Veterinary medicine - Repository of PHD, master's thesis
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The impact of night shift work on the health of nurses
No full textZdravstvena zaštita u Republici Hrvatskoj organizirana je na primarnoj, sekundarnoj, tercijarnoj te razini zdravstvenih zavoda. Većina medicinskih sestara i tehničara radi na sekundarnoj i tercijarnoj razini koja uključuje kontinuiranu 24-satnu skrb te je iz tog razloga i najveći broj medicinskih sestara i tehničara izloženo utjecaju noćnog rada. Noćni rad utječe na zdravlje na način da dovodi do deprivacije sna, umora, rizika za psihičke i fizičke smetnje te bolesti, ali i poremećaje u socijalnom i obiteljskom životu. Pretražene su 3 baze podataka: Pubmed, Google scholar i Proquest; kriterij za odabir bio je sustavni pregled literature i meta analiza, a u obzir su dolazili samo članci na engleskom jeziku. Pregled literature rađen je prema PRISMA smjernicama, kvaliteta članaka ocijenjena je AMSTAR-R instrumentom za ocjenjivanje, pouzdanost između ocjenjivača napravljena je Cohenovim kappa koeficijentom, a kako bi se utvrdilo preklapanje korištene literature korištena je metoda ispravljenog pokrivenog područja (eng. Corrected Covered Area (CCA)). Pregledom sustavnih pregleda i meta analiza, rezultati prikazani u ovom radu dobiveni su iz 8 istraživanja od kojih su 3 sistematski pregled, a 5 meta analize, objavljivani između 2013. i 2021. godine iz različitih dijelova svijeta (Europa, Azija, Amerika, Australija, Afrika). Istraživanja su pokazala da noćni rad utječe na san medicinskih sestara u smislu smanjenja njegove kvalitete te na samo zdravlje u smislu povećanja rizika od povećane težine, razvoja metaboličkog sindroma, dijabetesa tipa 2, kardiovaskularnih bolesti, karcinoma dojke, bolova u leđima te povećanja unosa alkohola. Osim utjecaja na san i zdravlje medicinskih sestara, noćni rad može dovesti i do drugih rizika kako za medicinske sestre poput rizika od ubodnih incidenata, ozljeda i bolova, psihičkih i emocionalnih smetnji, željom za odlaskom te automobilskih nesreća, tako i za krajnje korisnike zdravstvene zaštite, a to su pacijenti, a odnose se na rizik od pogrešne administracije lijekova, dekubitusa, hipoglikemije, urinarne infekcije te bolničke infekcije. Potrebna su dodatna istraživanja povezana s problematikom noćnog rada kako za same rizike koje on donosi tako i za utjecaj potencijalnih rješenja na iste. Osim toga, potrebna je trajna edukacija medicinskih sestara o ovom problemu kako bi se na vrijeme prepoznale posljedice, na njih pravovremeno reagiralo te na taj način smanjile dugoročne posljedice na zdravlje. Nužno je i kontinuirano praćenje zdravstvenog stanja te poboljšanje radnih uvjeta u skladu s procjenom rizika pojedinog radilišta.Health care in the Republic of Croatia is organized at the primary, secondary, tertiary and health care institutions. Most nurses and technicians work at the secondary and tertiary levels, which includes continuous 24-hour care, and for this reason most nurses and technicians are exposed to night work. Night work affects health in a way that leads to sleep deprivation, fatigue, risk of mental and physical disorders and illnesses, but also disturbances in social and family life. 3 databases were searched: Pubmed, Google scholar and Proquest, the selection criteria were a systematic review of the literature and meta-analyzes, and only articles in English were considered. The literature review was performed according to PRISMA guidelines, the quality of the articles was evaluated by the AMSTAR-R evaluation instrument, the reliability between evaluators was made by the Cohen kappa coefficient, and the Corrected Covered Area (CCA) method was used to determine the overlap of the used literature. )). A review of systematic reviews and meta-analyzes, the results presented in this paper were obtained from 8 studies, 3 of which are systematic reviews, and 5 meta-analyzes, were published between 2013 and 2021 from different parts of the world (Europe, Asia, America) , Australia, Africa). Research has shown that night work affects nurses' sleep in terms of reducing its quality, and health itself in terms of increasing the risk of weight gain, developing metabolic syndrome, type 2 diabetes, cardiovascular disease, breast cancer, back pain and increasing alcohol intake. In addition to the impact on nurses' sleep and health, night work can lead to other risks for nurses, such as the risk of needlestick incidents, injuries and pain, mental and emotional disturbances, the desire to leave and car accidents, and for end users of health care, which are patients, risk of mismanagement of drugs, pressure ulcers, hypoglycemia, urinary tract infections and nosocomial infections. Additional research is needed related to the issue of night work, both with the risks it brings and the impact of potential solutions on them. Continuous education of nurses on this problem is needed in order to timely recognize the consequences of responding to them in a timely manner and thus reduce long-term health consequences. It is also necessary to continuously monitor the health condition and improve working conditions in accordance with the risk assessment of each site
mef.hr (tema broja: Inovacije u medicini)
No full textlist Medicinskog fakulteta Sveučilišta u Zagrebu (prosinac 2024 / godina 43, br. 2
Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study
No full textBackground: During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe.
