Relationship Between Functional Disabilities and Home Care Needs of Elderly in the City of Zagreb

The demographic profile of the Republic of Croatia is changing intensively. According to published research, it is estimated that soon every fourth resident in Croatia including the City of Zagreb will be older than 65 years. Increased number of the elderly also increases the need for elderly care. Long-term care services make people dependent on someone else\u27s help over a longer period. Help most usually involves satisfying basic daily activities such as feeding, bathing, dressing, moving, maintaining personal hygiene, doing housework, and other similar activities. The aim of this work was to determine the functional status of the elderly in the City of Zagreb, and to investigate whether there are differences in self-assessed personal quality of life and functional status depending on whether the health care in the home of the elderly is provided. The study was conducted on elderly of both sexes (N = 100) from the City of Zagreb divided into the group of those who receive health care at home and those who have no need for such care. Structured questionnaire with sociodemographic issues of WHOQOL-BREF and scale of Bartel\u27s daily activity index were assessed. The study showed statistically significant differences in functional ability between the observed groups. The elderly receiving home health care have grater functional disability compared to the group of elderly not receiving home health care despite no statistically significant differences between groups in self-assessed quality of life

Everyday needs and activities of geriatric patients – users of home care

Care of elderly people at the primary health care level is usually performed by primary health care physicians, community nurses and nurses from home care facilities. The purpose of care is to assist older people in the community and to ensure the quality of life in their own home through measures of primary, secondary and tertiary prevention. Community health care is a medical social activity that implements specific health care in order to promote and preserve the health of individuals, families and communities. The main goal of nursing in the community is to provide care to beneficiaries outside health facilities; in their homes. It is particularly important to provide comprehensive care in the most vulnerable stages of life, such as illness, old age, infirmity, disability or poor social or economic condition. In order to solve various problems of elderly people regular cooperation of all the professionals that take care of an older person in their home is essential. Thus, in case of need for the implementation of health care, community nurse assesses the state of the user and determines the need for diagnostic and therapeutic procedures to be implemented in the user’s home. A nurse from the institution carries out approved home care services over approved time, lasting no more than 30 days. After 30 days, nurse reassesses the patient’s condition. This paper will show the duration of the continuous provision of home care services for patients. The objectives of the health care for the elderly people in their home are: to provide optimum conditions for better quality of life in their own home environment, implementation of measures and procedures for the preservation of health, implementation of measures and procedures aimed at disease control, implementation of measures aimed at identifying risk factors in the environment, integration of older users in the company and ensuring the quality of life, all of which will be presented in the paper

Liječenje bolesnika oboljelih od mijastenije gravis s COVID-19: pregled literature

