Volleyball as a model of health-oriented physical activity

Odbojka je danas zbog svoje dinamike i uzbudljivosti, sa čak 220 zemalja članica koje su dio FIVB-e (Fédération Internationale de Volleyball- Međunarodna odbojkaška organizacija), postala jedan od najpopularnijih sportova svijeta. Neprofesionalna odbojka koja se igra u slobodno vrijeme ima metabolički ekvivalent 3-4 METa, čime spada u kategoriju umjerene tjelesne aktivnosti, dok profesionalna odbojka bilo u dvorani ili na pijesku nosi 8 METa, što nam govori kako se može igrati kako u profesionalne svrhe, tako i u smislu rekreacije i očuvanja zdravlja. Idealan je model zdravstveno usmjerene tjelesne aktivnosti jer poboljšava funkciju kardiorespiratornog sustava, smanjuje rizik nastanka metaboličkog sindroma i pridruženih kardiovaskularnih bolesti. U današnjem sedentarnom načinu života,kada oko 35% populacije ima prekomjernu tjelesnu težinu, veoma je važna u borbi protiv pretilosti. Smatra se da povećava i antioksidativni odgovor organizma, te dugotrajno smanjuje upalni odgovor. Osobito je značajan njen učinak kod žena u postmenopauzi, kod kojih smanjuje rizik nastanka osteoporoze, te u mlađoj dobi kada poboljšava strukturu koštanog sustava i motoričke sposobnosti. Kod osoba s invaliditetom je od izuzetnog značaja jer povećava samopouzdanje, interakciju, integraciju u društvo, te sveukupno podiže razinu kvalitete života. Sjedeća odbojka je u posljednje vrijeme pronašla svoje mjesto i u Republici Hrvatskoj gdje nastoji integrirati što veći broj invalida iz Domovinskog rata.Because of its dynamism and excitement , with 220 member countries that are a part of the FIVB ( Federation Internationale de Volleyball – International Volleyball Organization ) , volleyball has become one of the most popular sports in the world . Non-professional volleyball being played in leisure has metabolic equivalent of 3-4 METs , which falls into the category of moderate physical activity , while any professional volleyball,in the gym or on the sand, has metabolic equivalent of 8 METs , which tells us how it can be played in professional purposes ,as well in terms of recreation and preservation of health . It is an ideal model of health – oriented physical activity because it improves the function of the cardiorespiratory system , reduces the risk of metabolic syndrome and associated cardiovascular disease . In today's sedentary lifestyle , when about 35 % of the population is overweight , it is very important in the fight against obesity . It is believed that it increases the antioxidant response of the organism , and in the long-term reduces the inflammatory response . Particularly significant is it's effect on postmenopausal women , in which volleyball reduces the risk of osteoporosis , and in earlier age when it improves the structure of the skeletal system and motor skills . In persons with disabilities is of great importance because it increases selfconfidence, interaction , social integration , and raises overall quality of life.Sitting volleyball has recently found its place in Croatia ,where it tries to integrate a large number of persons with disabilities from the Croatian war of Independence

LONG-TERM GLUCOCORTICOID THERAPY AND THE RAPID DEVELOPMENT OF SQUAMOUS CELL CARCINOMA IN SYSTEMIC SCLEROSIS: IS THERE A CONNECTION?

