POSEBNOST DIJALIZE u STARIH I VRLO STARIH BOLESNIKA – DILEME

The global increase in the proportion of older population contributes to the increasing number of patients with renal insufficiency. This disorder particularly involves the old (age 70-75) and very old (over 80) population groups. The number of comorbidities is increasing and life expectancy reduced with aging. Cross-sectional analysis of ten-year survival showed a rate of 33.9% in patients treated at the Hemodialysis Center, 23.81% in transplanted patients and 19.35% in dialyzed patients. In patients having started hemodialysis (HD) at the age of ≥70, the mean survival was 20.27±18.62 months, in those that died 15.54±17.35 months, and in survivors 30.29±17.85 months. Among HD treated patients, 35% survived for up to one year, 18% for two years and 8% for ≥3 years. Karnofsky index was below 50% in all patients that survived, while the Malnutrition Inflammation Score and Subjective Global Assessment indicated malnutrition. In Croatia, the number of HD patients is constantly increasing as the result of population aging, better, accessible and equal health care that prolongs life span, easier access to substitution methods, more accesses to the vascular system, development of the national transplant network and good immunosuppressive therapy. All this provides biological, economic and normative space for replacement therapy. Old age, comorbidities and poor nutritional status influence high mortality, poor functional status and impaired quality of life. Survival results correspond to reports in the literature.U svijetu je ubrzan porast broja starijih bolesnika koji trebaju liječenje dijalizom. Ti se izvještaji poklapaju iz raznih zemalja. Problemi koje nosi starija dob su višestruki. Različiti su stavovi za stratifikaciju dobnih granica. Bilo kako bilo, dobne granice su produžene i porast starije populacije sa svim pratećim komorbiditetima je neizbježan. Kronična bubrežna bolest ima puno veću incidenciju u među starom negoli među mlađom populacijom i u stalnom je porastu u svijetu bilo kao bolest, komorbiditet ili posljedica raznih stanja. Ova činjenica nameće pitanja fiziologije i patofiziologije starenja i promjena u glomerularnoj filtraciji (GF). Ima li jasnih stavova o normalnim laboratorijskim vrijednostima prilagođenim dobnoj granici? U kojem stupnju je GF fiziološka varijanta za konkretnu dob? Produžava li liječenje hemodijalizom životni vijek vrlo starih osoba? Odgovori nisu uvijek precizni. Stara populacija često je izložena odlukama liječnika, obitelji ili skrbnika mimo svoje želje, bilo zbog nedostatka komunikacije ili zbog nepoznavanja postupaka. Procedure mogu na bolesnika ostaviti psihičke i fizičke posljedice (patnje), bez obzira na to što su sve napravljene profesionalno, oni često kažu “da sam znao što me čeka, ne bih pristao”. Zbog toga je nužno poštivati odluku bolesnika. Analizom vlastitih podataka vidljiva je prisutnost veoma stare populacije s velikim brojem pridruženih komorbiditeta te visokim stupnjem pothranjenosti (MIS) i Karnofskyjeva skora. U Centru je više od 49,23% populacije starije od 70 godina, s velikom zastupljenošću privremenog ili trajnog centralnog venskog katetera kao pristupa za dijalizu (42,35%). Najviše preživjelih do 1, 2 i 3 godine bilo je u skupini od 76-80 godina, a u skupini starijih od 80 godina nitko nije preživio 4 ili 5 godina. Kod preživjelih bolesnika visoke dobi sposobnost za samostalno funkcioniranje je veoma mala. Karnofskyjev zbir za preživjele 6 mjeseci i više bio je u prosjeku 50%

