Veterinary medicine - Repository of PHD, master's thesis
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Update in gastric cancer carcinogenesis
No full textRak želuca je nekoć bio drugi najčešći rak u svijetu, no stope incidencije su značajno smanjene zahvaljujući poboljšanim sanitarnim uvjetima, upotrebi antibiotika i povećanoj konzumaciji svježeg voća i povrća. Unatoč tome, rak želuca ostaje izazovan za liječenje u zapadnim zemljama gdje se često dijagnosticira u uznapredovaloj fazi. Glavna zapažanja rada uključuju identificiranje ključnih genetskih mutacija poput TP53, CDH1 i PIK3CA, koje igraju ključnu ulogu u razvoju i progresiji karcinoma želuca. Autor također ističe važnost epigenetskih promjena poput metilacije DNA i modifikacija histona koje doprinose deregulaciji gena bitnih za staničnu proliferaciju i preživljavanje. Uloga signalnih putova kao što su Wnt/beta-kateninski i Hedgehog također je značajna u regulaciji staničnih procesa poput proliferacije, diferencijacije i apoptoze. Mikrookolina tumora, uključujući mikrobiom i imunosne stanice, također ima važnu ulogu u progresiji bolesti, gdje kronična upala uzrokovana infekcijom bakterijom H. pylori može dovesti do oštećenja stanica i genetskih mutacija. Autor naglašava da unatoč napretku u razumijevanju molekularnih mehanizama, rak želuca ostaje izazov za liječenje. Poboljšanja u terapijskim pristupima, uključujući ciljane terapije i imunoterapiju, te daljnje istraživanje genetskih i epigenetskih promjena ključni su za unapređenje liječenja i prognoze pacijenata s ovom bolešću.Gastric cancer was once the second most common cancer in the world, but the incidence rates have significantly decreased due to improved sanitary conditions, the use of antibiotics and increased consumption of fresh fruits and vegetables. Nevertheless, gastric cancer remains challenging to treat in Western countries where it is often diagnosed at an advanced stage. The main findings of the study include the identification of key genetic mutations such as TP53, CDH1, and PIK3CA, which play a crucial role in the development and progression of gastric cancer. The author also emphasizes the importance of epigenetic changes such as DNA methylation and histone modifications that contribute to the deregulation of genes essential for cell proliferation and survival. The role of signaling pathways like Wnt/beta-catenin and Hedgehog is also significant in regulating cellular processes such as proliferation, differentiation, and apoptosis. The tumor microenvironment, including the microbiome and immune cells, also plays an important role in disease progression, where chronic inflammation caused by H. pylori infection can lead to cell damage and genetic mutations. The author highlights that despite advancements in understanding the molecular mechanisms, gastric cancer remains a challenge to treat. Improvements in therapeutic approaches, including targeted therapies and immunotherapy, as well as further research into genetic and epigenetic changes, are crucial for improving the treatment and prognosis of patients with this disease
Induction of labour
No full textIndukcija vaginalnog porođaja (IOL) čest je medicinski postupak u porodništvu, s rastućom učestalošću diljem svijeta. Razlozi za ovaj porast uključuju promjene u populaciji trudnica, neujednačene smjernice i rastuću primjenu elektivnih indukcija. Iako mehanizmi početka porođaja nisu potpuno razjašnjeni, znanstvenici smatraju da ključnu ulogu igraju fiziološki i hormonski signali zrelog fetusa, koji potiču upalne procese i kontrakcije maternice.
Indikacije za indukciju uključuju prenošenje trudnoće, hipertenziju, preeklampsiju, dijabetes, intrauterini zastoj rasta (IUGR) i intrauterinu smrt ploda.
Važan korak u procesu indukcije je pravilna preindukcijska procjena, koja uključuje ocjenu stanja fetusa i trudnice te zrelost cerviksa putem Bishopovog indeksa. Ako je cerviks nezreo, preindukcijski postupci poput primjene prostaglandina i mehaničkih metoda (osmotski dilatatori, balonski kateteri) mogu pomoći u sazrijevanju cerviksa. Kada je cerviks zreo, indukcija se često provodi primjenom oksitocina ili amniotomijom.
