Kvaliteta života povezana sa zdravljem u bolesnika s primarnim glaukomom otvorenog kuta

The purpose of this research was to evaluate the relationship between general health-related quality of life (GHRQL) and sociodemographic factors in primary open-angle glaucoma (POAG) patients. A prospective cross-sectional study included 207 glaucoma patients. GHRQL was determined via two self-administered questionnaires: the 36-Item Short Form Survey (SF-36) and the EuroQol-5D (EQ-5D) questionnaire. Male and 50- to 69-year-old glaucoma patients, followed by patients who regularly used antiglaucoma therapy and those without progression of glaucoma reported a significantly higher quality of life as measured by the EQ-5D index and the EQ-5D visual analog scale (VAS) (p<0.05 all). Similarly, the Physical Component Summary (PCS) and Mental Component Summary (MCS) of SF-36 had significantly higher values for these patients (p<0.05 all). Furthermore, glaucoma patients with higher education and economic status, glaucoma patients who lived in rural areas, and those who were married achieved higher scores on EQ-5D and SF-36. In conclusion, progression of the disease, female sex, older age, lower education and economic status, urban area and unmarried status negatively affect quality of life in glaucoma patients.Svrha ovoga istraživanja bila je utvrditi odnos između kvalitete života povezane s općim zdravljem (GHRQL) i sociodemografskih čimbenika u bolesnika s primarnim glaukomom otvorenog kuta (POAG). Riječ je o presječnoj studiji u kojoj je sudjelovalo 207 bolesnika s POAG. GHRQL mjerena je pomoću dva upitnika: kratkog upitnika zdravstvenog statusa s 36 pitanja (SF-36) i upitnika EuroQol-5D (EQ-5D). Muškarci i bolesnici s glaukomom u dobi od 50-69 godina, zatim bolesnici koji su redovito koristili antiglaukomsku terapiju i oni bez progresije glaukoma izvijestili su o znatno višoj kvaliteti života mjerenoj indeksom EQ-5D i vizualnom analognom ljestvicom EQ-5D (VAS) (p<0,05 za sve usporedbe). Slično tome, Sažetak fizičkih komponenata (PCS) i Sažetak mentalnih komponenata (MCS) upitnika SF-36 imali su značajno veće vrijednosti za ove bolesnike (p<0,05 za sve usporedbe). Nadalje, ispitanici s visokim stupnjem obrazovanja i ekonomskim statusom, ispitanici koji žive u ruralnim područjima i oni koji su u braku postigli su veće rezultate na EQ-5D i SF-36. Zaključno, napredovanje bolesti, ženski spol, starija životna dob, niži stupanj obrazovanja i ekonomski status, urbano područje življenja i samoća negativno utječu na kvalitetu života bolesnika s glaukomom

NEW INSIGHTS INTO SCHIZOPHRENIA: A LOOK AT THE EYE AND RELATED STRUCTURES

Background: Schizophrenia is a multifactorial neurodevelopmental disorder associated with cognitive dysfunction and changes in primary sensory processing. This article aims to explore the current insights into the relationship between schizophrenia and different visual disturbances. Methods: To provide a literature review of visual impairments in schizophrenia, we performed a PubMed/MEDLINE and Scopus search to identify all articles in English on the topic up to the end of 2018. Results: Multiple retinal functional and structural abnormalities are found in patients with schizophrenia. Wider retinal venules suggest chronically insufficient brain supply of oxygen and this could contribute to the occurrence of psychotic symptoms. Optical coherence tomography studies showed that retinal nerve fiber layer, macular thickness, and macular volume were significantly lowered in the chronic phase of schizophrenia. Results from electroretinogram recordings have demonstrated different declinations such as abnormalities of a - wave activity in the photoreceptors or b - wave activity in the bipolar and Muller cells. Abnormalities in eye movements, such as a notable decrease in saccades and smooth pursuit eye movements, are one of the most reliable and reproducible impairments associated with schizophrenia. Disrupted visual processing of the magnocellular pathway may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking. Visual perceptual abnormalities occur in more than 60% of schizophrenic patients and these are visual hallucinations, perceptual distortion of colors, shapes and light intensity, decrease in contour integration and surround suppression. Other, frequently present eye disorders include impaired visual acuity, strabismus and nystagmus. Conclusion: Visual impairments are one of the most important features of schizophrenia, which could help in defining the disease state and assigning appropriate treatment

