Veterinary medicine - Repository of PHD, master's thesis
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Use of antidepressants in psychiatric disorders
No full textAntidepresivi su raznovrsna skupina lijekova koja se može klasificirati na puno načina, ali najviše se spominje njihova podjela po mehanizmu djelovanja. Tako postoje skupine antidepresiva kao što su selektivni inhibitori ponovne pohrane serotonina (SIPPS), selektivni inhibitori ponovne pohrane serotonina i noradrenalina (SNRI), inhibitori ponovne pohrane noradrenalina (NARI), noradrenergički i specifični serotoninergički antidepresivi (NASSA), inhibitori ponovne pohrane noradrenalina i dopamina (NDRI), serotoninski antagonisti i inhibitori ponovne pohrane serotonina (SARI), multimodalni antidepresivi, agonisti melatoninskih receptora i antagonisti 5-HT2 receptora, triciklički antidepresivi (TCA) te inhibitori monoaminooksidaze (MAOi). Što se tiče podjele antidepresiva po brzini djelovanja, treba spomenuti brzodjelujuće antidepresive, koji predstavljaju važan pomak u farmakoterapiji psihijatrijskih poremećaja. Iako su ovi lijekovi najpoznatiji po svom učinku na simptome depresije, mogu biti od velike koristi i u liječenju stanja kao što su anksiozni poremećaji, opsesivno kompulzivni poremećaj (OKP) te posttraumatski stresni poremećaj (PTSP).
Anksiozni poremećaji očituju se stresom koji je toliko jak da ometa normalno funkcioniranje osobe, a ne tek simptomima obične anksioznosti koje svatko ponekad osjeti (napetost, nemir, strah). U najpoznatije anksiozne poremećaje ubrajaju se dijagnoze kao što su panični poremećaj, generalizirani anksiozni poremećaj (GAP), agorafobija te socijalni anksiozni poremećaj.
Opsesivno-kompulzivni poremećaj (OKP) odlikuje se opsesijama (misli ili osjećaji koji se pacijentima stalno nameću protiv njihove volje) i kompulzijama (ponavljajuće, svjesne radnje koje osoba izvodi, ali doživljava ih kao nametnute). Simptomi koje osoba koja boluje od OKP-a pokazuje najčešće se mogu svrstati u neku od kategorija kao što su strah od onečišćenja ili nesreće, kompulzivno provjeravanje, intruzivne misli i težnja simetriji.
PTSP je poremećaj koji se javlja nakon proživljenog traumatskog događaja i ima tri karakteristične skupine simptoma: izbjegavanje svega što podsjeća na traumu, flashback epizode i noćne more, te simptomi povišene pobuđenosti. DSM-5 klasifikacija dodaje i četvrtu skupinu: negativno raspoloženje i kogniciju.
Depresija je poremećaj raspoloženja koji se očituje gubitkom volje i energije, smetnjama nagona i osjećajem krivnje te sniženim raspoloženjem. Ovaj poremećaj nije obična tuga, već je tuga koja se pojavljuje bez razloga te ometa normalno funkcioniranje pacijenta.Antidepressants are a diverse drug group that can be classified in many ways, the most common classification being the one by their mechanism of action. Therefore, there are groups of antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), noradrenaline reuptake inhibitors (NARI), noradrenergic and specific serotonergic antidepressants (NASSA), norepinephrine and dopamine reuptake inhibitors (NDRIs), serotonin antagonists/reuptake inhibitors (SARIs), multimodal antidepressants, melatonin receptor agonists and 5-HT2 receptor antagonists, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). As far as classifying the antidepressants by their onset of action is concerned, rapid-acting antidepressants should be mentioned, for they represent an important shift in the pharmacotherapy of psychiatric disorders. Although antidepressants are most famous for their effect on the symptoms of depression, they can also be of great use in treating the conditions like anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
Anxiety disorders are characterized by stress so strong that it interferes with normal functioning of the person, and not by mere symptoms of ordinary anxiety that are felt by everyone from time to time. The most well-known anxiety disorders are conditions such as panic disorder, generalized anxiety disorder (GAD), agoraphobia and social anxiety disorder.
