Moralne osobine medicinske sestre

Moral, kao skup pravila kojima se utvrđuje pozitivan odnos prema društvu, drugima pa i samom sebi, neophodan je za civiliziranu egzistenciju društva. Između ostaloga, čovjek je i etično biće čije se moralne osobine najviše zrcale u temeljnoj etičkoj kategoriji koja obuhvaća brigu za ostale ljude. Postoje mnoga zanimanja u kojima navedeno dolazi do izražaja, a u ovome radu posebno će biti govora o moralnim osobinama medicinske sestre koja bi kao valjan zdravstveni radnik trebala razvijati poželjne moralne osobine uz intelektualne, komunikacijske i psihomotorne vještine. Navedeno može se postići stručnim usavršavanjem, intelektualnim radom te holističkim i individualnim pristupom pacijentu

Usporedba 18F-FDG pozitronske emisijske tomografije i kompjutorizirane tomografije u bolesnika s kolorektalnim karcinomom i limfomom: naša početna klinička iskustva

Findings obtained by fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and computed tomography (CT) were compared in patients with malignant lymphoma and colorectal carcinoma. In 14 malignant lymphoma patients, 16 18F-FDG PET procedures were performed to assess chemotherapy and/or radiotherapy outcome (remission). One patient with clinically overt relapse of non-Hodgkin.s lymphoma underwent PET to assess disease dissemination prior to prescribing second-line chemotherapy. Two patients were submitted to PET on two occasions. PET pointed to residual disease in six of 14 patients and was inconclusive in one patient. These patients underwent computed tomography (CT), some of them before and others after PET examination. Then PET and CT findings were compared and therapeutic response, i.e. disease remission was assessed. The signs of residual disease were present in four and absent in nine patients, whereas inconclusive findings in terms of residual disease were recorded in one patient. Although our initial clinical experience was acquired in quite a small number of patients, CT modified clinical evaluation of residual disease in two patients and should be included along with PET in diagnostic work-up of these patients.Usporedili smo nalaze fluoro-18-fluorodeoksiglukoza (FDG) pozitronske emisijske tomografije (18F-FDG PET) i kompjutorizirane tomografije (CT) u bolesnika s malignim limfomom i kolorektalnim karcinom. U 14 bolesnika 18F-FDG PET je učinjen 16 puta radi procjene ishoda kemoterapije i/ili radioterapije, odnosno remisije. U jednog bolesnika s klinički jasnim recidivom ne-Hodgkinova limfoma PET je proveden radi procjene proširenosti bolesti prije ordiniranja druge linije kemoterapije. U dvoje bolesnika PET je učinjena dva puta. U šestoro od 14 bolesnika nalaz PET ukazivao je na rezidualnu bolest, dok je u jednog bolesnika bio dvojben. Stoga je u tih bolesnika učinjena i CT; u nekih bolesnika CT je izvedena prije PET, a u drugih nakon PET. Tada smo usporedili nalaze PET i CT te procijenili terapijski odgovor, tj . remisiju bolesti. Znaci rezidualne bolesti bili su prisutni u četvoro bolesnika, odsutni u devetoro bolesnika, dok je kod jednog bolesnika i dalje bilo nejasno je li rezidualna bolest prisutna ili nije. Iako se ovo naše početno kliničko iskustvo odnosi na mali broj bolesnika, CT je promijenio kliničku procjenu rezidualne bolesti u dvoje bolesnika i smatramo da bi uz PET i CT trebao biti sastavni dio dijagnostičke obrade takvih bolesnika

Usporedba 18F-FDG pozitronske emisijske tomografije i kompjutorizirane tomografije u bolesnika s kolorektalnim karcinomom i limfomom: naša početna klinička iskustva

