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Neuroimaging research in posttraumatic stress disorder – focus on amygdala, hippocampus and prefrontal cortex
Get PDFNeuroimaging research reflects the complexity of post-traumatic stress disorder and shares some common difficulties of post-traumatic stress disorder research, such as the different classifications of the disorder over time, changes in diagnostic criteria, and extensive comorbidities, as well as precisely delineated and prevailing genetic and environmental determinants in the development of the disorder and its clinical manifestations. Synthesis of neuroimaging findings in an effort to clarify causes, clinical manifestations, and consequences of the disorder is complicated by a variety of applied technical approaches in different brain regions, differences in symptom dimensions in a study population, and typically small sample sizes, with the interplay of all of these consequently bringing about divergent results. Furthermore, combinations of the aforementioned issues serve to weaken any comprehensive meta-analytic approach. In this review, we focus on recent neuroimaging studies and those performed on larger samples, with particular emphasis on research concerning the amygdala, hippocampus, and prefrontal cortex, as these are the brain regions postulated by the core research to play a prominent role in the pathophysiology of post-traumatic stress disorder. Additionally, we review the guidelines for future research and list a number of new intersectional and cross-sectional approaches in the area of neuroimaging. We conclude that future neuroimaging research in post-traumatic stress disorder will certainly benefit from a higher integration with genetic research, better profiling of control groups, and a greater involvement of the neuroimaging genetics approach and from larger collaborative studies
Acetabular osteometric standards for sex estimation in contemporary Croatian population
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To determine the sexual dimorphism of acetabular measurements in contemporary Croatian population and to provide a discriminant function equation for sex estimation. ----- METHODS:
The sample consisted of 200 adult pelvic bones (100 male and 100 female) from positively identified victims of Croatian War of Independence. In total, 96 left (48 male and 48 female) and 104 right (52 male and 52 female) acetabula were measured. One author measured two acetabular parameters using a sliding caliper: acetabular diameter (AD) and transverse acetabular diameter (TAD). Another author re-measured the acetabula of 40 randomly selected individuals to determine the inter-observer error. ----- RESULTS:
Both measured variables showed significant sexual dimorphism. Men had significantly higher values for AD and TAD than women. Receiver operating characteristic curve analysis showed that the cut-off point for prediction of male sex when using acetabular diameter was higher than 54 mm. For transverse acetabular diameter it was higher than 52 mm. The discriminant function was generated by using both acetabular variables, with 88% of accuracy in sex estimation. Inter-observer error was not significant. ----- CONCLUSION:
The acetabular measurements can be used for sex estimation in contemporary Croatian population with high accuracy
Čimbenici povezani s promjenama antiretrovirusne terapije u bolesnika koji su započeli s liječenjem u Hrvatskoj u razdoblju od 1998. – 2013. [Factors related to antiretroviral drug modifications in individuals starting therapy in Croatia between 1998 and 2013]
Get PDFInfection with Human Immunodeficiency virus (HIV) is chronic, progressive disease which starts when HIV enters the organism. If not treated this condition leads to collapse of immunologic system, opportunistic infections and death. Introduction of antiretroviral therapy (ART) dramatically changed the prognosis of these patients. Modifications to ART regimens can occur for a number of reasons, including adverse effects. We have investigated the reasons and the frequency of ART modifications during the first 3 years after initiation of ART among 732 adult patients who started treatment in the period 1998-2013 in Croatia. We divided the patients in two groups: those who started ART between 1998 and 2005 and those who started ART between 2006 and 2013 and we found significant differences between periods. In the first period the most frequent reason for modification of ART were adverse effects and in the second one it was the decision of the physician guided by the prevention of adverse effects. Older age, female sex and certain drugs (stavudine) and drug classes (protease inhibitors) were significantly associated with the modification of the therapy due to adverse effects. Our findings were similar to many studies who analysed the same period. Less toxic and better-tolerated treatments should be available and used in Croatia in order to optimize the therapy
The prevalence of muscular dystrophy and spinal muscular atrophy in Croatia: data from national and non-governmental organization registries
Get PDFAim: To determine the prevalence of muscular dystrophy (MD) and spinal muscular atrophy (SMA) in Croatia by use of multiple epidemiological tools.
----- Methods: This epidemiological study collected data from three national patient registries and one database of a non-governmental organization (NGO) of MD and SMA patients. The study involved all individuals who either had undergone hospital treatment for MD or SMA, had consulted their primary health care providers for MD- and SMA-related symptoms, were listed as disabled due to MD or SMA, or were members of the mentioned NGO in 2016. In order to prevent double entries, we created a new database of all living individuals, each with a unique identification number. The prevalence rates for 2016 were calculated by age and sex groups.
----- Results: There were 926 patients diagnosed with MD (544 men). Most men diagnosed with MD were in the age group 10-19, whereas most women were in the age group 50-59. MD prevalence in Croatia was 22.2 per 100 000 population. There were 392 patients diagnosed with SMA (198 men). Most men with SMA were in the age group 50-59, whereas most women were in the age group 60-69. SMA prevalence in Croatia was 9.3 per 100 000 population.
----- Conclusion: SMA prevalence rate in Croatia is similar to SMA prevalence worldwide. However, MD prevalence rate is higher than worldwide estimates. This difference could be attributed to the fact that we could not confirm whether every patient registered in these databases actually met the diagnostic criteria for MD and SMA
Emerging trends in the epidemiology of West Nile and Usutu virus infections in Southern Europe
Get PDFThe epidemiology of West Nile (WNV) and Usutu virus (USUV) has changed dramatically over the past two decades. Since 1999, there have been regular reports of WNV outbreaks and the virus has expanded its area of circulation in many Southern European countries. After emerging in Italy in 1996, USUV has spread to other countries causing mortality in several bird species. In 2009, USUV seroconversion in horses was reported in Italy. Co-circulation of both viruses was detected in humans, horses and birds. The main vector of WNV and USUV in Europe is Culex pipiens, however, both viruses were found in native Culex mosquito species (Cx. modestus, Cx. perexiguus). Experimental competence to transmit the WNV was also proven for native and invasive mosquitoes of Aedes and Culex genera (Ae. albopictus, Ae. detritus, Cx. torrentium). Recently, Ae. albopictus and Ae. japonicus naturally-infected with USUV were reported. While neuroinvasive human WNV infections are well-documented, USUV infections are sporadically detected. However, there is increasing evidence of a role of USUV in human disease. Seroepidemiological studies showed that USUV circulation is more common than WNV in some endemic regions. Recent data showed that WNV strains detected in humans, horses, birds, and mosquitoes mainly belong to lineage 2. In addition to European USUV lineages, some reports indicate the presence of African USUV lineages as well. The trends in WNV/USUV range and vector expansion are likely to continue in future years. This mini-review provides an update on the epidemiology of WNV and USUV infections in Southern Europe within a multidisciplinary "One Health" context
Admission C-reactive protein and outcomes in acute aortic dissection: a systematic review
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To assess the prognostic role of admission C-reactive protein (CRP) in patients with acute aortic dissection (AAD). ----- METHODS:
We searched Medline and Scopus for studies published before January 2019 that evaluated the prognostic impact of CRP on all-cause mortality during short- and mid-term follow-up period in patients with AAD. Additional studies were identified by manual search of the references from the original studies. Receiver-operating characteristic curves were used to determine the optimal cut-off values of admission CRP for the prediction of mortality, and patients were categorized into two groups based on the CRP cut-off levels. ----- RESULTS:
Medline, Scopus, and manual literature search yielded 138 citations. Based on the title and abstract analysis and review of potentially relevant studies, five studies, involving 711 patients, were included in the final analysis. Multivariate statistical analysis was performed in all the studies. The median admission CRP value across the studies was 13 mg/L (range 4-21 mg/L). Two out of three studies that evaluated in-hospital outcome and all of the studies that evaluated medium-term outcome reported a significant association between elevated CRP values and mortality. The studies that included treatment strategy (surgery vs conservative treatment) as a confounding variable confirmed a significant effect of elevated CRP values on both in-hospital and mid-term unfavorable outcomes. ----- CONCLUSION:
This systematic review demonstrated a clear association between elevated admission serum CRP levels and increased in-hospital and mid-term mortality risk in AAD
Procjena oštećenja bubrežne funkcije i kvalitete života bolesnika nakon poslijeoperacijske radiokemoterapije zbog karcinoma želuca
