Nursing care for patient with Crohn's disease in the surgical department

U radu se prikazuje vanjskotrgovinska razmjena Republike Hrvatske od 2012. do 2016. godine. Glavne komponente vanjskotrgovinske razmjene su, izvoz i uvoz, a njihov odnos iskazuje se na vanjskotrgovinskoj bilanci, u pozitivnom iznosu kao suficit, u negativnom kao deficit. Rad prikazuje kretanje izvoza i uvoza u apsolutnim iznosima i strukturu vanjskotrgovinske bilance te daje pregled vanjskotrgovinske razmjene s najvažnijim zemljama partnerima Republike Hrvatske. Činjenica je da sve zemlje teže ostvarivanju suficita, stoga se u radu naglašava važnost i mogućnosti stimuliranja izvoza u Republici Hrvatskoj. Metodom intervjua, na primjeru iz prakse jednog izvoznika, prikazani su problemi s kojima se susreće u poslovanju.This thesis discusses foreign trade in the Republic of Croatia since 2012 until 2016. Relations in the foreign trade are determined by Croatia's foreign trade policy. Key foreign trade components have been defined, as well as import and export. Their relations are shown in the foreign trade balance, in the positive amount as surplus and in the negative as deficit. This thesis shows the movement of exports and imports in absolute terms and structure of foreign trade balance and it gives an overview of foreign trade with the most important Croatia's partner countries. It is a fact that all countries seek to achieve a surplus, therefore, the importance and the possibility of export stimulation has been emphasized. This paper shows, in an interview, all the problems that a Croatian exporter has had during his business experience

FLOW CYTOMETRY IN MYELODYSPLASTIC SYNDROME- CORRELATION WITH CYTOMORPHOLOGY RESULTS

Introduction: In the absence of significant dysplasia in suspected myelodysplastic syndrome (MDS), flow cytometry (FC) analysis helps to distinguish clonal cytopenia. The aim of the study was to analyse the concordance of cytomorphological characteristics and flow cytometry in patients with newly diagnosed MDS in KB Merkur in the period from March 2016 to April 2023. Methods: We analyzed bone marrow FC in 69 patients (38 men, 31 women) who were diagnosed with MDS based on bone marrow morphology. Results: In 57 patients (82%), the morphological diagnosis of MDS was also confirmed in the flow cytometry findings. In 11 (91%) of a total of 12 patients in whom the FC analysis did not prove MDS, no blasts were observed in the cytological findings. The expression of CD34, CD117, CD13 and CD33 (cut off 20%) was analyzed in 57 patients in whom MDS was suspected in the myelogram and FC . CD117 and CD33 did not differ between groups, regardless of MDS subtype. CD34 and CD13 was statistically significantly higher in high-risk MDS than in low-risk MDS. There was no statistically significant difference in the level of hemoglobin and expression of CD antigen, while the level of platelets correlated negatively with the level of CD117, CD13 and CD34. The expression of CD34 positively correlated with the level of C reactive protein. Conclusions: Flow cytometry in MDS is a valuable additional method in discriminating MDS from other forms of cytopenia to improve both diagnosis and prognosis, but there is a need to establish standard techniques in everyday use

Exploratory meta-analysis on dose-related efficacy and morbidity of bone morphogenetic protein in spinal arthrodesis surgery

Bone morphogenetic protein (BMP) is frequently used for spinal arthrodesis procedures in an "off-label" fashion. Whereas complications related to BMP usage are well recognized, the role of dosage is less clear. The objective of this meta-analysis was to assess dose-dependent effectiveness (i.e., bone fusion) and morbidity of BMP used in common spinal arthrodesis procedures. A quantitative exploratory meta-analysis was conducted on studies reporting fusion and complication rates following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF) supplemented with BMP. A literature search was performed to identify studies on BMP in spinal fusion procedures reporting fusion and/or complication rates. From the included studies, a database for each spinal fusion procedure, including patient demographic information, dose of BMP per level, and data regarding fusion rate and complication rates, was created. The incidence of fusion and complication rates was calculated and analyzed as a function of BMP dose. The methodological quality of all included studies was assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were analyzed using a random-effects model. Event rates are shown as percentages, with a 95% CI. Forty-eight articles met the inclusion criteria: ACDF (n = 7), PCF (n = 6), ALIF (n = 9), TLIF/PLIF (n = 17), and PLF (n = 9), resulting in a total of 5890 patients. In ACDF, the lowest BMP concentration analyzed (0.2-0.6 mg/level) resulted in a fusion rate similar to the highest dose (1.1-2.1 mg/level), while permitting complication rates comparable to ACDF performed without BMP. The addition of BMP to multilevel constructs significantly (p < 0.001) increased the fusion rate (98.4% [CI 95.4%-99.4%]) versus the control group fusion rate (85.8% [CI 77.4%-91.4%]). Studies on PCF were of poor quality and suggest that BMP doses of ≤ 2.1 mg/level resulted in similar fusion rates as higher doses. Use of BMP in ALIF increased fusion rates from 79.1% (CI 57.6%-91.3%) in the control cohort to 96.9% (CI 92.3%-98.8%) in the BMP-treated group (p < 0.01). The rate of complications showed a positive correlation with the BMP dose used. Use of BMP in TLIF had only a minimal impact on fusion rates (95.0% [CI 92.8%-96.5%] vs 93.0% [CI 78.1%-98.0%] in control patients). In PLF, use of ≥ 8.5 mg BMP per level led to a significant increase of fusion rate (95.2%; CI 90.1%-97.8%) compared with the control group (75.3%; CI 64.1%-84.0%, p < 0.001). BMP did not alter the rate of complications when used in PLF. The BMP doses used for various spinal arthrodesis procedures differed greatly between studies. This study provides BMP dosing recommendations for the most common spine procedures

Clinical experience and management of adverse events in patients with advanced ALK-positive non-small-cell lung cancer receiving alectinib.

Alectinib is a preferred first-line therapy for patients with advanced anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) in several national clinical practice guidelines. The randomized, global, phase III ALEX study has demonstrated significant improvement in progression-free survival for alectinib over crizotinib in treatment-naive ALK-positive NSCLC. It was also the first study to show clinically meaningful improvement in overall survival for a next-generation ALK tyrosine kinase inhibitor relative to crizotinib. The J-ALEX and ALESIA phase III studies confirmed the clinical benefit of alectinib relative to crizotinib in the first-line ALK-positive NSCLC treatment setting in Japanese and Asian patients, respectively. Across these pivotal phase III trials, alectinib had a manageable, well-characterized safety profile. Here, we review the safety and tolerability of long-term alectinib treatment in patients with advanced ALK-positive NSCLC and provide guidance for physicians, based on clinical experience, on the management of the most frequently reported adverse events (AEs). Most AEs associated with alectinib can be managed by dose reduction. Some alectinib-related AEs are not yet fully characterized, including myalgia and peripheral oedema and deciphering their underlying mechanism of action could enhance their management. With longer-term follow-up, the safety profile of alectinib continues to remain consistent in the ALEX study, with no new safety signals observed. Safety and tolerability data from the first-line phase III alectinib trials are also consistent with those observed in clinical trials of alectinib in later-line settings. These results add to the weight of evidence recommending alectinib as a preferred therapy for treatment-naive advanced ALK-positive NSCLC