Quality of Life of HIV-Infected Persons in Croatia

The aim of this study was to examine health-related quality of life among Croatian HIV infected individuals, and to assess the impact of socio-demographic and disease-related variables on health-related quality of life. This was a crosssectional study of 111 HIV-infected adults who received care at the University Hospital for Infectious Diseases in Zagreb, Croatia. The World Health Organization Quality of Life Questionnaire for HIV brief version (WHOQOL-HIV BREF) was used to assess each patient’s quality of life. Ratings of quality of life differed across age, marital status, level of education, health status and »currently ill« status. Subjects who perceived themselves as not ill and their health status as better reported better quality of life for all quality of life domains (p<0.01). Subjects who were in relationships gave higher ratings for the social relationships domain (p<0.01). Subjects with higher level of education gave significantly higher ratings within the independence (p<0.05) and environment (p<0.01) domains. Younger subjects perceived their psychological state as better (p<0.05). The findings demonstrate a moderate degree of overall quality of life (X=112.2; SD= 18.92) with main concerns related to social relationships. These results highlight the need for better access to psychosocial support and medical and legal services for people living with HIV/AIDS in Croatia

Translacija učinkovitosti piridinijevih oksima kod trovanja tabunom iz in vitro sustava u in vivo primjenu

Even if organophosphorus (OP) nerve agents were banned entirely, their presence would remain a problem as weapons of terror (like in Syria). Oxime antidotes currently used in medical practice still fall short of their therapeutic purpose, as they fail to fully restore the activity of cholinesterases, the main target for OPs. As orphan drugs, these antidotes are tested too seldom for anybody’s benefit. Over the last few decades, search for improved reactivators has reached new levels, but the translation of data obtained in vitro to in vivo application is still a problem that hinders efficient therapy. In this study, we tested the strengths and weaknesses of extrapolating pyridinium oxime antidotes reactivation efficiency from in vitro to in vivo application. Our results show that this extrapolation is possible with well-determined kinetic constants, but that it also largely depends on oxime circulation time and its tissue-specific distribution. This suggests that pharmacokinetic studies should be planned at the early stages of antidote development. Special attention should also be given to improving oxime distribution throughout the organism to overcome this major constraint in improving overall OP therapy.Iako su organofosforni živčani bojni otrovi potpuno zabranjeni za upotrebu, njihova je prisutnost i dalje velik problem, posebice kao kemijsko oružje u terorističkim napadima (poput nedavnih u Siriji). Oksimi koji se danas koriste kao protuotrovi u tretmanu nemaju dostatno djelovanje na reaktivaciju aktivnosti kolinesteraza, glavnih meta djelovanja organofosfornih spojeva. Valja napomenuti kako se klinička testiranja ovih protuotrova rijetko provode zbog svoje iznimne specifičnosti. Tijekom zadnjih desetljeća učinjen je napredak u istraživanju novih učinkovitijih protuotrova, međutim još je uvijek veliki nedostatak u poboljšavanju terapije translacija in vitro dobivenih rezultata u in vivo primjenu. Ovom studijom ispitali smo mogućnosti ekstrapolacije reaktivacijske učinkovitosti određene za oksimske protuotrove iz in vitro u in vivo sustav. Naši rezultati pokazuju kako je ova translacija moguća uz detaljno određene kinetičke parametre in vitro i uz poznavanje distribucije oksima i vremena cirkulacije u organizmu. Takav rezultat ističe važnost planiranja i farmakokinetičkih istraživanja već u samom početku razvoja protuotrova. Također, poseban naglasak u istraživanju trebalo bi staviti i na poboljšanje tkivo-specifične distribucije oksima u organizmu čime bi se poboljšala cjelokupna terapijska učinkovitost

Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis

Development of cardiac allograft vasculopathy represents the major determinant of long-term survival in patients after heart transplantation. Due to graft denervation, these patients seldom present with classic symptoms of angina pectoris, and the first clinical presentations are progressive heart failure or sudden cardiac death. Although coronary angiography remains the routine technique for coronary artery disease detection, it is not sensitive enough for screening purposes. This is especially the case in the first year after transplantation when diffuse and concentric vascular changes can be easily detected only by intravascular ultrasound. The treatment of the established vasculopathy is disappointing, so the primary effort should be directed toward early prevention and diagnosis. Due to diffuse vascular changes, revascularization procedures are restricted only to a relatively small proportion of patients with favorable coronary anatomy. Percutaneous coronary intervention is preferred over surgical revascularization since it leads to better acute results and patient survival. Although there is no proven long-term advantage of drug-eluting stents for the treatment of in-stent restenosis, they are preferred over bare-metal stents. Severe vasculopathy has a poor prognosis and the only definitive treatment is retransplantation. This article reviews the present knowledge on the pathogenesis, diagnosis, treatment, and prognosis of cardiac allograft vasculopathy

Razvoj ranih grafomotoričkih sposobnosti u djece s neurorazvojnim rizikom

Drawing as an early form of a child’s graphomotor skill is used as an element in the assessment of visual-motor coordination. Development of artistic expression is a precursor of the later development of writing that requires a high degree of coordination and precision. Children with perinatal impairment of the central nervous system and prematurely born children belong to a group of children with neurodevelopmental risk. Some of the possible results of this type of difficulty can be mild forms of motor disabilities. A retrospective study was conducted by archive review of children under the age of 3 hospitalized at University Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center. The aim was to determine the incidence of graphomotor difficulties in children with perinatal impairments of the central nervous system and prematurely born children. The study included 50 children aged 12-36 months. The results showed 72% of the tested children to have drawings within the limits expected for their age, 13 children showed graphic abilities below the expectations for their age, while one child did not show functional use of pen. Literature indicates a common learning disability and difficulties with attention and fine motor skills in preschool and particularly in schoolchildren born with neurodevelopmental risk. This study therefore suggests that, despite good initial compensation in the early development of graphomotor skills, it is necessary to maintain follow-up procedures in order to prevent later difficulties in the development of graphomotor and writing skills.Crtež kao rani oblik grafomotoričkih sposobnosti djeteta u ranom djetinjstvu koristi se kao procjena vizuo-motorne koordinacije. Razvoj crteža preteča je kasnijem razvoju pisanja koje zahtijeva visok stupanj koordinacije i preciznosti. Djeca s perinatalnim oštećenjem središnjega živčanog sustava i prijevremenim porodom pripadaju skupini neurorizične djece. Jedan od mogućih ishoda ovoga tipa oštećenja su i blaže motoričke teškoće. Provedeno je retrospektivno istraživanje pregledom arhive za djecu do 3 godine koja su hospitalizirana na Klinici za reumatologiju, fizikalnu medicinu i rehabilitaciju Kliničke bolnice „Sestre milosrdnice“ radi utvrđivanja vremena pojavnosti teškoća u grafomotoričkim sposobnostima kod djece s neurorazvojnim rizikom. Istraživanjem je obuhvaćeno 50 djece u dobi od 12 do 36 mjeseci. Kod ispitane djece u 72% slučaja crtež je bio u granicama očekivanima za dob, kod 13 djece grafičke sposobnosti su bile ispod očekivanih za dob, dok jedno dijete nije pokazivalo funkcionalnu upotrebu olovke. Literatura ukazuje na učestale teškoće učenja, pozornosti i fine motorike u predškolskoj i osobito u školskoj dobi kod djece rođene s neurorazvojnim rizikom. Ovo istraživanje stoga ukazuje na to da je unatoč dobroj početnoj kompenzaciji u ranom razvoju grafomotoričkih sposobnosti nužno praćenje ove populacije djece kako bi se na vrijeme spriječile moguće kasnije teškoće u razvoju grafomotorike i pisanja

