The Washington Agreement - Salvation or Ruin for Croats in Bosnia and Herzegovina?

Položaj Hrvata u Bosni i Hercegovini na početku 1994. može se označiti kritičnim u političko-vojnom pogledu i fizičkom opstanku uopće. Pored toga, a zbog povezanosti s događanjima u BiH, kao i utjecaja na Hrvat iz BiH, RH je došla u vrlo težak međunarodno-politički položaj, s tendencijom pogoršavanja i mogućeg uvođenja sankcija. Preuzimanje inicijative SAD-a, sa ciljem da se zaustavi rat na prostoru bivše Jugoslavije, i posredovanje u formiranju hrvatsko-bošnjačke federacije, označava prekretnicu u vojnom i političkom pogledu na prostoru BiH, odnosno bivše Jugoslavije. Iako se hrvatska politika, potpisivanjem Washingtonskog sporazuma, a time i Hrvati u BiH, spasila izolacije i vratila u okrilje međunarodne zajednice, njena daljnje nedorečeno i nedosljedno držanje glede situacije u BiH dovelo je do toga da su se pozitivni efekti i preuzeta inicijativa ubrzo izgubili. Unatoč tome, može se ustvrditi da je Washingtonski sporazum usmjerio djelovanje međunarodne zajednice u drugom pravcu, te da je stvorio pretpostavke i temelje konačnom zaustavljanju rata na prostoru bivše Jugoslavije, odnosno Daytonskom sporazumu.The situation of Croats in Bosnia and Herzegovina in the beginning of 1994 can be defined as critical as regards to the political and military terms and the physical survival. 1n addition, due to connection with developments in Bosnia and Herzegovina as well as to the influence on Croats from Bosnia and Herzegovina, the Republic of Croatia found itself in a very difficult international political position. Furthermore, the situation showed a tendency toward deterioration and very likely to imposition of sanctions. When the USA took the initiative, in an effort to stop the war in the area of the farmer Yugoslavia, and when they intervened in the creation of the Federation of Bosnia and Herzegovina, it marked a turning point in the military and political terms in the area of Bosnia and Herzegovina, i.e. the farmer Yugoslavia. By the signing of the Dayton Peace Accord, the Croatian policy, and thereby Croats in Bosnia and Herzegovina also, rescued itself from isolation and it was back in the fold of international community. However, its continued understated and inconsistent attitude toward the situation in Bosnia and Herzegovina led to a rapid loss of the positive effects and the initiative which had been assumed. Even so, we can assert that the Washington Agreement directed the activities of the international community in another way and that it created the conditions and the foundations far the Dayton Accords, that is to finally bring to an end the war in the former Yugoslavia

Perioperative optimization of fluid and coagulation status in polytrauma patients

Kompleksnost i raznovrsnost stanja politraume čini te bolesnike iznimno zahtjevnim za ispravno zbrinjavanje. Kompleksnost je uvjetovana pravovremenim inicijalnim zbrinjavanjem politraumatiziranih bolesnika, ali i točnošću zbrinjavanja istih, jer manjkavosti i u jednom i u drugom aspektu dovode do produženog liječenja i loših ishoda. Budući da je dokazano kako je mortalitet politraumatiziranih bolesnika veći zbog intraoperativnog metaboličkog zatajenja, nego zbog nedovršenosti kirurškog zbrinjavanja, inicijalni operativni zahvati imaju za cilj normalizirati fiziologiju pacijenta te onemogućiti stvaranje nove, patološke homeostaze, putem damage control operativnih zahvata. Pri tome je postoperativna skrb bolesnika u jedinicama intenzivne medicine od iznimne važnosti, a današnji pristupi individualizacije medicinske intervencije, ciljane terapije volumenom i korekcije poremećaja koagulacije mijenjaju ranije unificirane i poopćene postupke. Pri tome se pokazalo kako detaljno i precizno praćenje volumnog stanja i koagulacije pomoću viskoelastičnih testova može uvelike ubrzati i poboljšati zbrinjavanje bolesnika, kako intraoperativno za vrijeme prvog damage control zahvata, tako i u jedicinama intenzivne medicine nakon i u pripremi za definitive kirurške zahvate.The complexity and variety of polytrauma conditions make these patients extremely complex for proper care. Complexity is conditioned by the acuteness of treating polytraumatized patients, but also by the accuracy of their care, because deficiencies in both aspects lead to prolonged treatment and reduced success. Since it has been proven that the mortality of polytraumatized patients is higher due to intraoperative metabolic failure than due to the incompleteness of surgical care, the initial surgical procedures aim to normalize the patient’s physiology and prevent the creation of a new, pathological homeostasis, through damage control surgical procedures. Postoperative care of patients in intensive care units is extremely important, and today’s perspectives, individualization of medical care and targeting of volume therapy and correction of coagulation disorders are changing previously unified and generalized procedures. In doing so, it was shown that more detailed monitoring of the patient’s volume status and monitoring of the coagulation status using viscoelastic tests can greatly speed up and improve patient care, both intraoperatively during the first damage control procedure, and in intensive care units after and in preparation for definitive surgical procedures

