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Burnout syndrome in medical students
No full textSindrom sagorijevanja sve je češća pojava u modernom svijetu. Prekomjeran opseg posla, zahtjevni radni uvjeti, osobine ličnosti i privatni razlozi pojedinca utječu na porast prevalencije i incidencije ovoga sindroma. Karakteriziraju ga emocionalna iscrpljenost, depersonalizacija i smanjen osjećaj osobnog postignuća uz ostale psihološke i psihosomatske smetnje te povećanu sklonost infekcijama. Ispituje se brojnim upitnicima od kojih je najčešće korišten Maslachin upitnik za sindrom sagorijevanja. Najčešće obuhvaća zdravstvene djelatnike uključujući i studente medicine, što je i tema ovoga rada. U studenata, pojava ovog sindroma povezana je s organizacijom fakulteta, opsegom gradiva, ličnošću samog studenta, njegovim stilom učenja te njegovim životnim stilom. Studenti s izraženom dimenzijom ličnosti neuroticizma te koji uče površno-dezorganiziranim stilom su češće zahvaćeni sindromom sagorijevanja. Alkohol, pušenje, konzumacija droga, loša prehrana, manjak tjelesne aktivnosti i spavanja povećavaju šansu za razvoj ovog sindroma. U raznim državama svijeta različita je njegova prevalencija. Razlozi za to su različiti načini ispitivanja sindroma sagorijevanja te različite kulturološke i političke prilike. Ako se ne intervenira na vrijeme, posljedice sindroma sagorijevanja na mentalno zdravlje osobe mogu biti teške i čak dovesti do samoubojstva. Studenti medicine rijetko traže psihološku pomoć, u strahu od stigme ili ne vjerujući u ozbiljnost svog problema. Da bi se prevenirao ovaj sindrom, potrebno je osvještavanje ovog problema kod nastavnika i studenata, promjena u organizaciji nastave i ocjenjivanju, uklanjanje stigme oko traženja psihološke pomoći i redovna provjera mentalnog zdravlja rizičnih skupina.Burnout syndrome is becoming an increasingly common phenomenon in the modern world. Excessive workload, demanding working conditions, individual personality traits, and personal reasons contribute to the prevalence and incidence of this syndrome. It is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, along with other psychological and psychosomatic issues, and an increased susceptibility to infections. It is often assessed using various questionnaires, the most used being the Maslach Burnout Inventory. This syndrome primarily affects healthcare professionals, including medical students, which is the focus of this study. Among students, the occurrence of this syndrome is related to the organization of the faculty, the volume of study material, the student's personality, their learning style, and their lifestyle. Students with pronounced personality trait neuroticism and those who study in a surface-disorganized manner are more frequently affected by burnout syndrome. Alcohol consumption, smoking, drug use, poor diet, and lack of physical activity and sleep increase the likelihood of developing this syndrome. The prevalence of this syndrome varies across different countries. The reasons for this include different methods of assessing burnout and varying cultural and political conditions. If timely intervention is not taken, the consequences of burnout syndrome on an individual's mental health can be severe and may even lead to suicide. Medical students rarely seek psychological help due to the fear of stigma or disbelief in the seriousness of their problem. To prevent this syndrome, it is necessary to raise awareness of the issue among teachers and students, implement changes in the organization of classes and assessment methods, eliminate the stigma associated with seeking psychological help, and regularly monitor the mental health of high-risk groups
High - sensitive Troponin I values in patients with left-sided breast cancer undergoing hypofractionated adjuvant radiotherapy with concurrent anti-HER2 therapy
