MEDICAL NUTRITION THERAPY IN MANAGEMENT OF EATING DISORDERS

The treatment of eating disorders demands a comprehensive medical approach, where a dietitian has an important role, primarily due to numerous instances of malnutrition. The objective of this paper was to recapitulate the research findings and clinical evidence which show the importance of medical nutrition therapy in the treatment of eating disorders; furthermore, they present significant guidelines for clinical practice. The research methods have entailed a thorough exploration of literature available at research data bases. The results of the research studies published so far have unambiguously pointed out that, when eating disorders are concerned, there is an urgent need for a diet therapy in order for the patient to restore the appropriate body weight as well as normal eating habits. On the one hand, certain authors suggest returning to normal nutritional habits immediately, whereas, on the other hand, certain others advocate a diet therapy program, that is, a gradual process of recovery. Patients incapable of oral food intake receive enteral nutrition. Parenteral nutrition is applied for recovering the lost electrolytes and fluids, but it should be applied rarely, primarily in states of urgency. For patients suffering from eating disorders the increase in weight indicates good chances of recovery; therefore, the patient’s nutritional status should be carefully and continuously noted. Finally, it is important that our country, too, should adopt a carefully prescribed and conducted diet therapy as an obligatory step in the treatment of patients with eating disorders

Manifestations of mid-life crisis, the sense of meaning in life and the balance between professional and family roles in Serbia

