Koagulopatija kod traumatske ozljede mozga

Traumatic brain injury associated coagulopathy is a widely recognized risk factor for secondary brain damage and a powerful predictor related to outcome and prognosis. It is estimated that two thirds of patients with severe TBI will develop a coagulopathy. Pathophysiological pathway of TBI associated coagulopathy remains poorly defined. It includes combination of hypercoagulable and hypofibrinolytic states that result in persistent and delayed intracranial haemorrhage and systemic bleeding. The proposed mechanisms include release of tissue factor, hyperfibrinolysis, disseminated intravascular coagulopathy, platelet disfunction and protein C activation. The goal of this review is to summarize the current knowledge regarding the mechanisms of traumatic brain injury associated coagulopathy and treatment options.67Koagulopatije kod traumatske ozljede mozga bitan su faktor u razvoju sekundarnih ozljeda mozga i snažan su prediktor za ishod i prognozu liječenja. Procijenjuje se da dvije trećine pacijenata sa teškom traumom mozga razvije koagulopatiju. Patofiziološki mehanizam koagulopatije kod traumatske ozljede mozga je slabo razjašnjen. Uključuje otpuštanje tkivnog faktora, hiperfibrinolizu, diseminiranu intravaskularnu koagulopatiju, poremećaj funkcije trombocita i aktivaciju proteina C. Cilj ovoga rada je osvrnuti se na aktualna saznanja o patofiziologiji koagulopatije kod traumatske ozljede mozga i metode liječenja

Use Offirearms and Other Means of Force During Arrest: Normative Restrictions in the Context of the Right to Life and Prohibition of Torture

Nije sporno da zakonita uporaba sredstava prisile predstavlja razlog isključenja protupravnosti premda više nije kao takva izrijekom propisana Kaznenim zakonom. Slučajeve u kojima je uporaba sredstava prisile dopuštena propisuje Zakon o policijskim poslovima i ovlastima, ali i međunarodno pravo, koje je po svojem rangu iznad domaćeg zakonodavstva. Praktično je u toj domeni najvažnija Konvencija za zaštitu ljudskih prava i temeljnih sloboda, a osobito njezini članci 2. i 3. (pravo na život i zabrana mučenja). U radu se domaći normativni okvir uspoređuje sa standardima postupanja razvijenima u praksi Europskog suda za ljudska prava. Pozornost je naročito posvećena problematici dopuštenosti uporabe vatrenog oružja u spornim situacijama kao što je sprječavanje bijega.In Continental legal theory, lawful use of force is regarded as a ground of justification of an otherwise wrongful act, although it is no longer expressly prescribed by the Criminal Code of Croatia. Cases in which the use of force is permissible are governed by the Act on Police Duties and Powers, but also by international law, which is superior to domestic law. In this area, the most important legal instrument is the Convention for the Protection of Human Rights and Fundamental Freedoms, and in particular its Art. 2 and 3 (right to life and prohibition of torture). This paper compares the national regulatory framework with the standards developed by the European Court of Human Rights. Particular attention is paid to the issue of permissibility of the use of firearms in controversial situations such as the prevention of escape