Obsessive-compulsive disorder is characterized by obsessions (thoughts or feelings that are constantly imposed on patients against their will) and compulsions (repeating, conscious actions which a person performs but perceives them as imposed). Symptoms shown by people suffering from OCD can usually be classified in some of the categories like fear of pollution or accidents, compulsive checking, intrusive thoughts and a desire for symmetry.
PTSD is a disorder that occurs after experiencing a traumatic event and manifests by three typical groups of symptoms: avoiding everything that is a reminder of the trauma, „flashback“ episodes and nightmares, as well as the symptoms of increased arousal. DSM-5 classification also adds the fourth group: negative mood and cognition.
Depression is a mood disorder characterized by the loss of will and energy, impaired impulses and the feeling of guilt, as well as feeling down. This disorder is not mere sadness but rather the sadness that appears for no reason and interferes with normal functioning of the patient
Person-centered Medicine and People-centered Healthcare
No full textPriroda bolesti i način održavanja zdravlja jedinstveni su za svaku osobu. Skrb usmjerena na pojedinca temelji se na sveobuhvatnom pristupu koji uključuje biološke, psihološke, sociokulturne i duhovne aspekte. Takva skrb obuhvaća ne samo liječenje bolesti, već i očuvanje zdravlja.
Briga o pacijentu središte je medicine. Da bismo pacijente tretirali kao cjelovite osobe, potrebno je spojiti biomedicinsku perspektivu i najnovija znanstvena saznanja s osobnim iskustvima pacijenata i njihovim životnim kontekstom. Ključno je poticati kontinuirani razvoj pacijenata u skladu s njihovim životnim okolnostima i mogućnostima, što pomaže u lakšem suočavanju s bolešću, a veća uključenost pacijenata u proces donošenja odluka tijekom liječenja može poboljšati ishode liječenja.
Medicina usmjerena na osobu teži promicanju cjelovitog zdravlja pojedinca kroz podršku u ostvarivanju njihovih životnih ciljeva. Takav pristup njeguje suradnju i partnerstvo između pacijenata, njihovih bližnjih i zdravstvenih radnika kroz uzajamno poštovanje i razumijevanje.
Zdravstvena skrb usmjerena na ljude omogućava pojedincima i zajednicama sudjelovanje u pouzdanim (zdravstvenim) sustavima koji holistički zadovoljavaju njihove potrebe. Zdravlje zajednice oblikovano je brojnim čimbenicima koji nadilaze tradicionalne uzroke bolesti. Društvene odrednice zdravlja, poput fizičkog, psihosocijalnog i ekonomskog okruženja te
dostupnosti zdravstvenih usluga, značajno utječu na ponašanje i životni stil ljudi. Kao što anatomske i fiziološke osnove pomažu razumjeti ljudsko tijelo, tako je ključno da liječnici razumiju i socijalne, kulturne te okolišne uvjete u kojima pružaju skrb.The nature of illness and the way of maintaining health are unique to each individual. Person-centered care is based on a comprehensive approach that includes biological, psychological, sociocultural, and spiritual aspects. Such care encompasses not only the treatment of illness but also the preservation of health.
Caring for the patient is at the heart of medicine. To treat patients as whole persons, it is necessary to combine a biomedical perspective and the latest scientific knowledge with patients' personal experiences and their life context. It is crucial to encourage the continuous development of patients in accordance with their life circumstances and capabilities, which
helps them better cope with illness. Additionally, greater involvement of patients in the decision-making process during treatment can improve treatment outcomes.
Person-centered medicine aims to promote the overall health of individuals by supporting them in achieving their life goals. This approach fosters collaboration and partnership between patients, their loved ones, and healthcare workers through mutual respect and understanding.
People-centered healthcare enables individuals and communities to participate in reliable (healthcare) systems that holistically meet their needs. The health of a community is shaped by numerous factors that go beyond the traditional causes of illness. Social determinants of health, such as the physical, psychosocial, and economic environment, as well as the availability of healthcare services, significantly influence people's behaviour and lifestyle. Just as anatomical and physiological foundations help us understand the human body, it is essential for physicians to understand the social, cultural, and environmental conditions in which they provide care
Immune and non-immune fetal hydrops
No full textFetalni hidrops označava nakupljanje tekućine u najmanje dva različita fetalna prostora, kao što su trbušna šupljina, pluća, srce ili koža. Ovo stanje može biti uzrokovano različitim etiološkim čimbenicima, imunološke ili neimunološke prirode.