Odabir metode ovisi o specifičnim okolnostima i stanju trudnice. Oksitocin je brz, ali može povećati rizik od carskog reza i hiperstimulacije maternice. Prostaglandini, poput dinoprostona i mizoprostola, učinkoviti su u sazrijevanju cerviksa, dok mehaničke metode poput Foleyeva katetera i osmotskih dilatatora nude sigurnije alternative s manjim rizikom od komplikacija. Ključne komplikacije uključuju tahisistoliju i moguće poremećaje srčanog ritma fetusa, osobito kod primjene prostaglandina i oksitocina.Induction of labour (IOL) is a common medical procedure in obstetrics, with increasing prevalence worldwide. This rise is attributed to changes in the population of pregnant women, inconsistent guidelines, and the growing use of elective inductions. Although the mechanisms of labour initiation are not fully understood, it is believed that physiological and hormonal signals from the mature fetus play a crucial role, stimulating inflammatory processes and uterine contractions.
Indications for induction include post-term pregnancy, hypertension, preeclampsia, diabetes, intrauterine growth restriction (IUGR), and intrauterine fetal demise.
A critical step in the induction process is a proper pre-induction assessment, which involves evaluating the fetal and maternal condition as well as cervical maturity using the Bishop score. If the cervix is immature, pre-induction methods such as prostaglandin application and mechanical methods (osmotic dilators, balloon catheters) can assist in cervical ripening. Once the cervix is mature, induction is often carried out using oxytocin or amniotomy.
The choice of method depends on specific circumstances and the condition of the pregnant woman. Oxytocin is fast-acting but may increase the risk of cesarean delivery and uterine hyperstimulation. Prostaglandins, such as dinoprostone and misoprostol, are effective in cervical ripening, while mechanical methods like Foley catheters and osmotic dilators offer safer alternatives with a lower risk of complications. Key complications include tachysystole and potential fetal heart rate abnormalities, particularly with the use of prostaglandins and oxytocin
Trevor disease
No full textTrevorova bolest, poznata i kao dyspasia epiphysialis hemimelica (DEH) rijetka je nenasljedna bolest koja zahvaća epifize dugih kostiju te histološki nalikuje na osteohondrom. Opisana incidencija bolesti je 1:1000000, a neki autori navode kako je incidencija vjerojatno i veća, ali se slučajevi pogrešno klasificiraju kao osteohondromi i slični entiteti. Smatra se bolešću dječje dobi, iako postoje sporadični slučajevi ove bolesti u odraslih osoba. Glavno patološko zbivanje u Trevorovoj bolesti jest bezbolna koštana izraslina koja zahvaća dio zgloba, lokalizirano uz epifizu jedne ili obje zglobne kosti. Izraslina je najčešće smještena u gležnju, koljenu ili kuku. U nekih pacijenata pristune su multiple koštane izrasline, bilo na istom ili različitim udovima. Trenutno nisu poznati okolišni i genetski čimbenici bolesti te su mjereni parametri u Trevorove bolesti potpuno jednaki vrijednostima pronađenima u zdravom tkivu. U literaturi nema opisanih slučajeva maligne alteracije. Pri dijagnostici bolesti ključno je tražiti znakove Trevorove bolesti, a oni su asimetrija, smanjena pokretljivost i deformitet zgloba. Nakon pronalaženja istih, koristi se jednu ili više radioloških tehnika od kojih su najkorisniji rendgenogram, kompjuterizirana tomografija i magnetska rezonancija. Po vizualizaciji lezije, odabire se terapijski pristup koji, ovisno o radiološkom i kliničkom nalazu, može biti konzervativne ili kirurške naravi. Uz ranu dijagnozu i tretman moguće je izbjeći komplikacije poput invaliditeta uzrokovanog neadekvatnom mehanikom zglobova ili osteoartritisa. Oporavak je nakon tretmana relativno brz, s jednim od opisanih slučajeva oporavka od samo 28 dana. Obzirom na pedijatrijsku dob oboljelih, plastičnost skeletalnog sustava uvelike doprinosi dobrim rezultatima i brzini oporavka.Trevor disease, also known as dysplasia epiphysialis hemimelica (DEH) is a rare non-hereditary disease affecting the epiphyses of long bones. Histologically, it resembles osteochondromal tissue. Described incidence rate of the disease is 1:1000000, with some authors claiming higher incidence rate in reality due to probably misdiagnosed cases classified as osteochondromas or other similar