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
Carfilzomib in relapsed/refractory multiple myeloma patients – real world evidence – experiences of the Croatian cooperative group for hematologic diseases (KROHEM)
No full textBackground: Carfilzomib-based regimens brought a significant improvement in the treatment of relapsed/refractory multiple myeloma (RRMM). Even though efficacy and safety profiles of carfilzomib are well-established in several clinical trials, there is limited real-world data with carfilzomib-based protocols. Here we present our real-world experience with carfilzomib-based regimens for treatment of patients with RRMM in Croatia.
Methods: Data on patients with RRMM starting carfilzomib-based protocols in the period between June 2019 and February 2023 was collected by retrospective chart review from 14 Croatian centres.
Results: A total of 119 patients with RRMM were included; median age was 66 years (range 45-83 years), 59 (49.6 %) were females, and the median number of previous lines of therapies was 2 (range 1-8). Triplet based regimen was treatment choice in 84 (70.6 %) and 35 (29.4 %) patients were treated with carfilzomib in combination with dexamethasone (Kd). Overall response rate was 61.7 %, with 20 patients (18.7 %) achieving complete response (CR). Median progression free survival (PFS) and overall survival (OS) for entire cohort were 9.4 and 13.2 months, respectively. Median PFS was 12.8 months and 4.1 months for the triplets and doublets, respectively; the corresponding median OS was 18.6 and 7.9 months, respectively. The most common adverse events were anemia and thrombocytopenia; 19 patients (16 %) experienced cardiovascular events.
Conclusion: This is the first study to analyze clinical outcomes of RRMM patients treated with carfilzomib-based regimens in Croatia. Carfilzomib-based regimens showed substantial efficacy and acceptable toxicity in RRMM, especially in earlier treatment lines and triplet combinations
Challenges in recognizing and treating patients with adrenal insufficiency
No full textAdrenalna insuficijencija (AI) je rijetko, ali po život opasno stanje karakterizirano nedovoljnom proizvodnjom kortizola, koje zahtijeva cjeloživotno liječenje i edukaciju bolesnika. Unatoč dostupnosti terapije, prepoznavanje i zbrinjavanje ovih bolesnika i dalje predstavljaju klinički izazov. Cilj ovog diplomskog rada bio je opisati glavne izazove u dijagnostici i liječenju AI u odraslih, s naglaskom na trijažu bolesnika, interpretaciju laboratorijskih nalaza te optimizaciju zamjenske terapije. U tu svrhu, proveden je narativni pregled literature pretraživanjem baza podataka PubMed, Scopus, Cochrane Library i Hrčak za razdoblje od 1984. do 2025. godine. U završnu sintezu uključena su 63 rada koji su zadovoljili unaprijed definirane kriterije. Analizom literature utvrđeno je da dijagnostika AI predstavlja značajan izazov zbog nespecifičnih simptoma koji često dovode do kašnjenja u postavljanju dijagnoze. Interpretacija biokemijskih testova dodatno je otežana zbog postojanja "sive zone" nalaza jutarnjeg kortizola te razlika u metodama i referentnim vrijednostima. U liječenju, standardna nadomjesna terapija glukokortikoidima ne uspijeva oponašati fiziološki cirkadijalni ritam, što dovodi do razdoblja prekomjerne i nedovoljne supstitucije te posljedično povećava rizik od dugoročnih komplikacija poput osteoporoze i kardiovaskularnih bolesti, uz smanjenu kvalitetu života. Prevencija adrenalne krize ostaje ključan, ali često nedovoljno ostvaren cilj.Adrenal insufficiency (AI) is a rare but life-threatening condition characterized by insufficient cortisol production, which requires lifelong treatment and patient education. Despite the availability of therapy, the recognition and management of these patients continue to present a clinical challenge. The aim of this thesis was to describe the main challenges in the diagnosis and treatment of AI in adults, with an emphasis on patient triage, interpretation of laboratory findings, and the optimization of replacement therapy. For this purpose, a narrative literature review was conducted by searching the PubMed, Scopus, Cochrane Library, and Hrčak databases for the period from 1984 to 2025. A total of 63 papers that met predefined criteria were included in the final synthesis. The literature analysis found that the diagnosis of AI presents a significant challenge due to nonspecific symptoms, which often lead to delays in establishing the diagnosis. The interpretation of biochemical tests is further complicated by the existence of a "grey zone" for morning cortisol results and by differences in assays and reference values. In treatment, standard glucocorticoid replacement therapy fails to mimic the physiological circadian rhythm, leading to periods of over- and under-replacement, and consequently increasing the risk of long-term complications such as osteoporosis and cardiovascular diseases, along with a reduced quality of life. The prevention of adrenal crisis remains a key, yet often insufficiently achieved, goal
Current treatment in macrophage activation syndrome worldwide: a systematic literature review to inform the METAPHOR project
No full textObjective: To assess current treatment in macrophage activation syndrome (MAS) worldwide and to highlight any areas of major heterogeneity of practice.