Imuni fetalni hidrops nastaje kao posljedica hemolitičke bolesti fetusa, koju uzrokuju majčina protutijela koja napadaju fetalne eritrocite. Najčešći uzrok ovog oblika hidropsa je RhD aloimunizacija, pri kojoj majčino tijelo proizvodi protutijela protiv RhD pozitivnih fetalnih eritrocita. Iako je primjena anti-D imunoglobulina znatno smanjila učestalost ovog poremećaja, i dalje postoji mogućnost imunizacije zbog prisutnosti drugih Rh antigena ili antigena iz drugih krvnih grupa. U slučaju teške anemije uzrokovane hemolitičkom bolešću, intrauterine transfuzije mogu biti potrebne za stabiliziranje stanja.
Neimuni fetalni hidrops čini više od 90% svih slučajeva fetalnog hidropsa. Ovaj oblik hidropsa može biti uzrokovan različitim čimbenicima, uključujući poremećaje strukture i funkcije srca, kromosomske poremećaje, malformacije ili infektivne bolesti. Dijagnoza se postavlja ultrazvukom, prepoznavanjem znakova kao što su ascites, pleuralni izljev, perikardijalni izljev ili edem kože. Rano prepoznavanje i praćenje ovog stanja ključni su za pravilan tretman i smanjenje mogućih komplikacija. Važno je učiniti sveobuhvatnu obradu, uključujući pretrage za otkrivanje uzroka i planiranje odgovarajućeg liječenja.Fetal hydrops is characterized by the accumulation of fluid in at least two different fetal compartments, such as the abdominal cavity, lungs, heart, or skin. This condition can be caused by various factors, either immunological or non-immunological.
Immune fetal hydrops results from hemolytic disease of the fetus, caused by maternal antibodies attacking fetal red blood cells. The most common cause of this type of hydrops is RhD alloimmunization, where the mother’s body produces antibodies against RhD-positive fetal red blood cells. Although the use of anti-D immunoglobulin has significantly reduced the frequency of this disorder, there is still a risk of sensitization due to the presence of other Rh antigens or antigens from other blood group systems. In cases of severe anemia caused by hemolytic disease, intrauterine transfusions may be necessary to stabilize the condition.
Non-immune fetal hydrops accounts for more than 90% of all cases of fetal hydrops. This form of hydrops can be caused by a range of factors, including cardiac structural and functional abnormalities, chromosomal disorders, malformations, or infections. Diagnosis is made through ultrasound by identifying signs such as ascites, pleural effusion, pericardial effusion, or skin edema. Early detection and monitoring of this condition are crucial for effective treatment and reducing potential complications. A comprehensive approach is essential, including tests to identify the underlying cause and plan appropriate management
Ultrasound-guided interventional procedures
No full textIntervencijski zahvati pod nadzorom ultrazvuka poboljšavaju preciznost i sigurnost izvođenja
različitih medicinskih zahvata. Pružaju više prednosti u usporedbi s tradicionalnim metodama,
kao što su vizualizacija anatomskih struktura u realnom vremenu, manji rizik za razvoj
komplikacija, minimalno invazivni pristup koji dovodi do manje traume tkiva i kraćeg
postoperativnog oporavka pacijenata, smanjena izloženost zračenju i cijena izvođenja. Neka od
ograničenja ultrazvuka su ovisnost o znanju i vještinama operatera i slabija mogućnost prikaza
koštanog tkiva i drugih tkiva kroz koja ultrazvučni valovi slabije prodiru.
Još jedna od prednosti široki je raspon zahvata u kojima se može primijeniti ultrazvuk. Rade se
endovaskularni pristupi postavljanja katetera, stentova i širenja suženja krvnih žila balonskom
dilatacijom. Biopsije tkiva primjenjuju se u dijagnostičke svrhe, poput otkrivanja karcinoma.
Postupcima perkutane ablacije destruiraju se tumorske mase. Drenažnim zahvatima odstranjuju
se nakupine tekućina, apscesi ili ciste iz abdomena, prsišta, zglobova i drugih dijelova tijela.