No full textCilj našeg istraživanja je evaluirati utjecaj doze zračenja na srčane strukture na vrijednosti visokoosjetljivog Troponina I (hscTnI) kao ranog biljega kardiotoksičnosti kod bolesnica s HER2 pozitivnim rakom lijeve dojke koje provode adjuvantnu radioterapiju konkomitantno s anti-HER2 terapijom koristeći trastuzumab, kombinaciju trastuzumab - pertuzumab ili trastuzumab emtanzin te ustanoviti korelaciju vrijednosti hscTnI s dozama zračenja na srčane strukture. Kod 61 bolesnice vrijednosti hscTnI su mjerene prije početka i po završetku radioterapije. Izrađeni su dozno volumni histogrami za srce, lijevu klijetku (LV) te prednju lijevu silaznu arteriju (LAD). Porast vrijednosti hscTnI je zabilježen kod 17 bolesnica (Grupa 1). Bolesnice u ovoj skupini imale su značajno veću srednju dozu zračenja na srce (p = 0,02), LV (p = 0,03) i LAD (p = 0,04) te AUC za srce i LV (p = 0,01 za oba) u odnosu na bolesnice bez porasta hscTnI (Grupa 2). Kod bolesnica u Grupi 1 veći volumen srca i LV su primili dozu od 2 Gy (p = 0,01 za oba) i 4 Gy (p = 0,02 za oba) te je veći volumen LAD-a primio dozu od 2 Gy (p = 0,03), 4 Gy (p = 0,02) i 5 Gy (p = 0,02). Opažena je pozitivna korelacija porasta vrijednosti hscTnI s dozama zračenja na srce, LV i LAD.Aim of this study was to evaluate the influence of radiation dose on cardiac structures on the values of early cardiotoxicity marker high sensitivity cardiac troponin I (hscTnI) in patients with HER2 positive left breast cancer undergoing adjuvant radiotherapy concomitantly with anti-HER2 therapy (using either trastuzumab, combination of trastuzumab and pertuzumab or trastuzumab emtansine) and to establish correlation of hscTnI values with cardiac radiation doses. In 61 patients hscTnI values were measured prior to and upon completion of radiotherapy. Dose volume histograms were generated for heart, left ventricle (LV) and left anterior descending artery (LAD). An increase of hscTnI values was observed in 17 patients (Group 1). These patients had significantly higher mean radiation doses for the heart (p = 0.02), LV (p = 0.03) and LAD (p = 0.04) and AUC for heart and LV (p = 0.01 for both) than patients without hscTnI increase (Group 2). Patients in Group 1 had larger volumes of heart and LV receiving 2 Gy (p = 0.01 for both) and 4 Gy (p = 0.02 for both) and larger volumes of LAD receiving 2 Gy (p = 0.03), 4 Gy (p = 0.02) and 5 Gy (p = 0.02). The increase of hscTnI was positively correlated with radiation doses on the heart, LV and LAD
Diabetes Mellitus-related musculoskeletal disorders
No full textGlobalno gledano, šećerna bolest (DM) je veliki javnozdravstveni problem koji uzrokuje funkcionalnu nesposobnost među oboljelima. Dok su vaskularne komplikacije DM dobro poznate i predstavljaju glavni uzrok mortaliteta i morbiditeta, mišićno-koštane (MSK) manifestacije DM su česte i iako nisu opasne po život, važan su uzrok morbiditeta, boli i invaliditeta. Pojedina su stanja specifična za osobe oboljele od šećerne bolesti, dok su druga prisutna u općoj populaciji, ali imaju veću prevalenciju u populaciji bolesnika sa šećernom bolešću. Točna patofiziologija većine MSK poremećaja ostaje nejasna. U pozadini povećane učestalosti MSK poremećaja kod DM mogu biti neuropatija, poremećaji vezivnog tkiva, vaskulopatija ili kombinacija navedenih problema. Najvažniji rizični čimbenik za MSK poremećaje kod bolesnika s DM je dugotrajna i nekontrolirana hiperglikemija. MSK manifestacije DM uključuju dijabetičku heiroartropatiju, palmarni fasciitis s posljedičnom Dupuytrenovom kontrakturom prstiju šake, stenozirajući fleksorni tenosinovitis šake (tzv. škljocavi prst), adhezivni kapsulitis ramena (tzv. smrznuto rame), osteoartritis perifernih zglobova i kralježnice (Morbus Forestier ili DISH), osteoporozu (tzv. dijabetoporozu), sarkopeniju, neuropatiju (perifena kompresivna neuropatija najčešće kao sindrom karpalnog kanala, polineuropatija najčešće kao simetrična distalna senzomotorna polineuropatija, dijabetička amiotrofija ili dijabetička lumbosakralna radikulopleksopatija), dijabetička osteoartropatija ili neuropatska artropatija (Charcotov zglob) i posttraumatski regionalni bolni sindrom. Dijagnoza MSK poremećaja u DM postavlja se prvenstveno kliničkim pregledom. U pojedinim slučajevima