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Izgubljeno vrijeme u otkrivanju i početku liječenja tuberkuloze: što treba napraviti?

Ovim istraživanjem željelo se odrediti veličinu i analizirati čimbenike koji utječu na kašnjenje u otkrivanju i započinjanju liječenja tuberkuloze. Oboljeli od plućne tuberkuloze detaljno su intervjuirani o rizičnom načinu života, različitim demografskim, socioekonomskim i zdravstvenim obilježjima te je izračunano vrijeme od početka simptoma do početka liječenja. Medijan i 75. percentil navedenog vremena iznosili su 68 i 120 dana. Unutar mjesec dana od početka simptoma liječiti se počelo 16,7 % bolesnika, u drugome mjesecu 23,8 %, 23,3 % u trećem mjesecu, 12,9 % u četvrtome mjesecu, dok je 23,3 % ispitanika liječenje započelo više od četiri mjeseca nakon početka simptoma. Uporaba droga bila je povezana s vremenom dužim od medijana, što se smatralo dugim kašnjenjem (p=0,021) u otkrivanju i liječenju tuberkuloze. Najniži stupanj obrazovanja (p=0,021), minimalan (p=0,039) te minimalni do prosječni mjesečni obiteljski prihod (p=0,020), pušenje (p=0,050) i komorbiditet (p=0,048) pokazali su se značajnima kad je promatran 75. percentil izmjerenog vremena, što se smatralo ekstremnim kašnjenjem. U multiplome modelu uporaba droga ostala je značajno povezana s dugim kašnjenjem, a najniži stupanj obrazovanja (p=0,033), sadašnje (p=0,017) i bivše (p=0,045) pušačke navike s ekstremnim kašnjenjem. U uvjetima smanjivanja incidencije tuberkuloze kašnjenje u otkrivanju i liječenju tuberkuloze može se smanjiti zdravstvenim prosvjećivanjem opće populacije ne samo o tuberkulozi nego i općenito o zdravlju te stavovima i navikama glede prevencije i ranog liječenja. Istodobno se mora povećati i znanje o tuberkulozi te dijagnostičke sposobnosti zdravstvenih radnika.

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Respiratory Symptoms in Fish Processing Workers on the Adriatic Coast of Croatia

Respiratory Symptoms in Fish Processing Workers on the Adriatic Coast of Croatia

This article describes respiratory symptoms and lung function in 98 fish processing female workers employed in a fish processing plant located on the Croatian Adriatic coast and 95 matching controls. The study included chronic and acute respiratory symptoms which developed during the shifts. Lung function measurements included forced vital capacity (FVC), one-second forced expiratory volume (FEV1) and maximal expiratory rates at 50 % and the last 25 % (FEF50, FEF25). Chronic respiratory symptoms were significantly dominant in fish processing workers compared to controls. The most common chronic symptoms were hoarseness (57.1 %), nasal catarrh (51.0 %), chronic cough (42.9 %), chronic phlegm (34.7 %), and frequent chest cold (35.7 %). Exposed smokers and nonsmokers had a similar prevalence of chronic respiratory symptoms. Acute symptoms over the work shift were high, with headache in lead (smokers: 62.5 %; nonsmokers: 56.1 %). Most of the ventilatory capacity parameters were significantly lower than predicted, FEF25 in particular, indicating obstructive changes predominantly in the smaller airways. These findings suggest that fish processing workers are prone to developing acute and chronic respiratory symptoms as well as to lung function changes. This calls for medical and technical preventive measures to be introduced in the work environment of the fish processing plant.

Open access
Genital Herpes / Genitalni herpes

Abstract

Genital herpes is a chronic, nearly always active herpes simplex virus (HSV) infection of sacral ganglia, that may appear bilaterally and in more ganglia than previously thought. It represents one of the most prevalent sexually transmitted infections, and the most frequent cause of genital ulcer disease in the general populations of developed countries. It is caused by HSV type-2 (HSV-2) in 60-80% of cases, with HSV-1 infections causing the remainder. Genital herpes caused by HSV-1 is on the rise. Since genital HSV-1 infections have higher risk for transmission from mother to infant during delivery than HSV-2, they account for 30% of all cases of neonatal herpes. Serological studies have found prevalence of HSV-2 in the general population of developed contries to be up to 25%. Thirty years ago, herpes was defined as “Today’s Scarlet Letter”in the absence of reliable serological tests and highly effective medications, for diagnosis and treatment of genital herpes. In 2000, apart from virus isolation in cell culture (70% sensitivity), that has long been regarded as the diagnostic gold standard, type specific serological tests and higly effective antiviral agents have evolved. However, the following questions were raised: should serological testing be routinely recommended in asymptomatic patients; can antiviral therapy reduce asymptomatic shedding of the virus; can antiviral therapy reduce sexual transmission of infection; can antiviral therapy reduce acquisitation of viral copathogens, such as human immunodeficiency virus (HIV)? Now, ten years later, we know the answers. Type specific HSV DNA detection by real-time PCR assays (100% sensitivity) are tests of choice for every person with recurrent genital ulcers lasting more than 4 days, and must be available in those laboratories currently performing a significant number of PCR tests for different purposes. Type specific IgG serology assays are indicated in all asymptomatic persons who are at increased risk for HSV infection. In sexually active patients experiencing 6 recurrences per year, daily supressive dose of acyclovir, valacyclovir or famciclovir should be discontinued after a maximum of a year of continuous antiviral therapy in order to reassess recurrence frequency. If necessary, the therapy should be restarted after at least two recurrences. With such expansive diagnostic possibilities and more aggressive therapeutic approaches, we can define genital herpes not as a “Scarlet Letter”, but as a “widespread untoward consequence of human sexuality”.

Open access
Gene-Environment Interaction: A Genetic-Epidemiological Approach

Gene-Environment Interaction: A Genetic-Epidemiological Approach

Classical epidemiology addresses the distribution and determinants of diseases in populations, and the factors associated with disease causation, with the aim of preventing disease. Both genetic and environmental factors may contribute to susceptibility, and it is still unclear how these factors interact in their influence on risk. Genetic epidemiology is the field which incorporates concepts and methods from different disciplines including epidemiology, genetics, biostatistics, clinical and molecular medicine, and their interaction is crucial to understanding the role of genetic and environmental factors in disease processes. The study of gene-environment interaction is central in the field of genetic epidemiology. Gene-environment interaction is defined as »a different effect of an environmental exposure on disease risk in persons with different genotypes,« or, alternatively, »a different effect of a genotype on disease risk in persons with different environmental exposures.« Five biologically plausible models are described for the relations between genotypes and environmental exposures, in terms of their effects on disease risk. Therefore, the study of gene-environment interaction is important for improving accuracy and precision in the assessment of both genetic and environmental factors, especially in disorders of less defined etiology. Genetic epidemiology is also applied at the various levels of disease prevention.

Open access
Contribution of Selected Medicinal Plants for Cancer Prevention and Therapy

Contribution of Selected Medicinal Plants for Cancer Prevention and Therapy

Since time immortal, plants have been used for maintaining health and curing disease. With cancer being a widespread threat to humanity, plants play an important role in cancer prevention, as well as in therapy. Medicinal plants provide new active chemopreventive molecules. In addition, treatment with plants can ease side-effects as well as provide support to the fears and anxieties of the sick.

In this review, methods of exploring new plants and new active plant-derived compounds are described, including ethnobotanical research and screening procedures. Three newly researched medicinal plants, native of Israel, are selected, and new research findings related to their anticancer activities are presented.

The plants are: Crocus sativus, Vitex agnus-cactus and Withania somnifera.

All three plants are known in traditional medicine and their therapeutical uses are documented. Most findings are preliminary and further studies are required for clinical applications.

Open access
Urethritis and antimicrobial resistance

Abstract

Urethritis is a clinical syndrome which is characterized by mucopurulent or purulent urethral discharge with or without dysuria, due to an increased number of polymorphonuclear leukocytes in the anterior urethra. Antimicrobial therapy and preventive measures are essential in the management of bacterial urethritis. However, these drugs may cause antimicrobial resistance, resulting in unsuccessful treatment and complications of urethritis. Resistance of Neisseria gonorrhoeae to antibiotics is well known for decades, and in recent years there are more cases of resistance of Chlamydia trachomatis and Mycoplasma genitalium to different antibiotics. There is a danger that in the future certain strains of N. gonorrhoeae will be resistant to all available antimicrobial agents, unless new antibiotics to which resistance will not develop rapidly or an effective vaccine are developed.

Open access
Lipoproteins and other Risk Factors for Cardiovascular Disease in a Student Population

Summary

Background: Cardiovascular disease (CVD) is a major cause of mortality and morbidity in many populations, especially in developed countries. The aim of the study was to analyze the lipid status in a student population at increased risk for CVD in comparison with students who are not at increased risk for CVD.