Methods: A systematic literature search was performed in both EMBASE and PubMed databases. Paper screening was done by two independent teams based on agreed criteria. Data extraction was standardized following the PICO framework. A panel of experts assessed paper validity, using the Joanna Briggs Institute appraisal tools and category of evidence (CoE) according to EULAR procedure.
Results: Fifty-seven papers were finally included (80% retrospective case-series), describing 1148 patients with MAS: 889 systemic juvenile idiopathic arthritis (sJIA), 137 systemic lupus erythematosus (SLE), 69 Kawasaki disease (KD) and 53 other rheumatological conditions. Fourteen and 11 studies specified data on MAS associated to SLE and KD, respectively. All papers mentioned glucocorticoids (GCs), mostly methylprednisolone and prednisolone (90%); dexamethasone was used in 7% of patients. Ciclosporin was reported in a wide range of patients according to different cohorts. Anakinra was used in 179 MAS patients, with a favourable outcome in 83% of sJIA-MAS. Etoposide was described by 11 studies, mainly as part of HLH-94/04 protocol. Emapalumab was the only medication tested in a clinical trial in 14 sJIA-MAS, with 93% of MAS remission. Ruxolitinib was the most reported Janus kinase inhibitor in MAS.
Conclusion: High-dose GCs together with IL-1 and IFNγ inhibitors have shown efficacy in MAS, especially in sJIA-associated MAS. However, the global level of evidence on MAS treatment, especially in other conditions, is still poor and requires standardized studies to be confirmed
Patient adherence to diabetes treatment in family medicine in Croatia according to the EUROASPIRE V survey
No full textŠećerna bolest predstavlja jedan od vodećih javnozdravstvenih problema u svijetu, a adherencija bolesnika prema preporučenom liječenju neophodna je za uspješnu regulaciju glikemije, kontrolu bolesti i prevenciju komplikacija. Cilj ovoga rada jest utvrditi adherenciju bolesnika prema promjeni životnih navika i farmakoterapiji šećerne bolesti tipa 2 u Republici Hrvatskoj temeljem istraživanja EUROASPIRE V. Ispitanici i metode: Presječno retrospektivno istraživanje provedeno je u devet ordinacija obiteljske medicine u Zagrebu. Uključeno je 58 ispitanika oboljelih od šećerne bolesti tipa 2, a korišteni su dijelovi upitnika EUROASPIRE V istraživanja o farmakoterapiji, promjeni životnih navika te upitnik o samoprocjeni adherencije prema lijekovima. Rezultati: Samoprocijenjeno uzimanje farmakoterapije cijelo vrijeme odnosno stopostotna adherencija prema svim antihiperglikemicima zabilježena je kod 53,4% bolesnika. Najveći broj bolesnika u terapiji uzima metformin, od kojih je stopostotnu adherenciju navelo 55,1% bolesnika. Prema upitniku o promjeni životnih navika, najveća adherencija zabilježena je prema smanjenju unosa šećera (84,5%), dok je najmanja adherencija zabilježena prema pohađanju fitness centra kao obliku TA (3,4%), smanjenju prekomjernog unosa alkohola (44,8%) te smanjenju tjelesne mase (48,3% sudjelovanjem u TA i 44,8% pridržavanjem prehrane). Pušenje je reduciralo 15% savjetovanih bolesnika, a 35% bolesnika je prestalo pušiti. U usporedbi sa zbirnim rezultatima istraživanja EUROASPIRE V, koje uključuje i druge europske zemlje, samoprocijenjena stopostotna adherencija prema svim antihiperglikemicima bila je