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Today, anesthesia and analgesia are so safe and effective that surgical procedures for cervical dysplasia can be performed as day surgery. Anesthesia techniques in day surgery are related to significantly less morbidity and mortality. Until 2015, all surgical procedures for cervical dysplasia at the Sestre milosrdnice University Hospital Center in Zagreb were performed under general anesthesia, with the average length of hospital stay longer than 30 hours and shorter than 72 hours. We have conducted retrospective research at the Department of Gynecology and Obstetrics for the period from January 2015 to December 2019, as cone biopsy procedures have been performed under local anesthesia since then. We have studied the frequency of local and regional anesthesia in relation to the type of cone biopsy, frequency of the type of anesthesia in relation to the age group and risk assessment of the patient undergoing anesthesia, and length of hospital stay in relation to the type of surgical procedure. In the period from 2015 to 2019, there was a steady increase in the share of local anesthesia in the total number of large loop excisions of the transformation zone (LLETZ) by 36.46 % (49/104 procedures in 2015 compared to 112/134 procedures in 2019). From October 2018, when the spinal block was introduced as a method of anesthesia for the cold knife cone biopsy, until December 2019, the share of the spinal block in the total number of cold knife cone biopsies increased by 17.29 % (2/65 procedures in 2018 compared to 11/54 procedures in 2019). Our research provides an analysis of the difference in the incidence of anesthesia techniques depending on the type of surgical procedure, risk assessment and age of the patient undergoing anesthesia for cervical dysplasia, and length of hospital stay in relation to the type of cone biopsy.

Objectives. Adherence to medication is an important factor that can influence Parkinson’s disease (PD) control. We aimed to explore patients’ adherence to antiparkinsonian medication and determine factors that might affect adherence to medications among PD patients. Methods. A cross-sectional, exploratory survey of PD patients treated with at least one antiparkinsonian drug and with a total score of MoCA (Montreal Cognitive Assessment) ≥26 was conducted. The final sample included 112 PD patients. A patient’s adherence was assessed through ARMS (Adherence to Refills and Medications Scale). ARMS scores higher than 12 were assumed lower adherence. In addition, each patient underwent neurological examination, assessment of depression, anxiety, and evaluation of the presence of PD nonmotor symptoms. Results. The mean ARDS value in our cohort was 14.9 ± 2.5. Most PD patients (74.1%) reported lower adherence to their medication. Participants in the lower adherence group were younger at PD onset, had significantly higher UPDRS (Unified PD Rating Scale) scores, as well as UPDRS III and UPDRS IV subscores, HARS (Hamilton Anxiety Rating Scale), and NMSQuest (Non-Motor Symptoms Questionnaire for PD) scores compared to the fully adherent group ( p = 0.013 , p = 0.017 , p = 0.041 , p = 0.043 , and p = 0.023 , respectively). Among nonmotor PD symptoms, the presence of cardiovascular, apathy/attention-deficit/memory disorders, hallucinations/delusions, and problems regarding changes in weight, diplopia, or sweating were associated with lower adherence. Multivariate regression analysis revealed depression as the strongest independent predictor of lower adherence. Conclusion. Depressed PD patients compared to PD patients without clinical depression had a three times higher risk for lower adherence to pharmacotherapy. Recognition and adequate treatment of depression might result in improved adherence.

Infertility is one of the major medical problems nowadays. Couples who opt for In Vitro Fertilization (IVF) face a great deal of stress which certainly affects the outcome of the procedure. Therefore, we aimed to reduce the stress during the oocyte retrieval procedure by applying midazolam. Total oxidant (TOC) and antioxidant (TAC) capacities of serum, as well as glutathione (GSH) content and catalase activity, were measured in both control and midazolam groups. Follicular fluid was also tested for oxidant capacity and IL1β. Results implied that the midazolam group increased TAC at the end of the procedure. At the same time, the control group decreased GSH at the beginning of the procedure, and both groups decreased catalase activity at the end of the procedure. The results imply that stress during the procedure affects oxidative and antioxidative parameters of the patients, but did not affect the frequency of the pregnancy at the end of this pilot study. Yet, the results imply that oxidative and antioxidative mechanisms during IVF should be investigated in detail as they could affect the outcome of IVF.