Značenje agregacije trombocita u bolesnika s bubrežnim zatajenjem

The exact etiology of the conflicting hemostatic disorder in the advanced stage of chronic renal disease, i.e. prothrombotic versus bleeding tendency, is not completely understood. Abnormal platelet function in patients with renal failure is not caused by high concentrations of urea, although the presence of fibrinogen fragments may prevent binding of normal fibrinogen and formation of platelet aggregates. Hemostatic abnormalities in end-stage kidney disease may be affected, to some extent, by the choice of renal replacement therapy. Patients on hemodialysis have an increased risk of thrombotic events, primarily due to the release of thromboxane A2 and adenosine diphosphate into the circulation, as well as platelet degranulation. Some activation of platelets occurs due to the exposure of blood to the roller pump segment, but microbubbles may also play a role. Renal transplantation is the treatment of choice for patients with end-stage renal disease. Immunosuppressive therapy is associated with an increased risk of thromboembolic complications. Additional research is required to identify the potential benefits of different immunosuppressive therapies in relation to platelet aggregation, keeping in mind the long term need for immunosuppression in renal transplant patients.Točna etiologija proturječnih hemostatskih poremećaja u terminalnom stadiju bubrežne bolesti, tj. tromboze i sklonosti krvarenju, nije u potpunosti razjašnjena. Poremećena funkcija trombocita u bolesnika s bubrežnim zatajenjem nije uzrokovana povišenom koncentracijom ureje, premda prisutnost fragmenata fibrinogena može spriječiti vezivanje normalnog fibrinogena, odnosno stvaranje agregata tromobocita. Na poremećaj hemostaze kod bolesnika s bubrežnim zatajenjem može utjecati i izbor nadomjesnog bubrežnog liječenja. Bolesnici na hemodijalizi imaju povećani rizik tromboze prvenstveno zbog oslobađanja tromboksana A2 i ADP -a u cirkulaciju, kao i zbog degranulacije trombocita. U stanovitoj mjeri trombociti se aktiviraju i prolaskom krvi kroz sustav crpki, dok moguću ulogu imaju i mikromjehurići. Transplantacija bubrega je metoda izbora u liječenju bolesnika s bubrežnim zatajenjem. Imunosupresivna terapija je povezana s povećanim rizikom razvoja trombembolijskih komplikacija. Imajući u vidu dugotrajnu potrebu za imunosupresivnim liječenjem kod bolesnika s transplantiranim bubregom potrebna su daljnja istraživanja radi utvrđivanja mogućeg povoljnog učinka različitih imunosupresiva u odnosu na agregaciju trombocita

Značenje agregacije trombocita u bolesnika s bubrežnim zatajenjem

The exact etiology of the conflicting hemostatic disorder in the advanced stage of chronic renal disease, i.e. prothrombotic versus bleeding tendency, is not completely understood. Abnormal platelet function in patients with renal failure is not caused by high concentrations of urea, although the presence of fibrinogen fragments may prevent binding of normal fibrinogen and formation of platelet aggregates. Hemostatic abnormalities in end-stage kidney disease may be affected, to some extent, by the choice of renal replacement therapy. Patients on hemodialysis have an increased risk of thrombotic events, primarily due to the release of thromboxane A2 and adenosine diphosphate into the circulation, as well as platelet degranulation. Some activation of platelets occurs due to the exposure of blood to the roller pump segment, but microbubbles may also play a role. Renal transplantation is the treatment of choice for patients with end-stage renal disease. Immunosuppressive therapy is associated with an increased risk of thromboembolic complications. Additional research is required to identify the potential benefits of different immunosuppressive therapies in relation to platelet aggregation, keeping in mind the long term need for immunosuppression in renal transplant patients.Točna etiologija proturječnih hemostatskih poremećaja u terminalnom stadiju bubrežne bolesti, tj. tromboze i sklonosti krvarenju, nije u potpunosti razjašnjena. Poremećena funkcija trombocita u bolesnika s bubrežnim zatajenjem nije uzrokovana povišenom koncentracijom ureje, premda prisutnost fragmenata fibrinogena može spriječiti vezivanje normalnog fibrinogena, odnosno stvaranje agregata tromobocita. Na poremećaj hemostaze kod bolesnika s bubrežnim zatajenjem može utjecati i izbor nadomjesnog bubrežnog liječenja. Bolesnici na hemodijalizi imaju povećani rizik tromboze prvenstveno zbog oslobađanja tromboksana A2 i ADP -a u cirkulaciju, kao i zbog degranulacije trombocita. U stanovitoj mjeri trombociti se aktiviraju i prolaskom krvi kroz sustav crpki, dok moguću ulogu imaju i mikromjehurići. Transplantacija bubrega je metoda izbora u liječenju bolesnika s bubrežnim zatajenjem. Imunosupresivna terapija je povezana s povećanim rizikom razvoja trombembolijskih komplikacija. Imajući u vidu dugotrajnu potrebu za imunosupresivnim liječenjem kod bolesnika s transplantiranim bubregom potrebna su daljnja istraživanja radi utvrđivanja mogućeg povoljnog učinka različitih imunosupresiva u odnosu na agregaciju trombocita

Hydrogeothermal resources in spa areas of Serbia: Main properties and possible improvement of use

