Veterinary medicine - Repository of PHD, master's thesis
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Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit
No full textBackground: Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness.
Objectives: In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams.
Methods: As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam's appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient's age and sex, inpatient/outpatient patient status, anatomical area, and referring physician's specialty were statistically examined within each country.
Results: The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound.
Conclusion: This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use.
Key points: Question Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons. Findings Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors. Clinical relevance International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally
Correlation between C-reactive protein and high-sensitivity troponin I values in acute coronary syndrome
No full textCilj: Cilj ovog istraživanja bio je analizirati povezanost vrijednosti C-reaktivnog proteina (CRP) i visokoosjetljivog troponina I (hsTnI) u bolesnika s akutnim koronarnim sindromom (AKS) te istražiti njihovu povezanost s kliničkim parametrima kao što su lokalizacija infarkta, sistolička funkcija lijeve klijetke i prisutnost višežilne koronarne bolesti.
Materijali i metode: U retrospektivnu analizu uključeno je 242 bolesnika hospitalizirana zbog AKS-a, podvrgnuta perkutanoj koronarnoj intervenciji (PCI). Prikupljeni su demografski, klinički, laboratorijski i angiografski podaci. Vrijednosti CRP-a i hsTnI-a analizirane su u tri vremenske točke – pri prijemu u bolnicu, 6 sati nakon PCI-a te 12 sati nakon PCI-a. Bolesnici su, prema tim vrijednostima, podijeljeni u tri skupine:
- 1. skupina: hsTnI < 3xURL (gornja referentna vrijednost),
- 2. skupina: hsTnI između 3–5×URL,
- 3. skupina: hsTnI >5×URL.
Rezultati: Nije pronađena statistički značajna povezanost između povišenog CRP-a i hsTnI-a u 1. i 2. skupini, ali je u 3. skupini zabilježen veći udio bolesnika s povišenim CRP-om, iako bez statističke značajnosti (p> 0.05). U 3. skupini, u koju su svrstani bolesnici s hsTnI vrijednostima većim od 5 puta gornje referentne granice, 68.1% bolesnika imalo je povišene vrijednosti CRP-a (≥3 mg/L), što je naspram prve dvije skupine predstavljalo izraženiji upalni odgovor. Nadalje, analiza je pokazala da bolesnici s višežilnom koronarnom bolešću te smanjenom ejekcijskom frakcijom lijeve klijetke češće imaju povišene vrijednosti CRP-a, a jasna statistička korelacija pronađena je između povišenih vrijednosti CRP-a i okluzije desne koronarne arterije. Premda rezultati nisu dosegli razinu statističke značajnosti u svim ispitivanim podskupinama, uočen je dosljedan trend koji upućuje na povezanost povišenog CRP-a s težim kliničkim slikama i složenijim angiografskim nalazima.
Zaključak: Rezultati sugeriraju postojanje klinički relevantnog, ali statistički nesignifikantnog odnosa između CRP-a i hsTnI-a. Više vrijednosti CRP-a mogu ukazivati na složenije oblike koronarne bolesti i lošiju sistoličku funkciju, no daljnja istraživanja su potrebna za potvrdu prognostičke vrijednosti ovih biomarkera.Objective: This study aimed to analyze the relationship between C-reactive protein (CRP) levels and high-sensitivity troponin I (hsTnI) in patients with acute coronary syndrome (ACS) and to investigate their association with clinical parameters such as infarct location, left ventricular systolic function, and the presence of multivessel coronary artery disease.
Materials and methods: A retrospective analysis included 242 patients hospitalized for ACS who underwent percutaneous coronary intervention (PCI). Demographic, clinical, laboratory, and angiographic data were collected. CRP and hsTnI values were analyzed at three time points: upon hospital admission, 6 hours after PCI, and 12 hours after PCI. Based on these values, patients were divided into three groups:
- Group 1: hsTnI<3xURL (upper reference limit),
- Group 2: hsTnI between 3–5×URL,
- Group 3: hsTnI >5×URL.