Coronavirus disease 2019 (COVID-19), caused by the late 2019 outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a respiratory disease which could put myasthenia gravis (MG) patients at a greater risk of developing severe disease course, since infections and some drugs are a well-recognized trigger of symptom exacerbation in MG patients. Out of ten most commonly used past and present drugs used in COVID-19 treatment, two (quinolone derivatives and azithromycin) are known to worsen MG symptoms, whereas another two (tocilizumab and eculizumab) might have positive effect on MG symptoms. Colchicine, remdesivir, lopinavir, ritonavir and favipiravir seem to be safe to use, while data are insufficient for bamlanivimab, although it is also probably safe to use. Considering MG treatment options in patients infected with SARS-CoV-2, acetylcholine esterase inhibitors are generally safe to use with some preliminary studies even demonstrating therapeutic properties in regard to COVID-19. Corticosteroids are in general safe to use, even recommended in specific circumstances, whereas other immunosuppressive medications (mycophenolate mofetil, azathioprine, cyclosporine, methotrexate) are probably safe to use. The only exception is rituximab since the resulting B cell depletion can lead to more severe COVID-19 disease. Concerning plasmapheresis and intravenous immunoglobulins, both can be used in COVID- 19 while taking into consideration thromboembolic properties of the former and hemodynamic disturbances of the latter. As current data suggest, all known COVID-19 vaccines are safe to use in MG patients.Koronavirusna bolest 2019 (COVID-19) uzrokovana širenjem virusa SARS-CoV-2 izaziva respiracijsku bolest koja potencijalno može dodatno ugroziti pacijente koji boluju od mijastenije gravis. Uz infekcije, egzacerbaciju simptoma mijastenije gravis mogu uzrokovati i neki lijekovi. Od deset najčešće primjenjivanih skupina lijekova za liječenje COVID-19, dvije skupine lijekova (kinoloni i azitromicin) mogu uzrokovati pogoršanje simptoma mijastenije gravis, a dvije skupine lijekova (tocilizumab i ekulizumab) imaju pozitivne učinke na simptome mijastenije gravis. Kolhicin, remdesivir, lopinavir, ritonavir i favipiravir nemaju učinka na simptome mijastenije gravis, dok su podatci za bamlanivimab nedostatni, no isti je vjerojatno siguran za upotrebu u bolesnika s mijastenijom gravis. Što se tiče primjene lijekova za mijasteniju gravis kod bolesnika zaraženih virusom SARS-CoV-2, inhibitori acetilkolinestaraze su u pravilu sigurni za primjenu; neke studije su čak dokazale i terapijske mogućnosti navedenih lijekova u liječenju COVID-19. Kortikosteroidi su uglavnom sigurni za primjenu, a čak se i preporučaju u određenim okolnostima, dok su ostali imunosupresivi (mikofenolat mofetil, azatioprin, ciklosporin i metotreksat) sigurni za primjenu. Jedina iznimka je rituksimab učinak kojega na B-staničnu imunost može rezultirati težom kliničkom slikom bolesti COVID-19. Plazmafereza i intravenski imunoglobulini, dvije najčešće primjenjivane terapijske opcije liječenja akutnih egzacerbacija mijastenije gravis, mogu se primijeniti kod bolesnika s COVID-19 uzimajući u obzir tromboembolijske učinke intravenskih imunoglobulina, odnosno hemodinamske učinke plazmafereze. Sva cjepiva COVID-19, koliko je poznato, sigurna su za primjenu u bolesnika s mijastenijom gravis

Polyneuropathy and myopathy of critical illness

Kritična bolest je svako životno ugrožavajuće stanje bez čije bi farmakološke i/ili mehaničke potpore vitalnim organima nastupio smrtni ishod. Liječi se u Jedinicama intenzivnog liječenja (JIL). Vrlo česta komplikacija liječenja je mišićna slabost stečena u JIL-u, pri čemu se izdvajaju dva entiteta: miopatija kritične bolesti (CIM) i polineuropatija kritične bolesti (CIP), tj. sindrom njihovog preklapanja – polimioneuropatija kritične bolesti (CIPNM). Klinički se očituju simetričnom mišićnom slabošću, izraženije proksimalne muskulature, a na njih se posumnja prilikom neuspjeha odvajanja pacijenata od mehaničke ventilacije. Prema podacima iz literature, do 62% pacijenata kod kojih dođe do neuspjeha odvajanja od mehaničke ventilacije, ima neki oblik neuromuskularne bolesti. Različiti su patofiziološki mehanizmi u pozadini, od oksidativnog stresa, mitohondrijalne disfunkcije do promjena u mikrocirkulaciji uzrokovanih sistemskim upalnim zbivanjima. Rizični čimbenici navedenih stanja su sindrom sistemnog upalnog odgovora (SIRS, eng. systemic inflammatory response syndrome), sepsa, hiperglikemija, hipoalbuminemija, upotreba vazopresora i neurmoskulatornih blokatora. Dijagnoza se postavlja kombinacijom kliničkih značajki i nalazima elektrofizioloških testiranja. Liječenje se zasniva na liječenju osnovne bolesti, sprječavanju komplikacija i ranoj rehabilitaciji. Postoje podaci o učinkovitosti električne mišićne stimulacije (EMS) u liječenju i prevenciji mišićne slabosti stečene u JIL-u. Kod jedne četvrtine pacijenata prilikom otpusta iz bolnice zaostaje neki od stupnjeva mišićne slabosti ili osjetnih ispada.Critical illness is any life-threatening condition wich would, without appropriate pharmacological and/or mechanical support to vital organs, lead to death. It is treated in the Intensive Care Unit (ICU). A very common complication of treatment is muscle weakness acquired in the ICU, whereby two entities are distinguished: critical illness myopathy (CIM) and critical illness polyneuropathy (CIP), and their overlapping syndrome – critical illness polymyoneuropathy (CIPNM). Clinically, they are manifested by symmetrical muscle weakness, more pronounced in the proximal musculature, and they are suspected when patients fail to be weaned from mechanical ventilation. According to data from the literature, up to 62% of patients who fail to be weaned from the mechanical ventilation have some form of neuromuscular disease. There are various pathophysiological mechanisms in the background, from oxidative stress, mitochondrial dysfunction to changes in microcirculation caused by systemic inflammatory events. Risk factors for the aforementioned conditions are systemic inflammatory response syndrome (SIRS), sepsis, hyperglycemia, hypoalbuminemia, use of vasopressors, steroids, and neuromuscular blockers. The diagnosis is established by a combination of clinical features and the findings of electrophysiological testing. Treatment is based on treatment of the underlying disease, prevention of complications and early rehabilitation. There are data on the effectiveness of electrical muscle stimulation (EMS) in the treatment and prevention of muscle weakness acquired in the ICU. One quarter of patients have some degree of residual muscle weakness or loss of sensation when they are discharged from the hospital