entities. It is considered a disease of pediatric age population, even though there are sporadic cases of the disease among adults. The main pathological finding in Trevor disease is a painless bone growth affecting a part of the joint, localized along the epiphysis of one or both articular bones. The growth is commonly found in the ankle, the knee or the hip. In some patients, multiple bone growths are present, either along the same or different limbs. Currently, there are no known envirnomental and genetic factors with measured parameters in Trevor disease being completely equal to the values found in healthy tissue. There are no described cases of malignant alteration in the literature. Diagnostic-wise, it is crucial to look for the signs of Trevor disease – asymmetry, impaired mobility and joint deformity. After finding those signs, one or more radiology tehniques are used with the most useful being x-ray, computerized tomography and magnetic resonance imaging. After the lesion is visualized, a thearapeutic approach is chosen, either conservative or surgical, depending on both radiological and clincal findings. With early diagnosis and treatment it is possible to avoid complications like disability caused by impaired mobility of the joint or osteoarthritis. Recovery after the treatment is relatively fast, with one of the described cases stating only 28 days. Considering the pediatric age of the affected, plasticity of the skeletal system greatly contributes to the good results and fast recovery time
Prophylactic therapy of migraine headaches
No full textMigrena je neurološka bolest koja se manifestira jakom, pulsirajućom boli u trajanju od 4 do 72 sata, često popraćenom simptomima poput mučnine, povraćanja, fotofobije i fonofobije. Prema globalnom istraživanju opterećenosti bolestima, migrena je drugi najčešći neurološki poremećaj na svijetu s većom prevalencijom kod žena i uzrokuje veću invalidnost nego svi drugi neurološki poremećaji zajedno. Točan uzrok migrene nije poznat, no smatra se da je kompleksnost ove bolesti posljedica interakcije genetskih i okolišnih čimbenika, stila života i navika, te združenog pretjeranog odgovora aktivacije neuroloških i vaskularnih struktura na pojedine čimbenike. Prema današnjim saznanjima, ključ u patofiziologiji migrene je aktivacija trigeminovaskularnog sustava i lučenje CGRP peptida s posljedičnom neurogenom inflamacijom i dilatacijom intrakranijskih krvnih žila. Dijagnoza migrene postavlja se na temelju kliničke slike i simptoma, te se sukladno kriterijima Medunarođnog društva za glavobolju (engl. International Headache Society) svrstava u odgovarajuću klasifikaciju. Prema prepoukama Europske federacije neuroloških društava (engl. European Federation of Neurological Societies), terapija je usmjerena na abortivno i profilaktičko liječenje. Profilaktička terapija podijeljena je na farmakološke i nefarmakološke opcije, čijom se združenom primjenom može unaprijediti cjelokupni proces liječenja. Farmakološka terapija može se podijeliti na nespecifičnu u kojoj se primjenjuju lijekovi koji izvorno nisu razvijeni za liječenje migrene, ali su pokazali određenu razinu učinkovitosti, te specifičnu, u koju se ubrajaju CGRP antagonisti. Riječ je o skupini lijekova koja je posljednjih godina prošla kroz pravu revoluciju. Razvoj novih lijekova ciljanih za liječenje migrene pokazao je obećavajuće rezultate, kako u terapiji, tako i u sigurnosti primjene.Migraine is a neurological disease characterized by intense, pulsating pain lasting from 4 to 72 hours, often accompanied by symptoms such as nausea, vomiting, photophobia, and phonophobia. According to the Global Burden of Disease survey, migraine is the second most common neurological disorder in the world, with a higher prevalence in women, causing more disability than all other neurological disorders combined. The exact cause of migraine is unknown, but it is believed that the complexity of this disease results from the interaction of genetic and environmental factors, lifestyle and habits and the combined excessive response of neurological and vascular structures to certain triggers. Current knowledge suggests that the key to the pathophysiology of migraine lies in the activation of the trigeminovascular system and the release of CGRP peptide, leading to neurogenic inflammation and dilation of intracranial blood vessels.
