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Karačić A, Brkić J, Theunissen M, Sović S, Karimollahi M, Bakula B, Karačić J, Rosmarin DH. Are religious patients less afraid of surgery? A cross-sectional study on the relationship between dimensions of religiousness and surgical fear. PLoS One 2023; 18:e0287451. [PMID: 37440556 PMCID: PMC10343077 DOI: 10.1371/journal.pone.0287451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental health, particularly anxiety. OBJECTIVE This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia. DESIGN Cross-sectional study among elective surgery patients at different departments of a single hospital. SETTING University Hospital Sveti Duh, a tertiary health care facility in Croatia. MEASUREMENTS Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses. RESULTS 178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R2 = 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear. LIMITATIONS The study was single-center and cross-sectional and did not assess patients' specific religious identity. CONCLUSIONS This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.
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Affiliation(s)
- Andrija Karačić
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Jure Brkić
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Slavica Sović
- Statistics Department, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Branko Bakula
- Department of General Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Jelena Karačić
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, Basel, Switzerland
| | - David H. Rosmarin
- Spirituality & Mental Health Program, McLean Hospital, Belmont, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Karačić A, Theunissen M, Sović S, Sever M, Bakula B, Semanjski K. VALIDATION OF THE CROATIAN VERSION OF THE SURGICAL FEAR QUESTIONNAIRE (SFQ) IN ADULT PATIENTS WAITING FOR ELECTIVE SURGERY. Acta Clin Croat 2023; 62:153-161. [PMID: 38304381 PMCID: PMC10829953 DOI: 10.20471/acc.2023.62.01.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/12/2021] [Indexed: 02/03/2024] Open
Abstract
The Surgical Fear Questionnaire (SFQ) is an instrument for self-assessment of surgical fear and consists of two subscales, one assessing the fear of short-term consequences (SFQ-s) and another one of long-term consequences (SFQ-l) of surgery. The aim of this study was to test the Croatian version of the SFQ with regard to its psychometric properties. This prospective cohort study included patients who presented to the Department of Surgery for elective surgery in the inpatient setting at a tertiary health care facility in Croatia between April 1 and May 31, 2019. Data on 144 patients were suitable for data analysis. Data collection was performed in the afternoon before surgery using the Personal Information Form, Numerical Rating Scale self-report instruments (NRS), SFQ and Hospital Anxiety and Depression Scale (HADS) assessing sociodemographic factors, surgical fear via NRS and SFQ, expected pain and emotional state. The Cronbach alpha value as a statistical measure for reliability of psychometric tests for the SFQ-s subscale was 0.79, for SFQ-L subscale 0.84, and for total SFQ 0.81. The exploratory factor analysis (EFA) showed a two-factor structure. Significant correlations of the SFQ with the NRS and HADS-anxiety subscale were demonstrated. Our study demonstrated the Croatian version of the SFQ to have a high level of reliability and hence can be used as a self-report instrument for surgical fear with two subscales. Convergent validity of the SFQ with other self-report instruments is shown.
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Affiliation(s)
- Andrija Karačić
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Slavica Sović
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Sever
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Branko Bakula
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
| | - Kristina Semanjski
- Division of Digestive Surgery, Department of Surgery, Sveti Duh University Hospital, Zagreb, Croatia
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Bakula B, Karačić A, Stanić G, Romić I, Bakula M, Bogut A. Colorectal adenocarcinoma presenting with a pathological fracture due to a solitary bone metastasis to the tibia: a case report and literature review. Prz Gastroenterol 2023; 18:115-122. [PMID: 37007751 PMCID: PMC10050980 DOI: 10.5114/pg.2023.126044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/12/2021] [Indexed: 04/04/2023]
Abstract
Introduction Solitary bone metastasis of colorectal carcinoma (CRC) without other metastasis sites is extremely rare and can be found in less than 1% of patients with CRC. Aim In the present study, we report the first case of a solitary tibia metastasis and its pathologic fracture as the first presenting feature of a colorectal adenocarcinoma. Material and methods A 78-year-old female patient presented to our emergency department due to atraumatic pretibial swelling. Plain radiography did not detect any pathology. The swelling was incised and serous-bloody collection was evacuated, and the patient was discharged. On the 17th postoperative day, during a regular walk, the patient fell down and broke her leg, which transpired to be a pathologic fracture of the proximal tibial diaphysis, confirmed by X-ray. A biopsy of the altered bone tissue from the fracture site revealed metastatic colorectal adenocarcinoma. On colonoscopy, a circular mass in the upper rectum was found. Conclusions Solitary bone metastases are most commonly found in bones that are related to venous drainage via the paravertebral plexus of Batson - the pelvis, vertebrae, and sacrum. Long bones are extremely rare localizations of solitary CRC metastases, with only few cases published so far in medical literature. In our case, the patient`s first symptom was related to the osseous tibial metastasis - leg swelling. No tumour was suspected until the pathologic fracture occurred. It is important to consider osseous metastasis in every patient with unexplained swelling, haematoma, or pain of the extremities and make a bone scan to recognize the metastasis early.
