The Ageing of Croatian Population

With a share of people older than 65 years of 16.64 per cent in total population, Croatia is considered a very old country regarding it’s population. This percentage is one of the highest in already old Europe. Demographic projections reveal a further increase of share of people older than 65 years in future. There are many causes of this condition. This fact carries negative economic and healt care implications which burden Croatia. Many administrative reforms are necessary to resolve this issue and to avoid economy problems and intergenerational conflicts

Sekundarna arterijsko-enterična fistula: prikaz slučaja i pregled literature

Arterio-enteric fistula is a rare, but potentially deadly cause of gastrointestinal bleeding. The disease occurs in two forms: primary as a result of atherosclerotic aortic aneurysm, aortitis, trauma, radiation, tumor invasion or penetrating ulcer, and secondary as a consequence of surgical aortal reconstruction. The clinical manifestation is mostly gastrointestinal bleeding, rarely back pain, fever and sepsis. Computed tomography with contrast medium is the most suitable diagnostic test, however, the diagnosis frequently requires explorative laparotomy. A case is presented of secondary arterio-enteric fistula, found two years after surgical treatment of chronic pancreatitis with pseudocystojejunostomy, which clinically manifested with gastrointestinal bleeding. Although there was strong suspicion of arterio-enteric fistula, the diagnosis was not verified by routine workup, but only on explorative laparotomy.Arterijsko-enterična fistula je rijedak, ali potencijalno smrtonosan uzrok krvarenja iz probavnog sustava. Bolest se javlja u dva oblika: kao primarna, nastala kao rezultat aterosklerotski promijenjene aneurizme aorte, aortitisa, traume, zračenja, invazije tumora ili penetrirajućeg ulkusa, te kao sekundarna, odnosno posljedica kirurške rekonstrukcije aorte. Klinički se najčešće manifestira u vidu krvarenja iz probavnog sustava, rjeđe bolovima u leđima, vrućicom i sepsom. Najprikladniji dijagnostički test je kompjutorizirana tomografija, no sama dijagnoza se često postavlja tek eksploracijskom laparotomijom. Prikazuje se slučaj sekundarne arterijsko-enterične fistule nađene dvije godine nakon kirurškog liječenja kroničnog pankreatitisa pseudocistojejunostomijom, koja se klinički manifestirala gastrointestinalnim krvarenjem. Iako je postojala velika sumnja na arterijsko-enteričnu fistulu dijagnoza se nije mogla potvrditi standardnim dijagnostičkim postupcima, nego tek na eksploracijskoj laparotomiji