Danas su anestezija i analgezija tako sigurne i učinkovite da se kirurški zahvati kod displazije vrata maternice mogu obavljati unutar jednodnevne kirurgije. Anesteziološke tehnike u jednodnevnoj kirurgiji povezane su sa značajno manje morbiditeta i mortaliteta. Do 2015. godine svi su se kirurški zahvati kod displazije vrata maternice u Kliničkom bolničkom centru Sestre milosrdnice u Zagrebu radili u općoj anesteziji, a prosječni boravak u bolnici trajao je duže od 30, a kraće od 72 sata. U Klinici za ženske bolesti i porodništvo proveli smo retrospektivno istraživanje u periodu od siječnja 2015. do prosinca 2019. godine, budući da su se od tada zahvati konizacije započeli izvoditi u lokalnoj anesteziji. Proučavali smo učestalost opće i regionalne anestezije u odnosu na vrstu konizacije, učestalost vrste anestezije u odnosu na dobnu skupinu i procjenu rizika bolesnica za anesteziju, te duljinu hospitalizacije u odnosu na vrstu kirurškog zahvata. U periodu od 2015. do 2019. godine zabilježen je stalni porast udjela lokalne anestezije u ukupnom broju elektrodijatermijski odstranjenih transformacijskih zona velikom petljom (engl. Large loop excision of the transformation zone) za 36,5% (49/104 zahvata 2015. u odnosu na 112/134 zahvata 2019.). Od listopada 2018., kada je uveden spinalni blok kao metoda anestezije za konizaciju hladnim nožem, do prosinca 2019. godine udio spinalnog bloka u ukupnom broju konizacija hladnim nožem porastao je za 17,3% (2/65 zahvata 2018. u odnosu na 11/54 zahvata 2019.). Istraživanje prikazuje analizu razlike pojavnosti anestezioloških tehnika ovisno o vrsti kirurškog zahvata, procjeni rizika i životnoj dobi bolesnica za anesteziju kod displazije vrata maternice te duljinu hospitalizacije u odnosu na vrstu konizacije.

Tijekom posljednjih godina epiduralna analgezija za obezboljavanje vaginalnog porođaja primjenjuje se sve češće i jedna je od najčešće rabljenih regionalnih tehnika. Epiduralna anestezija uglavnom se rabi za hitni carski rez u rodilja koje već imaju postavljen epiduralni kateter za epiduralnu analgeziju tijekom vaginalnog porođaja. U rodilištu Kliničkoga bolničkog centra Sestre milosrdnice proveli smo retrospektivnu kohortnu studiju od 2008. do 2018. godine. Proučavali smo desetogodišnji trend incidencije epiduralne analgezije u odnosu prema ukupnom broju porođaja i incidencije epiduralne anestezije za hitni carski rez u odnosu prema ukupnom broju hitnih carskih rezova. U 2008. godini učestalost epiduralne analgezije u odnosu prema ukupnom broju porođaja bila je 21% (662/3125), a u 2018. godini 34% (1059/3083). U 2008. godini broj epiduralnih anestezija u odnosu prema ukupnom broju anestezija za hitni carski rez bio je 9% (51/552), a u 2018. 27% (172/639). Trend porasta vidljiv je kod obaju postupaka i iznosi 13% za epiduralne analgezije i 18% pri epiduralnim anestezijama., Over the years, epidural analgesia for pain relief of vaginal delivery is increasingly being applied and is one of the most frequently used regional techniques. Epidural anesthesia is mainly used in emergency cesarean section in parturients who already have an epidural catheter for epidural analgesia during vaginal delivery. In the delivery ward at the Sestre milosrdnice University Hospital Center we have conducted a retrospective cohort study from 2008 to 2018.We studied the incidence of epidural analgesia in relation to the total number of births and the incidence of epidural anesthesia for emergency cesarean section in relation to the total number of emergency cesarean sections. In 2008, the incidence of epidural analgesia in the relation to the total number of births was 21% (662/3125),and in 2018 it was 34% (1059/3083). In 2008, the number of epidural anesthesia for emergency cesarean section in the relation to the total number of emergency cesarean sections was 9% (51/552), andn in 2018 it was 27% (172/639). An increasing trend is seen in both procedures and is 13% for epidural analgesiaand 18% for epidural anesthesia.