HALLUCINATORY EXPERIENCES IN VISUALLY IMPAIRED INDIVIDUALS: CHARLES BONNET SYNDROME – IMPLICATIONS FOR RESEARCH AND CLINICAL PRACTICE

Background: Charles Bonnet syndrome (CBS) refers to visual hallucinations that occur in individuals with preserved cognitive functions associated with visual impairment. Methods: This article reviews occurence of visual hallucinations in subjects with CBS by journals published in English in the Pubmed database in the period 1992-2018. Criteria for selection of appropriate papers were sufficient information and perspicuous view on pathogenesis, epidemiology, clinical presentation and treatment possibilities of CBS. Results: Most commonly, visual hallucinations in patients with CBS are complex, repetitive and stereotyped. Such individuals have preserved insight that those percepts are not real, and there is an absence of secondary explanatory delusions and hallucinations within other modalities. Seeing as the aforementioned percepts do not share all the characteristics of hallucinations, it remains unresolved how they should be referred to. Terms as release hallucinations, one that is reflecting its underlying pathogenesis, or confabulatory hallucinatory experiences have been proposed. Moreover, CBS has also been referred to as phantom vision syndrome and may occur in any ophthalmological disease. It is not particularly connected with loss of function along any level of the visual pathway. Although this syndrome is mostly associated with age-related macular degeneration, glaucoma and cataract, it could be related to almost any other ophthalmological conditions. The incidence of CBS alongside with mostly other ocular pathology is rising as population is ageing. Conclusions: Nonetheless, CBS remains commonly underreported, under recognized and/or misrecognized. Albeit the treatment recommendations and guidelines are not yet fully established, it is important to raise awareness of this specific and distinct condition, which inevitably implicates many differential diagnostic deliberations

