Phototherapy in the treatment of generalized vitiligo – a case report

Cilj: Cilj rada je prikaz slučaja bolesnika s generaliziranim oblikom vitiliga koji je liječen lokalnim kortikosteroidima i uskospektralnom UVB fototerapijom, kao i pregled novih oblika liječenja vitiliga. Prikaz slučaja: Četrdesetdvogodišnji bolesnik zaprimljen je zbog generalizirane pojave vitiliga. Kliničkim pregledom uočene su depigmentirane mliječnobijele makule simetrično raspoređene po koži lateralnih strana trupa, gornjih i donjih ekstremiteta, kao i vratu te periorbitalno na desnoj strani lica. U terapiju je uvedena kortikosteroidna krema, mometazon furoat, a potom i uskospektralna UVB fototerapija koja se provodila tri puta tjedno uz povećanje doze za 20% prilikom svakog obasjavanja do pojave blagog eritema. Ukupna primljena doza iznosila je 69.213 J/cm2. Liječenje je dovelo do poboljšanja u smislu mjestimične repigmentacije vitiliginoznih lezija, zaustavljena je progresija postojećih, kao i nastajanje novih lezija. Rasprava i zaključak: Iako postoje brojne dostupne metode liječenja, ne postoji univerzalna terapija koja bi bila učinkovita u svih bolesnika s vitiligom. Raznolikost kliničke slike vitiliga posljedica je različitih patogenetskih mehanizama, stoga zahtijeva i različite pristupe u liječenju. Nova istraživanja na polju etiopatogeneze vitiliga omogućit će razvoj novih učinkovitijih modaliteta liječenja koji bi doveli do trajnog izlječenja bolesti.Aim: To present a patient with generalized vitiligo who was treated with topical corticosteroids and narrow band ultraviolet B phototherapy and to give an overview of treatment modalities for vitiligo. Case report: A 42 year-old men was admitted because of generalized vitiligo. Clinical examination revealed depigmented milky-white macules distributed symmetrically on lateral sides of trunk, upper and lower extremities, neck and periorbital region of the right facial side. A topical corticosteroid, mometazon furoat, was prescribed once a day and narrow band UVB phototherapy was initiated. Phototherapy was administered three times a week with the initial dose of 0.3 J/cm2 and dose increment at the rate of 20% of the previous dose until the formation of a mild erythema. Total dose received was 69.213 J/cm2. After received therapy, repigmentation was partially achieved, and the progression, as well as the appearance of the new vitiliginous lesions, were stopped. Discussion and conclusion: Various modalities of treatment are used in therapy of vitiligo, but there is still no universal therapy that could be effective in all vitiligo patients. Different clinical manifestations of vitiligo are the result of different pathogenetic mechanisms and require different treatment approaches. Therefore, future research is needed in order to clarify the etiopathogenetic mechanisms and provide new, more effective therapeutic opportunitie

Applying a transtheoretical model in studying the process of change in obese persons

Cilj je ovoga istraživanja bio provjera transteorijskog modela u ispitivanju procesa promjene u pretilih osoba (Prochaska i DiClemente, 1983). Model pretpostavlja da u procesu promjene osobe prolaze kroz stadije koji idu od predkontemplacije, preko kontemplacije i akcije do održavanja. Provjerene su psihometrijske karakteristike Skale za mjerenje procesa promjene (URICA; McConnaughy, DiClemente, Prochaska i Velicer, 1989), Upitnika donošenja odluke o kontroli tjelesne težine te Upitnika učinkovitosti kontrole težine (prema Rossi, Rossi, Velicer i Prochaska, 1995). U ispitivanju je sudjelovalo 279 prekomjerno teških i pretilih ispitanika, 97 muškarca i 182 žene. Provedene su faktorske analize i provjerene pouzdanosti svih korištenih mjera koje su se pokazale visokima. Radi provjere strukture Skale za mjerenje procesa promjene provedena je konfirmatorna faktorska analiza. Rezultati su pokazali da je četverofaktorska struktura statistički prihvatljiva, bez obzira na visoke međusobne korelacije između stadija kontemplacije, akcije i održavanja. Ovi su rezultati u skladu s nalazima drugih autora i konzistentni s transteorijskim modelom. Rezultati pokazuju da se ova skala može koristiti kao četverofaktorska mjera jednako kao kontinuirana što ovisi o cilju tretmana. Poznavanje stadija u kojemu se nalazi pojedinac može pomoći i u određivanju najpogodnijeg oblika tretmana, voditi kliničara u odlučivanju o prirodi i vremenu potrebnom za terapijsku intervenciju, poboljšati razumijevanje te olakšati istraživanja iz područja motivacije za promjenom kod osoba prekomjerne težine.The main goal of this study was to apply a transtheoretical model in studying the process of change in obese persons. According to the transtheoretical model (Prochaska & DiClemente, 1983), health behavior change involves graduating through stages of readiness: from precontemplation through contemplation and action to maintenance. The psychometric properties of The University of Rhode Island Change Assessment Scale (McConnaughy, DiClemente, Prochaska & Velicer, 1989), the Decisional Balance Inventory and Weight Efficacy Life-Style Questionnaire (Rossi, Rossi, Velicer &Prochaska, 1995) were determined. Two hundred and seventy nine participants took part in the study, 97 male and 182 female persons. Factor and reliability analyses were performed. Using a confirmatory factor analysis, the structure of The University of Rhode Island Change Assessment Scale was examined. A four-factor structure was confirmed despite relatively high correlation coefficients between scores on contemplation, action and maintenance scales. These results are similar to the results of other studies and consistent with the transtheoretical model. The results have shown that this scale could be used as a four factor measure and as a continuous measure of readiness for change depending on the treatment aim. Knowing the stage at which an individual is, could lead a clinician into deciding about the nature and time needed for therapeutic intervention, into a better understanding of the problem and into facilitating research in the field of readiness for change in overweight and obese persons