Migraine is diagnosed based on clinical presentation and symptoms and is classified according to the criteria of the International Headache Society (IHS). According to the recommendations of the European Federation of Neurological Societies (EFNS), treatment is focused on both abortive and prophylactic management. Prophylactic therapy is divided into pharmacological and non-pharmacological options, with their combined use potentially enhancing the overall treatment process. Pharmacological therapy can be further divided into non-specific, where medications not originally developed for migraine treatment are used but have shown some efficacy, and specific, which includes CGRP antagonists. This group of drugs has undergone a significant revolution in recent years. The development of new drugs specifically targeted for migraine treatment has shown promising results in both efficacy and safety
Recurrent spontaneous abortions
No full textDefinicija ponavljanih spontanih pobačaja nije jedinstveno prihvaćena, a prema većini smjernica stručnih društava ona se odnosi na gubitak tri ili više trudnoća prije 24. tjedna gestacije. Ovo stanje pogađa oko 1-2% parova koji pokušavaju začeti, što ga čini značajnim problemom reproduktivnog zdravlja. Mogu imati različite uzroke, uključujući genetske, strukturalne, hormonske, autoimunosne, infektivne i uzroke povezane s načinom života. Genetski uzroci često uključuju kromosomske abnormalnosti kod jednog ili oba roditelja. Strukturne abnormalnosti maternice, poput septuma, mioma ili adhezija, također mogu dovesti do ponavljanih spontanih pobačaja. Hormonske neravnoteže, uključujući poremećaje štitnjače i defekt lutealne faze, značajni su čimbenici. Autoimunosne bolesti, poput antifosfolipidnog sindroma, i određene infekcije dodatno povećavaju rizik. Povećana dob majke, pušenje, pretjerana konzumacija alkohola i pretilost dodatni su čimbenici rizika. Dijagnoza uključuje sveobuhvatnu evaluaciju oba partnera te uzimanje detaljne opstetričke anamneze, fizikalni pregled, genetsko testiranje (kariotipizacija) za identifikaciju kromosomskih abnormalnosti i slikovne studije kao što su ultrazvuk i histeroskopija za otkrivanje abnormalnosti maternice. Krvni testovi provode se radi procjene razine hormona i funkcije imunološkog sustava. Strategije liječenja prilagođene su uzroku. Strukturalne abnormalnosti mogu zahtijevati kirurške intervencije, poput histeroskopske resekcije septuma maternice ili mioma. Hormonske neravnoteže liječe se hormonskom terapijom, poput suplementacije progesteronom. Autoimunosne bolesti često zahtijevaju antikoagulanse, primjerice niske doze aspirina ili heparina. Ključne su promjene načina života, uključujući prestanak pušenja, smanjenje unosa alkohola i postizanje zdrave tjelesne težine. U slučajevima genetskih abnormalnosti, mogu se razmatrati opcije poput preimplantacijskog genetskog testiranja ili donorskih gameta. Prognoza za parove s ponavljanim spontanim pobačajima varira, ali mnogi postižu uspješne trudnoće uz odgovarajuće liječenje i podršku. Bitno je kontinuirano praćenje i multidisciplinarni pristup koji uključuje opstetričare, genetičare i reproduktivne specijaliste. Ponavljani spontani pobačaji su složeno i emocionalno izazovno stanje koje zahtijeva temeljitu evaluaciju i individualizirano liječenje.Definition of recurrent spontaneous abortions isn’t universally recognized, however, most professional associations define it as a loss of three or more pregnancies before the 24th week of gestation. It affects about 1-2% of couples trying to conceive. Causes include genetic, structural, hormonal, autoimmune, infectious and lifestyle-related factors. Genetic causes often involve chromosomal abnormalities in one or both parents. Structural abnormalities of the uterus, such as septum, fibroids or adhesions, can also lead to recurrent spontaneous abortions. Hormonal imbalances, including thyroid disorders and luteal phase defects, are significant contributors. Autoimmune conditions such as antiphospholipid syndrome and certain infections further increase the risk. Advanced maternal age, smoking, excessive alcohol consumption and obesity are additional risk factors. Diagnosing recurrent spontaneous abortions includes a comprehensive evaluation of both partners. This involves a detailed medical history, physical examination, genetic testing (karyotyping) to identify chromosomal abnormalities and imaging studies such as ultrasound and hysteroscopy to detect uterine abnormalities. Blood tests are conducted to assess hormone levels and immune function. Treatment strategies are tailored to the underlying cause. Structural abnormalities