Generalizirana ateroskleroza, metabolički sindrom i rezistentna hipertenzija - uzroci i posljedice

e components of metabolic syndrome lead to generalized atherosclerotic changes and micro- and macrovascular complications with damage to systems and organs. Consequently, patients’ treatment with the resulting changes in the target organs is costly, complicated, and unpredictable. We present a 65-year-old patient with diabetes diagnosed with hyperlipidemia, unregulated arterial hypertension in the presence of other metabolic syndrome components and who consequently developed complications of generalized atherosclerosis. Despite detailed, individually tailored therapy, in line with current recommendations, we suggest that treatment success is very closely related and dependent on dietary measures, healthy living habits, and patient cooperation.Komponente metaboličkog sindroma dovode do generaliziranih aterosklerotskih promjena te mikro i makrovaskularnih komplikacija s oštećenjem sustava i organa. Slijedom toga, liječenje bolesnika s posljedicama promjena na ciljnim organima vrlo je skupo, složeno i nepredvidljivo. Predstavljamo 65-godišnjeg pacijenta, dijabetičara, kojem je dijagnosticirana hiperlipidemija, neregulirana arterijska hipertenzija u prisutnosti drugih komponenata metaboličkog sindroma i posljedično razvijene komplikacije generalizirane ateroskleroze. Unatoč detaljnoj, individualno prilagođenoj terapiji, u skladu s trenutnim preporukama, smatramo da je uspjeh liječenja vrlo usko povezan i ovisi o prehrambenim mjerama, zdravim životnim navikama i suradnji pacijenta

Water Carrying Ships in the Adriatic Region - Zadar Region Analysis

In this paper the main objective was to analyse water distribution market on Adriatic islands, mainly those without any water piping infrastructure. Those islands are mostly supplied by water carrying ships. The used methodology consisted of analysing, in last four years, the number of water deliveries and amount of precipitation in the research area. The analysis showed that the most critical situation occurs from June to September, when the number of residents grows and the amount of precipitation lowers. In order to avoid critical situations, like water reductions and draughts, important factors are pointed out which could lead to such situations and with proper precautions action can be avoided

Renal dysplasia with the ipsilateral ectopic ureter mimicking abscess of the prostate

Introduction. In males the ectopic ureter usualy drains into the prostate (50%). During ureteric developement a thin membrane (Chawalla’s membrane) separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. Case report. A subfebrile (37.3°C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE) showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS), but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI) was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient’s recovery was uneventful. Conclusion. To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too craniall sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter

Model agonističkog selfa: oblici razvoja i promene

Predmet ovog rada su oblici razvoja i promene agonistički koncipiranog selfa (Gutvajn i Džinović, 2019; Džinović, 2020), koji se oslanja na polifono, fukoovsko i konstruktivističko stanovište. Ovaj model se delimično nadovezuje na doprinose eriksonovskog, narativnog i dijaloškog modela identiteta, koji su naglasili kontinuitet u doživljaju sebe (Erikson, 2008), kroz konstruisanje ličnog narativa, aproprijacijom metanarativa (Bruner, 1991; 2003; McAdams, 1996, 2003; Nelson, 2003), u kojem različite Ja-pozicije (glasovi) demokratski pregovaraju (Hermans, 2018). Razvojno-teorijske pretpostavke koje delimo odnose se na relacionu ontologiju privatnog: unutrašnji plan se ko-konstruiše u socijalnoj praksi, na prvom mestu jezičkoj (Vigotski, 1960/1996), u kojoj se nužno neprekidno pozicioniramo i bivamo pozicionirani u okviru javnih diskursa (Bamberg, 1997, 2011; Davies & Harre, 1990).XXVI Nаučnа konferencijа „Pedаgoškа istrаživаnjа i školskа prаksа

“I am tilting at windmills”: Tensions in teacher professional identity from the perspective of the model of the agonistic self