Results: No statistically significant association was found between elevated CRP and hsTnI levels in Groups 1 and 2. However, in Group 3, a higher proportion of patients had elevated CRP levels, though this did not reach statistical significance (p > 0.05). In Group 3, which included patients with hsTnI levels greater than five times the upper reference limit, 68.1% of patients had elevated CRP levels (≥3 mg/L), indicating a more pronounced inflammatory response compared to the first two groups. Furthermore, the analysis revealed that patients with multivessel coronary artery disease and reduced left ventricular ejection fraction were more likely to have elevated CRP levels. A clear statistical correlation was identified between elevated CRP levels and occlusion of the right coronary artery. While the results did not achieve statistical significance across all examined subgroups, a consistent trend was observed, suggesting an association between elevated CRP levels and more severe clinical presentations and complex angiographic findings.
Conclusion: The results suggest a clinically relevant but statistically nonsignificant association between CRP and hsTnI. Higher CRP values may reflect more complex coronary pathology and impaired systolic function. Further studies are needed to determine the prognostic value of these biomarkers in ACS
Cardiorespiratory arrest in out-of-hospital settings
No full textKardiorespiratorni arest u izvanbolničkim uvjetima predstavlja ozbiljan javnozdravstveni problem s visokom stopom mortaliteta i lošim neurološkim ishodima preživjelih. U ovom diplomskom radu analizirani su najvažniji aspekti zbrinjavanja bolesnika s kardiorespiratornim arestom, uključujući epidemiologiju, etiologiju, smjernice za osnovno i napredno održavanje života, postreanimacijsku skrb te ishode liječenja. Izvanbolnički arest se najčešće javlja unutar stambenih prostora, češće pogađa muškarce, a najčešći uzrok je ishemijska bolest srca. Temelj pravodobne intervencije čini lanac preživljavanja koji uključuje rano prepoznavanje aresta, pozivanje pomoći, početak laičke kardiopulmonalne reanimacije, ranu defibrilaciju, primjenu naprednih mjera održavanja života i adekvatnu postreanimacijsku skrb. Poseban naglasak stavljen je na edukaciju laika, dostupnost automatskih vanjskih defibrilatora te ulogu dispečera hitne medicinske pomoći. U okviru naprednog održavanja života obuhvaćene su defibrilacija, zbrinjavanje dišnog puta, primjena lijekova, uporaba mehaničkih pomagala i izvantjelesne kardiopulmonalne reanimacije. Postreanimacijska skrb uključuje stabilizaciju vitalnih funkcija, ciljanu regulaciju temperature i neurološku procjenu. Unatoč unapređivanju smjernica za reanimaciju, preživljenje nakon izvanbolničkog aresta ostaje nisko. Ishod ovih pacijenata ovisi o brzini i kvaliteti intervencije, dostupnosti medicinskih resursa, edukaciji stanovništva te multidisciplinarnom pristupu. Ovaj rad naglašava važnost kontinuirane edukacije, standardizacije protokola te potrebe za daljnjim istraživanjima i tehnološkim unaprjeđenjima kako bi se povećala stopa preživljenja i poboljšao neurološki ishod bolesnika nakon srčanog zastoja u izvanbolničkim uvjetima.Out-of-hospital cardiac arrest is a significant public health issue characterized by high mortality rates and poor neurological outcomes among survivors. This thesis explores the key components in the management of out-of-hospital cardiac arrest, including its epidemiology, etiology, guidelines for basic and advanced life support, post-resuscitation care, and treatment outcomes. Out-of-hospital cardiac arrest most often occurs at home, affects males more frequently, and is primarily caused by ischemic heart disease. Early recognition of arrest, prompt emergency calls, bystander cardiopulmonary resuscitation, early defibrillation, and timely advanced life support with post-resuscitation care form the chain of survival. Emphasis is placed on educating laypersons, providing access to automated external defibrillators, and dispatcher-assisted cardiopulmonary resuscitation. Advanced interventions include defibrillation, airway management, drug administration, use of mechanical support devices, and extracorporeal cardiopulmonary resuscitation. Post-resuscitation care involves stabilizing vital functions, implementing targeted temperature management, and conducting a neurological evaluation. Despite advancements in resuscitation guidelines, survival after out-of-hospital cardiac arrest remains low. Outcomes depend on the rapid and high-quality provision of intervention, the availability of medical resources, effective public education, and a multidisciplinary approach. This thesis highlights the significance of ongoing education, protocol standardization, and further research and innovation in enhancing survival rates and neurological outcomes following cardiopulmonary arrest in out-of-hospital settings
Mammography breast cancer screening
No full textRak dojke najčešći i najsmrtonosniji je rak u ženskoj populaciji, te kako bi što uspješnije liječili pacijentice s rakom dojke vrlo nam je bitno rano otkrivanje raka. Zbog toga se od 2006. godine u Republici Hrvatskoj provodi Nacionalni program ranog otkrivanja raka dojke, u kojem se žene starosti 50 do 69 godina pozivaju na mamografsko snimanje svake 2 godine.