veća u odnosu na ispitanike u Hrvatskoj i iznosila je 76,5%. Kod promjene životnih navika, adherencija prema smanjenju prekomjernog unosa alkohola (51,3%) i smanjenju unosa masti (76,5%) bila je veća, dok je adherencija prema redovitoj TA (51,4%) i smanjenju unosa šećera (80,8%) bila manja od onih zabilježenih u Hrvatskoj. Zaključak: Rezultati istraživanja EUROASPIRE V koje je provedeno u Republici Hrvatskoj pokazuju nedovoljnu adherenciju bolesnika oboljelih od šećerne bolesti tipa 2 prema farmakoterapiji i promjeni životnih navika. Za uspješnu regulaciju glikemije i kontrolu bolesti potrebno je učiniti dodatne napore u povećanju adherencije prema liječenju.Diabetes represents one of the leading public health problems worldwide and patients’ adherence to the recommended therapy is essential for achieving optimal glycemic control, disease control, and prevention of complications. The aim of this research is to determine the patients’ adherence to lifestyle changes and pharmacotherapy for type 2 diabetes based upon the EUROASPIRE V survey conducted in Croatia. Patients and methods: A cross-sectional retrospective study was carried out in nine primary care centres in Zagreb. A total of 58 patients with type 2 diabetes were included. Questionnaires on pharmacotherapy, lifestyle changes, and the medication adherence questionnaire from the EUROASPIRE V survey were used. Results: A total of 53.4% patients selfreported 100% adherence to antihyperglycemic medication. The majority of patients were prescribed metformin and 55.1% of them reported 100% adherence. According to the lifestyle changes questionnaire, the highest adherence was reported for the reduction of sugar intake (84.5%), while the lowest adherence was reported for attending a fitness center as a form of PA (3.4%), reducing excessive alcohol intake (44.8%) and weight loss (48.3% by participating in regular PA and 44.8% by following dietary recommendations). Smoking reduction was reported by 15% of advised smokers and 35% of participants stopped smoking. According to the results of the EUROASPIRE V survey, which includes other European countries, self-reported 100% adherence to antihyperglycemic medication was higher compared to the participants in Croatia (76.5%). According to the lifestyle changes questionnaire, adherence to reducing excessive alcohol intake (51.3%) and reducing fat intake (76.5%) was higher, while adherence to regular PA (51.4%) and reducing sugar intake (80.8%) was lower than those recorded in Croatia. Conclusion: The results of the EUROASPIRE V survey carried out in Croatia demonstrate insufficient adherence to pharmacotherapy and lifestyle changes among patients with type 2 diabetes. In order to achieve optimal glycemic and disease control, additional efforts are required to enhance adherence to treatment
Dynamics of hyperglycemia of patients treated with alpelisib: exploratory interim analysis of ITACA trial
No full textBackground: Alpelisib and fulvestrant combination has improved outcomes in patients with phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated, hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-)- advanced breast cancer (BC) who relapsed or progressed on prior endocrine therapy. Hyperglycemia, on target toxicity, is a frequent adverse event occurring in over 60% of patients.
