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Статья посвящена инвазивным методам лечения болезни Паркинсона – глубокой стимуляции мозга и методу введения леводопа + карбидопа интестинального геля. Обсуждаются общие показания и противопоказания к назначению инвазивной терапии, а также индивидуальные особенности при отборе пациентов для проведения той или иной методики, преимущества и возможные осложнения каждого из методов, The article is devoted to the invasive methods of Parkinson’s disease treatment, i.e. deep brain stimulation and the method of levodopa/carbidopa intestinal gel injection. General indications and contraindications for surgical treatment are discussed along with the personalized features of patient selection for a particular method, advantages, and potential complications of each method.

Razvoj bio-tehnologije, snažno je utjecao i na razvoj medicinske struke što je zahvatilo i područje perinatalne medicine. Uz perinatalnu medicinu vežu se brojni bioetički prijepori eugeničkog mentaliteta, utemeljeni na omalovaženom biološko-antropološkom te pravnom statusu ljudskog embrija. Prenatalna dijagnostika provodi brojne zahvate invazivnih i neinvazivnihmetoda i pretraga koje se mogu izvoditi u prenatalnom periodu sa svrhom„pravovremenog“ otkrivanja potencijalnih bolesti i malformacija. Ovim testovima moguće je detektirati niz bolesti uključujući i one recesivno nasljedne. Iako je pobačaj vodeća nemoralna metoda „liječenja“ eventualno detektiranih oboljenja, prenatalna dijagnostika treba zadržati svoju terapeutsku narav čija je svrha medikamentno i kirurško fetalno liječenje. Predimplantacijska dijagnostika vezana je uz zametak stvoren:invitro, a najučestalija joj je svrha diskriminatorna provedba implantacije, isključivo, dobrih i zdravih zametaka. Samim time degradira se fetus i njegova svetost i nepovredivost ljudskog života. O toj problematici značajno progovara i Katolička Crkva u svojim brojnim dokumentima s ciljem očuvanja dostojanstva svakog čovjeka od ranog začeća. The development of bio-technology has strongly influenced the entire medical profession, which also affected the field of perinatal medicine. Perinatal medicine is as sociated with numerous bioethical controversies of the eugenic mentality, based on the underestimated biological-anthropological and legal status ofthe human embryo. Prenatal diagnostics carries out numerous interventions, using invasiv eand non-invasive methods and tests, that can be performedin the prenatal period with the purpos eof "timely" detection of potential diseases and malformations. With those tests, itispossible to detect a number of diseases, including recessively inheritedones. Although abortion is the leading immoral method of "treatment" of any detected diseases, prenatal diagnosis should retainitst herapeutic nature, the purpose of which is medical and surgical fetal treatment. Pre-implantation diagnostics is related to the embryo created: invitro, and its most frequent purpose is the discriminatory implementation of implantation, exclusively, of good and healthy embryos. This alone degrades the fetus and it´s sanctity and inviolability of human life. The Catholic Church also speaks significantly about this issue in its numerous documents with the aim of preserving the dignity of every human being from early conception.

Cilj rada: Svrha rada je detaljno prikazati načine uzorkovanja i metode otkrivanja infekcije uzrokovane bakterijom Helicobacter pylori te otkriti najučinkovitiju metodu dijagnosticiranja ove bakterije. Materijali i metode Dijagnostika infekcija uzrokovanih bakterijom Helicobacter pylori temlji se na uporabi invazivnih i neivazivnih metoda. U invazivne metode spadaju histološka analiza, kultura, brzi ureaza test i PCR metoda, dok u neinvazivne spadaju test dokaza antigena bakterije Helicobacter pylori u stolici, urea izdisajni test i serološki test. U Nastavnom zavodu za javno zdravstvo Splitsko – dalmatinske županije koristi se neivazivna metoda dokaza antigena bakterije Helicobacter pylori. Rezultati: Pozitivan nalaz kod ispitivanja prisutnosti bakterije Helicobacter pylori očitava se na testnoj kazeti pojavom dvije crvene linije: kontrolne i linije u T regiji testa za uzorak. Od 9 uzoraka ispitanih u Nastavnom zavodu za javno zdravstvo Splitsko – dalmatinske županije jedan je test bio pozitivan na ovu bakteriju. Zaključak: Helicobacter pylori je bakterija koja se prenosi kontaminiranom hranom i vodom, poljupcem ili fekalno – oralnim putem. Moguća je pojava asimptomatske infekcije, a ukoliko je simptomatska uzrokuje razne tegobe poput nadutosti, osjećaja žarenja u želudcu, gubitka apetita i povraćanja. Histološka metoda se i dalje smatra zlatnim standardom, međutim, radi raznih čimbenika koji ometaju proces dijagnostike, sve se više koristi neinvazivna metoda otkrivanja antigena bakterije Helicobacter pylori u uzorku stolice. Objectives: The aim of the study is to present in detail the methods of sampling and detection methods of infection caused by the bacterium Helicobacter pylori and to discover the most effective method for bacterial diagnosis. Material and methods: Diagnostic methods of infection caused by Helicobacter pylori bacteria are based on the use of invasive and non-invasive methods. Invasive methods include histological analysis; bacterial culture; rapid urease test and PCR method, while non-invasive include a test for evidence of Helicobacter pylori antigen in stool; urea breath test and serological test. The Teaching Institute for Public Health of Split-Dalmatia County uses a non-invasive method of proving Helicobacter pylori antigen. Results: A positive result for presence of the Helicobacter pylori antigen is interpreted on the test cassette by the appearance of 2 red lines: control line and the line in the T region for test sample. Out of 9 samples tested at the Teaching Institute for Public Health of Split-Dalmatia County, one of them was positive for bacteria. Conclusion: Helicobacter pylori is a bacterium that is transmitted through contaminated food and water, by kissing, or fecal-oral route. Asymptomatic infection is possible. If infection is symptomatic, it causes various complaints such as bloating, burning sensation in the stomach, loss of appetite and vomiting. The histological method is still considered the gold standard. However, due to various factors that interfere with diagnosis, a non-invasive method of detecting Helicobacter pylori antigen in a stool sample is increasingly being used.