U skoro dva desetljeća provođenja programa s prosječnim odazivom od oko 60% značajno se povećao broj slučajeva u ranom lokaliziranom stadiju, a smanjio broj slučajeva s regionalnim i udaljenim metastazama, što je u kombinaciji s boljim terapijskim opcijama dovelo do smanjenja smrtnosti.
Mamografija je u osnovi rendgenska snimka dojki, kojoj je prednost to što se malom zračenju izlažu samo dojke. Na snimci je ponekad teško razlikovati manifestaciju benigne i maligne lezije zbog čega je ponekad potrebno koristiti i dodatne slikovne metode, kao što su ultrazvuk i magnetska rezonancija. Unatoč razvoju tehnologije i komplementarnih dijagnostičkih metoda, osjetljivost u detekciji mikrokalcifikata kao ranog znaka malignih promjena kod asimptomatskih pacijentica, što i dalje čini mamografiju dijagnostičkom metodom izbora.
Stoga će fokus ovog rada biti prvenstveno na mamografskom probiru iako će biti obrađene i modernije komplementarne metode.Breast cancer is the deadliest and most common cancer among the female population, so in order to treat patients more successfully it’s of great importance to detect it early. Thus, the National Breast Cancer Early Detection Program has been implemented in the Republic of Croatia since 2006, in which women aged 50 to 69 are encouraged to have a mammogram every 2 years.
In almost two decades of its existence with an average response rate of 60% the number of cases with early localised stage has increased, and the number of cases with regional and distant metastases has decreased, which combined with better treatment options has led to a decrease in the number of deaths.
Mammography is basically an x-ray imaging of the breasts, which is practical because only the breasts are exposed to a small dose of radiation. Sometimes it’s difficult to differentiate the manifestations of benign and malign lesions on the image so it’s sometimes practical to use complementary imaging techniques, as ultrasound and magnetic resonance imaging. Despite the technological advancements of other diagnostic methods, the precision in detecting microcalcifications as an early sign of malign transformations in asymptomatic patients is what makes mammography the diagnostic method of choice.
Thus, the focus of this paper will mainly be on early detection using mammography but will also cover newer complementary methods
Decrease of muscle mass in patients with rheumatoid arthritis
No full textReumatoidni je artritis progresivna, kronična, autoimunosna, upalna reumatska bolest za koju je specifična upala malih zglobova šaka i stopala. Rizični čimbenici su pušenje i određene infekcije. Nastaje zbog međudjelovanja okolišnih čimbenika, genske predispozicije i poremećaja u imunološkom sustavu. U akutnoj fazi prisutni su oteklina, bol, nemogućnost pokretanja, a u kroničnoj fazi nastaju deformiteti zglobova. Ne postoji jedinstven nalaz koji bi sa sigurnošću potvrdio dijagnozu RA, stoga se koriste ACR/EULAR kriteriji iz 2010. godine. Liječenje se sastoji od smanjenja simptoma upale i sprječavanja daljnje progresije bolesti. Liječi se NSAR-ovima, glukokortikoidima i DMARD-ovima. Izvanzglobna očitovanja bolesti su pojava reumatoidnih čvorića, vakulitisi i drugi kao i osteometaboličke promjene u vidu osteoporoze i sarkopenije. Sarkopenija je progresivna, mišićno-koštana, generalizirana bolest smanjenja mišićne mase, snage i tjelesne sposobnosti. Povezuje se s različitim komorbiditetima i povećanim rizikom od pada i prijeloma. Sarkopenija u RA je sekundarna. Rizični su čimbenici za razvoj sarkopenije razni. Etiopatogeneza nastanka smanjene mišićne mase i sarkopenije još nije u potpunosti poznata, no smatra se da nastaje trijasom uzroka, smanjene tjelesne aktivnosti, uporabe glukokortikoida i upale koja dovodi mišićnu homeostazu u disbalans. Postoje razna društva koja se bave sarkopenijom, a najpoznatija su EWGSOP i AWGS. EWGSOP društvo je 2018. donijelo smjernice za dijagnostiku sarkopenije. Sastoji se od SARC-F upitnika, procjene mišićne