Povezica narušenog periodontalnog zdravlja u mlađih bolesnika sa shizofrenijom s pogoršanjem simptoma tijekom remisije: prospektivno kohortno istraživanje

Objectives - The aim of this prospective cohort study was to investigate whether the association of periodontal status with schizophrenia treatment outcomes differs by patient’s age. Subjects and methods - The study was performed on the consecutive sample of 67 patients diagnosed with schizophrenia and discharged because achieving remission criteria. Papilla bleeding index (PBI) was measured at hospital discharge. Positive and negative syndrome scale (PANSS) total score, positive, negative and general symptoms subscales’ scores were measured at hospital discharge, after three, and after six months. Results: - After the adjustment for potential confounders, baseline PBI was significantly unfavorably associated with PANSS total score, negative and general symptoms subscales scores in the patients younger than 45 three and six months after the hospital discharge, and with the positive symptoms sub-scale in patients younger than 34. At youngest 10% of patients, a unit difference in baseline PBI resulted in the 8.12 (95% CI 2.78-13.47; p=0.004) points higher total PANSS score three months later. Our study showed that the younger patients with worse periodontal status are at higher risk for poorer schizophrenia treatment outcomes and faster worsening of remission. This study demonstrates the necessity of more rigorous and more frequent control of younger schizophrenia patients with worse periodontal status after hospital discharge to achieve overall improvement of the patients’ quality of life as well as the efficacy of psychiatric therapies aimed toward the primary mental disorder.Cilj ove prospektivne kohortne studije bio je istražiti postoji li razlika u povezanosti parodontnog statusa sa slabljenjem kvalitete remisije shizofrenije ovisno o dobi pacijenta. Ispitanici i metode: - Istraživanje je provedeno na susljednom uzorku od 67 pacijenata s dijagnosticiranom shizofrenijom koji su otpušteni iz bolnice radi ostvarenih kriterija remisije. Indeks krvareće papile (PBI, engl. papilla bleeding index) izmjeren je pri otpustu iz bolnice. Ispitanici su procijenjeni ljestvicom pozitivnih i negativnih simptoma (PANSS) pri otpustu iz bolnice, nakon tri i nakon šest mjeseci. Rezultati: - Nakon prilagodbe za potencijalne zbunjujuće varijable, indeks krvareće papile bio je značajno inverzno povezan s ukupnim PANSS rezultatom, te rezultatom subljestvica za negativne i generalne psihotične simptome kod pacijenata mlađih od 45 godina nakon tri i nakon šest mjeseci poslije otpusta iz bolnice, te s rezultatom subljestvice za pozitivne simptome kod pacijenata mlađih od 34 godine. Kod najmlađih 10% pacijenata, jedinična razlika u indeksu krvareće papile bila je za 8.12 (95% CI 2.78-13.47; p=0.004) viša za ukupni PANSS rezultat tri mjeseca nakon otpusta iz bolnice. Zaključci: Naše je istraživanje pokazalo da mlađi pacijenti s lošijim parodontnim statusom imaju povećan rizik za lošiju kvalitetu remisije shizofrenije, odnosno brže pogoršanje simptoma tijekom remisije. Ovo istraživanje ukazuje na potrebu za pojačanom i češćom kontrolom mlađih pacijenata sa shizofrenijom koji imaju lošiji parodontni status nakon otpusta iz bolnice kako bi poboljšali kvalitetu života pacijenta kao i pridonijeli učinkovitijoj terapiji primarnog mentalnog poremećaja

Malignant Diseases and Mental Disorders - Prevalence, Mortality, Therapeutic Challenge

