FUNCTIONAL BLOATING, CONSTIPATION AND DIARRHEA

Funkcionalni poremećaji i bolesti uglavnom se dijagnosticiraju na osnovi isključenja, kada ne postoje jasni dokazi o prisutnosti upalnog, anatomskog, metaboličkog ili neoplastičkog procesa koji bi objasnio i opravdao simptome i poteškoće bolesnika. Rimski III dijagnostički kriteriji za funkcionalne poremećaje gastrointestinalnog sustava (engl. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders – FGIDs) usvojeni su i primjenjuju se u kliničkoj i znanstvenoj medicini. Funkcionalni poremećaji gastrointenstinalnog sustava za odrasle, prema III rimskim dijagnostičkim kriterijima svrstani su u šest skupina. U skupinu C uvršteni u funkcionalni poremećaji crijeva (engl. functional bowel disorders), a koja uključuje: sindrom iritabilnog kolona (C1), funkcionalnu nadutost (C2), funkcionalnu opstipaciju (C3) i funkcionalnu dijareju (C4). Simptomi funkcionalnih gastrointestinalnih poremećaja često su kombinacija raznih poremećenih fi zioloških funkcija, kao što su povećana motorička reaktivnost crijeva, visceralna hipersenzitivnost, oštećena imunološka i infl amatorna funkcija crijevne sluznice sa posljedičnom promjenom bakterijske fl ore crijeva te poremećene CNS-ENS (engl. Central Nervous System - Enteric Nervous System) regulacije zbog izloženosti raznim psihosocijalnim i sociokulturološkim čimbenicima. Simptomi moraju biti prisutni barem šest mjeseci prije kliničke pojave bolesti i aktualno prisutni i dijagnostički potvrđeni u posljednja tri mjeseca. Dijagnostički postupci su individualno usmjereni, ovisno o dobi bolesnika, karakteru postojećih simptoma i ostalim kliničkim i laboratorijskim obilježjima. Liječenje se temelji na zdravstvenom odgoju, savjetovanju o prehrani, medikamentnom liječenju i psihološkoj potpori.Functional disorders and diseases are usually diagnosed by exclusion when there is no clear presence of infl ammatory, anatomic, metabolic, or neoplastic processes which would explain the symptoms and diffi culties of the patient. The Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders (FGID) are used in clinical and scientifi c medicine. Functional disorders of the upper gastrointestinal system in adults are classifi ed into six groups. Group C are functional bowel disorders which include irritable bowel syndrome (C1), functional bloating (C2), functional constipation (C3) and functional diarrhea (4). The symptoms of functional gastrointestinal disorders are often a combination of disrupted physiological functions, such as an increase in motor reactivity of the intestine, visceral hypersensitivity, impaired immune functions and infl ammatory intestinal mucosa followed by change in the intestinal bacterial fl ora and disrupted central nervous system-enteric nervous system regulation because of exposure to different psychosocial and sociocultural factors. The symptoms must be present for at least six months before clinical manifestation of the disease and also must be currently present and diagnostically confi rmed in the last three months. Diagnostic procedures are targeted individually, depending on the patient age, nature of symptoms, and other clinical and laboratory characteristics. Treatment is based on health education, nutrition counseling, medication and psychological support

The effect of subminimal inhibitory concentrations of antibiotics on the adherence ability of Pseudomonas aeruginosa to epithelial cells in vitro

Background and purpose: The aim of this study was to examine the influence of subminimal inhibitory concentrations (subMICs) of ceftazidime, ciprofloxacin and gentamicin on the adherence ability and morphology of wild-type Pseudomonas aeruginosa strains to the Buffalo green monkey kidney cell line, using indirect immunofluorescence staining. Materials and methods: Bacterial adherence changes were tested before and after exposure to 1/2, 1/4, 1/8, 1/16 and 1/32 MIC of antibiotics. Results: A statistical difference in the number of attached bacteria after exposure to all subMICs of ceftazidime and ciprofloxacin was observed (p<0.05), even after only 1/2 MIC of gentamicin. Conclusion: The results of this study have shown that antibiotics in much lower concentrations than those necessary for inhibition of bacterial multiplications could damage the adherence of Pseudomonas aeruginosa to the epithelial cell line

The effect of subminimal inhibitory concentrations of antibiotics on the adherence ability of Pseudomonas aeruginosa to epithelial cells in vitro

Background and purpose: The aim of this study was to examine the influence of subminimal inhibitory concentrations (subMICs) of ceftazidime, ciprofloxacin and gentamicin on the adherence ability and morphology of wild-type Pseudomonas aeruginosa strains to the Buffalo green monkey kidney cell line, using indirect immunofluorescence staining. Materials and methods: Bacterial adherence changes were tested before and after exposure to 1/2, 1/4, 1/8, 1/16 and 1/32 MIC of antibiotics. Results: A statistical difference in the number of attached bacteria after exposure to all subMICs of ceftazidime and ciprofloxacin was observed (p Conclusion: The results of this study have shown that antibiotics in much lower concentrations than those necessary for inhibition of bacterial multiplications could damage the adherence of Pseudomonas aeruginosa to the epithelial cell line.</p