Objectives: The ITACA trial explores whether low carbohydrate dietary modifications and evening dosing of alpelisib to potentially mitigate impact of food on hyperglycemia. This exploratory interim analysis aimed to quantify the incidence and timing of hyperglycemia in the ITACA trial's pooled sample.
Methods: This exploratory interim analysis of the ongoing ITACA trial included 23 patients with HR+, HER2-negative metastatic BC receiving alpelisib and fulvestrant. The exploratory outcomes were grade 2-4 hyperglycemia-free survival and time to onset of hyperglycemia.
Results: Most patients, 21 (91.3%), experienced any-grade hyperglycemia (Grade 1: 9 [39.1%], Grade 2: 8 [34.8%], Grade 3: 4 [17.4%], and Grade 4: 0 [0.0%]) within the first week of alpelisib initiation. The median grade 2-4 hyperglycemia-free survival was 6 days (95% CI 3; 44 days).
Conclusions: This exploratory interim analysis demonstrated the rapid onset of hyperglycemia in patients receiving alpelisib, even with the ITACA trial's dietary interventions. Proactive monitoring, within the first week after initiation of treatment, and early management of hyperglycemia are crucial in this patient population
Association of Epstein-Barr virus expression and prognosis in patients with primary cutaneous T-cell lymphoma
No full textCilj ovog istraživanja bio je odrediti utjecaj Epstein-Barr virusa (EBV) na kliničku sliku i prognozu kod bolesnika s primarnim kožnim T-staničnim limfomom (CTCL) te prepoznati skupinu bolesnika koja bi eventualno razvila bržu progresiju bolesti i pojavnost drugog primarnog malignoma. U ovu retrospektivnu studiju bila su uključena 84 bolesnika kod kojih je postavljena dijagnoza CTCL-a u Kliničkom bolničkom centru Zagreb u razdoblju od siječnja 2003. godine do prosinca 2017. godine te su opservirani minimalno pet godina. Metodom in situ hibridizacije (ISH) nije dokazan EBV kod bolesnika s CTCL-om te je EBV isključen kao potencijalni etiopatogenetski čimbenik. Od 84 ispitanika, njih 16 (19%) imalo je drugu primarnu neoplazmu, a 50% neoplazmi bilo je hematološke etiologije. Niti jedan ispitanik nije imao melanom iako je 58,3% njih liječeno fotokemoterapijom (PUVA). U našem istraživanju do progresije bolesti došlo je u 22,6% ispitanika (n=19), a ispitanici su imali neki od posebnih oblika MF-a, kao što su FMF i velikostaničnu transformaciju (P<0,001). Nijedan laboratorijski parametar niti klinički pokazatelj nije bio statistički značajan među bolesnicima s i bez progresije bolesti. Ispitanici s posebnim oblikom MF-a ili SS-a imali su značajno kraće vrijeme do progresije bolesti te značajno lošije preživljenje. Ovim istraživanjem, EBV odbačen je kao potencijalni etiopatogenetski čimbenik razvitka CTCL-a, kao i eventualne progresije. Definirana je skupina bolesnika koji su brže razvili progresiju bolesti te imali viši mortalitet.The aim of this research was to determine the impact of Epstein-Barr virus (EBV) on the clinical findings and prognosis in patients with primary cutaneous Tcell lymphoma (CTCL) and to identify a group of patients who would develop a progression of the disease and the development of a second primary malignancy. This retrospective study included 84 patients who were diagnosed with CTCL in the Clinic for Dermatovenerology and the Clinic for Pathology and Cytology of the Zagreb Clinical Hospital Center in the period from January 2003 to December 2017. All patients were followed up at least 5 years. The method of in situ hybridization (ISH) did not prove EBV in patients with CTCL, and EBV was excluded as a potential pathogenetic factor. Of the 84 subjects, 16 (19%) had a second primary malignancy, and 50% of the neoplasms