may require surgical interventions, such as hysteroscopic resection of a uterine septum or fibroids. Hormonal imbalances are managed with hormone therapy, such as progesterone supplementation. Autoimmune disorders often require anticoagulants, such as low-dose aspirin or heparin. Lifestyle modifications, including smoking cessation, reducing alcohol intake and achieving a healthy weight, are crucial. In cases of genetic abnormalities, options like preimplantation genetic testing or donor gametes may be considered. The prognosis for couples varies, but many achieve successful pregnancies with appropriate treatment and support. Continuous monitoring and a multidisciplinary approach involving obstetricians, geneticists, and reproductive specialists are essential. Recurrent spontaneous abortions are a complex and emotionally challenging condition requiring thorough evaluation and individualized treatment
Medication adherence in patients with cardiovascular disease
No full textAdherencija na lijekove definira se kao stupanj do kojeg pacijenti slijede propisanu terapiju. Dosadašnja istraživanja su pokazala da je slaba adherencija značajan problem u kardiovaskularnoj skrbi, što značajno utječe na zdravstvene ishode. Ovaj rad istražuje i uspoređuje adherenciju na tri grupe kardiovaskularnih lijekova – antihipertenzive, hipolipemike i hipoglikemike u odraslih bolesnika s poznatom koronarnom bolesti. Kohorta pacijenata koja je uzeta u istraživanje je dio uključenih pacijenata iz
Kliničkog bolničkog centra Zagreb u međunarodni EUROASPIRE IV i EUROASPIRE V registar koji su provođeni u različitim vremenskim intervalima (EUROASPIRE IV 2012. 2014.; EUROASPIRE V 2016.-2018.). Iz svakog registra je analizirano 50 pacijenata koji su prije najmanje šest mjeseci ili imali akutni koronarni sindrom ili im je elektivno postavljena intrakoronarna potpornica (stent) ili im je učinjeno aortokoronarno premoštenje. Analizirani su demografski podaci, suradljivost oko terapije, upitnici o kvaliteti života, depresiji i anksioznosti. Rezultati su pokazali kako je adherencija na terapiju bila u obje skupine odlična > 90% s time da je u EUROASPIRE V grupi bila značajnije i veća (99-100%). Nije bilo razlike u dobi, spolu, pušačkom statusu i tjelesnoj masi izmežu skupina bolesnika. Pacijenti u EUROASPIRE V grupi su imali bolju kvalitetu života, manje depresije i anksioznosti. Adherencija u sekundarnoj prevenciji kardiovaskularnih bolesti je dobra i preduvjet je za povoljnije ishode. Analiza većeg uzorka pacijenata je potrebna da bi rezultati imali značajnu snagu.Adherence to medication is defined as the extent to which patients follow prescribed therapy. Previous research has shown that poor adherence is a significant problem in cardiovascular care, substantially affecting health outcomes. This study investigates and compares adherence to three groups of cardiovascular drugs — antihypertensives, lipid-lowering agents, and antidiabetic drugs in adult patients with known coronary artery disease. The patient cohort included in the study is part of the patients from the University Hospital Centre Zagreb enrolled in the international EUROASPIRE IV and EUROASPIRE V registries, conducted at different time periods (EUROASPIRE IV 2012-2014; EUROASPIRE V 2016-2018). From each registry, 50 patients were analyzed who, at least six months prior, had either experienced acute coronary syndrome or had undergone elective intracoronary stent placement or coronary artery bypass grafting. Demographic data, medication adherence, and questionnaires on quality of life, depression, and anxiety were analyzed. The results showed that adherence to therapy was excellent in both groups, >90%, with significantly higher adherence in the EUROASPIRE V group (99-100%). There were no differences in age, sex, smoking status, or body mass between the groups. Patients in the EUROASPIRE V group had a better quality of life and less depression and anxiety. Adherence in secondary prevention of cardiovascular diseases is good and a prerequisite for favorable outcomes. An analysis of a larger sample of patients is needed for the results to have higher significance
Similarities and differences between long-acting and short-acting antipsychotics
