Specifics of Sex Life and Methods of Birth Control among Students at the University of Osijek

The aim of this study is to define specifics of sex life and methods of birth control among students at University of Osijek. Participants were students who study at Josip Juraj Strossmayer University of Osijek. A newly formed questionnaire containing 31 question was used to for this purpose. The study included 549 voluntairly students, 54,3% of students had first sexual experience between 16 and 18 of age. Most of them were long- term couples, who are managing better with sexual activities then students in short term relationships, who are more stressed because of their studies. When it comes to the type of contraceptives, 71, 9 % of students used some of birth control methods, and most common is condom (75,9 %). However, 27, 9 % of students believe that natural methods of birth are safe enough. There are no significant differences in age at the time of first sexual activity considering gender, year at university and residency. The biggest reason for not using contraception is long-term relationship in which students do not feel fear of sexually transmitted diseases and pregnancy

Putting Functional Gastrointestinal Disorders within the Spectrum of Inflammatory Disorders Can Improve Classification and Diagnostics of These Disorders

The spectrum, intensity, and overlap of symptoms between functional gastrointestinal disorders (FGIDs) and other gastrointestinal disorders characterize patients with FGIDs, who are incredibly different in their backgrounds. An additional challenge with regard to the diagnosis of FGID and the applicability of a given treatment is the ongoing expansion of the risk factors believed to be connected to these disorders. Many cytokines and inflammatory cells have been found to cause the continuous existence of a low level of inflammation, which is thought to be a basic pathophysiological process. The idea of the gut–brain axis has been created to offer a basic framework for the complex interactions that occur between the nervous system and the intestinal functions, including the involvement of gut bacteria. In this review paper, we intend to promote the hypothesis that FGIDs should be seen through the perspective of the network of the neuroendocrine, immunological, metabolic, and microbiome pathways. This hypothesis arises from an increased understanding of chronic inflammation as a systemic disorder, that is omnipresent in chronic health conditions. A better understanding of inflammation’s role in the pathogenesis of FGIDs can be achieved by clustering markers of inflammation with data indicating symptoms, comorbidities, and psycho-social factors. Finding subclasses among related entities of FGIDs may reduce patient heterogeneity and help clarify the pathophysiology of this disease to allow for better treatment

Diagnostic Value of MPO in Patients Admitted for Suspected Acute Coronary Syndrome- A Study of Adult in Mostar, Bosnia AND Herzegovina

We assessed the diagnostic efficacy of plasma Myeloperoxidasis (MPO) alone or in combination with cardiac troponin I (cTnI) for detecting ACS in patients presenting with chest pain initiating within 24 h before the hospital admission. In this prospective cohort study were included all respondents who have visited outpatient clinic of internal diseases, University Hospital Mostar because of chest pain and suspected acute coronary syndrome within 24 h of the onset of the period of 6 months and the total sample consisted of 114 patients. Troponin and myeloperoxidase were significantly positively correlated at the beginning of treatment, myeloperoxidase was significantly positively associated with adverse cardiovascular events during hospitalization and myocardial infarction (P0.05). Sensitivity of myeloperoxidase as a valid test detection of myocardial infarction at baseline was 0.15 and specificity was 0.85, suggesting good diagnostic value usable in the clinical practice