snage, mišićne mase i procjene tjelesne sposobnosti. Lijek za sarkopeniju još ne postoji, ali se simptomi mogu djelomično poboljšati liječenjem osnovne bolesti, prehranom i tjelovježbom.Rheumatoid arthritis is a progressive, chronic, autoimmune, inflammatory rheumatic disease characterized by inflammation of the small joints of the hands and feet. Risk factors include smoking and certain infections. It occurs due to the interaction of environmental factors, genetic predisposition, and immune system disorders. In the acute phase patients present with swelling, pain, and inability to move, while in the chronic phase, joint deformities develop. There is no single finding that would confirm the diagnosis of RA with certainty, therefore the ACR/EULAR criteria from 2010 are used. Treatment consists of reducing symptoms of inflammation and preventing further progression of the disease. It is treated with NSAIDs, glucocorticoids, and DMARDs. Extra-articular symptoms of the disease include the appearance of vasculitis, rheumatoid nodules, as well as osteometabolic changes in the form of osteoporosis and sarcopenia. Sarcopenia is a progressive, musculoskeletal, generalized disease of decreased muscle mass, strength, and physical fitness. It is associated with various comorbidities and an increased risk of falls and fractures. Sarcopenia in RA is secondary. Risk factors for the development of sarcopenia are diverse. The etiopathogenesis of the occurrence of reduced muscle mass and sarcopenia is not yet fully known, but it is believed to be caused by a triad of causes, reduced phisical activity, glucocorticoid use, and inflammation that imbalances muscle homeostasis. There are various societies that deal with sarcopenia, the most famous of which are EWGSOP and AWGS. The EWGSOP society released guidelines for the diagnosis of sarcopenia in 2018. It consists of the SARC-F questionnaire, an assessment of muscle strength, muscle mass, and an assessment of physical fitness. There is no cure for sarcopenia yet, but symptoms can be partially improved by treating the underlying disease, diet, and exercise
Immunotherapy in the second-line treatment of non-small cell lung cancer
No full textKarcinom pluća, osobito nemalih stanica, i dalje je jedna od vodećih nezaraznih bolesti razvijenog svijeta. Nastanak karcinoma je najčešće povezan s pušenjem, a zbog nespecifičnosti simptoma u ranoj fazi, većina bolesnika u trenutku dijagnoze ima prošireni stadij bolesti, kada su mogućnosti liječenja ograničene. Bolje razumijevanje karcinogeneze kao složenog genetskog, molekularnog i imunološkog procesa dovelo je do značajnog iskoraka u razvoju imunoterapije. U posljednjem desetljeću, imunoterapija inhibitorima imunoloških kontrolnih točaka PD-1/PD-L1 pokazala je bolje ishode u liječenju uznapredovalog stadija NSCLC-a u usporedbi s do tad standardnom kemoterapijom. Imunoterapijski lijekovi odobreni u drugoj liniji liječenja su pembrolizumab, nivolumab i atezolizumab te su svi pokazali jednako dobru učinkovitost, osobito u bolesnika s visokom ekspresijom PD-L1 (>50%). Novija istraživanja usmjerena su na pronalazak idealnog tumorskog biomarkera koji bi omogućio precizniji odabir pacijenata koji bi imali najviše koristi primjene imunoterapije. Određena ograničenja koja utječu na terapijski odgovor su razne imunološki posredovane nuspojave, razvoj rezistencije na terapiju te specifičnost samog tumorskog mikrookruženja. Iako je imunoterapija odnedavno uvrštena u prvu liniju liječenja metastatskog NSCLC-a, odabir imunoterapije u drugoj liniji liječenja i dalje ima važnu ulogu u bolesnika koji nisu bili kandidati za njihovu primjenu u prvoj liniji. Daljne razumijevanje molekularne podloge nastanka tumora i složenog imunološkog odgovora ključni su za dodatan razvoj ciljanih terapija koje će dodatno unaprijediti liječenje uznapredovalog NSCLC-a.Lung cancer, particularly non-small cell lung cancer, remains one of the leading non-communicable diseases in the developed world. The