Psihički poremećaji koji dolaze u komorbiditetu s karcinomom drastično smanjuju kvalitetu života i utječu na ishod bolesti, povećavaju mortalitet, a prema literaturi smatra se da se javljaju kod 50 % pacijenata s dijagnozom karcinoma. Rana detekcija psihičkih poremećaja, probir, odabir adekvatnih dijagnostičkih ljestvica i odabir adekvatne terapije preduvjet su poboljšanja kvalitete života takvih bolesnika i utjecaja na povoljniju prognozu. Cilj ovog preglednog rada bio je odgovoriti na pitanja: koji su to psihički poremećaji koji se javljaju, kakva je kvaliteta života, postoje li specifične ljestvice za procjenu, dobivaju li psihijatrijski pacijenti adekvatnu skrb, postoje li specifičnosti terapije kao i interakcija onkološke terapije te može li terapija onkološkog pacijenta inducirati nastanak psihičkog poremećaja. Pretraživali smo literaturu koristeći bazu podataka US National Center for Biotechnology Information (NCBI) Σ Medline/Pubmed sistem. Uzimali smo u obzir publikacije tijekom zadnjih deset godina. Psihološke reakcije i psihički poremećaji su brojni, a rezultat su same dijagnoze koja podrazumijeva doživotno liječenje, agresivnih medicinskih tretmana, promjena u načinu života, no i direktnog utjecaja tumora. Većina studija ukazuje na protektivnu ulogu shizofrenije i psihofarmaka, no neke nuspojave psihofarmaka dovode se u direktnu vezu s kancerogenim učinkom. Postoje specifične ljestvice za procjenu psihičkog stanja kod pacijenata koji boluju od malignih bolesti. Što se pak tiče skrbi, pacijenti koji boluju od karcinoma, a u komorbiditetu imaju psihičke poremećaje ili bolesti ne dobivaju adekvatan tretman važeći prema današnjim smjernicama za liječenje karcinoma. To znanje pak ukazuje na važnost timskog, multidisciplinskog pristupa koji jedini može pravovremeno, kvalitetno pomoći takvim bolesnicima.Mental disorders comorbid with carcinoma, which according to the literature occur in 50% of cases of cancer, drastically decrease the quality of life of patients, increase mortality rate, and affect the outcome of the disease. Early detection of mental disorders, screening, the use of adequate diagnostic scales, and therapy are a prerequisite to improving of the quality of life of such patients and achieving a better prognosis. The aim of this review paper is to find an answer to the following questions: which mental disorders can occur? What is the quality of life of these patients? Are there specific assessment scales? Do psychiatric patients receive adequate treatment? Are there any therapeutic specificities and interactions with the oncological therapy? Can an oncological patient’s therapy cause the occurrence of a mental disorder? We went through the literature with the help of the US National Centre for Biotechnology Information (NCBI) database Σ the Medline/Pubmed system Σ and we took into consideration publications from the past ten years. There are many psychological reactions and mental disorders that occur as a result of diagnoses that requires a lifetime of treatment, aggressive medical treatments, lifestyle changes, and of the influence of the tumour itself. Most studies indicate a protective role of schizophrenia and psychopharmacology but also that certain side-effects of drugs are directly linked with a cancerogenic effect. There are specific scales to assess the mental state of patients suffering from malignancies. According to current guiding principles, patients suffering from carcinoma in comorbidity with mental disorders or diseases do not receive adequate treatment. Our current knowledge, however, indicates the importance of team-work and an interdisciplinary approach as the only solution to effectively and adequately help patients

Difficulties of Caregivers of Individuals Suffering from Alzheimer’s Disease

U današnjem društvu postoji jasan trend porasta broja osoba starije životne dobi pa time i sve veća statistička značajnost broja osoba oboljelih od Alzheimerove bolesti što generira povećanu potrebu adekvatne skrbi za oboljele. Uz formalne oblike skrbi (pružene od profesionalaca iz sustava zdravstvene i socijalne skrbi), neformalna njega značajan je resurs u pružanju skrbi osobama s demencijom. Neformalni njegovatelji su pojedinci koji se dobrovoljno brinu za člana obitelji ili prijatelja koji se suočava sa bolešću, invaliditetom ili bilo kojim drugim stanjem koje zahtijeva posebnu pažnju. S obzirom na tijek i duljinu trajanja Alzheimerove bolesti i sama skrb za oboljelog je dugotrajna i iscrpljuća, a uključuje sve razine funkcioranja njegovatelja pa ju je potrebno sagledavati u kontekstu kako ekonomskog, tako i emocionalnog, mentalnog i fizičkog stanja njegovatelja. Iako može imati i neke blagotvorne aspekte, skrb za oboljeloga je obično vrlo stresna i može u značajnoj mjesti utjecati na zdravlje i dobrobit njegovatelja te je stoga potrebno razmotriti probleme i opterećenja s kojima se susreću njegovatelji osoba oboljelih od Alzheimerove bolesti.In modern society, the number of elderly individuals is higher and so is the statistical significance of people living with Alzheimer’s disease. This trend results in a higher demand for adequate care for such patients. Along with formal care (provided by social workers and other health care professionals), informal care has become a significant resource in the nursing of individuals with dementia. Informal caregivers are individuals who voluntarily attend to the needs of a family member or a frend living with illness, handicap, or any other condition that requires special needs. Considering the course and duration of Alzheimer’s disease, the nursing of patients can also be lengthy and exhausting. Moreover, all aspects of a caregiver’s job must be taken into consideration starting the mental, emotional, and physical health to nursing expences. Although there are positive aspects, nursing an individual with dementia is extremely stressful and significantly affect the health and wellbeing of the caregiver, and therefore it is necessary to take into consideration all difficulties and problems caregivers of people living with Alzheimer’s disease may encounter

Microbiological Quality of Raw Donkey Milk from Serbia and Its Antibacterial Properties at Pre-Cooling Temperature

The aim of this study was to examine the microbiological quality of raw donkey milk of an indigenous Serbian breed as well as the changes in the microbial populations during storage at 4 °C. In addition, antibacterial activity of donkey milk against E. coli, L. monocytogenes and S. aureus at 15 °C as well as the content of the two main antibacterial proteins lysozyme and lactoferrin were investigated. Microbiological examination of 137 individual milk samples collected over a period of 21 months showed good microbiological quality since foodborne pathogens such as Salmonella spp. and L. monocytogenes were not detected in any of the analyzed samples, while the number of E. coli, Enterobacteriaceae, total coliform bacteria, sulfite-reducing Clostridia and aerobic sporogenic bacteria was below the limit of quantification (<1 cfu mL−1). During the six-days storage at 4 °C, total bacterial counts and the counts of lactic acid bacteria remained at the initial level while pathogenic bacteria were not detected. The strongest antibacterial activity of the tested milk was observed against E. coli, while S. aureus was the least sensitive to milk antibacterial compounds. Although further research is needed to fully elucidate the antibacterial mechanism and synergistic activity of different compounds in donkey milk, the high content lysozyme (2.63 ± 0.03 g L−1) and lactoferrin (15.48 mg L−1) observed in tested milk could contribute to its strong antibacterial activity and extension of the storage period during which it can be safely consumed