Soil reaction_ a crucial preconditions for choosing horticultural plants

Da bismo vanjski prostor što ljepše i ekonomičnije uredili, potrebno je dobro poznavati tlo i biljku, ali i sve one čimbenike koji na njih utječu. Oblikovanje prostora, bilo da se radi o okućnici ili bilo kojem drugom segmentu krajolika: voćnjaku, vinogradu, povrtnjaku, cvjetnjaku ili travnjaku, a to znači hortikulturi u njezinom punom značenju, zahtijeva pomno planiranje i pripremu. Jedan od vrlo važnih čimbenika u pripremi tla je dobro poznavanje reakcije tla (pH). Reakcija tla značajno utječe na primanje svih hraniva, a varira ovisno o potrebama kultura od kiselog do alkalnog. Cilj ovog rada je detaljno obraditi potrebe pojedinih ukrasnih vrsta za reakcijom tla, koristeći rezultate terenskih istraživanja i uspoređujući ih s navodima u literaturi. U tu svrhu korištene su kemijske analize (reakcija tla u 1M KCl) koje je proveo Zavod za ishranu bilja, Agronomskog fakulteta Sveučilišta u Zagrebu, uz vizualno praćenje u okolišu. Prema dobivenim rezultatima istraživanja 47% od ukupno 131 očitanog uzorka spada u neutralna tla (D). U alkalna tla (E) spada 37%, u slabo kisela (C) spada 11%, u kisela tla (B) 5 %, a u kategoriju jako kiselih tala (A) ušao je samo jedan uzorak. Stoga rezultati naših istraživanja ukazuju da često puta navodi u literaturi za pojedine ukrasne vrste nisu apsolutno primjenjivi u datim okolnostima, odnosno da su primjenjivi uz manje ili veće korekcije. Općenito se za krajobrazno uređenje individualnih i javnih površina preporuča slabo kisela do neutralna reakcija tla (5,5,-7,2 – CD), jer većina ukrasnog bilja uspješno raste u tom rasponu. Za vrste koje više vole ekstremnu pH reakciju tla, potrebno je provesti korekciju primjenom adekvatnih gnojiva ili supstrata. Tako se Erica sp. i Rhododendron sp. preporučuju za jako kisela i kisela tla (pH 4,0-5,5 – AB) dok za slabo kisela tla (5,5-6,5 – C) predlažemo Abies sp., Cupressus sp., Juniperus sp., Pinus sp., te trave. Za kiselo tlo (4,5-5,5 – B) predlažemo Hydrangeu (plavu), Ilex sp., te Picea sp. Za slabo kiselo i neutralno tlo (5,5-7,2 – CD) Chrysanthemum sp., Magnolia sp., Quercus sp., Rosa sp. i Hedera sp. Neutralna reakcija (6,5-7,2 – D) optimalna je za rodove Chamaecyparis i Prunus. Za tla neutralne i alkalne reakcije (6,5-7,2 – DE) predlažemo nešto veći broj vrsta iz rodova Acer, Araucaria, Buxus, Crataegus, Forsythia, Hydrangea (roza i bijela), Lavandula, Thuja, te Vinca. Širok raspon reakcije tla (5,5-7,5 – CDE) podnose vrste iz roda Carpinus, Cedrus, Corylus, Cotinus, Cotoneaster i Taxus.Economy and aesthetic quality of landscaping require a good knowledge of soil and plant, but also of all the factors that affect them. Landscaping, wether a private holding or any other segment of the landscape: orchard, vineyard, vegetable garden, flower garden or lawn, which means horticulture in the full sense of the word, requires careful planning and preparation. One of the very important factors in soil preparation is a good understanding of soil reaction (pH). Soil reaction has a strong influence on all nutrients uptake and varies, dependending on crop requirements, from acid to alkaline. The aim of this paper is to deal in detail with the soil reaction requirements of particular ornamental species, using the results of field research and comparing them with the literature reports. For this purpose, use was made of the chemical analyses (soil reaction in 1M KCl) made in the Department of Plant Nutrition, Faculty of Agriculture, University of Zagreb, along with visual monitoring in the landscape. According to the research results, 47% of the 131 analyzed samples are neutral soils (D), 37% alkaline soils (E), 11% weakly acid soils (C), 5% acid soils (B), while only one sample belongs to the category of very acid soils (A). Hence our results show that literature reports for particular ornamental species are often not absolutely applicable in the given conditions, or that their application requires certain corrections. Weakly acid to neutral soil reaction (5,5-7,2 – CD) is generally recommended for landscape planning of individual and public areas, because most ornamental plants grow well within this range. For species that prefer extreme pH reaction of the soil, corrections should be made by applying adequate fertilizers or substrates. Thus, Erica sp. and Rhododendron sp. are recommended for very acid and acid soils (pH 4,0-5,5 – AB) while we suggest Abies sp., Cupressus sp., Juniperus sp., Pinus sp., and grasses for weakly acid soils (5,5-6,5 – C). Hydrangea (blue), Ilex sp., and Picea sp. are recommended for acid soils (4,5-5,5 – B). Chrysanthemum sp., Magnolia sp., Quercus sp., Rosa sp. and Hedera sp. are recommended for weakly acid and neutral soils (5,5-7,2 – CD). Neutral reaction (6,5-7,2 – D) is optimal for genera Chamaecyparis and Prunus. A larger number of species from the genera Acer, Araucaria, Buxus, Crataegus, Forsythia, Hydrangea (pink and white), Lavandula, Thuja, and Vinca are recommended for soils of neutral and alkaline reaction (6,5-7,2 – DE). Species of the genera Carpinus, Cedrus, Corylus, Cotinus, Cotoneaster and Taxus tolerate a wide range of soil reaction (5,5-7,5 – CDE)