Mood disorders in later life and challenges of care in general/family medicine

Poremećaji raspoloženja se tradicionalno smatraju problemom adolescentne i mlađe odrasle dobi. Novije spoznaje stavljaju naglasak na poremećaje raspoloženja u starijoj životnoj dobi zbog njihovog devastirajućeg učinka na zdravlje i funkcionalnu sposobnost starijih osoba. Ipak, te poremećaje, uključujući i one najčešće, kao što je generalizirani anksiozni poremećaj i depresija velikih depresivnih epizoda, obiteljski doktori često ne prepoznaju. Glavni razlozi su česti komorbiditet sa somatskim stanjima i kognitivnim poremećajima te shvaćanje pacijenata da su mentalni poremećaji normalan dio procesa starenja. Probir osoba starih 60 i više godina na anksiozne poremećaje i depresiju pomoću standardiziranih upitnika, prilagođenih za primjenu u starijoj populaciji, mogao bi biti koristan za poboljšanje prepoznavanja tih poremećaja. Postavljanje konačne dijagnoze bi se trebalo temeljiti na primjeni dijagnostičkih kriterija koje preporučuju najnovije DSM i ICD klasifikacije te detaljnom postupku kliničke evaluacije, a na osnovi intervjua s pacijentom ili njegovim skrbnikom. Iako se obiteljskim doktorima nalaze na raspolaganju djelotvorni lijekovi za liječenje poremećaja raspoloženja, njihova primjena u osoba starije dobi može biti ograničena zbog povećanog rizika od interakcija među lijekovima i neželjenih reakcija na lijekove. Psihosocijalne intervencije su od posebnog značaja u toj populacijskoj skupini, ali nema dovoljno dokaza o tome koji postupak kome primijeniti. Način kako poboljšati skrb za osobe starije dobi s poremećajima raspoloženja u općoj/obiteljskoj medicini bi bio putem intenziviranja istraživanja, s ciljem stjecanja boljih dokaza, te putem davanja veće pozornosti praktičnoj edukaciji obiteljskih doktora iz područja psihijatrije, kao i putem strategija usmjerenih na povećanje svjesnosti javnosti o poremećajima raspoloženja u starijoj životnoj dobi i načinu njihove prezentacije.Mood disorders have been traditionally considered a problem of adolescenthood and early adulthood. Recent findings are pointing to mood disorders in later life due to their devastating effects on health and functional capabilities of older adults. However, those disorders, including those most common such as generalized anxiety disorder and major depressive disorder, are frequently unrecognised by family doctors. Main reasons for that are frequent comorbidities with medical conditions and cognitive disorders and patients’ treating mental disorders as normal aspects of aging. Screening 60 years old patients and older for anxiety and depression by standardised questionnaires, adapted for the use in older population, could be helpful in improving recognition rates. Definite diagnosis should combine the latest update of the DSM or the ICD classification criteria and a thorough clinical evaluation based on responses drown from a patient or a caregiver. Although effective medications for mood disorders are available to family doctors, their application in older adults may be compromised by the increased risk of medication interaction and adverse reaction. Psychosocial interventions are particularly important in this population group but evidence is insufficient regarding who should receive which treatment. The way of improving management of mood disorders in older adults, in family medicine, would be by intensifying research, in order to gain more evidence. More attention should be given to formal psychiatric training of family doctors, as well as to the strategies aimed at increasing the public awareness of mood disorders in later life and their modes of presentation

CORRELATION OF CLINICAL AND ENDOSCOPIC INDICES IN IBD PATIENTS IN UNIVERSITY CLINICAL HOSPITAL MOSTAR

Background: To explore correlation between clinical and endoscopic indices in inflammatory bowel disease (IBD) patients. Subjects and methods: There were 112 patients with inflammatory bowel disease. All patients with diagnosed IBD was established a degree of clinical and endoscopic disease activity. CDAI (Crohn\u27s disease activity index) was used as clinical and SESCD (Simplified Endoscopic Crohn Disease Index) as endoscopic index for Crohn\u27s disease. For ulcerative colitis Truelov & Witts index was used as clinical and Baron as endoscopic activity index. Correlation of clinical and endoscopic indices were compared in Crohn disease (CD) and ulcerative colitis (UC). Patients were analyzed by clinical entities - CD and UC, according to sex, age, parameters of anemia, duration of disease and education. Results: In the total of 112 IBD patients there were 69 patients diagnosed as ulcerative colitis (61.6%) and 43 as Crohn\u27s disease (38.4%). There were 58 (51.8%) women and 54 (48.2%) men. Comparison between endoscopic and clinical indices in CD and UC demonstrated no significant differences in ilnness activity. Endoscopic and clinical disease activity was associated with a higher inflammatory parameters (CRP and leucocytes, L) and lower parameters of hemoglobin (Hb) and MCV. Conclusion: Our research has established a good correlation between clinical and endoscopic index of disease activity in the CB and UC in inflammation. Clinical indices can be used for monitoring inflammation