Get PDFPREAMBLE: Postoperative radiochemotherapy after surgical procedure greatly enhances overall survival and locoregional control of the disease in patients with adenocarcinoma of the stomach in the stage IB to IIIC of the disease. The acute consequences of such treatment methods are well known and successfully controlled with supporting therapy, while the later consequences are relatively indistinct, especially damage to kidney function. -----
STUDY GOAL: We have tried to assess the resulting damage to kidney function according to various formulas used to calculate GFR and define the incidence, occurrence dynamics and the stages of the damage. We were interested in the quality of patients' lives, as well as whether there was any connection between the patient's quality of life and the stage of the damage to kidney function. -----
STUDY PARTICIPANTS AND METHODS: The research has been conceived as a prospective cohort clinical study. It was carried out at the Institute of Oncology in Ljubljana, Radiotherapy Division.
The subjects were brought into the study in the period from November 2009 leading up to March 2013. In total 118 patients were involved in the study. The period of monitoring following the end of the oncology treatment amounted to 5 years and consisted of 7 control examinations. Standardized EORTC QLQ C 30 questionnaire assessing the quality of patients' lives had been filled in prior to the post-operative radiochemotherapy and later during 3 control examinations (after the first, third and fifth year). -----
RESULTS: The estimated GFR level at the final control five years after the end of the oncology treatment was statistically significantly lower in comparison to the values prior to the adjuvant treatment, regardless of the formula used to calculate it. Statistically, the lowest results were obtained by calculating the eGFR according to the CG formula, and the average value at the final control examination was 71.2 ml /min / 1.73 m2. At the last control examination, 33.4 % patients displayed eGFR value lower than 60 ml/min /1.73 m2 according to the CG formula, 20 % patients according to the CKD- EPI formula and 17.7 % according to the MDRD formula. The most sensitive dose-volume parameter that can point to developing damage to kidney function is V12 Gy for a bilateral kidney that in our study amounted to 54 %. Statistical analysis of standardized EORTC QLQ C 30 questionnaires showed a significant rise in the general health condition and quality of our patients' lives when compared to the previous control examination. The damage to kidney function is clinically irrelevant and therefore has no bearing on the quality of life.
The analysis of survival rate showed that all the patients died due to the progress of the underlying disease and that the overall survival (OS) is equal to the disease-specific survival (DSS) and amounted to 60.7 % The disease-free survival (DFS) amounted to 60.3 %. Locoregional control (LRC) amounted to 81.6 %. -----
CONCLUSION: Following the post-operative treatment with capecitabine, damage to kidney function and chronic kidney disease develop. The influence of kidney damage on the quality of life has not been proven. It is vital that the damage is revealed in the early stages of the kidney disease because changes in the way of life and renoprotective drugs can inhibit the progress of the disease into later stages. Due to the progressive character of radiation nephropathy, it is necessary to continue the systematic monitoring of these patients. Standardized EORTC questionnaire QLQ C30 represents a simple and economical manner of screening potential damage to many physical and psychological functions that require further multidisciplinary treatment
Usporedba kliničke djelotvornosti probiotika Lactobacillusa reuteri i enteroadsorbenta polimetilsiloksana u liječenju rotavirusnog gastroenteritisa u djece u dobi od 6 do 36 mjeseci [Comparison of clinical efficacy of probiotic Lactobacillus reuteri versus enteroadsorbent polymethylsiloxane (Enterosgel®) in the treatment of rotaviral gastroenteritis in children 6-36 months old]
Get PDFRotavirus gastroenteritis is the most common cause of acute infectious diarrhea in infants and young children. It is a very frequent cause of childhood hospitalisation due to its sudden onset of symptoms - vomiting, diarrhea and fever. There is still no causative therapy against rotavirus. However, there are many adjunctive therapies available to alleviate the symptoms of infection. Once very popular enterosorbent, medicinal activated charcoal, was replaced by some new agents, namely probiotics. Amongst many probiotic preparations only a few showed some advantages over placebo. In the last few years a new enterosorbent, polymethylsiloxane (Enterosgel) has emerged on the Croatian market and we wanted to compare it to the stardard therapy, probiotic L. reuteri (BioGaia). We chose L. reuteri because it was the first probiotic preparation registered for safe use in infants. We also wanted to compare two gastroenteritis clinical severity assessment scales and describe some clinical characteristics of rotavirus infection in our region.