Importance of early detection of colorectal cancer

SAŽETAK. Tijekom posljednjih dvadesetak godina zabilježen je značajan porast učestalosti i smrtnosti od kolorektalnog karcinoma. Unatoč stručnom i znanstvenom napretku medicine, nije se bitno promijenila činjenica da bolesnici žive dulje od pet godina. Spoznaja da je adekvatnom organizacijom zdravstvene skrbi i prevencijom moguće umanjiti ove poražavajuće podatke, potaknula je pokretanje nacionalnih programa s ciljem ranog otkrivanja karcinoma debelog crijeva. Nova saznanja na području dijagnostike i endoskopije omogućuju brže i sigurnije postavljanje dijagnoze. Osnovu liječenja čini kirurško liječenje poduprto stalnim tehničkim napretkom, a dodatnu i ne manje bitnu ulogu ima nova i sve učinkovitija kemoterapija i radioterapija. Navedene metode i saznanja ukazuju na mogućnost izlječenja sve većeg broja bolesnika i uspjeh u borbi protiv karcinoma debelog crijeva.ABSTRACT. A significant increase in the incidence and mortality of colorectal cancer has been detected during the last twenty years. Despite the progress in medical practice and science there has been no indicative change in the 5-year survival of patients. The knowledge that an adequate health care organization and prevention can decrease these defeating data, prompted the start of national programs for early detection of colorectal cancer. New cognitions in the fields of diagnostics and endoscopy make diagnosis faster and more accurate. Surgical therapy, which is supported by constant technical progress, represents the basis of cancer treatment, while the new and more effective chemotherapy and radiotherapy have an additional and important therapeutical role. The above mentioned methods and knowledge indicate that there is a possibilty in curing a large number of patients and succeeding in the struggle against colorectal cancer

Prvi prikaz slučaja probavnog stromalnog tumora (GIST) pozitivnog na koneksin 43

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms most frequently found in the stomach and presenting without symptoms or with unspecific ones such as hemorrhage and abdominal pain. The malignant potential of GIST is variable and there are several prognostic indexes for treatment and follow up. The superior diagnostic method is endoscopic ultrasound combined with fine needle aspiration biopsy (EUS-FNA) immunocytochemistry. Surgery is the preferable treatment option, while recurrent or advanced disease is best managed with thyrosine kinase inhibitors. We report a case of a 20-year-old man that presented with gastrointestinal bleeding and anemia. Upper gastrointestinal endoscopy detected a submucosal lesion and computerized tomography revealed a node near the liver. EUS-FNA immunocytochemistry found CD-117 positive cells suggestive of GIST and the patient was operated on. The diagnosis was confirmed by histopathology with immunostaining. Prognostic assessment was done according to tumor size and Ki-67 index with mitosis count on microscopy. Many studies have shown that tumors demonstrate an abnormal number, structure and occurrence of connexin proteins with altered connexin-mediated intercellular communication. Since a great deal of gastroenterological tumors express connexin 43, our aim was to find out whether it was present in GIST. Immunohistochemically, the tumor was positive for connexin 43, which was not previously described as typical. The early postoperative course was uneventful, free from complications. At three-year postoperative follow-up, the patient was subjectively well and without clinical signs of disease recurrence.Gastrointestinalni stromalni tumor (GIST) spada u novotvorine mezenhimnog podrijetla, a najčešće se nalazi u želucu. Često bude bez simptoma ili se prezentira paletom nespecifičnih simptoma poput gastrointestinalnog krvarenja ili boli u abdomenu. Maligni potencijal GIST-a je raznolik te postoji nekoliko prognostičkih indeksa za dijagnostiku i praćenje. Najznačajniju dijagnostičku metodu čini endoskopski ultrazvuk kombiniran s citološkom biopsijom. S terapijske strane najpoželjniji izbor je kirurško liječenje, a za uznapredovale ili recidivne oblike bolesti liječenje je farmakološko inhibitorima tirozin-kinaze. Ovdje se prikazuje slučaj 20-godišnjeg mladića koji je došao na obradu zbog gastrointestinalnog krvarenja i anemije. Gastroskopijom se otkrila submukozna promjena koja se na kompjutoriziranoj tomografiji prikazala kao čvor uza stražnji rub jetre. Citopunkcijom uz pomoć endoskopskog ultrazvuka nađene su stanice pozitivne na CD-117 koje ukazuju na GIST, te je bolesnik operiran. Dijagnoza je potvrđena patohistološki uz imunohistološko bojanje. Prognostička patohistološka procjena je učinjena prema veličini tumora, Ki 67 mitotskom indeksu. Brojne studije su pokazale kvantitativne ili kvalitativne promjene koneksinskih proteina te promijenjene međustanične komunikacije posredovane tijesnim vezama. Kako je u velikom broju tumora probavne cijevi primijećena promjena ekspresije koneksina Cx43, naš je cilj bio ispitati zastupljenost u GIST-u. Naš slučaj bio je pozitivan na Cx43, što nije ranije opisano kao očekivano. Rani poslijeoperacijski tijek u bolesnika je bio bez komplikacija, a dosad se kroz ambulantno praćenje unatrag 3 godine osjeća dobro, kontrolni nalazi labolatorija su uredni, te se kliničkom obradom ne nalazi znakova recidiva bolesti