Medical and Psychological Parameters in Overweight and Obese Persons Seeking Treatment

The aim of the study was to analyse psychological characteristics and medical parameters in obese and overweight to identify the possible psychosocial consequences of obesity that may occur along with the numerous medical problems associated with excess body weight. Analysis was made on 296 patients (103 males and 193 females, median age 50, range 16–81) divided in three groups, depending on their Body mass index (BMI). Group I included 41 patients with BMI ranging from 25 to 29.9, group II included 170 patients with BMI from 30 to 34.9, and group III 85 patients with BM 35. We compared medical (glucose, cholesterol, triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, body fat percentage) and psychological parameters (anxiety, depression, pros and cons of losing weight, self efficacy and four stages of change) in the patients included in the study. Univariate analysis has shown statistically significant difference among obese and overweight patients in goal weight, systolic and diastolic blood pressure, body fat percentage, glucose and cholesterol serum level. People with higher BMI (>30) found more advantages (pros) over disadvantages (cons) of weight loss but the level of anxiety and depression did not differ significantly among those 3 groups of patients. The results have shown that overweight and obese people have serious medical problems. They also differ in some psychological characteristics which have to be taken into consideration. Therefore, approach to these patients should be multidisciplinary, including dietary care, physical activity, psychological and medical care

Effects of Nutritional Support in Patients with Colorectal Cancer during Chemotherapy

Nutritional support, addressing the specific needs of this patient group, is required to help improve prognosis, and reduce the consequences of cancer-associated nutritional decline. Early intervention with nutritional supplementation has been shown to halt malnutrition, and may improve outcome in some patients. In our study we tried to assess the influence of nutritional support (counseling, oral liquids, megestrol acetate) on nutritional status and symptoms prevalence in patients with colorectal cancer during chemotherapy. Group I consisted of 215 (55%) patients with medium age 68 2.6 years who were monitored prospectively and were given nutritional support. Group II included 173 (45%) patients (medium age 67 2.9 years) without the proper nutritional counseling, in whom the data were collected retrospectively during a 6 years period of time. After evaluation Nottingham Screening Tool Score, Appetite Loss Scale and Karnofsky Performance Status) all patients in the group I received nutritional counseling, 153 of them (72%) were taking form of enteral food supplement and 103 (48%) patients were using megestrol acetate. Evaluating the initial risk measurements according to BMI, decrease in weight gain and NST, we did not find any significant difference between the two groups. After chemotherapy completion, patients in group I had a 15.3% drop of those who’s BMI was <20,65% patients increased their body weight, with an average weight gain of 1.5 kg (0.6–2.8 kg). Contrary, in group II we found increase in weight loss ³2 kg/month in 39% of patients. The appetite improvement was detected on Appetite Loss Scale from 3.1 (pre-chemotherapy) to 4.7 (post-chemotherapy) in group I, especially in those receiving megestrol acetate. In both groups Karnofsky Performance Status didn’t change significantly reflecting the impact of the disease itself and chemotherapy procedures to the patient’s condition. Nutritional counseling, supplemental feeding and pharmacological support do temporarily stop weight loss and improve appetite, social life and quality of life in those groups of patients. However, this improvement have no implications on patients KPS and course of their disease