Veterinary medicine - Repository of PHD, master's thesis
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Optimization of cardiovascular risk factor management in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms, current knowledge, and perspectives
No full textThe exact prognostic role of cardiovascular (CV) risk factors in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms (MPNs) remains unknown as it is often masked by other MPN-related features that bear strong prognostic impact on thrombotic risk. Therefore, current MPN treatment is not primarily guided by presence of CV risk factors. Treatment of CV risk factors in MPN patients usually mirrors that from the general population, despite the fact that CV risk factors in MPNs have their own specificities. Moreover, the optimal target levels for different metabolic deflections in MPNs (i.e., low-density lipoprotein, serum uric acid, or glycated hemoglobin levels) have not been defined. In the current review, we separately discuss the most important aspects of every individual CV risk factor (arterial hypertension, hyperlipidemia, chronic kidney disease, smoking, diabetes mellitus, hyperuricemia, and obesity and cachexia) in MPNs, summarize recent advances in the field, and propose future directions and research areas which may be needed to appropriately manage CV risk factors in MPNs
Equivalent: Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia
No full textAim
To describe epidemiological characteristics and baseline clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coronavirus disease 2019 (COVID-19) patients treated at a tertiary institution specialized for COVID-19 patients.
Methods
This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbidities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors.
Results
The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m2. The most relevant comorbidities were diabetes mellitus (32.6%), arterial hypertension (71.2%), congestive heart failure (19.1%), chronic kidney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dimer, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, PaO2/FiO2 ratio, and glomerular filtration rate at admission. Length of ICU stay was 9 days. The median survival was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated.
Conclusion
The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify individual mortality risk factors
Risk factors analysis of West Nile virus infection in Croatia
No full textU ovom istraživanju analizirana je prevalencija, epidemiološke značajke i abiotički čimbenici VZN infekcije u Hrvatskoj, 2011.-2014. godine. Istraživana je povezanost klimatoloških, geomorfoloških, prostornih i demografskih parametara s pojavnošću infekcija u konja tijekom četiri uzastopne sezone u županijama s najviše dokazanih infekcija. Dokazana je značajna razlika u učestalosti akutnih infekcija i seroprevalencije tijekom pojedinih sezona kao i regionalno. Udio akutno zaraženih konja iznosio je 0,1-1,4%, a IgG seroprevalencija 6,9-12,9%, što odgovara pojavi akutnih infekcija u ljudi 2012. i ukazuje na intenzivniju cirkulaciju virusa s njezinim posljedičnim porastom. Korelacijskom analizom utvrđena je značajna pozitivna povezanost IgG seroprevalencije s temperaturom 2011., 2013. i 2014., s vlagom 2012., a značajna negativna povezanost 2011. i 2014. i s količinom oborina u 2013. godini. Poplavno područje i udaljenost od šuma pokazali su se statistički značajni prediktori IgG seropozitiviteta konja na univarijatnoj razini, a kao negativni prediktori udaljenost od vodenih površina i nadmorska visina. Na multivarijatnoj razini značajni su samo udaljenost od šuma i nadmorska visina. Seroprevalencija VZN u ljudi u odabranim županijma 2013. godine iznosila je 4,2%, a 2014. godine 0,9%. U četiri od šest promatranih županija, utvrđena je značajna povezanost između seroprevalencije u konja i ljudi, u Zagrebačkoj županiji, Gradu Zagrebu, Osječko-baranjskoj i Vukovarsko-srijemskoj županiji.The prevalence, epidemiological features, and abiotic factors of WNV infection in Croatia were analyzed in the period from 2011 to 2014. The association of climatological, geomorphological, spatial and demographic parameters with the occurrence of infections in horses during four consecutive seasons in the counties with the highest number of infections was investigated. The frequency of acute infections and seroprevalence differed significantly between seasons as well as regionally. The proportion of acutely infected horses was 0.1-1.4%, and the IgG seroprevalence was 6.9-12.9%, which corresponds to the occurrence of acute infections in humans in 2012 and indicates a more intensive circulation of the virus with its consequent increase. Correlation analysis revealed a significant positive association of IgG seroprevalence with temperature in 2011, 2013, and 2014, with humidity in 2012, and a significant negative correlation in 2011 and 2014, and with the amount of precipitation in 2013. Flood area and distance from forests were statistically significant predictors of IgG seropositivity in horses at the univariate level, while water surface distance and altitude were negative predictors. At the multivariate level, only forest distance and altitude are significant. The WNV seroprevalence in humans in selected counties was 4.2% in 2013, and 0.9% in 2014. In four of the six analyzed counties, a significant association was observed between seroprevalence in horses and humans, in Zagreb County, the City of Zagreb, Osijek-Baranja and Vukovar-Srijem Counties
Prevalence of HIV and Hepatitis C and access to opioid substitution treatment among people who inject drugs in three cities in Croatia: findings from the second wave of respondent-driven sampling surveys
No full textBackground: The second wave of integrated bio-behavioural surveys was conducted among people who inject drugs (PWID) in the cities of Zagreb, Split, and Rijeka in Croatia to estimate the prevalence of HIV and hepatitis C virus (HCV) antibodies and sexual and injecting risk behaviours.