The main objective of this research was to explore the relationship beetwen characteristic manifestations of mid-life crisis, the attained sense of meaning in life, the satisfaction with professional and family roles, and the way people in Serbia balance all of these. More precisely, it examined the connection beetwen denial by escape, denial by overcompensation, decompensation, and creative and successful coping with the crisis, as different aspects of the external manifestations of midlife crisis, and the establishment of a new balance between the opposites such as young-old, masculine-feminine, destructioncreation and closeness-separation, which are all profound internal changes caused by the crisis, with the attained meaning in life, satisfaction with different aspects of professional and family roles, and the ways people balance them in Serbia. The values of these variables are compared with those of middle-aged people, as well as younger and older people, in order to identify any specific characteristics that middle-aged population might have. In addition to these main differences, some others were observed, measured and noted down following the comparison to the 8 control variables. For the purpose of this research, which is part of a doctoral dissertation, a sample of 600 respondents was chosen, 200 of whom were middle-aged (between 40 and 64 years), 200 younger (between 25 and 39 years), and another 200 older (aged 65 to 80 years). Data were collected from July to December of 2012. The study included five major regions, or 10 cities of the Republic of Serbia (Northern Serbia: Novi Sad and Belgrade, Central Serbia: Jagodina and Kruševac, Southern Serbia: Leskovac and Lebane, Eastern Serbia: Niš and Knjaževac and Western Serbia: Novi Pazar and Užice) . The following instruments were used: A list of subjects’ basic biodata, Midlife Crisis Scale-MCS, Midlife Crisis Scale-SKSG, which was specially created for the purposes of this study, Bem Sex-Role Inventory, adapted Loyola generativity scale, adapted scale of preferred aloneness, Meaning in Life Questionnaire, the modified Role Quality Scale, Work-Family Conflict Scale, Work-Family Positive Spillover Scale, Measures of Supports from Family and Work, adapted Work-Family Role Interdependence Scale and Scale of stressful life events occurring on the modified list of stressful life events by Jelena Vlajković. Descriptive statistics was used to process the data, including appropriate correlation coefficients, specific procedures for determining the normality of distribution of all variables in the scores of respondents, specific procedures for identifying and testing psychometric characteristics of the instruments and methods of factor analysis to determine the adequacy of the internal structure of the instrument, correlation coefficients for determining the correlation between variables and various procedures for testing the difference between groups of respondents. The statistical analysis of the data was performed using SPSS version 20 for data analysis in social sciences. Obtained results show the connection between certain external and internal manifestations of midlife crisis with the attained sense of meaning in life, means of balancing professional and family roles and different aspects of satisfaction with their performance. The paper offers models (schematic diagram) of the relationships of these variables, in relation to both the whole sample, and the middle-aged portion of the sample. Furthermore, it can be concluded that differences in these key variables between groups of participants of different gender, level of education, financial status, employment status, marital status, with different places of residence and work in one of the five major 8 regions of Serbia, as well as different numbers and types of stressful events that were experienced in life. When it comes to the deep internal changes, which are of unconscious nature, middleaged people first display a change in behavior. Denial by overcompensation is most intense in the period between 25 and 30 years of age, because it includes behaviors that are typical of this age. Decompensation and denial by escape occur most intensely between the ages of 50 and 54, possibly as the first response to the crisis and the new state. It takes some time for a person to fully realize what has happened to them and to gain the capacity to find a creative and successful way to deal with the crisis, which in the majority of people occurs somewhere between the ages of 60 and 64. These changes are indicative of the existence of deep, and most importantly, long-term psychological processes of shifting the internal balance, which results in significant changes in the internal structure of a person much later in life. The first internal change in which it is possible to register a significant progress in establishing a new balance and the reconciliation of a pair of opposites, is the one related to the reconciliation of male and female roles in a person, or masculine and feminine personality traits, and it happens somewhere between the ages of 40 and 44. Finally accepting one’s own finality and the process of aging as inevitable but normal and natural life process, or the reconciliation between youth and old age, is most intense between 60 and 64 years of age. The most intensive progress in establishing a new balance between the last two pairs of opposites – the gain-loss and closeness-separation reconciliation is the last to take place in one’s life, and occurs between the ages of 75 and 80. Each life crisis causes a person at some point to open and re-examine the basic existential questions about the meaning of life. Generally speaking, middle-aged people have the lowest level of stable feeling towards the existence of meaning in life. It is lower than the intensity of this feeling among young people, and reaches its lowest between the ages of 55 and 59, or according to some more rough estimates, between 50 and 59 years of age. In the elderly the sense of meaning is almost fully formed, and with the passage of time, they increasingly seek to find some of its new aspects. On the other hand, middle-aged people are constantly faced with discovering new aspects of meaning in life. The search for the meaning of life begins to grow more intense somewhere between the ages of 45 and 49, then fluctuates slightly over the next nine years, and culminates in the period between 60 and 64 years of age, after which it has been recorded to decrease in intensity. It can be concluded that, generally speaking, mid-life is the period of life characterised by questioning the meaning of life. People don’t have a clear notion that they have found adequate and satisfactory sense in their lives, and they are constantly trying to find or rediscover it. In the group of middle-aged people, the conflict of roles is most pronounced in the period between the ages of 40 and 44, while the spillover reaches its peak slightly later, between the ages of 60 and 64. The intertwining of roles and the sacrifice of time that could be spent with the family due to professional obligations as a forms of interdependence of work and family roles, are also most intense between the ages of 40 and 44. This could mean that people, upon entering mid-life fail to adequately distinguish and separate family and professional roles, which are often in some kind of conflict. It is only at the end of this period that we see a positive exchange of experiences, which enriches and facilitates the performance of family and professional responsibilities and activities. Compared to young and old, mid-life people are most content with performing certain family and professional roles, yet at the same time, they feel the highest level of stress, too. The stress seems to reach its peak earlier, in the period of life between the ages of 50 and 54, while the contentment with the role is at its height between the ages of 60 and 64. The lowest level of stress and contentment with roles were observed in the elderly, between 65 and 69 years of age. In mid-life people, the highest levels of stress were noted between 50 and 54 9 years of age, when a rapid decline in values begins, while at the same time satisfaction with children oscillates, reaching its maximum in the third phase of life. As a general conclusion it may be pointed out that mid-life and crises occurring at the transition from the first to the second half of life is really an important milestone in the development, which requires a substantial reconstruction of the previous way of functioning in all important aspects of life. The second half of life is more difficult, painful and certainly more complex than the first. However, if the person is wise and manages to listen to the voices from the depths of their soul, they will succeed in finding new resources and developing their potential despite the complexity of circumstances. Each person must find their own unique path in life