Findings obtained by fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and computed tomography (CT) were compared in patients with malignant lymphoma and colorectal carcinoma. In 14 malignant lymphoma patients, 16 18F-FDG PET procedures were performed to assess chemotherapy and/or radiotherapy outcome (remission). One patient with clinically overt relapse of non-Hodgkin.s lymphoma underwent PET to assess disease dissemination prior to prescribing second-line chemotherapy. Two patients were submitted to PET on two occasions. PET pointed to residual disease in six of 14 patients and was inconclusive in one patient. These patients underwent computed tomography (CT), some of them before and others after PET examination. Then PET and CT findings were compared and therapeutic response, i.e. disease remission was assessed. The signs of residual disease were present in four and absent in nine patients, whereas inconclusive findings in terms of residual disease were recorded in one patient. Although our initial clinical experience was acquired in quite a small number of patients, CT modified clinical evaluation of residual disease in two patients and should be included along with PET in diagnostic work-up of these patients.Usporedili smo nalaze fluoro-18-fluorodeoksiglukoza (FDG) pozitronske emisijske tomografije (18F-FDG PET) i kompjutorizirane tomografije (CT) u bolesnika s malignim limfomom i kolorektalnim karcinom. U 14 bolesnika 18F-FDG PET je učinjen 16 puta radi procjene ishoda kemoterapije i/ili radioterapije, odnosno remisije. U jednog bolesnika s klinički jasnim recidivom ne-Hodgkinova limfoma PET je proveden radi procjene proširenosti bolesti prije ordiniranja druge linije kemoterapije. U dvoje bolesnika PET je učinjena dva puta. U šestoro od 14 bolesnika nalaz PET ukazivao je na rezidualnu bolest, dok je u jednog bolesnika bio dvojben. Stoga je u tih bolesnika učinjena i CT; u nekih bolesnika CT je izvedena prije PET, a u drugih nakon PET. Tada smo usporedili nalaze PET i CT te procijenili terapijski odgovor, tj . remisiju bolesti. Znaci rezidualne bolesti bili su prisutni u četvoro bolesnika, odsutni u devetoro bolesnika, dok je kod jednog bolesnika i dalje bilo nejasno je li rezidualna bolest prisutna ili nije. Iako se ovo naše početno kliničko iskustvo odnosi na mali broj bolesnika, CT je promijenio kliničku procjenu rezidualne bolesti u dvoje bolesnika i smatramo da bi uz PET i CT trebao biti sastavni dio dijagnostičke obrade takvih bolesnika

Clinical and histological correlation in the diagnosis of lipodermatosclerosis

Uvod: Lipodermatoskleroza je kronični fibrozirajući panikulitis povezan s venskom insuficijencijom. Kliničke manifestacije odnose se na zadebljanje i hiperpigmentaciju kože jedne ili obje noge. Karakteristična značajka kronične lipodermatoskleroze je pseudomembranozni tip nekroze masti, poznat većini patologa. Prikaz slučaja: Bolesnica je primljena radi obrade i liječenja sideropenične anemije. Kao glavne tegobe navodila je ljubičaste bolne potkožne nodule prisutne na potkoljenicama. Patohistološki nalaz bioptata kože upućivao je na lipodermatosklerozu. Bolesnica nije pristala na preporučenu terapiju. Zaključak: Pri kliničkoj sumnji na dijagnozu lipodermatoskleroze, bitno je učiniti biopsiju kože i patohistološku analizu bioptata, kako bi potvrdili dijagnozu, te isključili druge moguće uzroke.Introduction: Lipodermatosclerosis is a chronic fibrosing panniculitis associated with venous insufficiency. Clinical manifestation refers to the induration and hyperpigmentation of the skin on one or both legs. The characteristic feature of chronic lipodermatosclerosis is a pseudomembranous type of fat necrosis, known by most pathologists. Case report: A female patient was admitted for a diagnostic procedure and treatment of sideropenic anemia. The patient complained about purple subcutaneous painful nodules on the skin in the lower limbs. The pathohistological finding of skin biopsy indicated lipodermatosclerosis. Our patient didn’t accept any suggested therapy. Conclusion: When the diagnosis of lipodermatosclerosis is suspected, it is essential to do a biopsy of the affected skin and a pathohistological analysis, to support the diagnosis, while it can be confused with other panniculitides

Apocrine Carcinoma of the Scalp with Aggressive Clinical Course – A Case Report and Review of the Literature