Methods: Respondent-driven sampling (RDS) was used to recruit a total of 301 PWID in Split, 130 in Rijeka, and 86 in Zagreb from March to July 2022. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RDS-Analyst software was used to calculate weighted population estimates with 95% confidence intervals (95% CI).
Results: Approximately one in four PWID were women (range from 24.3% in Zagreb to 29.9% in Rijeka). Overall, HIV prevalence was low, with no cases identified in Zagreb, and 0.6% and 0.8% in Split and Rijeka, respectively. HCV antibody prevalence was 37.2% among PWID in Zagreb and Rijeka, and as high as 59.5% in Split. Testing for HIV and HCV in the 12 months before the survey was reported by 11.3-19.8% and 17.3-21.6% of PWID across the cities, respectively. Use of needles and syringes in the past 30 days that had already been used by someone else was reported by 8.9-26.5% across the cities. A large proportion of PWID-54.0% in Zagreb, 31.0% in Rijeka and 29.9% in Split-never used needle and syringe exchange programmes. Being in drug addiction treatment at the time of the survey was reported by 50.8% in Split, 57.3% in Rijeka and 73.3% in Zagreb. Injecting cocaine in 30 days before the survey was common, ranging from 12.7 to 32.1% across the cities.
Conclusion: HIV prevalence continues to be low among PWID in Croatia, whereas HCV prevalence is substantial. Due to low coverage of HIV and HCV testing and insufficient use of harm reduction services, there is a potential for further spread of drug-related infectious diseases in this population
Germline mutations of the BRCA1/2 genes as a predictor of response to cyclin-dependent kinase 4/6 inhibition in breast cancer
No full textKarcinom dojke predstavlja veliki javnozdravstveni problem u cijelome svijetu te je glavni uzrok smrti od malignih bolesti u žena, a pokazuje trend porasta incidencije. CDK 4/6 inhibitori u kombinaciji s endokrinom terapijom postali su standard u liječenju HR+ HERABC. Zametne BRCA1/2 mutacije imaju značajnu ulogu u patogenezi raka dojke te njihova detekcija nosi i terapijski i prognostički značaj. BRCA1/2 geni sudjeluju u popravku DNA, regulaciji staničnog ciklusa i hormonskoj signalizaciji. Testiranje na gBRCAm postaje ključno u terapijskom odlučivanju, a PARP inhibitori sve se više koriste u terapiji ABC kod nositelja tih mutacija, posebno kod HER2 negativnih i TNBC podtipova raka dojke. U ovom retrospektivnom istraživanju analizirani su podaci 49 pacijenata s HR+ HER2- ABC liječenih CDK 4/6 inhibitorima u KBC-u Zagreb, s ciljem usporedbe kliničke slike i odgovora na
terapiju između pacijenata s potvrđenim zametnim BRCA1/2 i PALB2 mutacijama i onih bez mutacija. U skupini s mutacijama zabilježen je statistički značajan kraći medijan TTF u trajanju od 9 mjeseci, za razliku od 23 mjeseca u skupini bez mutacija, uz p vrijednost 0,03, iako nije potvrđena statistička značajnost relativnog rizika za progresiju (RR=1,32, p=0,415). Također je uočen trend kraćeg ukupnog preživljenja koji je u skupini s mutacijom iznosio 39 mjeseci, a u skupini bez mutacije 48 mjeseci, ali bez statističke značajnosti (p=0,8). Rezultati također ukazuju na agresivniju kliničku sliku u svih ispitanika. Potvrđena je hipoteza da
pacijenti s gBRCAm imaju lošiji ishod liječenja CDK 4/6 inhibitorima u usporedbi s pacijentima bez mutacija, čime se podupire potreba za širim genskim testiranjem i primjenom ciljane terapije poput PARP inhibitora u liječenju ovih pacijentica.Breast cancer represents a major public health issue worldwide and is the leading cause of cancer-related death in women, with an increasing trend in incidence. CDK 4/6 inhibitors in combination with endocrine therapy have become the standard treatment for HR+ HER2- ABC. Germline BRCA1/2 mutations play a significant role in the pathogenesis of breast cancer, and their detection carries both therapeutic and prognostic importance. The BRCA1/2 genes are involved in DNA repair, cell cycle regulation, and hormonal signaling. Testing for gBRCAm is becoming crucial in therapeutic decision-making, and PARP inhibitors are increasingly being used in the treatment of ABC in