were of hematological etiology. No patient had melanoma even though 58.3% of them were treated with PUVA photochemotherapy. In our study, disease progression occurred in 22.6% of subjects (n=19), and the subjects had some of
the special forms of MF, such as FMF and large cell transformation (P<0.001). None of the laboratory parameters or clinical indicators were statistically significant between patients with and without disease progression. Subjects with a special form of MF or SS had significantly shorter time to disease progression and significantly worse survival. This research rejected EBV as a potential pathogenetic factor in the development of CTCL itself, as well as disease progression. We defined a group of patients who developed disease progression and had higher mortality significantly more often
Suicides in healthcare facilities in Zagreb and Zagreb County
No full textSamoubojstvo je jedan od najčešćih načina počinjenja nasilnih smrti u Hrvatskoj i svijetu te ga se stoga smatra ozbiljnim javnozdravstvenim problemom. Prema dostupnim podacima stope suicida su više u hospitaliziranih pacijenata u odnosu na opću populaciju. Cilj ovog rada je istražiti učestalost, okolnosti i specifične čimbenike rizika za samoubojstva počinjena u zdravstvenim ustanovama. U tu su svrhu analizirani rezultati ranije provedenih studija, pregledane statističke analize službenih izvora te prikupljeni, analizirani i statistički obrađeni podaci iz sudskomedicinskih arhiva.
Rezultati istraživanja pokazali su da su samoubojstva u zdravstvenim ustanovama često povezana s teškim psihijatrijskim i somatskim bolestima, te da njihov udio, gledajući sva samoubojstva na području Zagreba i Zagrebačke županije, nije zanemariv. Analizom dobivenih podataka utvrđene su razlike u stopama samoubojstava ovisno o spolu, dobi, načinu počinjenja i vrsti zdravstvene ustanove. Također, identificirani su ključni nedostaci u postojećim izvorima podataka za ovakav tip istraživanja, te su razmotrene mogućnosti za njihovo poboljšanje.
Zaključno, rad naglašava potrebu za sustavnim unaprjeđenjem prevencije suicida u zdravstvenim ustanovama, uključujući bolje prepoznavanje rizičnih pacijenata, povećanje dostupnosti psihološke podrške te uvođenje specijaliziranih edukacija za medicinsko osoblje u cilju povećanja učinkovitosti strategija prevencije prilagođenih specifičnim potrebama pacijenata u bolničkom okruženju.Suicide is one of the most common types of violent death in Croatia and worldwide, making it a serious public health issue. According to available data, suicide rates are higher among hospitalized patients compared to the general population. The aim of this study is to investigate the frequency, circumstances, and specific risk factors for suicides committed in healthcare facilities. For this purpose, the study analyzed the results of previously conducted research, reviewed statistical analyses from official sources, and collected, analyzed, and statistically processed data from forensic medical archives.
The research results indicate that suicides in healthcare facilities are often associated with severe psychiatric and somatic illnesses and that their share, considering all suicides in the area of Zagreb and Zagreb County, is significant. Data analysis identified differences in suicide rates based on gender, age, method of suicide, and type of healthcare facility. Additionally, key deficiencies in existing data sources for this type of research were identified, along with potential improvements.