Ultrazvuk se može koristiti i kao pomoćna metoda u drugim zahvatima. Intravaskularni
ultrazvuk napredna je slikovna metoda putem koje se kateterom uvedenim izravno u krvnu žilu
vizualizira njezina unutrašnjost i dobiva uvid u morfologiju kakvu nije moguće prikazati drugim
tradicionalnim metodama. Intravaskularni ultrazvuk značajno je utjecao u radu intervencijske
kardiologije pružajući bolje razumijevanje vaskularnih bolesti i poboljšavajući sigurnost i
uspješnost koronarnih intervencija.Ultrasound-guided interventional procedures enhance the accuracy and safety of various
medical interventions. They offer several advantages compared to traditional methods, such as
real-time visualization of anatomical structures, lower risk of complications, minimally
invasive approach leading to less tissue trauma and shorter recovery for patients, reduced
radiation exposure and lower costs. Some limitations of ultrasound include dependence on
knowledge and skills of the operator and reduced ability to image bone and other tissues that
ultrasound waves penetrate poorly.
Another advantage is the wide range of procedures in which ultrasound can be applied.
Endovascular approaches include catheter placement, stent insertion and balloon dilation to
widen narrowed blood vessels. Tissue biopsies are used for diagnostic purposes, such as
detecting cancer. Percutaneous ablation procedures destroy tumor masses. Drainage procedures
remove fluid collections, abscesses or cysts from the abdomen, chest, joints and other parts of
the body.
Ultrasound can also be used as an auxiliary method in other procedures. Intravascular
ultrasound is an advanced imaging technique where a catheter introduced directly into the blood
vessel visualizes its interior and provides insights into the morphology that cannot be depicted
by other traditional methods. It has significantly impacted interventional cardiology by
providing a better understanding of vascular diseases and improving the safety and efficacy of
coronary interventions
Osteoporosis and ankylosing spondylitis
No full textOsteoporoza je metabolička bolest kostiju koju također prati smanjena gustoća kostiju. Najčešće se javlja u starijoj populaciji i to obično kod žena u postmenopauzi, te kao komplikacija drugih koštanih ili izvankoštanih bolesti. Često dovodi do osteoporotičnih prijeloma koji nastaju već pri maloj ili neznatnoj traumi. Ankilozantni spondilitis (AS) je kronična upalna bolest s tendencijom progresije. Zahvaća aksijalni skelet, i to posebice kralješke i sakroilijakalne zglobove. U općoj populaciji njena prevalencija iznosi oko 0,2%, te se češće javlja kod muškaraca mlađe dobi. Pokazuje jaku povezanost s HLA-B27 antigenom. Kronična upala zajedno s brojnim upalnim citokinima dovodi do oštećenja mikroarhitekture kostiju. Time se smanjuje mineralna gustoća kosti i povećava rizik za pojavu osteoporoze, koja je i jedna od komplikacija AS-a. Ako se osteoporoza javi u bolesnika s AS-om, dolazi to dodatnog povećavanja rizika za prijelome. Međutim, za razliku od osteoporotičnih prijeloma u postmenopauzi, ovi prijelomi češće zahvaćaju vratnu kralježnicu uz jače izraženu kliničku sliku, a mogu dovesti i do neuroloških ispada. Najvažniji rizični čimbenici koji pogoduju razvoju osteoporoze u AS bolesnika su kronična upala (posebno važni proupalni citokini TNF-α, IL-1 i IL-6) koja stimulira razgradnju kosti te smanjena tjelesna aktivnost zbog ankiloze kralježaka. Prijelomi su razlog povećanog mortaliteta u usporedbi s zdravom populacijom, a liječe se imobilizacijom ili kirurški. Dijagnoza prijeloma je otežana jer se oni na RTG-u zbog obilja osteofita često teško uočavaju, tako da je glavna dijagnostička metoda CT.Osteoporosis is a metabolic bone disease that is also accompanied by reduced bone density. It most often occurs in the elderly population, frequently in postmenopausal women, and as a complication of other bone or extra-osseous diseases. Osteoporosis often causes osteoporotic fractures that occur even with mild or minor trauma. Ankylosing spondylitis (AS) is a chronic inflammatory disease with a tendency to progression. It affects the axial skeleton, especially the vertebral and sacroiliac joints. In the general population, its prevalence is about 0.2%, and it occurs more often in younger men. It shows a strong association with