INFLUENCE OF HORMONAL STATUS AND MENSTRUAL CYCLE PHASE ON PSYCHOPATOLOGY IN ACUTE ADMITTED PATIENTS WITH SCHIZOPHRENIA

Background: The gender differences in onset, symptom severity, and outcome of schizophrenia are now thought to support the hypothesis that sex hormones may also have a role in etiology, as well as treatment, of schizophrenia. A number of reproductive hormones may be implicated, including testosterone, progesterone, or luteinising hormone, and thus it is important to acknowledge that there is a complex interplay of hormones occurring. This study was introduced to highlight the effect of the menstrual cycle, and sex hormones on female patients with schizophrenia. Subjects and methods: The sample consisted of 31 consecutively acute admitted women, aged 18 to 45 years with schizophrenia diagnosed by DSM-5 criteria. The sample consisted of women who were regulary menstruating and to be undergoing regular hormonal fluxes. Each subject was enrolled and received psychopathology and hormone (estradiole, progesterone, testosterone) assessments. Psychopathology was measured with Positive end Negative Syndrome Scale (PANSS). The subjects were divided into folicular (high estrogen) and luteal (low estrogen) phase admissions. Data were analyzed by regression analysis and t-test for independent samples. Values are given as means ±SD. Results: There were no differences between the folicular and luteal phase admission grups with regard to age, duration of illness and age at onset of illness. We found that significantly more women were admitted during the luteal (low estrogen) phase of menstrual cycle (68%) as compared to follicular (high estrogen) phase (32%). Conclusion: There was a significant increase in hospital admissions in the luteal phase of menstrual cycle in women suffering from exacerbation of schizophrenia. The influence of particulary sex hormones (estrogen, progesterone and testosterone) on admission rate and clinical psychopatology was found insignificant

Adjuvatno liječenje melanoma

For decades, interferon-alpha (IFN-α) has been the only option in the adjuvant treatment of high-risk melanoma. Despite numerous clinical trials and meta-analyzes, IFN-α is not yet a gold standard. It indeed showed benefit in progressionfree survival (PFS) and to a lesser extent in overall survival (OS) but at the cost of high toxicity. The emergence of new, revolutionary therapies in the treatment of metastatic melanoma, like immunotherapy (checkpoint inhibitors - CTLA4 and PD1 inhibitors) and targeted therapies (BRAF and MEK inhibitors), led to considering their potential effect in adjuvant/preventive use. A number of phase II and phase III trials analyzed the adjuvant application of targeted therapies and immunotherapies in completely resected stage III melanoma (IIIA, IIIB, IIIC) and stage IV melanoma (PD1 inhibitor nivolumab). They showed a clear benefit in relapse-free survival (RFS) and overall survival (OS). This led to a change in guidelines for adjuvant treatment of melanoma and approval of immunotherapy and targeted therapy by the FDA (Food and Drug Administration) and EMA (European medicines agency) in the indications mentioned above. Further trials are underway in other high-risk stages (like IIC) and in neoadjuvant treatment of stage III melanoma.Desetljećima je interferon alfa bio jedina opcija u adjuvatnoj terapiji visokorizičnog melanoma. Unatoč brojnim studijama i meta analizama, interferon nije zaživio kao zlatni standard liječenja visokorizičnog melanoma. Pokazao je svakako benefit u vremenu do progresije bolesti (PFS, progression free survival) te u manjem dijelu u ukupnom preživljenju (OS, overall survival) pod cijenu visoke toksičnosti. Pojavom revolucionarnih terapija u liječenju metastatskog melanoma; imunoterapije, anti CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) i anti PD-1 inhibitora (programmed cell death protein 1) te ciljane terapije (BRAF i MEK inhibitori) razmišljalo se o njihovom potencijalnom učinku u adjuvatnom/preventivnom smislu. Brojne studije faze II i III ispitivale su adjuvantnu primjenu ciljane terapije i imunoterapije u kompletno reseciranom stadiju III (IIIA, IIIB, IIIC) i stadiju IV (anti PD-1 inhibitor nivolumab). Pokazale su jasan benefit u vremenu do povratka bolesti (PFS) i ukupnom preživljenju (OS). Navedeni rezultati su promijenili smjernice za adjuvantnu terapiju kod melanoma u vidu registracije imunoterapije te ciljane terapije od strane FDA (Food and drug administration) i EMA (European medicines agency) za adjuvantnu primjenu. U tijeku su daljnja ispitivanja i u drugim visokorizičnim stadijima (npr. IIC) te neoadjuvantno liječenje stadija III