dodatno se vrše radiološke, elektrofiziološke, laboratorijske i druge pretrage, važne u diferencijalnoj dijagnozi. Trenutno ne postoji specifično liječenje za takva stanja. Ublažavanje simptoma i komplikacija provodi se konzervativnim i/ili kirurškim načinom. Važnu ulogu ima fizikalna terapija. Obzirom da je DM, kao temeljnu bolest bez pridodanih komplikacija i poremećaja, lakše liječiti, stroga kontrola glikemije, pravovremeno prepoznavanje i zbrinjavanje MSK manifestacija DM važan je dio skrbi za pacijente oboljele od DM. U prevenciji i liječenju MSK poremećaja ključni faktor je optimalno upravljanje metabolizmom ugljikohidrata.Globally, diabetes mellitus (DM) is a major public health problem, causing functional disability among those affected. While vascular complications of DM are well known and represent a major cause of mortality and morbidity, musculoskeletal (MSC) manifestation of DM are common and, although not life-threatening, are an important cause of morbidity, pain, and disability. Some conditions are specific to people who are suffering from diabetes, while others are more distributed throughout the common population, but are still more prevalent in patient with diabetes. The exact pathophysiology of most MSK remains unclear. Connective tissue disorders, neuropathy, vasculopathy or a combination of these problems may be behind the increased frequency of MSK in DM. The most important risk factor for musculoskeletal disorders in patients with diabetes mellitus is long-term and uncontrolled hyperglycemia. MSK manifestations of DM include diabetic cheiroarthropathy, palmar fasciitis with consequent Dupuytren's contracture of the fingers of the hand, flexor tenosynovitis, known as a “trigger finger, adhesive capsulitis of the shoulder (so-called frozen shoulder), osteoarthritis of the peripheral joints and spine (Morbus Forestier or DISH), osteoporosis (so-called diabetes mellitus), sarcopenia, neuropathy (peripheral compressive neuropathy most often as carpal tunnel syndrome, polyneuropathy most often as symmetrical distal sensorimotor polyneuropathy, diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy, diabetic osteoarthropathy or neuropathic arthropathy (Charcot joint) and post-traumatic regional pain syndrome. A diagnosis of musculoskeletal dysfunctions in diabetic patients is made by clinical findings. In some cases, radiological, electrophysiological, laboratory and other tests, important in differential diagnosis, are additionally performed. No specific treatment for the disorders is available at the moment. Alleviation of symptoms and complications is carried out conservatively and/or surgically. Physical therapy plays an important role. Since DM, as a basic disease without added complications and disorders, is easier to treat, strict glycemic control, timely recognition and treatment of MSK manifestations of DM is an important part of care for patients suffering from DM. Optimal management of carbohydrate metabolism is essential in the prevention and treatment of MSK disorders
Genes Involved in Glioma Cellular Senescence
No full textUvod: Stanična senescencija je proces u kojem se stanice trajno prestaju dijeliti, a koji ima ključnu ulogu u kontroli tumorskog rasta i odgovoru na terapiju. Gliomi su najčešći primarni tumori središnjeg živčanog sustava, a prognoza im je često nepovoljna zbog agresivnog kliničkog tijeka i česte rekurencije nakon terapije. Sve više istraživanja upućuje na značaj senescentnih stanica glioma na takav klinički tijek ovih tumora. Cilj ove studije je analizirati učestalost i tip promjena gena uključenih u staničnu senescenciju u različitim tipovima glioma.
Materijali i metode: Analizirali smo 3425 uzoraka glioma koristeći podatke s cBioPortala za genomiku tumora. Odabrali smo 10 najčešće promijenjenih gena povezanih sa senescencijom: TP53, CDKN2A, EGFR, ATM, TNFRSF1A, IGFBP7, TNFRSF11B, TP53BP1, HGF i SERPINE1. In silico analiza podataka uključivala je određivanje učestalosti mutacija, amplifikacija, delecija i višestrukih promjena u svakom tipu glioma.
