BOTANICAL THERAPY IN POSTMENOPAUSE AS A PART OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

Istraživanja Svjetske zdravstvene organizacije procjenjuju da 65–80% svjetske populacije koristi tradicionalnu medicinu kao osnovni oblik zdravstvene intervencije. Uporaba herbalnih pripravaka, dominantna forma liječenja u zemljama u razvoju, u značajnom je porastu i u zemljama Zapada. Zajednica praktičara konvencionalne medicine ne pridaje komplementarnoj i alternativnoj medicini (KAM) veliko značenje zbog nedostatnih i ponekad metodološki neprihvatljivih studija.¬ S druge strane, većina medicinara i zdravstvenih profesionalaca nije upoznata s kvalitetnim znanstvenim dokazima koji uistinu postoje. Zato je potrebno insistirati na prospektivnim, dobro dizajniranim istraživanjima koja će prikazati stupanj djelotvornosti i sigurnosti postupaka i terapija karakterističnih za KAM. Prikazan je pregled činjenica baziranih na znanstvenim istraživanjima biljaka ili biljnih ekstrakata koji se koriste u perimenopauzalnoj medicini.The World Health Organization estimates that 65%–80% of the world’s population use traditional medicine as their primary form of health care while about half of general population in developed countries uses complementary and alternative medicine (CAM). Many health professionals consider CAM as not serious according to non-adequate research, any compelling evidence base and methodological problems and biases. On the other hand, many physicians are uninformed¬ about the quality of evidence that does exist. Assessment of safety and efficacy of herbal remedies is important issue in future research. Brief facts on the herbals used in postmenopausal medicine are presented and discussed

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY

SAŽETAK. Premda u Hrvatskoj do danas nije zabilježena smrt zbog ektopične trudnoće (ET), to je i dalje hitno stanje opasno po život, zahtijeva hospitalizaciju i adekvatno liječenje. Učestalost ET iznosi oko 2%, s tendencijom rasta zadnjih 30 godina. Zahvaljujući ranoj dijagnozi (pomoću -hCG-a i transvaginalnog ultrazvuka) moguće je rano i pravodobno laparoskopsko liječenje preko 90% ET u nerupturiranom stanju. Laparoskopski se može učiniti salpingektomiju, salpingotomiju, mužnju jajovoda i/ili instiliranje farmakološki aktivnih otopina. Prikazuju se načini izvođenja pojedinih metoda, prednosti, komplikacije i mane laparoskopskog liječenja ET. Trajanje zahvata, hospitalizacija i radna nesposobnost značajno su kraći nego u operiranih laparotomijom. Laparoskopija je danas u dijagnostici i liječenju ET zlatni i obvezujući standard, pouzdana je, jednostavna i brza, visoko je uspješna, poboljšava željeno naknadno intrauterino zanošenje, a hospitalizacija i bolovanje su kratkog trajanja.Despite the fact that no mortality due to ectopic pregnancy (EP) has been registred in Croatia, EP is still life-threatening state, demanding hospital bed rest, monitoring and appropriate treatment. EP incidence is around 2%, and is increasing in past 30 years. With early diagnosis (by means of -hCG and transvaginal ultrasound), laparoscopic treatment is possible in early, unruptured state for majority of EP. Laparoscopic treatments are: salpingectomy, salpingotomy, milking and/or injection of pharmacological substances. Presented and discussed are methods, results and complications. Duration of procedure, hospital stay and working dissablity are significantly shorter than for laparotomy. Laparoscopy is golden and obligatory standard in diagnosis and treatment of EP as it achieves excellent results, is reliable, simple, fast and promotes intrauterine pregnancy

Methylated Host Cell Gene Promoters and Human Papillomavirus Type 16 and 18 Predicting Cervical Lesions and Cancer

Change in the host and/or human papillomavirus (HPV) DNA methylation profile is probably one of the main factors responsible for the malignant progression of cervical lesions to cancer. To investigate those changes we studied 173 cervical samples with different grades of cervical lesion, from normal to cervical cancer. The methylation status of nine cellular gene promoters, CCNA1, CDH1, C13ORF18, DAPK1, HIC1, RARβ2, hTERT1, hTERT2 and TWIST1, was investigated by Methylation Specific Polymerase Chain Reaction (MSP). The methylation of HPV18 L1-gene was also investigated by MSP, while the methylated cytosines within four regions, L1, 5’LCR, enhancer, and promoter of the HPV16 genome covering 19 CpG sites were evaluated by bisulfite sequencing. Statistically significant methylation biomarkers distinguishing between cervical precursor lesions from normal cervix were primarily C13ORF18 and secondly CCNA1, and those distinguishing cervical cancer from normal or cervical precursor lesions were CCNA1, C13ORF18, hTERT1, hTERT2 and TWIST1. In addition, the methylation analysis of individual CpG sites of the HPV16 genome in different sample groups, notably the 7455 and 7694 sites, proved to be more important than the overall methylation frequency. The majority of HPV18 positive samples contained both methylated and unmethylated L1 gene, and samples with L1-gene methylated forms alone had better prognosis when correlated with the host cell gene promoters’ methylation profiles. In conclusion, both cellular and viral methylation biomarkers should be used for monitoring cervical lesion progression to prevent invasive cervical cancer