UTJECAJ VJEŽBANJA I RAZINE OSPOSOBLJENOSTI NA MIKROCIRKULACIJU RETINE

Aim: To examine differences in retinal microcirculation between people with different degrees of physical fi tness. Methods: The subjects were divided into athletes and non-athletes. Both groups took part in two examinations. The fi rst examination was performed before short-term exercise and the second one immediately after it. First group consisted of 25 athletes (50 eyes), and the second group of 25 non-athletes (50 eyes) who were not previously exposed to acute physical stress. Athletes are defi ned as people who have been engaged in some form of regular physical activity for at least 5 years, and have met certain criteria according to the International Physical Activity Questionnaire (IPAQ). Non-athletes were those who were physically inactive or at least not regularly engaged in physical activity during the same period and did not meet the IPAQ criteria. The subjects were men and women between 18 and 26 years of age who did not have any cardiovascular disease, used drugs affecting the cardiovascular system, nor had an eye disease or a refractive error greater than spherical equivalent of +/-3 diopters. The examination consisted of optical coherence tomography angiography (OCT-A) imaging pre- and post-workout. The parameters taken into account were vascular density (VD) at three different macular areas according to the standard Early Treatment Diabetic Retinopathy Study (ETDRS) grid, i.e., central zone, inner zone and full area; perfusion density (PD), also at the three mentioned zones; and the area of foveal avascular zone (FAZ) in both eyes. The research also included a standardized survey on physical activity of the subjects (IPAQ), which was completed before the examination. The acute physical exercise consisted of the standardized incremental cycling ergometer test (ICET), which was performed on a stationary exercise bike for 5 minutes, at a given load of 12 degrees. On statistical processing of the data obtained, SPSS for Windows (version 13.0, SPSS Inc., Chicago, Illinois, USA) software was used. Results: Baseline measures of VD and PD were similar between the groups. FAZ surface was signifi cantly increased in the athlete group compared with non-athletes both at baseline and after short-term exercise. VD was signifi cantly higher in athletes post-exercise compared with the non-athlete group. Central PD was also signifi -cantly increased after exercise in the athlete group, and not in the non-athlete group. Conclusion: The results obtained in this study demonstrated that athletes exhibited a more intensive vascular reaction to exercise. The parameters in basal conditions did not show signifi cant difference between the two groups, except for FAZ which was larger in athletes. Signifi cant differences present post-workout in other measured values indicated a more dynamic vascular system in physically active individuals.ilj rada: Ispitati razlike u retinalnoj mikrocirkulaciji između osoba s višim i nižim stupnjem tjelesne osposobljenosti. Postupci: Ispitanici su bili podijeljeni na sportaše i nesportaše. Obje skupine pristupile su dvama odvojenim mjerenjima. Prvi pregled obavljen je prije fi zičkog opterećenja, a drugi neposredno nakon njega. Prvu skupinu činilo je 25 sportaša (50 očiju), a drugu 25 nesportaša (50 očiju) koji prethodno nisu bili izloženi akutnom fi zičkom stresu. Sportaše defi niramo kao osobe koje se najmanje 5 godina bave nekim oblikom redovite tjelesne aktivnosti u obliku treniranja nekog sporta, fi tnesa, aerobnog treninga i sl. te ispunjavaju određene uvjete prema međunarodnom upitniku o tjelesnoj aktivnosti (International Physical Activity Questionnaire, IPAQ). Neki sportaši nisu bili fi zički aktivni ili barem ne redovito tijekom istog razdoblja i nisu ispunjavali navedene kriterije IPAQ. Ispitanici su bili muškarci i žene u dobi između 18 i 26 godina koji nisu imali nikakvu srčanožilnu bolest, nisu uzimali lijekove koji utječu na srčanožilni sustav niti su imali ikakvu bolest očiju ili refraktivnu grešku veću od sfernog ekvivalenta +/-3 dioptrije. Prikupljanje podataka provedeno je pomoću optičke koherentne tomografske angiografi je (OCT-A). Analizirani su sljedeći parametri: vaskularna gustoća (VG) u tri različita područja makule prema mreži ETDRS (Early Treatment Diabetic Retinopathy Study): središnja zona, unutarnja zona i puna zona; perfuzijska gustoća (PG), također u tri navedena područja; te površina fovealne avaskularne zone (FAZ). Istraživanje je uključivalo i standardiziranu anketu o tjelesnoj aktivnosti ispitanika (IPAQ) koja se ispunjavala prije samog pregleda. Fizičko opterećenje sastojalo se od standardiziranog testa ICET (incremental cycling ergometer test), koji se izvodio na stacionarnom sobnom biciklu u trajanju od 5 minuta pri zadanom opterećenju od 12 stupnjeva, nakon čega su ispitanicima izmjereni puls i saturacija. Također, prije same vježbe ispitanicima su izmjerene srčana frekvencija i saturacija u mirovanju. Za statističku obradu dobivenih podataka primijenjen je softverski sustav SPSS for Windows (verzija 13.0, SPSS Inc., Chicago, Illinois, SAD). Rezultati: Mjerenja u bazalnim uvjetima pokazala su slične vrijednosti VGi PG između skupina. Površina FAZ bila je statistički značajno veća u skupini sportaša u usporedbi s nesportašima i u bazalnim uvjetima i nakon tjelovježbe. Nakon tjelovježbe VG i središnji PG pokazali su statistički značajno povećanje u sportaša, dok u nesportaša nije bilo razlike prije i nakon tjelovježbe. Zaključak: Rezultati dobiveni u ovoj studiji pokazali su da sportaši imaju intenzivniju vaskularnu reakciju na vježbanje. Parametri u bazalnim uvjetima nisu pokazali značajnu razliku između dviju skupina osim za FAZ, koja je bila veća u sportaša. Značajne razlike bile su prisutne nakon treninga u drugim izmjerenim vrijednostima i ukazuju na dinamičniji vaskularni sustav u fi zički aktivnih pojedinaca

