Intrauterine device migration to the urinary bladder

The intrauterine device (IUD) is a common method of contraception among women. As one of complications of IUD, perforation occurs in approximately 1-2 in 1000 insertions. Although migration of IUD may pursue asymptomatic course, symptoms of migration to the urinary bladder can include lower urinary tract symptoms, stone formation around the IUD and uterovesical fistula. In this report, we present a case of an IUD migration into the urinary bladder of a 34-year-old woman at the Clinical Hospital Center Zagreb

Mortalitet u šećernoj bolesti

Šećerna bolest (diabetes mellitus) je složen metabolički poremećaj karakteriziran apsolutnim ili relativnim nedostatkom inzulina te posljedičnom hiperglikemijom uz poremećaje u metabolizmu ugljikohidrata, masti i bjelančevina. Povezana je s povišenim rizikom od nastanka mikrovaskularnih i makrovaskularnih komplikacija, smanjenom kvalitetom života i povišenim mortalitetom u odnosu na referentnu populaciju. Procjenjuje se da je na svjetskoj razini dijabetes 5. vodeći uzrok smrti (nakon zaraznih bolesti, kardiovaskularnih bolesti, maligniteta i ozljeda) sa postotnim udjelom od 5.2% (1). Unatoč značajnom napretku u zbrinjavanju i liječenju šećerne bolesti koji je postignut u proteklim desetljećima, stope mortaliteta kod dijabetičke populacije su još značajno više u odnosu na opću populaciju (2). Više stope mortaliteta kod oboljelih od šećerne bolesti dovode do smanjenog očekivanog trajanja života koje je kod sredovječnih osoba sa šećernom bolešću 8 godina kraće u odnosu na opću populaciju (3). Procjenjuje se također da bi dijabetes mogao biti odgovoran za usporavanje sniženja stopa mortaliteta recentno vidljivo u općoj populaciji (4). Postojanje kvalitetnih podataka o šećernoj bolesti, kako na svjetskoj tako i na nacionalnoj razini je neophodno za usmjeravanje djelatnosti vezanih uz taj problem. Kvalitetni epidemiološki podaci mogu značajno unaprijediti naše razumijevanje prirode bolesti te ukazati na koju bismo značajku bolesti mogli bolje djelovati. Praćenje mjera rasprostranjenosti bolesti u populacijama nam može ukazati na određene genetske ili okolišne rizične čimbenike, a praćenje stopa smrtnosti i uzroka smrti kod osoba sa šećernom bolešću i njihova usporedba na različitim populacijama nam daju uvid u vrstu i kvalitetu zdravstvene skrbi određene regije. Time se omogućava dodjela i/ili realokacija sredstava za zbrinjavanje šećerne bolesti kako bi se najuspješnije nosilo sa komplikacijama iste, uz odgovarajući cost-benefit. Podaci o mortalitetu osoba sa šećernom bolešću se najčešće uzimaju iz sustava vitalne, odnosno mortalitetne statistike koji u Hrvatskoj ima višestoljetnu tradiciju (5). Na populacijskoj razini oni su korisni za praćenje trendova o smrti pripisivoj šećernoj bolesti. Problem predstavlja činjenica potvrđena u mnogim studijama (6-8) da se šećerna bolest često ne nalazi na potvrdi o smrti, niti kao osnovni niti doprinoseći uzrok smrti. Posljedično tomu, nacionalne statistike koje se oslanjaju na mortalitetnu statistiku značajno podcjenjuju utjecaj šećerne bolesti na zdravlje populacije (9). Podaci ukazuju da se šećerna bolest nalazi u znatno većem broju potvrda o smrti kao jedan od razloga smrti nego kao osnovni razlog (10). Drugi način prikupljanja podataka o smrtnosti pripisivoj šećernoj bolesti su kohortne studije koje imaju nekoliko prednosti u odnosu na klasičnu mortalitetnu statistiku. Najočitija prednost je činjenica da one mogu pratiti mortalitet u svih osoba sa šećernom bolešću (u uzorku čiji se rezultati generaliziraju na populaciju), a ne samo onih kojima je dijabetes naveden na potvrdi o smrti. Njima se također mogu istraživati povezanost između rizičnih faktora i ishoda te dodatni rizik smrtnosti dijabetičke u odnosu na ne-dijabetičku populaciju u povezanosti s rizičnim čimbenicima. No, iako kohortne studije identificiraju subpopulaciju sa šećernom bolešću, većina njih se još uvijek oslanja na potvrde o smrti da bi odredili uzrok smrti

Kliničke karakteristike i liječenje lupusnog nefritisa - preliminarna analiza opservacijskih podataka Nacionalnog referentnog centra

Lupus nephritis (LN) is one of the most severe features of systemic lupus erythematosus (SLE). Data on LN is scarce in the Croatian population. We analysed the characteristics of LN patients diagnosed at our tertiary referral centre. In this retrospective study, we analysed the following features of patients with biopsy-proven LN diagnosed between 2011 and 2020: demographics, renal laboratory parameters, renal histopathology, and treatment. A total of 38 patients were included (30 females; mean age 39±15 years). The most common indication for kidney biopsy was proteinuria (89%). The proportion of LN classes was: class I (2.6%), II (5.3%), III (18.4%), IV (42.1%), V (13.2%), III+V (10.5%), IV+V (5.3%). The median time from SLE diagnosis to histologic confirmation of LN was 1.0 year. All patients were treated with methylprednisolone (MP), 68% received MP pulses. Induction treatment included intravenous (IV) cyclophosphamide (CYC) (71%) (15 patients treated per Euro-Lupus and 9 per the National Institutes of Health regimen), oral CYC (3%), or mycophenolate mofetil (11%). 79% of patients received antimalarials. While there is heterogeneity between different populations, our patient profile was similar to that from other European studies. Further follow-up of this group is necessary to assess outcomes in our population.Lupusni nefritis (LN) je česta i vrlo ozbiljna manifestacija sustavnog eritemskog lupusa (SLE). Još uvijek nema dovoljno podataka o karakteristikama bolesnika s LN u Hrvatskoj. Analizirali smo karakteristike bolesnika s LN koji su liječeni u referentnom centru naše tercijarne ustanove. U ovu retrospektivnu studiju uključili smo bolesnike s biopsijom potvrđenim LN u periodu od 2011. do 2020. godine, analizirali smo demografske podatke, parametre bubrežne funkcije, patohistološki nalaz bioptata bubrega i liječenje. U studiju je uključeno 38 bolesnika (30 žena, prosječna dob 39±15godina). Najčešća indikacija za biopsiju bubrega bila je proteinurija (89%). Raspodjela klasa LN bila je sljedeća: klasa I(2,6 %), II(5,3 %), III(18,4 %), IV(42,1 %), V(13,2 %), III+V(10,5 %), IV+V(5,3 %). Prosječno vrijeme od dijagnoze SLE do histološke potvrde LN bilo je 1,0 godina. Svi bolesnici su liječeni kortikosteroidima, 68 % liječeno je bolusima metilprednizolona. Indukcijska terapija uključivala je parenteralnu primjenu ciklofosfamida (CYC) (71 %) (15 bolesnika liječeno je prema Euro-lupus protokolu, 9 bolesnika prema protokolu Nacionalnog instituta za zdravlje (NIH)), peroralni CYC (3 %) ili mikofenolat mofetil (11 %). Antimalarike je primilo 79 % bolesnika. Unatoč heterogenosti između različitih populacija s LN, profil bolesnika uključen u ovu studiju sličan je ostalim europskim studijama. Daljnje praćenje potrebno je da bi se istražili ishodi u ovoj populaciji

Acute kidney failure as a single complication of varicella virus Infection in an adult patient

Background: Varicella zoster virus (VZV) is distributed worldwide and is highly contagious. In adults and immunosuppressed patients of any age, the clinical course is much more severe. The most severe complications are pneumonia (the main cause of lethal outcomes in this infection), encephalitis, and very rarely Reye syndrome and hepatitis. ----- Case Presentation: We present a 59-year-old man who came to the emergency department due to varicella and diarrhea. During initial evaluation acute kidney failure (AKF) was diagnosed, and the patient was admitted to the intensive care unit. Continuous renal replacement therapy was applied, and the patient was treated with acyclovir in adjusted doses; renal biopsy revealed acute tubular necrosis. Complete renal function recovery was established after 12 days. ----- Conclusion: VZV infection occurs in a range of clinical scenarios, sometimes presenting only with mild symptoms, but in some other setting it can result in severe AKF even in healthy kidneys. Acute VZV infection can lead to isolated, clinically significant kidney failure. The administration of continuous renal replacement therapy and adjusted doses of acyclovir has a favorable effect on the course of the infection, with complete recovery of kidney function

Distribution of human papillomavirus genotypes in women with high-grade cervical intraepithelial lesions and cervical carcinoma and analysis of human papillomavirus-16 genomic variants

Aim To analyze the distribution of high-risk human papil - lomavirus (HR-HPV) genotypes and the diversity of HPV16 genomic variants in Croatian women with high-grade squamous intraepithelial lesions (HSIL) and cervical carci - noma. Methods Tissue biopsy specimens were obtained from 324 women with histopathologically confirmed HSIL or cervical carcinoma, 5 women with low-grade SIL, and 49 women with negative histopathology. HR-HPV DNA was detected with Ampliquality HPV-type nucleic-acid hybrid - ization assay, which identifies 29 different HPV genotypes. HPV-16 genomic variants were analyzed by an in-house se - quencing. Results The most common HPV type in women with HSIL was HPV-16, detected in 127/219 (57.9%) specimens. HPV16 was also the dominant type in squamous cell cervical carcinoma (46/69 or 66.7%) and in adenocarcinoma (18/36 or 50.0%). Out of 378 patients, 360 had HR-HPV (282 sin - gle infections and 79 multiple infections), 3 (0.8%) patients had low-risk HPV, and 15 (4%) tested negative. HPV-16 vari - ants were determined in 130 HPV-16 positive specimens, including 74 HSIL and 46 carcinoma specimens. In HSIL specimens, 41 distinct variants were found, 98.6% belong - ing to the European branch and 1.4% belonging to the African branch. In cervical carcinoma specimens, 95% isolates grouped in 41 variants belonging to the European branch, one isolate (2.5%) belonged to the North American, and one (2.5%) to the Asian-American branch. Conclusion HPV-16, mainly belonging to the European branch, was the most frequent HPV genotype in women from Croatia with histologically confirmed HSIL and cervi - cal cancer