development of carcinoma is most commonly associated with smoking and due to the non-specific nature of symptoms in the early stage, most patients have advanced-stage disease at the time of diagnosis, when treatment options are limited. Better understanding of carcinogenesis as a complex genetic, molecular and immunological process has led to significant advances in the development of immunotherapy. In the last decade, immunotherapy with PD-1/PD-L1 immune checkpoint inhibitors has shown better outcomes in treating advanced-stage NSCLC compared to previously standard chemotherapy. Immunotherapeutic drugs approved for second-line treatment are pembrolizumab, nivolumab and atezolizumab, all of which have shown equally good efficacy, particularly in patients with high PD-L1 expression (>50%). Recent research has focused on finding the ideal tumor biomarker that would enable more precise selection of patients who would benefit most from immunotherapy. Certain limitations that affect therapeutic response include various immune-mediated adverse effects, development of therapy resistance and the specificity of the tumor microenvironment itself. Although immunotherapy has recently been included in first-line treatment of metastatic NSCLC, the selection of immunotherapy in second-line treatment still plays an important role in patients who were not candidates for its application in first-line therapy. Further understanding of the molecular basis of tumor development and complex immune response is crucial for additional development of targeted therapies that will further improve the treatment of advanced NSCLC
Interstitial lung disease in Sjögren's syndrome
No full textSjögrenov sindrom (SS) je sustavna kronična autoimunosna bolest nepoznate etiologije karakterizirana suhoćom sluznica. Suhoća može zahvatiti sluznice dišnih puteva, probavnog i genitalnog sustava, što rezultira tzv. sicca sindromom. Bolešću može biti zahvaćen bilo koji organ. Ukoliko su zahvaćena pluća, najčešće očitovanje je intersticijska plućna bolest (ILD, prema eng. interstitial lung disease) koja je čest uzrok smrti kod ovih bolesnika.
Cilj ovog retrospektivnog presječnog istraživanja je prikazati i analizirati kliničke karakteristike bolesnika s intersticijskom plućnom bolesti u Sjögrenovom sindromu u razdoblju od siječnja 1992.g. do siječnja 2025. g., liječenih u Zavodu za kliničku imunologiju i reumatologiju Klinike za unutarnje bolesti Kliničkog bolničkog centra Zagreb. U radu je analizirana skupina od 110 bolesnika od kojih su većina žene (N=109). Prosječna dob pojave prvih simptoma je 47 godina, a prosječna dob pri postavljanju dijagnoze SS-a je 52 godine. Od ukupnog broja bolesnika (N=110) s dijagnozom SS-a, u 5 % je dijagnosticiran ILD. Dijagnoza ILD-a očitovala se kao limfocitni intersticijski pneumonitis u 4 bolesnika te kao intersticijska plućna fibroza u 2 bolesnika. Spirometrijom je u 33 % bolesnika nađen restriktivni tip smetnji ventilacije. U 83 % bolesnika vrijednosti CO-difuzije su bile snižene. Svi bolesnici bili su na terapiji glukokortikoidima (prednison i metilprednisolon) i imunosupresivnim lijekovima: azatioprin, klorokin i hidroksiklorokin. Terapija se u pojedinih bolesnika mijenjala ovisno o kliničkom stanju i razvoju nuspojava na lijekove. Nakon postavljanja dijagnoze ILD-a, kod troje bolesnika došlo je do promjene terapije. U prvom slučaju u terapiju je uveden ciklofosfamid, u drugom je umjesto azatioprina uveden mikofenolat-mofetil, a u trećeg bolesnika je započeto liječenje rituksimabom.Sjögren's syndrome (SS) is a systemic chronic autoimmune disease of unknown etiology characterized by dryness of the mucous membranes. Dryness can affect the mucous membranes of the respiratory tract, digestive and genital systems, resulting in the so-called sicca syndrome. SS can affect any organ or system. If the lungs are affected, the most common manifestation is interstitial lung disease (ILD), which is a common cause of death in these patients.