No full textUvođenje antipsihotika kod oboljelih od shizofrenije i srodnih poremećaja dovelo je do odgovarajuće kontrole pozitivnih simptoma i mogućnosti pretežito izvanbolničkog liječenja psihotičnih bolesnika čime se postigla bolja kvaliteta njihovih života, smanjilo opterećenje zdravstvenog sustava i potreba za dugotrajnom hospitalizacijom. Tipični antipsihotici su učinkoviti u eliminiranju pozitivnih simptoma, ali ne i kod perzistentnih negativnih simptoma te njihova primjena rezultira relativno čestim razvojem ekstrapiramidalnih nuspojava. Atipični antipsihotici pokazali su bolju podnošljivost i manju vjerojatnosti izazivanja ekstrapiramidalnih nuspojava te neki djelomično pokrivaju negativne simptome. Zbog manjka uvida u stanje kod oboljelih relativno čest problem kod oralne terapije je neadherencija koja povećava vjerojatnost recidiva, ponovne hospitalizacije, kasnije otežanog liječenja te dovodi do progresije kroničnog tijeka shizofrenije koja se očituje tvrdokornijim pozitivnim i negativnim simptomima, ali i kognitivnim deficitom i socijalnim nefunkcioniranjem. U novije vrijeme, dostupni su dugodjelujući intramuskularni antipsihotici koji su pokazali superiornost u odnosu na prvobitno razvijene oralne kratkodjelujuće antipsihotike u kontroli poremećaja iz shizofrenog spektra te smanjuju vjerojatnost neadherencije. Primjenom dugodjelujućih intramuskularnih antipsihotika postiže se stabilnija koncentracija aktivne komponente u krvi što se povezuje s manje čestim recidivima i hospitalizacijama te s poboljšanjem kognitivog i socijalnog funkcioniranja. Kratkodjelujući intramuskularni antipsihotici primjenjuju se kod akutnih agitiranih i delirantnih stanja.The introduction of antipsychotics in patients with schizophrenia led to adequate control of positive symptoms and the possibility of mainly outpatient treatment of psychotic patients, who achieved a better quality of their lives, reduced the burden on the health system and the need for long-term hospitalization. Typical antipsychotics are effective in eliminating positive symptoms, but not in persistent negative symptoms, and their use results in the frequent development of extrapyramidal side effects. Atypical antipsychotics have shown better tolerability and lower possibility for extrapyramidal side effects, additionally some partially cover negative symptoms. Due to the lack of insight into the condition , a relatively common problem with oral therapy is non-adherence, which increases the likelihood of relapse, re-hospitalization, later difficult treatment and leads to the progression of the chronic course of schizophrenia, which is manifested with persistent positive and negative symptoms and also cognitive deficit and social dysfunction. More recently, long-acting intramuscular antipsychotics have become available, which have shown superiority over the originally developed oral short-acting antipsychotics in treatment disorders from the schizophrenic spectrum and in reducing the likelihood of non-adherence. With the use of long-acting intramuscular antipsychotics, a more stable concentration of the active component in the blood is achieved, which is associated with less frequent relapses, hospitalizations and with an improvement in cognitive and social functioning. Short-acting intramuscular antipsychotics are used in acutely agitated and delirious patient
Detection and monitoring of patients with dementia in primary care
No full textDemencija je čest i onesposobljavajuć sindrom karakteriziran stečenim gubitkom kognitivnih sposobnosti u višestrukim kognitivnim područjima dovoljno težak da utječe na socijalnu ili radnu sposobnost. Postoje mnogi tipovi demencija od kojih je najučestalija Alzheimerova bolest, a ostale uključuju vaskularna kognitivna oštećenja, demencija Lewyjevih tjelešaca, demencija u Parkinsonovoj bolesti te frontotemporalna demencija. Zbog starenja populacije, demencije su značajan brzorastući javnozdravstveni problem. Liječnik obiteljske medicine je često mjesto prvog kontakta pacijenata sa zdravstvenim sustavom te ima mogućnost prepoznati znakove demencije kod svojih pacijenata. Koristeći razne instrumentalne testove za probir, poput testa crtanja sata ili Mini-Mental State Examination (MMSE), liječnik obiteljske medicine može prepoznati demenciju i pravovremeno reagirati. Uz specifičnu farmakoterapiju za neke oblike demencije kao što su inhibitori kolinesteraze ili memantin, liječnik obiteljske medicine može uvidjeti potrebu za nespecifičnim lijekovima, poput antidepresiva ili antipsihotika. Terapeutski postupci ovise o stadiju bolesti, a uključuju propisivanje lijekova za demenciju, rješavanje neuropsihijatrijskih simptoma i bihevioralnih problema, racionalnu primjenu psihoaktivnih lijekova te pružanje adekvatne pomoći skrbnicima, koji su i sami pod povećanim zdravstvenim rizikom.Dementia is a common and debilitating syndrome characterized by acquired loss of cognitive abilities in more than one cognitive domain severe enough to affect social or occupational ability. There are multiple types of dementia, the