Rezultati: Rezultati su pokazali da su u ukupnom uzorku TP53, CDKN2A i EGFR najčešće promijenjeni geni. CDKN2A, EGFR, ATM, IGFBP7, TP53BP1 i HGF su imali veći postotak promjena u gliomima visokog stupnja (HGG), dok su TP53, TNFRSF1A, TNFRSF11B i SERPINE1 bili češće promijenjeni u gliomima nižeg stupnja (LGG). Statistički značajna razlika u promjenama između HGG i LGG skupina je utvrđena za TP53, CDKN2A, EGFR, IGFBP7 te TNFRSF11B.
Zaključak: Pokazali smo kako su proučavani geni češće promijenjeni u gliomima viših gradusa. Obrasci promjena odgovaraju dosadašnjim spoznajama iz literature. Ovi nalazi naglašavaju važnost specifičnih genetskih promjena u regulaciji stanične senescencije i njihov utjecaj na malignost glioma. Daljnja istraživanja su potrebna kako bi se bolje razumjeli mehanizmi kojima ovi geni utječu na senescenciju i klinički tijek glioma.Introduction: Cellular senescence is a process in which cells permanently cease to divide, playing a key role in controlling tumor growth and response to therapy. Gliomas are the most common primary tumors of the central nervous system, often with a poor prognosis due to aggressive clinical behavior and frequent recurrence after therapy. Increasing research indicates the significance of senescent glioma cells in shaping the clinical profile of these tumors. The aim of this study was to analyze the frequency and type of alterations in genes involved in cellular senescence in different types of gliomas.
Materials and Methods: We analyzed 3425 glioma samples using data from the cBioPortal for Cancer Genomics. We selected and studied the 10 most frequently altered genes related to senescence: TP53, CDKN2A, EGFR, ATM, TNFRSF1A, IGFBP7, TNFRSF11B, TP53BP1, HGF and SERPINE1. Data analysis included determining the frequency of mutations, amplifications, deletions, and multiple alterations in each type of glioma.
Results: The results showed that TP53, CDKN2A, and EGFR were the most frequently altered genes. CDKN2A, EGFR, ATM, IGFBP7, TP53BP1, and HGF had a higher percentage of alterations in high-grade gliomas (HGG), while TP53, TNFRSF1A, TNFRSF11B and SERPINE1 were more frequently altered in low-grade gliomas (LGG). A statistically significant difference in alterations between the HGG and LGG groups was found for TP53, CDKN2A, EGFR, IGFBP7 and TNFRSF11B.
Conclusion: We have shown that the studied genes are more frequently altered in high-grade gliomas. The patterns of alterations correspond to the existing knowledge in the literature. The results highlight the importance of specific gene changes in cellular senescence and their association to glioma grade. Further research is needed to better understand the mechanisms by which these genes influence senescence and the clinical course of gliomas
Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations
No full textPurpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice.
Materials and methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured.
Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%).
Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial
Bone Density Disorders in Patients with Rheumatoid Arthritis
No full textReumatoidni artritis (RA) autoimuna je upalna bolest koja primarno zahvaća zglobove, ali može zahvatiti i druge organe. Uz zglobne manifestacije bolesti često su prisutne i udružene bolesti kao što je osteoporoza. Cilj ovog istraživanja bio je utvrditi učestalost poremećaja koštane gustoće u bolesnika s RA. Istraživanje je provedeno u Kliničkoj bolnici “Sveti Duh”, a uključivalo je 42 ispitanika, od toga 38 žena i 4 muškarca prosječne dobi 60 +/- 11,49 godina. Najveći udio ispitanika (48%) bolovao je od RA u trajanju od 5 do 10 godina, 14% ispitanika bolovalo je kraće od 5 godina, a 38% dulje od 10 godina. Denzitometrijom je mjerena koštana gustoća u 40 od 42 ispitanika. Poremećaj koštane gustoće utvrđen je u 50% ispitanika, od toga osteopenija u 35%, a osteoporoza u 15%. Prijelomi su pronađeni u 8 ispitanika. Povećani indeks tjelesne mase pronađen je u 28 ispitanika, a srednja i visoka aktivnost bolesti izmjerene su pomoću DAS28-CRP u 12 ispitanika. Uočena je pozitivna korelacija veće aktivnosti bolesti i većeg indeksa tjelesne mase s poremećajem koštane gustoće. Glukokortikoidnu terapiju primalo je 11 ispitanika, terapiju lijekovima skupine csDMARD primalo je 16 ispitanika, bDMARD 17, a tsDMARD 10. NSAID je primalo 5 