Dementia is More Frequent in Women

Demencija je sindrom globalnog i progresivnog oštećenja stečenih kognitivnih sposobnosti pri očuvanoj svijesti prouzročen organskom bolešću središnjeg živčanog sustava u kojem su posebno oštećene sposobnosti pamćenja, učenja, apstraktnog mišljenja, orijentacije te poimanja vidno‐prostornih odnosa. Prevalencija i incidencija Alzheimerove bolesti (AB), najčešćeg uzroka demencije, znatno je veća kod žena nego kod muškaraca, a ta se razlika s dobi povećava. Dvostruko veća učestalost AB kod žena u odnosu na muškarce djelomično se može objasniti time što žene imaju očekivano dulji životni vijek. Žene imaju lošiju kognitivnu izvedbu na mnogim neuropsihologijskim testovima u odnosu na muškarce u istom stadiju bolesti, odnosno višestruke kognitivne funkcije kod žena teže su i šire zahvaćene nego kod muškaraca. Mogući razlozi za ovakvu nepovoljnost naspram žena su redukcija estrogena u postmenopauzi, veće kognitivne rezerve muškaraca te utjecaj apolipoproteina E. Određeni biološki čimbenici također bi mogli objasniti različite kliničke manifestacije AB s obzirom na spol. Osim što prema prezentiranim podatcima žene češće obolijevaju od AB, žene su također te koje u bitno većoj mjeri pružaju neformalnu njegu ljudima s demencijom, te su oko dvije trećine neformalnih njegovatelja žene. Zaključno, u daljnjem istraživačkom i kliničkom radu s AB svakako bi trebalo obratiti pozornost na spoznaje o spolnim razlikama u razvoju i progresiji ove bolesti.Dementia is a syndrome of global and progressive impairment of acquired cognitive abilities with preserved consciousness caused by an organic illness of the central nervous system with especially pronounced damage to the ability to memorise, learn, think abstractly, orientate, and perceive spatial relations. The prevalence and incidence of Alzheimer’s Disease (AD), the most common cause of dementia, is considerably greater in women than in men, and that difference increases with age. The fact that AD occurs twice as often in women than in men may be partially explained by a longer life expectancy among women. Women show worse cognitive performance on numerous neuropsychological tests in comparison to men during the same stage of the disease, meaning that multiple cognitive functions are more widely and severely impaired in women than in men. Possible reasons for such unfavourable results among women are a reduction of oestrogen during post-menopause, larger cognitive reserves in men, and the influence of apolipoprotein E. Certain biological factors may also explain various clinical manifestations of AD regarding sex. Apart from the fact that, according to presented data, women develop AD more often than men, women are also those who offer informal care to people with dementia in much greater numbers, and almost two thirds of informal caregivers are women. In conclusion, further research and clinical work with AD should certainly pay attention to insights about sex differences in the development and progression of this disease

A REPORT OF RARELY OBSERVED RESISTANCE PATTERN TO CARBAPENEMS IN A CLINICAL ISOLATE OF ENTEROBACTER CLOACAE

Rad izvještava o pojavi soja Enterobacter cloacae u kojeg je dokazan rijetko viđen oblik otpornosti na karbapeneme posredovan enzimom IMI-1, skupine A beta-laktamaza. Soj je izoliran iz obriska rane u bolesnika koji je zbog infekcije kirurške rane prethodno liječen meropenemom. Ograničen izbor antibiotika kojima se mogu liječiti infekcije uzrokovane ovakvim uzročnicima upućuje na nužnost točne identifikacije višestruko otpornih gram-negativnih mikroorganizama i otkrivanje njihovih mehanizama otpornosti. Prepoznavanje višestruko otpornih mikroorganizama naglašava važnost kontinuiranoga mikrobiološkog nadzora bolesnika, osobito u jedinicama intenzivnog liječenja. U prikazanoj ustanovi nije bilo sekundarnog širenja ovog soja. Identifikacija novih mehanizama otpornosti pomaže kliničarima u izboru ciljane terapije, a istodobno je nužna za uspješno sprječavanje širenja infekcija izazvanih višestruko otpornim mikroorganizmima.The paper reports on the emergence of strain in which Enterobacter cloacae has demonstrated an unusual form of resistance to carbapenems mediated by enzyme IMI-1, class A beta-lactamase. The strain was isolated from a wound swab in the patient who had a surgical wound infection previously treated with meropenem. Limited choice of antibiotics that can treat infections caused by these pathogens indicates the necessity of accurate identification of multiple resistant gram-negative microorganisms and mechanisms of their resistance. Recognition of multiresistant gram-negative microorganisms emphasizes the importance of continuous microbiological monitoring of patients, especially in intensive care units. In the investigated institution there was no secondary spread of this strain. Identifying new mechanisms of resistance will be helpful to clinicians in selection of targeted therapy, while important for efficient prevention of spreading infections caused by multiple resistant microorganisms

