Quality of Life and Sexual Functioning of Women after Breast Cancer Surgery

BACKGROUND: Women with breast cancer can experience changes in sexual functioning and body images that can seriously affect their quality of life. AIM: The aim of this research was to study the quality of life and sexual functioning of women after a mastectomy and after a breast-conserving surgery and to compare post-operative quality of life. SUBJECTS AND METHODS: This cross-sectional study included 204 participants, 101 patients after a mastectomy and 103 patients after a quadrantectomy. The research was conducted using the Croatian version of the questionnaire of the European Organization for Research and Treatment of Breast Cancer, the questionnaire with the breast cancer module EORTC QLQ - BR 23. RESULTS: On the EORTC QLQ –BR23 scale, participants with mastectomy rated their sexual functioning (p < 0.001), sexual pleasure (p < 0.001), and systemic side effects (p = 0.04) lower comparing to women after breast-conserving surgery. The overall functionality scale was significantly lower (p = 0.03) for women who underwent mastectomy compared to those who underwent breast-conserving surgery. Participants under 51 years of age had worse body image 1 month after mastectomy (p = 0.006), while sexual functioning was better (p = 0.03) than in older age groups. In breast-conserving surgery group, 1 month after surgery, participants in the age group of 61 years and older assessed body image better (p = 0.04) than in the younger age group. Sexual functioning was rated better by women aged 51–60 years (p = 0.03). CONCLUSION: Results of this study show that women after breast conserving surgery have better quality of life, better sexual functioning and less side effects of systemic therapy compared to women after mastectomy. The type of surgery, patient’s age and time passed after completion of treatment are important factors which influence sexual functioning and quality of life in breast cancer survivors.

Epidemiologija problema mentalnog zdravlja u mladih s područja Osijeka, korištenjem upitnika snaga i teškoća (SDQ)

Introduction: Mental disorders begin at an early age. Screening is the first step in early intervention for the mental health problems of children and adolescents. The aim of this study was to analyse the prevalence of mental health problems among adolescents from Osijek, to early detect the risks of possible mental disorders, and to analyse gender differences. Materials and methods: The main screening instrument was The Strengths and Difficulties Questionnaire (SDQ), which assesses the emotional and behavioural difficulties of children and adolescents, as well as the prosocial skills. Over 5 school years (2012/13-2016/17), a total of 5787 students were examined. 5514 (95.3%) first-year students from 16 high schools and 273 (4.7%) seventh-grade students from 10 elementary schools were examined in the City of Osijek. Results: 10.4% of students had the borderline or abnormal score on the Total difficulties score. Girls had higher scores on the Total difficulties score (p<0.01), Emotional symptoms subscale (p<0.01), Prosocial behaviour subscale (p<0.01), and on the Hyperactivity/inattention subscale (p<0.01). On the Conduct problems subscale and the Peer relationships problem subscale, boys scored significantly higher than the girls (p<0.01). Conclusion: In the Osijek area, girls are more affected by mental problems than boys, scoring higher on the total scale, as well as on the emotional and hyperactivity scale. Whereas boys scored higher on the conduct and peer relationship scales. The data obtained through this screening allows for further planning of public health measures, preventive activities, treatment, and mental health promotion.

IMPORTANCE OF ZINC CONCENTRATION IN SEMINAL FLUID OF MEN DIAGNOSED WITH INFERTILITY

The prevalence and importance of male infertility make it a serious worldwide medical and social problem. The aim of this study was to determine if there were any significant differences in zinc concentrations in seminal fluid in men diagnosed with infertility compared to control group, and if there were, to determine how it affected the number and percentage of sperm cells with normal motility and morphology. A case-control study was conducted in the Osijek-Baranja County from January 2014 to June of 2015. The study included 276 subjects referred to biochemistry laboratory of the Osijek University Hospital Centre, 100 (36.2%) of them with low sperm count confirmed by spermiogram after 3 months. Semen samples were processed according to the World Health Organization criteria, and zinc concentrations were determined using spectrophotometry and direct colorimetry without deproteinization on a chemistry analyzer (Olympus AU 680, Beckman Coulter, Tokyo, Japan). Study results showed the men with low sperm count to be significantly older (Mann Whitney U test: p=0.013) and to have lower zinc levels (χ²-test: p<0.001). Further analysis included 100 (36.2%) patients with low sperm count. In the group of infertile men, those with low sperm count had higher zinc levels compared to men with azoospermia (Mann Whitney U test: p=0.036), suggesting a connection between lower zinc level in seminal fluid and male fertility. Zinc as a biological marker and an antioxidant affects sperm count, motility and morphology. Zinc supplemental therapy could improve seminal parameters in patients diagnosed with low sperm count. Dietary habits of the subjects differ regionally, and future research could make a solid foundation for complementary approach to treatment of male infertility.

Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study

The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.

THE EFFECT OF DAILY PHYSICAL ACTIVITY ON THE ACTIVITY OF INFLAMMATORY BOWEL DISEASES IN THERAPY-FREE PATIENTS

It has been suggested that various environmental factors play a very important role in the etiology of inflammatory bowel diseases (IBDs) and that they have a significant effect on the course of these diseases. The aim of this study was to investigate the effect of daily physical activity on the activity of IBDs in therapy-free patients. This cross-sectional population based study was conducted in eastern Croatia from January to June 2016. The study included 312 patients, mean age 49.9±15.0 years, 53.2% of males and 46.8% of females; there were 63.4% of ulcerative colitis (UC) and 36.6% of Crohn’s disease (CD) patients. Sociodemographic characteristics of patients, data on their daily physical activity and type of therapy taken were collected through a specifically designed and validated questionnaire, while the activity of UC and CD was evaluated using the Mayo index and Harvey-Bradshaw index. The study showed that 24.0% of patients were not taking therapy. Daily physical activity was connected to IBD in study patients when taking both diseases collectively (Fisher exact test; p<0.001), as well as to the inactivity of CD (Fisher exact test; p=0.001) and UC (Fisher exact test; p=0.006), when observing each disease separately. Daily physical activity was connected to the inactivity of IBDs in patients not taking therapy. It is necessary to educate all IBD patients about the importance of physical activity in order to control their disease.

Management of cervical ectopic pregnancy after unsuccesful methotrexate treatment

BACKGROUND

Cervical pregnancy is rare and dangerous form of ectopic pregnancy which can be treated surgically or conservatively. Methotrexate is reasonable conservative option with high efficiency and acceptable level of side effects. Aim of this paper is to present possible treatment option in case of methotrexate failure, still keeping the postulates of minimal invasive surgery.

CASE

We describe a case of cervical ectopic pregnancy in nulliparous female that was unsuccessfully treated with single dose, local, ultrasound guided intraamniotic methotrexate. Due to vaginal bleeding caused by remaining products of conception a hysteroscopic resection was performed.

CONCLUSION

Despite the problems that can occur in methotrexate treatment, it is still by far, cheapest and most effective treatment of cervical pregnancies. If necessary, procedure can be combined with other minimal invasive surgical procedures leading to satisfactory results. Hysteroscopic resection has enabled us to remove the product of conception from cervix making the minimal damage to the local tissue, thus preserving fertility.

Cervical cancer in Osijek-Baranja County--possibilities for prevention

In Osijek-Baranja County, there was a rise in the number of non-invasive and fall of invasive cervical cancer in the period 2000-2008, but cervical cancer still represents an important public health problem in Osijek-Baranja County. Cervical cancer in 2008 was the ninth female cancer site and represents 3.5% of all malignant diseases in women. In the same year it was also at the ninth place of all cancer deaths in women with a share of 3.3%. The large number of women cervical cancer was detected at an advanced stage of the disease so that there is an pincrease in mortality from cervical cancer. Although the incidence of cervical cancer is lower in relation to Croatia and other countries in the region, the mortality rate is still higher than in the countries of Western Europe. In order to reduce the incidence and mortality of cervical cancer primary task of the public health system is the introduction of secondary prevention through properly organized screening program. The program should be tailored to the financial and human resources and local specificities, with the agreement on a strategy that will give the best results.

Tumor-Cell-Targeted Methionine-enkephalin Analogues Containing Unnatural Amino Acids: Design, Synthesis, and in Vitro Antitumor Activity

A series of new peptides (8-25) containing different unnatural amino acids of the adamantane type (1-6), was synthesized. Possible cytotoxic activity on human cervical adenocarcinoma (HeLa), larynx carcinoma (HEp-2), colon carcinomas (HT-29, Caco-2), poorly differentiated cells from lymph node metastasis of colon carcinoma (SW-620), mammary gland adenocarcinoma (MCF-7), and melanoma (HBL) cells were tested by the MTT assay. The results were compared with the effect of methionine-enkephalin (Tyr-Gly-Gly-Phe-Met, or opioid growth factor, OGF), and its shorter N-terminal fragments. Peptide analogues containing C(alpha alpha)-dialkylated glycine (Aaa1, 1) or C(alpha)-alkylated glycine (Aaa2, 2) amino acid residues showed antitumor activity against melanoma, larynx carcinoma, colon carcinomas, and colon metastasis cell lines in vitro. The pentapeptide Tyr-(R,S)-Aaa2-Gly-Phe-Met (18) was the most effective analogue especially against the most antitumor drug-resistant cell lines HEp-2 and SW-620. Apoptosis as a mode of cell death was confirmed in these tumor cells after exposure to pentapeptide 18.