Blood pressure (BP) measurement is the main monitoring parameter related to the cardiac system, and the use of animals is vital for understanding the physiological mechanism and studying pathologies related to this system. The most recommended measurement procedures in rodents in the literature are: The non-invasive method (tail cuff) and the invasive methods (catheter with fluid and telemetry). The objective of this study was to verify the main arterial measurement techniques in rodents, evaluate their positive and negative points and classify which is the most viable and effective technique for initial experimental tests. An integrative literature review was carried out using the descriptors and their respective synonyms, “real time device”, “blood pressure measurements”, “rats” using the Boolean “AND” in PubMed, Scielo and Medline databases. As inclusion criteria, articles that addressed the aforementioned theme, in Portuguese, English or Spanish, complete, from experimental trials on rodents, published within the last 21 years were adopted. As exclusion criteria were articles that were not available for full reading and studies that did not use rodents as a sample. Thirteen articles were selected that met the criteria. The results demonstrate that invasive methods can be advantageous for continuous measurements, but that it would be preferable to use the non-invasive method as it is safer and easier to perform. It is concluded that for initial experimental trials, the procedure to be chosen would be the non-invasive method, tail cuff. La medición de la presión arterial (PA) es el principal parámetro de monitorización relacionado con el sistema cardíaco, y el uso de animales es vital para comprender el mecanismo fisiológico y estudiar las patologías relacionadas con este sistema. Los procedimientos de calibración en roedores más recomendados por la literatura son: El método no invasivo (manguito de cola) y los métodos invasivos (catéter de fluidos y telemetría). El objetivo de este estudio fue verificar las principales técnicas de medición arterial en roedores, evaluar sus puntos positivos y negativos y clasificar qué técnica es la más viable y eficaz para los ensayos experimentales iniciales. Se llevó a cabo una revisión bibliográfica integradora utilizando los descriptores y sus respectivos sinónimos, “real time device”, “blood pressure measurements”, “rats” utilizando el booleano "AND" en las bases de datos PubMed, Scielo y Medline. Los criterios de inclusión fueron artículos que abordaran el tema mencionado, en portugués, inglés o español, completos, de ensayos experimentales en roedores, publicados en los últimos 21 años. Los criterios de exclusión fueron los artículos que no estaban disponibles para la lectura del texto completo y los estudios que no utilizaban roedores como muestra. Se seleccionaron trece artículos que cumplían los criterios. Los resultados muestran que los métodos invasivos pueden ser ventajosos para las mediciones continuas, pero que sería preferible utilizar el método no invasivo porque es más seguro y fácil de realizar. Se concluye que para los primeros ensayos experimentales, el procedimiento a elegir sería el método no invasivo, el manguito de cola. A aferição da pressão arterial (PA) é o principal parâmetro de monitoramento relacionado ao sistema cardíaco, e o uso de animais é vital para a compreensão do mecanismo fisiológico e estudo de patologias relacionadas a esse sistema. Os procedimentos de aferição em roedores mais recomendados pela literatura são: O método não invasivo (punho de cauda) e os métodos invasivos (cateter com fluido e telemetria). O objetivo deste estudo foi verificar as principais técnicas de medição arterial em roedores, avaliar seus pontos positivos, negativos e classificar qual a técnica mais viável e eficaz para ensaios experimentais iniciais. Foi realizado uma revisão integrativa da literatura utilizando os descritores e seus respectivos sinônimos, “real time device”, “blood pressure measurements”, “rats” fazendo o uso do booleano “AND” nas bases de dados PubMed, Scielo e Medline. Como critérios de inclusão foram adotados artigos que abordassem a temática supracitada, em português, inglês ou espanhol, completos, de ensaios experimentais em roedores, publicados com no máximo nos últimos 21 anos. Os critérios de exclusão foram artigos não disponíveis para leitura na integra e estudos que não utilizassem roedores como amostra. Foram selecionados 13 artigos que atendiam aos critérios. Os resultados demonstram que os métodos invasivos podem ser vantajosos para medições contínuas, mas que preferencialmente seria recomendado utilizar o método não invasivo por ser mais seguro e de fácil execução. Conclui-se que para ensaios experimentais iniciais, o procedimento a ser escolhido seria o método não invasivo, punho de cauda.