Sistemska skleroza (SSc) autoimunosna je bolest, koju prati rizik od razvoja malignoma, posebice karcinoma pluća, među kojima se prema učestalosti ističu adenokarcinom i planocelularni karcinom. Šezdesettrogodišnja bolesnica sa SSc-om hospitalizirana je zbog nesvjestice, lošeg općeg stanja i gangrenoznih promjena okrajina. Zbog epileptičkih napadaja koji su uslijedili te popratne ljevostrane slabosti učinjena je kompjutorizirana tomografi ja (CT) neurokranija koja je otkrila lezije tipa rasadnica (metastaza). Na CT-u pluća bila je vidljiva novotvorina u desnom hilusu koja je patohistološki evaluirala kao planocelularni karcinom 2. stupnja. Bolesnica je nakon jednomjesečne hospitalizacije uz potpornu terapiju, u klinički poboljšanom stanju, otpuštena na kućnu njegu s preporukom daljnjeg onkološkog liječenja, no nekoliko dana potom je preminula. S obzirom na adenokarcinome, planocelularni karcinomi pluća uobičajeno se razvijaju u znatno dužem razdoblju te držimo da je atipično ubrzan njegov razvoj u ove bolesnice potaknut imunosupresivnim djelovanjem srednje visokih doza glukokortikoida koje je bolesnica samoinicijativno uzimala više godina.Systemic sclerosis (SSC) is an autoimmune disease associated with the risk of malignancies, especially lung cancer, among which adenocarcinoma and squamous cell carcinoma are the most frequent. A 63-year-old female patient with SSC was hospitalized due to blackouts, poor general condition, and changes in her fi ngers. Because of subsequent epileptic seizures resulting in weakness of the left side of her body, computerized tomography (CT) of the neurocranium was performed which showed metastatic lesions. A CT scan of the thoracic organs displayed pulmonary neoplasia in the right hilum, which were histologically evaluated as grade 2 squamous cell carcinoma. Aft er one month of hospitalization with supportive therapy, the patient’s clinical condition improved, and she was discharged into home care with recommendations for further oncological treatment. However, the patient died several days later. In comparison to adenocarcinomas, squamous cell carcinomas of the lungs usually develop through a signifi cantly longer period. We consider that the unusually rapid development of the carcinoma in this patient was stimulated by the immunosuppressive eff ect of high doses of glucocorticoids that she had been taking for several years on her own initiative

Autoimmune Liver Diseases

Autoimune bolesti jetre uključuju autoimuni hepatitis (AIH), primarni bilijarni kolangitis (PBC) i primarni sklerozirajući kolangitis (PSC), te se nerijetko pojavljuju i zajedno u vidu sindroma preklapanja (overlap). Dok AIH primarno pogađa jetrene stanice, druge dvije bolesti zahvaćaju bilijarni epitel i tipično se prezentiraju svrbežom, umorom, žuticom te kolestatskim profilom u laboratorijskim nalazima. AIH i PBC pogađaju dominantno osobe ženskog spola i imaju specifične, gotovo patognomonične serološke biljege, dok se PSC tipično javlja kod mladih muškaraca oboljelih od upalnih bolesti crijeva. Ove bolesti pretežito su asimptomatske ili vrlo nespecifičnih simptoma, zbog čega često prođu nezapaženo i otkriju se tek u stadiju uznapredovane fibroze ili ciroze. Dok je biopsija jetre zlatni standard u dijagnostici AIH i sindroma preklapanja, MRCP je metoda izbora u PSC-u. U terapijskom smislu, AIH uglavnom pokazuje dobar odgovor na imunosupresivnu terapiju za koju je ključno ne prekinuti je do postizanja ne samo biokemijske, već i histološke remisije, što nužno zahtijeva barem tri godine liječenja. Ursodeoksikolna i obetikolna kiselina te ERCP kod striktura ekstrahepatalnih žučnih vodova zasad su jedini modaliteti liječenja kolestatskih bolesti jetre. U razdoblju dekompenzirane ciroze jetre transplantacija ostaje kao posljednja mogućnost izlječenja, osobito u slučaju razvoja hepatocelularnog karcinoma.Autoimmune liver diseases include autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Sometimes they occur simultaneously in the form of the ‘overlap syndrome’. While AIH primarily affects liver cells, the other two diseases affect biliary epithelium and typically present with pruritus, fatigue, jaundice, and cholestatic profile in laboratory findings. AIH and PBC affect predominantly females and have specific, almost pathognomonic serologic features, whereas PSC typically occurs in young men with inflammatory bowel disease. These diseases are mostly asymptomatic, or manifest themselves in nonspecific symptoms, and are therefore often detected in advanced stages of fibrosis or cirrhosis. While liver biopsy is the gold standard in the diagnosis of AIH and the overlap syndrome, MRCP is the method of choice for PSC. Regarding therapy, AIH generally responds well to immunosuppressive therapy, but requires continued treatment until biochemical and histological remission is achieved, which inevitably implies at least three years of treatment. Ursodeoxycholic acid, obeticholic acid, and ERCP in extrahepatic bile duct strictures are currently the only modalities for the treatment of cholestatic liver diseases. In decompensated liver cirrhosis or hepatocellular cancer, liver transplantation remains the last treatment option

Helicobacter pylori infection and severity of coronary atherosclerosis in patients with chronic coronary artery disease

AIM: Controversy exists concerning the relation between Helicobacter pylori (HP) infection and coronary artery disease (CAD). We aimed to examine the relationship between HP infection and severity of coronary atherosclerosis in patients with chronic CAD. ----- PATIENTS AND METHODS: A total of 150 patients (109 [73%] men; mean age 62.61±10.23 years) scheduled for coronary artery bypass grafting surgery were consecutively enrolled in the cross-sectional study. According to rapid urease test and/or gastric biopsy samples stained with hematoxylin and eosin and according to Giemsa, patients were classified as HP positive (n=87; 58%) or HP negative (n=63; 42%). Coronary angiograms were scored by quantitative assessment, using multiple angiographic scoring system: 1) vessel score (number of coronary arteries stenosed ≥50%), 2) Gensini score (assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its topographic importance) and 3) angiographic severity score (number of coronary artery segments stenosed ≥50%). ----- RESULTS: In comparison to HP-negative patients, HP-positive patients were more frequently hypertensive (P=0.014), had higher values of systolic (P=0.043) and diastolic (P=0.005) blood pressure and total cholesterol (P=0.013) and had lower values of high-density lipoprotein-cholesterol (HDL-C; P=0.010). There were no significant differences between the groups in the severity of coronary atherosclerosis: vessel score (P=0.152), Gensini score (P=0.870) and angiographic severity score (P=0.734). ----- CONCLUSION: It is likely that HP infection is not a risk factor for the severity of coronary atherosclerosis in chronic CAD patients

ANTICOAGULANT THERAPY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION – EVIDENCE BASED MEDICINE AND CLINICAL PRACTICE

Cilj istraživanja bio je procijeniti usklađenost propisivanja tromboprofilaktičkog liječenja u bolesnika s permanentnom atrijskom fibrilacijom (pAF) s kliničkim smjernicama Europskoga kardiološkog društva. U prospektivno presječno istraživanje susljedno su uključena 674 bolesnika (59% muškaraca) otpuštenih s kardiološkog odjela s dijagnozom pAF. Težina tromboembolijskog (TE) rizika procijenjena je CHA2DS2-VASc-sustavom, a rizik od krvarenja HAS-BLED-sustavom. U skupinu velikog TE rizika klasificirano je 578 (86%), umjerenog 57 (8%), a malog 39 (6%) bolesnika. Tromboprofilaksa je primijenjena u 601 (89%) bolesnika: varfarin u 310 (46%), acetilsalicilna kiselina u 258 (38%), a klopidogrel u 33 (5%). Varfarin je propisan u 47% bolesnika velikog, 49% bolesnika umjerenog te u 26% bolesnika malog TE rizika (P=0,03), a acetilsalicilna kiselina u 39% bolesnika malog, 39% bolesnika umjerenog i 38% bolesnika velikog TE rizika (P=0,998). Acetilsalicilna kiselina (P<0,001) i varfarin (P=0,007) bili su značajno češće korišteni u skupini bolesnika s velikim rizikom od krvarenja, u kojoj je zabilježena jednaka učestalost propisivanja varfarina i acetilsalicilne kiseline (53% prema 47%; P=0,416). Dob ³75 godina bila je nezavisni prediktor neprimjenjivanja (OR 1,7; 95% CI 1,2–2,4; P=0,003), a anamneza moždanog infarkta primjenjivanja varfarina (OR 0,47; 95% CI 0,29–0,76;P=0,002). Prilikom propisivanja tromboprofilaktičkog liječenja bolesnicima s pAF liječnici se ne pridržavaju preporučenih smjernica. Unatoč nepostojanju kontraindikacija značajan udio bolesnika s velikim TE rizikom nije dobio varfarin. Istodobno, varfarin je propisivan bolesnicima s malim TE rizikom čime su nepotrebno izloženi neželjenim učincima antikoagulantnog liječenja.Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 Š59%Ć male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs. 38%; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age ³75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2–2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29–0.76; P=0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment

Osteoid osteom korakoidnog nastavka: prikaz slučaja i pregled literature

Osteoid osteoma (OO) is the most common benign osteogenic bone tumor that predominantly affects young adults. OO is commonly localized in long bones, and therefore, it is rarely considered in differential diagnosis of chronic shoulder pain. We report a case of a 22-year-old male athlete, without history of previous trauma, who presented to our Department with chronic shoulder pain, which escalated during the night and responded to nonsteroidal anti-inflammatory drug treatment. Considering these typical symptoms, diagnostic pathway was immediately directed towards OO, with magnetic resonance and computed tomography confirming the diagnosis of OO of the coracoid process (CP). Since neurovascular structures are in the proximity of CP, and this very delicate area does not support radiofrequency ablation, we decided to perform an open procedure with drilling of the lesion and excochleation. The pain withdrew immediately after the procedure, and on six-month follow up the patient remained pain free. In the treatment of OO of the CP, we recommend open surgical procedure with tumor ablation by drilling instead of CP resection, presenting a safe, simple and low-cost method that simultaneously completely destroys the lesion and preserves the anatomical and functional role of CP.Osteoid osteom (OO) je dobroćudni osteoblastični tumor kostiju koji se najčešće javlja u adolescenata i mlađih odraslih osoba. Uobičajena lokalizacija OO su duge kosti pa se rijetko razmatra u diferencijalnoj dijagnostici kronične boli u području ramena. Prikazujemo slučaj mladog sportaša u dobi od 22 godine koji se žalio na bolove u lijevom ramenu, i to bez prethodne ozljede. Intenzitet boli značajno se pojačavao tijekom noći, a bol se smirivala nakon primjene nesteroidnih protuupalnih lijekova. Ovi tipični simptomi odmah su usmjerili dijagnozu k OO, a magnetska rezonancija i kompjutorizirana tomografija pokazale su da je riječ o OO korakoidnog nastavka skapule. Budući da se žilnoživčani snop nalazi u blizini korakoidnog nastavka radiofrekventna ablacija nije prikladna metoda za liječenje OO te lokalizacije pa smo se odlučili za kirurško liječenje. Načinili smo ablaciju tumora svrdlanjem te ekskohleacijom. Od operacijskog zahvata bolesnik se više nije žalio ni na kakvu bol u području lijevog ramena. S obzirom na današnje spoznaje savjetujemo da se OO korakoidnog nastavka svakako liječi kirurškim zahvatom tijekom kojeg valja tumor uništiti svrdlanjem. Za razliku od resekcije korakoidnog nastavka, svrdlanjem se u potpunosti uništava leziju i istodobno čuva integritet korakoidnog nastavka, što je od velikog anatomskog i funkcionalnog značenja

Determinants of group cohesiveness in sports: individual and group factors

Većina istraživanja grupne kohezije u sportskim timovima temelje se na konceptualnom modelu grupne kohezije autora Carrona (1982). Ovaj je model je, između ostalog, identificirao neke individualne i grupne čimbenike koji pridonose razvoju grupne kohezije unutar sportskog tima. U kontekstu ovog modela, često se u literaturi može pronaći kako su anksioznost i samoefikasnost sportaša značajne individualne odrednice grupne kohezije, dok se od grupnih čimbenika kao značajnima navodi učinkovita komunikacija u timu te kolektivna učinkovitost. Međutim, istraživanja, općenito, nisu pokazala dosljedne rezultate u pogledu odnosa navedenih individualnih čimbenika i grupne kohezije, dok je odnos navedenih grupnih čimbenika i grupne kohezije nedovoljno istražen u literaturi. Stoga je cilj ovog rada bio provjeriti predviđaju li anksioznost i samoefikasnost sportaša grupnu koheziju, te predviđaju li grupnu koheziju komunikacija igrača u timu te njihova kolektivna učinkovitost. Također, cilj rada bio je i provjeriti koji čimbenici uspješnije predviđaju grupnu koheziju. Istraživanje je provedeno na uzorku muških i ženskih igrača rukometa (N=117) iz klubova na području Grada Zagreba, u dobi između 15 i 30 godina. Grupna kohezija je, u istraživanju, mjerena Upitnikom ozračja u grupi (Carron, Widmeyer, i Brawley, 1985), anksioznost Skalom sportske anksioznosti (Smith, Smol, Cumming i Grossbard, 2006), samoefikasnost Skalom opće samoefikasnosti (Schwarzer i Jerusalem, 1995), komunikacija Skalom učinkovite komunikacije u timskim sportovima (Sullivan i Short, 2011), dok se za mjerenje kolektivne učinkovitosti koristio Upitnik kolektivne učinkovitosti (Short, Sullivan i Feltz, 2005). Rezultati su obrađeni hijerarhijskom regresijskom analizom te je dobiveno kako su kolektivna učinkovitost i komunikacija značajni prediktori grupne kohezije, odnosno izraženija kolektivna učinkovitost te češći obrasci prihvaćanja i konstruktivnog rješavanja konflikata, prilikom komunikacije unutar tima, doprinose čvršćoj grupnoj koheziji tima. Individualni čimbenici nisu pokazali značajan doprinos grupnoj koheziji.Most research on group cohesion in sports teams is based on the conceptual model proposed by Carron (1982). Latter has identified some individual and group factors that contribute to the development of group cohesion within the sports team. In the context of this model, it is often found in literature that anxiety and self-efficacy of athletes are significant individual factors, while communication among athletes and collective efficacy are significant group factors that predict group cohesion. Overall research has not shown consistent results in relationship of mentioned individual factors or group factors with group cohesion. The goal of this paper was to determine whether anxiety and self-efficacy of athletes, and whether collective efficacy and communication can predict group cohesion. The aim was also to identify which factors predict group cohesion better. The research was conducted on a sample of handball players (N = 117) from clubs in the City of Zagreb, aged between 15 and 30. The group cohesion in the study was measured by the Group Environment Questionnaire (Carron, Widmeyer and Brawley, 1985), anxiety by the Sports Anxiety Scale-2 (Smith, Smol, Cumming and Grossbard, 2006), self-efficacy by the General Self-efficacy Scale (Schwarzer and Jerusalem, 1995), communication by Scale of Effective Communication in Team Sports–2 (Sullivan and Short, 2011), collective efficacy by Collective Efficacy Questionnaire for Sports (Short, Sullivan and Feltz, 2005). The results are conducted by hierarchical regression analysis and it is shown that collective efficacy and communication are significant group cohesion predictors, where higher collective efficacy, and frequent forms of acceptance, when communicating within the team, contribute to stronger team cohesion. Individual factors have not shown a significant contribution to group cohesion