SIRENOMELIA AND CAUDAL REGRESSION SYNDROME – THE RARE CONGENITAL ANOMALIES

Sirenomelija i sindrom kaudalne regresije su rijetke kongenitalne malformacije. Iako se sirenomelija prijašnjih godina smatrala teškim oblikom sindroma kaudalne regresije, danas se zna da su to dva različita stanja kojima je zajedničko da različitim patogenetskim mehanizmima nastaju u ranom embrionalnom razvoju ploda. Za sirenomeliju se smatra da nastaje zbog tzv. »fenomena krađe krvi«, a sindrom kaudalne regresije zbog poremećaja u diferencijaciji mezoderma. Jedan i drugi poremećaj nastaju u ranom embrionalnom razvoju ploda tijekom četvrtog postkoncepcijskog tjedna, za vrijeme razdoblja gastrulacije. U prikazu dva slučaja antenatalno dijagnosticiranih malformacija prikazane su razlike u patogenezi, pridružene anomalije, antenatalna dijagnostika te prognoza, s posebnim naglaskom na antenatalni probir malformacija koji omogućuje rano postavljanje dijagnoze te indikaciju za rano, manje traumatično dovršenje trudnoće.Sirenomelia and caudal regression syndrome present a rare congenital malformation. Although sirenomelia was thought to be severe type of the caudal regression syndrome in the previous years, it is known today that the sirenomelia and the caudal regression syndrome are, in fact, two mutually diverse states. Both states appear during the early embryogenic development of the fetus due to the different pathogenic mechanisms. The sirenomelia is considered to appear due to the vascular steal theory, whereas the caudal regression syndrome appears due to the disorder of the mesoderm differentiation. The sirenomelia and caudal regression syndrome come into existence in the early embryologic development of the fetus during the fourth postconceptional week at the period of gastrulation. The two reported case studies show the distinction between the pathogenesis, as well as the associated anomalies based upon the antenatally diagnosed malformations. The antenatal diagnostics and prognosis are discussed, especially emphasizing the antenatal screening of the malformations which enables the early diagnosis, as well as the indications for the early and less traumatic pregnancy termination

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

Health literacy improvement of eight grade students on reproductive health – presentation of workshops „Communication, emotions, sexuality“