carriers of these mutations, particularly in HER2-negative and TNBC subtypes. In this retrospective study, data from 49 patients with HR+ HER2- ABC treated with CDK 4/6 inhibitors at University Hospital Centre Zagreb were analyzed to compare clinical characteristics and treatment response between patients with confirmed germline BRCA1/2 and PALB2 mutations and those without mutations. In the mutation group, a statistically significant shorter median TTF was recorded, 9 months in the mutation group versus 23 months in the non-mutation group (p=0.03), although the relative risk for disease progression was not statistically significant (RR=1.32,
p=0.415). A trend toward shorter overall survival was also observed, 39 months in the mutation group compared to 48 months in the non-mutation group, but without statistical significance (p=0.8). The results also indicate a more aggressive clinical presentation in all subjects. The hypothesis that patients with gBRCAm have poorer outcomes when treated
with CDK 4/6 inhibitors compared to patients without mutations was confirmed, supporting the need for broader genetic testing and the introduction of targeted therapies such as PARP inhibitors in the treatment of these patients
Ossicular chain reconstruction possibilities
No full textOsikuloplastika je operativni postupak kojim se obnavlja kontinuitet lanca slušnih koščica i time poboljšava sluh u osoba s provodnim oštećenjem sluha. Diskontinuitet ili fiksacija slušnih koščica uzrokuju oko 55% slučajeva provodne nagluhosti. Kronična upala srednjeg uha uzrokuje više od 80% poremećaja lanca slušnih koštica, a manje česti uzroci su trauma i kongenitalne malformacije lanca. Oko polovice slučajeva uključuje više od jedne slušne koščice, a najčešće nedostaje nakovanj ili njegov dugi nastavak. S obzirom na oštećen dio lanca slušnih koščica, operacije se individualiziraju. Suvremene metode osikuloplastike uključuju zamjenu dva zgloba koščica s parcijalnom (PORP, partial ossicular replacement prosthesis) ili totalnom (TORP, eng. total ossicular replacement prosthesis) osikularnom protezom. Na taj se način lanac slušnih koščica pretvara u jedan klip kojim se sila prenosi s bubnjića izravno na suprastrukturu stremena kod PORP-a, na pločicu kod TORP-a. Prema obliku proteze od aloplastičnih materijala mogu biti totalne (TORP) ili parcijalne (PORP). Odabir proteze ovisi o razmjeru razaranja slušnih koščica. Najčešća komplikacija osikuloplastike je dislokacija proteze koja nastaje uslijed udarca u glavu, jakog puhanja nosa i sl. Osikuloplastika poboljšava sluh s postotkom uspješnosti od 75% za PORP i 68% za TORP u razdoblju od 12 do 18 mjeseci. Za uspjeh osikuloplastike je ključno postojanje stabilnog, dobro prozračenog okoliša srednjeg uha. Slaba ventilacija uha koja dovodi patologije srednjeg uha značajno smanjuje uspjeh osikuloplastike nego kirurška tehnika i karakteristike proteza. Osikuloplastika je uspješna metoda rekonstrukcije lanca slušnih koščica.Ossiculoplasty is a surgical procedure intended to reinstate the continuity of the ossicular chain and improving hearing in individuals with conductive hearing loss. Ossicular discontinuity or fixation occurs in approximately 55% of cases of conductive hearing loss. More than 80% of ossicular chain disorder cases are caused by chronic otitis media. Trauma or congenital malformations account for most of the remaining cases of ossicular damage. Around half of the cases include more than one ossicle, with the incus being primarily involved, especially the long process. Procedures are individualized with regard to the damaged component of the ossicular chain. Contemporary ossiculoplasty methods involve replacing the incudomalleolar joint as well as the incudostapedial joint with partial (PORP, partial ossicular replacement prosthesis) and total (TORP, total ossicular replacement prosthesis) ossicular prostheses. These procedures effectively transform the ossicular chain into a single piston, thus transmitting force from the tympanic membrane straight to the stapes superstructure or footplate. There are two main alloplastic prostheses classified according to their shape, TORP or PORP. The choice of prosthesis depends on the extent of the destruction of the auditory ossicles. The most common complication of ossiculoplasty is prosthesis dislocation, which occurs due to head trauma or strong nose blowing. Ossiculoplasty improves hearing with the succes rate of 75% for PORP and 68% for TORP over a period of 12 to 18 months. Establishing a stable, well aerated middle ear environment is critical for ossiculoplasty to be successsful. Middle ear pathology resulting from poor ventilation is significantly more detrimental to ossiculoplasty success than the surgical method and prosthetic factors. Ossiculoplasty is a successful method for reconstruction of the ossicular chain
Pelvic binder application in the outpatient treatment of polytraumatized patients
No full textPrijelomi zdjelice predstavljaju teške ozljede često povezane s visokim rizikom od masivnog krvarenja, hemodinamske nestabilnosti i smrti. Ove ozljede najčešće nastaju kod ozljeda visokom energijom poput prometnih nesreća, padova s visine ili nesreća uzrokovanih teškim predmetima te su često praćene pridruženim ozljedama drugih organskih sustava. U izvanbolničkim uvjetima jedan od najvažnijih postupaka zbrinjavanja prijeloma zdjelice jest primjena zdjeličnog pojasa čija je osnovna funkcija stabilizacija prijeloma, smanjenje volumena zdjelične šupljine i ograničavanje krvarenja. Brojne studije pokazale su da rana primjena zdjeličnog pojasa može značajno smanjiti potrebu za transfuzijama krvi, skratiti vrijeme boravka pacijenta u bolnici te poboljšati ishod, osobito kod pacijenata s hemodinamskom nestabilnošću. Osim što omogućuje stabilizaciju zdjelice, pojas može značajno smanjiti bolnost kod pacijenata čime se smanjuje potreba za primjenom analgetika. Njegova jednostavna primjena omogućuje brzo i efikasno zbrinjavanje pacijenta s prijelomom zdjelice na terenu i za vrijeme transporta u bolnicu. Dijagnostika prijeloma zdjelice u izvanbolničkim uvjetima je otežana jer se oslanja isključivo na kliničku procjenu, pri čemu je važno prepoznati znakove prijeloma poput boli u zdjelici, nestabilnosti kostiju zdjelice prilikom palpacije, hematoma ili vanjske rotacije donjih ekstremiteta. U potvrdi dijagnoze prijeloma zdjelice u bolničkim uvjetima zlatni standard predstavlja kompjuterizirana tomografija (CT), dok ultrazvučni pregled može pomoći u otkrivanju intraabdominalnog i retroperitonealnog krvarenja. Liječenje prijeloma zdjelice uključuje akutno zbrinjavanje s ciljem zaustavljanja krvarenja i stabilizacije pacijenta do definitivnog kirurškog zbrinjavanja koje uključuje osteosintezu. Unatoč brojnim dokazanim prednostima, primjena zdjeličnog pojasa nosi i određene rizike uključujući mogućnost nepravilnog postavljanja, ozljede kože, dekubituse te potencijalno maskiranje vrste prijeloma na radiološkim pretragama što može otežati daljnju dijagnostiku i planiranje liječenja. Iako se zdjelični pojas u hitnim medicinskim službama sve češće primjenjuje, istraživanja pokazuju značajnu varijabilnost u protokolima i tehnikama postavljanja, pri čemu je velik postotak pojaseva postavljen neadekvatno, najčešće previsoko iznad razine velikih trohantera, što smanjuje njegovu učinkovitost i povećava rizik od komplikacija. Standardizacija smjernica, kontinuirana edukacija medicinskog osoblja i pravilna primjena ključni su faktori u optimizaciji upotrebe zdjeličnog pojasa u hitnoj medicini.Pelvic fractures are serious injuries often associated with a high risk of massive bleeding, hemodynamic instability, and mortality. These injuries occur most often in high-energy trauma such as traffic accidents, falls from heights, or accidents caused by heavy objects, and are usually accompanied by associated injuries to other organ systems. In prehospital settings, one of the most important management procedures is the application of a pelvic binder, the main function of which is to stabilize the fracture, reduce the volume of the pelvic cavity, and limit bleeding. Numerous studies have shown that early application of a pelvic binder can significantly reduce the need for blood transfusions, shorten the patient's hospital