Multipla skleroza: novi aspekt imunopatogeneze

Multiple sclerosis (MS) is a multicomponent disease characterized by inflammation, neurodegeneration, and cancellation of the central nervous system recovery mechanisms. The cause of MS is still unknown, but it is undeniable that genetic, environmental and immune factors are involved in the etiopathogenesis of this complex and heterogeneous disease. From the aspect of im-munopathogenesis, until recently the opinion prevailed that autoreactive T lymphocytes played a major role, the activation of which is a key step in MS. The knowledge of the effector and regulatory roles of B cells supports a new concept of MS immunopathogenesis that is based on the highly complex interaction of T and B cells, with B cells actively participating in cellular immunity by directing the intensity and quality of cellular immune response. The mechanisms of B cell activity in MS immunopathogenesis are multiple and include antigen presentation and T cell costimulation, cytokine secretion, antibody synthesis, and formation of ectopic lymphoid B cell aggregates in the intrameningeal spaces. The importance of B cells has been confirmed by modern therapeutic options for the treatment of MS.Multipla skleroza (MS) je multikomponentna bolest koju karakterizira upala, neurodegeneracija i otkazivanje mehanizama za obnavljanje središnjega živčanog sustava. Uzrok MS još uvijek je nepoznat, ali je nedvojbeno da su genetski, okolišni i imuni čimbenici uključeni u etiopatogenezu ove složene i heterogene bolesti. S aspekta imunopatogeneze, donedavno je prevladavalo mišljenje da glavnu ulogu imaju autoreaktivni T limfociti aktiviranje kojih predstavlja ključni korak u nastanku MS. Saznanja o efektorskim i regulatornim ulogama B stanica podupiru novi koncept imunopatogeneze MS koji se temelji na vrlo kompleksnoj interakciji T i B stanica, s tim da B stanice aktivno sudjeluju u staničnoj imunosti tako što usmjeravaju intenzitet i kvalitetu staničnog imunog odgovora. Mehanizmi djelovanja B stanica u imunopatogenezi MS su višestruki te uključuju prezentaciju antigena i kostimulaciju T stanica, lučenje citokina, sintezu protutijela i formiranje ektopičnih limfoidnih B staničnih agregata u intrameningealnim prostorima. Značenje B stanica u imunopatogenezi MS potvrđuju i suvremene terapijske opcije za liječenje MS