Sustainable Development of Cycle Tourism Destinations in Croatia based on Innovative e-Tools

Cycle tourism in Croatia is not just a significant economic contributor but also a driver of rural development and job creation in sectors like hospitality, tourism, leisure, and cycle path maintenance. The unique preferences of cycle tourists for authentic experiences and local culture also boost the local economy. This research, with its practical implications, aims to provide a comprehensive understanding of the level of awareness of e-innovation tools in Croatia\u27s cycling tourism sector, identify challenges and potentials in terms of technological change, and highlight infrastructural gaps in Adriatic versus continental Croatia using a SWOT analysis. The insights from this research can be instrumental in fostering sustainable and long-term destination development, making it a valuable resource for all professionals in the field

INFLUENCE OF SERUM TESTOSTERONE LEVEL ON AGGRESSION IN WOMEN WITH SCHIZOPHRENIA

Background: Unlike in female population, the effect of testosterone on aggression in men has been investigated countless times so far. A scarce number of studies have examined the effect of testosterone on aggression in women. The results obtained so far are inconsistent for some studies indicated a positive, whilst others showed a negative correlation. Since testosterone turned out to be an important factor related to aggression in men, the aim of our study was to investigate whether this correlation existed in aggressive female patients with schizophrenia. Subjects and methods: The sample consisted of 120 women, aged from 18 to 45 years, diagnosed with schizophrenia by DSM-5 criteria. Those who were breastfeeding or suffered from specific hormonal or other physical disorders were excluded from the study. They were divided into two groups of 60 - those with aggressive behavior and those with nonaggressive behavior. Psychopathology was measured by several tests (Positive and Negative Syndrome Scale - PANSS, Overt Aggression Scale - OAS and PANSS Extended Subscale for Aggression Assessment). Serum testosterone hormone assays were performed. Statistical data analysis was done by parametric statistical tests, Kolmogorov-Smirnov test, Student\u27s t-test and simple linear regression. All data were presented as mean values and corresponding standard deviations (SD). Results: Testosterone levels didn\u27t differ significantly between aggressive and nonaggressive subjects. There were no significant differences between testosterone levels in suicidal aggressive subjects compared to nonsuicidal aggressive respondents (t=0.616; p=0.540). The largest number of subjects in both groups had referent testosterone levels. Conclusions: Despite expecting a significant effect of testosterone levels on aggression in women with schizophrenia, conducted by previous studies, no correlation has been found testosterone levels

Psychiatric Patient and Obesity

Debele osobe i osobe s prekomjernom tjelesnom težinom imaju više psihičkih poremećaja u usporedbi s osobama normalne tjelesne težine. Debljina je jedan od najčešćih tjelesnih problema u osoba oboljelih od teških i dugotrajnih psihičkih bolesti i poremećaja. Dok je prevalencija debljine u općoj populaciji 20 – 30%, prevalencija debljine u populaciji oboljelih od shizofrenije jest između 40 – 60%. Debljina se kod osoba oboljelih od shizofrenije povezuje s karakteristikama i značajkama same bolesti kao što su loše i nezdrave prehrambene navike, sjedilački način života, socijalno povlačenje, psihomotorna usporenost i činjenica da mnogi psihotropni lijekovi (antipsihotici, stabilizatori raspoloženja i antidepresivi) koji se rabe u liječenju ove bolesti povećavaju tjelesnu težinu. U liječenju debljine kod psihijatrijskih bolesnika mogu se primjenjivati farmakološke i nefarmakološke metode.Mental disorders are more common among obese and overweight people than among people with normal body weight. Obesity is one of the most frequent physical health problems found in patients suNering from severe and chronic mental disorders. Obesity prevalence in general population ranges from 20% to 30%, while in patients with schizophrenia it ranges from 40% to 60%. Obesity in patients with schizophrenia is associated with the characteristics and nature of the disorder, such as bad eating habits, sedentary lifestyle, social withdrawal and psychomotor retardation. In addition, a number of psychotropic medications used to treat schizophrenia (antipsychotics, mood stabilizers and antidepressants) cause weight gain. Both pharmacological and non-pharmacological methods are available for the treatment of obesity in patients with mental disorders

