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Penava N, Tirić D, Soldo D, Alilović IŠ, Tomić V, Sulić J. Placenta previa percreta following caesarean delivery: two case reports. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4903074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Virović Jukić L, Grgurević I, Mikolašević I, Filipec Kanižaj T, Milić S, Mrzljak A, Premužić M, Hrstić I, Knežević-Štromar I, Ljubičić N, Ostojić R, Stojsavljević Shapeski S, Amerl-Šakić V, Marković NB, Rađa M, Soldo D, Sobočan N, Lalovac M, Puljiz Ž, Podrug K, Ladić D. CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE. Acta Clin Croat 2021; 60:36-52. [PMID: 35528151 PMCID: PMC9036273 DOI: 10.20471/acc.2021.60.s1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.
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Affiliation(s)
- Lucija Virović Jukić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
| | - Ivica Grgurević
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Dubrava University Hospital, Zagreb, Croatia
| | - Ivana Mikolašević
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Rijeka University Hospital Center, Rijeka, Croatia
| | - Tajana Filipec Kanižaj
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Sandra Milić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Rijeka University Hospital Center, Rijeka, Croatia
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Marina Premužić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Irena Hrstić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Pula General Hospital, Pula, Croatia
| | - Ivana Knežević-Štromar
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Neven Ljubičić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Rajko Ostojić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Sanja Stojsavljević Shapeski
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
| | - Vjekoslava Amerl-Šakić
- Vjekoslava Amerl-Šakić Family Medicine Practice, Zagreb, Croatia
- Coordination of the Croatian Family Medicine for Prevention Programs, Zagreb, Croatia
| | - Nina Bašić Marković
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Nina Bašić Marković Family Medicine Practice, Rijeka, Croatia
- Society of Teachers of General-Family Medicine, Rijeka, Croatia
| | - Marko Rađa
- Healthcare Center of the Split-Dalmatia County, Split, Croatia
- Croatian Family Medicine Society, Split, Croatia
| | - Dragan Soldo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Zagreb-Center Healthcare Center, Zagreb, Croatia
- Andrija Štampar School of Public Health, Zagreb, Croatia
- Croatian Society of Family Physicians, Croatian Medical Association, Zagreb, Croatia
| | - Nikola Sobočan
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Miloš Lalovac
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Željko Puljiz
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Split, Split, Croatia
- Split University Hospital Center, Split, Croatia
| | - Kristian Podrug
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Split University Hospital Center, Split, Croatia
| | - Dinko Ladić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Osijek University Hospital Center, Osijek, Croatia
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Ljubičić N, Poropat G, Antoljak N, Bašić Marković N, Amerl Šakić V, Rađa M, Soldo D, Štimac D, Kalauz M, Iveković H, Banić M, Turalija F, Puljiz Ž, Brkić Biloš I. OPPORTUNISTIC SCREENING FOR COLORECTAL CANCER IN HIGH-RISK PATIENTS IN FAMILY MEDICINE PRACTICES IN THE REPUBLIC OF CROATIA. Acta Clin Croat 2021; 60:17-26. [PMID: 35528152 PMCID: PMC9036274 DOI: 10.20471/acc.2021.60.s2.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Colorectal cancer is a malignant neoplasm which has an increasing incidence and represents a global public health problem. The majority of patients are diagnosed after the age of 50, and the risk of developing it over lifetime is 5%. Development of preventive, diagnostic and treatment methods has resulted in a significant reduction in mortality and other negative clinical outcomes. Precisely because of the efficient method of prevention and early detection of this disease, numerous countries, including Croatia, have organized national colorectal cancer screening and monitoring programs. However, these programs are primarily organized for the population with the usual, i.e. average risk of developing colorectal cancer. High-risk groups include persons with endoscopically detected and removed colon polyps, persons surgically treated for colon cancer, persons with a positive family history of colorectal cancer, persons with inflammatory bowel diseases, individuals and families with hereditary disorders or genetic mutations that increase the risk of this disease several fold, persons with acromegaly, and patients who have undergone ureterosigmoidostomy. Recommendations for the detection and monitoring of high-risk groups are often not defined clearly, and some of the existing ones are based mostly on scarce scientific evidence. It is commonly accepted that screening in high-risk groups should start at an earlier age, with shorter intervals between follow-ups. The basic diagnostic method for screening and monitoring in these patient groups is endoscopic monitoring, or colonoscopy. The aim of this review paper is to present the characteristics of the abovementioned risk groups and provide clear screening recommendations.