The effect of subminimal inhibitory concentrations of antibiotics on the adherence ability of Pseudomonas aeruginosa to epithelial cells in vitro

Background and purpose: The aim of this study was to examine the influence of subminimal inhibitory concentrations (subMICs) of ceftazidime, ciprofloxacin and gentamicin on the adherence ability and morphology of wild-type Pseudomonas aeruginosa strains to the Buffalo green monkey kidney cell line, using indirect immunofluorescence staining. Materials and methods: Bacterial adherence changes were tested before and after exposure to 1/2, 1/4, 1/8, 1/16 and 1/32 MIC of antibiotics. Results: A statistical difference in the number of attached bacteria after exposure to all subMICs of ceftazidime and ciprofloxacin was observed (p&lt;0.05), even after only 1/2 MIC of gentamicin. Conclusion: The results of this study have shown that antibiotics in much lower concentrations than those necessary for inhibition of bacterial multiplications could damage the adherence of Pseudomonas aeruginosa to the epithelial cell line

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

From Bacteriophage to Antibiotics and Back

Life is a phenomenon, and evolution has given it countless forms and possibilities of survival and formation. Today, almost all relationship mechanisms between humans who are at the top of the ladder, and microorganisms which are the beginning are known. Preserving health, or life, is not just an instinctive response to threat anymore; rather it is a deliberate creation and use of knowledge. During major epidemics and wars which create great suffering, experiences of the man-disease (cause) relationships have been applied, so we note the use of bacteriophages in Poland and Russia before the Second World War and during the Second World War, while almost at the same time antibiotic therapy was introduced. Since bacteriophages - viruses "tracked" the evolution of bacteria, the mechanism of their action lies in the prokaryotic cell, so they are not dangerous to the eukaryotic cells of human parenchyma. It was, therefore, necessary only to reuse these experiences nowadays when we are convinced that bacteria have an inexhaustible genetic and phenotypic resistance mechanism of their own. Antibiotics continue to represent the foundation of health preservation, but now they work together with specific viruses – bacteriophages that we can produce and apply in the context of multi-resistance, but also for the preparation of new pharmacological preparations. Therefore, let us turn to this new knowledge and possibilities, and add "all the way to the new antibiotic-bacteriophage model" to the title of this paper

Clusters of Physical Frailty and Cognitive Impairment and Their Associated Comorbidities in Older Primary Care Patients

(1) Objectives: We aimed to identify clusters of physical frailty and cognitive impairment in a population of older primary care patients and correlate these clusters with their associated comorbidities. (2) Methods: We used a latent class analysis (LCA) as the clustering technique to separate different stages of mild cognitive impairment (MCI) and physical frailty into clusters; the differences were assessed by using a multinomial logistic regression model. (3) Results: Four clusters (latent classes) were identified: (1) highly functional (the mean and SD of the “frailty” test 0.58 ± 0.72 and the Mini-Mental State Examination (MMSE) test 27.42 ± 1.5), (2) cognitive impairment (0.97 ± 0.78 and 21.94 ± 1.95), (3) cognitive frailty (3.48 ± 1.12 and 19.14 ± 2.30), and (4) physical frailty (3.61 ± 0.77 and 24.89 ± 1.81). (4) Discussion: The comorbidity patterns distinguishing the clusters depend on the degree of development of cardiometabolic disorders in combination with advancing age. The physical frailty phenotype is likely to exist separately from the cognitive frailty phenotype and includes common musculoskeletal diseases