EXTENSIBLE NEURO-MYOPATHIES IN THE ELONGATION OF THE EXTREMITIES

U uvjetima distenzionih povreda ekstremiteta, a naročito pri kirurškim elongacijama radi izjednačavanja dužine ekstremiteta, česte su povrede neuro-muskularnih struktura. Najteži oblik je anatomski prekid kontinuiteta živca (neurotmesis), koji se liječi samo kirurškom intervencijom. Potpuni prekid aksona uz održan kontinuitet konektivnog tkiva živca (aksonotmesis) predstavlja ozljedu, koja se može spontano regenerirati ako je neuronska cijev sposobna voditi novostvorene izdanke. Najblaža komplikacija rastezne neuropatije predstavlja blok provodljivosti aksonima kroz određeno vrijeme (neuropraksija). Najdeblja vlakna miješanih živaca su najvulnerabilnija i oporavljaju se sporije od tanjih. Progresija oporavka je nepravilna, ne slijedi anatomski tok živca, ali je u većini slučajeva potpuna. Naglašava se važnost pravovremene i istovremene interpretacije kliničke slike rasteznih ozljeda perifernih živaca i mišića, komplikacije koje pri tome nastaju (kauzalgija, grčevi, kontrakture, ishemične paralize), te principi liječenja , koje determinira klinička slika, odnosno patomorfološki supstrat.Injuries of the neuro-muscular structures are frequent in the conditions of extensible injuries of the extremities, particularly in surgical elongations in order to equalize the lenghth of the extremities. The anatomic interruption of the nerve continuity (neurotmesis) is considered to be the most severe injury, which can be treated only surgically. The complete interruption of the axons with the retained continuity of the connective tissue of the nerve (axonotmesis) is an injury which can be regenerated spontaneously if the neuron tube is capable of leading new offsprings. The mildest complication in extensible neuropathy is the block of the axon conductivity over a definite period of time (neuropraxis). The thickest fibres of the mixed nerves are most vulnerable and recover slower than the thinner anes. Progression of the recovery is irregular; it does not follow the anatomic flow of the nerve, but the recovery is complete in most cases. Emphasis has been laid on the due and precise reading of the clinic picture of extensible injuries of the peripheral nerves and muscles, the complications that may develop (causalgia, cramps, contractions, ischemic paralysis), and the method of the treatment which are determined by the clinic picture, i. e. pathomorphological substrate

Dementia and Psychiatric Emergencies in the Elderly Population

S obzirom na kontinuirano povećanje broja starijih osoba u ukupnoj populaciji u Hrvatskoj, za očekivati je da će se broj starijih osoba s akutnim psihičkim smetnjama koje zahtijevaju hitno zbrinjavanje sve više povećavati. Najčešći psihički poremećaji kod starijih osoba su: depresivni poremećaji, kognitivni poremećaji, demencija, poremećaji vezani uz uzimanje alkohola, poremećaji vezani uz druga zdravstvena stanja i lijekovima izazvani poremećaji. Gerijatrijski bolesnici bi u pravilu prvo trebali biti pregledani od strane stručnjaka somatske medicine (internista, neurologa, kirurga) prije nego što se upućuju u hitnu psihijatrijsku službu, kako bi se ustanovilo da su primarne smetnje iz psihijatrijske domene. Izražena depresija, suicidalnost, agitacija, sklonosti lutanju i ostalim rizičnim ponašanjima kod kuće, izražena anksioznost i smanjena sposobnost brige o sebi, glavni su razlozi hospitalizacije kod ovih bolesnika.Related to the fact of the continuous increase in the number of elderly people in the total population of Croatia, it can be expected that the number of elderly people with acute psychiatric disorders that require emergency care will increase. The most common psychiatric disorders found in the elderly are depressive disorders, cognitive disorders, dementia, alcoholrelated disorders, disorders related to other health conditions and drug-induced disorders. Geriatric patients should, generally speaking, first be reviewed by a psychosomatic medical specialist (internist, neurologist, surgeon) before they are sent to psychiatric emergency services in order to establish that the primary complaint is connected with the psychiatric domain. Pronounced depression, suicidality, agitation, wandering tendencies and other home-based risk behaviours, with anxiousness and reduced self-care ability, are the main reasons for hospitalization