Sekundarna arterijsko-enterična fistula: prikaz slučaja i pregled literature

Arterio-enteric fistula is a rare, but potentially deadly cause of gastrointestinal bleeding. The disease occurs in two forms: primary as a result of atherosclerotic aortic aneurysm, aortitis, trauma, radiation, tumor invasion or penetrating ulcer, and secondary as a consequence of surgical aortal reconstruction. The clinical manifestation is mostly gastrointestinal bleeding, rarely back pain, fever and sepsis. Computed tomography with contrast medium is the most suitable diagnostic test, however, the diagnosis frequently requires explorative laparotomy. A case is presented of secondary arterio-enteric fistula, found two years after surgical treatment of chronic pancreatitis with pseudocystojejunostomy, which clinically manifested with gastrointestinal bleeding. Although there was strong suspicion of arterio-enteric fistula, the diagnosis was not verified by routine workup, but only on explorative laparotomy.Arterijsko-enterična fistula je rijedak, ali potencijalno smrtonosan uzrok krvarenja iz probavnog sustava. Bolest se javlja u dva oblika: kao primarna, nastala kao rezultat aterosklerotski promijenjene aneurizme aorte, aortitisa, traume, zračenja, invazije tumora ili penetrirajućeg ulkusa, te kao sekundarna, odnosno posljedica kirurške rekonstrukcije aorte. Klinički se najčešće manifestira u vidu krvarenja iz probavnog sustava, rjeđe bolovima u leđima, vrućicom i sepsom. Najprikladniji dijagnostički test je kompjutorizirana tomografija, no sama dijagnoza se često postavlja tek eksploracijskom laparotomijom. Prikazuje se slučaj sekundarne arterijsko-enterične fistule nađene dvije godine nakon kirurškog liječenja kroničnog pankreatitisa pseudocistojejunostomijom, koja se klinički manifestirala gastrointestinalnim krvarenjem. Iako je postojala velika sumnja na arterijsko-enteričnu fistulu dijagnoza se nije mogla potvrditi standardnim dijagnostičkim postupcima, nego tek na eksploracijskoj laparotomiji