The efficacy of the investigated therapies was tested on three levels - duration of symptoms, duration of hospital stay and the total number of liquid stools. We have found no significant differences between the therapies according to any of the tested parameters. We have noticed no significant side-effects of the tested therapies. Probiotic preparation seemed to have better palatability, however this might be attributed to a smaller single dose volume (BioGaia cca 1 mL; Enterosgel cca 20-30 mL).
Although very similar, the standard clinical severity scores for the evaluation of acute gastroenteritis, Vesikari's and Clark's, are not comparable. If there is a need for comparing different treatments or preventive measures (vaccinations) the same clinical score must be used. We also cannot use these scores for predicting the duration of symptoms of rotavirus disease. It would be beneficial if a single scale would be set as the standard on the international level, thus enabling easier comparison of future clinical trials.
The clinical and epidemiological characteristics of the rotavirus infection in our examinees did not significantly differ to the ones described in the standard textbooks. However, the expected slightly higher number of cases in the late autumn was not recorded, due to the limited duration of the trial or it could be just a reflection of the usual seasonal variability. We did not find a significant number of rare manifestations of rotavirus infection such as urticaria, reactive arthritis, hepatitis, encephalitis, nor did we notice any complications such as severe dehydration, encephalopathy, etc. One of the reasons for that can be prompt admission of patients with more severe rotavirus infection to the intensive care unit. Due to the nature of the trial, these patients were not recruitable or suitable for inclusion as we could not obtain the parents' consent.
Subsequently, the patients with the most severe and those with the most benign symptoms were not included in our trial. On the positive note, our study population was very homogeneous as all the patients had similar clinical characteristics thus making the comparison of treatment effectiveness more reliable.
In conclusion, with the statistical power of 80 %, we can claim that there is no difference in the efficacy between the new enterosorbent polymethylsiloxane and probiotic L. reuteri in the treatment of rotavirus gastroenteritis in children
Rani biokemijski biljezi i napredni hemodinamski nadzor u procjeni uzroka akutne ozljede bubrega u djece nakon kardiokirurškoga liječenja [Early biomarkers and advanced hemodynamic monitoring in assessment of acute kidney injury causes in children after cardiac surgery]
Get PDFCardicac surgery associated acute kidney injury (CSA-AKI) is a common and serious complication in children. It is defined by appropriate criteria based on acute serum creatinine (SCr) rise and/or diuresis reduction. One of the most frequently used criteria in children is the pRIFLE criterion. It is known that SCr is a late and unreliable marker for CSA-AKI. The discovery of new biomarkers, such as NGAL, KIM-1 and CysC, allow an earlier diagnosis of acute kidney injury than SCr. However, previous clinical studies on the evaluation of these early biomarkers in the diagnosis of CSA-AKI in children have shown contradictory results.
The pathogenesis CSA-AKI is very complex and undefined. In the literature it is often stated that the reduced cardiac index (CI) is one of the most important risk factors for CSA-AKI development. However, in children, the criteria for reduced CI after cardiac surgery are still undefined, and so are the limit values at which reduced CI represents a risk factor for the development CSA-AKI.
The advanced hemodynamic monitoring system PiCCO allows measurement of CI as well as its most important hemodynamic variables: preload, contractility and afterload. Owing to continuous venous oximetry, it is possible to measure the oxygen delivery and oxygen consumption index (DO2I and VO2I).
According to available literature no relevant research has yet been published on the use of the PiCCO system for predicting the development and estimating the cause of CSA-AKI development in children. Likewise, the role of CI, DO2I and the individual hemodynamic and oxygenation parameters measured by the PiCCO system in the CSA-AKI development estimation are currently unknown.
The aim of this prospective study is to estimate the joint contribution of early biomarkers, hemodynamic and oxygenation parameters measured by the PiCCO system in the early emergence of of CSA-AKI in children. In order to verify the hypothesis and achieve the aim of the study, we have included 100 patients with heart failure that had undergone cardiac surgery. The primary outcome was the development of CSA-AKI according to pRIFLE criteria. Patients were divided into two groups: the AKI and the non-AKI groups. In all patients hemodynamic and oxygenation parameters and early biomarkers prior to the onset of CPB and 2, 6, 12 and 24 hours after CPB were measured. The values before the CPB were used as baseline values.
Patients in the AKI group had significantly lower CI values at all time points of measurement. The cardiac index with defined cut-off values is an excellent predictor of CSA-AKI development, and the best sensitivity and specificity ratio was recorded in the first 12 hours.
Also patients in the AKI group had significantly decreased globale ejection fraction (GEF), cardiac power index (CPI), global enddiastolic volume index (GEDVI) and systemic vascular resistance index (SVRI). Each of these constituent variables of CI, with defined cut-off values, can predict the development of CSA-AKI.
Significantly lower values of DO2I and saturation of central venous blood oxygen (ScvO2) were observed in the AKI group along with significantly higher oxygen extraction rate (OER) and equal VO2I compared with the non-AKI group. All these oxygenation parameters, except for VO2I, may, with defined cut-off values, predict the development of CSA-AKI. The best predictor within the first 12 hours after CPB is DO2I.
The observance of significant correlations between CI and DO2I suggests that CI is one of the most important components of DO2I in cardiac surgery patients. The observation of significant correlation between DO2I, VO2I and OER suggests that oxygen consumption in cardiac surgery patients depends primarily on its delivery.
In this study we have confirmed that SCr is a late and unreliable marker, especially for the diagnosis of severe forms of CSA-AKI, and that diuresis is a completely unreliable criterion. On the other hand, measurement of early biomarkers (plasma CysC, urine and plasma NGAL, and urine KIM-1), individually and in combination, can predict the development of CSA-AKI already in the first hours after CPB. The best individual predictors of CSA-AKI are plasma CysC and urine NGAL, and the best combination of bimarkers is (+CysCpl and/or +NGALu), which improves the individual predictive characteristics of plasma CysC and urine NGAL. The results of this study have shown a significant negative correlation between the values of CI and DO2I with eraly bimarkers values. The lowest CI and DO2I dynamics overlap with the dynamics of the highest values of early biomarkers in AKI patients. The CI and DO2I values were best correlated with plasma CysC and urine NGAL values. Thus, we have confirmed that the reduced CI and DO2I in combination represent one of the most important causes of CSA-AKI, which can be diagnosed in time with the help of early biomarkers.
Finally, in this study we have shown that the combination (+CI and +DO2I and +CysCpl) is the best predictor of CSA-AKI development, because it improves the diagnostic characteristics of individual markers within that combination. This confirms our assumption that simultaneous measurement of CI and DO2I by an advanced hemodynamic monitoring system PiCCO and early biomarkers (in this case CysC in plasma) can improve the detection of early development of CSA-AKI in children