StOWIANSCY EMIGRANCI W KULTURZE CHORWACKIEJ

Z bogatej problematyky dotycz^cej wzajemnego przenikania chorwackiej i pozostalych kultur sjowianskich XIX. i XX. stulecia autorky wyodrgbniaj^ zagadnienia, ktore mialy najsilniejszy wplyw na ksztaltowanie sig kultury chorwackiej. Dzialalnosc emigrantow, ktorych motywacje emigracyjne mialy rozmaity Charakter (od politycznego, poprzez estetyczny po ekonomiczny), przejawiala sig najczjs\u27ciej w literaturze, jgzykoznawstwie i dziennikarstwie. Rosyjscy, czescy, slowaccy, polscy, slowenscy, serbscy i czarnogorscy emigranci byli b^dz informatorami o chorwackiej rzeczywistosci, b^dz tez stawali si? sami tworcami tej rzeczywistosci. Autorky wyrozniaj^ tu kilka typow dzialaczy emigracyjnych: 1. literatow tworzjcych w jgzyku ojczystym, 2. literatow tworz^cych zaröwno w jgzyku ojczystym jak i w chorwackim, 3. literatow tworz^cych tylko w jgzyku chorwackim, 4. publicystow i dziennikarzy informuj^cych o kulturze swego kraju, 5. publicystow i dziennikarzy informuj^cych o kulturze chorwackiej, 6. jgzykoznawcow dzialajjcych w jgzykoznawstwie chorwackim oraz 7. innych naukowcow i tlumaczy przyczyniaj^cych sig do rozwoju chorwacczyzny. Rozpatruj^c dzialalnosc slowianskych emigrantow w Chorwacji, autorky szczegöln^ uwagg zwröcily na przyczyny bgd^ce bezpos\u27rednim powodem ich przyjazdu do Chorwacji oraz analizuj^ co przyczynilo sig do podjgcia przez nich danej dzialalnos\u27ci

Macular Thickness after Glaucoma Filtration Surgery

The aim of present study was to analyze early postoperative changes in the macular area using optical coherence to- mography (OCT) after uncomplicated glaucoma filtration surgery. This prospective study included 32 patients (34 eyes) with open-angle glaucoma, which underwent trabeculectomy with or without use of mitomycin C. Exclusion criteria were macular edema, uveitis, age-related macular degeneration, blurred optical media, secondary glaucoma and angle-clo- sure glaucoma. All standard clinical examinations were made before surgery, at the 2nd day, 1 week and 1 month after surgery. Tomography of the macula was performed during every examination using Cirrus HD OCT for the analysis of central subfield thickness. Results show that thickening of the macula was slightly higher 1 week and 1 month after op- eration in comparison with baseline end 2nd day postoperativelly. There was no significant difference in the change of macular thickness in patients who have used topical prostaglandins compared with those who have used other topical medications. Also, there was no difference in macular changes between patients treated with or without mitomycin C. In conclusion, we found a slight subclinical increase in macular thickness after uncomplicated trabeculectomy, for which we considered that was the result in reduction of intraocular pressure after glaucoma surgery. Macular thickening after glaucoma filtering surgery could be a physiological reaction to the stress of the retina caused by a sudden reduction of intraocular pressure and it is the consequence of altered relationship between capillary pressure and interstitial fluid pressure

CHILD- AND FAMILY-CENTERED CARE IN THE TREATMENT OF CHILDREN - KNOWLEDGE, ATTITUDES, PRACTICE

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child\u27s well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children\u27s institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine