Epidemiological and clinical characteristics and treatment of laryngeal carcinoma in General hospital dr. Josip Bencevic, Slavonski Brod

CILJ ISTRAŽIVANJA. Cilj ove studije je utvrditi i usporediti ispitanike s obzirom na epidemiološke i kliničke karakteristike, modalitete liječenja te ishode bolesti s obzirom na stadij proširenosti i modalitete nakon 5 godina. USTROJ STUDIJE. Retrospektivna studija. ISPITANICI I METODE. U istraživanje je uključeno 46 bolesnika s planocelularnim karcinomom grkljana, liječena u periodu od 2005. do 2010. godine na Odjelu za otorinolaringologiju i kirurgiju glave i vrata, OB "Dr. Josip Benčević, u Slavonskom Brodu i podatci dobiveni tijekom izrade doktorske disertacije prof. dr. sc. Davorina Đanića pod naslovom "Prognostička vrijednost profila staničnog ciklusa kod planocelularnog karcinoma grkljana ", 1997. REZULTATI. Medijan dobi svih ispitanika iznosi 59,5. 54 % bolesnika dijagnosticirano je sa uznapredovalim karcinomom grkljana stadija 4. Totalnoj laringektomiji podvrgnuto je 46 % bolesnika i u 46 % rađena je radikalna disekcija vrata. Nakon kirurškog liječenja, 67 % je primilo radioterapiju, a 36 % kemoterapiju. Ukupno 5-godišnje preživljenje za sve stadije bolesti iznosi 58 %. 5-godišnje preživljenje pada sa 71 % na 41 % pojavom metastaze u limfne čvorove vrata. Podaci se značajno ne razlikuju od istraživanja prof. dr. sc. D. Đanića. ZAKLJUČAK: Planocelularni karcinom grkljana najčešći je u muškoj populaciji starije životne dobi. Većina bolesnika javlja se u uznapredovalom stadiju bolesti. U većine bolesnika primarno je primjenjen kirurški modalitet liječenja, totalna laringektomija i radikalna disekcija vrata, te postoperativno provedena radioterapija. 5-godišnje preživljenje ukupno za sve stadije je 58 % i ne razlikuje se značajno od prethodnih istraživanja. Preživljene značajno pada pojavom metastaze u regionalne limfne čvorove na vratu.OBJECTIVES. The aim of this study is to determine and compare examinees in relation to epidemiological and clinical characteristics, treatment modality and illness outcomes, all considering the stage of development and 5-year-period modalities. STUDY DESIGN. Retrospective study PARTICIPANS AND METHODS. The research included 46 patients with planocellular laryngeal carcinoma, treated from 2005 to 2010 at General Hospital Dr. Josip Bencevic, Departments of Otorhinolaryngology and Head and Neck Surgery in Slavonski Brod. The research also relied on the data obtained during the making of dr Davorin Đanićs doctoral thesis titled Prognostic Value of Planocellular Laryngeal Carcinoma Cell Cycle Profile (1997). RESULTS. The examinees median age is 59,5. Of all, 54 % of the examinees were diagnosed with advanced laryngeal carcinoma stage 4. 46 % underwent total laryngectomy and the same percentage went through radical neck dissection. Following the surgical treatment, 67 % of them received radiotherapy, and 36 % chemotherapy. The overall 5-year relative survival for all cancer stages is 58 %. If metastases appear in neck lymph nodes, the 5-year survival rate drops from 71 to 41 %. Comparing the data to the statistics found in dr Đanićs study, there is no significant difference. CONCLUSION. Planocellular laryngeal carcinoma is most common among elderly men. Most of them are admitted as advanced cancer patients. In most cases the method of choice is primarily a surgical treatment modality, total laryngectomy, radical neck dissection, and postoperative radiotherapy. Five-year survival rate is 58 % for all stages and it does not differ significantly from the previous research. It drops considerably with the appearance of regional neck lymph nodes metastases

Effect of Iron Deficiency Anemia and Other Clinical Conditions on Hemoglobin A1c Levels