The aim of this retrospective cross-sectional study is to analyze the clinical characteristics of patients with interstitial lung disease in Sjögren's syndrome in the period from January 1992 to January 2025, treated at the Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Center Zagreb. The study analyzed a group of 110 patients, most of whom were women (N=109). The average age of onset of the first symptoms was 47 years, and the average age at diagnosis of SS was 52 years. Of the total number of patients (N=110) diagnosed with SS, 5 % were diagnosed with ILD. In 4 patients, ILD presented as lymphocytic interstitial pneumonitis, and in 2 patients interstitial pulmonary fibrosis has developed. Spirometry revealed a restrictive type of ventilation impairment in 33% of patients. CO diffusion values were reduced in 83% of patients. All patients were treated with glucocorticoids (prednisone and methylprednisolone) and immunosuppressive drugs: azathioprine, chloroquine and hydroxychloroquine. The therapy was changed in individual patients depending on the clinical condition and the development of side effects to the drugs. After the diagnosis of ILD, three patients underwent a change in therapy. In the first case, cyclophosphamide was introduced into the therapy, in the second, mycophenolate mofetil was introduced instead of azathioprine, and in the third patient, treatment with rituximab was initiated
Knowledge of diabetic nutrition in patients with diabetes mellitus type 2
No full textDijabetes melitus (DM) tipa 2 kronična je bolest okarakterizirana povišenim razinama glukoze u krvi te neosjetljivosti na inzulin. Epidemiološka istraživanja utvrdila su da od otprilike 529 milijuna dijabetičara diljem svijeta, njih 96 % boluje od DM tipa 2. Liječenje se provodi raznim oblicima farmakoterapije te kontrolom prehrane za koju svrhu su osmišljene mnoge dijete poput keto dijete ili mediteranske dijete. Zajednička značajka svih dijabetičkih dijeta restrikcija je unosa kalorija. Cilj ovog istraživanja bio je proučiti jelovnik pacijenata s DM tipa 2 te ga usporediti sa zdravim kontrolama i preporukama mediteranske dijete. Također se istraživala korelacija između znanja o pravilnoj prehrani i vremena proteklog od dijagnoze DM tipa 2. Istraživanje je provedeno kao case-control studija na 60 ispitanika razvrstanih u skupinu ispitanika te skupinu kontrola. Svaka je skupina imala po 30 ispitanika (17 muškaraca, 13 žena). Medijan dobi ispitanika bio je 62,5 (IQR 53,0 – 71,8) godina , dok je medijan dobi kontrola bio 59 (IQR 54,2 – 68,0) godina. Svim sudionicima je zadano da ispune upitnik o dijabetesu tipa 2 i prehrani koji je konstruiran za potrebe ovog istraživanja. Količina jednostavnih ugljikohidrata bila je podjednaka u prosječnom jelovniku obje skupine ispitanika, ali kontrole su birale raznolikije izvore škroba. Razine konzumacije namirnica bogatih mastima bile su više u skupini bolesnika u odnosu na kontrole. Utvrđeno je također da oni koji dulje boluju od dijabetesa imaju bolje znanje o pravilnoj prehrani u odnosu na novodijagnosticirane bolesnike.Type 2 diabetes, also known as adult-onset diabetes, is a chronic disease characterized by elevated blood glucose levels and a relative insulin deficiency. Epidemiological studies have determined that out of approximately 529 million diabetics worldwide, 96% suffer from type 2 diabetes mellitus (DM). Treatment is carried out through various forms of pharmacotherapy and dietary control, for which many diets have been designed, such as the ketogenic or the Mediterranean diet. A common feature of all diabetic diets is the restriction of calorie intake. The aim of this study was to examine the menu of patients with type 2 DM and compare it with healthy controls and recommendations of the Mediterranean diet. The correlation between knowledge about proper nutrition and the time elapsed since the diagnosis of type 2 DM was also investigated. The study was conducted as a case-control study on 60 subjects divided into a patient and a control group. Each group had 30 subjects (17 men, 13 women).The median age of the patient group