Uvod. Hronični bol u donjem dijelu leđa je sindrom uzrokovan različitim anatomskim i funkcionalnim poremećajima lumbalne kičme i njene okoline koji traje duže od tri mjeseca. Kvalitet života obuhvata subjektivni doživljaj vlastitog stepena funkcionisanja, ali i objektivnu ocjenu zdravstvenog stanja. Cilj rada. Procijeniti uticaj prisustva komorbiditeta na stepen funkcionalne onesposobljenosti kod pacijenata sa hroničnim bolom u donjem dijelu leđa. Metod. Istraživanje je kao studija presjeka obavljeno u Domu zdravlja Krupa na Uni u periodu od 01.10.2016. do 01.09.2017. godine. Uzorak je činilo 115 slučajno odabranih pacijenata, 50 (43,48%) muškaraca i 65 (56,52%) žena, prosječne starosti 46 ± 8,9 godina. Instrument istraživanja bili su upitnici Roland Morris Disability Questionnaire, Fear Avoidance Beliefs, Patient Health Questionnaire, Generalized Anxiety Disorder, Beck's Depression Inventory, kao i posebno kreiran opšti upitnik za potrebe istraživanja. Obrada podataka vršena je standardnim statističkim metodima. Rezultati. Statistički značajno povećanje funkcionalne nesposobnosti potvrđeno je kod sledećih komorbiditeta: hronični gastritis 28.7% (p=0,006), gojaznost (BMI > 25) 65.2% (p=0.007), alkoholizam 10.4% (p=0,004), nodozna struma štittaste žlijezde 6.1% (p=0.006), anksioznost 73.7% (p=0.035) i depresija 37.4% (p=0.042). Zaključak. Rano otkrivanje i odgovarajući pristup praćenja pridruženih bolesti kod osoba sa hroničnim bolom u donjem dijelu leđa u ambulanti porodične medicine, značajno bi smanjili funkcionalnu onesposobljenost, troškove zdravstvene zaštite i gubitak prihoda zbog izgubljene produktivnosti. Ključne riječi: komorbiditet, funkcionalna onesposobljenost, hroničan bol.
Food additive is any substance of known chemical composition that is not normally used as food in itself or is a typical food ingredient, regardless of nutritional value, and is added specifically for technological and organoleptic properties of food in the technological process of production, during preparation, processing, finishing, processing, shaping, packaging, transport and storage, which leads or can be expected to lead to the fact that he or his by-product directly or indirectly becomes an ingredient of that food. Food additives are a necessity in food production technology. Their use causes consumer distrust and controversy among the professional public. The negative attitude of a significant number of consumers due to the lack of awareness of the legislation that precedes the approval of food additives can be removed through open, transparent, independent, responsible / timely communication on risk. On the other hand, research on inadequate labeling, toxicity and the use of illicit food additives requires continuous monitoring, improvement of the control system and elimination of deficiencies. The safe use of food additives is a joint responsibility of the state, producers, distributors, the profession, ie laboratories, but also the consumers themselves.
Uloga hipotiroidizma U nastankU metaboličkog sindroma i hepatične steatoze Uvod: Kontrolisane studije ukazuju da smanjena funkcija štitne žlijezde može predstavljati nezavisni faktor rizika za nastanak elemenata metaboličkog sindroma i hepatične steatoze, koja se smatra jetrenom komponentom metaboličkog sindroma. Cilj: Istraživanje je imalo za cilj ispitati ulogu hipotiroidizma u nastanku metaboličkog sindroma i hepatične steatoze. Metode: Istraživanje je obuhvatilo 27 (54.0%) žena i 23 (46.0%) muškarca prosječne starosti 48 ± 6.9 godina sa verifikovanim hipotiroidizmom i 29 (58.0%) žena i 21(42.0%) muškarca prosječne starosti 45 ± 5.8 godina sa urednom funkcijom štitne žlijezde. Podaci su prikupljeni na osnovu anamneze, fizikalnog pregleda, dostupne medicinske dokumentacije, laboratorijskih analiza i ultrazvučnog pregleda. Rezultati: Hipotiroidizam (otvoreni i subklinički) ima statistički značajnu ulogu u nastanku metaboličkog sindroma i hepatične steatoze (p<0.05). Zaključak: Pravovremena dijagnoza i adekvatan terapijski menadžment poremećaja štitne žlijezde značajno bi smanjili incidencu kardiovaskularnih komplikacija, mogućnost nastanka steatohepatitisa, troškove zdravstvene zaštite i gubitak prihoda zbog izgubljene produktivnosti. Ključne riječi: hipotiroidizam, metabolički, sindrom, hepatična steatoza. Role of hypothyroidism in the onset of metabolic syndrome and hepatic steatosis Introduction: The comorbidity of metabolic syndrome and hypothyroidism results in significant progression of the atherosclerotic process, bearing in mind the overlap of pathogenic mechanisms. Reduced thyroid function is an independent risk factor for liver steatosis, which is considered a hepatic component of metsbolic syndrome. Objective: The study aimed to examine the role of hypothyroidism in the onset of metabolic syndrome and hepatic steatosis.