Hemodynamic optimization is sepsis: a path towards personalization

Sepsa je hemodinamski vrlo kompleksno stanje koje zahtjeva akutne dijagnostičke i terapijske postupke. Uporaba noradrenalina kao vazoaktivne potpore i glavnog supstrata za održavanje srednjeg arterijskog tlaka iznad 65 mmHg dobro je ustoličena klinička praksa, ali ne bez svojih limita. Uporaba sekundarnih vazoaktivnih lijekova poput vazopresina i sintetskog angiotenzina II, akutnije i vremenski definiranije liječenje sve više ulaze u jedinice intenzivne medicine. Praćenje progresije sepse, odnosno septičnog šoka, također biva unaprijeđeno, putem novijih modaliteta hemodinamskog monitoringa te novih point-of-care laboratorijskih nalaza koji točnije prate progresiju bolesti, na primjer promatranja dinamike renina. U ovom preglednom radu prikazane su novi modaliteti liječenja i personalizirani pristup pacijentu sa septičnim šokom te praćenja uspješnosti liječenja.Sepsis is a hemodynamically very complex condition that requires acute diagnostic and therapeutic procedures. The use of norepinephrine as vasoactive support and the main substrate for maintaining mean arterial pressure above 65 mmHg is a well-established clinical practice, but not without its limits. The use of secondary vasoactive drugs such as vasopressin and synthetic angiotensin II, and more acute and time-determining treatment are increasingly entering the intensive care units. Monitoring the progression of sepsis, or septic shock, is also being improved, through newer modalities of hemodynamic monitoring and new point-of-care laboratory findings that more closely monitor disease progression, for example by observing renin dynamics. In this review paper, new modalities of treatment and personalization of care for patients with septic shock and monitoring of treatment success are presented

QUALITY OF LIFE OF PEOPLE WITH MENTAL HEALTH DIFFICULTIES

Svjetska zdravstvena organizacija definira kvalitetu življenja kao individualnu percepciju vlastite pozicije u životu, u kontekstu kulturalnih i vrijednosnih sustava u kojima se živi i u odnosu na vlastite ciljeve, očekivanja, standarde i preokupacije. Rad je usmjeren na propitivanje o kvaliteti života osoba s poteškoćama mentalnoga zdravlja. U novije vrijeme o tim se osobama najviše govori u kontekstu sve rasprostranjenijega procesa deinstitucionalizacije. Stigma je jedan od čimbenika koji pridonosi pogoršanju socijalnih odnosa, a time i kvalitete života osoba s poteškoćama mentalnoga zdravlja. Cilj provedena istraživanja bio je ispitati subjektivni doživljaj i neka obilježja kvalitete života osoba s poteškoćama mentalnoga zdravlja, koje su korisnici Centra za mentalno zdravlje u Tomislavgradu. Podatci su prikupljeni metodom polustrukturiranoga intervjua. Rezultati ukazuju na to da neformalnu potporu najviše dobivaju od članova obitelji, prijatelja i kolega. Kao formalnu potporu ističu zdravstvene ustanove. Sudionici istraživanja imaju pozitivnu sliku o sebi i prihvaćaju svoje stanje. Emocionalna potpora najviše se dobiva razgovorima kroz koje se iskazuje potreba za duhovnom izgradnjom. Kada je riječ o uključenosti u aktivnost zajednice, rezultati su dvojaki, primjerice, neki su korisnici uključeni u kulturne aktivnosti i svojim radom pridonose lokalnoj zajednici dok su drugi korisnici skloni samoizoliranju i neuključenosti u društvo. Iskazuje se zadovoljstvo životom, ali nezadovoljstvo ističu zbog socijalnih davanja koje smatraju oskudnima.The World Health Organization defines quality of life as an individual perception of your own position in life, in terms of the cultural and value systems in which one lives and in relation to one’s own goals, expectations, standards and preoccupations. The paper is focused on the quality of life of people with mental health difficulties. Recently they are being mentioned more and more in the context of the increasingly widespread process of deinstitutionalization. Stigma is one of the factors that contributes to the exacerbation of social relations as well as the quality of life of people with mental healt difficulties,. The aim of the research was to examine the subjective experience and some characteristics of the quality of life of people with mental health difficulties, who are users of the Center for Mental Health in Tomislavgrad. Data were collected using semi-structured interview method. The results indicate that most of their informal support is received from their family members, friends and colleagues. As formal support they mention health institutions. Research participants have a positive image of themselves and they accept their condition. Emotional support is mostly reflected through conversation, and they express the need for spiritual formation. In terms of involvement in community activity, the results are twofold - for example, some users are involved in cultural activities and their work contributes to the local community, whilst other users are prone to self-isolation and disengagement in society. Contentment with life is expressed, but dissatisfaction is expressed due to social benefits that they consider scarce

Effect of yeast on cereal spirit quality

Izbor kvasca za proizvodnju žitnog destilata može značajno utjecati na randman i koncentraciju etanola te konačnu kvalitetu proizvoda. Cilj rada bio je ispitati utjecaj dvije različite vrste kvasaca iz roda Saccharomyces na kvalitetu destilata dobivenog dvostrukom destilacijom fermentirane ječmene sladovine na jednostavnom destilacijskom uređaju. Korištena su dva kvasca, Saccharomyces cerevisiae komercijalnog naziva FERMOALE AY4, te kvasac Saccharomyces cerevisiae (ex. bayanus) komercijalnog naziva EC1118. Kemijskom analizom utvrđeno je kako je primjenom kvasca AY4 postignuta bolja iskoristivost šećera iz ječmene sladovine (3 % više etanola) i niža titracijska kiselost destilata. Plinskom kromatografijom utvrđene su koncentracije acetaldehida u oba uzorka iznad uobičajenih, pa je u uzorku destilata dobivenog korištenjem kvasca AY4 determinirano 274 mg L-1 a.a., a u uzorku dobivenom sa kvascem EC1118, 356 mg L-1 a.a. Nadalje, koncentracije viših alkohola u oba su uzorka bile iznad uobičajenih. U uzorku destilata AY4 determinirano je 2179 mg L-1 a.a, dok uzorak destilata EC1118 zbog determiniranih 3602 mg L-1 a.a. ukupnih viših alkohola ulazi u kategoriju destilata niže kvalitete. Uzorak destilata EC1118 bio je bogatiji etil acetatom, dok je uzorak destilata AY4 imao više koncentracije ostalih estera što je rezultiralo kompleksnijom aromom i punijim okusom destilata AY4.The choice of yeast in cereal spirit production can greatly affect ethanol yield, as well as final product quality. The aim of this study was to evaluate the effect of two different yeast on the quality of spirit produced by double distilling a fermented cereal wash on a simple still. Two yeasts were used, Saccharomyces cerevisiae FERMOALE AY4, and Saccharomyces cerevisiae (ex. bayanus) EC1118. Chemical analysis proved that yeast AY4, as expected, has a better ethanol yield (3 % more ethanol), lower titratable acidity, while ethyl acetate concentrations were slightly higher in sample EC1118. By gas chromatography analysis higher acetaldehyde concentrations than usual was identified in samples, in sample AY4 274 mg L-1 a.a., and 356 mg L-1 a.a. in sample EC1118 was determinated. Furthermore, larger amounts of higher alcohols were produced in both samples, sample AY4 contained 2179 mg L-1 a.a. while sample EC1118 with 3602 mg L-1 a.a. total higher alcohols enter the lesser quality spirit rank. While sample EC1118 was richer with ethyl acetate, sample AY4 had higher concentrations of other esters which made sample AY4 a distillate with more complex aroma and fuller flavour. Future experiments could yield interesting results if the fermentation conditions would match those in a distillery