was 62,5 (IQR 53,0-71,8) years, while the median age of the control group was 59 (IQR 54,2-68) years. All participants were asked to complete a questionnaire about type 2 diabetes and nutrition, designed for this study. The amount of simple carbohydrates was similar in the average menu of both groups, but the control group has shown more variety in their choice of starch sources. The levels of consumption of foods rich in fats were higher in the patient group compared to the controls. It was also found that those who have had diabetes for a longer time have better knowledge about proper nutrition compared to newly diagnosed patients
Changes and rehabilitation in the postpartum period
No full textPostporođajno razdoblje predstavlja kompleksnu fazu fiziološkog i psihološkog prilagođavanja ženskog organizma nakon trudnoće i porođaja. U tom razdoblju odvijaju se brojne promjene koje obuhvaćaju endokrini, reproduktivni, kardiovaskularni, mišićno-koštani i živčani sustav, uz izraženu emocionalnu osjetljivost i potrebu za redefiniranjem osobnog i socijalnog identiteta žene u ulozi majke. Način dovršenja trudnoće – bilo vaginalnim porođajem, carskim rezom ili patološkim ishodom poput nedonošenosti ili mrtvorođenja – značajno utječe na dinamiku i složenost oporavka. Hormonalne promjene karakterizira nagli pad estrogena i progesterona nakon porođaja dok porast koncentracija prolaktina i oksitocina omogućuje uspostavu dojenja. Dojenje predstavlja jedan od najvažnijih čimbenika fiziološkog oporavka – stimulira involuciju maternice, potiče stvaranje emocionalne povezanosti s novorođenčetom i ima ulogu u regulaciji psihičkog stanja majke. Ipak, uspostava laktacije može biti otežana, osobito nakon carskog reza, kod bolesnog ili prerano rođenog djeteta, te u kontekstu emocionalnog stresa. Odustajanje od dojenja ili njegovo izbjegavanje nosi rizik produljenog fiziološkog oporavka, slabije hormonalne regulacije i povećane ranjivosti u psihološkom smislu. Rehabilitacija u postporođajnom razdoblju podrazumijeva više od pukog fizičkog cijeljenja – uključuje obnavljanje hormonalne ravnoteže, prevenciju i liječenje psihičkih smetnji, edukaciju i podršku u usvajanju roditeljske uloge te osnaživanje žene u svakodnevnom funkcioniranju. Uspješna rehabilitacija osobito je važna kod žena koje su prošle kroz operativni porod, prijevremeni porođaj ili gubitak djeteta, jer su one izložene većem riziku od posttraumatskih reakcija, depresije i fizičkih komplikacija. Ključ učinkovitog oporavka leži u multidisciplinarnom pristupu – koji uključuje ginekologe, fizioterapeute, patronažne sestre, nutricioniste, psihologe i savjetnike za dojenje – s naglaskom na individualizirane potrebe svake žene. Edukacija, rana intervencija i dostupnost stručne podrške presudni su za očuvanje dugoročnog zdravlja žene, kvalitetnu uspostavu dojenja te njezino uspješno uključivanje u novu životnu ulogu.The postpartum period represents a complex phase of physiological and psychological adjustment following pregnancy and childbirth. During this time, a woman’s body undergoes extensive changes affecting the endocrine, reproductive, cardiovascular, musculoskeletal, and nervous systems, accompanied by emotional sensitivity and a need to redefine personal and social identity in the role of motherhood. The mode of delivery - whether vaginal birth, cesarean section, or a pathological outcome such as preterm birth or stillbirth - significantly influences the course and complexity of recovery. Hormonal changes are characterized by a rapid drop in estrogen and progesterone levels after delivery, while increased concentrations of prolactin and oxytocin facilitate the onset of lactation. Breastfeeding plays a central role in postpartum recovery - it stimulates uterine involution, strengthens the emotional bond between mother and infant, and contributes to psychological stabilization. Nevertheless, the establishment of lactation can be challenging, particularly after cesarean section, in cases of neonatal illness or prematurity, and in the context of emotional distress. Avoidance or early cessation of breastfeeding may