stay, and improve outcomes, especially in patients with hemodynamic instability. In addition to stabilizing the pelvis, the binder can significantly reduce pain in patients, thereby reducing the need for analgesics. Its simple application allows for rapid and efficient care of patients with pelvic fractures at the scene of accident and during the transport to the hospital. The diagnosis of pelvic fractures in the prehospital setting is difficult because it relies entirely on clinical assessment, and it is important to recognize signs of fracture such as pelvic pain, pelvic bone instability on palpation, hematoma, or external rotation of the lower extremities. In confirming the diagnosis of pelvic fractures in the hospital setting, the gold standard is computed tomography (CT), while ultrasound examination can help detect intra-abdominal and retroperitoneal bleeding. Treatment of pelvic fractures includes acute care to control bleeding and stabilize the patient until definitive surgical treatment, which includes osteosynthesis. Despite the numerous proven benefits, using a pelvic binder also carries certain risks, including the possibility of improper placement, skin injuries, pressure ulcers, and potential masking of the type of the fracture on radiological examinations, which can complicate further diagnosis and treatment planning. Although the use of pelvic binders is increasing in emergency medical services, research shows significant variability in protocols and placement techniques, with a high percentage of binders being placed inadequately, most often too high above the level of the greater trochanters, which reduces their effectiveness and increases the risk of complications. Standardization of guidelines, continued education of medical staff, and proper application are key factors in optimizing the use of pelvic binders in emergency medicine
Endocrine side effects of immune checkpoint inhibitors in treatment of malignant diseases
No full textMaligne bolesti predstavljaju jedan od vodećih javnozdravstvenih problema globalno, ali i u Hrvatskoj, gdje su drugi uzrok smrtnosti nakon kardiovaskularnih bolesti. U početku liječenje malignih bolesti bilo je usmjereno na kirurške zahvate i radioterapiju, uz kasnije uključivanje kemoterapije i hormonske terapije. Danas zahvaljujući rezultatima opsežnih i dobro dizajniranih kliničkih studija, imunoterapija zauzima ključno mjesto u liječenju različitih solidnih i hematoloških tumora; osobito se ističe razvoj inhibitora imunoloških kontrolnih točaka u koje ubrajamo anti-CTLA-4, anti-PD-1, anti-PD-L1 i anti-LAG-3 lijekove.
Endokrinološke nuspojave inhibitora imunoloških kontrolnih točaka javljaju se u približno 40% pacijenata ovisno o korištenom lijeku. Najčešće su zahvaćene štitnjača i hipofiza, dok se primarna adrenalna insuficijencija i dijabetes melitus javljaju rijeđe. Rijetke, ali moguće komplikacije su hipoparatireoidiziam, sindrom neodgovarajućeg izlučivanja antidiuretskog
hormona i autoimuni poliendokrini sindrom tip 2.
Simptomi endokrinoloških nuspojava često su nespecifični i preklapaju se sa kliničkom slikom osnovne bolesti zbog čega je dijagnostika otežana. Potrebna je suradnja između onkologa i endokrinologa te rutinsko monitoriranje pacijenata kako bi se omogućilo rano otkivanje endokrinoloških nuspojava. Većina endokrinoloških nuspojava je trajna i ireverzibilna zbog čega protuupalna terapija nije korisna u liječenju već je temelj liječenja hormonska nadomjesna terapija.Malignant diseases represent one of the leading public health issues globally, including in Croatia, where they are the second leading cause of mortality after cardiovascular diseases. In the beginning, the treatment of malignant diseases focused on surgical procedures and radiotherapy, with chemotherapy and hormonal therapy introduced later. Today, thanks to the results of extensive and well-designed clinical trials, immunotherapy plays a key role in the treatment of various solid and hematological tumors; of special significance is the development of immune checkpoint inhibitors, which include anti-CTLA-4, anti-PD-1, anti PD-L1, and anti-LAG-3 drugs.