Cilj: Ispitati procjenu znanja o komunikaciji, emocijama i spolnom zdravlju učenika osmih razreda. Ustvrditi najčešće probleme. Učiniti usporedbu po spolu. Ispitanici i Metode: Ispitanici su 174 učenika (Ž = 97 (56 %)), što predstavlja 81 % od ukupne populacije učenika osmih razreda jedne osnovne škole u PGŽ-u (N = 214) kroz tri generacije. Prije početka i po završetku radionica provedena je anonimna anketa. Prva anketa procjenjivala je početno znanje učenika o temama kojima će se radionica baviti. Druga anketa ocjenjivala je korisnost radionica i služila analizi procesa. Rezultati: Prosječna dob iznosila je 14 (13 do 15) godina. Učenici o svojim problemima vrlo često razgovaraju s majkom (45 %), prijateljima (41 %), ocem (19 %) i braćom/sestrama (16,9 %). Većina učenika ne razgovara sa školskim liječnikom (85,8 %), obiteljskim liječnikom (79,2 %), stručnim službama škole (69,1 %) i razrednicima/profesorima (50 %). Učenici vrlo često razgovaraju o školi (45,8 %), prijateljima (31,7 %) i zdravlju (25,8 %). Najmanje razgovaraju o simpatijama (36,5 %), spolnosti (29,1 %) i emocijama (17,8 %). Učenici najčešće smatraju da o seksu posjeduju vrlo dobra (24,7 %) i izvrsna (35,3 %) znanja, kao i o komunikaciji, vrlo dobra (42,2 %) i izvrsna (25,8 %). Dobrim procjenjuju svoje znanje o zdravlju (37 %) i SPB-u (32,2 %). Dječaci smatraju da više znaju o seksu od djevojčica (20,6 % vs. 14,7 %, P = 0,004). Djevojčice smatraju da znaju više o emocijama (15,3 % vs. 3,7 %, P = 0,003). Radionice su ocijenjene kao korisne (92,5 %). Zaključci: Prema iskustvima radionica sadržaje bi trebalo obrađivati kroz zasebnu aktivnost, izvan postojećih predmeta, kontinuirano tijekom cijele godine, koristeći se evokacija/razumijevanje/refleksija okvirom za poučavanje, a kratkoročne ciljeve definirati prema karakteristikama pojedine grupe i rezultatima ankete. Reproduktivno zdravlje djece i mladih kompleksno je područje koje zahtijeva interdisciplinarni pristup.Aim: To examine the knowledge about communication, emotions, and sexual health of 8th-grade students. To state the most common issues. Make a comparison by gender. Participants and methods: The sample of participants included 174 students (F=97 (56 %)), representing 81 % of the total population of 8th-grade students in one elementary school in the Primorje-Gorski kotar County (N=214) through three generations. An anonymous survey was conducted before the beginning and at the end of the workshops. The first survey evaluated the students’ initial knowledge of the topics to be covered by the workshops. The second survey evaluated the usefulness of the workshops and served as process analysis. Results: The average age was 14 (13-15) years. Students talk about their problems very often with their mother (45 %), their friends (41 %), their father (19 %), and their siblings (16.9 %). Most of the students do not talk to the school physician (85.8 %), family physician (79.2 %), specialist school services (69.1 %) and their classmasters/professors (50 %). They very often talk about school (45.8%), friends (31.7 %), and health (25.8 %). They talk the least about the boys/girls they are in love with (36.5 %), sexuality (29.1 %), and emotions (17.8 %). Students believe they possess very good (24.7 %) and excellent (35.3 %) knowledge about sex, and that they are very good (42.2 %) and excellent (25.8%) in communicating. They evaluate their knowledge about health (37 %) and STDs (32.2 %) as good. Boys think they know more about sex than girls (20.6 % vs 14.7 %, P=0.004). Girls think they know more about emotions (15.3 % vs 3.7 %, P=0.003). The workshops were rated as useful (92.5 %). Conclusions: Based on the insights from the workshops, their content should be addressed through a separate activity, beyond the existing subjects, continuously throughout the year, using an evocation/understanding/reflection-framework, and short-term goals should be defined according to the characteristics of each group and survey results. The reproductive health of children and the youth is a complex area requiring an interdisciplinary approach

Lower Urinary Tract Infections and the Effects of Hormone Therapy in Postmenopausal Women in the Zagreb Region

Urinary tract infections (UTI) remain one of the most common bacterial infections seen in adult women of all ages. In postmenopausal women, the aging process contributes to local complaints in the lower urogenital tissue, including UTI. Our study was conducted at gynecological practices of the health centers in the Zagreb region, Croatia, during 2009. The study included postmenopausal women with urinary symptoms divided into two groups: hormone therapy (HT) users and controls. The objectives were to estimate microbiologically proven lower UTIs (LUTIs) in postmenopausal women with urinary symptoms and the effect of regular HT use on microbiologically confirmed LUTIs. Out of 2338 postmenopausal patients, there was a significantly higher rate of women with urinary symptoms in HT users, namely 64.4% (143/221), compared to the control group at 4.8% (102/2116). Of the 245 patients with urinary symptoms, in 58.8% (144/245) the infection was microbiologically confirmed. Hormone therapy users showed a statistically significant lower rate of microbiologically proven LUTIs (46.9%, 67/143) compared to controls (75.5%, 77/102, p<0.001). Data analysis also showed the efficacy of local as well as systemic HT treatment compared with the control group (p<0.00, p=0.049). But there was a significant difference in the frequency of LUTIs between patients who used local (30.3%, 20/66) and systemic (61.1%, 47/77) HT (p<0.001). The patients who, regulary used therapy, in the local HT group as well as in the group on systemic HT, showed a lower incidence of LUTIs compared to controls (p<0.00, p=0.006). In patients who did not regulary use therapy , there were no significant differences between either local (63.6%, 7/11) ) or systemic (76. 9%, 20/26) HT non- regular users and the control group (75. 5%, 77/102) (p=0.917, p=0.625). The high percentage of patients with non-microbiologically confirmed LUTIs (41.2%, 101/245) suggested the significant role microbiological testing has in LUTI diagnosis. Both local and systemic HT use was related to LUTI reduction

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

Cervical HPV type-specific pre-vaccination prevalence and age distribution in Croatia

The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the most common HPVs in different cervical lesions and cancer prior to the implementation of organized population- based cervical screening and HPV vaccination in Croatia. In this study, 4, 432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18–24 years, which decreased continuously with age (P&lt;0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P&lt;0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P&lt;0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia