Veterinary medicine - Repository of PHD, master's thesis
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Aggression and psychiatric disorders
No full textAgresivnost je bilo koje ponašanje, od fizičkog nasilja do verbalnih prijetnji, koje uključuje napad na drugu osobu, živo biće ili predmet s namjerom nanošenja štete, boli ili ozljede. Predstavlja veliki javnozdravstveni problem jer utječe na osobe svih životnih dobi, a prema nekim procjenama na svjetskoj razini odnosi i do 1,3 milijuna života godišnje. Agresivnost se najčešće dijeli na proaktivnu ili instrumentalnu te na reaktivnu ili impulzivnu agresivnost. Kada je pojedinac proaktivno agresivan, to znači da su njegova agresivna djela unaprijed planirana i hladnokrvno provedena u svrhu postizanja nekog cilja. S druge strane, reaktivna agresivnost je najčešće odgovor na provokaciju i podražaj koji osoba percipira kao opasan ili prijeteći pa je kao takva neplanirana, impulzivna i popraćena aktivacijom autonomnog živčanog sustava. Na pitanje zašto se netko ponaša agresivno nema jednoznačnog odgovora: postoje mnogobrojni faktori koji mogu precipitirati agresivno ponašanje i dovesti do neadekvatnih akcija ili reakcija kod pojedinca. Nema sumnje da je kod pojedinih osoba podloga za nasilje neurobiološka. Najčešće se u tom kontekstu razmatraju moždane regije odgovorne za ponašanje, kontrolu reakcija, emocije i donošenje odluka na temelju posljedica: ventromedijalni (vmPFC), ventrolateralni (vlPFC) i dorzolateralni (dlPFC) prefrontalni korteks; prednji cingularni korteks (ACC) i inzularni korteks te strukture limbičkog sustava, ponajprije amigdala i hipokampus. Neuroslikovne pretrage kontinuirano pokazuju volumne i funkcionalne anomalije u ovim regijama kod nasilnih osoba i zatvorenika. Nadalje, sve je više istraživanja koja pokušavaju povezati određene gene s povećanom agresivnošću. Na tom polju ističu se geni koji kodiraju za enzime odgovorne za razgradnju kateholamina, ponajprije gen za monoaminooksidazu A (MAO-A) i katehol-O-metil transferazu (COMT). Također, istražuju se geni vezani za serotoninergični i dopaminergični sustav, ali i ostale neurokemijske čimbenike poput glutamata, GABA-e, oreksina, oksitocina/vazopresina, opioida i mnogih drugih. Smatra se da geni sami po sebi nisu apsolutno odgovorni za određeno ponašanje kod ljudi, već na njih veliki utjecaj imaju okolišni čimbenici. Među njima se ističu iskustva u ranom djetinjstvu kao što su zanemarivanje, nasilje, ovisnost i kriminalna povijest roditelja, a u odrasloj dobi svakako treba istaknuti ovisnost o alkoholu i ostalim psihoaktivnim supstancama. Određene traume, neurodegenerativne ili maligne bolesti mozga također mogu uzrokovati bihevioralne promjene kod prethodno neproblematične osobe. Psihijatrijski poremećaji, ponajprije poremećaji iz spektra shizofrenije, poremećaji ličnosti, ali i druge psihijatrijske dijagnoze poput bipolarnog afektivnog poremećaja (BAP) ili posttraumatskog stresnog poremećaja (PTSP) nose sa sobom određeni rizik od agresivnog ponašanja ili počinjenja nasilnog kaznenog djela. Relativni rizik da će psihijatrijski pacijent počiniti bilo kakvu vrstu nasilnog djela je dva do četiri puta veći nego za osobu bez psihijatrijske dijagnoze, premda je apsolutni rizik u općoj populaciji nizak. Ta informacija je važna s medicinskog, javnozdravstvenog i pravnog aspekta. Ponajprije, u javnosti postoji stigma prema psihijatrijskim bolesnicima, a neselektivna medijska izvještavanja često potpiruju taj strah. Pretpostavka da bi se neki pacijent mogao ponašati agresivno oblikuje terapijski pristup, pogotovo prilikom hospitalizacije. Također, psihijatrijska dijagnoza i eventualna neuračunljivost osobe prilikom počinjenja nekog nasilnog kaznenog djela utječe na sudsku presudu i kaznu za to djelo, a prepoznavanje faktora rizika djeluje u svrhu zaštite samog pacijenta, osoba koje ga okružuju i općeg stanovništva uz povećanje kvalitete života i sigurnosti svih članova zajednice. Faktori rizika koji se mogu koristiti kao prediktori za agresiju kod psihijatrijskih bolesnika su: faktori vezani uz samog pacijenta (npr. spol, dob, dijagnoza, težina psihopatologije, ovisnosti, povijest nasilnog ponašanja), faktori vezani uz psihijatrijsku ustanovu (npr. lokacija, atmosfera, prenapučenost, restrikcije) i faktori vezani uz osoblje (prosjek godina i spol medicinskog osoblja, godine iskustva, kvaliteta interakcije s pacijentima). Rizik od agresivnosti veći je kod pacijenata mlađe životne dobi, muškog spola, nižeg stupnja obrazovanja, ovisnika (pogotovo ako konzumiraju više supstanci istovremeno) i onih prisilno zadržanih u ustanovi, kod pacijenata koji su prethodno više puta hospitalizirani, imaju povijest nasilnog ponašanja prema sebi ili drugima, i kod onih koji imaju dijagnozu iz spektra shizofrenije (pogotovo ako su psihotični). Procjena rizika za agresivni ispad važan je korak u pristupu psihijatrijskom pacijentu. Procjena se provodi pomoću mnogobrojnih skala za procjenu. Statičke (nepromjenjive) faktore rizika proučavaju aktuarni instrumenti, dok se instrumenti za strukturiranu profesionalnu prosudbu baziraju na dinamičkim (promjenjivim) instrumentima. Općenito, poželjno je da se psihijatrijskom pacijentu pristupa s više kombiniranih metoda, odnosno farmakološkom terapijom uz psihoterapijsku potporu. Klozapin je atipični antipsihotik koji smanjuje neprijateljsku nastrojenost, impulzivnost i agresivnost kod psihotičnih pacijenata. Postotak onih kojima se kliničko stanje ne popravlja ni nakon dva različita antipsihotika doseže i do 30 %, a za njih je rješenje upravo klozapin. Nuspojave lijekova predstavljaju značajnu prepreku liječenju: od nepridržavanja