Medial Compartment Disease in Dogs

Bolest medijalnog odjeljka lakatnog zgloba odnosi se na vidljivu hromost, smanjen opseg kretnji zgloba, bol i degenerativne promjene kao posljedica različitih oblika fragmentacije medijalnog koronoidnog izdanka i patoloških promjena na hrskavici trochlee humeri, sa mogućom inkongruencijom samoga zgloba. Inkongruencija zgloba se može javiti zasebno ili u kombinaciji sa bolestima medijalnog koronoidnog izdanka i bolestima hrskavice. Najčešće je dijagnosticirana kod mladih pasa, najčešće u dobi od 6-18 mjeseci, srednjih do velikih i giganstkih pasmina. Psi sa osteohondritičnim promjenama počinju pokazivati znakove u dobi od 5-8 mjeseci, dok je dob za dijagnosticiranje bolesti medijalnog fragmentiranog koronoidnog izdanka tek oko 13 mjeseci, a znakove bolesti mogu početi pokazivati već i sa 4 mjeseca. Pasminska predispozicija je izražena i odnosi se na pasmine kao što su Labrador retriver, Zlatni retriver, Njemački ovčar, Rottweiler, Bernski Planinski pas i dr. Iako spolna predispozicija prividno ne postoji, istraživanja su pokazala da sa mužjaci dvostruko više pogođeni ovom bolešću od ženki. Patološke promjene inicijalno utječu na subhondralnu kost formirajući mikrofisure. Ove promjene tipično se pojavljuju ili na kraniodistalnom vrhu medijalnog dijela koronoidnog izdanka ili više aksijalno orijentirano prema regiji incisure radialis. Iako je priroda ove bolesti još uvijek vrlo nejasna većina autora se slaže da se veliki aspekt ove bolesti pripisuje humeroulnarnom konfliktu (HUC). Smatra se da je osteohondroza uzrokavana poremetnjom u enhondralnoj osifikaciji, koja ima za posljedicu stvaranja područja sa izrazito debelom hrskavicom. Patološki oblikovana hrskavica ima za posljedicu stvaranje područja ishemične nekroze, te lakše stvaranje fisura u istom području. Fisure koje se stvaraju u subhondralnoj kosti protežu se i kroz medijalni dio koronoidnog izdanka završavajući na zglobnim površinama i tako povećavaju rizik od fragmentacije izdanka. Psi sa bolesti medijalnog odjeljka zauzimaju stav gdje je lakat lagano abduciran, a kompletna prednja noga je rotirana lateralno kako bi se smanjila sila na medijalni odjeljak lakatnog zgloba. Najznačajniji znak kod kliničkog pregleda je izrazita bol pri manipulaciji i palpaciji lakatnog zgloba. Bol se, uglavnom, javlja kod duboke palpacije medijalnog dijela, posebice na mjestu gdje m. biceps brachii prelazi preko koronoidnog izdanka. Bol se , također javlja kod maksimalne fleksije lakatnog zgloba kombinirano sa supinacijom. Pozitivan nalaz gore navedenih znakova, čak i u odsutstvo ostalih znakova, treba pobuditi sumnju da se radi o bolestima medijalnog odjeljka lakatnog zgloba i takvu životinju se treba uputiti na daljnje dijagnostičke pretrage. U odabiru liječenja bolesti medijalnog odjeljka lakatnog zgloba potrebno je nekoliko faktora uzeti u obzir, prvenstveno jačinu degenerativnih promjena u zglobu. Najbolju prognostičku sliku daje rano kirurško liječenje kod mladih pasa, kombinirano sa postoperativnom fizikalnom terapijom i poduzetim preventivnim mjerama protiv osteoartritisa. Mnogo autora predlaže razne tablične algoritme kao smjernice u odabiru liječenja bolesti medijalnog odjeljka laktnog zgloba koji uključuju i konzervativno liječenje i kiruško kao što je otpuštanje bicepsa u području ulne ili subtotalnu koronoidnu ostektomijiu. S obzirom na nedostatak kliničkih istraživanja sa objektivno izmjerenom učinkovitosti pojedinih zahvata, odluka o liječenju ostaje na svakom kliničaru da odabere po svojim preferencama. Prognoza ovisi o jačini patoloških promjena na zglobu, posebice hrskavicama, o prisutnosti fragmenata i osteoartritičnim promjenama te starosti pacijenta.Medial compartment disease of the elbow joint refers to lameness, decreased range of motion, pain and degenerative changes associated with different forms of fragmentation of the medial portion of the coronoid process, and cartilage disease of the humeral trochlea and coronoid process, with or without incongruity of the joint. It is most commonly diagnosed in young, large to giant breed dogs, such as Labrador Retrievers, German Shepard dogs, Bernese Mountain Dogs etc. It is typically seen in immature dogs between 6 and 18 months of age. The ethiopatogenesis of medial coronoid disease has been particularly well studied, but remains poorly understood. It is believed that the fragmentation of the medial portion of the coronoid process is a manifestation of osteochondrosis, along with ununited anconeal process. These enteties resulted from a disturbance in enchondral ossification leading to retention of an abnormalla thick layer of cartilage. All conditions associated with medial compartment disease result in different degrees of lameness and pain with manipulation of the elbow joint. Dogs occasionally stand with the elbow slightly adducted and the antebrachium rotated laterally to decrease the loads applied to the medial compartment of the elbow. Several factors should be considered in the decision making process for treatment, especially the severity of preexisting degenerative joint disease. Treatment can include conservative and pharmacological treatment and surgical such as arthroscopy, subtotal coronoidectomy, bicipital ulnar release procedure and sliding humeral osteotomy. The surgical load bearing transferring techniques are promising treatment methods. The prognosis itself depends on the severity of pathological processes, age of the patient and postoperative care