Music therapy and rhythmic auditory stimulation with hospitalized children

U trenutcima kada se dijete sa zdravstvenim teškoćama odvaja od roditelja i poznate okoline i ostaje u nepoznatom bolničkom okruženju, moguće su različite negativne reakcije zbog doživljenog stresa. Iz tog razloga, vrijeme provedeno između različitih medicinskih terapija potrebno je upotpuniti aktivnostima ugodnim za dijete. U članku su navedene neke od tih aktivnosti, koje su ujedno i terapija u nemedicinskom obliku, s naglaskom na pozitivan učinak terapije glazbom i ritmičkih slušnih stimulacija. Terapija glazbom predstavlja jedinstvenu vrstu njege i psihosocijalne potpore u bolnici. U pedijatrijskom, bolničkom okruženju, ima za cilj podržati i pomoći djetetu na neki od idućih načina: pripomoći adaptiranju, smanjiti bol i stres, i potaknuti usvajanje razvojno prikladnih vještina. Glazba se može uključiti u jezično-govornu, fizikalnu i okupacijsku terapiju s ciljem relaksacije mišića, poboljšanja obrazaca kretanja i povećanja samostalnosti u svakodnevnom životu, te u poticanje socijalizacije i emocionalnog razvoja. Ritmičke slušne stimulacije predstavljaju neurološku tehniku koja koristi fiziološke utjecaje slušnog ritma na motorički sustav. Njihov ključni element je fenomen slušnog povlačenja odnosno sposobnost tijela da svoje pokrete ritmički uskladi. Ova metoda može biti korištena unutar neke druge terapije, primjerice fizikalne ili terapije glazbom, ili kao samostalni oblik terapije te je ekonomski povoljna. Još neke od strategija koje se koriste u suočavanju s neugodnim situacijama i ublažavanju simptoma hospitalizma su igra, terapija uz pomoć životinja, druženje s klaunovima itd. Primjetna je sve veća prepoznatost posljedica hospitalizacije, u zdravstvenim ustanovama i općenito u društvu. U rad s hospitaliziranom djecom uključuje se sve veći broj stručnjaka koji svojim timskim radom rade za dobrobit cjelokupnog razvoja djeteta.At times when a sick child needs to be separated from his/her family, and stay in an unfamiliar, hospital environment, it is possible to expect various negative reactions from the child due to stress. Therefore, time spent in-between therapies and medical procedures should be made interesting and comfortable for a child. This article explains several of those activities that also represent non-medical therapies, emphasizing positive effect of music therapy and rhythmic auditory stimulations. Music therapy is a unique way of care and psychosocial support in hospital settings. At pediatric departments, its goal is to support and help child to: adapt, minimize pain and stress, and stimulate development of skills. Music can also be incorporated in speech and language, physical and occupational therapy to aid muscle relaxation, improve movement patterns, and augment independency in every-day skills, and to stimulate socialization and emotional development. Another method, widely used in hospital environments, is rhythmic auditory stimulation. This neurological technique uses physiological effect of auditory rhythm on motor system. The key element of rhythmic stimulations is the phenomenon of auditory fun, or body’s ability to rhythmically adjust its movements. Due to its low economic value, this method can be used independently, or be incorporated in other therapies such as physical or music therapy. Other strategies used in coping with negative experiences and in moderating hospitalism symptoms are play, animal therapy, visits from clowns, etc. In modern hospitals, and society in general, the ability to recognize negative hospitalization consequences is growing. So, specialists from various disciplines work with hospitalized children, and are putting team efforts into holistic child development approach in hospitals

Spatial cognition of the Mediterranean in Croatia

Iako se Sredozemlje smatra jednom od najstarijih prostornih cjelina u svijetu, njegove su granice još uvijek predmet istraživanja i rasprava. Ovaj rad nastoji pridonijeti definiranju Sredozemlja ili Mediterana kroz ispitivanje percepcije njegova prostornog obuhvata u Hrvatskoj i povezanosti s fizičkim i sociokulturnim obilježjima prostora. Istraživanje je provedeno metodom kognitivnih karata na uzorku od dvjesto ispitanika. Kao rezultat dobivena je široka granična zona koja razdvaja tzv. \u27\u27pravo\u27\u27 Sredozemlje od područja koja nisu dijelovi Sredozemlja. Ta zona u određenoj mjeri ima svojstva neizrazitog skupa (engl. fuzzy set) koji predstavlja postupni prijelaz između polova pripadnosti određenom skupu. Rezultati istraživanja na ispitanicima pokazali su da je najveća podudarnost percipiranih granica Sredozemlja s dinarskim smjerom pružanja reljefa (sjeverozapad-jugoistok), osim u Istri, te s obalnom crtom u čitavom hrvatskom primorju. Rezultati također pokazuju da su pri odabiru percipirane granice Sredozemlja čimbenici prirodne sredine važniji od sociokulturnih.Although the Mediterranean is considered to be one of the oldest regions in the world, its borders are still the subject of discussion and research. This paper aims to contribute to the definition of the Mediterranean by studying the perception of its spatial coverage in Croatia and its links to the physical and socio-cultural attributes of space. The research was conducted by using the cognitive map method on the sample of 200 participants. The result was a broad border zone separating the so-called "real" Mediterranean from areas which are not part of the Mediterranean. This zone is somewhat similar to a fuzzy set, representing a gradual transition between two ends belonging to a certain set. The research indicates that the congruence of perception of the borders of the Mediterranean is the largest along the Dinaric Alps (northwest – southeast), except in Istria, and the coastal spread along the entire Croatian littoral. The results also indicate that factors relating to the natural environment take precedence over socio-cultural factors in the perception of borders of the Mediterranean

Pretransplant and perioperative predictors of early heart transplantation outcomes

Aim To identify predictors of 3-month mortality after heart transplantation in a Croatian academic center. Methods A retrospective review of institutional database identified 117 heart transplantations from January 2008 to July 2014. Two children <14 years were excluded from the study. The remaining 115 patients were dichotomized into survivors and non-survivors adjudicated at 3-months postoperatively, and their demographic, clinical, and longitudinal hemodynamic data were analyzed. Results 3-month survival after heart transplantation was 86%. Nonsurvivors were older (59 ± 8 vs 50 ± 14 years, P = 0.009), more likely to have previous cardiac surgery (44% vs 19%; odds ratio [OR] 3.28, 95% confidence interval [CI] 1.08-9.90; P = 0.029), lower body mass index (BMI) (25 ± 4 vs 28 ± 2 kg/m2, P = 0.001), and be diabetics (44% vs 23%; OR 2.57, 95% CI 0.86-7.66; P = 0.083). Creatinine clearance was marginally superior among survivors (59 ± 19 vs 48 ± 20 mL/ min, P = 0.059). Donor age and sex did not affect outcomes. Nonsurvivors were more likely to have had ischemic cardiomyopathy (69% vs 32%, P = 0.010). Postoperative utilization of epinephrine as a second line inotropic agent was a strong predictor of mortality (63% vs 7%; OR 21.91; 95% CI 6.15-78.06; P < 0.001). Serum lactate concentrations were consistently higher among non-survivors, with the difference being most pronounced 2 hours after cardiopulmonary bypass (9.8 ± 3.5 vs 5.2 ± 3.2 mmol/L, P < 0.001). The donor hearts exhibited inferior early hemodynamics in non-survivors (cardiac index 3.0 ± 1.0 vs 4.0 ± 1.1 L/min/m2, P = 0.001), stroke volume (49 ± 24 vs 59 ± 19 mL, P = 0.063), and left and right ventricular stroke work indices (18 ± 8 vs 30 ± 11 g/beat/m2, P < 0.001 and 5 ± 3 vs 7 ± 4 g/ beat/m2, P = 0.060, respectively). Non-survivors were more likely to require postoperative re-sternotomy (50% vs 12%; OR 7.25, 95% CI 2.29-22.92; P < 0.001), renal replacement therapy (RRT) (69% vs 9%; OR 22.00, 95% CI 6.24-77.54; P < 0.001), and mechanical circulatory assistance (MCS) (44% vs 5%; OR 14.62, 95% CI 3.84-55.62; P < 0.001). Binary logistic regression revealed recipient age (P = 0.024), serum lactates 2 hours after CPB (P = 0.007), and epinephrine use on postoperative day 1 (P = 0.007) to be independently associated with 3-month mortality. Conclusion Pretransplant predictors of adverse outcome after heart transplantation were recipient age, lower BMI, ischemic cardiomyopathy, reoperation and diabetes. Postoperative predictors of mortality were inferior donor heart hemodynamics, epinephrine use, and serum lactate concentrations. Non-survivors were more likely to require re-sternotomy, MCS, and RRT