terapiji do prekida liječenja. Tipične antipsihotike karakteriziraju ekstra-piramidalni simptomi, na primjer tardivna diskinezija. Ostale najčešće nuspojave su antikolinergični učinci, sedacija, hiperprolaktinemija i ortostatska hipotenzija. Atipični antipsihotici uzrokuju metaboličke promjene – hiperglikemiju, hiperlipidemiju i povećanje tjelesne mase. Sedacijski učinak razlikuje se od lijeka do lijeka. Klozapin se ističe specifičnim nuspojavama – neutropenijom, tj. agranulocitozom i konvulzijama. Kognitivno-bihevioralna terapija (KBT) pokazala se kao dobra nadopuna medikamentoznoj terapiji. Ne treba zanemariti niti programe zdravog životnog stila, socijalizacije i zapošljavanja te osiguravanja stambenog pitanja koji psihijatrijskim pacijentima podižu kvalitetu života i daju im priliku za relativno normalan život u zajednici.Aggression is any form of behavior, from physical violence to verbal threats, that involves attacking another person, living being or object with the intent to cause harm, pain, or injury. It represents a major public health issue as it affects individuals of all ages and, according to some estimates, accounts for up to 1.3 million lives globally each year. Aggressiveness is most commonly divided into proactive or instrumental and reactive or impulsive aggressiveness. When an individual is proactively aggressive, it means that their aggressive actions are premeditated and cold-bloodedly executed to achieve a certain goal. On the other hand, reactive aggressiveness is usually a response to provocation or a stimulus perceived by the person as dangerous or threatening; it is thus unplanned, impulsive, and accompanied by activation of the autonomic nervous system. There is no simple answer to the question of why someone behaves aggressively: numerous factors can precipitate aggressive behavior and lead to inappropriate actions or reactions in an individual. There is no doubt that in some individuals, the basis for violence is neurobiological. Brain regions responsible for behavior, control of reactions, emotions, and decision-making based on consequences are most often considered in this context: the ventromedial (vmPFC), ventrolateral (vlPFC), and dorsolateral (dlPFC) prefrontal cortex; the anterior cingulate cortex (ACC) and insular cortex; and structures of the limbic system, primarily the amygdala and hippocampus. Neuroimaging studies continuously show volumetric and functional anomalies in these regions in violent individuals and incarcerated offenders. Furthermore, there is increasing research attempting to link certain genes with increased aggressiveness. Genes encoding enzymes responsible for the breakdown of catecholamines, primarily the gene for monoamine oxidase A (MAO-A) and catechol-O-methyl transferase (COMT), stand out in this field. Additionally, genes related to the serotonergic and dopaminergic systems, as well as other neurochemical factors such as glutamate, GABA, orexin, oxytocin/vasopressin, opioids, and many others, are being investigated. It is believed that genes alone are not solely responsible for certain behaviors in humans; environmental factors also have a significant influence on them. Early childhood experiences such as neglect, violence, parental addiction, and criminal history, as well as substance abuse in adulthood, are particularly notable among these factors. Certain traumas, neurodegenerative or malignant brain diseases can also cause behavioral changes in previously unproblematic individuals. Psychiatric disorders, primarily schizophrenia spectrum disorders, personality disorders, but also other psychiatric diagnoses such as bipolar affective disorder (BAP) or post-traumatic stress disorder (PTSD), carry a certain risk of aggressive behavior or committing a violent crime. The relative risk that a psychiatric patient will commit any type of violent act is two to four times higher than for a person without a psychiatric diagnosis, although the absolute risk in the general population is low. This information is important from a medical, public health, and legal perspective. Firstly, there is a stigma towards psychiatric patients in society, and unselective media reporting often fuels this fear. The assumption that a patient might behave aggressively shapes the therapeutic approach, especially during hospitalization. Additionally, a psychiatric diagnosis and possible insanity at the time of committing a violent crime affect the court verdict and penalty for that crime, and recognizing risk factors serves to protect the patient themselves, those around them, and the general population, enhancing the quality of life and safety for all community members. Risk factors that can be used as predictors of aggression in psychiatric patients include: factors related to the patient (e.g., gender, age, diagnosis, severity of psychopathology, addictions, history of violent behavior), factors related to the psychiatric institution (e.g., location, atmosphere, overcrowding, restrictions), and factors related to staff (average age and gender of medical staff, years of experience, quality of interaction with patients). The risk of aggression is higher in younger patients, males, those with lower education levels, addicts (especially if they use multiple substances simultaneously), and those forcibly detained in the institution, patients who have been previously hospitalized multiple times, have a history of violent behavior towards themselves or others, and those diagnosed with schizophrenia spectrum disorders (especially if psychotic). Risk assessment for aggressive outbursts is an important step in approaching a