Geological complexity of the territory of Serbia is a world curiosity: six main geo-tectonic regions and tens sub-regions are delineated in a small area of 88,000 km2. Geologic origin and regional structure of some areas has long been the subject of discussion. Notable magmatism and associated tectonic events in the Earth's crust provided for a fairly large hydrogeothermal resource potential, which is manifested in more than 250 warm (mainly mineral) springs and more than 100 hydrothermal wells. Thermal springs and wells together discharge some 5 m3/s. This potential is used in part for balneal therapy (waters differ in temperature and chemical composition) in the spa areas of Serbia. The amounts of thermal water unused therapeutically or the amounts of heat energy from unused geo-thermal water may be used in almost all spas for space heating/cooling and thus increase the efficiency of the thermal water energy utilization. This also will be cost-effective, reduce emission of noxious gases, and improve the environmental-health image of the resorts. The hydrogeothermal resources are described for 29 spas with 700 l/s total discharge capacity of water temperature between 25°C and 96ºC, or an overall heat energy of 78.40 MWt. Feasibility of additional energy utilization of thermal water in spas is generally considered

Merdžeri i akvizicije: uvažavanje kulturnih različitosti u uslovima globalizacije

Savremena ekonomska kretanja karakteriše globalizacija tržišta koja se ogleda i kroz merdžere i akvizicije, kao procese restrukturiranja kompanija. Ova spajanja omogućuju kompanijama bolje pozicioniranje na tržištu. Cilj rada je da ukaže na veliki značaj kulturnih različitosti na uspeh M&A transakcija, kao i neophodnost uključivanja nacionalnih kulturnih normi u strategijske planove ovih transakcija, kako bi njihovi konačni efekti bili pozitivni, uz neizostavno prisustvo sinergetskog efekta. Značaj analize uvažavanja kulturnih različitosti bitan je i za privredu Republike Srbije, jer je realno očekivati dolazak novih multinacionalnih kompanija na naše tržište. Takođe, proces priključivanja Srbije Evropskoj uniji podrazumeva suočavanje velikog broja domaćih privrednih subjekata sa oštrom konkurencijom iz inostranstva, što može dovesti do toga da određen broj srpskih kompanija, zbog nemogućnosti nastavka uspešnog poslovanja na (zaštićenom domaćem) tržištu bude predmet spajanja i/ili preuzimanja sa multinacionalnim kompanijama. U radu je dat prikaz uticaja kulture na merdžere i akvizicije prvo kroz teorijske postavke, pre svega u radovima Geert Hofstede–a koji je definisao  četiri dimenzije primarne za razlikovanje nacionalnih i organizacionih kultura: distanciranost autoriteta, individualizam, muškost i stepen izbegavanja neizvesnosti. Ustanovljeno je da među zemljama postoje vrlo velike razlike u vrednostima ovih pokazatelja. Vrednosti pokazatelja dimenzije kulture ukazuju na uticaj koji ova determinanta ima prilikom M&A transakcija. Kulturne različitosti utiču na poslovanje i upravljanje jedne kompanije pa samim tim i na ishod M&A transakcija. Kada su komplementarne sa ciljevima ovim transakcija, kulturni faktori mogu biti sredstvo za ostvarenje tih ciljeva, dok u suprotnom postaju značajan faktor rizika. U radu je pokazano i to da ukoliko menadžment ne uvažava postojeće kulturološke razlike prilikom sprovođenja M&A transakcije male su šanse da će ishod biti pozitivan. Ova pretpostavka je potkrepljena nizom primera kroz analizu studije slučaja multinacionalne kompanije Ahold, gde je dat uvid u dobru praksu M&A transakcija koju je ova kompanija imala, pre svega u SAD i Paragvaju, ali i primeri loših transakcija ove kompanije u Maleziji, Tajlandu i Indoneziji

Interactive Application for Learning the Latin Language

Computers in education are an integral part of the teaching process, but the use of them mostly depends on the competence and willingness of individual teachers, as well as the availability of adequate hardware and software. When it comes to learning a language, computer assisted language learning software mostly covers languages such as English, or German, while other, less popular languages still do not have a good software foundation. The interactive application for learning the Latin language is an example of software that seeks to facilitate students studying Latin within all grammar schools in Croatia. The Latin language, although very often called a dead language, is still a part of the culture in general, and important in fields such as medicine, law, agriculture, etc. Results obtained by our research confirm that students are willing to use such software and that the increase in student motivation and interest are proportional to the final test results