Primary cutaneus apocrine carcinoma is a rare malignancy with about 50 cases reported in the literature. Axilla is the most common site of occurrence, but locations like scalp, anogenital region, ear canal, chest, wrist, finger and eyelid have been described. The neoplasm presents itself as an asymptomatic, slow-growing, solid or cystic mass that varies in color. Most patients have a history of a long-standing neoplasm before the diagnosis is made. The disease is considered to have an indolent clinical course with favorable outcome although more than half of reported patients had regional lymph node metastases at the time of diagnosis. Systemic dissemination to lung, bones, liver and brain is extremely rare with only 14 cases documented in the literature. Wide surgical excision with lymph node dissection upon confirmation of the lymph node metastases remains the only curable treatment. Care and management of the disseminated disease is still challenging. We report a case of a 65-year-old woman with a very aggressive apocrine carcinoma of the scalp prone to local recurrence and distant metastases to lung and bones

Retrospective study of the incidence and outcomes of sepsis in a Center

Background: sepsis is the common cause of death in immunocompromised patients and those suffering from malignant diseases. The mortality can be significantly reduced when early and correct diagnosis is given and the appropriate therapy is administered. Here we set to determine the incidence, sources and outcomes of sepsis and to resolve which bacteria, based on Gram staining, are more often the cause of sepsis. Patients and methods: we conducted a retrospective study of medical history in a two-year period, from April 2014 to April 2016. Diagnosis was given based on patients’ blood culture findings or their clinical presentation. Results: during a two-year period 1663 patients were treated. Sepsis was diagnosed in 35 patients (2.10%). The median age was 73 years and 22 patients (63%) were male. Sepsis was the primary cause of death in 10 patients (29%). Gram-positive bacteria were isolated in 21 patients (60%), and Gram-negative bacteria in 10 patients (31%). Conclusion: in our retrospective study, the gastrointestinal tract had the highest frequency of identified sepsis source. The incidence of sepsis caused by Gram-positive bacteria found in blood cultures was higher than by Gram-negative bacteria. However, due to small sample size, no difference in mortality was found based on Gram status

Prijenos Cs-137, Sr-90, Ra-226, Pb-210 i K-40 iz tla u biljku u različitim poljoprivrednim kulturama u Hrvatskoj

In this study, we investigated the soil-to-plant transfer of Cs-137, Sr-90, Ra-226, Pb-210 and K-40 in different types of vegetables and fruits collected on family farms in Croatia. The difference in radionuclide distribution between different plant compartments was also investigated. Our results suggest that, in general, the transfer of selected radionuclides within studied soil/plant agricultural ecosystems is on the lower part of ranges reported by IAEA for the temperate environments. Nevertheless, for all studied radionuclides, the transfer to the fruits and vegetables peels was higher than to the pulp. Overall, observed differences in the transfer of radionuclides indicate other additional exposure pathways and mechanisms that affect radionuclide content in plants besides soil activity concentrations.U ovom smo radu istražili prijenos Cs-137, Sr-90, Ra-226, Pb-210 te K-40 iz tla u različite vrste povrća i voća sakupljenih na obiteljskim poljoprivrednim imanjima u Hrvatskoj. Istovremeno su istražene i razlike u prijenosu radionuklida u različite dijelove plodova. Rezultati ovog istraživanja ukazuju da je generalno prijenos radionuklida obuhvaćenih ovom studijom unutar raspona transfer faktora sugeriranih od strane IAEA za umjerena područja, ali na njihovom nižem dijelu. Unatoč nižem transferu, uočen je povišeni prijenos svih istraživanih radionuklida u kore plodova u odnosu na pulpu. Sveukupno, primjećene razlike u prijenosu radionuklida sugeriraju, osim sadržaja radionuklida u tlu, i druge mehanizme i puteve izlaganja radionuklidima, a koje utječu na njihove količine u biljkama.XXXII Simpozijum Društva za zaštitu od zračenja Srbije i Crne Gore, 4-6. oktobar 2023; Budva, Crna GoraProceedings: [https://vinar.vin.bg.ac.rs/handle/123456789/11602