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Affiliation(s)
- Neven Ljubičić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
| | - Goran Poropat
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Rijeka University Hospital Center, Rijeka, Croatia
- Croatian Society of Gastroenterology, Rijeka, Croatia
| | - Nataša Antoljak
- School of Medicine, University of Zagreb, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
| | - Nina Bašić Marković
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Nina Bašić Marković Family Medicine Practice, Rijeka, Croatia
- Society of Teachers of General-Family Medicine, Rijeka, Croatia
| | - Vjekoslava Amerl Šakić
- Vjekoslava Amerl Šakić Family Medicine Practice, Zagreb, Croatia
- Coordination of the Croatian Family Medicine for Prevention Programs, Zagreb, Croatia
| | - Marko Rađa
- Healthcare Center of the Split-Dalmatia County, Split, Croatia
- Croatian Family Medicine Society, Split, Croatia
| | - Dragan Soldo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Zagreb-Center Healthcare Center, Zagreb, Croatia
- Andrija Štampar School of Public Health, Zagreb, Croatia
- Croatian Society of Family Physicians, Croatian Medical Association, Zagreb, Croatia
| | - Davor Štimac
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
| | - Mirjana Kalauz
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
| | - Hrvoje Iveković
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Marko Banić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Franjo Turalija
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
- Franjo Turalija Family Medicine Practice, Zaprešić, Croatia
| | - Željko Puljiz
- Croatian Society of Gastroenterology, Zagreb, Croatia
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
- School of Medicine, University of Split, Split, Croatia
- Split University Hospital Center, Split, Croatia
| | - Ivana Brkić Biloš
- National Monitoring Committee for the Implementation of the National Colon Cancer Early Detection Program of the Croatian Ministry of Health, Zagreb, Croatia
- Croatian Institute of Public Health, Zagreb, Croatia
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Augustin G, Mijatovic D, Zupancic B, Soldo D, Kordic M. Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review. J OBSTET GYNAECOL 2019; 39:587-593. [PMID: 30822180 DOI: 10.1080/01443615.2018.1540561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A small bowel prolapse through the vaginal introitus after a transvaginal instrumental gravid uterus perforation is a surgical emergency. To define the mechanisms of an irreversible, small bowel ischaemia due to small bowel prolapse through a vaginal introitus, ClinicalTrials.gov, PubMed, PubMed Central, and Google Scholar were searched. Out of the 81 articles screened, 28 cases of a small bowel evisceration through vaginal introitus were included. A small bowel obstruction severity grading was defined with risk factors; potential mechanisms of different severity grades after a transvaginal instrumental gravid uterine perforation with a vaginal evisceration. The duration of symptoms or a delay in the diagnosis did not change the incidence of the two most severe grades-mesenteric stripping and a small bowel degloving. Both obstruction types develop immediately during an instrumental abortion. The severity of obstruction does not influence the maternal outcome.
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Affiliation(s)
- Goran Augustin
- a Department of Surgery , University Hospital Centre Zagreb , Zagreb , Croatia.,b School of Medicine , University of Zagreb , Zagreb , Croatia
| | - Davor Mijatovic
- a Department of Surgery , University Hospital Centre Zagreb , Zagreb , Croatia.,b School of Medicine , University of Zagreb , Zagreb , Croatia
| | - Bozidar Zupancic
- c Department of Pediatric Surgery , Children's Hospital Zagreb , Zagreb , Croatia
| | - Dragan Soldo
- d Department of Gynecology and Obstetrics , University Hospital Mostar , Mostar , Bosnia and Herzegovina
| | - Mario Kordic
- e Department of Urology , University Hospital Mostar , Mostar , Bosnia and Herzegovina
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Soldo D, Mikulić-Kajić M, Spalldi Barišić L, Penava N, Orlović M, Soldo N, Kajić M. Effect of n-3 long-chain polyunsaturated fatty acids supplementation in healthy mothers on DHA and EPA profiles in maternal and umbilical blood: a randomized controlled trial. J Perinat Med 2019; 47:200-206. [PMID: 30315737 DOI: 10.1515/jpm-2018-0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
Abstract
Background The objective of the study was to compare the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dietary supplementation on their concentration in total lipids (TL) and lipid fractions of maternal and umbilical vein (UV) blood. The specific objective was to analyze the impact of EPA and DHA supplementation on pregnancy outcome and neonatal birth weight. Methods Women were randomly single-blinded (randomized controlled trial; ISRCTN36705743) allocated to the group receiving EPA and DHA supplementation (supplemented group) or the group receiving placebo-corn oil (control group) in the time period from January 1st, 2016 until March 1st, 2017. Women in the supplemented group (n=45) took 360 mg EPA and 240 mg DHA daily while controls (n=42) were given a placebo. Maternal and UV bloods were obtained at delivery. After lipid extraction, phospholipids (PL), cholesterol esters (CE), triacylglycerols (TG) and non-esterified fatty acids were separated by thin layer chromatography and analyzed by gas chromatography. Results Higher DHA concentrations in TL (37.24±21.87 mg/L), PL (13.14±8.07 mg/L) and triacylglycerols (2.24±2.21 mg/L) were recorded in mothers from the supplemented group when compared to the study group (TL 21.89±14.53 mg/L; P<0.001; PL 9.33±5.70 mg/L; P=0.013; TG 0.56±0.43 mg/L; P<0.001). Higher DHA concentrations in UV samples were found in TL (11.51±7.34 mg/L), PL (5.29±3.31 mg/L) and triacylglycerols (0.62±0.46 mg/L) from the supplemented groups compared with controls (TL 7.37±3.60 mg/L; P=0.002; PL 3.52±2.19 mg/L; P=0.005; TG 0.40±0.46 mg/L; P=0.035). The ratio of AA:DHA was lower in maternal (2.43) and UV serum (4.0) of the supplemented group than in the control group (maternal 3.85 P<0.001; UV 4.91 P<0.001). Conclusion The study demonstrated the higher ratio of AA/DHA in the control group indicating that pregnant women on the traditional Herzegovina diet need supplementation with DHA and EPA.