Alzheimer’s Disease – Influence on Female Caregivers’ Living and Mental Health

Demencija je javnozdravstveni problem koji će postati sve vidljiviji kako stanovništvo stari. Danas u svijetu živi 50 milijuna ljudi oboljelih od demencije, a procjenjuje se da će do 2030. broj oboljelih narasti na 65,7 milijuna, odnosno na 115,4 milijuna oboljelih do 2050. godine. Danas kada demenciju nastojimo dijagnosticirati što ranije, bitno je oboljelima i njihovim obiteljima ponuditi kontinuirani i što kvalitetniji program liječenja i skrbi. U ovom radu željeli smo pokazati koji su glavni problemi vezani uz Alzheimerovu bolest i druge demencije u suvremenom svijetu, a bitno utječu na život žena njegovatelja. Opisan je utjecaj na žene koje skrbe za ljude s demencijom u ulozi profesionalnog njegovatelja i na žene koje preuzimaju ulogu neformalnog njegovatelja osobe oboljele od demencije. Rano prepoznavanje emocionalnog stresa kod njegovatelja nužno je kako bi se uspjelo preventivno djelovati (savjetovanje, suportivna psihoterapija, kognitivno-bihevioralni tretman), te spriječiti razvoj ili pogoršanje već postojećih tjelesnih bolesti (npr. kardiovaskularnih), odnosno mentalnih poremećaja od kojih su, osim nesanice, najčešći anksioznost i depresivnost.Dementia is a public health problem that will become more obvious as the population grows older. There are 50 million people with dementia in the world, and it is estimated that the number of people with dementia will rise to 65.7 million by 2030, and 115.4 million by 2050. At present, we are trying to diagnose dementia as early as possible, and it is important to offer patients and their families a continuous and high-quality program of treatment and care. In this article, we wanted to show the main problems connected with Alzheimer’s disease and other dementias in the modern world which influence the lives of female caregivers. The influence on women who take care of people with dementia as professional caregivers, as well as women who take the role of an informal caregiver of a person with dementia has been described. Early recognition of emotional stress in caregivers is necessary for successful preventive actions (counselling, supportive psychotherapy, cognitive-behavioural treatment) and for preventing the development or worsening of already existing somatic diseases (e.g. cardiovascular), as well as mental disorders, among which, apart from insomnia, anxiety and depression are the most common forms

Alzheimer’s Disease – Influence on Female Caregivers’ Living and Mental Health

Demencija je javnozdravstveni problem koji će postati sve vidljiviji kako stanovništvo stari. Danas u svijetu živi 50 milijuna ljudi oboljelih od demencije, a procjenjuje se da će do 2030. broj oboljelih narasti na 65,7 milijuna, odnosno na 115,4 milijuna oboljelih do 2050. godine. Danas kada demenciju nastojimo dijagnosticirati što ranije, bitno je oboljelima i njihovim obiteljima ponuditi kontinuirani i što kvalitetniji program liječenja i skrbi. U ovom radu željeli smo pokazati koji su glavni problemi vezani uz Alzheimerovu bolest i druge demencije u suvremenom svijetu, a bitno utječu na život žena njegovatelja. Opisan je utjecaj na žene koje skrbe za ljude s demencijom u ulozi profesionalnog njegovatelja i na žene koje preuzimaju ulogu neformalnog njegovatelja osobe oboljele od demencije. Rano prepoznavanje emocionalnog stresa kod njegovatelja nužno je kako bi se uspjelo preventivno djelovati (savjetovanje, suportivna psihoterapija, kognitivno-bihevioralni tretman), te spriječiti razvoj ili pogoršanje već postojećih tjelesnih bolesti (npr. kardiovaskularnih), odnosno mentalnih poremećaja od kojih su, osim nesanice, najčešći anksioznost i depresivnost.Dementia is a public health problem that will become more obvious as the population grows older. There are 50 million people with dementia in the world, and it is estimated that the number of people with dementia will rise to 65.7 million by 2030, and 115.4 million by 2050. At present, we are trying to diagnose dementia as early as possible, and it is important to offer patients and their families a continuous and high-quality program of treatment and care. In this article, we wanted to show the main problems connected with Alzheimer’s disease and other dementias in the modern world which influence the lives of female caregivers. The influence on women who take care of people with dementia as professional caregivers, as well as women who take the role of an informal caregiver of a person with dementia has been described. Early recognition of emotional stress in caregivers is necessary for successful preventive actions (counselling, supportive psychotherapy, cognitive-behavioural treatment) and for preventing the development or worsening of already existing somatic diseases (e.g. cardiovascular), as well as mental disorders, among which, apart from insomnia, anxiety and depression are the most common forms