In conclusion, the study emphasizes the need for systematic improvements in suicide prevention in healthcare institutions, including better identification of at-risk patients, increased availability of psychological support, and the introduction of specialized training for medical staff. These measures aim to enhance the effectiveness of prevention strategies tailored to the specific needs of patients in a hospital setting
Fertility preservation in the treatment of endometrial cancer
No full textKarcinom endometrija najčešći je zloćudni tumor ženskog spolnog sustava te četvrti najčešći kod žena u razvijenom dijelu svijeta, nakon karcinoma dojke, debelog crijeva i pluća. Njegov je najčešći histološki podtip endometrioidni karcinom endometrija. U pravilu se češće javlja u perimenopauzalnoj i postmenopauzalnoj dobi, a rjeđe i kod žena mlađih od 40 godina. Zbog povećane prevalencije rizičnih čimbenika poput pretilosti i dijabetesa, anovulacijskih stanja, smanjene upotrebe hormonske terapije tijekom menopauze te veće prevalencije nulipara, incidencija karcinoma endometrija raste. Mnoge žene u reproduktivnoj dobi žele liječenjem očuvati svoj reproduktivni potencijal te ostvariti trudnoću, zbog čega standardni postupak totalne histerektomije s bilateralnom salpingo-ooferektomijom za njih nije najsretnija metoda. U takvim se slučajevima, kod žena s endometrioidnim karcinom endometrija u reproduktivnoj dobi sa zadovoljenim određenim kriterijima, razmatraju alternativne metode liječenja kojima bi se moglo produžiti reproduktivno razdoblje kako bi pacijentica mogla zatrudnjet i roditi. Najčešće korištena vrsta terapije je sintetskim progesteronima, progestinima, koji se primjenjuju oralno ili u obliku intrauterinog uloška. Ostale se metode poput histeroskopske resekcije, primjene metformina, gonadotropin-oslobađajućeg hormon agonista, inhibitora aromataze, ciljane molekularne terapije te imunoterapije istražuju ili selektivno primjenjuju u rijetkim slučajevima. Nakon tri mjeseca od početka terapije, preporučeno je histološkom analizom provjeriti odgovor na terapiju te nakon dvije negativne biopsije savjetovati pacijentici da što prije zatrudni. Medicinski potpomognuta oplodnja odličan je izbor kod takvih žena kojima je bitno što prije začeti i iznijeti trudnoću kako bi što ranije mogle biti operirane jer se preporučuje, uzevši u obzir visoku stopu povratka bolesti, nakon poroda, učiniti totalnu histerektomiju s bilateralnom salpingo-ooferektomijom.Endometrial cancer is the most common malignant tumor of the female reproductive system and the fourth most common cancer among women in developed countries, following breast, colorectal, and lung cancers. Its most frequent histological subtype is endometrioid endometrial carcinoma. It typically occurs in perimenopausal and postmenopausal women but can also appear, though less commonly, in women under the age of 40. Due to the increasing prevalence of risk factors such as obesity, diabetes, anovulatory conditions, reduced use of hormone replacement therapy during menopause, and a higher proportion of nulliparous women, the incidence of endometrial cancer is rising. Many women of reproductive age wish to preserve their fertility and achieve pregnancy, making the standard treatment of total hysterectomy with bilateral salpingo-oophorectomy less favorable for this population. In such cases, for women of reproductive age with endometrioid endometrial carcinoma who meet specific criteria, alternative treatment methods are considered in order to prolong the reproductive window, allowing the patient to conceive and give birth. The most commonly used treatment involves synthetic progesterones, or progestins, administered either orally or via an intrauterine device (IUD). Other methods, such as hysteroscopic resection, the use of metformin, gonadotropin releasing hormone (GnRH) agonists, aromatase inhibitors, targeted molecular therapy, and immunotherapy, are currently under investigation or selectively used in rare cases. After three months of therapy, a histological evaluation is recommended to assess the treatment response. If two consecutive biopsies show no signs of malignancy, the patient is advised to conceive as soon as possible. Assisted reproductive technologies are an excellent option for these women, as achieving pregnancy quickly allows for earlier surgical intervention. Given the high recurrence rate of the disease, it is recommended that after childbirth, total hysterectomy with bilateral salpingo-oophorectomy be performed
Treatment of neuromuscular scoliosis
No full textSkolioze su trodimenzionalna zakrivljenja kralježnice raznovrsne etiologije. Dijele se na strukturalne i nestrukturalne. Najčešće strukturalne su idiopatske i neuromuskularne skolioze. Neuromuskularne bolesti karakterizirane su disfunkcijama mišićnog ili živčanog tkiva. Dijele se na miopatske i neuropatske, koje se dalje dijele na bolesti gornjeg i donjeg motoneurona. Često su praćene skoliozama s velikim i dugim zakrivljenjima oblika slova C, brzo su progresivne i nerijetko udružene s kosom zdjelicom. Potrebno ih je čim prije uočiti, postaviti dijagnozu, te pravovremeno započeti liječenje.