FUNCTIONAL BLOATING, CONSTIPATION AND DIARRHEA

Funkcionalni poremećaji i bolesti uglavnom se dijagnosticiraju na osnovi isključenja, kada ne postoje jasni dokazi o prisutnosti upalnog, anatomskog, metaboličkog ili neoplastičkog procesa koji bi objasnio i opravdao simptome i poteškoće bolesnika. Rimski III dijagnostički kriteriji za funkcionalne poremećaje gastrointestinalnog sustava (engl. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders – FGIDs) usvojeni su i primjenjuju se u kliničkoj i znanstvenoj medicini. Funkcionalni poremećaji gastrointenstinalnog sustava za odrasle, prema III rimskim dijagnostičkim kriterijima svrstani su u šest skupina. U skupinu C uvršteni u funkcionalni poremećaji crijeva (engl. functional bowel disorders), a koja uključuje: sindrom iritabilnog kolona (C1), funkcionalnu nadutost (C2), funkcionalnu opstipaciju (C3) i funkcionalnu dijareju (C4). Simptomi funkcionalnih gastrointestinalnih poremećaja često su kombinacija raznih poremećenih fi zioloških funkcija, kao što su povećana motorička reaktivnost crijeva, visceralna hipersenzitivnost, oštećena imunološka i infl amatorna funkcija crijevne sluznice sa posljedičnom promjenom bakterijske fl ore crijeva te poremećene CNS-ENS (engl. Central Nervous System - Enteric Nervous System) regulacije zbog izloženosti raznim psihosocijalnim i sociokulturološkim čimbenicima. Simptomi moraju biti prisutni barem šest mjeseci prije kliničke pojave bolesti i aktualno prisutni i dijagnostički potvrđeni u posljednja tri mjeseca. Dijagnostički postupci su individualno usmjereni, ovisno o dobi bolesnika, karakteru postojećih simptoma i ostalim kliničkim i laboratorijskim obilježjima. Liječenje se temelji na zdravstvenom odgoju, savjetovanju o prehrani, medikamentnom liječenju i psihološkoj potpori.Functional disorders and diseases are usually diagnosed by exclusion when there is no clear presence of infl ammatory, anatomic, metabolic, or neoplastic processes which would explain the symptoms and diffi culties of the patient. The Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders (FGID) are used in clinical and scientifi c medicine. Functional disorders of the upper gastrointestinal system in adults are classifi ed into six groups. Group C are functional bowel disorders which include irritable bowel syndrome (C1), functional bloating (C2), functional constipation (C3) and functional diarrhea (4). The symptoms of functional gastrointestinal disorders are often a combination of disrupted physiological functions, such as an increase in motor reactivity of the intestine, visceral hypersensitivity, impaired immune functions and infl ammatory intestinal mucosa followed by change in the intestinal bacterial fl ora and disrupted central nervous system-enteric nervous system regulation because of exposure to different psychosocial and sociocultural factors. The symptoms must be present for at least six months before clinical manifestation of the disease and also must be currently present and diagnostically confi rmed in the last three months. Diagnostic procedures are targeted individually, depending on the patient age, nature of symptoms, and other clinical and laboratory characteristics. Treatment is based on health education, nutrition counseling, medication and psychological support

Classification of general/family medicine patients into subgroups based on differences in the degree of severity of frailty syndrome and affective and cognitive disorders

Ciljevi istraživanja Utvrditi kako se pacijenti obiteljske medicine stari 60 ili više godina razvrstavaju u podskupine (latentne klase) na temelju funkcionalnih poremećaja, tjelesne nemoći i kognitivnog deficita. Nacrt istraživanja Istraživanje je presječno istraživanje, provedeno 2018. godine u ambulanti obiteljske medicine u Osijeku. Ispitanici i metode U istraživanju su sudjelovala 263 ispitanika koji su probirani redom dolaska u ambulantu. Za ispitivanje kognitivnih poremećaja korišten je MMSE test (engl. Mini Mental State Examination), a za stupanj tjelesne nemoći frailty test Fried i sur. Za podjelu ispitanika u klase korištena je metoda analize latentnih klasa (softver Mplus 8.1, Muthén & Muthén, 2015), a za ispitivanje razlika u varijablama između klasa standardne statističke metode te multinomijalna regresijska analiza. Razina značajnosti postavljena je na alpha = 0,05 uz dvostrane p-vrijednosti. Rezultati Identificirane su četiri podskupine (latentne klase) koje su nazvane: 1) visoko funkcionalni (N = 161) (aritmetička sredina bodova i SD na frailty testu 0,58 ± 0,72, a na MMSE testu 27,42 ± 1,5); 2) kognitivno slabi (N = 63) (aritmetička sredina bodova i SD na frailty testu 0,97 ± 0,78, a na MMSE testu 21,94 ± 1,95); 3) kognitivno i tjelesno slabi (N = 21) (aritmetička sredina bodova i SD na frailty testu 3,48 ± 1,12, a na MMSE testu 19,14 ± 2,30) i 4) tjelesno slabi (N = 18) (aritmetička sredina bodova i SD na frailty testu 3,61 ± 0,77, a na MMSE testu 24,89 ± 1,81). Zaključak Osobe dobi 60 ili više godina mogu se razvrstati u podskupine prema funkcionalnim sposobnostima.Aims and Objectives To determine how family medicine patients old 60 years or more are classified into subgroups (latent classes) based on their functional abilities represented as degrees of physical frailty and cognitive decline. Study Design The study is a cross-sectional study, conducted in 2018 in a family medicine residency in the town of Osijek. Subjects and Methods The study included 263 patients who were interviewed at regular encounters. The MMSE test (Mini Mental State Examination) was used to examine cognitive disorders, and the degree of physical frailty using the “frailty” test by Fried et al. The latent class analysis method (software Mplus 8.1, Muthén & Muthén, 2015) was used to divide the examinees into classes, and the standard statistical method and multinomial regression analysis were used to examine the differences in the variables between the classes. The significance level was set to alpha = 0.05 with two-sided p-values. Results Four subgroups (latent classes) were identified, based on the results of MMSE and "frailty" tests and were identified as: 1) highly functional (N = 161) (the mean and SD of "frailty" test 0.58 ± 0.72, and of MMSE test 27.42 ± 1.5); 2) cognitively weak (N = 63) (the mean and SD of “frailty” test 0.97 ± 0.78, and of MMSE test 21.94 ± 1.95); 3) cognitively and physically weak (N = 21) (the mean and SD of “frailty” test 3.48 ± 1.12, and of MMSE test 19.14 ± 2.30) and 4) physically weak (N = 18) (the mean and SD of “frailty test 3.61 ± 0.77, and of MMSE test 24.89 ± 1.81). Conclusion Persons old 60 years or more can be classified into subgroups according to their functional abilities