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Affiliation(s)
- Dragan Soldo
- Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Mostar Clinical Hospital Center, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Matija Mikulić-Kajić
- Specialist in Obstetrics and Gynecology at Health Center, Siroki Brijeg, Bosnia and Herzegovina
| | - Lara Spalldi Barišić
- Director of Ian Donald Inter-University School of Medical Ultrasound, Croatian Branch, and Specialist in Obstetrics and Gynecology at Private Clinic Veritas d.o.o, Zagreb, Croatia
| | - Nikolina Penava
- Department of Obstetrics and Gynecology, Mostar Clinical Hospital Center, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Martina Orlović
- Department of Obstetrics and Gynecology, Mostar Clinical Hospital Center, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Neven Soldo
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Martin Kajić
- Department of Surgery, Mostar Clinical Hospital Center, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
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Djelmis J, Ivaniševic M, Desoye G, van Poppel M, Berberovic E, Soldo D, Oreskovic S. Higher Cord Blood Levels of Fatty Acids in Pregnant Women With Type 1 Diabetes Mellitus. J Clin Endocrinol Metab 2018; 103:2620-2629. [PMID: 29722816 DOI: 10.1210/jc.2018-00272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/25/2018] [Indexed: 01/11/2023]
Abstract
CONTEXT Type 1 diabetes mellitus (T1DM) is associated with a disturbance of carbohydrate and lipid metabolism. OBJECTIVE To determine whether T1DM alters maternal and neonatal fatty acid (FA) levels. DESIGN Observational study. SETTING Academic hospital. PATIENTS Sixty pregnant women (30 women with T1DM with good glycemic control and 30 healthy women) were included in the study. Maternal blood, umbilical vein, and artery blood samples were collected immediately upon delivery. Following lipid extraction, the FA profiles of the total FA pool of maternal serum and umbilical vein and artery serum were determined by gas chromatography. RESULTS Total FA concentration in maternal serum did not differ between the study groups; it was significantly higher in umbilical vein serum of the T1DM group compared with that in the control group [median (interquartile range)]: T1DM 2126.2 (1446.4 to 3181.3) and control 1073.8 (657.5 to 2226.0; P < 0.001), and in umbilical artery vein serum: T1DM 1805.7 (1393.1 to 2125.0) and control 990.0 (643.3 to 1668.0; P < 0.001). Composition of FAs in umbilical vein serum showed significantly higher concentrations of saturated, monounsaturated, and polyunsaturated FAs (SFAs, MUFAs, and PUFAs, respectively) in the T1DM group than compared with those in the control group (P = 0.001). Furthermore, cord blood levels of leptin (P < 0.001), C-peptide (P < 0.001), and insulin resistance (P = 0.015) were higher in the T1DM group compared with controls. CONCLUSION The neonates born to mothers with T1DM had higher concentrations of total FAs, SFAs and MUFAs, as well as PUFAs, compared with control newborns.
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Affiliation(s)
- Josip Djelmis
- Referral Center for Diabetes in Pregnancy, Ministry of Health Republic of Croatia, Clinical Department of Obstetrics and Gynecology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marina Ivaniševic
- Referral Center for Diabetes in Pregnancy, Ministry of Health Republic of Croatia, Clinical Department of Obstetrics and Gynecology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Edina Berberovic
- Clinical Department of Obstetrics and Gynecology, Holy Spirit University Hospital, Zagreb, Croatia
| | - Dragan Soldo
- Department of Obstetrics and Gynecology, Mostar Clinical Hospital Center, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Slavko Oreskovic
- Referral Center for Diabetes in Pregnancy, Ministry of Health Republic of Croatia, Clinical Department of Obstetrics and Gynecology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
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Abstract
The aim of this review is to analyze the role of obesity on fertility outcome in women undergoing in vitro fertilization (IVF) with respect to clinical or live birth rates and pregnancy loss rates. Despite findings from several earlier and newer studies that obesity does not adversely affect pregnancy outcome in women attempting conception, numerous reports from mostly recent studies suggest that obesity undoubtedly impairs IVF outcomes. Obesity impairs ovarian responsiveness to gonadotrophin stimulation, requiring higher doses of medication, increased risk of cycle cancelation, pre-term delivery, low birth weight or miscarriage, and decreases implantation, clinical pregnancy or live birth rates compared to women of normal weight. The mechanisms underlying the adverse effects of female obesity on IVF outcome may be primarily explained by functional alterations to the hypothalamic-pituitary-ovarian axis. Additionally, obesity appears to affect deleteriously the number and quality of oocytes or embryos, and impairs endometrial decidualization which is necessary for uterine receptivity. Nevertheless, attaining normal body weight by the use of lifestyle modifications, including a healthy diet and exercise over time of several months before and during an IVF treatment, may be successful in achievement of gradual and sustainable weight loss with improvement of IVF outcome.