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Affiliation(s)
- Branko Bakula
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Andrija Karačić
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
- Address for correspondence: Andrija Karačić MD, Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia, Sveti Duh 64, 10 000 Zagreb, Croatia, e-mail:
| | - Gabrijela Stanić
- Department of Pathology, University Hospital Sveti Duh, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirko Bakula
- Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ante Bogut
- Department of Gastroenterology, University Hospital Mostar, Mostar, Bosnia and Herzegovinia
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Soldo AM, Soldo I, Karačić A, Konjevod M, Perkovic MN, Glavan TM, Luksic M, Žarković N, Jaganjac M. Lipid Peroxidation in Obesity: Can Bariatric Surgery Help? Antioxidants (Basel) 2022; 11:antiox11081537. [PMID: 36009256 PMCID: PMC9405425 DOI: 10.3390/antiox11081537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity and chronic oxidative stress, often being associated with each other in a vicious circle, are important factors of chronic diseases. Although it was usually considered to accompany aging and wealth, global trends show the increase in obesity among children even in Third World countries. Being manifested by an imbalance between energy consumption and food intake, obesity is characterized by an excessive or abnormal fat accumulation, impaired redox homeostasis and metabolic changes often associated with the self-catalyzed lipid peroxidation generating 4-hydroxynonenal, pluripotent bioactive peroxidation product of polyunsaturated fatty acids. Conservative methods targeting obesity produced only modest and transient results in the treatment of morbid obesity. Therefore, in recent years, surgery, primarily bariatric, became an attractive treatment for morbid obesity. Since adipose tissue is well known as a stress organ with pronounced endocrine functions, surgery results in redox balance and metabolic improvement of the entire organism. The source of bioactive lipids and lipid-soluble antioxidants, and the complex pathophysiology of lipid peroxidation should thus be considered from the aspects of personalized and integrative biomedicine to treat obesity in an appropriate way.
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Affiliation(s)
- Ana Maria Soldo
- Department of Gastroenterology, General Hospital “Dr. Ivo Pedisic”, 44000 Sisak, Croatia
| | - Ivo Soldo
- Surgery Clinic, University Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Andrija Karačić
- Surgery Clinic, University Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
| | | | | | - Martina Luksic
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Neven Žarković
- Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
- Correspondence: (N.Ž.); (M.J.)
| | - Morana Jaganjac
- Division of Molecular Medicine, Ruder Boskovic Institute, 10000 Zagreb, Croatia
- Correspondence: (N.Ž.); (M.J.)
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Bakula B, Sever M, Karačić A, Bakula M, Grbavac M, Romic I, Bogut A, Zadro Z. Extensive Abdominal Skin Necrosis Following Anterior Component Separation for a Large Ventral Hernia: A Case Report. Front Surg 2022; 8:779046. [PMID: 34977144 PMCID: PMC8718503 DOI: 10.3389/fsurg.2021.779046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Hernia surgery is one of the most common operative procedures, performed in about 20 million cases per year all over the world, with ventral hernia accounting for about 30% of the cases. Although the introduction of the anterior component separation (ACS) method, popularized primarily by Oscar Ramirez, has greatly facilitated the closure of the largest abdominal wall defects, the 30-year experience in this technique has pointed to the risk of ischemic skin complications consequential to the major subcutaneous tissue dissection required. The aim of this case presentation of a patient who developed extensive necrosis of the abdominal wall skin following ACS procedure is to emphasize the importance of preserving rectus abdominis perforator blood vessels in order to preserve skin vitality. Case Presentation: We present a case of a 58-year-old female patient with a large recurrent ventral hernia. The hernial defect was closed by placing a large (30 × 25 cm) polypropylene mesh in the retro-rectus space using the Rives-Stoppa technique. To facilitate upper fascia closure ACS according to Ramirez was performed bilaterally. The rectus perforator vessels were not preserved. Recovery of the patient was complicated with the extensive abdominal skin necrosis which was successfully treated with negative pressure wound therapy. Discussion: Transection of the musculocutaneous perforators of the epigastric artery during ACS results with the compromised blood supply of the abdominal skin depending solely upon the intercostal arteries. Skin ischemia following ACS is a serious complication that can be presented with extensive necrosis associated with high morbidity and even mortality, while the treatment is long lasting, complex, and expensive. Considering the ever-increasing prevalence of large ventral hernias, ever greater popularity of the ACS technique, and the growing proportion of surgeons performing large ventral hernia operations independently, we think that the role of preserving perforated rectus vessels has not been emphasized enough. Therefore, the objective of this case study is to stimulate surgeons to preserve skin vascularity and promote it in their routine in order to avoid these severe postoperative complications.