psychiatric patient. Assessment is conducted using numerous scales for evaluation. Actuarial instruments study static (unchangeable) risk factors, while structured professional judgment instruments are based on dynamic (changeable) factors. In general, it is desirable to approach a psychiatric patient with a combination of methods, i.e., pharmacological therapy combined with psychotherapeutic support. Clozapine is an atypical antipsychotic that reduces hostility, impulsivity, and aggressiveness in psychotic patients. The percentage of those whose clinical condition does not improve even after two different antipsychotics reaches up to 30%, and for them, clozapine is the solution. Drug side effects present a significant barrier to treatment, from non-adherence to therapy to discontinuation of treatment. Typical antipsychotics are characterized by extrapyramidal symptoms, for example, tardive dyskinesia. Other common side effects are anticholinergic effects, sedation, hyperprolactinemia, and orthostatic hypotension. Atypical antipsychotics cause metabolic changes—hyperglycemia, hyperlipidemia, and weight gain. The sedative effect varies from drug to drug. Clozapine stands out with specific side effects—neutropenia, i.e., agranulocytosis, and convulsions. Cognitive-behavioral therapy (CBT) has proven to be a good complement to medication therapy. Healthy lifestyle programs, socialization and employment programs, and securing housing, which raise the quality of life for psychiatric patients and give them a chance for a relatively normal life in the community, should not be neglected either
Radiological methods for imaging expansive processes of the osteomuscular system
No full textEkspanzivni procesi u osteomuskularnom sustavu odnose se na patološke promjene koje dovode do povećanja volumena ili prostornog pritiska unutar kostiju, mišića ili drugih struktura koje su povezane s mišićno-koštanim sustavom. Ovi procesi mogu biti benigni ili maligni te uključuju različite vrste tumora, ciste ili upalne promjene. Tumori također mogu biti primarni (nastaju unutar kosti/mekog tkiva) i sekundarni (metastatski). U ovom diplomskom radu navesti ćemo klasifikaciju tumora kostiju i mekog tkiva i opisati neke njihove karakteristike. Nakon toga su opisane radiološke metode prikaza tumora osteomuskularnog sustava. Radiološka evaluacija tumora osteomuskularnog sustava uključuje multimodalni pristup, prilikom čega svaki od modaliteta pruža jedinstvene dijagnostičke uvide. RTG je početna dijagnostička metoda procjene tumora osteomuskularnog sustava, a daljnji izbor radiološke metode određuje se na temelju RTG snimke, povijesti bolesti pacijenta, nalaza fizikalnog pregleda i lokacije lezije. Nakon obične radiografije slijede tehnike snimanja presjeka kao što su kompjutorizirana tomografija (CT) ili magnetska rezonancija (MR). Dodatno, scintigrafija nuklearne medicine, ultrazvuk i pozitronska emisijska tomografija (PET) mogu se koristiti zajedno s početnom evaluacijom ili nakon nje. MR je preferirana metoda za snimanje tumora mekih tkiva, dok se i CT i MR koriste za procjenu opsega tumora kostiju.Expansive processes in the musculoskeletal system refer to pathological changes that lead to an increase in volume or spatial pressure within bones, muscles, or other structures associated with the musculoskeletal system. These processes can be benign or malignant and include various types of tumors, cysts, or inflammatory changes. Tumors can also be primary (originating within bone/soft tissue) or secondary (metastatic). In this thesis, we will present the classification of bone and soft tissue tumors and describe some of their characteristics. Following this, we will describe the radiological methods used to image tumors of the musculoskeletal system. Radiological evaluation of musculoskeletal system tumors involves a multimodal approach, with each modality providing unique diagnostic insights. X-ray is the initial diagnostic method for assessing musculoskeletal system tumors, and the subsequent choice of radiological method is determined based on the X-ray image, the patient's medical history, physical examination findings, and the lesion's location. Following plain radiography, cross-sectional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are used. Additionally, nuclear medicine scintigraphy, ultrasound, and positron emission tomography (PET) can be utilized in conjunction with or following the initial evaluation. MRI is the preferred method for imaging soft tissue tumors, while both CT and MRI are used to assess the extent of bone tumors
Complications of celiac disease
No full textCelijakija je kronična autoimunosna enteropatija koja zahvaća oko 1% populacije globalno i može se pojaviti u bilo kojoj životnoj dobi. Nastaje u genetski predisponiranih pojedinaca nakon izlaganja glutenu u hrani. Gluten, smjesa pšeničnih proteina, sveprisutni je sastojak današnje prehrane pa se tako može naći u kruhu i pekarskim proizvodima, tjestenini, keksima i kolačima. Slični proteini glutenu, nalaze se i u raži i ječmu, dok se za zob smatra da je sigurna i u većine neće izazvati simptome celijakije. Peptidi glutena, koji nastaju nakon djelomičnog probavljivanja, ulaze u laminu propriju tankoga crijeva te tako aktiviraju i urođeni i stečeni imunosni odgovor ukoliko postoji genetska predispozicija koja obuhvaća prisutnost HLA -DQ 2 i DQ 8 haplotipa na antigen prezentirajućim stanicama. Naime HLA-DQ2 i DQ8 vežu deamidirane ostatke glutena te tako aktiviraju CD4+ T stanice. Osim CD4+ T stanica, u patogenezi celijakije sudjeluju i CD8+ T stanice, interferoni, interleukini IL-7, IL-15, IL-21 i B stanice koje proizvode protutijela na tkivnu transglutaminazu i deamidirani glijadinski peptid. Simptomi celijakije posljedica su upale, deficijencije mikronutrijenta i autoimunosnog odgovora na tkivnu transglutaminazu, a mogu se prezentirati crijevnim i izvancrijevnim simptomima. Upravo zbog mogućnosti zahvaćanja gotovo bilo kojeg organskog sustava, danas je otežano i često, zakašnjelo dijagnosticiranje celijakije. Dijagnoza celijakije uključuje serologiju i potvrdu anti-tTG protutijela te biopsiju sluznice tankoga crijeva. Celijakija se uspješno liječi strogom doživotnom bezglutenskom prehranom. Kasno prepoznata ili neliječena celijakija može dovesti do razvoja brojnih komplikacija, malignih i nemalignih, dok pravilno provođenje bezglutenske prehrane sprječava njihov razvoj. Cilj ovog rada je prikazati moguće komplikacije celijakije te ukazati na važnost ranog prepoznavanja i pravilnog liječenja.Celiac disease is a chronic autoimmune enteropathy that affects about 1% of the global population, and can occur at any age. It develops in genetically predisposed individuals after exposure to dietery gluten. Gluten, a mixure of wheat proteins, is a ubiquitous component of today’s diet and can be found in bread and other baked goods, pasta, cookies and cakes.
Similar proteins to gluten can also be found in rye and barley, while oats are considered safe and do not cause symptoms of celiac disease in most people. Gluten peptides, which result from incomplete digestion, enter the lamina propria of the small intestine and thus activate both innate and adaptive immune response in genetically predisposed individuals. Genetic
predisposition includes the presence of HLA-DQ2 and DQ8 haplotypes present on antigenpresenting cells. HLA-DQ2 and DQ8 bind deaminated gluten residues and thus activate CD4+ T cells. In addition to CD4+ T cells, CD8+ T cells, interferons, interleukins IL-7, IL-15, IL-21 and B cells which produce antibodies to tissue transglutaminase and deaminated gliadin peptide, are involved in the pathogenesis of celiac disease. The symptoms of celiac disease are a consequence of inflammation, micronutrient defficiency and an autoimmune response to tissue transglutaminase and can present with both intestinal and extraintestinal symptoms. Due to the possibility of affecting almost every organ system, diagnosis of celiac disease is often difficult and delayed. The diagnosis includes serology and confirmation of anti-tTG antibodies, as well as biopsy of the small intestine mucosa. Celiac disease can successfully be managed with a strict, lifelong gluten-free diet. Late diagnosis or untreated celiac disease can lead to the development of numerous complications, both non-malignant and malignant, while proper adherence to a gluten-free diet prevents their development. The aim of this paper is to present the possible complications of celiac disease and highlight the importance of early diagnosis and treatment
Krivi vrat
No full textKrivi vrat je specifični simptom asimetričnog držanja glave i vrata koji se javlja kod djece i odraslih zbog čega se ne smatra dijagnostičkim entitetom. Unatoč postojanju više različitih vrsta podjela danas se pretežno koristimo tradicionalnom podjelom na prirođeni i stečeni krivi vrat. Postoji nekoliko teorija nastanka krivog vrata, ali etiologija nije potpuno razjašnjena. Uzroci su različiti i variraju ovisno o kojem tipu krivog vrata se radi. Prirođeni oblik krivog vrata je treća najčešća malformacija u djece nakon displazije kukova i uvrnutog stopala s incidencijom od 0,5 – 5 % novorođene djece. Javlja se podjednako u spola, a češće se javlja kod djece rođene na zadak. Za razliku od prirođenih oblika, stečeni krivi vrat se javlja kao sekundarna deformacija uzrokovana nizom različitih bolesti i patoloških stanja, koja služe kao primarni uzrok nastanka abnormalnog položaja glave i vrata. Prilikom palpacije sternokleidomastoidni mišić je skraćen, napet, zadebljan ali bezbolan. Glava je nagnuta na stranu zahvaćenog mišića, a rotirana na suprotnu stranu. Stoga je diferencijalnodijagnostički bitno uzeti dobru anamnezu i temeljito napraviti klinički pregled. Ukoliko je stečeni krivi vrat rezultat traume, upale ili koštanih promjena u vratnoj kralježnici, važno je razmotriti primjenu radioloških pretraga radi identifikacije specifičnih anatomskih promjena, kao i laboratorijskih pretraga za procjenu upalnih parametara. Liječenje ovisi o kliničkim simptomima odnosno o tipu krivog vrata. U svakom slučaju potrebno je početi s konzervativnim, simptomatskim liječenjem, a operativnom zahvatu pristupiti samo u slučaju da konzervativnim liječenjem nije došlo do izlječenja.Wry neck is a specific symptom of asymmetric head and neck posture that occurs in children and adults, which is why it is not considered a diagnostic entity. Despite the existence of several different classifications, today we mostly adhere to the traditional division into congenital and acquired wry neck. There are several theories about the origin of wry neck, but the etiology is not fully understood. The causes vary depending on the type of wry neck. Congenital wry neck is the third most common malformation in children after hip dysplasia and clubfoot, with an incidence of 0.5% to 5% in newborns. It occurs equally in both sexes, and more frequently in children born breech. In contrast to congenital forms, acquired wry neck appears as a secondary deformity caused by a range of different diseases and pathological conditions, which serve as the primary cause of abnormal head and neck position. During palpation, the sternocleidomastoid muscle is shortened, tense, thickened but painless. The head is tilted towards the affected muscle and rotated to the opposite side. Therefore, it is crucial to take a thorough medical history and conduct a comprehensive clinical examination for differential diagnosis. If acquired torticollis is the result of trauma, inflammation, or bony changes in the cervical spine, it is important to consider the use of radiological imaging to identify specific anatomical changes, as well as laboratory tests to assess inflammatory parameters. Treatment depends on clinical symptoms and the type of wry neck. In any case, it is necessary to start with conservative, symptomatic treatment, and surgical intervention should only be considered if conservative treatment does not lead to cure
Internet addiction
No full textDanas je nemoguće zamisliti svijet bez upotrebe interneta. Zbog sve veće dostupnosti interneta i drugih predisponirajućih čimbenika u svijetu raste relativno nova ovisnost – ovisnost o internetu. Ovisnost o internetu prvenstveno spada u bihevioralne ovisnosti tj. ovisnosti gdje je isključena konzumacija psihoaktivne tvari, no neki autori ga definiraju kao poremećaj kontrole impulsa ili kompulzivni poremećaj. Različiti autori nude različite definicije ovisnosti o internetu, no svima im je zajednička nemogućnost kontrole korištenja interneta. Postoji neslaganje stručnjaka oko toga koje sve vrste ovisnosti o internetu postoje te također postoji nekoliko vrsta modela koji objašnjavaju nastanak ovog fenomena. Za ovisnost o internetu se u stručnoj literaturi pojavljuju različiti nazivi poput problematične upotrebe interneta, patološke upotrebe interneta, kompulzivne upotrebe interneta, poremećaj ovisnosti o internetu itd. Ovisnost o internetu ne postoji kao službena dijagnoza u petom izdanju Dijagnostičkog i statističkog priručnika za mentalne poremećaje (DSM-5) niti u 10. izdanju Međunarodne klasifikacije bolesti i srodnih zdravstvenih problema (MKB-10) što otežava dijagnozu, mjerenje prevalencije, planiranje intervencija i preventivnih programa. No, ovisnost o video igrama je uvrštena u najnovije izdanje Međunarodne klasifikacije bolesti (MKB-11) što implicira priznavanje tehnoloških ovisnosti. Ovisnost o internetu se pojavljuje uz niz drugih komorbiditeta poput depresije, poremećaja pažnje s hiperaktivnošću, anksioznosti, bipolarnog poremećaja, no postavlja se pitanje kauzalnosti – uzrokuje li ovisnost o internetu ostale mentalne poremećaje ili mentalni poremećaji dovode do ovisnosti o internetu. Ovisnost o internetu uzrokuje niz posljedica na mentalno i fizičko zdravlje te je neophodno ponuditi učinkovite modalitete liječenja, a kao glavni se navode psihološki, farmakološki i kombinirani pristup. Od iznimne je važnosti educirati populaciju osobito najranjiviju dobnu skupinu odnosno adolescente i mlade odrasle kako bi na vrijeme prepoznali simptome i kako bi se na vrijeme krenulo s liječenjem. Cilj ovog rada je prikazati pregled literature na temu ovisnosti o internetu dotičući se nekoliko aspekata poput terminologije, definicije, dijagnostike, posljedica, liječenja i prevencije.It is impossible to imagine the world today without the use of the Internet. Due to the increasing availability of the Internet and other predisposing factors, a relatively new addiction is on the rise globally – Internet addiction. Internet addiction primarily falls under behavioral addictions meaning it excludes the consumption of psychoactive substances. However, some authors define it as an impulse control disorder or a compulsive disorder. Various authors offer different definitions of Internet addiction but they all share the common characteristic of the inability to control Internet use. There is disagreement among experts about the various types of Internet addiction and there are also several models that explain the emergence of this phenomenon. In professional literature different terms are used for Internet addiction, such as problematic Internet use, pathological Internet use, compulsive Internet use, and Internet addiction disorder, among others. Internet addiction is not recognized as an official diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or in the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10), which complicates diagnosis, measurement of prevalence, planning of interventions, and preventive programs. However, video game addiction is included in the latest edition of the International Classification of Diseases (ICD-11) which implies a recognition of technological addictions. Internet addiction appears alongside a range of other comorbidities such as depression, ADHD, anxiety, bipolar disorder but there is the question of causality – does Internet addiction cause other mental disorders or do mental disorders lead to Internet addiction. Internet addiction causes numerous consequences for mental and physical health making it essential to offer effective treatment modalities primarily psychological, pharmacological and combined approaches. Most importante is to educate the population especially the most vulnerable group – adolescents and young adults – to recognize symptoms in time and to start treatment promptly. The aim of this paper is to provide a literature review on the topic of Internet addiction touching on several aspects such as terminology, definition, diagnostics, consequences, treatment and prevention
Exploring changes in the perception of e-professionalism among medical and dental students: a quantitative cross-sectional study
No full textAim: To compare e-professionalism perceptions between medical and dental students, focusing on their awareness and understanding of guidelines for developing e-professionalism.