CORRELATION BETWEEN BIOCHEMICAL AND HISTOPATHOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN

Aim: The main goal of this study was to compare the biochemical and histopathological findings in patients with sustained virological response (SVR) before and two years after the therapy with pegylated interferon α-2a and ribavirin in chronic hepatitis C. Subjects and methods: The study was conducted at the Department of Internal Medicine and the Clinic for Infectious Diseases of the Clinical Hospital Mostar. The study included 48 patients whose treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin was finished two years prior to the achieved SVR at the end of the treatment. The main criterion for inclusion was a negative result of HCV RNA, determined by the RealTime HCV assay. After taking a history, physical examination, laboratory tests: AST, ALT, GGT, a liver biopsy were performed with the help of the ultrasound. The assessment of necroinflamatory score was determined by histologic activity index (HAI) score, and the stage of fibrosis according to Knodell\u27s numerical score. Results: The values of AST and ALT levels were statistically significantly decreased after the successful treatment (p<0.001), as well as the value of HAI score (p=0.001) and the stage of fibrosis (p=0.010), in contrast to GGT (p=0.054). For the components of HAI score like focal necrosis (0.001) and portal inflammation (0.042) the result showed that they were significantly higher before the therapy, which was not true for the piecemeal (p=0.054) and confluated necrosis (p=0.078). The improvement of HAI score after therapy was found in 36 patients (75.0%), and 27 patients (56.2%) showed an improvement in the degree of fibrosis with the most common improvement of 1 degree (85.7%). One third of patients (31.3%) had the same result in the degree of fibrosis before and after the therapy. Before the treatment, a positive correlation was observed between ALT (p=0.039) and AST (p=0.04) with HAI, AST and the stage of fibrosis (p=0.04). In contrast, after the treatment the only correlation was observed between AST and the stage of fibrosis (p=0.042). Conclusion: Virological and biochemical responses in patients with SVR may not reflect the histopathological effects of the treatment and therefore these patients should be monitored for the possible development of the liver cirrhosis and hepatocellular carcinoma

ANXIETY, DEPRESSION AND PERSONALITY TYPES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: COMPARISONS WITH PEPTIC ULCER AND THE GENERAL POPULATION

Background: To explore corellation of anxiety, depression ant type of personality in inflammatory bowel disease (IBD) and compare with peptic ulcer (PU). Subjects and methods: In this study, prevalence of anxiety, depression and type of personality was investigated in 362 cases divided into three groups: 112 of IBD patients, 122 of peptic ulcer patients and 128 of control group who didn\u27t have any gastrointestinal or psychic complaints. IBD and peptic ulcer diagnosis were established by standard diagnostic procedures (anamnesis, clinical manifestations, laboratory, endoscopy and biopsy in IBD and upper endoscopy in peptic ulcer). Anxiety and depression were established by Hamilton anxiety rating scale (HAM-A) and Hamilton rating test for depression (HAM-D). Type of A/B personality was established by Bortner scale and D type of personality by Denollet scale (DS14). Results: Anxiety was found in 47 (41.9%) and depression in 44 (38.3%) of a total of 112 IBD cases. In group with peptic ulcer anxiety was found in 40 (32.8%) and depression aalso in 40 (32.8%) of total 122 cases. In control group anxiety was diagnosed in 21 (16.4%) and depression in 20 (15.6%) of total 128 cases. Anxiety and depresson were significantly higher in both groups than in control group but anxiety and depression were significantly higher in IBD group than peptic ulcer group. D type of personality was statistically significant in peptic ulcer group. Conclusion: Anxiety and depression in IBD and peptic ulcer cases have a greater prevalence compared to the normal population and surprisingly are higher in IBD than peptic ulcer group. D type of personality is associated with peptic ulcer

CORRELATION BETWEEN BIOCHEMICAL AND HISTOPATHOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN

Aim: The main goal of this study was to compare the biochemical and histopathological findings in patients with sustained virological response (SVR) before and two years after the therapy with pegylated interferon α-2a and ribavirin in chronic hepatitis C. Subjects and methods: The study was conducted at the Department of Internal Medicine and the Clinic for Infectious Diseases of the Clinical Hospital Mostar. The study included 48 patients whose treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin was finished two years prior to the achieved SVR at the end of the treatment. The main criterion for inclusion was a negative result of HCV RNA, determined by the RealTime HCV assay. After taking a history, physical examination, laboratory tests: AST, ALT, GGT, a liver biopsy were performed with the help of the ultrasound. The assessment of necroinflamatory score was determined by histologic activity index (HAI) score, and the stage of fibrosis according to Knodell\u27s numerical score. Results: The values of AST and ALT levels were statistically significantly decreased after the successful treatment (p<0.001), as well as the value of HAI score (p=0.001) and the stage of fibrosis (p=0.010), in contrast to GGT (p=0.054). For the components of HAI score like focal necrosis (0.001) and portal inflammation (0.042) the result showed that they were significantly higher before the therapy, which was not true for the piecemeal (p=0.054) and confluated necrosis (p=0.078). The improvement of HAI score after therapy was found in 36 patients (75.0%), and 27 patients (56.2%) showed an improvement in the degree of fibrosis with the most common improvement of 1 degree (85.7%). One third of patients (31.3%) had the same result in the degree of fibrosis before and after the therapy. Before the treatment, a positive correlation was observed between ALT (p=0.039) and AST (p=0.04) with HAI, AST and the stage of fibrosis (p=0.04). In contrast, after the treatment the only correlation was observed between AST and the stage of fibrosis (p=0.042). Conclusion: Virological and biochemical responses in patients with SVR may not reflect the histopathological effects of the treatment and therefore these patients should be monitored for the possible development of the liver cirrhosis and hepatocellular carcinoma

Seasonality of the Cardiac Biomarker Troponin in the Eastern Croatian Population

Background: The seasonality of acute myocardial infarction and progressive heart failure has been well established so far. Cardiac troponins (cTns) are organ-specific, not disease-specific, biomarkers. The seasonality of cTns has not been reported before. Methods: Data were collected from the emergency admission unit of a community hospital in eastern Croatia for each month of the year 2014 covering the number of patients whose doctors requested high-sensitivity cTn I (hs-cTn I) testing, the number of positive test results and hospital admissions. Results: The proportion of patients with positive test results was 15.75% (350 patients out of 2221 patients referred to testing), with the males being outnumbered by the females (F: 57.15%, M: 42.85%) (p = 0.069). The month with the highest number of patients with positive test results was December, whereas the month with the lowest number of those patients was January (p &lt; 0.001). The highest numbers of patients referred to testing (30.9%) and of those with positive test results (50.8%) were found in the oldest age group (76+). Conclusion: Tracking the results of cTns testing during patient admissions to emergency departments would be a more effective approach from a public health perspective than tracking the number of patients diagnosed with a particular cardiovascular (CV) disease and could be used as a research approach to guide a search for precipitating factors for CV disease specific to a local community

Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness

Abstract Background Aging is associated with many personal, social, and environmental challenges that increase the risk of loneliness. Loneliness is a painful emotional experience associated with a perceived lack of connection and intimacy. Loneliness accelerates health deterioration, but the presence of chronic health conditions (comorbidities) in older individuals may potentiate the feeling of loneliness. The relationships between health status and loneliness in older individuals have not been assessed in an integrated manner, although it is necessary for planning efficient interventions. The aim of this study was to fill in this knowledge gap, by attempting to create an integrated model of loneliness in older individuals. Methods The sample consisted of 189 (58% F) older individuals (> 60 years) (mean ± SD, 78.47 ± 6.65), attendees in Primary Health Care. Different factors associated with loneliness in the older population were assessed, and classified as demographic, environmental, physical (health-related), and psychological, in addition to functional abilities. A set of standard questionnaires was used to assess psychological factors and functional abilities. The hierarchical regression model assessed the effect of particular blocks of factors on status loneliness. The second aim was to analyze how psychological factors mediate associations between health status (comorbidity level) and loneliness. Results Indicated that increasing comorbidity, anxiety, lack of positive moods, not having hobbies/activities, low perception of social support, impaired cognitive function, and suppression of emotion expression, are significant predictors of loneliness. Mediation analysis informed us of how to help patients with comorbidities feel less lonely. Interventions that were suggested were those that can reduce anxiety and depression, improve cognitive abilities and emotional regulation control, and enhance social support. Conclusions Results can help understand the pathophysiology loops linking poor health status (comorbidity level) of older individuals and loneliness, and have significant potentials from the translational perspectives, as a decision-support tool