MEĐUNARODNA POVIJEST TERORIZMA

Jussi M. Hanhimäki i Bernhard Blumenau (2013) An International History Of Terrorism – Western and Non-Western Experiences. Oxon: Routledge, 318 str

Regionalne razlike u faktorima rizika novooboljelih pacijentica od raka dojke u Hrvatskoj

Background: Presence of breast cancer environmental risk factors may vary between the regions and settlement of residence size depending on the differences in lifestyle and level of specific exposures. Genetic risk factors could also show differences between regions. The aim of this cross-sectional study was to explore regional differences in breast cancer risk factors pertaining to the environment and genetics in medical history of newly diagnosed female patients in Croatia. Methods: We surveyed 203 women with newly diagnosed, previously untreated breast cancer (BCa) from all parts of Croatia, hospitalized consecutively between December 2016 and August 2017, for known BCa risk factors using the self-administered questionnaire. Data were analyzed separately by two main Croatian regions (continental, Mediterranean) and settlement of current residence size (urban, semi-urban/rural), as defined by Croatian Bureau of Statistics. Results: Women living in urban settlements were more often nulliparous or had their first child at an older age, had higher education level, lower number of children, more often consumed alcohol and were obese compared to those from semi-urban/rural areas. Women living in continental part of the country more often breast fed shorter. Several of the differences were also found between premenopausal and postmenopausal women. Conclusion: In total breast cancer population, we noticed several regional and urban BCa risk factor variations characteristical for lifestyle differences.Uvod: Prisutnost vanjskih rizičnih faktora za rak dojke može varirati između regija i veličine naselja u kojima žena živi, ovisno o razlikama u načinu života i razini specifičnih izloženosti. Genetski rizični faktori također mogu pokazivati razlike između regija. Cilj ovog presječnog istraživanja bio je istražiti regionalne razlike u vanjskim i genetskim rizičnim faktorima raka dojke u anamnezi žena s novootkrivenim rakom dojke u Hrvatskoj. Metode: Poznati rizični faktori raka dojke ispitani su samoispunjavanjem upitnika kod 203 novodijagnosticirane prethodno neliječene žene koje su konsekutivno hospitalizirane između prosinca 2016 i kolovoza 2017. Podaci su analizirani prema dvije glavne regije Hrvatske (kontinentalna, mediteranska) i veličini naselja (urbana, semi-urbana/ruralna) trenutnog prebivanja, definiranih prema Državnom zavodu za statistiku. Rezultati: Žene koje prebivaju u urbanim naseljima češće nisu rađale ili su imale prvo dijete u starijoj dobi, višu razinu edukacije, manji broj djece, češće su konzumirale alkohol i bile pretile u usporedbi s ženama iz semi-urbanih/ruralnih područja. Žene koje prebivaju u kontinentalnom dijelu zemlje češće su kraće dojile. Pojedine od navedenih razlika su nađene i između premenopauzalnih i postmenopauzalnih žena. Zaključak: U ukupnom uzorku bolesnica s rakom dojke, za rizične faktore je opaženo nekoliko regionalnih i razlika prema veličini naselja karakterističnih za razlike u načinu života

Trend and development of epidural analgesia and epidural anesthesia in the maternitiy ward of UHC Sestre milosrdnice over the past ten years