Methods: A cross-sectional quantitative study was conducted at the University of Zagreb School of Medicine (UZSM) and School of Dental Medicine (UZSDM) in 2022/2023. Data were gathered through a questionnaire designed specifically for the survey.
Results: Of the 646 questionnaires collected, 626 were analyzed, with a response rate of 33.95% for UZSM and 37.83% for UZSDM. Most respondents (71.4%) were female, with a median age of 21. Medical students significantly more frequently considered it unprofessional to publish posts containing photos of patients/clients (96.5% vs 75.1%), endorsements of health products without conflict-of-interest disclosures (60.6% vs 33.0%), and posts describing patient interactions without revealing identifying information (51.7% vs 27.4%). In contrast, dental medicine students more frequently considered it unprofessional to publish posts with swearing or foul language (81.2% vs 67.4%), critical comments about lecturers (68.0% vs 46.9%), and criticisms of course material or the institution (52.3% vs 36.4%). Only 23.2% of students were aware of e-professionalism guidelines, with 37.9% of those familiar with their content.
Conclusion: While medical and dental students recognize the importance of e-professionalism, their perceptions have substantial differences. The need for promoting existing guidelines and integrating e-professionalism into curricula is evident. Continuous monitoring and research in this domain are essential to ensure future health care professionals maintain high standards of online professionalism
Genital manifestations of systemic diseases
No full textIstražujući složenu povezanost između sistemskih bolesti i njihovih manifestacija na genitalnom području, ističe se važan, ali često zanemaren aspekt medicinskih pregleda. Tipično, pregledi genitalnog područja nisu rutinski uključeni u sveobuhvatne kožne preglede, a u toj praksi mogu se propustiti rani znakovi osnovnih sistemskih stanja. Na primjer, alergijske bolesti mogu se manifestirati simptomima poput svrbeža, peckanja i iritacije posebno na genitalnom području. Slično tome, upalne bolesti poput psorijaze i atopijskog dermatitisa ne uzrokuju samo nelagodu, već značajno utječu na seksualno zdravlje i kvalitetu života. Psorijaza, posebno, može dovesti do ljuskavih plakova popraćenih svrbežom koji se često zanemaruju ako genitalno područje nije temeljito pregledano. Metaboličke bolesti, kao što je dijabetes, također utječu na genitalno područje stvaranjem uvjeta koji potiču komplikacije poput gljivičnih infekcija. Loše regulirani dijabetes pogoduje opetovanim javljanjem infekcija zbog kože i sluznice bogatom glukozom. Onkološke bolesti predstavljaju značajan problem jer se brojni karcinomi mogu se inicijalno manifestirati kao neobične novotvorine ili lezije na genitalnom području, a to su znakovi koji bi mogli biti zanemareni bez temeljitog pregleda. Stanja poput HIV-a i tuberkuloze mogu pokazati rane znakove na genitalnom području, a prepoznavanje tih može dovesti do pravovremenih intervencija. Autoimune bolesti, uključujući sistemski eritemski lupus i Crohnovu bolest, često pokazuju rane znakove na genitalnom području, što, ako se prepozna, može značajno utjecati na tijek bolesti i ishode za pacijente. Vitalan je multidisciplinarni pristup koji uključuje dermatologe, interniste, specijaliste za infektivne bolesti, endokrinologe, ginekologe, proktologe, urologe i druge. Ova suradnička strategija osigurava to da simptomi, posebno oni koji se manifestiraju na manje pregledanim područjima poput genitalija, ne budu zanemareni. Poboljšanjem svijesti i razumijevanja među zdravstvenim radnicima i pacijentima možemo smanjiti stigmu oko pregleda genitalnog područja. To potiče otvoreni dijalog, vodeći do boljih zdravstvenih ishoda i poboljšanja kvalitete života za pacijente koji se suočavaju s kompleksnim sustavim stanjima.Exploring the complex connection between systemic diseases and their manifestations in the genital area highlights an important but often overlooked aspect of medical examinations. Typically, genital examinations are not routinely included in comprehensive skin exams, which can lead to missing early signs of underlying systemic conditions. For instance, allergic diseases can manifest with symptoms such as itching, burning, and irritation, particularly in the genital area. Similarly, inflammatory diseases such as psoriasis and atopic dermatitis not only cause discomfort but also significantly impact sexual health and quality of life. Psoriasis, in particular, can lead to scaly plaques accompanied by itching, which are often overlooked if the genital area is not thoroughly examined. Metabolic diseases, such as diabetes, also affect the genital area by creating conditions that promote complications like fungal infections. Poorly regulated diabetes favors the recurrence of infections due to glucose-rich skin and mucous membranes. Oncological diseases pose a significant problem as many cancers can initially manifest as unusual growths or lesions in the genital area, signs that could be missed without a thorough examination. Conditions like HIV and tuberculosis can show early signs in the genital area, and recognizing these can lead to timely interventions. Autoimmune diseases, including systemic lupus erythematosus and Crohn's disease, often show early signs in the genital area, which, if recognized, can significantly impact disease progression and patient outcomes. A multidisciplinary approach involving dermatologists, internists, infectious disease specialists, endocrinologists, gynecologists, proctologists, urologists, and others is vital. This collaborative strategy ensures that symptoms, especially those manifesting in less frequently examined areas like the genitals, are not overlooked. By improving awareness and understanding among healthcare workers and patients, we can reduce the stigma around genital examinations. This
fosters open dialogue, leading to better health outcomes and improved quality of life for patients facing complex systemic conditio
Simptomatology and treatment of avoidant restrictive food intake disorder
No full textIzbjegavajuće restriktivni poremećaj unosa hrane (IRPUH) novo je priznati poremećaj hranjenja karakteriziran izbjegavanjem određenih vrsta hrane odnosno restrikcijom u hranjenju. Manifestira se perzistentnim neuspjehom u adekvatnoj prehrani i posljedičnim gubitkom na masi. Poremećaj nije uvjetovan nedostatkom hrane, a karakteristična je i odsutnost zabrinutosti o tjelesnom izgledu i obliku. Razumijevanje ovog poremećaja ključno je za rano postavljanje odgovarajuće dijagnoze i u konačnici
uspješno liječenje.
