Psychiatric dilemmas: Schizophrenia therapy – Case report

Cilj: Izbor antipsihotika u liječenju shizofrenije važan je zbog potencijalnih nuspojava, a dobre rezultate u liječenju mogu dati pravilan odabir i kombinacija psihijatrijskih metoda liječenja. Prikaz slučaja: Studentica prve godine fakulteta oboljela je od shizofrenije, te je u akutnoj fazi bolesti hospitalizirana. Pozitivni simptomi shizofrenije (fenomen nametanja misli, slušne halucinacije) uz strah i smetnje sna i alimentacije bili su indikacija za hospitalizaciju. U bolničkim uvjetima uveden je atipični antipsihotik kvetiapin koji je titriran do dnevne doze od 600 mg koja je dovela do remisije simptoma. Nuspojava lijeka bila je značajan porast tjelesne težine od 30 kg, što je bio razlog uvođenja drugog atipičnog antipsihotika olanzapina (10 mg na dan). Po olanzapinu su simptomi ostali u remisiji, a zabilježen je pad tjelesne težine od 10 kg. Bolesnica je radno i socijalno zadovoljavajuće funkcionirala. Za čitavo vrijeme liječenja nalazila se u psihoterapijskom tretmanu (grupnom i individualnom). Rasprava: Iako postoji izbor u liječenju shizofrenije, s obzirom na činjenicu da uzrok bolesti još uvijek nije poznat, nema univerzalne terapije koja bi bila učinkovita kod svih bolesnika. Kombinacija različitih oblika liječenja može dovesti do remisije bolesti i potpunog oporavka. Zaključak: Kombinacija terapija (psihofarmaka i psihoterapije) daje bolje rezultate u liječenju shizofrenije nego svaka od navedenih terapija pojedinačno. Cilj liječenja je postići što dulju remisiju bolesti.Aim: The choice of antypsychotics in schizophrenia treatment is very important due to the potential side-effects, and yet, some good treatment outcomes are achieveable if an adequate choice is made and a combination of psychiatric methods is applied. Case report: A 1st year degree student became ill with schizophrenia and ended up hospitalized in the acute phase of the illness. The reason for hospitalization were the positive symptoms she manifested (obtrusive thoughts phenomenon, auditory hallucinations) as well as fright, sleep disturbances and disordered alimentation. The inpatient treatment commenced with a titration of quetiapine, an atypical antipsychotic, with a daily dose of 600 mg, which lead to remission of the illness. Very soon a side effect became evident; a significant weight gain of 30 kilos which was the main reason of introducing a new atypical antipsychotic – olanzapine, with a 10 mg daily dose. This new atypical antipsychotic kept the illness in remission and a weight loss of 10 kilos was achieved, while the patient retained her working ability and social functioning. Throughout her therapy, the patient was actively participating in a psychotherapy treatment (individual and group). Discussion: Despite the accessability of choices of treatment methods for treating schizophrenia, while considering the fact that an exact cause of the illness is yet to be determined, the availability of an universal therapy adequate for all schizophrenia patients, is still not available,. A combination of different treatment methods can lead to remission of the illness and a complete recovery, relating to the working ability as well as social functioning. Conclusion: A combination therapy (psychopharmacs and psychotherapy) is more effective as a treatment for schizophrenia than any of the therapies mentioned, when applied independently. The aim of the treatment is achieveing the longest possible remission of the illness

Ima li opravdanja za proaktivan pristup kontroli bakterije Legionella u okolišu?