AGREGACIJA TROMBOCITA U ZAVRŠNOM STADIJU ZATAJIVANJA BUBREGA – RAZLIKE IZMEĐU BOLESNIKA KOJI SU LIJEČENI HEMODIJALIZOM I PERITONEJSKOM DIJALIZOM

End-stage renal disease patients (ESRD) suffer from procoagulant abnormalities that lead to excessive cardiovascular events, as well as from platelet dysfunction manifesting as an increased risk of bleeding. The exact pathogenesis of complex hemostatic disorders in ESRD patients is not completely understood. The aim of our study was to investigate the possible different effects of hemodialysis (HD) and peritoneal dialysis (PD) on platelet function in patients with ESRD by using the platelet function analyzer (PFA-100) which in vitro simulates the process of aggregation and platelet activation. Tests were performed with collagen/epinephrine (COL/EPI) and collagen/adenosine-5-diphosphate (COL/ADP) cartridges. The study included 44 patients with ESRD undergoing regular HD (n=32) or PD (n=12). Although there were no significant differences in COL/EPI and COL/ADP tests, it is indicative that more than 50% of HD patients had COL/EPI test values above the upper limit. These findings correlated with a higher chance for bleeding in HD group.Additionally, patients in HD group were significantly older and had significantly lower platelet count compared to PD patients.Završni stadij kronične bubrežne bolesti obilježen je različitim prokoagulantnim odstupanjima koja dovode do razvoja tromboembolijskih komplikacija uz istodobno poremećenu funkciju trombocita s posljedičnim porastom rizika za nastanak krvarenja. Točna etiologija složenih hemostatskih poremećaja u završnom stadiju kronične bubrežne bolesti nije u potpunosti razjašnjena. Cilj ovoga istraživanja bio je usporediti učinak hemodijalize i peritonejske dijalize na funkciju tromobocita kod bolesnika u završnom stadiju kronične bubrežne bolesti primjenom analizatora funkcije trombocita (PFA-100) koji in vitro stimulira proces aktivacije i agregacije trombocita. Ispitivanje je provedeno na 2 testa (COL/EPI i COL/ADP) koji mjere vrijeme potrebno cirkulirajućoj krvi da okludira membranu obloženu kolagenom i adrenalinom (COL/EPI) odnosno kolagenom i ADP-om (COL/ADP). U istraživanje su bili uključeni bolesnici na hemodijalizi (n=32) odnosno peritonejskoj dijalizi (n=12). Premda nije zabilježena statistički značajna razlika između testova COL/EPI i COL/ADP, indikativno je da su u više od 50% ispitanika na hemodijalizi vrijednosti testa COL/EPI bile iznad gornje granice referentnog intervala. Ovi rezultati mogu se povezati s većom mogućnosti krvarenja u bolesnika na hemodijalizi. Uz to, bolesnici na hemodijalizi bili su značajno stariji te su imali statistički značajno niži broj trombocita u odnosu na ispitanike na peritonejskoj dijalizi

Scalp block for hemodynamic stability during neurosurgery

Background and Purpose: For elective neurosurgery procedures maintaining perioperative hemodynamic stability and optimal cerebral perfusion is of outmost importance. Beside numerous anesthetics techniques, risk of hemodynamic instability is still very high. Materials and Methods: We retrospectively analyzed perioperative values of heart rate and arterial blood pressure in 39 patients who underwent neurosurgery. We combined general anesthesia with scalp block. We blocked the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with 0,5% chirocaine, including 5 μg/mL of epinephrine that was performed after general anesthesia induction, before pin placement. Heart rate and blood pressure values were measured before anesthesia induction, after induction, after pins placement, after craniotomy and at the end of surgery. Changes of heart rate and blood pressure values less than 20% after painful stimuli was considered as a good hemodynamic stability of applied anesthetic technique. Result: Scalp block was successfully performed in all patients without complications. Measured values of heart rate and blood pressure before and after anesthesia induction compered to values after painful stimuli werewithin the 20% change. Conclusion: Scalp block, combined with general anesthesia provide good hemodynamic stability during neurosurgery

