Uloga hormona tiroidne žlezde u proceni preživljavanja bolesnika u odeljenjima intenzivne nege

Background/Aim. Patients in intensive care units (ICUs) often exhibit disturbances in the concentration of thyroid hormones (THs), even if they had no previous thyroid disorders. The aim of the study was to determine whether there is a correlation between THs and the survival rate in the ICU and whether these hormones have predictive capability for mortality rate assessment. Methods. The study included 41 patients (23 women and 18 men) divided into two groups: survivors (70.7%) and non-survivors (29.3%). In peripheral blood samples taken within the first 24 hrs after ICU admission, TH levels were measured: triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH), as well as procalcitonin (PCT). The Sequential Organ Failure Assessment Score (SOFAS) was calculated for each patient. Results. A statistically significant difference between the study groups (survivor vs. non-survivor patients, p < 0.05) was found for PCT, SOFAS, T3, T4, and FT4. The area under the receiver operating characteristic (ROC) curve (AUC) – (AUROC) for the SOFAS was 0.991 [95% confidence interval (CI): 0.898–1.000, p < 0.001], for T3 was 0.727 (95% CI: 0.566–0.854, p = 0.0097), for T4 was 0.793 (95% CI: 0.638–0.903, p = 0.0008), for FT3 was 0.707 (95% CI: 0.544–0.8389, p = 0.0299), and for FT4 was 0.795 (95% CI: 0.640–0.904, p = 0.0005). Compared to other parameters, T3 had higher sensitivity (91.67%), FT4 had higher specificity (93.10%), while SOFAS had both the highest sensitivity (91.67%) and specificity (96.55%) in relation to all other tested parameters. Multiple linear regression analysis showed that FT4 and T4 were significant predictors of survival time (β = -0.362, p = 0.012 and β = -0.356, p = 0.014, respectively). Conclusion. Among all examined THs, only FT4 and T4 showed strong predictive potential for assessing mortality in ICU patients. This study has highlighted the significance of assessing THs levels in critically ill patients. This is crucial because it opens the possibility of implementing specific therapies to rectify issues stemming from hormonal deficiencies.Uvod/Cilj. Bolesnici u odeljenjima intenzivne nege (OIN) često imaju poremećaj u koncentraciji tiroidnih hormona (TH), čak i u slučajevima kada nisu prethodno imali poremećaj funkcije tiroidne žlezde. Cilj rada bio je da se utvrdi da li postoji korelacija između TH i stepena preživljavanja u OIN, kao i da li ovi hormoni imaju prediktivni značaj u proceni smrtnosti bolesnika. Metode. U studiji je učestvovalo 41 bolesnika (23 žene i 18 muškaraca) koji su bili podeljeni u dve grupe: grupu preživelih (70.7%) i grupu preminulih (29.3%). U uzorcima periferne krvi koji su uzimani u toku prv a 24 sata od prijema u OIN određivani su nivoi TH: trijodtironin (T3), tiroksin (T4), slobodan T3 (free T3 – FT3), slobodan T4 (FT4) i tiroid-stimulirajući hormon (TSH), kao i prokalcitonin (PCT). Za svakog bolesnika izračunat je Sequential Organ Failure Assessment Score (SOFAS). Rezultati. Statistički značajna razlika između ispitivanih grupa (preživeli vs. preminuli, p < 0,05) utvrđena je za parametre SOFAS, T3, T4 i FT4. Površina ispod receiver operating characteristic (ROC) krive [area under the ROC curve (AUC) – (AUROC)] iznosila je za SOFAS 0,991 [95% confidence interval (CI): 0,898–1,000, p < 0,001], za T3 0,727 (95% CI:0,566–0,854, p = 0,0097), za T4 0,793 (95% CI: 0,638– 0,903, p = 0,0008), za FT3 0,707 (95% CI: 0,544–0,8389, p = 0,0299) i za FT4 0,795 (95% CI: 0,640–0,904, p = 0,0005). U poređenju sa ostalim parametrima, T3 je imao višu osetljivost (91,67%), FT4 višu specifičnost (93,10%), dok je SOFAS imao istovremeno i najvišu osetljivost (91,67%) i specifičnost (96,55%) u odnosu na sve druge ispitivane parametre. Primenom multiple linearne regresione analize utvrđeno je da su FT4 i T4 bili značajni prediktori vremena preživljavanja bolesnika (β = -0,362, p = 0,012 i β = -0,356, p = 0,014, redom). Zaključak. Među svim ispitanim TH, pokazano je da FT4 i T4 imaju snažan prediktivni potencijal za procenu smrtnosti bolesnika u OIN. Ovom studijom je istaknut značaj određivanja nivoa TH kod kritično obolelih, što je ključno jer otvara mogućnost primene specifičnh terapija koje bi korigovale poremećaje nastale zbog deficita hormona