Methods: Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity.
Results: Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy.
Conclusions: The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics
Assessment of the Attitudes of the 6th Year Medical Students about Human Sexuality
No full textUvod: edukacija o ljudskoj seksualnosti predstavlja stalni izazov za sve faze obrazovanja u Republici Hrvatskoj. Procjena potreba i mogućnosti edukacije na diplomskom studiju medicine postaje sve važnija porastom pojavnosti seksualnih problema i proširenjem terapijskih mogućnosti medicinskih intervencija na planu ljudske seksualnosti.
Cilj rada: cilj rada je utvrditi stavove studenata VI. godine Medicinskog fakulteta Sveučilišta u Zagrebu o seksualnosti te ih usporediti sa znanstveno utvrđenim činjenicama.
Ispitanici i metode: istraživanje je obuhvatilo gotovo sve studente VI. godine Medicinskog fakulteta Sveučilišta u Zagrebu tijekom zimskog semestra akademske godine 2019./20. Provela ga je autorica rada prilikom održavanja kolegija Obiteljske medicine pri čemu je ispitanicima/studentima ponuđen upitnik od 15 pitanja s odgovorima točno/netočno. U analizi rezultata je korištena programska podrška STATISTICA, vers. 10.0.
Očekivani doprinos: istraživanjem se želi steći uvid u potencijalne edukacijske potrebe studenata VI. godine medicine o ljudskoj seksualnosti u svrhu implementacije seksualne edukacije na studij medicine s ciljem poboljšanja seksualnog i reproduktivnog zdravlja stanovništva.Introduction: education related to human sexuality remains constant challenge during the whole period of the formal education process. Assessment of the undergraduate medicine students’ educational needs related to sexuality is important in time when medical doctors are more often confronted with the patients' sexual problems in their everyday practice.
Aim of study: to get the insight into the attitudes of the 6th year medical students on the selected topics related to the human sexuality and to compare it with the evidence-based medicine facts.
Respondents and Methods: the survey covered all the 6th year students of the School of Medicine, University of Zagreb during the winter semester of the academic year 2019/20. It was conducted by the author of the thesis during a Family Medicine course, whereby the included respondents/students were offered a questionnaire composed of 15 questions, with the with true/false answers. The STATISTICA software, vers. 10.0 was used in the results analyses.
Expected contribution: to gain insights into the educational needs of the 6th year medical students about the human sexuality with the purpose of the implementation of the sexual education in the medical faculties in order to improve the sexual and the reproductive health of the population
Equivalent: Microbial causative agents and their antimicrobial susceptibility patterns in chronic rhinosinusitis – impact on antibiotic prophylaxis and treatment
No full textKronični rinosinuitis (KRS) je iscrpljujuće stanje koje čini upala nosne sluznice i sluznice paranazalnih sinusa, a zahtjeva konzervativnu i, ponekad, kiruršku terapiju. Funkcionalna endoskopska operacija sinusa je kirurška procedura koja se primjenjuje za KRS. Tijekom takve procedure može se vršiti i druga dodatna dijagnostika. Prije samog zahvata provodi se preoperativna antibiotska profilaksa. U tom slučaju, empirijski aplicirana antibiotska terapija treba pokrivati najčešće mikrobne uzročnike za navedeno stanje.
Cilj ove studije bio je identificirati mikrobne uzročnike izolirane iz sino-nazalnih šupljina kod pacijenata koji su bili podvrgnuti endoskopskoj operaciji sinusa te im odrediti bakterijsku osjetljivost kako bi se dobiveni podaci mogli potom usporediti s trenutno važećim smjernicama za antibiotsko liječenje i perioperativnu antibiotsku profilaksu. Provedeno je retrospektivno kohortno istraživanje na 456 uzoraka prikupljenih od 2016. do 2019. godine u sklopu Klinike za otorinolaringologiju i kirurgije glave i vrata i Zavoda za mikrobiologiju, parazitologiju i hospitalne infekcije na Kliničkoj bolnici Sestara milosrdnica u Zagrebu.