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Affiliation(s)
- Miro Kasum
- a Department of Obstetrics and Gynaecology, School of Medicine , University Hospital Centre Zagreb , Zagreb , Croatia
| | - Slavko Orešković
- a Department of Obstetrics and Gynaecology, School of Medicine , University Hospital Centre Zagreb , Zagreb , Croatia
| | - Ermin Čehić
- b Department of Obstetrics and Gynaecology , Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina
| | - Albert Lila
- c Gynaecology Cabinet , Kosovo Ocupational Health Institute , Giakove , Kosovo
| | - Emina Ejubović
- b Department of Obstetrics and Gynaecology , Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina
| | - Dragan Soldo
- d Department of Obstetrics and Gynaecology , University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina
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Orlovic M, Tomic V, Vukojevic K, Hudic I, Mandic V, Azinovic I, Soldo D, Kajic M, Soljic V. Decreased expression of MMP-9 in CD8 + cells in placenta with severe preeclampsia. Biotech Histochem 2017; 92:288-296. [PMID: 28498052 DOI: 10.1080/10520295.2017.1309069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We compared the number of CD4-positive (CD4+) and CD8-positive (CD8+) cells in severe and non-severe preeclampsia (PE), and in normal pregnancy. We also evaluated the expression of matrix metalloproteinase 9 (MMP-9) in CD4+ and CD8+ cells. Immunohistochemistry for CD4+ and CD8+ was performed on the decidua basalis of 15 severe and 13 non-severe PE women and compared to decidual tissue of 19 normal pregnancies (control group). Co-expression of MMP-9 with CD8+ and CD4+ cells was determined by double immunofluorescence staining. The median number of CD8+ cells/mm2 was significantly lower for the severe PE group than for the normal pregnancy group, as was the number of CD4+ cells and MMP-9+CD8+ cells. No statistical difference was found between the non-severe PE group and the normal pregnancy group. The significant decrease of CD4+, CD8+ and MMP-9+CD8+ cells at the fetal-maternal interface only in the severe PE group suggests that immunological disorders play a role in the pathophysiology of severe PE.
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Affiliation(s)
- M Orlovic
- a Department of Gynecology , University Hospital in Mostar
| | - V Tomic
- a Department of Gynecology , University Hospital in Mostar.,b Faculty of Health Studies , University of Mostar
| | - K Vukojevic
- c Laboratory of Morphology, Department of Histology and Embryology , School of Medicine, University of Mostar , Mostar , Bosnia and Herzegovina.,d Laboratory for Early Human Development, Department of Anatomy , Histology and Embryology, School of Medicine, University of Split , Split , Croatia
| | - I Hudic
- e Clinic of Gynecology and Obstetrics, University Clinical Center , Tuzla
| | - V Mandic
- a Department of Gynecology , University Hospital in Mostar
| | - I Azinovic
- c Laboratory of Morphology, Department of Histology and Embryology , School of Medicine, University of Mostar , Mostar , Bosnia and Herzegovina
| | - D Soldo
- a Department of Gynecology , University Hospital in Mostar
| | - M Kajic
- a Department of Gynecology , University Hospital in Mostar
| | - V Soljic
- c Laboratory of Morphology, Department of Histology and Embryology , School of Medicine, University of Mostar , Mostar , Bosnia and Herzegovina.,f Department of Pathology , Cytology and Forensic Medicine, University Hospital in Mostar , Mostar , Bosnia and Herzegovina
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Hoffmann K, Paget J, Wojczewski S, Katic M, Maier M, Soldo D. Influenza vaccination prevalence and demographic factors of patients and GPs in primary care in Austria and Croatia: a cross-sectional comparative study in the framework of the APRES project. Eur J Public Health 2016; 26:395-401. [PMID: 26936080 DOI: 10.1093/eurpub/ckw006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to compare influenza vaccination coverage rates in Austria and Croatia, countries with missing data in the Eurosurveillance and European Centre for Disease Prevention and Control reports. In addition, we assessed demographic factors of GPs and patients and calculated associations regarding vaccination rates. METHODS This cross-sectional study was conducted within the context of thethe appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance (APRES) project. Between November 2010 and July 2011, 40 GP practices attempted to recruit 200 patients to complete questionnaires about their influenza vaccination status and demographics. Statistical analyses included subgroup analyses and logistic regression models. RESULTS Data from 7269 patient questionnaires could be analyzed (3309 Austria and 3960 Croatia). The vaccination coverage rates were low (2009/2010: A 18.2 vs. C 20.9%, P < 0.001; 2010/2011: A 13.7 vs. C 18.6%; P < 0.001). The rates were found to be highest in persons aged 65 years and older (2009/2010: A 35.1 vs. C 49.5%, P < 0.001; 2010/2011: A 31.1 vs. C 45.7%, P < 0.001) and lowest in children (2009/2010: A 8.5 vs. C 2.0%, P < 0.001; 2010/2011: A 4.3 vs. C 1.6%, P = 0.002). Besides, demographics in the adjusted regression model for Austria being vaccinated was associated with consulting a female GP (OR, 4.20; P < 0.001) and in Croatia with five or more GP consultations per year (OR, 4.41; P < 0.001). CONCLUSION The vaccination coverage rates for Austria and Croatia were low, with the highest rates found in persons aged 65 years and older, showing that public coverage of the vaccination costs might increase vaccination rates. However, other factors seem to be relevant, including the engagement of GPs.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Silvia Wojczewski
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Milica Katic
- Department of Family Medicine, Andrija Stampar School of Public Health, Zagreb University School of Medicine, Zagreb, Croatia
| | - Manfred Maier
- Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Dragan Soldo
- Department of Family Medicine, Andrija Stampar School of Public Health, Zagreb University School of Medicine, Zagreb, Croatia
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Rahelić D, Altabas V, Bakula M, Balić S, Balint I, Marković BB, Bicanić N, Bjelinski I, Bozikov V, Varzić SC, Car N, Berković MC, Orlić ZC, Deskin M, Sunić ED, Tomić NG, Goldoni V, Gradiser M, Mahecić DH, Balen MJ, Erzen DJ, Majanović SK, Kokić' S, Krnic M, Kruljac I, Liberati-Cizmek AM, Martina L, Metelko Z, Mirosević G, Vrbica SM, Renar IP, Petric D, Prasek M, Prpić-Kizevać I, Radman M, Soldo D, Sarić T, Tesanović S, Kurir TT, Wensveen TT, Botica M, Vrkljan M, Rotkvic VZ, Zorić C, Krznarić Z. [CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES]. Lijec Vjesn 2016; 138:1-21. [PMID: 27443001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. PARTICIPANTS as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. EVIDENCE These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. CONCLUSIONS An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes.