Research background. Legionella are Gram-negative bacteria that are ubiquitous in the natural environment. Contaminated water in man-made water systems is a potential source of transmission of legionnaires’ disease. The aim of this study is to explore the prevalence of Legionella pneumophila in the drinking water distribution system (DWDS) of Primorje-Gorski Kotar (PGK) County, Croatia, for the period 2013-2019, coupled with the incidence of legionnaires’ disease. A number of L. pneumophila-positive samples (>100 CFU/L), serogroup distribution and the degree of contamination of specific facilities (health and aged care, tourism, and sports) were assessed. Based on the obtained results, the reasoning for the implementation of a mandatory Legionella environmental surveillance program was assessed. Experimental approach. Sample testing for Legionella was carried out according to the standard method for enumeration of this bacterium. A heterotrophic plate count (HPC) and Pseudomonas aeruginosa number were analysed along with the basic physicochemical indicators of drinking water quality. The research period was divided into two parts, namely, the 2013-2018 period (before implementation of the prevention program, after the outbreak of legionnaires’ disease), and the year 2019 (proactive approach, no disease cases recorded). Results and conclusions. During the 7-year observation period in PGK County, an increase in the number of samples tested for Legionella was found. An increase in Legionella-positive samples (particularly pronounced during the warmer part of the year) was recorded, along with a growing trend in the number of reported legionnaires’ disease cases. In addition to hot water systems, the risk of Legionella colonisation also applies to cold water systems. Health and aged care facilities appear to be at highest risk. In addition to the higher proportion of positive samples and a higher degree of microbiological load in these facilities, the highest proportion of L. pneumophila SGs 2-14 was identified. Due to the diagnostic limitations of the applied tests, the number of legionnaires’ disease cases is underdiagnosed. Novelty and scientific contribution. The introduction of a mandatory preventive approach to monitoring Legionella in DWDS water samples, along with the definition of national criteria for the interpretation of the results will create the preconditions for diagnosis and adequate treatment of larger numbers of legionnaires’ disease cases.Pozadina istraživanja. Legionella spada u skupinu Gram-negativnih bakterija sveprisutnih u prirodnom okolišu. Potencijalni izvor prijenosa legionarske bolesti je onečišćena voda koja se nalazi u vodoopskrbnim sustavima. Svrha je ove studije bila istražiti raširenost bakterije Legionella pneumophila u distribucijskom sustavu vode za piće Primorsko-goranske županije, Hrvatska, u razdoblju od 2013. do 2019. godine te ispitati učestalost pojave legionarske bolesti. Određen je broj uzoraka pozitivnih na L. pneumophila (>100 CFU/L), kao i raspodjela serogrupa te stupanj onečišćenja pojedinih vrsta objekata (zdravstvene ustanove i ustanove za starije i nemoćne osobe, turistički i sportski objekti). Na osnovi dobivenih rezultata procijenjena je opravdanost provedbe obveznog programa nadzora bakterije Legionella u okolišu. Eksperimentalni pristup. Prisutnost bakterije Legionella u uzorcima ispitana je prema standardnoj metodi za brojenje ove bakterije. Analiziran je broj izraslih kolonija i broj bakterija Pseudomonas aeruginosa, zajedno s osnovnim fizikalno-kemijskim pokazateljima kakvoće vode za piće. Razdoblje istraživanja podijeljeno je u dva dijela, od 2013. do 2018. godine (prije provedbe preventivnog programa, nakon pojave legionarske bolesti) i 2019. godina (proaktivan pristup, bez zabilježenih slučajeva bolesti). Rezultati i zaključci. Tijekom sedmogodišnjeg razdoblja istraživanja je u Primorsko-goranskoj županiji utvrđeno povećanje broja uzoraka ispitanih na prisutnost bakterije Legionella. Zabilježen je porast pozitivnih uzoraka (osobito izražen tijekom toplijeg dijela godine), zajedno s rastućim trendom broja prijavljenih slučajeva legionarske bolesti. Osim sustava potrošne tople vode, rizik od kolonizacije bakterijom Legionella povezan je i sa sustavima hladne vode. Najveći rizik javlja se u zdravstvenim ustanovama i ustanovama za njegu starijih osoba. Uz veći udjel pozitivnih uzoraka i veći stupanj mikrobiološkog opterećenja, u tim objektima identificiran je i najveći udjel L. pneumophila SG 2-14. Zbog ograničenja primijenjenih dijagnostičkih testova, određeni broj slučajeva legionarske bolesti ostaje nedijagnosticiran. Novina i znanstveni doprinos. Uvođenjem obveznog preventivnog pristupa praćenja bakterije Legionella u sustavima distribucije vode za piće te definiranjem nacionalnih kriterija interpretacije rezultata stvorit će se preduvjeti za dijagnostiku i odgovarajuće liječenje većeg broja slučajeva legionarske bolesti

Tick-Borne Encephalitis Due to Consumption of Raw Goat Milk, Gorski kotar, 2019: Clinical Case Reports

Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.Tick-borne encephalitis (TBE) is the most common central nervous system (CNS) infection in the endemic areas of Central Europe. TBE is a zoonosis whose reservoir are forest rodents, and other mammals and vectors are Ixodes ticks. Humans become infected through a tick bite, but recently many TBE outbreaks after consumption of unpasteurized milk and dairy products from infected livestock have been described. The aim of this study was to analyze clinical characteristics of five TBE cases who were infected after consumption of unpasteurized goat milk and dairy products from a small family farm in Primorje-Gorski Kotar County (June 2019). Tree patients developed CNS infection while two had febrile illness. None of the infected patients reported a history of a tick-bite or were vaccinated against TBE. The infection was confirmed by detection of TBE specific antibodies. Since "healthy" lifestyle that encourages consumption of raw milk and dairy products is increasingly fashionable, we would like to point out the importance of pasteurizing or boiling milk before the consumption

Prirodni ljekoviti činitelji

Glavni potencijali i oslonci budućeg razvoja zdravstvenog turizma u Republici Hrvatskoj su kvalitetni i stručni zaposlenici, prirodni ljekoviti činitelji na bazi termalne i morske vode, naftalana, peloida i ostalih, raznolikost prirodnog bogatstva, ekološke kvalitete prostora, more, blagotvorno podneblje i zdrava hrana, povećanje svijesti stanovništva o preventivnoj skrbi i brizi za vlastiti zdravlje. Udžbenik Prirodni ljekoviti činitelji doprinosi početcima stvaranja stručnog osoblja koji će iste činitelje na pravi način znati iskoristiti u liječenju i podizanju kvalitete života

Natural Health Remedies

The main potentials and pillars of the future development of health tourism in the Republic of Croatia are high-quality and professional employees, natural medical agents based on thermal and sea water, naphthalene, peloids and others, the diversity of natural resources, the ecological quality of the area, the sea, the beneficial climate and healthy food, the increase awareness of the population about preventive care and care for their own health. The textbook Natural healing agents contributes to the beginnings of creating professional employees who will know how to use the same agents in the right manner in the treatment and improving the quality of life

Natural Health Remedies

The main potentials and pillars of the future development of health tourism in the Republic of Croatia are high-quality and professional employees, natural medical agents based on thermal and sea water, naphthalene, peloids and others, the diversity of natural resources, the ecological quality of the area, the sea, the beneficial climate and healthy food, the increase awareness of the population about preventive care and care for their own health. The textbook Natural healing agents contributes to the beginnings of creating professional employees who will know how to use the same agents in the right manner in the treatment and improving the quality of life

Could the CCR5-Δ32 Mutation be Protective in SARS-CoV-2 Infection?

Increasing evidence points to host genetics as a factor in COVID-19 prevalence and outcome. CCR5 is a receptor for proinflammatory chemokines that are involved in host responses, especially to viruses. The CCR5 Δ32 minor allele is an interesting variant, given the role of CCR5 in some viral infections, particularly HIV-1. Recent studies of the impact of CCR5-Δ32 on COVID-19 risk and severity have yielded contradictory results. This ecologic study shows that the CCR5-Δ32 allelic frequency in a European population was significantly negatively correlated with the number of COVID-19 cases (p=0.035) and deaths (p=0.006) during the second pandemic wave. These results suggest that CCR5-Δ32 may be protective against SARS-CoV-2 infection, as it is against HIV infection, and could be predictive of COVID-19 risk and severity. Further studies based on samples from populations of different genetic backgrounds are needed to validate these statistically obtained findings

Prirodni ljekoviti činitelji

Glavni potencijali i oslonci budućeg razvoja zdravstvenog turizma u Republici Hrvatskoj su kvalitetni i stručni zaposlenici, prirodni ljekoviti činitelji na bazi termalne i morske vode, naftalana, peloida i ostalih, raznolikost prirodnog bogatstva, ekološke kvalitete prostora, more, blagotvorno podneblje i zdrava hrana, povećanje svijesti stanovništva o preventivnoj skrbi i brizi za vlastiti zdravlje. Udžbenik Prirodni ljekoviti činitelji doprinosi početcima stvaranja stručnog osoblja koji će iste činitelje na pravi način znati iskoristiti u liječenju i podizanju kvalitete života