of diabetes
prior to pregnancy, baseline severity of DR, and poor glycemic control. Treatment
options considered safe during pregnancy, such as laser photocoagulation, are
outlined, while the use of anti-VEGF therapy is indicated only in exceptional cases,
and surgical interventions are generally reserved for the postpartum period unless
life-threatening complications for the mother arise. The final part of the paper
discusses the impact of DR on pregnancy outcomes, delivery method choices, and
the importance of monitoring during the postpartum period due to the potential for
disease progression, particularly in the early weeks after childbirth
Psychiatry and Psychotherapy in the Internet Era
No full textOvaj diplomski rad bavi se sve izraženijim utjecajem interneta i društvenih mreža na mentalno zdravlje, posebno djece i mladih. Prikazan je način na koji digitalno okruženje oblikuje stavove prema psihičkim bolestima, utječe na porast anksioznosti, depresije, ovisnosti i suicidalnosti, ali i dodatno produbljuje stigmu koja okružuje mentalne poremećaje. Posebna pažnja posvećena je rizičnim sadržajima na internetu kao što su poticanje na samoozljeđivanje i promoviranje nezdravih oblika ponašanja.
Pandemija COVID-19 bila je trenutak u kojem su se mnogi psihički problemi dodatno pogoršali, a višak vremena pred ekranima posebno je utjecao na djecu. Pojavila se i potreba za većom dostupnošću stručne pomoći pa je online psihoterapija postala sve prisutnija i njen razvoj se nastavlja, ali sa sobom nosi i različite etičke izazove.
Prikazana je i uloga roditelja u regulaciji screen time-a kod djece te važnost njihovog aktivnog uključivanja u postavljanje zdravih digitalnih navika.
Iako internet sa sobom nosi brojne rizike za mentalno zdravlje on također može biti i prostor edukacije, prevencije i podrške.This thesis explores the growing impact of the Internet and social media on mental health, particularly among children and adolescents. It presents how digital enviroment shapes attitudes toward mental illness, contributes to rising level of anxiety, depression, addicition, suicidality and further deepens the stigma surrounding mental disorders. Special attention is given to risky online content such as the promotion of self-harm and unhealthy behaviour patterns.
The COVID-19 pandemic marked a turning point during which many psychological issues worsened and the increased time spent online had a particularly strong impact on young people. As the need for accessible professional help grew, online psychotherapy became more widespread. Its development continues, though it brings various ethical challenges.
The role of parents regulating screen time and promoting healthy digital habits among children is also discussed.
Although the Internet carries many risks for mental health it can also serve as a space for education, prevention and support