the HLA-B27 antigen. Chronic inflammation associated with numerous inflammatory cytokines lead to bone microarchitecture damage. This reduces bone mineral density and increases the risk of osteoporosis, the latter being one of the complications of AS. If osteoporosis occurs in patients with AS, it further increases the risk of fractures. However, unlike postmenopausal osteoporotic fractures, these fractures more often affect the cervical spine with more pronounced symptoms, and can also lead to neurological dysfunction. The most important risk factors favoring the development of osteoporosis in AS patients are chronic inflammation (especially important pro-inflammatory cytokines TNF-alpha, IL-1, and IL-6) which stimulate bone breakdown, and reduced physical activity due to vertebral ankylosis. Fractures are the cause of increased mortality compared to the healthy population, and are treated with immobilization or surgery. The diagnosis of fractures is difficult because they are hard to identify on X-ray, due to the abundance of osteophytes. Hence, CT is the method of choice
Composite free flaps in oromandibular reconstruction
No full textTrauma, onkološka resekcija, upale ili kongenitalne malformacije samo su neki od uzroka nastanka oromandibularnih defekata. Najčešći razlog onkološke resekcije je planocelularni karcinom usne šupljine i orofarinksa. Najčešća sijela planocelularnog karcinoma usne šupljine su dno usne šupljine i jezik. Pravodobno prepoznavanje prekanceroznih lezija i početnih stadija tumora, utječe na bolju prognozu bolesti. U manjoj ili većoj mjeri svi ti uzroci djeluju na estetski izgled lica, ali i funkciju usne šupljine. Složeni defekti glave i vrata potaknuli su kirurge glave i vrata na razmišljanje kako što bolje rekonstruirati oromandibularnu regiju i koja tkiva su pogodna za takvu rekonstrukciju. Prije svega važno je klasificirati oromandibularne defekte, neovisno jesu li oni urođeni ili stečeni, po veličini koštanog defekta koji nastaje, ali i količini mekotkivne komponente koja nedostaje i pokušati procjeniti funkcionalne nedostatke koji mogu nastati. Klasifikacije olakšavaju planiranje rekonstruktivnih zahvata i izbor adekvatne vrste tkiva za rekonstrukciju. Od svih kompozitnih slobodnih režnjeva, režanj fibularne arterije zauzima najvažnije mjesto u oromandibularnoj rekonstrukciji. Osim njega dobre alternative, a nekad i primarni izbor za neke defekte su režanj grebena crijevne kosti, režanj supskapularne arterije i oseokutani radijalni režanj podlaktice. Za planiranje rekonstrukcije, precizniju izradu i oblikovanje kostiju, kao i prilagođavanje implantata i prostetike, danas se koriste CAD (engl. computer-aided design) i CAM (engl. computer-aided manufacturing) 3D tehnologija, koja olakšava navedene aspekte rekonstrukcije. Osim toga, ova tehnologija može planirati i olakšati odabir pravog režnja kao opcije za rekonstruktivne zahvate, ali i omogućiti relativno zadovoljavajuću predikciju postoperativnog ishoda kod pacijenta. Mogu se napraviti 3D dizajnirane i precizno izmjerene mrežice i pločice od titana koje služe kao pomagala i prostetika u rekonstruktivnim zahvatima. Napradak tehnika bioinjžinjeringa tkiva i to sustavima za ispis tkiva donosi nove mogućnosti u rekonstruktivnu praksu, a u bližoj budućnosti velika je vjerojatnost uporabe VR tehnologije u operacijama.Trauma, oncological resection, inflammation or congenital malformations are just some of the causes of oromandibular defects. The most common reason for oncological resection is squamous cell carcinoma of the oral cavity and oropharynx. The most common sites of squamous cell carcinoma of the oral cavity are the floor of the oral cavity and the tongue. Timely recognition of precancerous lesions and initial stages of tumors affects a better prognosis of the disease. To a greater or lesser extent, all these causes affect the aesthetic appearance of the face, as well as the function of the oral cavity. Complex head and neck defects have encouraged head and neck surgeons to think about reconstructing the oromandibular region as best as possible and which tissues are suitable for such reconstruction. First of all, it is important to classify oromandibular defects, regardless of whether they are congenital or acquired, according to the size of the resulting bone defect, but also the amount of missing soft tissue component, and try to assess the functional defects that may arise. The classifications facilitate the planning of reconstructive procedures and the selection of an adequate type of tissue for reconstruction. Of all composite free flaps, the fibular artery flap occupies the most important place in oromandibular reconstruction. Apart from that, good alternatives, and sometimes the primary choice for some defects, are the iliac crest flap, the subscapular artery flap and the osseous radial forearm flap. Today, CAD (computer-aided design) and CAM (computer-aided manufacturing) 3D technologies are used for reconstruction planning, more precise creation and shaping of bones, as well as adaptation of implants and prosthetics, which facilitates the mentioned aspects of reconstruction. In addition, this technology can plan and facilitate the selection of the right flap as an option for reconstructive procedures, but also enable a relatively satisfactory prediction of the patient's postoperative outcome. 3D-designed and precisely measured meshes and titanium plates can be made that serve as aids and prosthetics in reconstructive procedures. The development of tissue bioengineering techniques and tissue printing systems brings new possibilities to reconstructive practice, and soon there is a high probability of using VR technology in operations
Focal therapy of prostate cancer
No full textKarcinom prostate je najčešći dijagnosticirani maligni tumor muškaraca u više od polovine svjetskih zemalja, uključujući i Republiku Hrvatsku. Najčešće se otkriva u muškaraca starijih od 70 godina. Najvažniji rizični faktori za nastanak bolesti su dob pacijenta, obiteljska anamneza i stil života. Klinička slika karcinoma prostate je nespecifična i podudara se sa simptomatologijom drugih stanja poput benigne hiperplazije prostate i prostatitisa. Fizikalni pregled je ograničen i nije dovoljno specifičan niti osjetljiv za postavljanje dijagnoze. Krajem prošlog stoljeća u kliničku praksu se uvodi određivanje prostata specifičnog antigena (PSA) koji i danas ima značajnu ulogu u probiru pacijenata sa sumnjom na bolest. Preoperativna lokalizacija karcinoma prostate je od vitalne važnosti u svrhu određivanja terapijskog pristupa. Danas se za tu namjenu koriste radiološke metode i biopsija prostate. Trenutno, multiparametrijska magnetska rezonancija (mpMR) ima najveću osjetljivost i specifičnost od svih radioloških metoda u detekciji karcinoma prostate, dok se aktivno traga za novim ultrazvučnim tehnologijama kako bi se prebrodili nedostaci cijene i pristupačnosti magnetske rezonancije. Biopsija prostate je još uvijek zlatni standard u definitivnom postavljanju dijagnoze maligne bolesti. Krajnji ciljevi terapije karcinoma su osiguranje kontrole ili potpunog izlječenja bolesti, pri čemu se procjenjuje korist terapije naspram rizika progresije bolesti. Ideja fokalne terapije raka prostate proizašla je iz definiranja indeks lezije, budući da radikalne kirurške resekcije u većini slučajeva za sobom ostavljaju velike posljedice. Najvažniji cilj fokalne terapije prostate je smanjenje ukupne stope mortaliteta povezane s karcinomom prostate, a zatim i smanjenja morbiditeta uzrokovanog bilo samom bolešću ili onog povezanog s liječenjem, kao i unaprjeđenje ukupne kvalitete života oboljelih pacijenata. Tipovi fokalne terapije koji se koriste u kliničkoj praksi su : krioterapija, fokusirani ultrazvuk visokog inteziteta (HIFU), fotodinamska terapija (PDT), fokalna laserska ablacija (FLA) i ireverzibilna elektroporacija (IRE). Svaka od navedenih tehnika ima svoje prednosti i mane a poseban naglasak se stavlja na potrebu za provođenjem multicentričnih istraživanja čijim bi se rezultatima stručnjaci koristili u svrhu pisanja smjernica za pravilan odabir pacijenata i terapijskih metoda kako bi onkološki i funkcionalni ishodi bili što bolji.Prostate cancer is the most commonly diagnosed malignant tumor in men in more than half of the world's countries, including the Republic of Croatia. It is most often detected in men older than 70 years. The most important risk factors for the onset of the disease are the patient's age, family history and lifestyle. The clinical picture of prostate cancer is non-specific and coincides with the symptoms of other conditions such as benign prostatic hyperplasia and prostatitis. Physical examination is limited and not specific or sensitive enough to make a diagnosis. At the end of the last century, the determination of prostate specific antigen (PSA) was introduced into clinical practice, which still plays a significant role in the screening of patients with suspected disease. Preoperative localization of prostate cancer is of vital importance in order to determine the therapeutic approach. Today, radiological methods and prostate biopsy are used for this purpose. At the moment, multiparametric magnetic resonance (mpMR) has the highest sensitivity and specificity of all radiological methods in the detection of prostate cancer, while new ultrasound technologies are actively sought to overcome it's disadvantages of cost and accessibility. Prostate biopsies still remain the gold standard for definitive diagnosis of prostate cancer. The ultimate goals of cancer therapy are to ensure control or complete cure of the disease, weighing the benefit of therapy against the risk of disease progression. The idea of focal therapy came from defining the index lesion, since radical surgical resections in most cases leave behind major consequences. The most important goal of focal therapy is to reduce the overall mortality rate associated with prostate cancer, and to reduce the morbidity caused either by the disease itself or that associated with treatment, as well as improving the overall quality of life of affected patients. Types of focal therapy used in clinical practice are: cryotherapy, high intensity focused ultrasound (HIFU), photodynamic therapy (PDT), focal laser ablation (FLA) and irreversible electroporation (IRE). Each of the mentioned techniques has its advantages and disadvantages, while special emphasis is placed on the need to conduct multicenter researches, the results of which would be used by experts for the purpose of writing guidelines for the proper selection of patients and therapeutic methods in order to improve oncological and functional outcomes
Continued antibiotic prophylaxis in children with vesicoureteral reflux
No full textVezikoureteralni refluks (VUR) najčešća je kongenitalna anomalija mokraćnog sustava u dječjoj dobi, koja se obično dijagnosticira prilikom evaluacije djece s infekcijom mokraćnog sustava (engl. urinary tract infection, UTI). Zlatni standard za dijagnozu VUR-a je mikcijska cistouretrografija, premda se danas zbog izbjegavanja izlaganja ionizirajućem zračenju više koristi kontrastna mikcijska urosonografija. VUR je povezan s ponavljajućim infekcijama mokraćnog sustava (engl. recurrent urinary tract infection, rUTI) i bubrežnim ožiljkavanjem, odnosno refluksnom nefropatijom (RN). RN može rezultirati kroničnom bubrežnom bolešću s progresivnim opadanjem bubrežne funkcije, koja u konačnici zahtijeva bubrežnu nadomjesnu terapiju. Kirurškim i konzervativnim pristupom nastoje se spriječiti ove posljedice, međutim izbor optimalne terapije u djece s VUR-om usprkos brojnim istraživanjima još je uvijek uzrok kontroverzi. Kirurškim pristupom vršimo korekciju refluksa, dok profilaktičnom primjenom antibiotika (engl. continued antibiotic prophylaxis, CAP) nastojimo prevenirati UTI-je i tako zaštititi bolesnika od novog bubrežnog ožiljkavanja. S obzirom na veliku učestalost spontane rezolucije, osobito kod nižih stupnjeva VUR-a, opravdano je odlučiti se za konzervativni pristup, koji osim CAP-a uključuje i pomno praćenje. Multicentrične randomizirane kliničke studije na velikom broju ispitanika pokazale su značajnu korist CAP-a u prevenciji rUTI-ja. K tome, djeca s VUR-om i dodatnim rizičnim čimbenicima za rUTI, poput disfunkcije mokraćnog mjehura i crijeva, imaju još izraženiju korist od CAP-a, koji je preporučena terapija u toj populaciji. S druge strane, trenutno nema uvjerljivih dokaza da CAP može učinkovito spriječiti nastanak ili progresiju RN-a. K tome, CAP može dovesti do neželjenih pojava poput antimikrobne rezistencije i multirezistentnih bakterija. Stoga je potrebno prepoznati individualne čimbenike rizika u djeteta s VUR-om, procijeniti korist CAP-a naspram drugih intervencija te uključiti obitelj u zajedničko donošenje odluke o liječenju.Vesicoureteral reflux (VUR) is the most common congenital anomaly of the urinary tract in childhood, typically diagnosed during the evaluation of children with urinary tract infections (UTIs). The gold standard for diagnosing VUR is voiding cystourethrography, although to avoid radiation exposure, contrast enhanced urosonography is nowadays becoming the preferred method. VUR is associated with recurrent urinary tract infections (rUTIs) and renal scarring, also known as reflux nephropathy (RN). RN can lead to chronic kidney disease with progressive decline in renal function, ultimately requiring renal replacement therapy. Both surgical and conservative approaches aim to prevent these consequences; however, the choice of optimal therapy in children with VUR is a subject of considerable debate. Surgical intervention corrects the reflux, while continued antibiotic prophylaxis (CAP) aims to prevent UTIs and thus protect the patient from further renal scarring. Given the high rate of spontaneous resolution, particularly in lower grades of VUR, a conservative approach, including CAP and close monitoring, is justified. Multicentric randomized clincal trials with large cohorts have shown significant benefits of CAP in preventing rUTIs. Moreover, children with VUR and additional risk factors for rUTIs, such as bladder and bowel dysfunction, have even greater benefit from CAP, which is the recommended therapy for this population. On the other hand, there is currently no compelling evidence that CAP can effectively prevent the development or progression of RN. Additionally, CAP can lead to adverse effects such as antimicrobial resistance and multidrug-resistant bacteria. Therefore, it is essential to identify individual risk factors in children with VUR, assess the benefits of CAP against other interventions, and involve the family in the shared decision-making process regarding treatment
Visceral leishmaniasis
No full textVisceralna lišmanioza spada u zanemarene tropske bolesti (eng. NTD, Neglected tropical disease) i gorući je javnozdravstveni problem u slabije razvijenim zemljama. Još se naziva i kala-azar, odnosno crna bolest na hindski, jer može dovesti do crnosivog obojenja kože. Budući da neliječena uzrokuje smrtnonost u preko 95% slučajeva, liječenje bolesti je imperativ. Posebnu problematiku predstavlja dermalna sekvela bolesti pod nazivom post kala-azar dermalna lišmanioza. Naime, nakon izliječene visceralne lišmanioze moguć je razvoj dermalnih simptoma s odmakom koji varira od nekoliko mjeseci do par godina. Nije u potpunosti jasno nastaje li kao posljedica perzistencije parazita ili reinfekcije, no pacijenti s ovim oblikom bolesti predstavljaju važan izvor infekcije i time otežavaju eliminaciju bolesti. Osim toga, bilježi se i porast HIV-VL koinfekcije koju karakteriziraju učestali relapsi i slabiji odgovor na terapiju. Iako je u nekim zemljama postignut značajan napredak u kontroli bolesti, klimatske promjene, siromaštvo i brojne migracije pogoduju opstanku Leishmania spp., stoga su potrebni daljnji napori ne bi li se spriječilo širenje bolesti i uspostavila kontrola u endemskim zemljama.Visceral leishmaniasis is categorized as a neglected tropical disease (NTD) and represents critical public health issue in less developed countries. It is also known as kala-azar, or black sickness in Hindi, because it can lead to black or gray discoloration of the skin. Due to the fact that untreated cases result in a mortality rate of over 95%, treating the disease is a necessity. Another important issue is the dermal sequela of the disease called post-kala-azar dermal leishmaniasis. After being cured of visceral leishmaniasis, dermal symptoms may develop, with an onset ranging from several months to a few years. It is still not clear whether this occurs as a result of persistent parasites or reinfection, but patients with this form of the disease represent an important source of infection and consequently complicating efforts to eliminate the disease. Moreover, rises in HIV-VL co-infection are being recorded, recognizible by frequent relapses and a poor outcome to treatment. Although meaningful progress has been made in some countries in controlling the disease, climate change, poverty, and numerous migrations favor the survival of Leishmania spp., further efforts are needed in order to stop the spreading of the disease and for gaining control over the disease in endemic countries