Effect of Olanzapine on Disruptive Behavior in Institutionalized Patients with Severe Intellectual Disability – A Case Series

Considerable number of intellectual disabled people experience some form of disruptive behavior. Antipsychotics are the most common treatment for these behaviors. Numerous patients were efficiently treated with thioridazine, recently withdrawn. The authors describe a case series of »thioridazine responders« treated with olanzapine. Thirty three patients with severe intellectual disability were recruited. All patients were assessed for seven types of disruptive behavior on five point scale. Patients with severe behavior disturbances were included in treatment. The time points of assessment were at day 0, 30, 60 and 180. Twenty one patient accomplished inclusion criteria. A significant decrease occurred at day 30 for all types of behavior. Total score, self injurious behavior, compulsive and destructive behavior showed further decrease at day 60 and became stable until the end of study. Olanzapine appears to be efficacious in the treatment of disruptive behavior in the intellectually disabled and could be substitute for thioridazine treatment

Effect of Olanzapine on Disruptive Behavior in Institutionalized Patients with Severe Intellectual Disability – A Case Series

Considerable number of intellectual disabled people experience some form of disruptive behavior. Antipsychotics are the most common treatment for these behaviors. Numerous patients were efficiently treated with thioridazine, recently withdrawn. The authors describe a case series of »thioridazine responders« treated with olanzapine. Thirty three patients with severe intellectual disability were recruited. All patients were assessed for seven types of disruptive behavior on five point scale. Patients with severe behavior disturbances were included in treatment. The time points of assessment were at day 0, 30, 60 and 180. Twenty one patient accomplished inclusion criteria. A significant decrease occurred at day 30 for all types of behavior. Total score, self injurious behavior, compulsive and destructive behavior showed further decrease at day 60 and became stable until the end of study. Olanzapine appears to be efficacious in the treatment of disruptive behavior in the intellectually disabled and could be substitute for thioridazine treatment

Parental involvement in the war in Croatia 1991-1995 and suicidality in Croatian male adolescents

Aim To investigate the association between parental war involvement and different indicators of psychosocial distress in a community sample of early adolescents ten years after the war in Croatia 1991-1995. Methods A total of 695 adolescents were screened with a self-report questionnaire assessing parental war involvement, sociodemographic characteristics, and alcohol and drug consumption. Personality traits were assessed with the Junior Eysenck Personality Questionnaire; depressive symptoms with the Children’s Depression Inventory (CDI); and unintentional injuries, physical fighting, and bullying with the World Health Organization survey Health Behavior in School-aged Children. Suicidal ideation was assessed with three dichotomous items. Suicidal attempts were assessed with one dichotomous item. Results Out of 348 boys and 347 girls who were included in the analysis, 57.7% had at least one veteran parent. Male children of war veterans had higher rates of unintentional injuries (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.56 to 2.63) and more frequent affirmative responses across the full suicidal spectrum (thoughts about death – OR, 2.1; 95% CI, 1.02 to 4.3; thoughts about suicide – OR, 5; 95% CI, 1.72 to 14.66; suicide attempts – OR, 3.6; 95% CI, 1.03 to 12.67). In boys, thoughts about suicide and unintentional injuries were associated with parental war involvement even after logistic regression. However, girls were less likely to be affected by parental war involvement, and only exhibited signs of psychopathology on the CDI total score. Conclusion Parental war involvement was associated with negative psychosocial sequels for male children. This relationship is possibly mediated by some kind of identification or secondary traumatization. Suicidality and unintentional injuries are nonspecific markers for a broad range of psychosocial distresses, which is why the suggested target group for preventive interventions should be veteran parents as vectors of this distress