У овом раду представљамо експлоративно истраживање у чијем су фокусу тензије у професионалном идентитету наставника, које смо конципирали ослањајући се на модел агонистичког селфа. У истраживању је учествовало девет наставница предметне и разредне наставе из две београдске основне школе. Истраживање смо дизајнирали као вишеструку студију случаја у којој смо као помоћну методу анализе података, добијених путем полуструктурисаног интервјуа, користили тематску анализу. Као критеријум селекције тензичних ситуација користили смо присуство једног од четири типа тензичних односа у агонистичком селфу: критичко прихватање, продуктивна тензија, акутни сукоб и трајни сукоб. Ове односе интерпретирали смо као различите начине одвијања психосоцијалне динамике и решавања психолошке тензије учесница. Селектоване ситуације смо, потом, тематски категорисали. Идентификовали смо 9 тема у вези са којима наставнице имају професионалне дилеме. Наши резултати указују на то да се иста професионална дилема у селфу наставника манифестује кроз различите типове тензичног односа, што сугерише да није довољно усмерити истраживачку пажњу на садржај наратива о професионалним дилемама већ и на различите механизме психосоцијалне динамике путем којих се дате тензије одвијају и разрешавају. Оваквав поглед на професионалне дилеме наставника представља допринос за осмишљавање нових и унапређивање постојећих модела професионалног развоја наставника.In this paper, we present an exploratory study on tensions in teacher professional identity based on the Model of Agonistic Self. The sample comprised nine class and subject teachers employed at two primary schools in Belgrade. The research was conceived as a multiple-case study in which thematic analysis was used as an auxiliary method for analyzing the data obtained via a semi-structured interview. The criterion for the selection of tense situations was the presence of one of the four types of tense relations in the agonistic self: acceptance with critique, productive tension, acute conflict, and permanent conflict. These relations were interpreted as different forms of psychosocial dynamics and ways of resolving psychological tension among participants. Subsequently, we thematically categorized the selected situations. We identified nine themes in relation to which our participants had professional dilemmas. Our findings indicate that the same professional dilemma within a teacher’s self can manifest itself in different kinds of tense relations. This suggests that it is not sufficient to direct research attention towards the content of the narratives about professional dilemmas, but that it is also necessary to explore different mechanisms of psychosocial dynamics through which these tensions develop and get resolved. This perspective on teachers’ professional dilemmas represents a contribution to the creation of new models and the refinement of existing models of teacher professional development

The power relations between the voices of the self as strategies of self-regulation : the case of teacher professional behavior

In this study we explore how a new model of the multiple self can help to better understand self-regulation of human behavior. We start from the dialogical self theory and the social cognitive theory of personality. The dynamics of the multiple self is conceived in terms of the patterns of power relations between the voices as personifications of beliefs and guides for socially accountable behavior. The multi-voiced self is understood as a processing component of personality which is responsible for self-regulated behavior and its voices may be viewed as the interacting mediating processes. The goal of this work is to present the most common patterns of interaction between the voices as strategies of self-regulation on the example of teacher professional behavior. The research participants (9 elementary school teachers, all females, years of experience: 1-10 (N=3), 10-20 (N=4), >20 (N=2)) elicited the voices and described their relationships while being interviewed. We used a combine deductiveinductive thematic approach to analyze the data. Starting from preexisting categories of ’dominance’ (ability to manage the actions of others), ‘resistance’ (ability to counter-act in relation to the dominant position), conflict and cooperation we inductively developed the matrix of the categories and main categories. Critical dialogues between the researchers were practiced as the multi-iteration procedure for establishing the intersubjective agreement. The main categories are: 1) functions of the voices; 2) forms of exercising power; 3) tactics; 4) the voices’ relations and 5) constellations (patterns of interaction among the voices). The main category of constellations will be further elaborated. The most frequent constellations show that the regulation of teachers’ professional behavior is manifested through the stable domination of voices who personify core professional values, implemented either by a common group of executors and facilitators (‘The team’ constellation) or by alternative executors and facilitators, often those who personify undesirable (rough, aggressive) acts, when the dominant ideology was temporally ‘dethroned’ by the opponents (’The Intervention team’ constellation). The second most common regulatory strategy ensures the dispersion of power as a way to prevent its monopolization by a single ideological stance (‘Clash of ideologies’ constellation). This model of self-regulation may be used to improve teacher competencies and to prevent burnout.Knjiga rezimea / XXVII naučni skup Empirijska istraživanja u psihologij