Endocrine side effects of immune checkpoint inhibitors occur in approximately 40% of patients, depending on the drug used. The thyroid and pituitary glands are most commonly affected, while primary adrenal insufficiency and diabetes mellitus are less common. Rare but possible complications include hypoparathyroidism, syndrome of inappropriate antidiuretic hormone secretion, and autoimmune polyendocrine syndrome type 2.
Symptoms of endocrine side effects are often nonspecific and overlap with the clinical presentation of the underlying disease, which complicates diagnosis. Collaboration between oncologists and endocrinologists, as well as routine patient monitoring, is necessary for early detection of endocrine adverse events. Most endocrine side effects are permanent and irreversible; therefore, anti-inflammatory therapy is not useful and instead, treatment is primarily based on hormone replacement therapy
Acute Pancreatitis
No full textAkutni pankreatitis je upalni poremećaj gušterače povezan sa značajnim morbiditetom i mortalitetom. Globalna incidencija iznosi približno 35 na 100 000 stanovnika i bilježi porast, dijelom zbog poboljšane dijagnostike, a dijelom zbog štetnih životnih navika u razvijenim zemljama. Ukupna smrtnost od akutnog pankreatitisa kreće se oko 2%, a u težim oblicima može dosegnuti i do 35%. Patofiziološki mehanizam temelji se na aktivaciji gušteračnih enzima koji uzrokuju autodigestiju i oštećenje tkiva. Najčešći etiološki čimbenici su konzumacija alkohola i žučni kamenci, no svako stanje koje ometa protok kroz ekskretorne kanale može potaknuti razvoj bolesti. Klinički se manifestira naglom, jakom boli u epigastriju sa širenjem prema leđima. Opći simptomi su tahikardija, tahipneja, znojenje i povišena tjelesna temperatura. Prema revidiranoj Atlanta klasifikaciji, za postavljanje dijagnoze potrebno je ispuniti najmanje dva od tri kriterija: tipična abdominalna bol, karakteristični radiološki nalazi te razine amilaze i lipaze najmanje trostruko iznad gornje granice normale. Ta ista klasifikacija dijeli slučajeve na blagi, umjereni i teški oblik. Glavni prognostički modeli su APACHE II i Ransonov zbroj. Liječenje se temelji na potpornoj terapiji: rana i agresivna nadoknada tekućine, kontrolirana analgezija te rana enteralna prehrana. Nadoknada tekućine mora početi rano i biti agresivna, koristeći izotoničnu kristaloidnu otopinu, po mogućnosti Ringerova laktata. Istovremeno se prate kardiovaskularne funkcije, hematokrit, diureza i koncentracija ureje te se nadoknada prilagođava ovisno o promjenama tih vrijednosti. Analgezija se postiže primjenom parenteralnih opioida poput tramadola, petidina, morfina i fentanila. Enteralna prehrana smanjuje morbiditet bolesnika jer pojačava peristaltiku i crijevnu perfuziju, što smanjuje rizik od nekroze i infekcije. U slučaju inficirane nekroze primjenjuje se ciljana antibiotska terapija, a teško oboljeli pacijenti se liječe u jedinici intenzivne skrbi uz mogućnost endoskopskih ili kirurških intervencija. Krajnji cilj terapije je postizanje hemodinamske stabilnosti, prevencija komplikacija i sprječavanje prijelaza u teže oblike bolesti.Acute pancreatitis is an inflammatory disorder of the pancreas associated with significant morbidity and mortality. The global incidence is approximately 35 per 100,000 people and is pancreatitis is around 2%, but in severe cases, it can reach up to 35%. The pathophysiological mechanism is based on the activation of pancreatic enzymes that cause autodigestion and tissue damage. The most common etiological factors are alcohol consumption and gallstones, though any condition that obstructs flow through the excretory ducts can trigger increasing, partly due to improved diagnostics and partly due to harmful lifestyle habits in developed countries. The overall mortality rate of acute the disease. Clinically, it manifests as sudden, severe epigastric pain radiating to the back. General symptoms include tachycardia, tachypnea, sweating, and elevated body temperature. According to the revised Atlanta classification, at least two of three criteria are required for diagnosis: typical abdominal pain, characteristic radiological findings, and amylase or lipase levels at least three times the upper normal limit. This same classification categorizes cases into mild, moderate, and severe forms. The main prognostic models are APACHE II and the Ranson score. Treatment is based on supportive therapy: early and aggressive fluid resuscitation, controlled analgesia, and early enteral nutrition. Fluid replacement must begin early and be aggressive, using an isotonic crystalloid solution, preferably Ringer's lactate. At the same time, cardiovascular function, hematocrit, urine output, and urea concentration are monitored, and fluid administration is adjusted according to changes in these parameters. Analgesia is achieved through the use of parenteral opioids such as tramadol, pethidine, morphine, and fentanyl. Enteral nutrition reduces patient morbidity by enhancing peristalsis and intestinal perfusion, which lowers the risk of necrosis and infection. In cases of infected necrosis, targeted antibiotic therapy is applied, and critically ill patients are treated in intensive care units with the possibility of endoscopic or surgical interventions. The ultimate goal of therapy is to achieve hemodynamic stability, prevent complications, and stop the progression to more severe forms of the disease
Cardiorenometabolic approach to the treatment of type 2 diabetes in family medicine
No full textŠećerna bolest tipa 2 (ŠBT2) jedna je od najčešćih kroničnih nezaraznih bolesti s rastućom globalnom prevalencijom, a često je udružena s bubrežnim i kardiovaskularnim bolestima. Kombinacija šećerne bolesti (ŠB), srčanog zatajivanja (SZ) i kronične bubrežne bolesti (KBB) danas se promatra kao kardiorenometabolički (KRM) sindrom, međusobno povezani i progresivni poremećaji koji pogoršavaju stanje bolesnika.
Integrirani, KRM pristup liječenju ŠBT2 u obiteljskoj medicini, s naglaskom na novije terapijske opcije poput inhibitora natrij-glukoza kotransportera 2 (SGLT2), agonista GLP-1 receptora i nesteroidnog, selektivnog blokatora mineralokortikoidnih receptora, finerenona predstavlja novi sveobuhvatni pristup liječenju. Poseban naglasak stavljen je na ulogu obiteljskog liječnika u ranom prepoznavanju bolesnika, primjeni smjernicama vođene terapije i dugoročnom praćenju kroničnih komorbiditeta.
Patofiziološki mehanizmi koji povezuju ŠBT2, SZ i KBB, kao što su upala, oksidativni stres, metabolički poremećaji i disfunkcija mitohondrija zajedno utječu na progresiju i daljni razvoj bolesti. S dokazima iz relevantnih kliničkih ispitivanja, navedene su kliničke koristi suvremene terapije i to smanjenje smrtnosti, hospitalizacija i progresije KBB. Opisana je važnost biomarkera (npr. HbA1c, NT-proBNP, eGFR) u praćenju terapije te naglašeni izazovi u implementaciji takvog pristupa u praksi obiteljske medicine.
Zaključno, holistički, individualizirani model liječenja koji obuhvaća srčanu, bubrežnu i metaboličku komponentu bolesti predstavlja nužnost u skrbi za bolesnike sa ŠBT2, a obiteljski liječnik je ključan u njegovoj primjeni.Type 2 diabetes mellitus (T2DM) is one of the most common chronic non-communicable diseases, with a rising global prevalence, and is often associated with renal and cardiovascular diseases. The combination of diabetes, heart failure (HF), and chronic kidney disease (CKD) is now recognized as the cardiorenometabolic (CRM) syndrome—a cluster of interrelated and progressive disorders that collectively worsen the patient's condition.
An integrated cardiorenometabolic approach to the treatment of T2DM in family medicine, with a focus on newer therapeutic options such as sodium-glucose co-transporter 2 (SGLT2) inhibitors, GLP-1 receptor agonists, and finerenone, represents a new comprehensive treatment paradigm. Special emphasis is placed on the role of the family physician in early identification of patients, implementation of guideline-directed medical therapy (GDMT), and long-term monitoring of chronic comorbidities.
The pathophysiological mechanisms linking T2DM, HF, and CKD—such as inflammation, oxidative stress, metabolic disturbances, and mitochondrial dysfunction—all contribute to disease progression. The clinical benefits of modern therapy, including reductions in mortality, hospitalization rates, and CKD progression, are supported by evidence from major clinical trials. The importance of biomarkers (e.g., HbA1c, NT-proBNP, eGFR, BHB) in monitoring treatment efficacy is described, alongside the challenges in implementing this approach in everyday family practice.
In conclusion, a holistic, individualized model of care encompassing cardiac, renal, and metabolic components is essential for patients with T2DM, with the family physician playing a pivotal role in its execution