Skolioze se dijagnosticiraju kombinacijom fizikalnog pregleda i rendgenograma, na kojem se korištenjem metode po Cobb-u izmjeri Cobbov kut, a za detaljniju dijagnostiku koristimo CT i MR. Neuromuskulane se skolioze liječe kombinacijom neoperacijskog i operacijskog liječenja. Neoperacijsko uključuje poboljšanje stava pri sjedenju, upotreba ortoza i drugo, a operacijsko uključuje metode kontrole rasta i spondilodezu kralješnice. Spondilodeza (ukočenje kralješnice), krajnji je oblik terapije koji se odgađa do koštane zrelosti. Prilikom spondilodeze zbog manjeg postotka komplikacija peferira se stražnji pristup.
Najčešći oblik neoperacijskog liječenja neuromuskularnih skolioze, jesu primjena invalidskih kolica s individualnom prilagodbom sjedišta, te primjena ortoza. Primjenu ortoza često prate komplikacije u smislu ograničenja respiratorne funkcije i iritacije kože s natiscima i mogućom infekcijom. Komplikacije nakon operacijskih zahvata kod neuromuskularnih skolioza su daleko češće jer se najčešće radi o teškim pacijentima s brojnim komorbiditetima. Pacijenti su vezani za IK, nisu aktivni, te je kvaliteta kosti lošija. Primjenom korekcijske sile na implantate postavljene u mekanijoj, slabijoj kosti može doći do primarnog ili sekundarnog pomaka. Nadalje lošija kardiorespiratorna funkcija, slabija uhranjenost, podložnost infekcijama, dodatno povećavaju rizik od značajnih komplikacija kod liječenja NM skolioza. Unatoč većeg rizika od značajnih komplikacija adekvatno provedeno operacijsko liječenje izrazito podiže kvalitetu života i olakšava skrb za bolesnike s NM skoliozama.Scoliosis is a three-dimensional curvature of the spine with various etiologies. It is classified into structural and non-structural types. The most common structural scolioses are idiopathic and neuromuscular scolioses. Neuromuscular diseases are characterized by dysfunctions of muscle or nerve tissue. They are divided into myopathic and neuropathic conditions, with the latter further classified into upper and lower motor neuron disorders. Neuromuscular scolioses often present with large, long C-shaped curves, are rapidly progressive, and are frequently associated with a tilted pelvis. Early detection, diagnosis, and timely initiation of treatment are essential.
coliosis is diagnosed through a combination of physical examination and X-ray imaging, where the Cobb angle is measured using the Cobb method. For more detailed diagnostics, CT and MRI are used. Treatment of neuromuscular scoliosis involves a combination of non-surgical and surgical methods. Non-surgical treatment includes improving seated posture, the use of orthoses, and other aids. Surgical treatment involves growth control techniques and spinal fusion (spondylodesis). Spinal fusion is the final stage of treatment and is typically postponed until skeletal maturity. Due to a lower complication rate, the posterior approach is preferred during spinal fusion.