most common being Alzheimer's disease. Other types of dementia include vascular cognitive deficits, Lewy body dementia, Parkinson's disease dementia and frontotemporal dementia. Due to the aging of the population, dementias are a significant rapidly growing public health issue. The initial contact with the health care system is most commonly through the primary care physicians and as such they have the possibility to recognize dementia signs in their patients. By using various screening instruments, like clock drawing test or Mini-Mental state examination (MMSE), primary care physician can recognize dementia and react accordingly.Along the specific pharmacotherapy such as cholinesterase inhibitors or memantine, primary care physician can see the need for nonspecific therapy, like antidepressants or antipsychotics.. Therapeutic procedures depend on the stage of the disease and they include providing the specific medication, resolving neuropsychiatric and behevioral issues, rational use of psychoactive medications and offering adequate help to the caretakers, which are also at the increased risk of health issues
Progressive Supranuclear Palsy
No full textProgresivna supranuklearna paraliza (PSP) sporadična je neurodegenerativna bolest čiji je uzrok nepoznat. Međutim, posljednjih godina pri praćenju njene rastuće incidencije i prevalencije je uočena povezanost s određenim okolišnim čimbenicima i genetskom predispozicijom. Uočeno je da određeni oblici mogu biti genetski povezani s mutacijama u genima za protein tau povezan s mikrotubulima (engl.microtubule-associated protein tau - MAPT), koji kodira tau protein ili genima koji su povezani s drugim neurodegenerativnim bolestima. Ovi genetski oblici PSP-a su iznimno rijetki i ne čine većinu slučajeva bolesti. Karakteristična je za stariju životnu dob te se obično javlja u šestom desetljeću života. Fenotipska prezentacija bolesti razlikuje se među bolesnicima ovisno o tome koji dio mozga je patološki zahvaćen što može otežati njenu dijagnozu. U svrhu olakšavanja dijagnoze iste razvijena je podjela u podtipove, kao i činjenica što je relativno rijetka bolest čiji varirajući simptomi mogu podsjećati na druge neurodegenerativne bolesti. Iako se definitivna dijagnoza donosi na temelju neuropatološkog pregleda nakon smrti pacijenta, tokom života ključnu ulogu ima MRI (engl.magnetic resonance imaging) mozga kao neinvazivna dijagnostička metoda te neurološki klinički pregled i opširno uzeta anamneza pacijenta. Iako za samu bolest ne postoji lijek, postoji niz lijekova koji se daju u svrhu simptomatskog liječenja radi olakšavanja fizičkih i psihičkih tegoba s kojima se bolesnici suočavaju. U tijeku su istraživanja potencijalno učinkovite imunološke i ostale terapije.Progressive Supranuclear Palsy (PSP) is a sporadic neurodegenerative disease of unknown cause, However, in recent years monitoring of its increasing incidence and prevalence has revealed associations with specific environmental factors and genetic predisposition. Certain forms of PSP have been observed to be genetically linked to mutations in the MAPT gene (microtubule-associated protein tau) ,which encodes tau protein or genes associated with other neurodegenerative diseases. These genetic forms of PSP are exceptionally rare and do not constitute the majority of cases of the disease. It is characteristic of older age and typically manifests in the sixth decade of life. The phenotypic presentation of the disease varies among patients depending on which part of the brain is pathologically affected, which can complicate its diagnosis. In order to facilitate the diagnosis, PSP has been classified into subtypes, given its rarity and variable symptoms that may resemble other neurodegenerative diseases. While a definitive diagnosis is established through neuropathological examination after the patient's death, MRI (magnetic resonance imaging) plays a crucial role during life as a non-invasive diagnostic method, alongside neurological clinical examination and comprehensive patient history. Even though there is currently no cure for the disease, there are several medications used for symptomatic treatment to alleviate the physical and psychological challenges faced by patients. Research is ongoing into potentially effective immunological and other therapies
Treatment of benign prostatic hyperplasia
No full textProstata, muška spolna žlijezda, počinje se razvijati oko desetog tjedna trudnoće pod utjecajem androgena. Sastoji se od tri histološke zone: periferne, središnje i prijelazne. Najčešće bolesti prostate su benigna hiperplazija prostate (BPH), karcinom prostate i prostatitis.