Prospects for wider energetic utilization of subgeothermal water resources: Eastern Serbia case study

Intenzivno korišćenje fosilnih goriva širom sveta uzrok je ozbiljnih zagađenja prirode i utiče na globalno zagrevanje. Otuda je jedan od glavnih ciljeva energetske politike evropskih zemalja korišćenje efikasnije 'zelene' energije iz obnovljivih i sopstvenih izvora. Generalno, geotermalna energija predstavlja vid obnovljivih izvora energije. Ipak, i dalje se smatra da korišćenje subgeotermalne energije niske entalpije (temperature podzemnih voda od 30°C i niže) za potrebe grejanja nije u potpunosti ekonomski opravdano. Standardna tehnologija za primenu ovog vida energije zahteva velike površine pod panelima sa cevima koje provode toplu vodu i/ili upotrebu toplotnih pumpi sa visokim stepenom iskorišćenja. Razvoj kaskadne toplotne pumpe i njena šira primena omogućila bi daleko efikasniju upotrebu 'lako' dostupnih podzemnih vodnih resursa temperature između 10-30°C i stoga je u više projekata realizovanih poslednjih godina analizirana i razvijana ova tehnologija. Hidrogeološki uslovi u terenima istočne Srbije, su veoma povoljni sa aspekta eksploatacije subgeotermalnih resursa. Područje se odlikuje značajnim količinama podzemnih voda i terestičnim toplotnim tokom u okviru geoloških formacija u osnovnim geo-strukturnim jedinicama ovog regiona (Karpato-Balkanidi i Dakijski basen). Blizina urbanizovanih naselja i manjih gradova i postojanje razvijenog i centralizovanog grejanja su činjenice koje povoljno utiču na mogućnost eksploatacije subgeotermalnih vodnih resursa. Održivo korišćenje podzemnih vodnih resursa podrazumevalo bi i potrebnu termalnu rekonstrukciju i bolju izolaciju postojećih građevinskih objekata, kao i donošenje novih zakonskih propisa u Srbiji u cilju podsticaja korišćenja obnovljivih izvora energije. U području istočne Srbije, procenjene količine energije koje se mogu dobiti iz subgeotermalnih voda iznose oko 33 MWt, što bi predstavljalo oko 16% ukupnih energetskih potreba nekoliko odabranih većih naselja za koje je ova analiza vršena. I pored činjenice da se ne očekuje potpuno iskorišćenje ovog potencijala, evidentno je da je on daleko veći od 4 % koliko je u planovima energetskog razvoja predviđeno da bi moglo iznositi učešće geotermalnih vodnih resursa na nivou cele Srbije.Extensive worldwide usage of fossil energy sources causes high pollution and contributes to global warming. Hence, achieving energy independence by stimulating efficient use of energy and environmentally friendly exploitation of renewable sources is a main orientation of European countries. Geothermal energy is generally treated as a renewable and inexhaustible energy source. Nonetheless, direct use of low enthalpy subgeothermal resources, i.e. groundwater of 30.C or lower, for heating is commonly viewed as economically unjustified. To enable its usage, large panel surfaces or a high-temperature heat pump with excellent efficiency is required. The development of a cascade type heat pump and its wide application would enable more efficient utilization of widely available and easy replenished groundwater sources with temperatures of 10-30.C. The hydrogeological conditions in eastern Serbia are particularly favourable for exploitation of subgeothermal resources due to rich aquifer systems and notable terrestrial heat flow formed into the main geo-structures of the region (Carpathian-Balkan arch and Dachian basin). More intensive exploitation of subgeothermal sources additionally justifies the existence of a number of urbanized small and medium-size cities with a heating infrastructure already developed and centralized. Sustainable use of groundwater resources should be followed by thermal reconstruction of the previously constructed buildings as well as new legislation which supports and encourages development of renewable energy sources. It is estimated that the total potential thermal power which can be generated from subgeothermal waters in the study area is around 33 MWt, which corresponds to some 16 % of the total heat requirements