The most common form of non-surgical treatment for neuromuscular scoliosis includes the use of customized wheelchairs and orthoses. However, orthoses often cause complications such as restricted respiratory function, skin irritation, pressure sores, and potential infections. Complications after surgical procedures in neuromuscular scoliosis are far more frequent due to the severity of patients' conditions and the presence of multiple comorbidities. These patients are often wheelchair-bound, physically inactive, and have poor bone quality. The application of corrective force on implants placed in softer, weaker bone can lead to primary or secondary displacement. Additionally, reduced cardiopulmonary function, poor nutritional status, and infection susceptibility increase the risk of serious complications during the treatment of neuromuscular scoliosis. Despite the increased risk of significant complications, well-executed surgical treatment greatly improves quality of life and facilitates care for patients with neuromuscular scoliosis
Overtraining syndrome in athletes in sports with high static load
No full textSindrom pretreniranosti ozbiljan je problem u suvremenom sportu, osobito kod sportaša koji se bave disciplinama s visokim statičkim opterećenjem poput dizanja utega, veslanja, hrvanja i daljinskog plivanja. Nastaje kao posljedica neravnoteže između intenzivnog opterećenja i nedovoljnog oporavka, dovodeći do nemogućnosti održavanja homeostaze organizma. Manifestira se kroničnim umorom, smanjenjem sportske izvedbe, poremećajima spavanja, povećanom učestalošću ozljeda, hormonalnim disbalansom i ozbiljnim psihološkim simptomima kao što su depresija, anksioznost i demotivacija. Pretreniranost se razvija kroz kontinuum: funkcionalno presezanje (kratkoročni umor nakon kojeg slijedi poboljšanje performansi), nefunkcionalno presezanje (dugotrajan pad performansi praćen izraženim psihološkim simptomima) te sindrom pretreniranosti kao najteži oblik s dugotrajnim posljedicama. Dijagnoza je komplicirana zbog nedostatka specifičnih bio markera, stoga je nužna klinička procjena uz isključivanje drugih bolesti, a koristi se i EROS model koji kombinira kliničke, hormonalne i psihološke parametre. Prevencija se temelji na pravilnom planiranju, periodizaciji i programiranju treninga, pažljivom praćenju super kompenzacije te individualiziranoj prehrani, hidraciji, kvalitetnom snu i psihološkoj podršci sportašima. Kada se sindrom razvije, nužan je višedimenzionalan pristup liječenju kroz smanjenje opterećenja, kratkotrajni pasivni odmor te postepeni aktivni oporavak niskog intenziteta, uz optimizaciju prehrane, sna i psihološku podršku. Edukacija sportaša i stručnog tima ključna je za pravovremeno prepoznavanje simptoma, očuvanje zdravlja sportaša te dugoročnu održivost sportske karijere. Samo sustavni pristup može osigurati učinkovito upravljanje pretreniranosti i očuvanje performansi sportaša.Overtraining syndrome is a serious issue in modern sports, especially among athletes involved in disciplines with high static loads, such as weightlifting, rowing, wrestling, and open-water swimming. It arises from an imbalance between intensive training loads and insufficient recovery, leading to a disruption of the body's homeostasis. Symptoms include chronic fatigue, decreased athletic performance, sleep disturbances, increased injury rates, hormonal imbalances, and significant psychological symptoms such as depression, anxiety, and loss of motivation. Overtraining develops along a continuum: functional overreaching (short-term fatigue followed by performance improvement), non-functional overreaching (prolonged performance decline with marked psychological symptoms), and overtraining syndrome itself as the most severe form with long-term consequences. Diagnosis is challenging due to the lack of specific biomarkers, thus relying on clinical assessment and the exclusion of other medical conditions. The EROS model, combining clinical, hormonal, and psychological parameters, is frequently utilized. Prevention involves proper training planning, periodization, and programming, careful monitoring of super compensation, individualized nutrition, hydration, quality sleep, and psychological support for athletes. When the syndrome occurs, treatment demands a multidimensional approach including reduced training loads, short-term passive rest, gradual active recovery at low intensity, and optimized nutrition, sleep, and psychological support. Education of athletes and professional teams is crucial for timely recognition of symptoms, athlete health preservation, and sustainable athletic career longevity. Only a systematic approach can effectively manage overtraining and safeguard athletes' performance