Reversal of FLT3 Mutational Status and Sustained Expression of NPM1 Mutation in Paired Presentation, and Relapse Samples in a Patient with Acute Myeloid Leukemia

We report a case of de novo acute myeloid leukemia (AML) with unstable FLT3 gene mutations and stable NPM1 mutation. FLT3/D835 and NPM1 (Type A) mutations were detected upon diagnosis. During the relapse, the FLT3/D835 mutation changed to an FLT3/ITD mutation while the NPM1 (Type A) mutation was retained. Cytogenetic analyses showed the normal karyotype at diagnosis and relapse. Our findings raise interesting questions about the significance of these mutations in the leukemogenic process, about their stability during the evolution of the disease, and regarding the selection of appropriate molecular markers for the monitoring of minimal residual disease

Susceptibility to oxidative stress, insulin resistance, and insulin secretory response in the development of diabetes from obesity

Background/Aim. Oxidative stress plays a critical role in the pathogenesis of various diseases. Recent reports indicate that obesity may induce systemic oxidative stress. The aim of the study was to potentiate oxidative stress as a factor which may aggravate peripheral insulin sensitivity and insulinsecretory response in obesity in this way to potentiate development of diabetes. The aim of the study was also to establish whether insulin-secretory response after glucagonstimulated insulin secretion is susceptible to prooxidant/ antioxidant homeostasis status, as well as to determine the extent of these changes. Methods. A mathematical model of glucose/insulin interactions and C-peptide was used to indicate the degree of insulin resistance and to assess their possible relationship with altered antioxidant/prooxidant homeostasis. The study included 24 obese healthy and 16 obese newly diagnozed non-insulin dependent diabetic patients (NIDDM) as well as 20 control healthy subjects, matched in age. Results. Total plasma antioxidative capacity, erythrocyte and plasma reduced glutathione level were significantly decreased in obese diabetic patients, but also in obese healthy subjects, compared to the values in controls. The plasma lipid peroxidation products and protein carbonyl groups were significantly higher in obese diabetics, more than in obese healthy subjects, compared to the control healthy subjects. The increase of erythrocyte lipid peroxidation at basal state was shown to be more pronounced in obese daibetics, but the apparent difference was obtained in both the obese healthy subjects and obese diabetics, compared to the control values, after exposing of erythrocytes to oxidative stress induced by H2O2. Positive correlation was found between the malondialdehyde (MDA) level and index of insulin sensitivity (FIRI). Conclusion. Increased oxidative stress together with the decreased antioxidative defence seems to contribute to decreased insulin sensitivity and impaired insulin secretory response in obese diabetics, and may be hypothesized to favour the development of diabetes during obesity

Diffuse osteolytic lesions in leukemic transformation of myelofibrosis

Myelofibrosis is a clonal myeloproliferative disorder characterized by splenomegaly, abnormal deposition of reticulin and collagen in the bone marrow, extramedullary hematopoiesis, dacryocytosis and leukoerythroblastic blood smear. Development and sustainment of fibrosis are mediated by complex network of several cytokines. Osteosclerosis is the most frequently observed bone change in myelofibrosis. We present an atypical case of leukemic transformation in myelofibrosis associated with diffuse osteolytic lesions and extremely elevated lactate dehydrogenase in serum, which indicates high bone turnover during leukemic infiltration and bone destruction

Impact of COVID pandemic on attitude and prevalence of plant-based food products consumption in Serbia

COVID pandemic influence on eating behavior and dietary habits with respect to various plant-based foods in Serbia were estimated by an anonymous questionnaire. Most examinees agree that fruits and vegetables contribute to strengthening immunity and that herbal medicines and natural products have beneficial effects on health. Around 55% of examinees consider their diet balanced, and 4% have started to drink herbal teas more often when the pandemic started. Garlic and ginger were the most frequently reported newly included plants in examinees’ diet. The attitudes toward plant-based food products are not strongly dependent on the education level. The age and previous dietary habits of examinees have great influence in the current frequency of consuming fruits, vegetables, herbal teas, spices, and dietary supplements. There was a significant shift toward greater use of herbal teas and dietary supplements, especially among the population that has already consumed them occasionally. Somewhat concerning is the fact that around half of respondents use dietary supplements without the recommendation of an expert. People with good dietary habits and the elderly were most prone to improving their diet. Roughly 15% of all respondents now have the same habits as before the pandemic, although they improved their diets temporarily at the beginning of COVID pandemic

Role of parental monitoring in the prevention of peer violence on the internet

Numerous studies show that the prevalence of bullying on the Internet is increasing. Preventing exposure and manifestation of this form of bullying is a particular challenge for parents. Their protective role is diminished, as children are more information-technology literate and have devices that allow unlimited internet access. Supervision of a child’s activities on the Internet is a specific type of parental monitoring. Most parents use restrictive strategies, in the form of time and content limitations, which have weak effects. There is a need to educate parents about effective strategies to monitor child’s activities on the Internet that can contribute to preventing and reducing bullyBrojna istraživanja pokazuju da je prevalencija vršnjačkog nasilja na inter- netu u porastu. Prevencija izloženosti i ispoljavanja ovog oblika vršnjačkog nasilja predstavlja poseban izazov za roditelje. Njihova protektivna uloga je umanjena, jer su deca informaciono-tehnološki pismenija i poseduju uređaje koji omogućavaju neograničen pristup internetu. Nadzor nad aktivnostima dete- ta na internetu predstavlja specifičnu vrstu roditeljskog nadzora. Većina roditelja koristi restriktivne strategije, u vidu ograničavanja vremena i sadržaja, koje imaju slabe efekte. Postoji potreba za edukacijom roditelja o efektivnim strategijama nadziranja aktivnosti deteta na internetu koje mogu doprineti prevenciji i redukovanju vršnjačkog nasilja

Relationship between restrictive strategies of parental control and digital violence in adolescence

Modern studies show that children and adolescents represent the population of users who spend the most time online and that are significantly more exposed to risk behaviors, mostly in cyberbullying. Therefore, the aim of this paper is to determine the effectiveness and frequency of using restrictive strategies in parental control over a child's online activities. The survey sample contains 183 first and fourth grade high school students answering questions about parental monitoring and cyberbullying. Parental monitoring was examined by a short questionnaire consisted of several categorical questions, while the Cyber Victim and Bullying Scale was used to examine cyberbullying. The results of this study show that parents infrequently use restrictive strategies in monitoring child's internet use. Parents use their strategies mostly to avoid child's chatting with strangers (51.9%) and leaving personal information on the Internet (35.5%), while certain parents have a password of the devices that child uses to access the Internet (37.2%). Only one in five parents limit access to certain websites, while one in ten limit amount of time their teen can go online. The final analysis showed that there is no statistically significant association of restrictive strategies in parental control and digital violence. Parental control can become a significant role in preventing and reducing digital violence in adolescents, but it is necessary to direct parents to make decisions about online rules of conduct in agreement with children and in accordance with their activities and encourage them to use other, adequate parental control strategies.Savremene studije pokazuju da deca i adolescenti predstavljaju populaciju korisnika koja najviše vremena provodi na internetu, te su znatno više izloženi rizičnim ponašanjima, a najviše digitalnom nasilju. Stoga je cilj u ovom radu utvrđivanje razlika u učestalosti digitalnog nasilja kod adolescenata u zavisnosti od primene restriktivnih strategija roditeljskog nadzora. Uzorak istraživanja čini 183 učenika prvog i četvrtog razreda gimnazije koji su odgovarali na pitanja o roditeljskom nadzoru i digitalnom nasilju. Roditeljski nadzor ispitivan je kratkim upitnikom, koji se sastojao iz niza kategoričkih pitanja, dok je za ispitivanje digitalnog nasilja korišćena Skala sajber žrtve i nasilnog ponašanja (Cyber Victim and Bullying Scale). Rezultati ovog istraživanja pokazuju da roditelji neredovno koriste restriktivne strategije u vršenju roditeljskog nadzora nad aktivnostima deteta na internetu. Roditeljski nadzor se najčešće svodi na zabranu dopisivanja sa nepoznatim ljudima (51,9%) i nešto manje na zabranu ostavljanja ličnih podataka (35,5%) i posedovanje šifre od uređaja preko kog dete pristupa internetu (37,2%). Završna analiza pokazala je da ne postoji statistički značajna povezanost restriktivnih strategija roditeljskog nadzora sa učinjenim nasiljem na internetu, niti sa doživljenim nasiljem. Kako bi roditeljski nadzor imao značajnu ulogu u prevenciji i redukovanju digitalnog nasilja kod dece adolescentnog uzrasta neophodno je usmeriti roditelje da odluke o pravilima ponašanja na internetu donose u dogovoru sa decom i u skadu sa njihovim aktivnostima i podstaći ih na korišćenje drugih, adekvatnih strategija roditeljskog nadzora

Upotreba alkohola kod mladih u studentskim domovima

The aim of this paper is to examine the prevalence and characteristics of alcohol use among students in student dormitories. The sample contains 223 students of University of Belgrade, aged 19-30, who lived in student dormitories during the research. The questionnaire of the Core Institute was used for this research. The results of this study show that one-fifth of students in student dormitories consumes alcohol four or more times a week, while in the past two weeks 40% of students have consumed five or more drinks in one occasion. Most students have positive attitudes toward alcohol use, despite the fact they have experienced negative consequences of drinking. The final analysis showed that the use of alcohol among students in student dormitories is associated with some study characteristics and socio-demographic characteristics of the student.Cilj ovog rada je utvrđivanje učestalosti i karakteristika upotrebe alkohola kod studenata u studentskim domovima. Uzorak čini 223 studenta Univerziteta u Beogradu, uzrasta od 19 do 30 godina, koji su u vreme istraživanja živeli u studenskom domu. Za potrebe istraživanja korišćen je upitnik Korovog instituta (The Core Institut). Rezultati ovog istraživanja pokazuju da petina studenata u studentskim domovima konzumira alkohol četiri ili više puta nedeljno, dok je u prethodne dve nedelje 40% studenata popilo pet ili više pića u jednoj prilici. Većina studenata ima pozitivne stavove prema upotrebi alkohola, iako su iskusili negativne posledice pijenja. Završna analiza pokazala je da je upotreba alkohola kod studenata u studentskim domovima povezana sa nekim sociodemografskim karakteristikama i karakteristikama studiranja

Excitatory amino acid b-N-methylamino-L-alanine is a putative environmental neurotoxin

The amino acid b-N-methylamino-L-alanine (L-BMAA) has been associated with the amyotrophic lateral sclerosis/parkinsonism-dementia complex in three distinct western Pacific populations. The putative neurotoxin is produced by cyanobacteria, which live symbiotically in the roots of cycad trees. L-BMAA was thought to be a threat only to those few populations whose diet and medicines rely heavily on cycad seeds. However, the recent discovery that cyanobacteria from diverse terrestrial, freshwater, and saltwater ecosystems around the world produce the toxin requires a reassessment of whether it poses a larger health threat. Therefore, it is proposed that monitoring L-BMAA levels in cyanobacteria-contaminated water supplies might be prudent