Acta clinica Croatica最新文献

One of the factors involved in the colorectal cancer development is intracellular oxidative stress and antioxidative imbalance. The study aimed to explore the link between oxidative stress measured by the activity of antioxidative markers and lipid peroxidation product malondialdehyde (MDA) as possible cancer predictors of colorectal cancer by using several statistical methods. The study included 50 adult colorectal cancer patients of both genders. MDA level, the activity of antioxidative markers superoxide dismutase and catalase, and glutathione concentration were determined in patient sera. There was no age difference between male and female patients (p=0.579), and no gender differences according to cancer site (p=0.995), stage (p=0.083), and size (p=0.245). There were no differences in the levels of studied enzymes. Correlation analysis of antioxidative markers and MDA with cancer size and patient age revealed strongest individual correlation between the MDA and cancer size variables (r=-0.56).

The aim was to assess the frequency and success rate of prenatal diagnosis of congenital heart diseases (CHDs) in live-born neonates using ultrasound, as well as the occurrence of different types of CHD in the tertiary medical care institution in the period from January 1, 2016 till December 31, 2020. In this retrospective study, data were collected by reviewing medical history of both mothers and newborns. During the study period, there were 13,932 childbirths, and 42 newborns were diagnosed with CHD. Excluding the diagnoses of persistent duct of Botallo (n=4) and CHDs arising as a consequence of maternal condition (n=2), out of 36 newborns, 31 (86%) were diagnosed prenatally and 5 (14%) postnatally. The prevalence of CHDs was 30 per 10,000 births (3.0‰). In conclusion, the rate of prenatal diagnosis of CHDs was very high. The prevalence of CHDs was substantially lower than the European average published in the EUROCAT study for the 2016-2019 period. Additional education and examination algorithms need to be implemented to achieve more successful rates of prenatally diagnosed CHDs recorded in the best centers across Europe and the world.

This study aimed to evaluate prognostic values of the serum lipid panel data for development of macrovascular complications (MVC) in patients with type 2 diabetes mellitus (T2DM) alone and those with comorbid hypothyroidism (HT), diffuse non-toxic goiter (DNTG), or a combination of these disorders. The study included 596 inpatients. Receiver operating characteristic (ROC) analysis was used to identify prognostically significant values of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-cholesterol (non-HDL-C) and remnant cholesterol (RC). The following cut-off points that determine the relative risk of MVC development were established: TC >5.11 mmol/L, TG ≥2.03 mmol/L, LDL-C ≥2.97 mmol/L and non-HDL-C ≥4.29 mmol/L in T2DM patients with comorbid HT; TC ≥4.97 mmol/L, TG ≥2.54 mmol/L, LDL-C ≥3.21 mmol/L and non-HDL-C ≥4.20 mmol/L in T2DM patients with comorbid DNTG; and TC ≥4.89 mmol/L, TG ≥1.56 mmol/L, LDL-C ≥2.93 mmol/L, non-HDL-C ≥4.04 mmol/L and RC ≥1.14 mmol/L in those with comorbid HT and DNTG. Thus, serum levels of TC, TG, LDL-C, non-HDL-C and RC can be used for stratification of T2DM patients with comorbid thyroid dysfunction into the category of increased risk of MVC development.

Inflammation, axonal loss and demyelinating plaques in the brain, which are the background of multiple sclerosis, very often cause changes in speech or dysarthria, in a range from mild to so severe that they impair comprehension of speech by the interlocutor. As a consequence of multiple sclerosis, dysphagia can also occur. The aim of this paper is to present the speech and swallowing difficulties that result from multiple sclerosis, and the importance of assessing the speech and swallowing in people with multiple sclerosis. This article is descriptive and provides a comprehensive overview of the literature dealing with this topic. Speech difficulties impede daily functioning and are often the first sign that other people notice. Swallowing difficulties not only complicate daily life but, if not given sufficient attention, are a possible life-threatening consequence of multiple sclerosis. Assessment of speech and swallowing difficulties should be part of the clinical assessment in each person with multiple sclerosis. As multiple sclerosis progresses, so do speech and swallowing difficulties, and it is of utmost importance to provide appropriate treatment that can alleviate these difficulties. Speech-language pathologists should be part of a team making the diagnosis and providing treatment for a person with multiple sclerosis.

This research was conducted as a randomized study with the objective of determining the effects of breast milk, dry-keeping, and chlorhexidine methods used in umbilical cord care on the time of umbilical cord separation and on omphalitis and bacterial flora development. The study was carried out in 97 newborns divided into three groups, as follows: breast milk was used for umbilical cord care in group 1 of 32 newborns, dry-keeping was applied in group 2 of 35 newborns, and chlorhexidine was applied in group 3 of 30 newborns. Infants were assigned to three subgroups through randomization performed using a computer program. Swabs for culture were obtained from umbilical cord on postnatal day 2 and day 5. While difference in the results of the care methods applied was not significant on day 2, significant difference in the results was found on day 5. It was determined that there was no bacterial growth in 46.7% of the chlorhexidine group, while maximum bacterial growth was recorded in the dry-keeping group. In the chlorhexidine group, timing of umbilical cord separation was significantly shorter than in other groups. Study results indicated that the most effective method was the use of chlorhexidine. Dry-keeping can be risky since it was inefficient in preventing umbilical colonization, and in cases where the cost of chlorhexidine is an issue, the use of breast milk can be recommended.