Prenatalna medicina u smislu probira genetičkih anomalija fetusa nastala je 60-ih godina prošlog stoljeća. U 21. stoljeću, s razvojem tehnologija napredne i brze analize genoma, kao što su kromosomalni microarray te sekvenciranje genoma sljedeće generacije (NGS), prenatalna dijagnostika proširila se s najčešćih aneuploidija na detekciju i brojnih drugih strukturalnih kromosomskih anomalija (povećanje broja kopija gena, delecije, duplikacije), kao i monogenskih bolesti. Osim klasičnih invazivnih tehnika (biopsija korionskih resica, amniocenteza) kojima se prikupljaju stanice za citogenetičku i genomsku analizu, danas je moguće neinvazivno probirno analizirati genom fetusa putem analize slobodne DNA (engl. cell-free DNA) izolirane iz krvi majke. S obzirom na svoju relativno veliku točnost, jednostavnost i mogućnost rane primjene, izgledno je da će ovakvo neinvazivno testiranje zamijeniti klasični probir u prvom tromjesečju koji je kombinirao biokemijske i fetalne ultrazvučne parametre, dočim je u nekim državama EU već uvedeno kao nacionalno podržana probirna metoda za najčešće aneuploidije. Stoga nema sumnje da će neinvazivni probir analizom cfDNA, zajedno uz korištenje modernih tehnologija sekvenciranja zasigurno sve više postati dijagnostički iskoristiv u prenatalnoj medicini. Ipak, problem možda leži u analizi genomskih podataka gdje se katkad detektiraju neobjašnjive promjene u slijedu nukleotida za koje je klinička signifikantnost nepoznata i još ne postoji jasno definiran postupnik kliničkog djelovanja nakon takvih podataka. Cilj ovog preglednog rada je iz različitih izvora, kliničkih podataka, preglednih članaka, te meta-analize izložiti koherentan pregled suvremenih metoda molekularne dijagnostike u prenatalnoj medicini, primjenjivih u invazivnim i novijim neinvazivnim postupcima. Budući da se recentno događa porast prevalencije neinvazivnih prenatalnih probira, naglasak rada je na njihovim principima i kliničkim postupcima. Istaknute su prednosti i mane korištenja metoda probira te analitičke mogućnosti pojedinih molekularnih metoda, s krajnjim kritičkim osvrtom i konceptualizacijom budućnosti ovakvih postupaka., Prenatal medicine, in terms of screening for fetal genetic anomalies, originates from the 60s of the last century. In the 21st century, with the development of advanced and rapid genome analysis technologies, such as chromosomal microarray and next-generation genome sequencing (NGS), prenatal diagnostics has expanded from the most common aneuploidies to the detection of many other structural chromosomal abnormalities (DNA copy number variations, deletions, duplications) as well as monogenic diseases. In addition to the classical invasive techniques (chorionic villus sampling, amniocentesis) that collect cells for cytogenetic and genomic analysis, today it is possible to screen the fetal genome for abnormalities noninvasively by analyzing fetal cell-free DNA isolated from the mother's blood. Given its relatively high accuracy, simplicity and possibility for early application during pregnancy, it is likely that such non-invasive testing will replace conventional first-trimester combined screening using biochemical and fetal ultrasound parameters, while in some EU countries it has already been introduced as a nationally supported screening method for common aneuploidies. Therefore, there is no doubt that non-invasive screening by cfDNA analysis, together with the use of modern sequencing technologies, will certainly become more diagnostically useful in prenatal medicine, yet the problem may lie in genomic data analysis where unexplained changes in nucleotide sequence are sometimes detected, with unknown clinical significance, and there is no clearly defined procedure for clinical action after receiving such data. The aim of this review paper is to present a coherent overview of modern methods of molecular diagnostics in prenatal medicine, applicable in invasive and recent non-invasive procedures, from various sources, clinical data, review articles, and meta-analysis. Since the prevalence of noninvasive prenatal screenings has been expanding recently, the emphasis of the work lies on their principles and clinical procedures. The advantages and disadvantages of using genomic screening methods and the analytical possibilities of individual molecular methods are highlighted, with the ultimate critical review and conceptualization of the future of such procedures.

Background: Prenatal diagnosis of chromosomopathies is an indispensable part of prenatal care and is performed in the first and second trimesters of pregnancy. It includes a range of invasive and non-invasive methods. Non- invasive screening methods are used to determine the risk of aneuploidies in the fetus, while invasive methods can be used to diagnostically confirm chromosomal abnormalities. A noninvasive method of prenatal screening that can reliably determine the risk of the most common chromosomal aneuploidies is noninvasive prenatal testing of cell-free circulating fetal DNA from maternal blood (NIPT). Aim: The aim of this study was to present the results of NIPT analyses performed at the Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, in the period from January 2019 to August 2022, and to compare the obtained results with karyotype analyses. Patients and methods: During this period, NIPT analyses of 80 pregnant women were performed, with a significant annual increase in the number of subjects. Results: No statistically significant association was found between the proportion of fetal fraction and gestational week, body mass index, and maternal age. NIPT was an independent indication for amniotic fluid cytogenetic analysis in 49% of cases, followed by a combination of NIPT and ultrasound and a combination of NIPT and maternal age. The combination of NIPT and ultrasound had the highest accuracy in assessing the risk of fetal aneuploidy. Conclusion: NIPT analyses were most reliable in assessing risk for trisomy 21, especially in a combination with ultrasound, whereas it was less reliable in assessing sex chromosome aneuploidies.

Kromosomske abnormalnosti vodeći su uzrok intelektualnog zaostajanja. Povezane su s kongenitalnim anomalijama koje mogu rezultirati perinatalnom smrti ili rođenjem djeteta s malformacijom. Cilj ovoga rada bio je prikazati učestalost numeričkih i strukturnih promjena kromosoma te opisati indikacije za prenatalnu dijagnostiku koja je provedena u laboratoriju za citogenetiku Zavoda za medicinsku biologiju i genetiku, Medicinskog fakulteta Sveučilišta u Rijeci, u razdoblju od 01.01.2004. do 01.09.2020. godine. U ispitivanom razdoblju analizirano je 4054 uzoraka plodove vode. Uredan kariotip detektiran je u 3837 (94,6%) uzoraka, dok je u preostalih 217 (5,4%) utvrđen aberirani kariotip. Numeričke promjene kromosoma detektirane su u 51% ispitivanih uzoraka, a najčešća je bila trisomija 21 (67%). Strukturne promjene detektirane su u 49% slučajeva od toga vodeća promjena bila je pericentrična inverzija kromosoma 9 (75%). U preostalih 25% (26/106) uzoraka detektirana je balansirana recipročna translokacija, najčešće naslijeđena od majke. Robertsonova translokacija utvrđena je u 27% uzoraka plodove vode te je također bila najčešće naslijeđena od majke. Kao vodeća indikacija u 217 ispitivanih uzoraka s detektiranom kromosomopatijom pokazala se dob majke (59%). Slijedi nalaz biokemijskog testa probira II tromjesečja (17%). Medijan starosne dobi ispitanica na dan zahvata iznosio je 37 godina (raspon od 19 do 48 godina), dok je medijan gestacijske dobi bio 17 tjedana (raspon od 11 do 28 tjedana). Rezultati rada prikazuju značajan pad broja analiziranih uzoraka plodove vode tijekom ispitivanog razdoblja, što je najvjerojatnije posljedica demografskih obilježja, ali i uvođenja osjetljivijih testova probira za kromosomopatije, kao i novih metoda molekularne kariotipizacije. Međutim, konvencionalna kariotipizacija i dalje predstavlja zlatni standard dijagnostike, prvenstveno u detekciji balansiranih strukturnih promjena, ali i mozaičnog kariotipa niskog stupnja mozaicizma., Chromosomal abnormalities are the leading cause of intellectual disability. They are associated with congenital anomalies that may result in perinatal death or with the birth of a child with malformation. The aim of this study was to present the frequency of numerical and structural chromosomal aberrations and to list the indications for prenatal diagnosis in the cytogenetic laboratory at the Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, in the period from 1stJanuary 2004 until 1stSeptember 2020. In the observed period, 4054 samples of amniotic fluid were analyzed. Normal karyotype was detected in 3837 (94.6%) samples, while the remaining 217 (5.4%) samples showed an aberrant karyotype. Numerical chromosomal aberrations were determined in 51% samples. The most common aberration was trisomy 21 (67%). Structural chromosomal changes were detected in 49% samples. Leading one was a pericentric inversion of chromosome (75%) in rest of 26 samples balanced reciprocal translocation, was found in 58% of the samples and mostly inherited from the mother . Robertsonian translocation was found in 27% of amniotic fluid samples and was most commonly inherited from the mother, too. The leading indication among 217 examined samples with detected chromosomopathies was maternal age (59%), followed by the biochemical screening test of the second trimester (17%). The median age of the participants was 37 years (range 19 to 48 years), while the median gestational age was 17 weeks (range 11 to 28 weeks). The results indicate a significant decrease in the number of prenatal diagnostic samples which is most likely due to demographic circumstances, as well as development of more sensitive screening tests for aneuploidies and new methods of molecular karyotyping. However, conventional karyotyping still represents the gold standard, primarily for the detection of balanced structural changes, but also for detection of the mosaic karyotype with a low degree of mosaicism.

Background & objectives: The non-invasive method of haemoglobin (Hb) estimation has unique advantages of exemption of finger prick and associated pain, over invasive methods. This study was done to compare invasive and non-invasive methods of Hb estimation in blood donors keeping haematology analyzer (HA) as a reference method. Methods: The blood donors selected or deferred on the basis of CuSO4 method (Hb ≥12.5 g/dl), were included in the study. Hb values of the donors were estimated by HemoCue and then by OrSense methods. An immediate post-donation venous sample was drawn for analysis on HA. Results: The mean Hb value was 13.98±1.27 g/dl on HA, 14.87±1.03 g/dl on OrSense and 15.03±1.31 g/dl on HemoCue. CuSO4, HemoCue and OrSense demonstrated sensitivities of 18.7, 18.7 and 13.1 per cent, positive predictive values (PPV) of 64.5, 83.3 and 60.9 per cent and specificities of 98.9, 99.6 and 99.1 per cent, respectively. The intra-class correlation coefficient for OrSense was 0.726 while that for HemoCue was 0.851. Bland-Altman plots demonstrated 2SD difference of >2.0 g/dl in Hb estimations between HA and HemoCue/OrSense. Interpretation & conclusions: The non-invasive modality may provide the near-ideal pre-donation Hb screening platform if an improvement can be done in the sensitivity and PPV of the non-invasive method keeping in view its unique advantages.

Prostata je muška spolna žlijezda, smještena u zdjelici između završnog crijeva i mokraćnog mjehura. Njezina uloga je lučenje alkalne mliječne tekućine, bitne za motilitet spermija. Karcinom prostate pripada najčešćim malignim bolestima u muškaraca. Mortalitet je u usporedbi s drugim malignim bolestima nizak, a u prilog tome govori spora progresija bolesti. Postoje mnogi potencijalni rizični faktori za nastanak bolesti, a najistaknutiji je dob muškarca. U svrhu kliničke dijagnostike bolesti koristimo DRP, koncentraciju PSA, TRUZ, a pri određivanju patohistoloških karakteristika koristimo se biopsijom i gradiranjem prema Gleason scoru. Kod dijagnosticirane bolesti TNM klasifikacijom se služimo da bi odredili klinički stadij. U trenutku kad imamo klinički dijagnosticiranu bolest možemo odabrat modalitet liječenja s obzirom na dob muškarca, razinu PSA, GS, TNM i ostale komorbiditete. Liječenje možemo započet aktivnim praćenjem, ukoliko se radi o dobro diferenciranom i ograničenom tumoru te ako je PSA < 10 ng/ mL. Standard kurativnog liječenja čine kirurški zahvati i radioterapija. Kirurški zahvati mogu biti otvoreni, laparoskopski i robotski asistirani. Retropubični i transperinealni su pristupi u otvorenoj kirurgiji. Brahiterapija je invazivna metoda radioterapije u kojoj tumorske stanice pokušavamo uništiti implantiranjem radioaktivnih izotopa u prostatu ili isporučivanjem radijacije putem igala transperinealnim pristupom. Kriokirurgija prostate je metoda u kojoj se koristimo krioprobama da bi isporučili hladnoću koja će uzrokovat nekrozu unutar prostate., Prostate is male reproductive system gland, situated in pelvis between rectum and bladder. Prostate function is secreting alkaline milky substance which helps motility of spermatozoa. Prostate cancer is among most common malignant disease in men. Mortality is low in comparison with other common cancers, which speaks in favour of slow progression of disease. There are many potential risk factors for disease development, most prominent is male age. In diagnostic evaluation digitorectal exam, PSA, transrectal ultrasound are performed. We use biopsy and Gleason grading score for patohistological characteristics. In diagnosis we use TNM classification to determin clinical stage of disease. When we confirm diagnosis of prostate cancer we can choose modality to treat it. Age of patiente, PSA, GS, TNM, comorbidities are considred. Treatment can be started as active surveillance if cancer is well diferentieted, localised and PSA under 10 ng/mL. Standard for curative treatment is consisted of surgery and radiotherapy. Surgery can be performe open, laparascopic or robot-asisted (laparoscopic). In open radical prostatectomy there are 2 ways to approach: retropubic and perineal. Brachytherapy is invasive method of radiotherapy in which tumor cells are destroyed by implanting radioactive isotops into prostate or conducting radioactivity through needles. Cryosurgery is method in which cryoprobes are used to deliver freezing element that will cause necrosis in prostate.

Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive—with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP. Thus, there has been substantial interest in developing noninvasive techniques for assessment of ICP. Several approaches were reported, although none seem to provide a complete solution due to inaccuracy. ICP measurements are fundamental for immediate care of TBI patients in the acute stages of severe TBI injury. In severe TBI, elevated ICP is associated with mortality or poor clinical outcome. ICP monitoring in conjunction with other neurological monitoring can aid in understanding the pathophysiology of brain damage. This review article presents: (a) the significance of ICP monitoring; (b) ICP monitoring methods (invasive and non-invasive); and (c) the role of ICP monitoring in the management of brain damage, especially TBI.

The diploma thesis deals with the education of children with disorders of autistic spectrum in Kindergartens. The theoretical part describes autism from the historical point of view and also the classification of disorders of the autistic spektrum and diagnostics. Educating of children with special educational needs, preschool education, appropriate support for children with disorders of autistic spectrum in preschool age, games with children with disorders of autistic spectrum, examples of used interventions in preschool age, services for children and their parents are also described in the theoretical part. The analytical part deals with forms of support of children with autistic disorders in normal Kindergarten and which methods are used in their education. The aim of this part was to find out in what form did the pedagogues got the knowledge about methods of supporting education of children with autism disorders. We did an interviews with three pedagogues to complete the survey. From our survey we found out that the padagogues mostly use the structured learning method. This method is considered as the most appropirate in domestic literature. KEY WORDS Pre-shool child, disorder of autistic spectrum, Kindergarten, invasive methods, special educational needs

Rođenje djeteta svakako je jedan od najvažnijih događaja u životu. Sama objava radosne vijesti o trudnoći je velika sreća za cijelu obitelj. Kako savjeti dolaze sa svake strane, najčešće među njima se nađu i pretrage koje bi trebalo obaviti. Tu se nalazi i rani kombinirani probir za otkrivanje najčešćih kromosomskih trisomija, a to su Down sindrom ili trisomija 21, Edwardsov sindrom, trisomija 18 i Patau sindrom ili trisomija 13. Svaki od navedenih stanja dovodi do problema tijekom trudnoće i nerijetko do spontanog pobačaja. U današnjoj modernoj medicini postoje brojne invazivne, ali i neinvazivne metode koje su sastavni dio organizirane prenatalne skrbi. Riječ je o prenatalnoj dijagnostici pomoću koje se dijagnosticiraju malformacije u genetskim, kromosomskim predjelima. Invazivni dijagnostički testovi i to poput amniocenteze ili biopsije korionskih resica se primjenjuju kod visoko rizičnih trudnoća. S druge strane, neinvazivne metode poput biokemijskih i ultrazvučnih testova, testovi probira, primjenjuju se za sve trudnice i to bez obzira na njihovu dob te bez obzira na osobno ili obiteljsko genetičko opterećenje. Svrha navedenih probira je utvrđivanje povećanog rizika za određeni poremećaj. Cilj ovog rada je prikazati koje su to invazivne i neinvazivne metode prenatalne dijagnostike, koji su testovi u prvom i drugom tromjesečju koji se preporučuju napraviti kako bi se dobio uvid u napredak trudnoće i zdravlje djeteta, te koja je upućenost i stav populacije o ranom otkrivanju anomalija u trudnoći. Nastojao se steći uvid koliko je populacija upućena u provođenje dijagnostičkih pretraga za probir najčešćih trisomija, da li su se žene podvrgavale takvim testovima, što misle koliko su zapravo potrebni, što bi uradili u slučaju pozitivnog testa na neku od kromosomopatija. U istraživanju je sudjelovalo 225 osoba. Najviše sudionika bile su žene različite dobne skupine. Istraživanje je provedeno pomoću vlastito osmišljene ankete koja se sastojala od 15 pitanja, provedena je na internetskoj stranici uz suglasnost administratora. Uključivala je opće podatke te podatke o stavovima za provođenje prenatalnih testova. Iz navedene statističke obrade u nastavku rada vidljivo je da su mišljenja podijeljena kad je riječ o važnosti provođenja dijagnostičkih testova, međutim većina žena koje su sudjelovale upoznate su s testovima i podvrgnule su se u prijašnjim trudnoćama testovima na najčešće trisomije koje se pojavljuju kod djece. Birth of a child is certainly one of the most important events in life. The very announcement of the happy news about pregnancy is a great happiness for the whole family. As tips come from each side, the most common among them are the searches that should be done. There is also an early combination screen for the detection of most common chromosomal trisomies, such as Down syndrome or trisomy 21, Edwards syndrome, trisomy 18 and Patau syndrome or trisomy 13. Each of these conditions leads to problems during pregnancy and often spontaneous abortion. In today's modern medicine there are numerous invasive but noninvasive methods that are an integral part of organized prenatal care. It is a prenatal diagnosis that is used to diagnose malformations in genetic, chromosome domains. Invasive diagnostic tests such as amniocentesis or biopsy of chorionic ress are used in high-risk pregnancies. On the other hand, non-invasive methods such as biochemical and ultrasound tests, screening tests, are applied to all pregnant women regardless of their age and regardless of their personal or family genetic load. The purpose of the above mentioned probira is to determine the increased risk for a particular disorder. The aim of this paper is to demonstrate the invasive and non-invasive methods of prenatal diagnosis, which are the first and second trimesters recommended to be made to gain insight into the progression of pregnancy and healthy baby, and which is the attitude and attitude of the population about early detection of anomalies In pregnancy. He was trying to gain insight into how many populations he was referring to in conducting diagnostic trials to screen for the most common trisomy, whether women had undergone such tests, as much as they needed, which they would do in the case of a positive test on some of the chromosomal abnormalities. There were 225 people involved in the study. The majority of participants were women of different age groups. The research was conducted using a self-made questionnaire consisting of 15 questions, carried out on the website with the consent of the administrator. It included general information and data on attitudes to conduct prenatal tests. From the above mentioned statistical work, it is apparent that the opinions were divided when it comes to the importance of conducting diagnostic tests, but most of the women who participated were familiar with the tests and were subjected to previous pregnancies with the most commonly occurring trisomy tests in children.