prolong physiological recovery, impair hormonal regulation, and increase the mother’s vulnerability to psychological difficulties. Postpartum rehabilitation encompasses more than physical healing—it includes hormonal stabilization, prevention and management of mental health disorders, education and support in adopting the maternal role, and empowerment in daily functioning. Effective recovery is especially important in women who have experienced operative birth, preterm delivery, or perinatal loss, as they face a higher risk of trauma-related reactions, depression, and physical complications. The foundation of optimal recovery lies in a multidisciplinary approach involving gynecologists, physiotherapists, community nurses, nutritionists, psychologists, and lactation consultants, with a strong emphasis on individualized care. Education, timely intervention, and access to professional support are essential for long-term maternal health, successful breastfeeding, and a positive transition into motherhood
The role of bradykinin receptor type 2 in the development of brain and retinal ischemic lesion
No full textUsprkos velikom broju kliničkih i pretkliničkih dokaza o korelaciji ishemije mozga i mrežnice, malo je pažnje posvećeno zajedničkim patološkim mehanizmima razvoja ishemijske ozljede istih. Cilj ovog istraživanja bio je longitudinalnim in vivo praćenjem razjasniti ulogu bradikininskog receptora tipa 2 u razvoju ishemijske ozljede mozga i mrežnice te odrediti primjenjivost in vivo snimanja mrežnične vaskulature za određivanje cerebrovaskularnih promjena u mišjem modelu moždanog udara. Usporedbom Koizumi i Longa zahvata okluzije srednje moždane arterije i dugotrajnim praćenjem statusa cerebralne vaskularne perfuzije magnetskom rezonancijom pokazano je da kod Koizumi zahvata ishemiju prati kronična hipoperfuzija i ishemija mozga i mrežnice, za razliku od Longa zahvata, u kojem nakon ishemije nastupa potpuna reperfuzija koja rezultira izraženijom cerebralnom atrofijom bez znakova oštećenja mrežnice. Usporedbom miševa s onemogućenim genom za bradikininski receptor tipa 2 te njihovih kontrola nakon Koizumi zahvata, dugotrajnim praćenjem razvoja ishemije magnetskom rezonancijom, fotografijom i fluoresceinskom angiografijom očne pozadine, testovima ponašanja i mjerenjem vaskularne propusnosti pokazano je da nedostatak bradikininskog receptora tipa 2 u akutnoj fazi ishemije smanjuje oštećenje i propusnost cerebralne vaskulature, a kronično povećava atrofiju moždanog tkiva i funkcionalni deficit. U mrežnici je pokazano slično djelovanje, odnosno povećanje vaskularne propusnosti u subakutnoj fazi, te povećanje ishemijskog oštećenja u kroničnoj fazi ishemije.Despite ample clinical and preclinical evidence correlating cerebral and retinal ischemia, not enough attention has been paid to common pathological mechanisms of ischemic lesion development in these tissues. This research aimed to clarify the role of bradykinin receptor type 2 in the development of brain and retinal ischemia and to examine the applicability of in vivo retinal vascular imaging to determine cerebrovascular changes in a murine model of stroke. Comparing the Koizumi and Longa middle cerebral artery occlusion procedures by long-term cerebrovascular perfusion monitoring with magnetic resonance imaging showed that ischemia was followed by chronic hypoperfusion in both brain and retina in the Koizumi model. In contrast, complete reperfusion occurred in the Longa model, resulting in greater cerebral atrophy without retinal damage. By comparing bradykinin receptor type 2 knock-out mice and their controls after the Koizumi procedure using long-term monitoring with magnetic resonance, fundus photography, fluorescein angiography, behavioral tests and vascular permeability measurements, bradykinin receptor type 2 deficiency has been shown to reduce acute cerebral vascular permeability, while increasing cerebral atrophy and functional deficit in the chronic phase. Retinal findings showed a similar effect, increased subacute vascular permeability and increased ischemic damage in the chronic phase of ischemia