Liver diseases are currently the eleventh leading cause of global mortality, and cirrhosis holds the ninth position among the causes of death in Europe. The progression of cirrhosis gives rise to complications such as portal hypertension (PH), liver failure, and development of hepatocellular carcinoma. PH plays a pivotal role in the advancement of chronic liver disease and stands as an independent predictor of mortality in individuals with cirrhosis. Given the numerous updates in the classification, diagnosis, and treatment strategies for PH, the adoption of national guidelines has become imperative to enhance the care of this patient population. In the wake of Baveno VII consensus, as well as the recently published data, the working group of the Croatian Society of Gastroenterology drafted the guidelines that were discussed and agreed during 2023. Herein, we present a condensed version highlighting the key recommendations.

Leukotriene receptor antagonists are a class of drugs used in maintenance therapy of asthma. Among the adverse effects induced by them, particularly by montelukast, is eosinophilic granulomatosis with polyangiitis (EGPA), which manifests as a form of vasculitis co-occurring with severe asthma and eosinophilia. Our aim was to point to the importance of this particular diagnosis by analyzing the published cases of montelukast induced EGPA and to analyze them in order to identify if this form of EGPA presented some specific characteristics. Leukotriene receptor antagonist induced EGPA is a frequent adverse event compared to EGPA induced by other drugs, and specialists should be aware of it. We observed that more than half of patients were female. Montelukast induced EGPA occurred after a variable period of time. The most common clinical manifestation was neuropathy and most of the patients had a good outcome after immunosuppressant treatment. The present diagnosis should be considered by physicians when patients are prescribed montelukast followed by worsening of symptoms.

Psychotherapy is an independent, interdisciplinary science that encompasses psychotherapeutic directions based on scientific principles and methods. Through the psychotherapeutic process, psychotherapy aims to achieve personal growth, remove or lessen the intensity of existing psychosocial, psychosomatic and behavioral problems and suffering, as well as help develop more functional patterns of behavior and experiences of interpersonal relationships or value systems. Research has shown that the COVID-19 pandemic has had a strong impact on psychotherapy in terms of the way it is carried out, change in the environment in which it is performed, and online psychotherapy has been introduced. The aim of this study was to find information, through available literature, on the impact of the pandemic on mental health and psychotherapy, and also to spread awareness about the current identified risks connected to the greater morbidity of psychiatric disorders and diseases and the need of psychotherapeutic interventions. Previous studies have shown that the pandemic increased the incidence of psychological disorders and diseases and the need of psychological intervention. Available data have shown that in the times of strict epidemiological measures during the COVID-19 pandemic, certain modifications of the psychotherapeutic process were made in terms of the use of online psychotherapy.

The specificities of student population may lead to an increased risk of adverse mental health outcomes during the COVID-19 pandemic. The aim was to evaluate the levels of perceived stress, anxiety, and depression in medical students during COVID-19 lockdown, and the relationship of these constructs with various sociodemographic variables. The study was conducted online from April 20 to April 29, 2020, during the first COVID-19 pandemic lockdown (using sociodemographic questionnaire and DASS-21 scale), on a sample of 420 students (female 81.7%, M_age=22.53) at the University of Kragujevac. The majority of participants (55%-58%) had no self-reported symptoms of depression, anxiety or stress, and the mean values were in-between the categories of 'without any symptoms' and 'with mild symptoms'. Predictors of exhibiting depression symptoms were previous psychological problems (odds ratio [OR]=3.16), family history of mental illness (OR=2.12), and relationship status (OR=0.61). For the symptoms of anxiety, predictors were female gender (OR=2.38), reported previous psychological problems (OR=3.91), and age (OR=0.92). Predictors of the symptoms of stress were female gender (OR=2.31), previous psychological problems (OR=3.18), and age (OR=0.91). The results of our study imply that certain factors influence the development of adverse mental health outcomes during this period, which should be taken into account when planning psychological interventions and services.

This study aimed to compare the renal resistive index (RI) as an early marker of renal damage between normoalbuminuric children with type 1 diabetes mellitus (T1D) and normal age-matched controls. A total of 76 children with T1D (aged 10-18 years) and 76 healthy age-matched controls were enrolled. Anthropometric parameters, blood pressure, glycated hemoglobin (HbA1c), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), serum uric acid (SUA), urine albumin/creatinine ratio (ACR), and degree of pubertal development were determined in all participants. RI was measured using Doppler ultrasound in both groups. The T1D group had lower sCr and SUA values and higher ACR and mean RI values than the control group. Using the expectation-maximization method, 2 clusters of T1D patients were identified. Cluster 2 with higher RI values, eGFR and HDL cholesterol was more prone to albuminuria and could carry worse prognosis. In conclusion, renal RI is increased in the hyperfiltration phase of diabetic nephropathy in children with T1D. Renal RI could be helpful as a marker for diagnosing diabetic nephropathy in the early preclinical course of the disease in normoalbuminuric children with T1D.