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991- 1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following selfassessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes

Financijske obiteljske prilike, bračni status roditelja i samoozljeđivanje kod adolescenata u Hrvatskoj

Th e aim of this study was to determine the level of self-harm behaviors among adolescents in the general population (students of secondary schools in Zagreb, Croatia), as well as to determine if the level of self-harm behaviors diff ered according to fi nancial circumstances of the family and marital status of the parents. Th e study was conducted in 701 adolescents (male and female, age range 14 to 19 years). A specially designed questionnaire that included family and demographic data was used to determine the family fi nancial circumstances. Th e Scale of Auto-Destructiveness measuring instrument was used to assess the level self-harm. Study results revealed that 87.3% of adolescents indicated average levels of self-harm, whereas above-average and high above-average selfharm was indicated in 12.7% of the adolescents. Results also showed that single-parent families signifi cantly diff erentiated the level of self-harm among adolescents of both genders, whereas fi nancial deprivation (perception of fi nancial stress) partially diff erentiated these levels. Practical implications of this study emphasize the importance of social support to parents of adolescents grown up in singleparent and/or fi nancially challenged families.Cilj ovoga istraživanja bio je utvrditi razinu samoozljeđivanja kod adolescenata u općoj populaciji (učenici srednjih škola u Zagrebu, Hrvatska), kao i utvrditi razlikuje li se razina samoozljeđivanja prema obiteljskim fi nancijskim prilikama i bračnom statusu roditelja. Istraživanje je provedeno na 701 adolescentu (muški i ženski, u rasponu dobi od 14 do 19 godina). Za određivanje fi nancijskih obiteljskih prilika primijenjen je posebno dizajniran upitnik koji uključuje obiteljske i demografske podatke. Za procjenu razine autoagresivnosti rabio se mjerni instrument Ljestvica auto-destruktivnosti. Rezultati su poka zali da 87,3% adolescenata pokazuje prosječnu razinu autoagresivnosti, dok je iznadprosječna i vrlo visoko iznadprosječna autoagresivnost prisutna u 12,7% adolescenata. Rezultati pokazuju da adolescenti u jednoroditeljskim obiteljima iskazuju značajno višu razinu samoozljeđivanja i to među adolescentima oba spola, dok lošije obiteljske fi nancijske prilike (percepcija fi nancijskog stresa) razlikuju istu razinu samoozljeđivanja. Praktična primjena ovoga istraživanja naglašava važnost socijalne potpore roditeljima adolescenata koji odrastaju u jednoroditeljskim i/ili obiteljima lošijih fi nancijskih prilika

Osjetljivost i rezistencija bakterija na antibiotike u Varaždinskoj županiji u 2006. godini

Rezistencija bakterija na antibiotike predstavlja jedan od najvećih izazova današnje javnozdravstvene službe te rezultira povećanjem morbiditeta, mortaliteta i cijene liječenja. Prevencija nastanka rezistencije i sprječavanja širenja rezistentnih mikroorganizama reducirat će ove neželjene učinke