METABOLIC SYNDROME AND INFLAMMATION MARKERS IN PATIENTS WITH SCHIZOPHRENIA AND RECURRENT DEPRESSIVE DISORDER

Background: The high prevalence of metabolic syndrome in patients with psychiatric disorders, almost double the prevalence reported for the general population, is worrying. The aim of this study is to investigate the presence of metabolic syndrome and inflammatory marker levels in patients with schizophrenia and recurrent depressive disorder in a Croatian psychiatric sample. Subjects and methods: This study included 62 inpatients with schizophrenia and 62 with recurrent depressive disorder treated at the Department of Psychiatry, University Hospital Centre Split, enrolled from November 2011 until May 2012. The cases were compared to 124 healthy subjects from the general population. Results: The presence of metabolic syndrome was found in 56.5% of the patients with schizophrenia and 53.2% of the patients with depression, which was significantly more prevalent than in the control group (32.3%). The levels of inflammation markers (i.e., C-reactive protein and PAI-1) were significantly higher among patients with metabolic syndrome. Conclusions: Patients with schizophrenia and recurrent depressive disorder demonstrate a high prevalence of metabolic syndrome that is also related to inflammation processes. In the context of integrative medicine, clinicians and researchers should consider psychiatric patients within a holistic approach

Kirurško liječenje metastaza kralježnice

Spinal metastatic disease is a rather common occurrence and definitely warrants attention and treatment due to the high likelihood of leaving cancer patients severely disabled in their final months of life. Recent developments in the understanding of the behavior of different tumor types, as well as advances in surgical treatment, are allowing for the evolution of treatment algorithms, especially when surgical treatment is to be considered. Th is paper gives an overview of the decisionmaking process and the array of surgical options currently available.Metastatska bolest kralježnice je dosta učestala i zasigurno zaslužuje pozornost i liječenje zbog visoke vjerojatnosti da bi inače bolesnici s karcinomom ostali oduzeti u svojim posljednjim mjesecima života. Novija postignuća i shvaćanja ponašanja raznih tipova tumora te unaprjeđenja u kirurškim tehnikama omogućuju evoluciju algoritama, pogotovo kada se kirurško liječenje razmatra. Ovaj rad daje pregled postupka donošenja odluka i ističe razne kirurške mogućnosti koje su trenutno dostupne

Iskustva akreditacije Instituta za medicinska istraživanja i medicinu rada

Accreditation in accordance with the international General Requirements for the Competence of Testing and Calibration Laboratories (HRN EN ISO/IEC 17025 standard) has become a widely accepted method of quality management and objective evidence of technical competence, knowledge, and skills of testing and calibration laboratories. In 2010, the Institute for Medical Research and Occupational Health (IMROH) had its management system accredited against the HRN EN ISO/IEC 17025 standard for the following scopes: determination of radioactivity, testing of ambient air quality, and testing in the scope of ionising radiation protection. This accreditation encompassed three laboratories: Radiation Protection Unit, Environmental Hygiene Unit, and the Radiation Dosimetry and Radiobiology Unit. In accordance with the rules of the Croatian Accreditation Agency, the second re-accreditation is due in 2020. This paper describes and discusses the quality management system at IMROH over the ten years of its implementation. We share our experiences about non-conformities discovered during regular work, internal audits, and external audits performed by the Croatian Accreditation Agency. The accredited management system significantly improved the performance of the accredited units, and the Institute increased its visibility and marketing advantage, consequently improving its market position.Akreditacija u skladu sa zahtjevima međunarodnog standarda HRN EN ISO / IEC 17025 (Opći zahtjevi za osposobljenost ispitnih i umjernih laboratorija) postala je praktična i široko prihvaćena metoda upravljanja kvalitetom i objektivni dokaz tehničke osposobljenosti, znanja i vještina u ispitnim i umjernim laboratorijima. Institut za medicinska istraživanja I medicinu rada (IMROH) akreditirao je 2010. godine svoj sustav upravljanja u skladu sa zahtjevima HRN EN ISO / IEC 17025 norme za sljedeća područja primjene: određivanje radioaktivnosti, ispitivanja kvalitete zraka te ispitivanja u području zaštite od ionizirajućega zračenja. Akreditacija je obuhvaćala tri laboratorija: Jedinicu za zaštitu od zračenja, Jedinicu za higijenu okoline i Jedinicu za dozimetriju zračenja i radiobiologiju. U skladu s pravilima Hrvatske akreditacijske agencije, u 2020. godini planira se druga reakreditacija Instituta. U radu je opisan sustav upravljanja kvalitetom u IMROH-u i iskustva stečena tijekom desetogodišnjeg razdoblja. Analizirane su nesukladnosti otkrivene tijekom redovitog rada, u internim auditima te u vanjskim auditima koje je provodila Hrvatska akreditacijska agencija, tj. nacionalno akreditacijsko tijelo u Hrvatskoj. Može se zaključiti da je akreditirani sustav upravljanja značajno poboljšao rad uključenih akreditiranih jedinica, a Institut je povećao vidljivost na tržištu i marketinšku prednost te posljedično poboljšao svoju tržišnu poziciju

Infections of the musculoskeletal system – review article

Uvod: Infekcije lokomotornog sustava mogu se podijeliti u nekoliko osnovnih skupina ovisno o lokalizaciji, vremenu trajanja i prisutnosti stranog materijala. Kirurške infekcije povećavaju morbiditet i mortalitet bolesnika, financijski trošak liječenja te predstavljaju golemi globalni javnozdravstveni problem. Liječenje infekcija lokomotornog sustava može biti antibiotsko ili kirurško, a najčešće je potrebno kombinirati ove dvije metode. Cilj rada: Cilj je ovog rada dati pregled infekcija lokomotornog sustava s kojima se susreću ortopedi i traumatolozi u svojem radu, uz pregled suvremene literature dostupne na ovu temu. Rasprava: U raspravi su prikazane sve infekcije lokomotornog sustava i za svaku su opisane klinička slika, dijagnostika i suvremene opcije liječenja. Zaključak: Možemo zaključiti da su sve infekcije mišićno-koštanog sustava potencijalno vrlo teška stanja koja, ako se na vrijeme ne prepoznaju i ne liječe, mogu završiti trajnom invalidnošću, daljnjim hematogenim širenjem bakterija i razvojem sepse, pa čak i smrću bolesnika.Introduction: Infections of the musculoskeletal system can be divided into several basic groups depending on localization, duration and the presence of foreign material. Surgical infections increase the morbidity and mortality of patients, the financial cost of treatment, and represent a huge public health problem globally. Treatment of musculoskeletal infections can involve the use of antibiotics or surgery, and most often it is necessary to combine these two methods. Aim: The aim of this paper is to provide an overview of the musculoskeletal infections that orthopedic and trauma surgeons encounter in their work, along with an overview of the literature available on this topic. Discussion: In the discussion, all infections of the musculoskeletal system are presented individually and the clinical presentation, diagnostics and modern treatment options are described for each. Conclusion: We can conclude that all infections of the musculoskeletal system are potentially very serious conditions that, if not recognized and treated in time, can end in permanent disability, further hematogenous spread of bacteria and the development of sepsis, and even the death of the patien

Mosses and Some Mushroom Species as Bioindicators of Radiocaesium Contamination and Risk Assessment

Mosses, lichens, mushrooms are able to efficiently accumulate different radioactive elements from their environment to a much higher degree than other vegetation. They are sensitive bioindicators of radioactive contamination for various ecosystems, particularly in the event of a nuclear accident and uncontrolled emission oh fission products. Results of systematic, long-term measurements of 137Cs activities in mosses and in some edible mushroom species in North Croatia for the post-Chernobyl period (1986–2007) are summarized. The study was conducted in the Radiation Protection Unit of the Institute for Medical Research and Occupational Health in Zagreb, as a part of an extensive monitoring program of the Croatian environment. In the overall observed period the highest activity concentration of 137Cs deposited by fallout has been recorded in 1986, which is the year of Chernobyl accident, causing peak 137Cs activity concentration in moss of 8800 Bq/kg in May 1986. In the same period mean 137Cs activity concentration in grass was 390 Bq/kg. The highest value of 137Cs activity concentration in Cortinarius caperatus mushrooms of 1351 Bq/kg has been recorded in 1989. Fitting the measured 137Cs activity concentrations to the theoretical curve the ecological half-life of 137Cs in moss was found to be around 978 days, in grass around 126 days in the period 1986–1990, in Cortinarius caperatus mushroom around 5865 days (16.1 years). Regarding the risk assessment to Croatian population, due to consumption of mushrooms, the collective effective dose for Croatian population, estimated to be about 35 mSv per year, was found to be quite low. Therefore, it can be concluded that mushroom consumption was not a critical pathway for the transfer of radiocaesium from fallout to humans after the Chernobyl accident