ispitanika. Uočeno je manje poremećaja koštane gustoće u liječenih s tsDMARD, a pojavnost poremećaja koštane gustoće bila je veća u oboljelih od RA na glukokortikoidnoj i biološkoj terapiji. Vitamin D u terapiji primalo je 26 ispitanika te nije pronađena statistički značajna poveznica između primjene vitamina D i poremećaja koštane gustoće niti aktivnosti bolesti. U ovoj su studiji četiri pušača od 42 ispitanika te nije pronađena statistički značajna korelacija između pušenja i poremećaja gustoće kostiju. Poremećaji koštane gustoće česti su u oboljelih od RA. U svakodnevnoj kliničkoj praksi bolesnike s RA preporučljivo je uputiti na redovnu provjeru serumskih vrijednosti vitamina D i denzitometriju, evaluirati pojavu prijeloma te pažljivo birati terapiju uzimajući u obzir nuspojave lijekova, komorbiditete i aktivnost bolesti.Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that primarily affects joints, but can affect other organs as well. Alongside joint manifestations of the disease, many associated diseases are common, for example osteoporosis. The aim of this study was to determine the frequency of bone density disorders in patients suffering from RA. The research was conducted at the Clinical Hospital “Sveti Duh”. 42 subjects were included, 28 of which were female and 4 were male with an average age of 60 +/- 11,49 years. The largest proportion of respondents (48%) had been suffering from RA for a duration of 5 to 10 years, 14% for a duration of less than 5 years, and 38% for more than 10 years. Densitometry was used to measure bone density in 40 out of 42 subjects. Bone density disorders were found in 50% of the respondents, with 35% having osteopenia and 15% having osteoporosis. Fractures were found in 8 subjects. A positive correlation was observed between bone density disorders and higher disease activity and greater body mass index (BMI). Increased BMI was found in 28 subjects. DAS28-CRP was used to measure disease activity and the results revealed that 12 subjects had moderate to high scores. 11 respondents received glucocorticoid therapy, 16 were given csDMARDs, 17 bDMARDs and 10 were given tsDMARDs. 5 subjects received NSAIDs. Fewer bone density disorders were observed in those treated with tsDMARDs, while the prevalence of bone density disorders was higher in those on glucocorticoid and biological therapy. 26 subjects received vitamin D therapy, but no statistically significant association was found between the use of vitamin D and bone density disorders or disease activity. This study included 4 smokers out of 42 subjects. Statistically significant correlation between smoking and bone density disorders was not found, probably due to a small sample size. Bone density disorders are common in patients suffering from RA. It is advisable to monitor serum vitamin D levels and densitometry in patients suffering from RA in everyday clinical practice, to evaluate the occurrence of fractures and carefully choose between different therapeutic options, taking into account medication side effects, comorbidities and disease activity
The use of esketamine in psychiatry
No full textDepresija je poremećaj raspoloženja od kojeg u svijetu boluje više od 280 milijuna ljudi te predstavlja veliki javnozdravstveni problem. Karakterizira je sniženo raspoloženje, smanjenje energije i umor te nedostatak volje i zadovoljstva. Pacijenti koji boluju od depresije imaju smanjeno društveno i radno svakodnevno funkcioniranje. Temelj liječenja depresije čine antidepresivi. Zbog dostupnosti širokog spektra farmakoloških i nefarmakoloških opcija, između 70 i 90% pacijenata postiže zadovoljavajući terapijski odgovor, dok preostali pacijenti ispunjavaju kriterije za terapijski rezistentnu depresiju (TRD). TRD predstavlja veliki izazov za čitavo društvo te nemogućnost postizanja remisije uzrokuje veliku disfunkcionalnost pacijenata i njihovih obitelji, kao i velike financijske izdatke u zdravstvenom sustavu. U Republici Hrvatskoj odobren je brzodjelujući antidepresiv esketamin u intranazalnom spreju za liječenje TRD-a. Esketamin je S-enantiomer ketamina i nekompetitivni antagonist N-metil-D-aspartatnog receptora (NMDA) te ima veći afinitet za receptore od ketamina. Osim za TRD, esketamin je odobren za liječenje velikog depresivnog poremećaja sa suicidalnim ideacijama i ponašanjem. U liječenju se može davati u kombinaciji sa selektivnim inhibitorima ponovnog