Methods: This study included 238 students from the University of Novi Sad of both sexes (126 men and 112 women), with a mean age of 22.32±1.85 years. According to the body mass index (BMI) lower and higher than 25 kg/m2 and waist circumference (WC) of less and more than 94 cm (80 cm for females) the whole group of 238 students was divided into 2 subgroups: the group at increased risk for CVD (Group 1) and the group at lower risk for CVD (Group 2). Total cholesterol - TCH, triglycerides - TG, high density lipoprotein cholesterol - HDL-c, low density lipoprotein cholesterol - LDL-c, very low-density lipoprotein cholesterol - VLDL-c concentrations were determined and the index of atherosclerosis (IA), established risk factors RF-TCH/HDL-c ratio and non-HDL-c/HDL-c ratio were mathematically calculated.

Results: The values of TCH, LDL-c, non-HDL-c, VLDL-c and TG were significantly higher in Group 1 compared to Group 2 (P<0.001). IA, non-HDL-c/HDL-c and RF-TCH/HDL-c ratio were also significantly higher (P<0.001), while HDL-c was significantly lower (p<0.01) in Group 1 compared to controls. These results were not influenced by gender in both groups of subjects.

Conclusions: The data suggest that increased anthropometric parameters are followed by increased lipoprotein status in the group of students at increased risk for CVD and screening of the lipid status is necessary in students, especially in those who are at increased risk for CVD.

Open access
Human Lifespan: To Live and Outlive 100 Years?

Ljudski vijek: doživjeti i nadživjeti 100 godina?

Starenje populacije je dominantno demografsko obilježje razvijenih zemalja. Stogodišnjaci su selekcionirana skupina i samo jedna od 7.000 do 10.000 osoba dosegne tu dob. Čimbenici dugovječnosti vjerojatno su brojni i uključuju gensko predodređenje (lokus na 4. kromosomu), zdrav okoliš i zdrave životne navike (prehrana s malo kalorija), redovita tjelesna i psihička aktivnost, kao i dostupnost te učinkovitost zdravstvene zaštite s primjenom geroprofilakse. Stogodišnjaci se adaptiraju na novi život i na gubitak tjelesnih funkcija koji bivaju postupno sve izraženiji kako se dob povisuje. Granice ljudskog života produžuju se - do sada najstarija poznata osoba doživjela je 128 godina. Pojedina zemljopisna područja bilježe izrazito veći broj stogodišnjaka. Navedene su i neke dugovječne osobe s više od 100 godina u svijetu i na području Republike Hrvatske i nekih susjednih zemalja. Iako se uglavnom smatra da se granica trajanja života čovjeka ne može produžiti iznad 120 godina, za sada je ipak teško predvidjeti gdje su njezine granice.

Open access
Internet-Based Promotion of Safer Sex and Condom Use among Young People

Summary

Sex education is aimed at equipping individuals with sex-related information, motivation, and behavioral skills that will enable them to avoid sex-related problems and to achieve sexual well-being. Safer sex promotion and condom promotion and distribution programmes have grown significantly since the beginning of the AIDS epidemic. Condom use among young people is especially important because the young are often at greatest risk of HIV infection and have the least access to condoms. In many countries, where the Internet is part of the media landscape, not-for-profit agencies, governments and commercial condom companies alike have started utilising the Internet to promote safer sex and condom use. Most young people have regular access to the internet, and there is some expectation that the Internet is helping to fill the sexual health information gap. The development of an Internet-based, theoretically-driven, innovative approach to sex education weds the special strengths of the Internet as a rich, interactive, individualized pedagogical tool in order to provide effective sex education to large numbers of individuals in a very cost-effective fashion. The proposed approach exploits the characteristics of anonymity, availability, affordability, acceptability, and aloneness of using the Internet. Within this approach, learners are first individually assessed in terms of information, motivation, and behavioral skills deficits that are relevant to the individual's sexual problems and sexual well-being.

Open access
Actinic Keratosis: A New Approach to the Treatment / Aktinična Keratoza: Novi Pristup Lečenju

Abstract

Actinic keratosis is an intraepidermal proliferation of transformed, atypical keratinocytes, induced by exposure to solar ultraviolet radiation. Many authors believe that it is the earliest form of squamous cell carcinoma. More than 40% of all metastatic squamous cell carcinomas develop from actinic keratosis. The clinical, histological and molecular characteristics of actinic keratosis are those of squamous cell carcinomas. Since it can be extremely hard to distinguish actinic keratosis from some squamous cell carcinomas, treatment can be rather difficult. The best treatment of actinic keratosis is its prevention. The main reason for therapy which is universally accepted, is prevention of squamous cell carcinoma. A number of options are available, but when considering the efficacy, invasive procedures remain the standard treatment. Treatment of individual lesions may prevent further progression of actinic damage present in the surrounding skin

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