Epidemic spread of OXA-48 beta-lactamase in Croatia

PURPOSE: A dramatic increase in OXA-48 β-lactamase was observed recently not only in large hospital centres, but also in smaller suburban hospital centres in geographic areas bordering Croatia. The aim of the study was to analyse the epidemiology, the mechanisms of antibiotic resistance and the routes of spread of OXA-48 carbapenemase in Croatia. ----- METHODS: Carbapenemase and other β-lactamase and fluoroquinolone resistance genes were detected by PCR and sequencing. Whole-genome sequencing (WGS) was performed on five representative isolates. The isolates were genotyped by PFGE. ----- RESULTS: Forty-eight isolates positive for OXA-48, collected from seven hospital centres in Croatia from May 2016 to May 2017, were analysed (40 Klebsiella pneumoniae, 5 Enterobacter cloacae, 2 Escherichia coli and one Citrobacter freundii). Thirty-three isolates were ESBL positive and harboured group 1 CTX-M 1 β-lactamases. In addition to the β-lactam resistance genes detected by PCR (blaSHV-1, blaOXA-48 and blaOXA-1), WGS of five representative isolates revealed the presence of genes encoding aminoglycoside resistance, aadA2 and aph3-Ia, fluoroquinolone resistance determinants aac(6)Ib-c, oqxA and oqxB, the sulfonamide resistance gene sul1, and fosA (fosfomycin resistance). IncL plasmid was found in all isolates. Two K. pneumoniae isolates belonged to ST16, two E. cloacae to ST66 and E. coli to ST354. K. pneumoniae isolates were allocated to five clusters by PFGE which occured in different hospitals, indicating epidemic spread. ----- CONCLUSIONS: The OXA-48-positive organisms found in this study showed wide variability in antibiotic susceptibility, β-lactamase content and PFGE banding patterns. This study revealed a switch from the predominance of VIM-1 in 2012-2013 to that of OXA-48 in the 2015 to 2017

Role of the PD-1 and PD-L1 signal pathways in the suppression of the T-cell immune response in solid tumor progression

Rak je izrazit javnozdravstveni problem u Republici Hrvatskoj i drugi je uzrok smrti, nakon bolesti srca i krvnih žila. Solidni tumori čine velik postotak mortaliteta i morbiditeta raka te je starenjem stanovništva primijećeno povećanje incidencije. Terapija solidnih tumora je izrazito kompleksan predmet istraživanja, a novije spoznaje nam omogućuju pronalaženje novih meta i postupaka terapije. Nedavna su istraživanja pokazala kako solidni tumori uređuju imunološki odgovor te onemogućuju imunološki napad u tumorskom mikrookolišu, u procesu koji se opisuje kao tumorski bijeg. Jedna od ključnih komponenti u tumorskom bijegu o imunološkog sustava je PD-1 molekula koju nalazimo na površini aktiviranih T limfocita i koja dolazi u interakciju s PD-L1 i PD-L2. Tumorske stanice, ali i nekolicina drugih staničnih tipova, izražavaju PD-L1 na svojoj površini i tako dokidaju napad citotoksičnih T limfocita. Blokadom te inhibicije iscrpljeni T limfociti koji nastanjuju tumorski mikrookoliš ponovno poprimaju efektorski fenotip i pokreću obnovljeni napad na neoplastične stanice. Imunoterapija koja se bazira na blokadi PD-1/PD-L1 signalne osi pokazala je znatan potencijal u kliničkim istraživanjima. U Republici Hrvatskoj upravo je taj vid imunoterapije ušao u kliničku praksu u slučaju nekolicine solidnih tumora, primarno melanoma, trostruko negativnog karcinoma dojke, ne-sitnostaničnog karcinoma pluća, karcinoma mokraćnog mjehura te karcinoma bubrežnih stanica. U ovom diplomskom radu obrađeni su detalji vezani uz djelovanje osi PD-1/PD-L1 na imunološko uređivanje tumora i kliničke implikacije njene blokade.Cancer poses a major public health problem in the Republic of Croatia and it is the second leading cause of death, after cardiovascular disease. Solid tumours account for a large percentage of cancer mortality and morbidity, and an increased incidence has been observed as the population ages. Therapy of solid tumours is an extremely complex subject of research, and recent findings allow us to find new targets and procedures for therapy. Recent research has shown that solid tumours regulate the immune response and prevent an immune attack in the tumour microenvironment, in a process described as cancer immune escape. One of the key components in the tumour escape of the immune system is the PD-1 molecule found on the surface of activated T lymphocytes, which interacts with PD-L1 and PD-L2. Tumour cells, but also several other cell types, express PD-L1 on their surface and thus eliminate the attack of cytotoxic T lymphocytes. By blocking this inhibition, exhausted T lymphocytes that inhabit the tumour microenvironment regain the effector phenotype and commence a renewed attack on neoplastic cells. Immunotherapy based on the blockade of the PD-1/PD-L1 signalling axis has shown significant potential in clinical trials. In the Republic of Croatia, this type of immunotherapy has entered clinical practice in the case of several solid tumours, primarily melanoma, triple-negative breast cancer, non-small cell lung cancer, bladder cancer and renal cell carcinoma. In this thesis, the details related to the effect of the PD-1/PD-L1 axis on the immunoediting of the tumour and the clinical implications of its blockade are discussed