DEVICE ASSOCIATED HEALTHCARE INFECTION AND SEPSIS IN INTENSIVE CARE UNIT

U jedinicama intenzivnoga liječenja (JIL) intrahospitalne infekcije (nozokomijalne ili bolničke infekcije) (IHI) i sepsa su prosječno 5-10 puta učestalije u usporedbi s drugim bolničkim odjelima. Predispoziciju tome čine mnogi intrinzični i ekstrinzični faktori. Među njima su i neizostavne metode invazivnoga liječenja (IT). Učestalost IHI nastalih kao posljedica primjene IT-a (IHI-IT) u JIL-u iznosi 19 %. Incidencija IHI-IT-a je različita i specifi čna prema pojedinoj vrsti JIL-a (2-49 %). Najčešće IHI-IT su kateter sepse povezane s primjenom centralnog venskog katetera (IHI-CVK), pneumonije povezane s primjenom mehaničke ventilacije (IHI-VAP), infekcije urinarnog trakta kao posljedice uvedenog urinarnog katetera (IHI-UK) i infekcije pridružene kirurškim ranama (IHI-KR). IHI-KR se najčešće, zbog osobite specifi čnosti, opisuju odvojeno od IHI-IT-a. U posljednjih godina u izolatima kultura IHI-IT-a dominiraju gram-negativni bacili (Pseudomonas aeruginosa, Klebsiella pneumoniae i Acinetobacter spp) u odnosu na gram-pozitivne bakterije (Staphylococcusaureus, Enterococcus spp), nerijetko rezistentnih sojeva. Posljedično, gljivične infekcije urotrakta, povezane s IHI-UK pokazuju sve višu incidenciju. Infekcije i/ili sepse uzrokovane invazivnim liječenjem dodatno otežavaju stanje intenzivnoga bolesnika, usporavaju njegov oporavak, produžavaju dužinu hospitalizacije i povećavaju mortalitet. IHI-IT su od posebnog interesa bolničkih i nacionalnih povjerenstava za nadzor infektivnih bolesti radi unaprjeđenja cjelokupne sigurnosti i kvalitete liječenja bolesnika u JIL-u te racionalizacije ukupnih sredstava nužnih u liječenju bolesnika s IHI-IT-em. Praćenje učestalosti IHI-IT u JIL-u je najkorisnija intra- i interhospitalna metoda praćenja učinkovitosti nadzora i provedenih preventivnih mjera. Kao takva podliježe uniformnoj standardizaciji prema jedinstvenim međunarodnim protokolima CDC-a (engl. Centers for DiseaseControl and Prevention; u SAD-u NHSN - “The National Healthcare Safety Network” ili u Europi TESSy - „The European Surveillance System for Communicable Disease“) sadržanima u dokumentaciji svakog bolničkog povjerenstva za praćenje infektivnih bolesti.The incidence of healthcare-associated infections and sepsis (HAIs) is 5-10 times higher in patients in intensive care units (ICUs) than in those at other hospital departments. Predisposition for these lies in many intrinsic (disease severity, loss of immunity) and extrinsic factors (frequent use of broad-spectrum antibiotics with consequent presence of antibiotic-resistant pathogens). The majority of HAIs in ICUs are associated with the use of invasive devices (DA-HAIs; device-associated healthcare-associated infections) (19%). Their incidence differs among specifi c types of ICUs (2%-49%). The most frequent DA-HAI are central line-associated bloodstream infections (CLA-BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI) and surgical site infections (SSI). SSI is most often described as a distinct and separate entity of HAIs in ICUs. Recently, gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp.) are more frequently isolated in DA-HAIs than gram-positive ones (Staphylococcus aureus, Enterococcus spp.), often present as resistant strains. On the other hand, urinary or/and systemic infections tend to increase. DA-HAIs endanger and slow down patient recovery, prolong hospital stay, and generally increase the mortality rate. DA-HAIs are of special interest of the Hospital Committee Center for Infective Disease in order to improve patient safety and reduce total cost allocated for prevention of DA-HAIs. DA-HAI rate is the most useful intra- and inter-hospital measure to compare surveillance and effectiveness of preventive procedures among different ICU types