unosa serotonina (engl. selective serotonin reuptake inhibitor, SSRI, SIPPS) ili selektivnim inhibitorima ponovnog unosa serotonina i noradrenalina (engl. serotonin-norepinephrine reuptake inhibitor, SNRI). Najčešće nuspojave su vrtoglavica, disocijacija, mučnina, somnolencija i povišenje krvnog tlaka. Duljina trajanja nuspojava je najčešće do 2 sata nakon primjene esketamina. Trenutno se istražuje i za liječenje anksioznosti, bipolarne depresije, graničnog poremećaja ličnosti, postpartalne depresije i drugih psihičkih poremećaja. Iako je dokazano da je esketamin efikasan i siguran lijek, nužno je nastaviti istraživati kako bi se potpuno razjasnio njegov mehanizam djelovanja te umanjila moguća terapijska rezistencija kod pacijenata.Depression is a mood disorder from which more than 280 million people worldwide suffer and represents a major public health problem. It is characterized by lowered mood, reduced energy, and fatigue, as well as a lack of will and pleasure. Patients suffering from depression have reduced social and occupational daily functioning. The cornerstone of treatment are antidepressants. Given the availability of a wide range of pharmacological and non-pharmacological treatments, 70 to 90 % of patients achieve a satisfactory therapeutic response, while the remaining patients meet the criteria for treatment-resistant depression (TRD). TRD presents a major challenge for the entire society, and the inability to achieve remission causes significant dysfunction for patients, and their families, as well as large financial expenses in the healthcare system. In the Republic of Croatia, a fast-acting antidepressant, esketamine, in a nasal spray, has been approved for the treatment of TRD. Esketamine is the S-enantiomer of ketamine and a non-competitive antagonist of the N-methyl-D-aspartate receptor (NMDA) and has a higher affinity for the receptors than ketamine. Besides TRD, esketamine is approved for the treatment of major depressive disorder with suicidal ideation and behavior. In treatment, it can be given in combination with selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). The most common side effects are dizziness, dissociation, nausea, somnolence, and increased blood pressure. The duration of side effects is usually up to 2 hours after the administration of esketamine. It is currently being investigated for the treatment of anxiety, bipolar depression, borderline personality disorder, postpartum depression, and other psychiatric disorders. Although it has been proven that esketamine is an effective and safe drug, it is necessary to continue research to clarify its mechanism of action fully and to reduce possible therapeutic resistance in patients
Interaction between cerebrovascular disease and Alzheimer's disease
No full textInterakcija između cerebrovaskularnih bolesti i Alzheimerove bolesti predstavlja složen odnos u
kojem vaskularna oštećenja mozga mogu ubrzati i pogoršati simptome Alzheimerove bolesti.
Cerebrovaskularne bolesti smanjuju dotok krvi u mozak, što može dovesti do oštećenja
moždanog tkiva i dodatno narušiti kognitivne funkcije. Ovo oštećenje pojačava učinke
Alzheimerove bolesti, koja je već obilježena nakupljanjem amiloidnih plakova i tau proteina u
mozgu. Kombinacija ovih patoloških procesa rezultira bržim napredovanjem demencije i težim
kliničkim ishodima za pacijente. Vaskularni čimbenici poput hipertenzije i dijabetesa dodatno
doprinose razvoju obje bolesti, što naglašava važnost njihove prevencije i liječenja. Kontrola
krvnog tlaka i razine šećera u krvi može pomoći u usporavanju napredovanja Alzheimerove
bolesti, dok liječenje cerebrovaskularnih bolesti može poboljšati kognitivne funkcije kod
oboljelih. Terapije usmjerene na poboljšanje cerebralne perfuzije također imaju pozitivan učinak
na kogniciju. Ipak, mnogi pacijenti s kombinacijom ovih bolesti suočavaju se s lošom
prognozom i većom stopom invaliditeta. Stoga je rano prepoznavanje i liječenje
cerebrovaskularnih čimbenika rizika ključno za poboljšanje ishoda kod pacijenata s
Alzheimerovom bolešću. Konačno, integrirani pristup koji obuhvaća prevenciju i liječenje obje