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991- 1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following selfassessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes

Enteral feeding with nasoesophageal and nasogastric tubes in dogs and cats

Pilikom zaprimanja novih pacijenata važno je uočiti pothranjene pacijente, ali i sve one kojima potpora u obliku enteralne prehrane može pomoći pri pozitivnom ishodu liječenja. Ako životinja odbija samostalno uzimati hranu ili ne unosi hranu u dovoljnoj količini da bi zadovoljila energijske potrebe u mirovanju, pristupa se enteralnoj prehrani. Kratkoročna enteralna prehrana indicirana je u onih pacijenata u kojih je očekivano razdoblje za enteralnim hranjenjem kratko, najčešće do tjedan dana. U tu se svrhu uglavnom prednost daje postavljanju nazoezofagealne i nazogastrične te, rjeđe, nazojejunalne sonde. Glavna je prednost ovih sondi jednostavnost postavljanja, bez potrebe za općom anestezijom. Polimerni tekući pripravci prvi su izbor zbog uskog lumena sondi, ali uz adekvatno razrjeđenje moguće je koristiti i komercijalne polutekuće pripravake (konzerve). Odabir prehrane ovisit će o individualnim potrebama svake životinje, njihovu zdravstvenom i prehrambenom statusu, ali i o dostupnosti i cjenovnoj pristupačnosti pojedinog pripravka.When admitting new patients, it is important to detect malnourished patients and all those whom nutritional support can help with a positive treatment outcome. If the animal refuses to eat on its own or does not consume enough food to meet its resting energy requirements, assisted feeding is initiated. Short-term enteral nutrition is indicated in patients where the expected time period for nutritional support is short, usually up to a week. For this purpose, the choice is usually between a nasoesophageal and nasogastric tube, and less often a nasojejunal tube. The main advantages of these feeding tubes are the possibility of placement without the need for general anesthesia, ease of placement and cost-effectiveness. Polymeric liquid diets are the first choice due to the narrow lumen of the tubes, but with adequate dilution, it is also possible to use commercial semi-liquid diets (canned diets). The choice of diet depends on the individual needs of each animal, their health and nutritional status, but also on the availability and affordability of each diet

Screening for Mental Health Problems of Children in Kindergartens and Adolescents in Elementary Schools in the City of Zagreb Σ a Pilot Project Results

Prema podatcima Svjetske zdravstvene organizacije (SZO) 10-20 % djece do 18 godina ima neki poremećaj mentalnog zdravlja, a 50 % psihijatrijskih bolesti razvije se i progredira već u vrijeme djetinjstva i adolescencije. SZO preporuča provođenje javnozdravstvenih edukativnih aktivnosti, programa rane detekcije i intervencije te unaprjeđenje kvalitete zdravstvene skrbi za djecu s mentalnim poremećajima sa ciljem povećanja prevalencije liječenih, smanjenja latencije od početka poremećaja do početka liječenja i unaprjeđenja kvalitete života djece i njihovih obitelji. Poremećaji mentalnog zdravlja djece i mladih zbog visoke prevalencije, značajnog morbiditeta i mortaliteta te mogućnosti liječenja temeljenih na dokazima zadovoljavaju kriterije za provođenje probira. Sveobuhvatni probir prvi je korak u ranoj intervenciji za probleme mentalnog zdravlja djece i adolescenata. Cilj ovog rada je prikazati provedbu i rezultate probnog projekta „Probir i rana detekcija psihičkih odstupanja/ poremećaja kod djece u predškolskim ustanovama i adolescenata u osnovnim školama grada Zagreba“ koji je proveden tijekom 2016. godine.According to the World Health Organization (WHO), 10-20% of children under the age of 18 have some kind of a mental disorder, and 50% of all psychiatric disorders develop and progress during childhood and adolescence. WHO recommends public health educational programmes, early detection and intervention programmes, and improvement of mental health care with the aim of increasing the prevalence of treatment, reducing the latency between the onset of the disorder and initiation of treatment, and increasing the quality of life of children and their families. Because of high prevalence, significant morbidity and mortality, and evidence-based treatment, mental disorders fulfil the criteria for screening. Screening is the first step in early intervention for mental health problems of children and adolescents. This paper aims to present the pilot project ”Screening and Early Detection of Mental Health Problems of Children in Kindergartens and Adolescents in Elementary Schools in the City of Zagreb“ which was conducted in 2016