Iron deficiency anemia is the most common type of anemia in the world, the most common form of malnutrition deficit with a prevalence of 50% affecting the developed countries as well as developing countries with a strong influence on social and economic development. According to current guidelines of the American Diabetes Association (2019.) glycated hemoglobin (HbA1c) is a reflection of the patient\u27s glycemic status in the last three months and is used for monitoring of therapeutic effect as well as for diagnostic purposes. Previous studies have proven that not only iron deficiency anemia but also a range of other clinical conditions can affect the level of HbA1c independent of glycemic status. The exact mechanism of the effect of iron deficiency on glycated hemoglobin levels remains unknown and is still at the hypothesis level. Studies have proven that treatment of iron deficiency anemia leads to better control of HbA1c level, regardless of whether the patient is diabetic or not. A small number of studies have noted a correlation between iron deficiency and levels of glycated hemoglobin, thus further research on larger number of patients is certainly necessary in order to improve the therapeutic possibilities for patients with diabetes, more accurately diagnose and understand the pathophysiology of formation and influence on glycated hemoglobin levels. (Vučić D, Veselski K, Bosnić Z. Effect Of Iron Deficiency Anemia And Other Clinical Conditions On Hemoglobin A1c Levels. SEEMEDJ 2019; 3(2); 76-81

Assessment of Nutritional Status of Elderly People in a Practice of Family Medicine in Relation to MNA Test, Comorbidity and Chronic Therapy

Introduction: Nutrition assessment is one of the biggest challenges in family medicine practice because of the increasing number of older people with more comorbidities and chronic therapy. The MNA(Mini Nutritional Assessment) test has proven to be the most sensitive and exact tool for this type of research. The aim of this study was to assess whether there is a difference in the nutritional status of elderly people, over 65 years of age, with respect to sociodemographic characteristics, number and type of chronic diseases, and number of medications used in chronic therapy. Materials and methods: Research subjects were 207 patients at the age of 65 treated at the Medical Centre Slavonski Brod during a period of 3 months. During the visit, the nutritional status was examined by using the MNA test. The information on chronic diseases and number of medications the patients were using has been collected from the Medicus computer program. Results: According to the MNA test results, 62 subjects (30%) showed risk of malnutrition, average age of the subjects was 72 years and the median of MNA test results was 25.50. Also, multimorbidity is present in 64.73% of the subjects and 42% of them take more than three medications in chronic therapy. No statistically significant difference was found in the results of the MNA test regarding the number of chronic diseases (p =0.89) and number of medications (p = 0.87). Conclusion: It is important to regularly monitor the nutritional status in order to prevent progression of chronic diseases and reduce additional cost of treatment. (Bosnić Z, Miškić M, Veselski K, Vučić D, Trtica Majnarić Lj. Assessment of Nutritional Status of Elderly People in a Family Medicine Practice in Relation to MNA Test, Comorbidity and Chronic Therapy. SEEMEDJ 2019; 3(2); 1-10

Specifics of Sex Life and Methods of Birth Control among Students at the University of Osijek

The aim of this study is to define specifics of sex life and methods of birth control among students at University of Osijek. Participants were students who study at Josip Juraj Strossmayer University of Osijek. A newly formed questionnaire containing 31 question was used to for this purpose. The study included 549 voluntairly students, 54,3% of students had first sexual experience between 16 and 18 of age. Most of them were long- term couples, who are managing better with sexual activities then students in short term relationships, who are more stressed because of their studies. When it comes to the type of contraceptives, 71, 9 % of students used some of birth control methods, and most common is condom (75,9 %). However, 27, 9 % of students believe that natural methods of birth are safe enough. There are no significant differences in age at the time of first sexual activity considering gender, year at university and residency. The biggest reason for not using contraception is long-term relationship in which students do not feel fear of sexually transmitted diseases and pregnancy

The Correlation between Iron Deficiency and Recurrent Aphthous Stomatitis: A Literature Review

Aphthous lesions of the oral mucosa are a very common symptom and can be seen in both family medicine practice, dental medicine practice, and dermatology or otorhinolaryngology clinics. Some patients develop a chronic recurrent condition, which is clinically known as recurrent aphthous stomatitis (RAS). These ulcers are round, clearly defined, and can be visible on the movable part of the oral mucosa, with variations in size. A prodromal symptom like the burning or stinging sensation can precede the appearance of lesions. The main reason why patients seek medical help is oropharyngeal pain with lack of appetite. The exact etiopathogenesis of RAS remains unknown. Immune disorders, nutritional deficiencies, allergies, mechanical injuries, and even psychological disorders are being studied as potential causes of this condition. Some authors claim that iron deficiency may be a possible causative factor of RAS due to its role in DNA synthesis, mitochondrial function, and enzymatic activity. In iron deficiency, epithelial cells turn over more rapidly and produce an immature or atrophic mucosa. Such mucosa is vulnerable and can be a fertile soil for chronic inflammation and development of aphthae. Finally, our goals were to describe the clinical aspects and etiology of RAS, as well as to determine whether RAS may be related to iron deficiency, in order to identify potential patients with iron deficiency in everyday work

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health

The Relationship Between Appearance Satisfaction and Self-Esteem Among High School Students in Eastern Croatia

Due to the imposition of social media, a large number of adolescents face problems related to physical appearance and social contact. The research objectives were to examine the degree of satisfaction of high school students in Eastern Croatia, Vinkovci, regarding their physical appearance and self-esteem based on their gender, type of high school and the differences in socioeconomic status. The study was designed as a cross-sectional research and included 278 students from medical schools and high schools. Data was collected using a survey on the demographic and socio-economic status of participants. The Body Image Questionnaire was used in a modified and validated version in Croatia and contained fourteen questions to examine the level of satisfaction with the body image. Using Rosenberg’s ten-question test, the level of self-esteem was examined. The Median age of students was 18 years. The female students in high school were significantly more concerned about their physical appearance than the male students in the same school (χ² = 23.6, p < 0.001). The linear correlation between the degree of satisfaction regarding physical appearance and self-esteem confirmed the association between body image satisfaction and gender of students in medical schools (r = 0,157; p = 0,04) and students in high school (r = 0,371; p < 0,001). Adolescents in this region of Croatia are not overly concerned about their physical appearance despite relatively decreased self-esteem. Alcohol consumption has proven to be a big problem especially for high school students, which can be a result of stress due to maintaining excellent grades

Mood disorders in later life and challenges of care in general/family medicine

Poremećaji raspoloženja se tradicionalno smatraju problemom adolescentne i mlađe odrasle dobi. Novije spoznaje stavljaju naglasak na poremećaje raspoloženja u starijoj životnoj dobi zbog njihovog devastirajućeg učinka na zdravlje i funkcionalnu sposobnost starijih osoba. Ipak, te poremećaje, uključujući i one najčešće, kao što je generalizirani anksiozni poremećaj i depresija velikih depresivnih epizoda, obiteljski doktori često ne prepoznaju. Glavni razlozi su česti komorbiditet sa somatskim stanjima i kognitivnim poremećajima te shvaćanje pacijenata da su mentalni poremećaji normalan dio procesa starenja. Probir osoba starih 60 i više godina na anksiozne poremećaje i depresiju pomoću standardiziranih upitnika, prilagođenih za primjenu u starijoj populaciji, mogao bi biti koristan za poboljšanje prepoznavanja tih poremećaja. Postavljanje konačne dijagnoze bi se trebalo temeljiti na primjeni dijagnostičkih kriterija koje preporučuju najnovije DSM i ICD klasifikacije te detaljnom postupku kliničke evaluacije, a na osnovi intervjua s pacijentom ili njegovim skrbnikom. Iako se obiteljskim doktorima nalaze na raspolaganju djelotvorni lijekovi za liječenje poremećaja raspoloženja, njihova primjena u osoba starije dobi može biti ograničena zbog povećanog rizika od interakcija među lijekovima i neželjenih reakcija na lijekove. Psihosocijalne intervencije su od posebnog značaja u toj populacijskoj skupini, ali nema dovoljno dokaza o tome koji postupak kome primijeniti. Način kako poboljšati skrb za osobe starije dobi s poremećajima raspoloženja u općoj/obiteljskoj medicini bi bio putem intenziviranja istraživanja, s ciljem stjecanja boljih dokaza, te putem davanja veće pozornosti praktičnoj edukaciji obiteljskih doktora iz područja psihijatrije, kao i putem strategija usmjerenih na povećanje svjesnosti javnosti o poremećajima raspoloženja u starijoj životnoj dobi i načinu njihove prezentacije.Mood disorders have been traditionally considered a problem of adolescenthood and early adulthood. Recent findings are pointing to mood disorders in later life due to their devastating effects on health and functional capabilities of older adults. However, those disorders, including those most common such as generalized anxiety disorder and major depressive disorder, are frequently unrecognised by family doctors. Main reasons for that are frequent comorbidities with medical conditions and cognitive disorders and patients’ treating mental disorders as normal aspects of aging. Screening 60 years old patients and older for anxiety and depression by standardised questionnaires, adapted for the use in older population, could be helpful in improving recognition rates. Definite diagnosis should combine the latest update of the DSM or the ICD classification criteria and a thorough clinical evaluation based on responses drown from a patient or a caregiver. Although effective medications for mood disorders are available to family doctors, their application in older adults may be compromised by the increased risk of medication interaction and adverse reaction. Psychosocial interventions are particularly important in this population group but evidence is insufficient regarding who should receive which treatment. The way of improving management of mood disorders in older adults, in family medicine, would be by intensifying research, in order to gain more evidence. More attention should be given to formal psychiatric training of family doctors, as well as to the strategies aimed at increasing the public awareness of mood disorders in later life and their modes of presentation