U odraslih, intrakranijski prostor je zaštićen lubanjom, rigidnom strukturom sa stalnim unutarnjim volumenom od 1400 do 1700 mL. U fiziološkim stanjima , dijelovi intrakranijskog prostora su ( po volumenima): moždani parenhim – 80%, CST – 10%, i krv 10%. Monro- Kellieva doktrina govori da porast jednog od ovih volumena uzrokuje smanjenje ostala dva. Intrakranijski tlak može biti povišen u TOM-u, akutnom ishemijskom moždanom udaru opskrbnog područja velike arterije, intrakranijskom krvarenju i difuznim moždanim poremećajima poput meningitisa, encefalitisa te akutnog zatajenja jetre. Povećani IKT je poznat i kao intrakranijska hipertenzija i definiran je kao IKT veći od 20 mm Hg. IKT je normalno manji kod djece nego u odraslih, a može biti i subatmosferski u novorođenčadi. Mora se naglasiti da IKT nije samo broj nego se moraju uzeti u obzir dugotrajno mjerenje odnosno izgled valova tlaka koji mogu ukazivati na određena patološka stanja. Mjerenje IKT-a može se vršiti invazivno i neinvazivno. Invazivna mjerenja mogu se vršiti na različitim anatomskim mjestima: intraventrikularno, intraparenhimski, epiduralno, subduralno i subarahnoidalno te sa različitim senzorima: tekućinom spojenih, mikroprijenosnika te pneumatskih. VDL se smatra zlatnim standardom zbog preciznosti mada su i senzori s mikroprijenosnikom gotovo jednako precizni. VDL ima isto prednost jer je ujedno i terapijska metoda dreniranja viška likvora koja uzrokuje porast IKT-a. Obje metode povezane su s komplikacijama poput krvarenja i infekcija. Nadalje, nulti pomak je problem povezan s određenim mikroprijenosnicima. Novije studije dovode u pitanje svrhovitost invazivnog mjerenja IKT-a. Pojavljuju se i novije metode telemetrijskog bežičnog mjerenja. Neinvazivne tehnike mjerenja su TCD, mjerenje pomaka bubnjića, ONSD, NIRS, mjerenje OT-a, te korištenje CT-a i MRI-a. Te tehnike nemaju komplikacije povezane s invazivnim pristupom ali nisu pokazale preciznost mjerenja dovoljno veliku kako bi se rutinski primjenjivale., In adults, the intracranial compartment is protected by the skull, a rigid structure with a fixed internal volume of 1400 to 1700 mL. Under physiologic conditions, the intracranial contents include (by volume) : brain parenchyma — 80 percent, cerebrospinal fluid — 10 percent and blood — 10 percent. Monroe -Kellie doctrine states that the rise in one of those volumes will cause decrease in other two. Intracranial pressure (ICP) can be elevated in traumatic brain injury, large artery acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure. Raised ICP is also known as intracranial hypertension and is defined as a sustained ICP of greater than 20 mm Hg. ICP is normally lower in children than adults, and may be subatmospheric in newborns. It must be emphasized that ICP is not just a number but its long-time dynamic must also be taken into consideration because some specific shapes of pressure waves can indicate pathologic states. The measurement of ICP can be done using invasive and non- invasive methods.Invasive methods of ICP measuring can be undertaken in different intracranial anatomical locations: intraventricular, intraparenchymal, epidural, subdural, and subarachnoidal. Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers are generally just as accurate. Ventriculostomy has also an advantage of being therapeutic method as well because excess of cerebrospinal fluid causing the raise of ICP can be easily drained. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. Newer studies have questioned the benefit of the invasive intracranal pressure measurement.New methods of telemetric wireless measurement techniques are also emerging. Non-invasive methods include transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, ocular pressure, near - infrared spectroscopy, CT scan and MRI. Those techniques are without the invasive methods risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement.