Volleyball as a model of health-oriented physical activity

Odbojka je danas zbog svoje dinamike i uzbudljivosti, sa čak 220 zemalja članica koje su dio FIVB-e (Fédération Internationale de Volleyball- Međunarodna odbojkaška organizacija), postala jedan od najpopularnijih sportova svijeta. Neprofesionalna odbojka koja se igra u slobodno vrijeme ima metabolički ekvivalent 3-4 METa, čime spada u kategoriju umjerene tjelesne aktivnosti, dok profesionalna odbojka bilo u dvorani ili na pijesku nosi 8 METa, što nam govori kako se može igrati kako u profesionalne svrhe, tako i u smislu rekreacije i očuvanja zdravlja. Idealan je model zdravstveno usmjerene tjelesne aktivnosti jer poboljšava funkciju kardiorespiratornog sustava, smanjuje rizik nastanka metaboličkog sindroma i pridruženih kardiovaskularnih bolesti. U današnjem sedentarnom načinu života,kada oko 35% populacije ima prekomjernu tjelesnu težinu, veoma je važna u borbi protiv pretilosti. Smatra se da povećava i antioksidativni odgovor organizma, te dugotrajno smanjuje upalni odgovor. Osobito je značajan njen učinak kod žena u postmenopauzi, kod kojih smanjuje rizik nastanka osteoporoze, te u mlađoj dobi kada poboljšava strukturu koštanog sustava i motoričke sposobnosti. Kod osoba s invaliditetom je od izuzetnog značaja jer povećava samopouzdanje, interakciju, integraciju u društvo, te sveukupno podiže razinu kvalitete života. Sjedeća odbojka je u posljednje vrijeme pronašla svoje mjesto i u Republici Hrvatskoj gdje nastoji integrirati što veći broj invalida iz Domovinskog rata.Because of its dynamism and excitement , with 220 member countries that are a part of the FIVB ( Federation Internationale de Volleyball – International Volleyball Organization ) , volleyball has become one of the most popular sports in the world . Non-professional volleyball being played in leisure has metabolic equivalent of 3-4 METs , which falls into the category of moderate physical activity , while any professional volleyball,in the gym or on the sand, has metabolic equivalent of 8 METs , which tells us how it can be played in professional purposes ,as well in terms of recreation and preservation of health . It is an ideal model of health – oriented physical activity because it improves the function of the cardiorespiratory system , reduces the risk of metabolic syndrome and associated cardiovascular disease . In today's sedentary lifestyle , when about 35 % of the population is overweight , it is very important in the fight against obesity . It is believed that it increases the antioxidant response of the organism , and in the long-term reduces the inflammatory response . Particularly significant is it's effect on postmenopausal women , in which volleyball reduces the risk of osteoporosis , and in earlier age when it improves the structure of the skeletal system and motor skills . In persons with disabilities is of great importance because it increases selfconfidence, interaction , social integration , and raises overall quality of life.Sitting volleyball has recently found its place in Croatia ,where it tries to integrate a large number of persons with disabilities from the Croatian war of Independence

Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal

The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice