Koegzistencija sinkronog bilateralnog Wilmsova tumora i trisomije 21 – prvi prikaz i pregled literature

Introduction: Bilateral form of the Wilms tumor appears only in 5% of cases, and incidence in children before the age of 15 years is about 1: 250,000. Contrary to expectations, large population-based studies have shown that incidence of Wilms tumor is much lower in population with trisomy 21 than in the general population. To our knowledge, this is the first reported case of synchronous bilateral Wilms tumor appearing in patient with trisomy 21. Case report: 19-months-old male, previously known for trisomy 21, was admitted to hospital because of chronic constipation and abdominal pain. A month ago the child started to cry and suffer pain during defecation. He had last stool seven days before the examination. Abdominal palpation in left hypochondriac region revealed solid mass of about 6x6 cm in size. Ultrasound and Multislice Computed Tomography showed tumor on both kidneys; right smaller, and left larger - destroying most of the parenchyma and causing bowel obstruction. After 3 weeks of chemotherapy, left radical nephrectomy and right partial nephrectomy were made. 28-week chemotherapy continued postoperatively. Histopathology confirmed diagnosis of Wilms tumor. After recovery, the patient had a sufficient renal function. Conclusion: Coventional treatment with a combination of chemotherapy and surgical resection showed a good long-term outcome. However, in these cases special caution should be focused on the quantity of preserved renal tissue, because of an increased risk of renal failure.Uvod: Bilateralna forma Wilmsovog tumora javlja se samo u 5% slučajeva, a incidencija kod djece do 15. godine života iznosi oko 1:250 000. Suprotno očekivanjima, velike population-based studije pokazale su da je incidencija Wilmosovog tumora kod trisomije 21 mnogo manja nego kod opće populacije. Prema našim saznanjima, ovo je prvi prijavljeni slučaj sinkronog bilateralnog Wilmsovog tumora kod pacijenta s trisomijom 21. Prikaz slučaja: Muško dijete u dobi od 19 mjeseci, od ranije poznato zbog trisomije 21, dovedeno zbog kronične opstipacije i boli u trbuhu. Prije mjesec počeo se mučiti i plakati za vrijeme defekacije. Nije imao stolicu 7 dana pred pregled. Kliničkim pregledom se palpacijom lijevo hipohondralno pipala tvorba 6x6 cm. Ultrazvuk i višeslojna kompjuterizirana tomografija pokazali su u svakom bubregu po jednu tumorsku tvorbu; desno manju, a lijevo veću - koja destruira veći dio parenhima i urokuje opstukciju kolona. Nakon 3 tjedna kemoterapije, napravljena je lijevostrana radikalna nefrektomija i desnostrana parcijalna nefrektomija. Postoperativno je nastavljena kemoterapija u trajanju 28 tjedana. Patohistološka analiza potvrdila je dijagnozu Wilmsovog tumora. Nakon oporavka pacijent je imao zadovoljavajuću renalnu funkciju. Zaključak: Konvencionalno liječenje kombinacijom kemoterapije i kirurške resekcije imalo je dobar dugoročni ishod. Ipak, u ovakvim slučajevima poseban oprez je potrebno usmjeriti na količinu očuvanog renalnog tkiva, zbog povećanog rizika od bubrežnog zatajenja

IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH OF MEDICAL STUDENTS AT THE UNIVERSITY OF MOSTAR

Background: Previous studies have shown that medical students are more prone to depression, more tired, and more prone to emotional exhaustion, depersonalization and burnout syndrome than other students. In terms of mental health, they are a "more vulnerable" than individuals of the same age in the general population. In December 2019 in Wuhan (China) the outbreak of pneumonia caused by the new coronavirus captured worldwide attention. The implementation of strict quarantine measures kept a large number of people in self-isolation which affected all aspects of life. Objective of the study is to determine the direct impact of the COVID-19 pandemic on mental health and quality of life of medical students and the differences in the impact between genders and years of study. Subject and methods: This is a cross-sectional study conducted from May 25 to June 5 2020. It includes medical students who resided in the country affected by the COVID-19 pandemic. Participants completed a modified anonymous online questionnaire that assessed the Impact of Event Scale, indicators of negative mental health impacts, social and family support, and lifestyle changes due to a pandemic. Results: The mean IES score in the participants showed a moderate stressful impact, with the mean IES score of females being significantly higher than that of males (29 vs. 19) with p <0.001. More than half of the participants had an IES sh the onset of the pandemic, 71.5% of all medical students reported feeling increased stress from commitments. Conclusions: the pandemic had stressful impact on the mental health of medical students and it was significantly more stressful for women and students in the preclinical years of study. The COVID-19 pandemic had no impact on social and family support, however a positive impact on the lifestyle of medical students was found

IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH OF MEDICAL STUDENTS AT THE UNIVERSITY OF MOSTAR

Background: Previous studies have shown that medical students are more prone to depression, more tired, and more prone to emotional exhaustion, depersonalization and burnout syndrome than other students. In terms of mental health, they are a "more vulnerable" than individuals of the same age in the general population. In December 2019 in Wuhan (China) the outbreak of pneumonia caused by the new coronavirus captured worldwide attention. The implementation of strict quarantine measures kept a large number of people in self-isolation which affected all aspects of life. Objective of the study is to determine the direct impact of the COVID-19 pandemic on mental health and quality of life of medical students and the differences in the impact between genders and years of study. Subject and methods: This is a cross-sectional study conducted from May 25 to June 5 2020. It includes medical students who resided in the country affected by the COVID-19 pandemic. Participants completed a modified anonymous online questionnaire that assessed the Impact of Event Scale, indicators of negative mental health impacts, social and family support, and lifestyle changes due to a pandemic. Results: The mean IES score in the participants showed a moderate stressful impact, with the mean IES score of females being significantly higher than that of males (29 vs. 19) with p <0.001. More than half of the participants had an IES sh the onset of the pandemic, 71.5% of all medical students reported feeling increased stress from commitments. Conclusions: the pandemic had stressful impact on the mental health of medical students and it was significantly more stressful for women and students in the preclinical years of study. The COVID-19 pandemic had no impact on social and family support, however a positive impact on the lifestyle of medical students was found

Neurological Complications of COVID-19

Koronavirusna bolest u 2019. godini (COVID-19) uzrokovana je novootkrivenim korona virusom tipa 2 koji uzrokuje teški akutni respiratorni sindrom (SARS-CoV-2). Virus je otkriven u prosincu 2019. godine, a od strane Svjetske zdravstvene organizacije je, zbog broja oboljelih i proširenosti širom svijeta, proglašena pandemija. Klinička prezentacija COVID-19 varira od asimptomatskog do teškog oblika i smrtnog ishoda. Iako kliničkom slikom dominiraju respiratorne smetnje, mnogobrojne studije ukazuju na pojavu akutnih i kroničnih neuroloških komplikacija u skoro trećine oboljelih. Najčešći neurološki simptomi akutne faze COVID-19 su glavobolja, gubitak njuha i okusa, poremećaji stanja svijesti, encefalopatije, encefalitisi, moždani udar, bolovi u mišićima, epileptički napadaji, poliradikulopatije (GBS) te pojačan umor i netolerancija napora, poremećaji vegetativnih funkcija, kognitivne i psihičke smetnje u postinfekcijskoj fazi oboljenja. Potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja u akutnoj fazi uključuje koagulopatije s udruženim hipoksično-ishemijskim oštećenjima, poremećajem krvno-moždane barijere, endoteliopatijama i neuroinvazijom virusa, udruženom s neuro-imunim odgovorom. Cilj ovog članka je prikazati najčešće akutne i kronične neurološke poremećaje vezane uz COVID-19 kod odraslih bolesnika kao i potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja, a buduće epidemiološke studije o bolesnicima s COVID-19 bi trebali utvrditi pravu incidenciju neuroloških komplikacija COVID-19, razgraničiti specifične neurološke sindrome, postaviti dijagnostičke i terapijske protokole ta razjasniti mehanizam nastanka poremećaja.Coronavirus disease in 2019 (COVID-19) is caused by the newly discovered coronavirus type 2 which causes severe acute respiratory syndrome (SARS-CoV-2). The virus was discovered in December 2019, and the World Health Organization has declared a pandemic due to the number of cases and the spread around the world. The clinical presentation of COVID-19 varies from asymptomatic to severe and lethal outcome. Although the clinical picture is dominated by respiratory disorders, numerous studies indicate the occurrence of acute and chronic neurological complications in almost a third of patients. The most common neurological symptoms of the acute phase of COVID-19 are headache, loss of smell and taste, disturbances of consciousness, encephalopathies, encephalitis, stroke, muscle pain, epileptic seizures, polyradiculopathy (GBS) and increased fatigue and intolerance to stressful and mental disorders in the postinfectious phase of the disease. Potential pathophysiological mechanisms of the development of neurological disorders in the acute phase include coagulopathies with associated hypoxic-ischemic damage, blood-brain barrier disorder, endotheliopathies and neuroinvasion of viruses with associated neuro-immune response. The objective of this paper is to present the most common acute and chronic neurological disorders related to COVID-19 in adult patients as well as the potential pathophysiological mechanism of neurological disorders, and future epidemiological studies on patients with COVID-19 should determine the true incidence of specific neurological syndromes, to establish diagnostic and therapeutic protocols and to clarify the mechanism of disorder development

Obesity and Clonal Hematopoiesis of Indeterminate Potential: Allies in Cardiovascular Diseases and Malignancies

The clonal hematopoiesis of indeterminate potential (CHIP) is a term used to describe individuals who have detectable somatic mutations in genes commonly found in individuals with hematologic cancers but without any apparent evidence of such conditions. The mortality rate in individuals with CHIP is remarkably higher than the influence ascribed to hematologic malignancies, and it is plausible that cardiovascular diseases (CVD) could elucidate the apparent disparity. Studies have shown that the most frequently altered genes in CHIP are associated with the increased incidence of CVDs, type 2 diabetes mellitus (T2DM) and myeloid malignancies, as well as obesity. Additionally, multiple research studies have confirmed that obesity is also independently associated with these conditions, particularly the development and progression of atherosclerotic CVD. Considering the shared pathogenetic mechanisms of obesity and CHIP, our objective in this review was to investigate both preclinical and clinical evidence regarding the correlation between obesity and CHIP and the resulting implications of this interaction on the pathophysiology of CVDs and malignancies. The pro-inflammatory condition induced by obesity and CHIP enhances the probability of developing both diseases and increases the likelihood of developing CVDs, T2DM and malignancies, suggesting that a dangerous vicious loop may exist. However, it is vital to conduct additional research that will suggest targeted treatment options for obese individuals with CHIP in order to reduce harmful effects connected to these conditions