Polyphenols are compounds that contain in their structure one or more hydroxyl groups attached directly to one or more aromatic hydrocarbons. They represent one of the most numerous and widespread groups of secondary plant metabolites with more than 8000 polyphenolic structures. Polyphenols are antioxidants that reduce endothelial dysfunction and blood pressure, improve the immune defense, alleviate the inflammatory response, block platelet aggregation and oxidation of low-density lipoproteins. Some studies suggest that there is an indirect link between flavonoid intake and myocardial infarction and coronary heart disease. Dark chocolate, nuts, grapes, red wine and the Mediterranean diet (based on fruits and vegetables, fish and olive oil) are rich in polyphenols and are key in preventing cardiovascular disease. Polyphenols prevent neurodegenerative changes associated with cerebral ischemia. Blueberry anthocyanins have antiatherogenic and anti-inflammatory properties so they have a neuroprotective effect. Red wine extract, rich in anthocyanin, reduces injuries caused by cerebral ischemia. Food intake of polyphenols can reduce hypertension, anti-inflammatory and antioxidant effects, as well as increased production of nitric oxide. The importance of black and green tea in lowering blood pressure is especially pointed out. Further research on polyphenols is needed in order to make as clear recommendations as possible for their general preventive use.
bulantnog krvnog pritiska, signifikantan porast krvnog pritiska u jutarnjim časovima i tokom intenzivne fizičke aktivnosti. Ultrazvučnim pregledom se nalazi značajno povećanje dimenzija štitne žlijezde u odnosu na ranije nalaze, dok laboratorijska obrada detektuje hipotireozu. Pacijentkinja se upućuju u Zavod za nuklearnu medicinu gdje se indikuje totalna tiroidektomija. Mjesec dana nakon operacije pacijentkinja koristi Levotiroksin natrijum 100 mcg 1x1tokom 6 dana i 1x3/4 sedmi dan, dok je inicijalna antihipertenzivna terapija ograničena na Enalapril 5 mg 1x1. ZAKLJUČAK: Rana detekcija i adekvatna supstituciona terapija Hašimotovog tiroiditisa omogućava normalizaciju ili značajno smanjenje vrijednosti sekundarne hipertenzije, redukuje mogućnost nastanka ireverzibilnih promjena na krvnim sudovima i koegzistirajuće esencijalne hipertenzije. KLJUČNE RIJEČI: Hašimotov tiroiditis, sekundarna hipertenzija.