Classification of general/family medicine patients into subgroups based on differences in the degree of severity of frailty syndrome and affective and cognitive disorders

Ciljevi istraživanja Utvrditi kako se pacijenti obiteljske medicine stari 60 ili više godina razvrstavaju u podskupine (latentne klase) na temelju funkcionalnih poremećaja, tjelesne nemoći i kognitivnog deficita. Nacrt istraživanja Istraživanje je presječno istraživanje, provedeno 2018. godine u ambulanti obiteljske medicine u Osijeku. Ispitanici i metode U istraživanju su sudjelovala 263 ispitanika koji su probirani redom dolaska u ambulantu. Za ispitivanje kognitivnih poremećaja korišten je MMSE test (engl. Mini Mental State Examination), a za stupanj tjelesne nemoći frailty test Fried i sur. Za podjelu ispitanika u klase korištena je metoda analize latentnih klasa (softver Mplus 8.1, Muthén & Muthén, 2015), a za ispitivanje razlika u varijablama između klasa standardne statističke metode te multinomijalna regresijska analiza. Razina značajnosti postavljena je na alpha = 0,05 uz dvostrane p-vrijednosti. Rezultati Identificirane su četiri podskupine (latentne klase) koje su nazvane: 1) visoko funkcionalni (N = 161) (aritmetička sredina bodova i SD na frailty testu 0,58 ± 0,72, a na MMSE testu 27,42 ± 1,5); 2) kognitivno slabi (N = 63) (aritmetička sredina bodova i SD na frailty testu 0,97 ± 0,78, a na MMSE testu 21,94 ± 1,95); 3) kognitivno i tjelesno slabi (N = 21) (aritmetička sredina bodova i SD na frailty testu 3,48 ± 1,12, a na MMSE testu 19,14 ± 2,30) i 4) tjelesno slabi (N = 18) (aritmetička sredina bodova i SD na frailty testu 3,61 ± 0,77, a na MMSE testu 24,89 ± 1,81). Zaključak Osobe dobi 60 ili više godina mogu se razvrstati u podskupine prema funkcionalnim sposobnostima.Aims and Objectives To determine how family medicine patients old 60 years or more are classified into subgroups (latent classes) based on their functional abilities represented as degrees of physical frailty and cognitive decline. Study Design The study is a cross-sectional study, conducted in 2018 in a family medicine residency in the town of Osijek. Subjects and Methods The study included 263 patients who were interviewed at regular encounters. The MMSE test (Mini Mental State Examination) was used to examine cognitive disorders, and the degree of physical frailty using the “frailty” test by Fried et al. The latent class analysis method (software Mplus 8.1, Muthén & Muthén, 2015) was used to divide the examinees into classes, and the standard statistical method and multinomial regression analysis were used to examine the differences in the variables between the classes. The significance level was set to alpha = 0.05 with two-sided p-values. Results Four subgroups (latent classes) were identified, based on the results of MMSE and "frailty" tests and were identified as: 1) highly functional (N = 161) (the mean and SD of "frailty" test 0.58 ± 0.72, and of MMSE test 27.42 ± 1.5); 2) cognitively weak (N = 63) (the mean and SD of “frailty” test 0.97 ± 0.78, and of MMSE test 21.94 ± 1.95); 3) cognitively and physically weak (N = 21) (the mean and SD of “frailty” test 3.48 ± 1.12, and of MMSE test 19.14 ± 2.30) and 4) physically weak (N = 18) (the mean and SD of “frailty test 3.61 ± 0.77, and of MMSE test 24.89 ± 1.81). Conclusion Persons old 60 years or more can be classified into subgroups according to their functional abilities