Carski rez povezan je s povećanim brojem komplikacija i velikom postoperativnom boli koja uzrokuje produljenje oporavka za tri do pet dana u odnosu prema vaginalnom porođaju. Novijom kirurškom metodom FAUCS (engl. French Ambulatory Cesarean Section) smanjuju se poslijeoperacijske komplikacije i bolnost. U Klinici za ženske bolesti i porodništvo Kliničkoga bolničkog centra Sestre milosrdnice u Zagrebu započelo se primjenjivati ovu operacijsku metodu u ožujku 2019. godine, prvi put u Hrvatskoj. Spinalna (subarahnoidalna) anestezija jest anestezija izbora za ovakav zahvat zbog potrebe sudjelovanja rodilje pri ekstrakciji novorođenčeta. Bolnost je zahvata manja, stoga spinalna anestezija iziskuje nižu dozu lokalnog anestetika u odnosu prema uobičajenoj standardnoj dozi za carski rez. Sniženje doze lokalnog anestetika omogućuje brži oporavak motoričke funkcije, a samim time i bržu mobilizaciju rodilje. Uz spinalnu anesteziju kombinira se analgezija blokom ravnine transversusa abdominis (engl. Transversus abdominis plane – TAP block) na kraju zahvata. Blok TAP-a doveo je do potpunog uklanjanja boli tijekom prva 24 poslijeoperacijska sata. Potreba za medikamentnom terapijom boli smanjena je na najmanju moguću, a opioidni analgetici nisu bili potrebni. Ovakva kombinacija poštednijega carskog reza i regionalne analgezije omogućila je brži oporavak rodilje, što je povezano s brojnim dobrobitima i za majku i za dijete. Donosimo prikaz jedne od prvih primjena metode FAUCS uz spinalnu anesteziju i blok TAP-a u Hrvatskoj., Cesarean section is correlated with a higher number of complications and higher postoperative pain which prolongs recovery in comparison with vaginal delivery for three to five days. With a relatively new and advanced surgical technique French Ambulatory Cesarean section (FAUCS) there are fewer postoperative complications and lower pain scores. In our Clinical Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, we started with this surgical technique at the beginning of 2019 for the first time in Croatia. The choice of anesthesia for this procedure is spinal anesthesia because the cooperation of the patient is essential for successful extraction of the neonate. As this procedure is less painful it is possible to reduce the dosage of spinal local anesthetic in comparison with the usual dose for classical cesarean section. Lower local anesthetic dose enables faster recovery of motor function, and allows faster mobilization of the parturients. We combined spinal anesthesia with Trans-Abdominal Plain (TAP) block at the end of the procedure. TAP block led to the complete elimination of postoperative pain during the first 24 postoperative hours. The necessity for pain medication therapy after day one was reduced to minimal doses, and opiate analgesics were not used. This combination of less painful cesarean section and regional anesthesia enabled faster patient recovery with many benefits for the woman and the newborn. In this case report we present one of our first cases.

Delivery is a natural process associated with a certain level of pain. With today’s range of various pain relieving methods during labor, it is possible to shorten laboring, thus ensuring better compliance of parturient woman. Prepartal acupuncture is one of these methods. The results of this prospective study showed that prepartal acupuncture had a positive infl uence on pain experience of parturient women. There was no difference in duration of the fi rst stage of labor between comparable groups, even in the primipara group. This study found acupuncture to have a positive infl uence on psychological state of the parturient women and general compliance during labor. Acupuncture should be considered as one of the possible methods for pain relief in labor and preparation for labor., Porođaj je prirodni proces povezan s određenom jačinom boli. Uz današnji raspon raznih metoda za ublažavanje boli moguće je porođaj i vremenski skratiti te time osigurati bolju suradnju rodilje. Prepartalna priprema akupunkturom jedna je od takvih metoda. Rezultati ovoga prospektivnog istraživanja pokazali su da prepartalna priprema akupunkturom djeluje pozitivno na rodilje u smislu subjektivno manjeg osjećaja boli, no nismo uspjeli potvrditi da skraćuje prvu porođajnu dob. U skupini rodilja koje su bile na prepartalnoj pripremi akupunkturom 7/26 rodilja je porođaj smatralo laganim za razliku od skupine rodilja koje nisu prošle prepartalnu pripremu akupunkturom, gdje je samo 1/25 rodilja porođaj smatrala laganim. Analizom trajanja prve porođajne dobi nije bilo statistički značajne razlike među skupinama (trajanje prve porođajne dobi kraće od 4 sata imalo je 14/25 žena u kontrolnoj skupini, a samo 4/13 žena u akupunkturnoj skupini). Između skupina nije bilo ni statistički značajne razlike u trajanju prve porođajne dobi ni kada su se uzele u obzir samo prvorotkinje (trajanje prve porođajne dobi kraće od 4 sata imalo je 6/13 žena u kontrolnoj skupini i samo 4/16 žena u akupunkturnoj skupini). Ovo istraživanje ukazuje na pozitivan utjecaj prepartalne pripreme akupunkturom na psihičku stabilnost rodilje i dobru suradljivost te na važnost podizanja svijesti o akupunkturi kao mogućnosti jedne od metoda pripreme za porođaj.