Benigna hiperplazija prostate najčešći je benigni tumor u muškaraca, čija prevalencija raste sukladno s dobi. Poteškoće s mokrenjem, kao glavni simptom, mogu biti opstruktivne ili iritativne. Dijagnoza se postavlja na temelju fizikalnog pregleda, analize urina te samoprocjenom simptoma korištenjem IPSS upitnika. Liječenje varira od aktivnog praćenja do medikamentozne terapije te operacije. U liječenju se za ublažavanje simptoma koriste alfa-blokatori i inhibitori 5-alfa-reduktaze, a kombinirana terapija još je učinkovitija.
Konvencionalna kirurška metoda za liječenje BPH-a uključuje transuretralnu resekciju prostate, kojom se uklanja dio prostate kako bi se olakšao protok urina. Ostale kirurške opcije uključuju transuretralnu inciziju prostate i otvorenu jednostavnu prostatektomiju, koje se koriste u slučaju značajnijeg povećanja prostate.
Minimalno invazivne metode liječenja BPH-a, kao što su laserska terapija, transuretralna elektrovaporizacija prostate, transuretralna ablacija iglom, intrauretralni stentovi te transuretralna balonska dilatacija prostate, nude učinkovite alternative tradicionalnim kirurškim zahvatima. Te metode umanjuju krvarenje, ubrzavaju oporavak te pružaju dugoročno olakšanje simptoma uz niske stope komplikacija.
Redovita kontrola bolesnika s BPH-om neophodna je u praćenju statusa pacijenta te odgovora na određenu terapiju. Kod bolesnika s blagim simptomima preporučuju se godišnje kontrole, dok se nakon uvođenja terapije pacijenti procjenjuju u intervalima od četiri do dvanaest tjedana. Pacijenti koji ne osjete poboljšanje simptoma ili imaju nepodnošljive nuspojave mogu zahtijevati daljnju procjenu i razmatranje kirurških opcija.The prostate, the male sex gland, begins to develop around the tenth week of pregnancy under the influence of androgens. It consists of three histological zones: peripheral, central, and transitional. It can be affected by benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis.
Benign prostatic hyperplasia (BPH) is the most common benign tumor in men, the prevalence of which increases with age. Symptoms include difficulty urinating and may be obstructive or irritative. Diagnosis includes physical examination, urinalysis, and symptom assessment using the IPSS score. Treatment varies from watchful waiting to medication and surgery. Alpha-blockers and 5-alpha-reductase inhibitors are used to reduce symptoms, while combined therapy shows better results.
The conventional surgical method for treating BPH is transurethral resection of the prostate, which removes part of the prostate to facilitate urine flow. Alternative surgical options include transurethral incision of the prostate and open simple prostatectomy, which are used for significantly enlarged prostates.
Minimally invasive BPH treatment methods, such as laser therapy, transurethral electrovaporization of the prostate, transurethral needle ablation, intraurethral stents, and transurethral balloon dilatation of the prostate, offer effective alternatives to traditional surgical procedures. These methods reduce bleeding, speed recovery, and provide long-term symptom relief with low complication rates.
Regular follow-up of patients with BPH is essential to monitor their status and response to therapy. Annual follow-ups are recommended for patients with mild symptoms, while after starting therapy, patients are evaluated at intervals of four to twelve weeks. Patients who do not experience improvement in symptoms or have intolerable side effects may require further evaluation and consideration of surgical options