Serum chitotriosidase: a circulating biomarker in polycythemia vera

Objectives: Serum chitotriosidase activity (CHIT1) is a biomarker of macrophage activation with an important role in inflammation-induced tissue remodeling and fibrosis. Macrophages have been described to play a crucial role in regulating pathological erythropoiesis in polycythemia vera (PV). The aim of this study was to evaluate CHIT1 in patients diagnosed with Philadelphia-negative myeloproliferative neoplasms (MPNs). ----- Methods: Using fluorometric assay, we measured CHIT1 in 28 PV, 27 essential thrombocythemia (ET), 17 primary myelofibrosis (PMF), 19 patients with secondary myelofibrosis and in 25 healthy controls. ----- Results: CHIT1 was significantly higher in PV (p < .001) and post-PV myelofibrosis (MF) transformation (post-PV MF) (p = .020), but not in ET (p = .080), post-ET MF transformation (p = .086), and PMF patients (p = .287), when compared to healthy controls. CHIT1 in PV was positively correlated with hemoglobin (p = .026), hematocrit (p = .012), absolute basophil count (p = .030) and the presence of reticulin fibrosis in the bone marrow (p = .023). ----- Discussion: A positive correlation between CHIT1 and these distinct laboratory PV features might imply macrophages closely related to clonal erythropoiesis as cells of CHIT1 origin. In addition, a positive association between CHIT1 and reticulin fibrosis might indicate its potential role in PV progression. ----- Conclusion: CHIT1 might be considered as a circulating biomarker in PV. Additional studies are needed to clarify the role of CHIT1 in promoting disease progression and bone marrow fibrosis in PV

Smjernice za dijagnostiku i liječenje kronične limfocitne leukemije – Krohem B-CLL 2017.

Recent developments in the diagnosis and treatment of chronic lymphocytic leukemia (B-CLL) have led to change of approach in clinical practice. New treatments have been approved based on the results of randomized multicenter trials for first line and for salvage therapy, and the results of numerous ongoing clinical trials are permanently providing new answers and further refining of therapeutic strategies. This is paralleled by substantial increase in understanding the disease genetics due to major advances in the next generation sequencing (NGS) technology. We define current position of the Croatian Cooperative Group for Hematologic Disease on diagnosis and treatment of CLL in the transition from chemo-immunotherapy paradigm into a new one that is based on new diagnostic stratification and unprecedented therapeutic results of B-cell receptor inhibitors (BRI) and Bcl-2 antagonists. This is a rapidly evolving field as a great number of ongoing clinical trials constantly accumulate and provide new knowledge. We believe that novel therapy research including genomic diagnosis is likely to offer new options that will eventually lead to time limited therapies without chemotherapy and more effective clinical care for B-CLL based on individualized precision medicine.Nedavni događaji u dijagnostici i liječenju kronične limfocitne leukemije (B-KLL) doveli su do promjene pristupa u kliničkoj praksi. Nova liječenja su odobrena na temelju rezultata randomiziranih multicentričnih pokusa za prvu liniju terapije i za liječenje relapsa/refraktorne bolesti, a rezultati brojnih kliničkih pokusa u tijeku trajno doprinose daljnjem unaprjeđenju terapijskih strategija. Uz to prisutan je bitan porast razumijevanja genskih promjena bolesti zbog velikog napretka tehnologije nove generacije sekvencioniranja. Definiramo trenutni stav Hrvatske suradne skupine za hematološke bolesti o dijagnostici i liječenju B-KLL u sadašnjoj tranziciji iz kemo-imunoterapijske paradigme u novu koja se temelji na novoj dijagnostičkoj slojevitosti i izvrsnim terapijskim rezultatima inhibitora B-staničnih receptora (BRI) i Bcl-2 antagonista. To se područje brzo razvija kako velik broj kliničkih ispitivanja koja su u tijeku neprestance doprinosi i pruža nova znanja. Vjerujemo da će istraživanje novih terapija uz genomsku dijagnostiku pružiti nove mogućnosti koje će na kraju dovesti do vremenski ograničenog liječenja bez kemoterapije i do učinkovitije kliničke skrbi B-KLL na temelju individualizirane i precizne medicine