Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea

The high prevalence of both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in Western societies is well documented. However, OSA frequently remains unrecognized and untreated among patients with COPD. Patients with both conditions have a greater risk for fatal and nonfatal cardiovascular events compared with patients with COPD or OSA alone. Efficacious treatment with continuous positive airway pressure reduces the risk of cardiovascular complications in patients with OSA. The aim of the present review is to discuss the diagnostic approach to patients with both conditions and to delineate the benefits of timely recognition and treatment of OSA in patients with COPD

Mechanisms of endothelial dysfunction in obstructive sleep apnea

Endothelial activation and inflammation are important mediators of accelerated atherogenesis and consequent increased cardiovascular morbidity in obstructive sleep apnea (OSA). Repetitive episodes of hypoxia/reoxygenation associated with transient cessation of breathing during sleep in OSA resemble ischemia/reperfusion injury and may be the main culprit underlying endothelial dysfunction in OSA. Additional factors such as repetitive arousals resulting in sleep fragmentation and deprivation and individual genetic suseptibility to vascular manifestations of OSA contribute to impaired endothelial function in OSA. The present review focuses on possible mechanisms that underlie endothelial activation and inflammation in OSA

Joining EU: Reflections on Croatian Food Foreign Trade Relations

The aim of the paper was to analyze the impact of joining EU to the agricultural foreign trade relations and trade shifting from traditional destinations to the EU. The most important part in total Croatian agricultural value has crop production, mostly cereals production, while livestock products contribute with 40% in the total value of agricultural production. Wheat and maize area sawn stagnate with mild descending in the 2000-2015 period, while annual production oscillates a lot. The situation in livestock production is characterized by lower production capacities of agricultural family farms. A number of livestock stagnate (cattle) or decreasing (pigs) in period 2000-2015. Croatian agricultural foreign trade negative balance is increasing, although the export-import ratio improves in the period 2011- 2013, probably as an effect of EU pre-accession trade benefits. Negative indicators in agricultural production are in direct connect to enormous import and negative foreign trade balance, while coverage of import by export is 57%. Joining EU shifted the trade from CEFTA countries (mostly Bosnia and Herzegovina and Serbia) to EU because Croatian products have not got privileged free access. Croatian agricultural policy should urgently be addressed to the weak points if we want to sustain the sector and better position on the European scene. The CAP mechanisms correspond to the needs and offer solutions for solving the problems of Croatian agriculture and rural areas by implementing measures of rural development

Clinical review: Airway hygiene in the intensive care unit

Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients

Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure

Chronic obstructive pulmonary disease (COPD) and heart failure (CHF) are common conditions. The prevalence of COPD ranges from 20% to 30% in patients with CHF. The diagnosis of CHF can remain unsuspected in patients with COPD, because shortness of breath is attributed to COPD. Measurement of plasma B-type natriuretic peptide (BNP) levels helps to uncover unsuspected CHF in patients with COPD and clinical deterioration. Noninvasive assessment of cardiac function may be preferable to BNP to uncover unsuspected left ventricular (LV) systolic dysfunction in patients with stable COPD. Patients with COPD or CHF develop skeletal muscle alterations that are strikingly similar. Functional intolerance correlates with severity of skeletal muscle alterations but not with severity of pulmonary or cardiac impairment in COPD and CHF, respectively. Improvement of pulmonary or cardiac function does not translate into relief of functional intolerance in patients with COPD or CHF unless skeletal muscle alterations concomitantly regress. The mechanisms responsible for skeletal muscle alterations are incompletely understood in COPD and in CHF. Disuse and low-level systemic inflammation leading to protein synthesis/degradation imbalance are likely to contribute. The presence of COPD impacts on the treatment of CHF, as COPD is still viewed as a contraindication to beta-blockade. Therefore, COPD often deprives patients with CHF due to LV systolic dysfunction of the most beneficial pharmacologic intervention. A large body of data indicates that patients with COPD tolerate well selective beta-blockade that should not be denied to CHF patients with concomitant COPD

Percepcije študentov in univerzitetnih učiteljev Univerze v Črni gori o akademski integriteti

At the University of Montenegro, increasing emphasis has recently been placed on academic integrity. Academic integrity is based on the principles of honesty, objectivity, openness, freedom in teaching and research, and responsibility to academia and society/the community. One of the basic principles of academic integrity is honesty. The present study is based on examining the perception of students and teachers of the University of Montenegro concerning different segments of academic honesty. The aim of the research was to examine ethical behaviour related to respect for someone else’s work (using and referring to literature) and copying as well as using illicit means in exams. The research was conducted using quantitative research on a sample of 200 students and 50 teachers at the University of Montenegro. For this purpose, the authors used a Likert-type assessment scale. The findings suggest that the respondents understand the importance of academic integrity, that is, honesty as its principle, but that they do not recognise all of the segments that it covers in the same way. For example, different answers were received regarding the claim that students copy papers without paraphrasing, and despite the observed negative attitude towards the disciplinary procedure in both groups, teachers seem to lead in this attitude. (DIPF/Orig.

Factors affecting egg consumption in young consumers

Submitted 2020-06-11 | Accepted 2020-07-09 | Available 2020-12-01https://doi.org/10.15414/afz.2020.23.mi-fpap.1-6The research was carried out on consumers aged 20 to 30 years. The survey was conducted among the young population, on a sample of 200 respondents; male (M, n = 100) and female (F, n = 100). Respondents were asked to answer three sets of questions: a) egg quality indicators; b) which are the benefits of consuming eggs compared to other animal products; and c) which are the disadvantages of consuming eggs. A Likert scale (min = 1, max = 5) was used to evaluate the responses on the factors that influence egg consumption. The respondents (M 4.50 : F 4.11; P 0.05). Interval estimation of the mean values μ in male and female populations was made. 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Endothelial cell activation, reduced endothelial cell reparative capacity, and impaired endothelial-dependent vasodilation after anger provocation

The experience of anger increases the acute and long-term risks of incident cardiovascular disease (CVD) events [1] and [2]. The mechanism(s) whereby anger is associated with increased CVD risk remains to be fully characterized. One promising candidate mechanism is endothelial dysfunction. Endothelial dysfunction, as evidenced by impaired endothelial-dependent vasodilation, is an early pathogenic process underlying atherosclerosis development and CVD onset. More recent investigations have elucidated the cellular pathways underlying endothelial dysfunction. Endothelial cell (EC) injury can be assessed by measuring circulating levels of EC-derived microparticles (EMPs), which are phospholipid rich, submicron particles derived and released from the membranes of activated or apoptotic ECs [3]. In addition, the discovery of circulating, bone marrow-derived endothelial progenitor cells (EPCs) capable of EC repair and regeneration [4] suggests that endothelial function represents a balance between ongoing injury and repair. We previously reported that anger provocation acutely impairs arterial vasomotion in apparently healthy individuals [5]. We conducted a study to examine the acute effects of anger provocation not only on arterial vasodilation but also on levels of EMPs and bone marrow-derived EPCs. To our knowledge, this is the first report concerning the adverse effects of anger provocation on cellular pathways underlying EC health