Poremećaj se najčešće javlja u djece i adolescenata te klinička slika može varirati ovisno o dobi i psihopatologiji. IRPUH se na temelju prezentacije može podijeliti na poremećaj vezan uz nedostatak apetita, fobiju od neugodnosti prilikom hranjenja i senzoričku osjetljivost. Također, pacijenti s ovim poremećajem često boluju i od komorbiditeta poput anksioznih poremećaja, depresije, bolesti gastrointestinalnog sustava, alergija, autizma ili poremećaja hiperaktivnosti i deficita pažnje.
Dijagnostika se temelji na rezultatima strukturiranih kliničkih intervjua, samoispunjavajućih upitnika, kliničkog pregleda s antropometrijskim mjerenjima, prisutnosti deficijencije vitamina i drugih nutrijenata te ostalih prisutnih komorbiditeta.
Za uspješno prepoznavanje nužna je dobra informiranost i upućenost zdravstvenog osoblja u patologiju i prezentaciju ovog poremećaja. Liječenje zahtijeva psihoterapiju, najčešće u obliku kognitivno-bihevioralne terapije ili obiteljske terapije. Trenutno se razvijaju novi modeli i pristupi liječenju koji nastoje ciljano djelovati na temeljnu psihopatologiju poremećaja.Avoidant/restrictive food intake disorder (ARFID) is a newly recognized eating disorder characterized by the avoidance of certain types of food or restrictive eating behaviors. It manifests as a persistent failure to meet appropriate nutritional needs,
resulting in significant weight loss. The disorder is not caused by a lack of food, and there is an absence of concern about body shape and weight. Understanding this disorder is crucial for early diagnosis and, ultimately, successful treatment.
ARFID most commonly occurs in children and adolescents, and the clinical presentation can vary depending on age and psychopathology. Based on its presentation, ARFID can be divided into subgroups: loss of appetite, fear of feeding-related discomfort, and sensory sensitivity. Additionally, patients with this disorder often suffer from comorbidities such as anxiety disorders, depression, gastrointestinal diseases, allergies, autism, or attention deficit hyperactivity disorder (ADHD).
Diagnosis is based on the results of structured clinical interviews, self-report questionnaires, clinical examination with anthropometric measurements, the presence of vitamin and other nutrient deficiencies, and other comorbidities. Successful
recognition requires good knowledge and awareness of the disorder's pathology and presentation among healthcare professionals.
Treatment requires psychotherapy, most commonly in the form of cognitive-behavioral therapy or family therapy. New models and approaches to treatment are currently being developed to specifically address the underlying psychopathology of the disorder
Chronic recurrent multifocal osteomyelitis
No full textKronični rekurirajući multifokalni osteomijelitis (CRMO) kronična je neinfektivna autoinflamatorna osteoartropatija pedijatrijske populacije karakterizirana višestrukim upalnim sterilnim lezijama kostiju. Bolest se prvenstveno manifestira bolovima, pojačanima tijekom noći ili nakon fizičke aktivnosti, koji često ostanu neprepoznati jer se poistovjećuju s bolovima rasta kod djece. Stoga manjak informiranosti o CRMO otežava pravovremenu dijagnozu i početak terapije.
Cilj ovog rada jest uvodno prikazati osnovne koncepte iza nomenklature, povijesti i etiologije ove rijetke bolesti, moguće patogenetske mehanizme nastanka, kliničku sliku i pripadajuće diferencijalne dijagnoze. Zatim podrobnije opisati suvremene metode dijagnoze i dijagnostičke kriterije te najnovije algoritme liječenja i nove terapijske mogućnosti.Chronic recurrent multifocal osteomyelitis (CRMO) is a chronic non-infectious autoinflammatory osteoarthropathy of the pediatric population characterized by multiple inflammatory sterile bone lesions. The disease is primarily manifested by pains, intensified during the night or after physical activity, which often remain unrecognized because they are identified with growing pains in children. Therefore, the lack of information about CRMO makes timely diagnosis and initiation of therapy difficult.
This paper aims to introduce the basic concepts behind the terminology, history, and etiology of this rare disease, possible pathogenetic mechanisms of its occurrence, clinical presentation, and related differential diagnoses. Then, it will present in more detail modern methods of diagnosis and diagnostic criteria, as well as the latest treatment algorithms and new therapeutic options
Epidemiological and clinical characteristics of acute respiratory infections in hospitalized children positive for human bocavirus
No full textUvod i svrha rada: Cilj ovog istraživanja bio je istražiti epidemiološka i klinička obilježja akutnih respiratornih infekcija (ARI) u hospitalizirane djece kod koje je detektiran humani bokavirus (HBoV). Specifični ciljevi obuhvaćali su određivanje prevalencije HBoV, učestalost monodetekcije i kodetekcije s drugim respiratornim virusima, sezonsku pojavnost HBoV infekcije, kliničku prezentaciju i genotipizaciju izoliranih sojeva. Dalje, cilj je bio odrediti koncentraciju HBoV u nazofaringealnom sekretu oboljelih te ispitati postoji li povezanost između visoke koncentracije HBoV u uzorku i kliničke prezentacije i težine bolesti, potrebe za liječenjem nadoknadom kisika zbog razvoja respiratorne insuficijencije te duljine trajanja hospitalizacije u djece s dokazanim HBoV.
Materijali i metode: Istraživanje je provedeno u Klinici za dječje bolesti Zagreb i Općoj bolnici Karlovac u razdoblju od 2017. do 2021. godine. Ispitanici su bila djeca hospitalizirana zbog akutne respiratorne infekcije pretpostavljene virusne etiologije, kojima su uzeti uzorci obriska nazofarinksa i ždrijela. Učinjen je multipleks PCR na 15 respiratornih virusa, a za uzorke pozitivne na HBoV proveden je kvantitativni PCR. Za svakog ispitanika prikupljeni su demografski i klinički podaci. Uzorci u kojima je HBoV otkriven zajedno s drugim virusom dalje su istraženi primjenom MT-PCR-a te su rezultati MT-PCR-a uspoređeni s kvantitativnim PCR-om na HBoV. Genotipizacija izoliranih sojeva HBoV provedena je NGS metodom.
Rezultati: Od 957 testirane djece, HBoV je dokazan u 73 ispitanika te prevalencija ovog virusa u djece hospitalizirane zbog ARI iznosi 7,6 %. U preko 80 % slučajeva virus je dokazan u kombinaciji s drugim respiratornim virusom, najčešće s humanim rinovirusom. Virus je najčešće detektiran u djece od jedne do tri godine s vrhunem pojavnosti u zimskim mjesecima. Klinički se HBoV infekcija prezentirala kao infekcija gornjeg respiratornog sustava (IGDS) u 41,1 % djece, dok je 59,9 % djece s dokazanim HBoV razvilo infekciju donjeg dišnog sustava (IDDS). U slučajevima gdje je HBoV bio jedini dokazani patogen, koncentracije virusa su bile značajno više u nazofaringealnim sekretima djece koja su razvila IDDS u odnosu na na djecu s IGDS (p=0,016). Djeca koja su liječena nadoknadom kisika su imala veću koncentraciju HBoV u uzorcima u odnosu na djecu koja nisu trebala kisik (p=0,022), kao i ona koja su primala empirijsku antimikrobnu terapiju (p=0,049) ili imali predliježeće bolesti (p=0,017). Nije jednoznačno dokazana povezanost duljine hospitalizacije s količinom HBoV. Usporedbom kvantitativnog PCR-a i MT-PCR metode pokazana je podudarnost rezultata ovih dviju metoda, a Pearsonov koeficijent je iznosio 0,939. Genotipizacijom je dokazano da su svi sojevi pripadali HBoV 1 genotipu.
Zaključak: Učestalost HBoV u djece mlađe od 18 godina hospitalizirane zbog akutne respiratorne infekcije u okvirima je pojavnosti HBoV na globalnoj razini. U odnosu na RSV i humani rinovirus, HBoV inficira djecu starije dobi, a vrhunac pojavnosti ovog virusa pada u drugu godinu djetetova života. Pojavnost HBoV slijedi obrazac sezonstva karakterističan i za druge respiratorne viruse, s vrhuncem od studenog do ožujka. Djeca s većom koncentracijom virusa u nazofaringealnim sekretima češće imaju težu kliničku sliku. Usporedbom kvantitativnog PCR-a i MT-PCR metode, pokazali smo da se MT-PCR metoda može korisiti kao alternativa klasičnom kvantitativnom PCR-u za određivanje količine HBoV.Introduction and aim: The goal of this research was to investigate the epidemiological and clinical characteristics of acute respiratory infection (ARI) in hospitalized children with proven HBoV and to compare concentration of HBoV with clinical presentation of infection.
Material and methods: The research was conducted among children hospitalized for ARI in two institutions in northwest Croatia over a four-year period. Samples were analysed using multiplex PCR for 15 respiratory viruses, quantitative PCR for HBoV and MT-PCR. Clinical and demographic dana were collected. The genotyping of isolated strains was performed using the NGS method.
Results: The prevalence of HBoV was 7,6%. In cases of monodetection, HBoV was significantly more frequently present in high concentration in children with LRTI compared to children with URTI (p=0,016). Children receiving oxygen supplementation had a higher HBoV concentration in the sample (p=0,022), as well as children receiving empirical antibiotic therapy (p=0,01) and children with underlying diseases (p=0,017), respectively.
Conclusion: High concentration of HBoV was linked to more severe presentation of infection. MT-PCR method can be used as an alternative to classical quantitative PCR for HBoV