Role of the PD-1 and PD-L1 signal pathways in the suppression of the T-cell immune response in solid tumor progression

Rak je izrazit javnozdravstveni problem u Republici Hrvatskoj i drugi je uzrok smrti, nakon bolesti srca i krvnih žila. Solidni tumori čine velik postotak mortaliteta i morbiditeta raka te je starenjem stanovništva primijećeno povećanje incidencije. Terapija solidnih tumora je izrazito kompleksan predmet istraživanja, a novije spoznaje nam omogućuju pronalaženje novih meta i postupaka terapije. Nedavna su istraživanja pokazala kako solidni tumori uređuju imunološki odgovor te onemogućuju imunološki napad u tumorskom mikrookolišu, u procesu koji se opisuje kao tumorski bijeg. Jedna od ključnih komponenti u tumorskom bijegu o imunološkog sustava je PD-1 molekula koju nalazimo na površini aktiviranih T limfocita i koja dolazi u interakciju s PD-L1 i PD-L2. Tumorske stanice, ali i nekolicina drugih staničnih tipova, izražavaju PD-L1 na svojoj površini i tako dokidaju napad citotoksičnih T limfocita. Blokadom te inhibicije iscrpljeni T limfociti koji nastanjuju tumorski mikrookoliš ponovno poprimaju efektorski fenotip i pokreću obnovljeni napad na neoplastične stanice. Imunoterapija koja se bazira na blokadi PD-1/PD-L1 signalne osi pokazala je znatan potencijal u kliničkim istraživanjima. U Republici Hrvatskoj upravo je taj vid imunoterapije ušao u kliničku praksu u slučaju nekolicine solidnih tumora, primarno melanoma, trostruko negativnog karcinoma dojke, ne-sitnostaničnog karcinoma pluća, karcinoma mokraćnog mjehura te karcinoma bubrežnih stanica. U ovom diplomskom radu obrađeni su detalji vezani uz djelovanje osi PD-1/PD-L1 na imunološko uređivanje tumora i kliničke implikacije njene blokade.Cancer poses a major public health problem in the Republic of Croatia and it is the second leading cause of death, after cardiovascular disease. Solid tumours account for a large percentage of cancer mortality and morbidity, and an increased incidence has been observed as the population ages. Therapy of solid tumours is an extremely complex subject of research, and recent findings allow us to find new targets and procedures for therapy. Recent research has shown that solid tumours regulate the immune response and prevent an immune attack in the tumour microenvironment, in a process described as cancer immune escape. One of the key components in the tumour escape of the immune system is the PD-1 molecule found on the surface of activated T lymphocytes, which interacts with PD-L1 and PD-L2. Tumour cells, but also several other cell types, express PD-L1 on their surface and thus eliminate the attack of cytotoxic T lymphocytes. By blocking this inhibition, exhausted T lymphocytes that inhabit the tumour microenvironment regain the effector phenotype and commence a renewed attack on neoplastic cells. Immunotherapy based on the blockade of the PD-1/PD-L1 signalling axis has shown significant potential in clinical trials. In the Republic of Croatia, this type of immunotherapy has entered clinical practice in the case of several solid tumours, primarily melanoma, triple-negative breast cancer, non-small cell lung cancer, bladder cancer and renal cell carcinoma. In this thesis, the details related to the effect of the PD-1/PD-L1 axis on the immunoediting of the tumour and the clinical implications of its blockade are discussed

Sur une classe d'équations différentielles quasi-homogènes à plusieurs dimensions

Bandić Ivan. Sur une classe d'équations différentielles quasi-homogènes à plusieurs dimensions. In: Bulletin de la Classe des sciences, tome 59, 1973. pp. 345-353