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Affiliation(s)
- Branko Bakula
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Marko Sever
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Andrija Karačić
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Mirko Bakula
- Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Martin Grbavac
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
| | - Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ante Bogut
- Department of Gastroenterology, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Zvonko Zadro
- Department of Surgery, University Hospital Sveti Duh, Zagreb, Croatia
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Starčević N, Karačić A. Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options. Case Rep Orthop 2021; 2021:3530297. [PMID: 34580614 PMCID: PMC8464431 DOI: 10.1155/2021/3530297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking "classic" plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5 cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances.
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Affiliation(s)
- Neven Starčević
- Traumatology Department, University Hospital Sveti Duh, Sveti Duh, 64 Zagreb, Croatia
| | - Andrija Karačić
- Department of General Surgery, University Hospital Sveti Duh, Sveti Duh, 64 Zagreb, Croatia
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Delić D, Afechtal M, Djelouah K, Lolić B, Karačić A. First Report of Citrus tristeza virus in Citrus Orchards in Bosnia and Herzegovina. Plant Dis 2013; 97:1665. [PMID: 30716861 DOI: 10.1094/pdis-05-13-0548-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The citrus growing area in Bosnia and Herzegovina (B&H) is limited to the confluence of the river Neretva, which is close to the Adriatic coastal region. Approximately 6 ha are grown in the country. Mandarins (Citrus reticulata Blanco) and lemons (Citrus limon L.) grafted on trifoliate orange (Poncirus trifoliata (L.) Raf.) are the most cultivated species. In June 2012, 25 samples were collected from individual trees from three locations in Herzegovina district of B&H (Mostar, Čapljina, and Ljubuški). Samples of different Citrus spp. (C. reticulata Blanco, C. aurantium L., C. limon L., C. sinensis (L.) Osbeck, P. trifoliata (L.) Raf., and Fortunella margarita Lour) and varieties were collected from infield plants, commercial citrus orchards, and a nursery. Out of 25, 10 citrus trees exhibited leaves chlorosis, whereas as all others were apparently symptomless. Double antibody sandwich (DAS)-ELISA test, using commercial kit from the DSMZ, Germany (product code AS-0988), was carried out to confirm the presence of Citrus tristeza virus (CTV). In addition, further analyses were performed using reverse transcription (RT)-PCR targeting the coat protein gene (2). CTV was detected in 8 out of the 25 tested samples with DAS-ELISA, whereas CTV was detected in 14 samples by RT-PCR. Being grafted on P. trifoliata rootstock, no typical CTV symptoms in the field were observed on the CTV-infected trees; interestingly, the lab analyses evidenced the CTV presence in all inspected locations of the Herzegovina district. To our knowledge, this is the first report of CTV in Bosnia and Herzegovina; nevertheless, the virus presence is also reported from neighboring countries Croatia (1) and Montenegro (3). The PCR products of four samples were additionally analyzed by sequencing. The preliminary results by sequencing of the coat protein gene of four selected CTV isolates (Accessions HF947341, HF947342, HF947343, and HF947347) showed 99% nucleotide identity with the CTV resistance breaking isolates from Montenegro (FR871866) and Croatia (EU579422). Although a very small number of samples were tested in this study, CTV appears to be widely distributed in the citrus orchards of the country. This could be related to the traditional use of tolerant P. trifoliata rootstock that prevents the development of the tristeza decline as well as to the virus isolates present in the region, which appear not to cause another economically devastating CTV disease such as stem pitting. Further research will be dedicated to the biological properties of the genetic variability of these identified CTV isolates and the assessment of potential aphid vectors. References: (1) S. Černi et al. Plant Dis. 89:342, 2005. (2) M. E. Hilf et al. Options Méditerranéennes B 65:89, 2009. (3) T. Papic et al. Plant Dis. 89:434, 2005.
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Affiliation(s)
- D Delić
- University of Banjaluka, Faculty of Agriculture, Bulevar vojvode Petra Bojovića 1A, 78000 Banjaluka, Bosnia and Herzegovina
| | - M Afechtal
- CIHEAM - Mediterranean Agronomic Institute of Bari, Via Ceglie 09, 70010 Valenzano (BA), Italy
| | - K Djelouah
- CIHEAM - Mediterranean Agronomic Institute of Bari, Via Ceglie 09, 70010 Valenzano (BA), Italy
| | - B Lolić
- University of Banjaluka, Faculty of Agriculture, Bulevar vojvode Petra Bojovića 1A, 78000 Banjaluka, Bosnia and Herzegovina
| | - A Karačić
- Federal AgroMediterranean Institute of Mostar, 88000 Mostar, Bosnia and Herzegovina
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