CLASSIFICATION OF GLOMERULOPATHIES

Postoje brojne klasifikacije glomerulonefritisa prema kojima se oni dijele na akutne i kronične, primarne i sekundarne, nasljedne i stečene, proliferativne i neproliferativne i dr. U kliničkoj praksi najčešće se služimo klasifikacijom prema patohistološkom nalazu. Za mnoge glomerulonefritise histološka slika, kao i klinička prezentacija, jako variraju. Nijedna podjela glomerulonefritisa nije utemeljena na razumijevanju patogeneze pojedinih oblika bolesti glomerula. Kako nova znanstvena otkrića rasvjetljavaju patogenetske mehanizme, tako se mijenjaju i klasifikacije pojedinih glomerulopatija. Najbolji primjer za to je membranoproliferativni glomerulonefritis.Glomerular diseases may be classified as acute or chronic, primary or secondary, hereditary or acquired, proliferative or non-proliferative etc. The most commonly used is the classification according to the histopathological finding. For certain types of glomerulonephritides histopathological image, as well as clinical presentation, may vary widely. A while ago there was no classification based on the pathogenesis of certain types of glomerular diseases. However, as scientists ellucidate the underlying pathogenetic mechanism, current classifications change. The latter is best shown at the example of membranoproliferative glomerulonephritis

Chronic Noncommunicable Diseases – Burden of Disease in the Population of Croatia

Svijet je danas suočen s epidemijom kroničnih nezaraznih bolesti. One su glavni uzrok smrti u gotovo svim zemljama svijeta, a ugrožavaju život i zdravlje ljudi, ali i gospodarski razvoj. Obilježavaju ih zajednički čimbenici rizika, zajedničke determinante koje do njih dovode, kao i zajedničke mogućnosti prevencije. Posebno se ističu kardiovaskularne i zloćudne bolesti, dijabetes i kronične respiratorne bolesti povezane s četirima zajedničkim najvažnijim čimbenicima rizika – pušenjem, nepravilnom prehranom, tjelesnom neaktivnosti i štetnom konzumacijom alkohola. Međutim, potrebno je istaknuti i povezanost nezaraznih bolesti i zajedničkih čimbenika rizika s mentalnim poremećajima i ozljedama, koji zahtijevaju posebnu pozornost u sklopu kroničnih bolesti. Sve to zajedno znatno opterećuje zdravstveni sustav, uzrokuje visoke troškove i u konačnici utječe na socijalni i ekonomski razvoj države.Today, the world faces an epidemic of chronic noncommunicable diseases. They are the main cause of death in almost all countries of the world, endangering both the life and health of the people and economic development in general. They are characterized by shared risk factors, shared determinant causes, and shared prevention strategies. Particularly dangerous are cardiovascular and malignant diseases, diabetes, and chronic respiratory diseases associated with the four main shared risk factors – smoking, improper diet, lack of physical activity, and harmful alcohol consumption. However, it is important to also emphasize the association between noncommunicable diseases and shared risk factors with mental disorders and injuries, which requires special attention when discussing chronic diseases. All of this places a significant strain on the health care system, causes a large financial burden, and consequently influences the social and economic development of a country

ENDOMETRIOSIS, PAIN AND MENTAL HEALTH

Background: Endometriosis is a chronic and progressive disease which can significantly affect a woman\u27s personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. Subjects and methods: An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). Results: Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). Conclusions: This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease

Primjena diodnog lasera u histeroskopiji: što trenutno znamo i što možemo očekivati u budućnosti?

Histeroskopija je metoda vizualizacije šupljine maternice koja se koristi u svrhu dijagnosticiranja i liječenja intrakavitarne patologije. Zahvaljujući razvoju tehnike uloga histeroskopije mijenjala se od dijagnostičke, preko operativne u operacijskoj dvorani, do operativne u ambulantnom okruženju. Cilj ovog preglednog članka je analizirati uporabu diodnog lasera u histeroskopiji i minimalno invazivnim postupcima u području ginekologije, raspravljajući o pozitivnim i negativnim aspektima ove tehnologije s posebnim osvrtom na buduće primjene i perspektive u području ambulantne kirurške histeroskopije