Child’s play in the humanization of child’s stay in hospital

Prilikom bolničkog liječenja (hospitalizacije) potrebno je voditi brigu o zadovoljenju djetetovih potreba. Odlazak u bolnicu velika je promjena za dijete, i često praćena neugodnim emocionalnim stanjima koja se mogu opisati kao sindrom hospitalizma. Većina djece prolazi sljedeće faze kojima se opisuje ovaj sindrom: faza prosvjeda, faza očajanja i faza prividne prilagodbe. Mnogo je teorija o prirodi i smislu igre, a ono u čemu se one generalno slažu jest da je dječja igra puno više od same zabave. Kroz igru djeca otkrivaju okolinu, vlastite vještine, uvježbavaju naučeno, kreiraju što bi još mogla učiniti. Igra je slobodna i spontana dječja aktivnost. Problematiku hospitalizma, kao i način suočavanja djeteta s liječenjem u bolničkim uvjetima, naglašavaju i pravni propisi koji reguliraju dječja prava i pridonose humanijem pristupu prema djetetu. U ovom radu prezentirane su vrste igara koje se mogu provoditi na dječjim odjelima. Uloga stručnjaka važna je u procesu hospitalizacije.During the hospital treatment (hospitalisation) it is necessary to take care of the fulfillment of the child’s needs. Moving into a hospital is a big change for a child, often accompanied by the unpleasant emotional states which can be described as the hospitalism syndrome. Most of the children go through the phases being described by this syndrome: protest phase, desperation phase, and superficial adjustment phase. There are a lot of theories about the nature and the point of play, but what they generally agree on is that child’s play is much more than just leisure time. Through play children discover the environment, their own skills, they practice what they’ve learned, create what they might do. Play is a free and spontaneous children’s activity. Hospitalism and other coping strategies associated with children’s fears instigated by hospitalization are also validated within the law regulations to prioritise the rights and needs of children. This paper presents different types of games that hospitalised children play at hospital wards. Professional help is essential in supporting children and their families to cope with hospitalization

Understanding the Male Perspective: Evaluating Quality of Life and Psychological Distress in Serbian Men Undergoing Infertility Treatment

The experience of an infertility diagnosis and treatment imposes a profound burden on affected individuals, encompassing not only physical and medical aspects but also a plethora of psychological, social, and emotional factors. By employing a multimodal assessment featuring validated self-report questionnaires, physical measurements, and clinical records, the present study aimed to explore the quality of life and psycho-emotional distress of men undergoing infertility treatment in Serbia, thereby addressing the dearth of research on the underrepresented male perspective in this domain. Findings revealed diverse semen abnormalities among participants (n = 96, average age 37.69 ± 5.72), with significant associations between longer treatment durations and reduced sperm motility. The observed rates of men surpassing predetermined DASS-42 questionnaire thresholds for depression, anxiety, and stress in the analyzed cohort were 13.54%, 11.46%, and 22.92%, respectively. Summary scores in conceptual areas comprised in the SF-36 questionnaire ranged from 49.00 ± 6.25 for the mental health dimension to 90.16 ± 17.75 obtained in the physical functioning subscale. Patients with a longer treatment duration demonstrated lower scores in the role emotional domain, indicative of a less favorable emotional state. Expectedly, inverse correlations were found between the SF-36 mental health score and DASS-42 subscales. By addressing the existing knowledge gap and highlighting the unique needs of infertile men, the finding of this study may contribute to a more inclusive and holistic approach to infertility research and management

Cadmium and lead implication in testis cancer; is there a connection?

Testis cancer (TC) is the most common malignancy of young men. Current evidence from studies, alongside genetics and hormonal status, suggests a significant role of toxic metals, cadmium (Cd) and lead (Pb), in the origin and development of TC. Besides oxidative stress and endocrine disruption, interaction with bioelements is one of the critical mechanisms of Cd and Pb toxicity and malign transformation. This study aimed to investigate metal levels in blood, healthy, and tumor testis tissue and to reveal hormone, oxidative status, and bioelements levels in patients with TC. The study enrolled 52 patients with TC and 61 healthy volunteers. Toxic metals and bioelements levels were analyzed by atomic absorption spectrophotometry (AAS) while electrochemiluminescence immunoassay (ECLIA) and spectrophotometry methods were used for hormone and oxidative parameters evaluation. Significantly higher blood Cd levels were depicted in TC cohort. Furthermore, blood Cd elevation was associated with a 1.98 higher probability of TC developing. However, a metal concentration between healthy and tumor testis tissue did not differ significantly. Lower levels of estradiol and testosterone, established in a cohort of TC patients, followed the significant role of hormones in TC development. At the same time, ischemia-modified albumin (IMA) has been recognized as a parameter with very good accuracy as a potential diagnostic marker for TC. The study revealed different distribution patterns of copper (Cu) and zinc (Zn) in the three compartments of the patients, as well significant correlation between essential metals Cu/Zn and toxic metals Cd/Pb indicating metal-metal interactions as pivotal mechanisms of metals toxicity