Tijekom posljednjih godina epiduralna analgezija za obezboljavanje vaginalnog porođaja primjenjuje se sve češće i jedna je od najčešće rabljenih regionalnih tehnika. Epiduralna anestezija uglavnom se rabi za hitni carski rez u rodilja koje već imaju postavljen epiduralni kateter za epiduralnu analgeziju tijekom vaginalnog porođaja. U rodilištu Kliničkoga bolničkog centra Sestre milosrdnice proveli smo retrospektivnu kohortnu studiju od 2008. do 2018. godine. Proučavali smo desetogodišnji trend incidencije epiduralne analgezije u odnosu prema ukupnom broju porođaja i incidencije epiduralne anestezije za hitni carski rez u odnosu prema ukupnom broju hitnih carskih rezova. U 2008. godini učestalost epiduralne analgezije u odnosu prema ukupnom broju porođaja bila je 21% (662/3125), a u 2018. godini 34% (1059/3083). U 2008. godini broj epiduralnih anestezija u odnosu prema ukupnom broju anestezija za hitni carski rez bio je 9% (51/552), a u 2018. 27% (172/639). Trend porasta vidljiv je kod obaju postupaka i iznosi 13% za epiduralne analgezije i 18% pri epiduralnim anestezijama.Over the years, epidural analgesia for pain relief of vaginal delivery is increasingly being applied and is one of the most frequently used regional techniques. Epidural anesthesia is mainly used in emergency cesarean section in parturients who already have an epidural catheter for epidural analgesia during vaginal delivery. In the delivery ward at the Sestre milosrdnice University Hospital Center we have conducted a retrospective cohort study from 2008 to 2018.We studied the incidence of epidural analgesia in relation to the total number of births and the incidence of epidural anesthesia for emergency cesarean section in relation to the total number of emergency cesarean sections. In 2008, the incidence of epidural analgesia in the relation to the total number of births was 21% (662/3125),and in 2018 it was 34% (1059/3083). In 2008, the number of epidural anesthesia for emergency cesarean section in the relation to the total number of emergency cesarean sections was 9% (51/552), andn in 2018 it was 27% (172/639). An increasing trend is seen in both procedures and is 13% for epidural analgesiaand 18% for epidural anesthesia

Anesthesia and analgesia for FAUCS technique of cesarean section – case report

Carski rez povezan je s povećanim brojem komplikacija i velikom postoperativnom boli koja uzrokuje produljenje oporavka za tri do pet dana u odnosu prema vaginalnom porođaju. Novijom kirurškom metodom FAUCS (engl. French Ambulatory Cesarean Section) smanjuju se poslijeoperacijske komplikacije i bolnost. U Klinici za ženske bolesti i porodništvo Kliničkoga bolničkog centra Sestre milosrdnice u Zagrebu započelo se primjenjivati ovu operacijsku metodu u ožujku 2019. godine, prvi put u Hrvatskoj. Spinalna (subarahnoidalna) anestezija jest anestezija izbora za ovakav zahvat zbog potrebe sudjelovanja rodilje pri ekstrakciji novorođenčeta. Bolnost je zahvata manja, stoga spinalna anestezija iziskuje nižu dozu lokalnog anestetika u odnosu prema uobičajenoj standardnoj dozi za carski rez. Sniženje doze lokalnog anestetika omogućuje brži oporavak motoričke funkcije, a samim time i bržu mobilizaciju rodilje. Uz spinalnu anesteziju kombinira se analgezija blokom ravnine transversusa abdominis (engl. Transversus abdominis plane – TAP block) na kraju zahvata. Blok TAP-a doveo je do potpunog uklanjanja boli tijekom prva 24 poslijeoperacijska sata. Potreba za medikamentnom terapijom boli smanjena je na najmanju moguću, a opioidni analgetici nisu bili potrebni. Ovakva kombinacija poštednijega carskog reza i regionalne analgezije omogućila je brži oporavak rodilje, što je povezano s brojnim dobrobitima i za majku i za dijete. Donosimo prikaz jedne od prvih primjena metode FAUCS uz spinalnu anesteziju i blok TAP-a u Hrvatskoj.Cesarean section is correlated with a higher number of complications and higher postoperative pain which prolongs recovery in comparison with vaginal delivery for three to five days. With a relatively new and advanced surgical technique French Ambulatory Cesarean section (FAUCS) there are fewer postoperative complications and lower pain scores. In our Clinical Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, we started with this surgical technique at the beginning of 2019 for the first time in Croatia. The choice of anesthesia for this procedure is spinal anesthesia because the cooperation of the patient is essential for successful extraction of the neonate. As this procedure is less painful it is possible to reduce the dosage of spinal local anesthetic in comparison with the usual dose for classical cesarean section. Lower local anesthetic dose enables faster recovery of motor function, and allows faster mobilization of the parturients. We combined spinal anesthesia with Trans-Abdominal Plain (TAP) block at the end of the procedure. TAP block led to the complete elimination of postoperative pain during the first 24 postoperative hours. The necessity for pain medication therapy after day one was reduced to minimal doses, and opiate analgesics were not used. This combination of less painful cesarean section and regional anesthesia enabled faster patient recovery with many benefits for the woman and the newborn. In this case report we present one of our first cases