Purpose: Previously, pain treatment following episiotomy has relied on non-steroid anti- inflammatory drugs as analgesics, whose use during breastfeeding remains controversial due of their transfer to the child. Methods: This was a pilot randomized parallel single-center study aiming to evaluate the effects of auricular acupuncture on pain relief after episiotomy. The primary outcome was reduction of pain intensity using visual analogue scale (VAS) scores during the first three postpartum days. The patients were allocated to either of the groups by using a heads-tails binary result coin toss method and the allocation was not masked. The study was completed after including 60 healthy women that underwent mediolateral episiotomy performed during vaginal delivery, with 29 receiving acupuncture therapy and 31 not receiving acupuncture therapy for pain relief. Oral analgesic therapy was made available per request for all patients. Results: This study showed that subjective experience of pain was significantly reduced in the acupuncture group on the second and third postpartum days (P = 0.004, P = 0.005, P = 0.22). There were no adverse effects of acupuncture noted. Conclusions: Our findings confirm that auricular acupuncture therapy may be a valuable adjunct to analgesic therapy in patients undergoing episiotomy during vaginal delivery. The results prompt a question whether our current 'best practice' may yet be improved.

Major demographic change and the globalisation of the market bring with them changes in our eating habits. A string of public health measures in Croatia is increasingly gaining in importance, particularly the ecological surveillance of various sectors of the environment, of which food is inevitably an element. The main objective of the various industries is to produce, process and distribute food which will meet the requirements of health and safety, through the joint efforts of all parties in the food chain. ISO and HACCP enable the continual, documented surveillance of food safety management. The most efficient systems of food safety are introduced, implemented and modernized within a structured management system, becoming incorporated into the overall management of the manufacturing organisation. This paper describes verification procedures for the HACCP system. The analytical reports given here are individual cases in the introduction and implementation of this international system on examples in the food industry and the benefits deriving from it. From the results of this research, the author draws conclusions on the need to synchronise standards in order to meet both legal obligations and European Union norms., Velike demografske promjene u društvu i globalizacija tržišta za sobom donose dodatne promjene u našim prehrambenim navikama. Čitav niz javno zdravstvenih mjera sve više dobiva na važnosti, pri čemu treba naglasiti mjere ekološkog nadzora različitih medija okoliša, od kojih je hrana neizostavljiv segment. Glavni je cilj prehrambenih industrija proizvesti, preraditi i distribuirati hranu zajedničkim naporima svih strana koje sudjeluju u lancu hrane, a koja će ujedno udovoljiti zahtjevima zdravstvene ispravnosti iste. Implementacijom ISO i HACCP normi se uspostavlja proces kontinuiranog i dokumentiranog nadzora u sustavu upravljanja sigurnosti hrane. Najdjelotvorniji sustavi sigurnosti hrane uspostavljaju se, provode i moderniziraju u okviru strukturiranog sustava upravljanja, te se ugrađuju u ukupne upravljačke aktivnosti proizvodne organizacije. U radu se opisuje postupak verifikacije HACCP sustava. Nadalje, analitički izvještaji prikazani u radu su pojedinačni slučajevi uvođenja i primjene međunarodnog standarda HACCP na primjeru subjekata u poslovanju sa hranom, kao i rezultata postignutih uspostavom istog. U završnom dijelu rada autorica temeljem dobivenih rezultata istraživanja donosi zaključke o potrebi usklađivanja standarda radi zadovoljavanja zakonskih obveza kao i normativa Europske Unije.