Najčešće izolirani patogeni bili su Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. i Haemophilus influenzae. Prema dobivenim antibiogramima može se zaključiti da je empirijska terapija amoksicilin-klavulanskom kiselinom za ove uzročnike zadovoljavajuća. Međutim, primjena metronidazola empirijski ili za preoperativnu kiruršku profilaksu se ne preporučuje zbog visokog udjela rezistencije na navedeni antibiotik unutar skupine anaerobnih bakterija.Chronic rhinosinusitis (CRS) is debilitating condition comprising inflammation of the mucosa of the nasal and paranasal sinuses, requiring conservative and often surgical treatment. Functional endoscopic sinus surgery (FESS) is a CRS treatment during which a microbiological diagnostic procedure may be conducted. Preoperative antibiotic prophylaxis is administrated before FESS. When indicated, the administered empiric antibiotic therapy must cover most common causing microbial agents. The aims of this study were to identify microbial pathogens isolated from sinonasal cavities in patients undergoing endoscopic sinus surgery, to determine bacterial antibiotic susceptibility patterns and compare them with guidelines for treatment and perioperative prophylactic use of antimicrobial agents. A retrospective cohort study on 456 samples collected between 2016 and 2019 was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Microbiology, Parasitology and Hospital Infections in the Clinical University Centre Sestre milordnice, Zagreb. The most common isolated pathogens were Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. and Haemophilus influenzae. According to antibiotic susceptibility patterns, empiric antibiotic treatment with amoxicillin-clavulanic acid was appropriate. Due to high rates of antibiotic resistance of anaerobic bacterial isolates to metronidazole, it cannot be recommended in empirical antibiotic treatment or preoperative surgical antibiotic prophylaxis
Deoxyguanosine kinase deficiency: natural history and liver transplant outcome
No full textAutosomal recessive pathogenetic variants in the DGUOK gene cause deficiency of deoxyguanosine kinase activity and mitochondrial deoxynucleotides pool imbalance, consequently, leading to quantitative and/or qualitative impairment of mitochondrial DNA synthesis. Typically, patients present early-onset liver failure with or without neurological involvement and a clinical course rapidly progressing to death. This is an international multicentre study aiming to provide a retrospective natural history of deoxyguanosine kinase deficient patients. A systematic literature review from January 2001 to June 2023 was conducted. Physicians of research centres or clinicians all around the world caring for previously reported patients were contacted to provide followup information or additional clinical, biochemical, histological/histochemical, and molecular genetics data for unreported cases with a confirmed molecular diagnosis of deoxyguanosine kinase deficiency. A cohort of 202 genetically confirmed patients, 36 unreported, and 166 from a systematic literature review, were analyzed. Patients had a neonatal onset (≤ 1 month) in 55.7% of cases, infantile (>1 month and ≤ 1 year) in 32.3%, pediatric (>1 year and ≤18 years) in 2.5% and adult (>18 years) in 9.5%. Kaplan-Meier analysis showed statistically different survival rates (P < 0.0001) among the four age groups with the highest mortality for neonatal onset. Based on the clinical phenotype, we defined four different clinical subtypes: hepatocerebral (58.8%), isolated hepatopathy (21.9%), hepatomyoencephalopathy (9.6%), and isolated myopathy (9.6%). Muscle involvement was predominant in adult-onset cases whereas liver dysfunction causes morbidity and mortality in early-onset patients with a median survival of less than 1 year. No genotype–phenotype correlation was identified. Liver transplant significantly modified the survival rate in 26 treated patients when compared with untreated. Only six patients had additional mild neurological signs after liver transplant. In conclusion, deoxyguanosine kinase deficiency is a disease spectrum with a prevalent liver and brain tissue specificity in neonatal and infantile-onset patients and muscle tissue specificity in adult-onset cases. Our study provides clinical, molecular genetics and biochemical data for early diagnosis, clinical trial planning and immediate intervention with liver transplant and/or nucleoside supplementation
Supramolecular Solid Complexes between Bis-pyridinium-4-oxime and Distinctive Cyanoiron Platforms