Introduction. Hashimoto's thyreoiditis has a complex effect on the gastrointestinal tract, which includes hormone receptor alteration, neuromuscular disorders, myopathies caused by intestinal wall infiltration. Case report. A 44-year-old patient appears in the family medicine clinic due to moderate pain in the lower part of the abdomen present for the past three months, which intensifies before defecation and stops immediately after defecation. He has two to four liquid stools daily in which he has not noticed the presence of mucus or blood for the past two months. He negates earlier illnesses as well as diseases relevant to heredity. Physical examination provides a neat finding. Ultrasound examination of the abdomen is within the age range. Thyroid ultrasound identifies the right flap of a 48x24x10 mm diametre with hypoechogenic calcified nodus 14x12 mm in diameter (meets the criteria of the American Thyroid Association for aspiration biopsy), left flap of 44x20x14 mm diameter. The following are the laboratory findings: TSH 7.66 mIU/l, FT4 6.42 pmol/l, TG 5080 ng/ml, calcitonin 8.94 pg/ml, TG-At 24.99 IU/ ml, TPO-At 500 IU/ml. The patient is instructed on a hygienic dietary regimen and includes spasmolytic and antidiarrheal, and referred to a nuclear medicine specialist who performs an aspiration biopsy (TBSRTC IV follicular tumor). The Oncology Consilium indicates surgery (right-sided lobectomy) with extempore verification and further follow-up. Pathohistological examination of the removed right lobe excludes the presence of malignant disease (struma coloides multinodosa glandulae thyroideae). Antidiarrheal therapy is discontinued and replacement therapy is administered (levothyroxine sodium tablets 50 mcg, qd). Subsequent proctosigmoidoscopy shows a neat finding. One year after surgery the patient is in remission of the disease. Conclusion. Diagnostic evaluation of the thyroid gland in patients with irritable colon syndrome significantly improves quality of life, reduces occupational absenteeism and health care costs.
Food intolerance is a non-immunological response induced by a food or food component in a dose that is normally tolerated. It includes pseudo allergic and pharmacological effects caused by: salicylates, biogenic amines, sulphites, sodium glutamate, colours and preservatives, sweeteners, or enzymopathies. The pathophysiology, clinical manifestations, diagnosis and treatment of the most common food intolerances have been presented in this review article. The literature search was done with the help of the following keywords: intolerance, food, additives, carbohydrates and gluten within PubMed, Embase, Scopus, SCIndeks and Hrčak databases. According to the literature, it may be argued that the lack of standardized tests accounts for the discrepancy between the perceived prevalence of food-related adverse effects, which are extremely common, and the actual prevalence of non-immunological reactions to food within these events. Food intolerance is manifested primarily by gastrointestinal and then extraintestinal (neurological, cardiovascular, respiratory and dermatological) signs and symptoms. Diagnosis requires a detailed medical history, physical examination, as well as keeping a diet and symptom diary, implementing an elimination diet and double-blind placebo-controlled oral food exposure tests. Treatment includes dietary modification, supplementation and treatment of the underlying condition in persons with secondary intolerance.
The concept of quaternary prevention was integrated in 1999. into the international WONCA vocabulary as actions taken to identify patients at risk of overprescribing drugs and diagnostic procedures that would do them more harm than good. The aim was to determine the place and role of quaternary prevention in primary care. The papers published until 31.12.2022. have been analyzed. We searched Medline, PubMed, Cochrane Library, Scopus, Google Scholar, Science Direct, Mendeley, Serbian medical journals, books, strategies, and doctoral theses. The terms we used were: quaternary prevention, general medicine, overmedication, and diagnostic procedures. We restricted ourselves to works written in Serbian, English, and Croatian. Search has been performed from 01.09.2022. to 31.12.2022. Preferred Reporting Items for Systematic Review (PRISMA) scale parts were used to determine the validity of the papers collected. A total of 1899 papers were identified. We did not find meta-analyses, systematic literature reviews, and randomized studies. A total of 194 were analyzed. Highlighted as relevant 36. Quaternary prevention in primary care refers to the overuse of radiological and laboratory examinations, antibiotics, screening, individual patient access, good communication, reliance on evidence-based medicine, the workload in teams of selected doctors, and prompt consent to patient requests. Some sick patients are undiagnosed, concerned about their health, with functional problems, psychosomatic disorders, and unusual behavior during illness. Quaternary prevention has a place in breast and prostate cancer screening, immunization, mental health and osteoporosis drug marketing, hypertension, prediabetes, and dyslipidemia, a private health insurance program, and the use of high-resolution diagnostic technology. The most powerful way to avoid unnecessary medical procedures is to consistently apply evidence-based medicine.
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