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Katić M, Lazić K, Soldo D. [PALLIATIVE CARE OF PATIENT WITH GASTROINTESTINAL CANCER IN FAMILY MEDICINE]. Acta Med Croatica 2015; 69:233-244. [PMID: 29083558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person and his decision.
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Ozvacić Adzić Z, Katić M, Kern J, Lazić D, Cerovecki Nekić V, Soldo D. Patient, physician, and practice characteristics related to patient enablement in general practice in Croatia: cross-sectional survey study. Croat Med J 2009; 49:813-23. [PMID: 19090607 DOI: 10.3325/cmj.2008.49.813] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. METHODS A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged > or =18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. RESULTS In 5527 patients, the mean score (+/-standard deviation) for enablement at consultation was 6.6+/-3.3 and the mean consultation length was 11.5+/-5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P<0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P<0.05 for each). CONCLUSION Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice.
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Affiliation(s)
- Zlata Ozvacić Adzić
- Department of Family Medicine, Andrija Stampar School of Public Health, Zagreb University School of Medicine, Rockefellerova 4, Zagreb, Croatia.
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Katić M, Soldo D, Ozvacić Z, Blazeković-Milaković S, Vrcić-Keglević M, Bergman-Marković B, Tiljak H, Lazić D, Nekić VC, Petricek G. Information systems and the electronic health record in primary health care. Inform Prim Care 2007; 15:187-92. [PMID: 18005568 DOI: 10.14236/jhi.v15i3.658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.
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Affiliation(s)
- Milica Katić
- Department of Family Medicine, Andrija Stampar School of Public Health, University of Zagreb, Croatia
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Nekić VC, Tiljak H, Petricek G, Soldo D, Nekić G, Buljan N. [Quality of life assessment of the male with benign prostate hypertrophy]. Acta Med Croatica 2007; 61:49-55. [PMID: 17593641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Benign prostate hypertrophy (BPH) is prostate enlargement caused by the proliferation of the glandular, fibrous and muscular parenchyma of periurethral formations. BPH is a histological diagnosis with clinical manifestation of the lower urinary system symptoms. AIM The aim of the study was to assess the patients' quality of life and to identify BPH symptoms that do and do not influence the patients' quality of life. Assessment was made by use of IPSS questionnaire (International Prostate Symptom Score) and patients' own assessment. METHOD A prospective study of the BPH patients' quality of life was conducted at 5 family medicine practices. Statistical analysis was performed by use of SPSS software. RESULTS Data analysis showed the mean patient age to be 65.4 +/- 7.1 (X +/- SD) years. Medicamentous therapy was used in 86 and surgical therapy in 14 patients. The mean symptom duration was 8 +/- 4.3 (X +/- SD) years. Considering correlation of the quality of life with particular disease symptoms, results of this study showed only some BPH symptoms to influence the quality of life. The feeling of incomplete bladder emptying, weak urine stream and nocturnal frequency symptoms showed a statistically significant correlation with quality of life. Symptom score showed a statistically significant correlation with patients' quality of life assessment, i. e. the lower the quality of life assessment, the higher the symptom score. DISCUSSION The influence of only some disease symptoms on the patients' quality of life observed in this study could be explained by the small sample size, unfavorable distribution according to symptom presence, and treatment effects. CONCLUSION Most of our BPH patients had mild symptoms, however, in some patients symptoms were rather pronounced, requiring medicamentous or even surgical treatment. This prospective study included 100 patients from 5 family medicine practices, who filled out the IPSS questionnaire. Data analysis showed the mean patient age to be 65.4 years and mean duration of disease symptoms 8 years. Statistical analysis yielded no statistically significant difference in symptom duration among patients with mild, moderate and severe BPH symptoms. Considering correlation of the quality of life with particular disease symptoms, study results showed only some BPH symptoms to influence the quality of life. The feeling of incomplete bladder emptying, two urination intervals of less than 2 hours, weak urine stream and nocturnal urination frequency showed a statistically significant correlation with quality of life. The patients with mild BPH symptoms assessed their quality of life better than patients reporting moderate or even severe BPH symptoms. As BPH symptoms are significantly present in the male population over age 50, general/family practitioners should take in consideration the diagnosis of BPH, because this condition influences the quality of life as well sexual function in this male population age group.