Since the first evidence demonstrating the dramatically high incidence of H. pylori infection and the subsequent medical challenges it incurs, health management of H. pylori infection has been a high priority for health authorities worldwide. Despite a decreasing rate of infection in western countries, prevalence of H. pylori infection in developing and in some industrial countries is still very high. Whereas treatment and vaccination against H. pylori is a contemporary issue in medical communities, selective treatment and prior high-throughput screening of the subject population is a major concern of health organizations. So far, diagnostic tests are either elaborative and require relatively advanced medical care infrastructure or they do not fulfill the criteria recommended by the Maastricht IV/Florence consensus report. In this review, in light of recent scientific studies, we highlight current and possible future approaches for the diagnosis of H. pylori. We point out that novel non-invasive tests may not only cover the requirements of gold standard methods in H. pylori detection but also offer the potential for risk stratification of infection in a high throughput manner.

Since the first evidence demonstrating the dramatically high incidence of H. pylori infection and the subsequent medical challenges it incurs, health management of H. pylori infection has been a high priority for health authorities worldwide. Despite a decreasing rate of infection in western countries, prevalence of H. pylori infection in developing and in some industrial countries is still very high. Whereas treatment and vaccination against H. pylori is a contemporary issue in medical communities, selective treatment and prior high-throughput screening of the subject population is a major concern of health organizations. So far, diagnostic tests are either elaborative and require relatively advanced medical care infrastructure or they do not fulfill the criteria recommended by the Maastricht IV/Florence consensus report. In this review, in light of recent scientific studies, we highlight current and possible future approaches for the diagnosis of H. pylori. We point out that novel non-invasive tests may not only cover the requirements of gold standard methods in H. pylori detection but also offer the potential for risk stratification of infection in a high throughput manner.

O presente artigo apresenta uma descrição de todos os métodos de diagnóstico pré-natal de anormalidades genéticas e cromossômicas, bem como dos relativos a doenças infecciosas na gravidez. O autor discute as diferenças entre eles, e as novas ferramentas da biologia molecular que são aplicadas nesses diagnósticos. Ao final é feita uma descrição da técnica de diagnóstico pré-implantação e de seu uso in vitro em laboratórios de fertilidade situados a mais de dois mil quilômetros um do outro.This article contains all the methods for pré-natal diagnosis of genetic and chromosomal abnormalities, as well infectious diseases in pregnancy. The author discuss the difference among them and the new tools of molecular biology applied in these diagnoses. At the end there is a description of the technique of pre-implantation diagnosis and its use in vitro fertility laboratories distant as long as 2000 kilometers one from the other.

O presente artigo apresenta uma descrição de todos os métodos de diagnóstico pré-natal de anormalidades genéticas e cromossômicas, bem como dos relativos a doenças infecciosas na gravidez. O autor discute as diferenças entre eles, e as novas ferramentas da biologia molecular que são aplicadas nesses diagnósticos. Ao final é feita uma descrição da técnica de diagnóstico pré-implantação e de seu uso in vitro em laboratórios de fertilidade situados a mais de dois mil quilômetros um do outro. This article contains all the methods for pré-natal diagnosis of genetic and chromosomal abnormalities, as well infectious diseases in pregnancy. The author discuss the difference among them and the new tools of molecular biology applied in these diagnoses. At the end there is a description of the technique of pre-implantation diagnosis and its use in vitro fertility laboratories distant as long as 2000 kilometers one from the other.