Oxidative Stress Reduction by Midazolam Premedication during Oocyte Retrieval Procedure: Pilot Study

Infertility is one of the major medical problems nowadays. Couples who opt for In Vitro Fertilization (IVF) face a great deal of stress which certainly affects the outcome of the procedure. Therefore, we aimed to reduce the stress during the oocyte retrieval procedure by applying midazolam. Total oxidant (TOC) and antioxidant (TAC) capacities of serum, as well as glutathione (GSH) content and catalase activity, were measured in both control and midazolam groups. Follicular fluid was also tested for oxidant capacity and IL1β. Results implied that the midazolam group increased TAC at the end of the procedure. At the same time, the control group decreased GSH at the beginning of the procedure, and both groups decreased catalase activity at the end of the procedure. The results imply that stress during the procedure affects oxidative and antioxidative parameters of the patients, but did not affect the frequency of the pregnancy at the end of this pilot study. Yet, the results imply that oxidative and antioxidative mechanisms during IVF should be investigated in detail as they could affect the outcome of IVF

A prospective, randomized, double-blind, placebo-controlled trial of polyphenols on the outcomes of inflammatory factors and oxidative stress in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is commonly associated with hyperglycemia, dyslipidemia, oxidative stress and inflammation which are well known cardiovascular risk factors. Pomegranate peel polyphenols have a proven hypolipemic, antioxidant and anti-inflammatory activity. However, there is a lack of clinical studies that would confirm its antioxidant and anti-inflammatory effects in diabetic patients. The potential of pomegranate peel extract (PoPEx) to counteract inflammation and oxidative stress in T2DM patients was investigated. For this purpose, a randomized, double-blind placebo-controlled study involving adult T2DM patients treated with PoPEx or placebo for eight-weeks was conducted. Methods: Patients were randomly divided into two groups: the first group (n = 30) received capsules containing PoPEx 250 mg twice daily, while the placebo group (n = 30) received placebo capsules twice daily. Plasma concentration of inflammatory factors (interleukin 6 (IL-6), tumor necrosis factor α (TNF-α) and high sensitivity C reactive protein (hsCRP)), oxidative stress biomarkers (thiobarbituric acid reactive substances (TBARS), nitrites (NO2−), superoxide anion radical (O2−), hydrogen peroxide (H2O2), total antioxidant capacity (TAC)), homocysteine and lipid profile were analyzed. Results: The PoPEx treatment showed a significant reduction of inflammatory factors (IL-6, TNF-α, hsCRP), oxidative stress biomarkers (TBARS, NO2−, O2−) and homocysteine, while the TAC was increased. Moreover, a significant improvement in lipid profile was observed in the PoPEx group. Additional analysis showed a significant inverse correlation between the decrements of all measured inflammatory markers and TAC in the PoPEx group. Conclusions: The study demonstrated that eight-week-long PoPEx administration had favorable effects on inflammatory status and oxidative stress biomarkers in diabetic patients

Determination of ochratoxin A in barley-Contribution to the mycotoxin hypothesis on the etiology of endemic nephropaty

Cilj istraživanja bio je utvrditi koncentracije okratoksina A (OTA) u ječmu iz okolice Slavonskog Broda, područja pojavljivanja Balkanske endemske nefropatije (BEN), te ih usporediti s koncentracijama u ječmu iz „neendemskih“ Osijeka i Nove Gradiške. Tankoslojna kromatografija (TLC) i visokotlačna tekućinska kromatografija (HPLC) bile su korištene za detekciju okratoksina A u uzorcima ječma skupljenim tijekom 2000. i 2002. godine. Maksimalno dozvoljena koncentracija (MDK) okratoksina A u žitaricama je 5 μg/kg. Najviše koncentracije OTA (medijan 25 μg/kg; interval pouzdanosti 20,0-25,0 μg/kg) utvrđene su u ječmu iz Slavonskoga Broda iz 2000. godine, potom u ječmu iz istog područja prikupljenom 2002. godine (medijan 20 μg/kg; interval pouzdanosti 10,0-20,0 μg/kg; p < 0,001). U uzorcima ječma iz Osijeka prosječna koncentracija OTA u uzorcima iz 2000. godine iznosila je 12,5 μg/kg (medijan 12,5 μg/kg; interval pouzdanosti 10,0-20,0 μg/kg), dok niti u jednom uzorku iz 2002. godine, kao i u uzorcima iz Nove Gradiške nije utvrđen OTA. Utvrđena je statistički značajno veća koncentracija OTA u uzorcima sakupljenim 2000. godine u Slavonskom Brodu i Osijeku od onih iz 2002. godine. Uspoređujući međusobno uzorke prema lokaciji uzorkovanja utvrđena je statistički značajna razlika uzoraka iz Slavonskog Broda u odnosu na „neendemska područja“. Vlaga zrna niti u jednom uzorku nije prelazila dozvoljenih 14%. Kontaminacija ječma OTA značajno je viša u okolici Slavonskoga Broda u odnosu na ostala ispitivana područja, te višestruko prelazi dozvoljene koncentracije što govori o mogućoj povezanosti BEN i kontaminacije žitarica OTA i općenito mikotoksinima.The aim of the study was to determine ochratoxin A (OTA) concentration in barley from the Slavonski Brod area endemic for the Balkan endemic nephropathy (BEN) in comparison with barley from Osijek and Nova Gradiška areas free from BEN. Thin-layered chromatography and high-performance liquid chromatography were used on OTA detection in barley samples collected in 2000 and 2002 at Slavonski Brod, Osijek and Nova Gradiška locations. Considering the maximum allowable concentration (MAC) of 5 μg/kg for cereals, the highest OTA concentrations were determined in barley samples collected in the Slavonski Brod area in 2000 (median 25 μg/kg; confidence interval 20.0 – 25.0 μg/kg), followed by barley samples collected in the same area in 2002 (median 20 μg/kg; confidence interval 10.0 – 20.0 μg/kg) (p < 0.001). In the Osijek area, the median OTA concentration in barley samples from 2000 was 12.5 μg/kg (confidence interval 10.0 – 20.0 μg/kg), whereas barley samples collected in 2002 were free from OTA as were those collected in both 2000 and 2002 in the Nova Gradiška area. Comparison of barley samples in separate Slavonski Brod and Osijek areas yielded statistically significant differences in OTA concentration between the samples collected in 2000 and 2002. Mutual comparison of samples according to the sampling locations established a statistically significant difference between the samples collected in the Slavonski Brod area and those from non-endemic areas in 2000 and 2002. Grain humidity did not exceed the allowable level of 14% in any of study samples. In the Slavonski Brod area, barley contamination with OTA exceeded MAC several fold and was significantly higher in the Slavonski Brod area than in other study areas which suggests the possible connection between BEN and OTA contamination of cereals and mycotoxins in general

Rekombinirani aktivirani faktor VII kontrolira krvarenje povezano s kemoterapijom u bolesnika sa solidnim intra-abdominalnim tumorima: Tri pedijatrijska prikaza slučaja

Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) is used predominantly for the treatment of bleeding in patients with hemophilia and inhibitors, and in patients with traumatic injury. There are also literature reports of its use in chemotherapy-related bleeding in leukemia patients and intra- or postoperative bleeding in patients with solid tumors. We describe three pediatric patients where rFVIIa was successfully used to manage bleeding following the failure of conventional hemostatic treatments during chemotherapy for intra-abdominal tumors (hepatoblastoma, rhabdomyosarcoma and non-classified malignant sarcoma). Recombinant FVIIa proved effective and maintained hemostasis in two of three cases, with no evidence for toxic or adverse events in any of the treated patients.Rekombinirani aktivirani faktor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) rabi se za liječenje krvarenja kod bolesnika s hemofilijom i inhibitorima, kao i u bolesnika s traumatskim ozljedama. U literaturi se nalaze prikazi slučajeva njegove primjene kod krvarenja u bolesnika tijekom kemoterapije leukemije, kao i kod intra- ili poslijeoperacijskih krvarenja u bolesnika sa solidnim tumorima. Prikazujemo tri pedijatrijska bolesnika kod kojih je rFVIIa uspješno primijenjen nakon što su zakazali uobičajeni terapijski postupci zaustavljanja krvarenja tijekom kemoterapije intra-abdominalnih tumora (hepatoblastom, rabdomiosarkom i nediferencirani sarkom). Rekombinirani FVIIa pokazao se posve učinkovitim u dvoje od troje opisanih bolesnika, a da pritom nisu zabilježene nuspojave u liječene djece