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Affiliation(s)
- Venija Cerovecki Nekić
- Katedra za obiteljsku medicinu, Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet Sveucilista u Zagrebu, Hrvatska
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Vrcić-Keglević M, Katić M, Tiljak H, Lazić D, Nekić VC, Petricek G, Ozvacić Z, Soldo D. [Specialization in family medicine--has all the planned been achieved?]. Acta Med Croatica 2007; 61:95-100. [PMID: 17593648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The planned, comprehensive inclusion of general practitioners/family physicians in specialist education has begun with the project entitled Harmonization of Family Medicine Service with European Standards by the Implementation of Compulsory Residency. According to the Project, all physicians working in family medicine practice should have an opportunity to complete the respective residency by 2015. Analysis of the planned and completed family medicine residency in Croatia during the 2002-2006 period is presented. Of the total family medicine residency positions planned during the four-year period, 543 (90.5%) have been completed, with the greatest discrepancy recorded in program A applying to physicians younger than 35 having concluded a contract with the Croatian Institute of Health Insurance. In addition, this relationship varied among different countries. There are a number of obstacles hindering the Project implementation. However, it should be noted that the Project has made a breakthrough in upgrading the quality of family medicine practice, as a pledge of future development and rational performance of the entire health care system in Croatia, in order to promote the health care of the population at large.
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Affiliation(s)
- Mladenka Vrcić-Keglević
- Katedra za obiteljsku medicinu, Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet, Sveuciliste u Zagrebu, Zagreb, Hrvatska
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Jovanović A, Jurković L, Zlata O, Gluhak I, Soldo D. [Care for terminal cancer patients at general practitioner office]. Acta Med Croatica 2007; 61:63-8. [PMID: 17593643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The final goal of palliative care is symptom relief and improving the quality of life. Around 70% of cencer patients suffer pain. Therapy and care provided for dying cancer patients by general practitioners at Dugave-Travno GP Office were investigated. Medical records of 70 cancer patients were collected and analyzed. Sixty-seven patients had died. A total of 76 cancers at 22 various sites were diagnosed. There were 79 associated diseases diagnosed in 44 patients, along 43 diseases related to malignant disease in 26 patients. Physicians provided home nursing for 30 patients. In 66 cases family provided support. Physicians collaborated with community health nurses in 38 cases. A total of 66 patients were using analgesic therapy, 37 patients continuously, and 48 patients for up to one year. In 56 patients analgesic drugs were administered orally, in 25 parenterally, in 16 rectally, and in 21 patients transdermally. Physicians prescribed opioid therapy in 55 patients: codeine in 2, tramadol in 46, pentazocine in 7, methadone in 5, Kapanol in 15 and fentanyl in 21 patients. Sixty patients received adjuvant drug therapy. A total of 59 patients were hospitalized in terminal stage of the disease. Study results showed a high rate of associated diseases and diseases related to malignant disease in cancer patients. The collaboration between general practitioners and family members was satisfactory. Community health services should be improved, and the World Health Organization guidelines on palliative care, management of malignant pain in particular, should be more thoroughly followed.
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Affiliation(s)
- Aleksandar Jovanović
- Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet Sveucilista u Zagrebu, Zagreb, Hrvatska
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Civljak M, Ulovec Z, Soldo D, Posavec M, Oreskovic S. Why choose Lent for a "smoke out day?" Changing smoking behavior in Croatia. Croat Med J 2005; 46:132-6. [PMID: 15726687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
AIM To evaluate the impact on smokers' behavior of public health activity related to a religious event such as Lent in a predominantly Roman Catholic country. METHODS "Smoke out day" was organized on the first day of Lent, a period of self-denial for Roman Catholics, combining cultural and religious significance for Croatian people. The day was covered by a massive media campaign. Smoking behavior and attitudes to smoking were examined using a cross-sectional anonymous survey, conducted among 2,143 TV viewers and radio listeners aged 15 and older in their households. RESULTS More than 75% of the interviewed persons knew the exact date of the "Smoke out day." Among smokers, 27% had given up smoking on that day and 16% declared they would not smoke during Lent. Significantly more women (34%) than men (23%) abstained from smoking on the "Smoke out day" and more women (24% vs 10.8%) had decided to abstain from smoking during Lent. The majority of abstainers were in the 30-44 age group. The lowest response to antismoking campaign was from smokers with university education. CONCLUSION Antismoking mass media activity can influence smokers' behavior especially if it is connected to cultural and religious aspects. Some groups are much more sensitive to this kind of activities and may be, with a good media campaign and developed network of professional help and support, supported to transform their "Smoke out day" into a lifelong abstinence.
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Affiliation(s)
- Marta Civljak
- Department of Medical Sociology and Health Economics, Andrija Stampar School of Public Health, Zagreb University School of Medicine, Rockefellerova 4, 10000 Zagreb, Croatia.