Simplified description and interpretation of pathological thermography signs in malignant breast lesions

Background and Purpose: Breast cancer is the leading cause of death among women aged 20–59 years in developed countries, with similar mortality trends, observed among women in Croatia. Breast cancer detection usually relies on mammography, ultrasound (US) and magnetic resonance imaging (MRI), however, thermography is a noninvasive, reliable and applicable diagnostic procedure for early detection of breast disease that has attracted interest in this field. The aim of this study was to establish the frequency and characteristics of pathological thermographic signs in female patients, who were operated on malignant breast lesions. In addition, the authors offered a simplified description and interpretation of pathological thermographic signs, based on published literature. Matherial and Methods: The seventy four female patients with histopathologically confirmed breast cancer were included in the study. In all patients breast cancer was diagnosed using standard protocol which have included clinical examination, mammography, ultrasound and for selected patients MRI and/or fine needle aspiration (FNA). Thermographic imaging has been conducted 1 to 14 days before scheduled surgical procedures. Results: Mean tumor size positively correlated with number of pathological thermographic signs (IR 3 vs. IR 5, p < 0.05). Mean number of pathological thermographic signs per patient was 3.5±1, 72 (range 1 to 8). The most frequently noted singular signs were heat in area of finding and vascular signs, as well. Conclusion: The simplified description could offer a suitable clinical tool for standardization of pathological thermography signs in malignant breast lesions, taking into account the learning curve of medical teams involved and ethical aspects, as well

The challenges of the digital world

Izdavanje sveučilišnog interdisciplinarnog udžbenika pod nazivom Izazovi digitalnog svijeta rezultat je višegodišnjeg znanstvenog istraživanja, a obuhvaća inženjere, psihologe i pravnike – doktore znanosti i priznate stručnjake u svojim područjima. Ukupno 14 autora s različitih fakulteta Sveučilišta J. J. Strossmayera u Osijeku te Sveučilišta u Zagrebu napisalo je ukupno 12 poglavlja koja obuhvaćaju pregled psiholoških, pravnih i tehničkih aspekata informacijske sigurnosti i zaštite privatnosti i općenito digitalnog svijeta. Osim analize trenutnog stanja te prikaza uzročno posljedičnih odnosa između ponašanja i rizika od mogućih posljedica, navedene su i preporuke za zaštitu pojedinaca. Obrađene su teme koje obuhvaćaju područja informacijske sigurnosti i zaštite privatnosti, a koje su posljednjih godina izuzetno aktualne, kako u javnosti tako i u znanstvenim krugovima, zbog sve većih sigurnosnih problema koji se pojavljuju u gotovo svim aspektima ljudskoga života. Upravo je interdisciplinarni pristup, temeljen na analizi ponašanja korisnika raznih informacijsko-komunikacijskih sustava, omogućio sveobuhvatni pristup u ovome udžbeniku. Udžbenik je namijenjen svim korisnicima informacijsko-komunikacijskih sustava koji se u svojem svakodnevnim radu i aktivnostima susreću s raznim problemima digitalnog doba, od proboja informacijske sigurnosti, odnosno otuđenja i krađe digitalnih podatka te njihove zlouporabe, do različitih oblika zlostavljanja novim informacijsko-komunikacijskim tehnologijama