bolesti nudi najbolje izglede za očuvanje kognitivnih funkcija i kvalitete života.The interaction between cerebrovascular diseases and Alzheimer’s disease represents a complex relationship where vascular damage in the brain can accelerate and worsen the symptoms of Alzheimer’s disease. Cerebrovascular diseases reduce blood flow to the brain, which can lead to brain tissue damage and further impair cognitive functions. This damage exacerbates the effects of Alzheimer’s disease, which is already characterized by the accumulation of amyloid plaques and tau proteins in the brain. The combination of these pathological processes results in faster dementia progression and more severe clinical outcomes for patients. Vascular factors such as hypertension and diabetes also contribute to the development of both diseases, highlighting the importance of their prevention and treatment. Controlling blood pressure and blood sugar levels can help slow the progression of Alzheimer’s disease, while treating cerebrovascular diseases can improve cognitive functions in affected individuals. Therapies aimed at improving cerebral perfusion also have a positive impact on cognition. However, many patients with a combination of these diseases face a poor prognosis and higher rates of disability. Therefore, early recognition and treatment of cerebrovascular risk factors are crucial for improving outcomes in patients with Alzheimer’s disease. Finally, an integrated approach that includes the prevention and treatment of both diseases offers the best prospects for preserving cognitive functions and quality of life
Pain management
No full textBol je jedinstveni i kompleksan doživljaj u ljudskom životu. Percepcija bolnog podražaja ovisna je o mnoštvu čimbenika kao što su genetsko naslijeđe, okolina, emocije, prethodno iskustvo, te individualne karakteristike pojedinca. Nastanak boli može biti povezan s ozljedom tkiva, no ne mora. U dijagnostici intenziteta boli pomaže korištenje različitih skala od kojih je najučinkovitija VAS.
Terapija boli sastoji se od farmakoloških i nefarmakoloških metoda. Upotreba lijekova u liječenju boli temelji se na „WHO analgetskim ljestvama“. Bol manjeg intenziteta liječi se slabim analgeticima koji imaju manje nuspojava. Takvi lijekovi su NSAID, paracetamol i adjuvantni lijekovi. Kod boli većeg intenziteta ili rezistentne boli, propisuju se jači analgetici kao što su opioidni analgetici. Zbog rizika od nastanka ovisnosti i mnoštva nuspojava opioidnih lijekova, liječnici uključuju nefarmakološke metode u terapiju boli. Kod neframakološkog pristupa, liječenje se temelji na korištenju struja, magneta, radiofrekventnih valova, te kirurških zahvata u svrhu supresije boli. Osim peroralnih lijekova, farmakološki pripravci se još mogu aplicirati topikalno ili invazivno u obliku regionalnih blokova.
Liječnik pri odabiru optimalne terapije za pacijenta, trebao bi uzeti u obzir sve čimbenike koji utječu na percepciju boli, te uz temeljitu anamnezu osmisliti terapijski plan liječenja. Kako bi odabrao najučinkovitiji plan liječenja, liječnik treba biti educiran o svim dostupnim metodama liječenja koje su danas moguće.Pain is a unique and complex experience in human life. The perception of painful stimuli depends on numerous factors such as genetic inheritance, environment, emotions, prior experiences, and individual characteristics. The onset of pain may be associated with tissue injury, but it is not always the case. Various scales, with the Visual Analog Scale (VAS) being the most effective, are used in diagnosing pain intensity.
Pain therapy includes pharmacological and non-pharmacological methods. Pharmacological treatment is guided by the "WHO analgesic ladder". Mild pain is treated with weak analgesics that have fewer side effects, such as NSAIDs, acetaminophen, and adjuvant medications. For more intense or resistant pain, stronger analgesics like opioid analgesics are prescribed. Due to the risk of addiction and numerous side effects associated with opioids, physicians incorporate non-pharmacological methods into pain therapy. Non-pharmacological approaches may involve electrical currents, magnets, radiofrequency waves, and surgical interventions aimed at pain suppression. In addition to oral medications, pharmacological preparations can also be applied topically or invasively through regional blocks.
When choosing the optimal therapy for a patient, physicians should consider all factors influencing pain perception and design a therapeutic treatment plan based on thorough medical history. To select the most effective treatment plan, physicians should be educated about all available treatment methods currently possible