Antiepileptics and Drug Interactions

Antiepileptici (AEL) lijekovi su u kliničkoj primjeni dugi niz godina, a osim u liječenju epilepsija, rabe se i u drugim stanjima poput migrene, neuropatske boli ili psihijatrijskih poremećaja, uglavnom kao kronična terapija. Iako se njihova primjena preporučuje u obliku monoterapije, zbog karaktera bolesti često se primjenjuju i kao politerapija. Rabe se u svim dobnim skupinama, a često i u bolesnika s komorbiditetom, odnosno komedikacijom, što znatno povećava mogućnost interakcija s drugim lijekovima, a time i rizik od nuspojava. Stoga je, s obzirom na široku primjenu u kliničkoj praksi, osim o indikacijskom području i učinkovitosti, nužno voditi računa i o njihovim interakcijama s drugim lijekovima.Antiepileptic drugs (AEDs) have been used in clinical practice for many years. They have also been used for the treatment of conditions other than epilepsy, such as migraine, neuropathic pain and psychiatric conditions, mostly as chronic therapy. Although AED monotherapy is recommended, the character of the disease often requires that AEDs be used as part of polytherapy. AEDs are used in all age groups, frequently in patients with comorbidities requiring co-medication, which significantly increases the possibility of drug interactions and the risk of side effects. Thus, given the widespread use in clinical practice, it is highly important to consider not only the range of indications and the efficacy of AEDs, but also their possible interactions with other drugs

Improvement of cooperation of primary and secondary health care in primary prevention of cerebrovascular diseases

U Republici Hrvatskoj cerebrovaskularne bolesti predstavljaju jedan od vodećih javnozdravstvenih problema za koji postoje jasno definirani i velikim studijama identificirani rizični čimbenici. Također, dokazano je da se implementacijom programa prevencije, ranog otkrivanja i liječenja rizičnih čimbenika smanjuje incidencija moždanog udara. Mnoge države u svijetu imaju implementirane zdravstvene programe zasnovane na dokazima kojima je učinkovito postignuto smanjenje pojavnosti moždanog udara. U ovom su radu, korištenjem analitičkih upravljačkih alata, utvrđena kritična mjesta koja ometaju ili onemogućavaju cjelovitu primjenu intervencija za prevenciju CVB u Republici Hrvatskoj. Poseban fokus u analizi usmjeren je na aktivnosti primarne i sekundarne zdravstvene zaštite te njihovu suradnju. Analizom postojeće situacije definirani su ključni dionici i procesi te „uska grla“ u provedbi preventivnih programa usmjerenih ka smanjenju pojavnosti moždanog udara. Korištenjem tehnika „force field“ i „SWOT“ analize definirane su snage, slabosti te prilike i opasnosti za provođenje cjelovitih preventivnih intervencija. Rezultati rada predstavljaju skup preporuka za unapređenje prevencije cerebrovaskularnih bolesti u RH koje mogu biti značajne za rad „donosioca odluka“ i menadžera u zdravstvu.In Croatia, cerebrovascular diseases represent one of the leading public health problems for which there are clearly defined and identified risk factors. It was shown that by implementing the programs of prevention, early detection and treatment of risk factors the incidence of stroke can be reduced. Many countries have implemented evidence-based health programs which have effectively achieved reduction of the incidence of stroke. This paper establised the critical points that hinder or prevent the implementation of a comprehensive intervention for the prevention of CVD in Croatia using the analytical management tools. A special focus in the analysis was directed towards the activities of primary and secondary health care and their cooperation. Key stakeholders and processes as well as "bottlenecks" in the implementation of prevention programs aimed at reducing the incidence of stroke were defined in the analysis of the current situation. Strengths, weaknesses and opportunities and threats for the implementation of comprehensive prevention interventions were defined using the "force field" technique and "SWOT" analysis. Results of the work represent a set of recommendations aimed at improving the prevention of cerebrovascular diseases in Croatia that may be relevant to "decision makers" and managers in health care