Cystic Fibrosis – results of CFTR modulators in Croatia

Cistična fibroza najčešća je nasljedna bolest, koja skraćuje životni vijek, a uzrokuje je defekt u genu za transmembranski regulator provodljivosti cistične fibroze (eng. cystic fibrosis transmembrane regulator – CFTR). Poremećena je homeostaza elektrolita, što se očituje simptomima u više organskih sustava. Plućne manifestacije, s kroničnim infekcijama, upalom i, na kraju, respiratornim zatajenjem, ostaju i dalje najvažnija prijetnja životnom vijeku bolesnika. Do prije jednog desetljeća bilo je dostupno samo simptomatsko liječenje. Od 2012. g. dostupno je liječenje tzv. modulatorima CFTR-proteina i njihovim kombinacijama za osobe s cističnom fibrozom koje nose različite varijante CFTR-gena. Pojavom tih lijekova uvelike se promijenila perspektiva i kvaliteta života ljudi s cističnom fibrozom, ali postavljeni i novi izazovi u vezi s dugoročnim komplikacijama, pitanje eventualnog smanjenja konvencionalnog liječenja, ali i financiranja terapije, koja je mnogim bolesnicima nedostupna. Iznesene su bazične spoznaje o cističnoj fibrozi i funkciji CFTR-proteina, klasifikaciji varijanata CFTR-gena, mogućnostima liječenja CFTR-modulatorima te osnovni ishodi liječenja bolesnika s cističnom fibrozom u Hrvatskoj, gdje se ta terapija primjenjuje od jeseni 2021. godine.Cystic fibrosis, the most frequent lifespan shortening hereditary disease in Caucasians, is caused by a defect in the CFTR (cystic fibrosis transmembrane regulator) gene. Disturbed electrolyte homeostasis leads to the development of different symptoms in multiple organs. Pulmonary manifestations with chronic infections and inflammation result in respiratory failure and remain the most important life-shortening factor. Until recently only symptomatic treatment was available. In year 2012. a new treatment approach with small molecules that modulate the CFTR protein was introduced. Different combinations of CFTR modulators are applicable to certain patients carrying different variants of the CFTR gene. CFTR modulators made a huge difference in the quality of life and perspectives of people with cystic fibrosis. At the same time, new challenges emerged regarding long term complications and possible reduction of conventional treatment options, as well as financial issues that are an obstacle to the use of these drugs for many patients. This paper brings basic insight into cystic fibrosis, the function of CFTR protein, the classification of CFTR gene variants and possibilities of treatment with CFTR modulators as well as basic outcomes of CFTR modulators treatment in Croatia, where this therapy was introduced in autumn 2021

Uloga i važnost komunikacije u radu fizioterapeuta

U ovom završnom radu ukratko je opisana uloga i važnost komunikacije te metode kako se njome koristiti za uspješniji rad fizioterapeuta s pacijentima. Uvodni dio rada bavi se definicijom komunikacije i njenom podjelom. Osnovna podjela komunikacije je na verbalnu i neverbalnu. U daljnjem tekstu razrađena je tema komunikacije u zdravstvenom timu. Riječ je o njenoj važnosti u uspješnom provođenju kvalitetne i cjelovite zdravstvene skrbi. Kao glavni dio ove teme opisuje se uloga i važnost komunikacije u radu fizioterapeuta, kako bi trebao izgledati odnos između fizioterapeuta i pacijenta te koje su komunikacijske vještine bitne u unaprjeđenju komunikacije u fizioterapiji. U završnom dijelu ovog rada opisat će se kakva je to uspješna komunikacija između fizioterapeuta i pacijenta te kako tu komunikaciju učinkovito koristiti u svakodnevnom radu s pacijentima i ostalim zdravstvenim djelatnicima