Prediction of GO terms for IDPs based on highly connected components in PPI networks

Partitioning large biological networks can help biologists to retrieve new information for particular biological structures. In literature, various methods for partitioning and clustering biological networks have been proposed. The aim of such a network partitioning is to retrieve smaller structures which are easier to analyse, but still containing important information about relations between the network elements. Highly connected deletion problem is one of such network partitioning, with the aim to partition a network into highly connected components (hcd components) by deleting minimum number of edges. A network component with n nodes is a hcd component if the degree of every vertex is larger than n/2. For the purpose of this research, we used a specially constructed local search based heuristic approach to identify hcd components. Dealing with protein-protein interaction (PPI) networks, it has been noticed that proteins from the same hcd component in a network have same Gene Ontology (GO) annotations. Based on that, we proposed a new method for prediction of GO annotations, which consists of the following steps: (a) starting PPI network is partitioned to hcd components; (b) the obtained hcd components are expanded by proteins which became singletons in the partition set; (c) the newly formed extended hcd components are the subject of further enrichment analysis in DiNGO tool, which returns a list of existing GO terms for proteins from the considered extended component; (d) after propagation through GO hierarchy, the extended list of GO is obtained; (e) each protein from the extended hcd component is annotated by a number of GO terms obtained from the previous step; The proposed method is tested on the data from CAFA-3 challenge. Comparing the F1-measure of the obtained results, a combination of parameters (type of extension, cutoff for enrichment analysis and maximum number of GO terms) with the best performances is selected for the further usage. The method with the selected parameters was further applied on a class of Intrinsically Disordered Proteins (IDP). Preliminary results indicate that this method can be useful for proposing new GO terms for IDP proteins

Toxigenic and pathogenic fungi in Norway rat (Rattus norvegicus Berk., 1769) from natural populations in semiagricultural habitats

In this study, the presence of toxigenic and pathogenic fungi was detected in individuals of natural populations of Norway rats from semiagricultural habitats. The presence of fungi was noted in 19 out of 30 (63%) individuals examined. Six fungal species were isolated and identified, of which majority belonged to Hyphomycetes (Deuteromycotina) and Mucor racemosus from Zygomycotina. All of detected species are of public health importance and some of them might influence animals health.U ovom radu su prikazana istraživanja prisustva toksigenih i patogenih gljiva u jedinkama sivog pacova (Rattus norvegicus Berk., 1769) iz prirodnih populacija sa polupoljoprivrednih staništa (Omoljica, Kovin, Leštane, Ovča). Detekcija prisustva gljiva u biološkom materijalu (bris kože nosne šupljine i homogenat pluća) je vršena na selektivnoj Sabouraud Maltose Agar (SMA) podlozi. Istraživanje je pokazalo prisustvo šest vrsta gljiva od kojih pet pripada klasi Hyphomyceta (Deuteromycotina), a Mucor racemosus klasi Zygomycotina. Vrste roda Aspergillus su detektovane u homogenatima pluća šest jedinki, a Penicillium kod pet jedinki. Paecilomyces varioti je izolovan iz tkiva šest jedinki sivog pacova. Brisevi kože nosne šupljine su dali pozitivne rezultate u 15 (50%) od 30 jedinki (četiri pozitivna za Aspergillus, četiri za Penicillium, šest za Paecilomyces varioti i jedna za Mucor racemosus). Međutim, u samo 9 slučajeva zabeleženo je poklapanje prisustva gljiva u koži nosne šupljine i pluća. Nalazi koji pokazuju prisustvo patogena, izazivača teških gljivičnih oboljenja, ukazuju na sivog pacova kao na potencijalni rezervoar ovih agenasa. Dobijeni podaci predstavljaju, prema našem saznanju, prve podatke o prisustvu gljiva kod pacova iz prirodne sredine zabeležene kod nas.Projekat ministarstva br. 14303