No full textThe structural features and optical properties of supramolecular cyanoiron salts containing bis-pyridinium-4-oxime Toxogonin® (TOXO) as an electron acceptor are presented. The properties of the new TOXO-based cyanoiron materials were probed by employing two cyanoiron platforms: hexacyanoferrate(II), [Fe(CN)6]4– (HCF); and nitroprusside, [Fe(CN)5(NO)]2– (NP). Two water-insoluble inter-ionic donor–acceptor phases were characterized: the as-prepared microcrystalline reddish-brown (TOXO)2[Fe(CN)6]·8H2O (1a) with a medium-responsive, hydrochromic character; and the dark violet crystalline (TOXO)2[Fe(CN)6]·3.5H2O (1cr). Complex 1a, upon external stimulation, transforms to the violet anhydrous phase (TOXO)2[Fe(CN)6] (1b), which upon water uptake transforms back to 1a. Using the NP platform resulted in the water-insoluble crystalline salt TOXO[Fe(CN)5(NO)]·2H2O (2). The structures of 1cr and 2, solved by single-crystal X-ray diffraction, along with a comparative spectroscopic (UV–vis–NIR diffuse reflectance, IR, solid-state MAS-NMR, Mössbauer), thermal, powder X-ray diffraction, and microscopic analysis (SEM, TEM) of the isolated materials, provided insight for the supramolecular binding, electron-accepting, and H-bonding capabilities of TOXO in the self-assembly of these functionalized materials
Low Level of First Morning Urine Cardiac Troponin I: A Specific Hallmark of Aortic Stenosis Severity
No full textBackground: It has recently been shown that cardiac-specific troponin I concentrations in first morning urine samples can be measured with commercially available tests. Due to their accumulation in the first morning urine, scientific papers indicate a potential predictive value for cardiovascular diseases. Therefore, the aim of this study was to compare the concentration of cardiac troponin I in the first morning urine in patients with severe aortic stenosis and the healthy population.
Patients and Methods: Blood and first morning urine samples were collected from 34 healthy individuals (17 female) at University Hospital Merkur and 25 patients with severe aortic stenosis (14 female) before surgical treatment at University Hospital Dubrava. Cardiac troponin I and T values were determined using high-sensitivity assays using commercially available Abbott and Roche tests.
Results: Patients with severe aortic stenosis had significantly lower troponin I concentrations in the first morning urine samples (0.3 ng/L (0.1–0.6)) as compared to the healthy population (15.2 ng/L (8.4–19.9)) (p < 0.001). There was no statistically significant difference in troponin T concentrations between healthy individuals and patients with severe aortic stenosis. In parallel, both I and T plasma troponin concentrations were significantly higher in patients with severe aortic stenosis. Conclusions: In patients with severe aortic stenosis, cardiac troponin I values in the first morning urine are significantly lower than in healthy subjects
Pseudokidney Sign in Gastric Cancer
No full textPseudokidney sign (PKS) is a characteristic sonographic finding of an abnormal mass with a reniform appearance, and a hyperechoic central region surrounded by a hypoechoic area. It has been seldom documented in gastric cancer. A 75-year-old male patient presented with a palpable abdominal resistance in the left upper abdominal quadrant and ultrasound evaluation revealed a well-vascularized mass presenting with PKS. Regional lymphadenopathy was also found, and the working diagnosis of gastric cancer was established. The suspected diagnosis was later verified endoscopically and on pathohistological examinations as gastric adenocarcinoma. Computed tomography staging also revealed distant metastases to the lungs, liver, and adrenal glands and abdominal lymphadenopathy. The PKS often indicates gastrointestinal pathology, and it may be seen in benign and malignant conditions due to gastrointestinal wall thickening. Therefore, additional diagnostic examinations are advised for a more definite diagnosis
Ethical implications of COVID-19 management—is freedom a desired aim, or a desired means to an end?
No full textMost developed societies managed, due to their prosperity and resource abundance, to structure relationships among free individuals in such a way to leave them fundamentally unstructured, according to the free market principle. As the pandemic illustrated well, this lack of structure when facing collective threats makes it impossible to collectively and proportionately assess and manage its implications and consequences. This may be particularly precarious when introducing comprehensive, monitoring and tracking, surveillance systems dependent on the vaccination status of the individual. If our previously shared aims were successfully and collectively enacted with the greatest of costs, is it permissible that the degree of personal freedom is a commodity, and everyone is a compulsory participant? The need to control one’s COVID-19 status allows the individual to become legally free from excessive enactment of sovereignty of the state. Should these rights be regulated by the free market