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Posavec M, Civljak M, Soskić T, Soldo D, Simić Z, Oresković S. First toll free helpline for smoking cessation--analysis of results after one year of operation. Coll Antropol 2003; 27:461-7. [PMID: 14746132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The aim of the study was to prove that there is a strong need among the smoking population for the antismoking telephone helpline, and to describe the structure and dynamics of calls to the Call-center. Basic data on socio-demographic characteristics, smoking habits, and reasons for calling the Center were collected during telephone conversations with smokers. The data were entered into previously prepared tables. Statistical analysis included 7,452 telephone calls; most calls were received from persons aged 26-45 years (34%), followed by 19-24 (24%) and 45-60 (19%) age groups. There was no statistically significant difference in the number of calls between men and women (54% vs. 46%, respectively). Most callers consumed on average 20 cigarettes per day. The most frequent reason for calling was to get on how to stop smoking, whereas seeking information on professional literature was the least frequent reason for calling among our respondents. Four-fifths of persons making a call to the Center started smoking when they were between 16 and 20 years of age. We can conclude that there was a need for this type of intervention due to its accessibility and potentially wide coverage of interested users.
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Affiliation(s)
- Marija Posavec
- School of Public Health Andrija Stampar, School of Medicine, University of Zagreb, Zagreb, Croatia
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Brkljacic B, Sabljar-Matovinovic M, Putarek K, Soldo D, Morovic-Vergles J, Hauser M. Renal vascular resistance in autosomal dominant polycystic kidney disease. Evaluation with color Doppler ultrasound. Acta Radiol 1997; 38:840-6. [PMID: 9332241 DOI: 10.1080/02841859709172421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the performance of color duplex Doppler ultrasonography in the assessment of renal vascular resistance (RVR) by measuring resistive indices (RIs) and pulsatility indices (PIs) in patients with autosomal dominant polycystic kidney disease (ADPKD), and to correlate the measured values with renal function and the presence of arterial hypertension. MATERIAL AND METHODS In 42 patients with ADPKD and 65 control subjects, RIs and PIs were measured by means of color duplex Doppler sonography and correlated with clinical and laboratory findings and with morphological abnormalities at B-mode ultrasonography. RESULTS Mean RI in the control subjects was 0.59 +/- 0.03 (+/-SD) and in the patients 0.71 +/- 0.11, (p < 0.01). Mean PI in the controls was 1.00 +/- 0.11 and in the patients 1.69 +/- 0.21, (p < 0.01). Elevated RIs and PIs heralded a progression of ADPKD. Doppler indices correlated significantly with renal function tests and morphological changes in the affected kidneys at ultrasound. Significantly higher RIs (p < 0.01) and PIs (p < 0.04) were measured in hypertensive ADPKD patients as compared to normotensive patients. Correlation of patient age and Doppler indices did not reach statistical significance. CONCLUSION Doppler indices do reflect the increased RVR in patients with ADPKD and they correlate with renal function disturbance, with the development of systemic arterial hypertension, and with ultrasonographic abnormality of the kidney in these subjects.
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MESH Headings
- Adult
- Aged
- Arteries/diagnostic imaging
- Arteries/physiopathology
- Chronic Disease
- Female
- Humans
- Hypertension, Renal/diagnostic imaging
- Hypertension, Renal/physiopathology
- Kidney/blood supply
- Kidney/diagnostic imaging
- Male
- Middle Aged
- Polycystic Kidney, Autosomal Dominant/diagnostic imaging
- Polycystic Kidney, Autosomal Dominant/physiopathology
- Prospective Studies
- Pulsatile Flow
- Ultrasonography, Doppler, Color/instrumentation
- Ultrasonography, Doppler, Color/methods
- Ultrasonography, Doppler, Color/statistics & numerical data
- Vascular Resistance
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Affiliation(s)
- B Brkljacic
- Clinical Department of Radiology, University Hospital Merkur, University of Zagreb Medical School, Croatia
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Soldo D, Brkljacic B, Bozikov V, Drinkovic I, Hauser M. Diabetic nephropathy. Comparison of conventional and duplex Doppler ultrasonographic findings. Acta Radiol 1997; 38:296-302. [PMID: 9093169 DOI: 10.1080/02841859709172067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purposes of this study were: to compare conventional and duplex Doppler ultrasonography in the detection of renal changes in diabetes mellitus; to investigate whether a correlation was found with various clinical stages; and to assess whether increased renal vascular resistance in asymptomatic patients correlated with mild renal functional impairment. MATERIAL AND METHODS In 190 diabetic patients and 85 controls, conventional ultrasonography was used to assess renal length, parenchymal thickness, and cortical echogenicity. Renal vascular resistance was estimated by duplex Doppler measurements of intrarenal arterial resistive indices. According to clinical stage, the patients were classified into 3 groups. Resistive indices were compared between controls and patient groups and correlated with age and renal function. RESULTS In asymptomatic diabetic nephropathy, renal length and parenchymal thickness were significantly increased compared to that of controls, reflecting hyperfiltration-induced nephromegaly. Differences between controls and patients with clinically manifest nephropathy were insignificant; only in advanced renal disease were both values significantly decreased. Cortical hyperechogenicity was noted only in very advanced disease. Resistive indices correlated well with renal function, and pathologic values (i.e. > or = 0.70) were observed in 15% in the asymptomatic group and in 87% in the group with advanced nephropathy. CONCLUSION Renal changes in diabetic patients are detectable by conventional ultrasound only in very advanced stages of the disease. Pathologic resistive indices, however, may be detected in the earlier stages. Resistive indices correlate with serum creatinine levels and creatinine clearance rates. However, it remains unclear as to whether a diagnostic or prognostic benefit can be expected as compared to standard laboratory examinations.
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Affiliation(s)
- D Soldo
- Department of Medicine, University Hospital Dubrava, Zagreb, Croatia
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Brkljacic B, Sabljar-Matovinovic M, Putarek K, Soldo D, Morovic-Vergles J, Hauser M. Renal vascular resistance in autosomal dominant polycystic kidney disease. Acta Radiol 1997. [DOI: 10.3109/02841859709172421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Putarek K, Vuk T, Soldo D, Sarlija D, Grgicevic D, Jaksić B. [Pseudothrombocytopenia caused by ethylenediaminetetraacetic acid (EDTA) (case report)]. Lijec Vjesn 1997; 119:19-21. [PMID: 9213726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pseudothrombocytopenia is a laboratory artefact that can introduce serious problems in diagnosis and treatment in patients with low platelet count. The most common reason for this artefact is in vitro platelet clumping in blood samples collected into ethilenediaminetetraacetic acid (EDTA) anticoagulant. The clumping activity is greater at temperatures less than 37 degrees C, and the EDTA concentrations required for clumping are 20 times below anticoagulant concentrations. In this article we described the case of a female patient with diagnosed EDTA induced pseudothrombocytopenia. The cause of incorrectly low platelet counts was proved by simultaneous analysis in blood samples collected into EDTA anticoagulant and into heparin as a control sample. Absences of incorrectly low platelet count in heparin sample and rapid decrease of platelet count in EDTA sample were noticed. Decrease in platelet count was accompanied by increase in the number of leukocytes, so called pseudoleukocytosis. Careful examination of blood film is necessary to establish correct diagnosis, promptly after the blood collection and approximately two hours later. It is important to verify formation of clumps two hours after the blood collection and also progressive reduction in the platelet count in EDTA sample. By blood assessment conducted in this concern it is possible to avoid severe misinterpretation in such patients.
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Affiliation(s)
- K Putarek
- Odjel hematologije Klinike za unutarnje bolesti KB Merkur, Zagreb
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Brkljacić B, Mrzljak V, Drinković I, Soldo D, Sabljar-Matovinović M, Hebrang A. Renal vascular resistance in diabetic nephropathy: duplex Doppler US evaluation. Radiology 1994; 192:549-54. [PMID: 8029430 DOI: 10.1148/radiology.192.2.8029430] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate duplex Doppler sonography to assess renal vascular resistance (RVR) in diabetic patients. MATERIALS AND METHODS Resistive indexes (RIs) and pulsatility indexes (PIs) were measured in intrarenal arteries of 144 patients with diabetes mellitus and 61 control subjects. RIs and PIs were compared for control subjects and patients with diabetic nephropathy and correlated with laboratory and clinical findings. RESULTS In control subjects, the mean RI was 0.595 +/- 0.033 (standard deviation) and mean PI was 1.001 +/- 0.105. Elevated RIs and PIs accompanied progression of nephropathy. Statistically significant (P < .001) correlations were observed between both RI and PI and serum creatinine level, creatinine clearance rate, systolic and diastolic blood pressure measurements, and patient age. CONCLUSION Doppler indexes reflect increased RVR in diabetic nephropathy and correlate with laboratory and clinical parameters, but RI and PI measurements offer no advantages over these parameters to predict disease progress or in patient care.
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Affiliation(s)
- B Brkljacić
- Department of Radiology, University Hospital Merkur, Medical School, University of Zagreb, Croatia
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Brkljacić B, Drinković I, Sabljar-Matovinović M, Soldo D, Morović-Vergles J, Vidjak V, Hebrang A. Intrarenal duplex Doppler sonographic evaluation of unilateral native kidney obstruction. J Ultrasound Med 1994; 13:197-204. [PMID: 7932977 DOI: 10.7863/jum.1994.13.3.197] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
RIs were measured in intrarenal arteries in 66 kidneys of 33 examinees without renal impairment and in 42 kidneys of 21 patients with unilateral urinary obstruction. The mean RI in normal kidneys was 0.593 +/- 0.040. Patients with unilateral obstruction had a mean RI of 0.709 +/- 0.039 in obstructed kidneys and a mean RI of 0.591 +/- 0.033 in contralateral nonobstructed kidneys. Statistically significant differences have been noticed in the groups of normal versus obstructed kidneys (P < 0.001) and of obstructed versus contralateral nonobstructed kidneys (P < 0.001). The mean dRI was 0.118 +/- 0.034 in patients with unilateral obstruction, and it was 0.014 +/- 0.012 in examinees without renal impairment (P < 0.001). A comparison of RI values between the right and left kidneys in a patient with unilateral obstruction proved more useful than using a 0.7 RI cutoff value in a Doppler sonographic diagnosis of unilateral obstruction.
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Affiliation(s)
- B Brkljacić
- Department of Radiology, Medical Faculty of Zagreb, University Hospital Merkur, Croatia
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Gržeta-Plenković B, Popović S, Čelustka B, Ružić-Toroš Ž;, Šantić B, Soldo D. X-ray diffraction study of the system Ga2Se3–In2Te3. J Appl Crystallogr 1983. [DOI: 10.1107/s0021889883010717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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