Abdominal compartment syndrome in dogs

Sindrom abdominalnog odjeljka predstavlja karakteristično stanje s povišenim vrijednostima intraabdominalnog tlaka višim od 12 mmHg, dilatacijom abdomena popraćeno zatajenjem unutarnjih organa: bubrega, pluća i krvožilnog sustava. Budući da se uz njega često javljaju i brojne komplikacije kao i zatajenje brojnih organskih sustava, razvoj sindroma abdominalnog odjeljka predstavlja vrlo opasno i hitno stanje s visokom stopom mortaliteta. U humanoj medicini, ovaj sindrom je prepoznat već godinama, a do sada je dobro istražena i opisana njegova klasifikacija, etiologija, patofiziologija, klinička slika, dijagnostički postupci kao i smjernice za uspješno liječenje. U veterinarskoj medicini pojava ovoga sindroma u kliničkoj praksi vrlo često prolazi nedijagnosticirano. Zbog širokog spektra nespecifičnih simptoma koji se kod ovog oboljenja javljaju u pasa, kao i zbog prilično rijetkog prakticiranja mjerenja vrijednosti intraabdominalnog tlaka, razvoj sindroma abdominalnog odjeljka često se na vrijeme ne prepoznaje i/ili se kao takav pripisuje drugim patološkim stanjima različitih organskih sustava. Iz istog je razloga u veterinarskoj medicini do sada provedeno premalo kliničkih ispitivanja i znanstvenih radova u pasa, koji bi pružali odgovor i detaljnije objasnili etiologiju, mehanizam nastanka, progresiju, adekvatne dijagnostičke postupke te smjernice u liječenju ovoga sindroma. S obzirom da u pasa još uvijek nisu jasno definirane granične vrijednosti intraabdominalnog tlaka, teško je govoriti u kojem se trenutku javlja abdominalna hipertenzija i ako se javi hoće li rezultirati pojavom navedenog sindroma. Postavljanje egzaktne dijagnoze sindroma abdominalnog odjeljka u pasa je otežano s obzirom da do razvoja sindroma može doći zbog različitih traumatskih stanja, ozljeda, opekotina i različitih organskim ili sistemskih bolesti. Smjernice za liječenje za sada u veterinarskoj medicini nisu specifične, nije opisan jasan protokol liječenja u pasa, već se on odvija prema smjernicama preuzetim iz humane medicine. Sigurno je da je potrebno provesti dodatna znanstvena i klinička istraživanja koja će pridonijeti boljem shvaćanju ovoga sindroma. Usvojena nova znanja pridonijet će njegovu lakšem prepoznavanju, dijagnosticiranju i adekvatnom liječenju na dobrobit svih budućih pacijenata.Abdominal compartment syndrome is a characteristic condition with an intraabdominal pressure higher than 12 mmHg, dilatation of the abdomen accompanied by multiorgan failure, especially the kidney, lungs and cardiovascular system. The development of abdominal compartment syndrome is a very urgent and life-threatening condition with high mortality since it is often accompanied by numerous complications and multiple organ failure. This syndrome has been recognized in human medicine for years and its classification, aetiology, pathophysiology, clinical signs, diagnostic procedures and treatment guidelines have been described. On the other hand, this syndrome often goes unrecognized and undiagnosed in veterinary practice. Due to the broad range of non-specific clinical signs that occur in dogs and due to the rare practice of measuring intra-abdominal pressure, the development of compartment syndrome is often not recognized by veterinarians or it is attributed to other diseases. For the same reason, very few clinical trials or scientific studies in dogs have been conducted to explain the aetiology, pathophysiology, progression, adequate diagnostic procedures and treatment guidelines for this syndrome in veterinary medicine. Since the limits of intraabdominal pressure are not clearly defined in dogs, it is difficult to say when abdominal hypertension actually occurs, and once it occurs whether it will progress into a life-threatening condition. Making the final diagnosis of abdominal compartment syndrome in dogs is very difficult as it can develop due to different traumatic conditions, injuries, burns or organic and systemic diseases. The guidelines for treatment in veterinary patients are not specific, with no individual treatment protocol for dogs described to date, and so treatment is performed according to guidelines taken from human medicine. Indeed, scientific and clinical studies will be needed to gain a better understanding of compartment syndrome, which will enable its easier recognition, better diagnosis and more successful treatment for the benefit of all future patients

Proceedings of the 12th International Conference on Kinanthropology

Proceedings of the 12th Conference of Sport and Quality of Life 2019 gatheres submissions of participants of the conference. Every submission is the result of positive evaluation by reviewers from the corresponding field. Conference is divided into sections – Analysis of human movement; Sport training, nutrition and regeneration; Sport and social sciences; Active ageing and sarcopenia; Strength and conditioning training; section for PhD students