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Istraživanje čimbenika rizika za nastanak alergijskih dišnih bolesti s pomoću Bayesovih mreža temeljenih na podacima iz više izvora [Exploring the risk factors for the development of allergic respiratory diseases by Bayesian networks built on multiple-source data]
Get PDFIt is suggested that multi-source data analysis could help to elucidate the aetiology
of non-communicable, chronic diseases. However, statistical methods for
multi-source data analysis with partially overlapping data sources are not developed
enough.
The study proposes new method for meta-analysis of such data, G–MA, applying
it to Bayesian network of multi-source data. In simulation experiments, G-MA
showed lower mean squared error and narrower confidence intervals in parameter
estimation, when compared to single data source analyses.
Bayesian network with G-MA method (Bayes–G–MA) was applied to analyse the
factors related to the presence of allergic respiratory diseases (ARD) in four Croatian
epidemiological sources. Compared to single source analyses, Bayes–G–MA
recognised lower number of direct relationships with ARD (allergic diseases in childhood,
allergic diseases in parents, body mass index), while others became indirect
(gender, physical activity) or unrecognised (smoking). Bayes–G–MA suggested two
new relationships (with depression and alcohol consumption) between variables not
tested together in any single source. These results could reflect true relationships,
but also lack of statistical power or intrinsic property of the method to under-report
present relationships.
In conclusion, the main contribution of proposed method is in the assessment of parameters, with expert help needed in evaluation of causal relationships
Prijelomi distalnog radijusa u djece – uzroci i mjesta nastanka [Distal radius fractures in children – causes and places of occurrence]
Get PDFDistal radius fractures are the most common fractures in children and account for about 25% of all fractures. The main mechanism of occurrence is a fall on the outstretched hand. These fractures usually occur as a result of accidents, and rarely because of injuries and pathological conditions. In this retrospective study, we analyzed 182 hospital-treated distal radius fractures, of which 61 fractures (29.8%) represent epiphysiolysis. The causes are divided into three groups: fall 124 (68.1%), injuries in traffic 50 (27.5%), and strikes 8 (4.4%). Falls usually occur during sport or game playing 72 (39.6%), and traffic injuries occur during cycling 30 (52%) and roller skating 25 (43%). Children were most often injured in the areas of sports and recreational activities 115 (63%), on the street 38 (21%), and at the school 16 (9%). In our children the highest incidence of distal radius fractures was during sports and recreational activities, and the lowest in school and at home
Određivanje gradusa adenokarcinoma prostate prema klasifikaciji Svjetske zdravstvene organizacije iz 2016. godine [Prostatic adenocarcinoma grading system according to 2016 World health organization classification of tumors]
Get PDFGleason score, a measure of tumor differentiation, is a standard part of prostatic adenocarcinoma pathology report. It represents the sum of the most common and the second most common histological patterns in tumor, and can have a score of 2 to 10. After the introduction of Gleason grading system, some disadvantages were noted in routine practice. The most commonly used patterns were 6 (3+3) and 7 (3+4 or 4+3). Over the years, the Gleason grading system underwent a few revisions. In the current 2016 WHO classification, a five-grade group system was accepted, which is easier to apply and has a much better correlation to prognosis and therapeutic needs of patients. The major differences between old and new grading systems are specified in this review
Stražnja idiopatska fascikularna ljevoventrikularna tahikardija osjetljiva na verapamil – Belhassenova tahikardija – prikaz bolesnika [Posterior idiopathic fascicular left ventricular tachycardia, verapamil sensitive – Belhassen’s tachycardia – a case report]
Get PDFIntroduction: We present a rare ventricular tachycardia of unknown origin (idiopathic) which originates near the posterior fascicle of the left bundle branch of His. The tachycardia has four basic features: wide QRS complex, RBBB morphology, left (superior) axis deviation and sensitivity to verapamil. Since 1981 (when sensitivity to verapamil was discovered by Belhassen et al.) it has frequently been called Belhassen’s tachycardia. Aim: The purpose of this case report was to remind that correct diagnosis of this potentially dangerous arrhythmia can be made with detailed and correct interpretation of 12-lead ECG. Case report: Until now healthy adolescent girl came to the ER because of palpitations, dyspnoea and presyncopal attack. The 12-lead ECG was done. It showed three of four basic features of posterior idiopathic fascicular left ventricular tachycardia. After the conversion of tachycardia to sinus rhythm by intravenous application of verapamil, the fourth feature was also shown and by that the diagnosis was confirmed. Because of the frequent recurrence of ventricular tachycardia with clinical symptoms associated with cardiovascular system (palpitations, precordial oppressions, dizziness, presyncopal crisis) despite ever increasing dosage of oral verapamil and with taking into consideration a positive family history of sudden death syndrome, the adolescent girl was referred to the electrophysiology study and treatment with radiofrequency ablation. Conclusion:Detailed and correct interpretation of 12-lead ECG can correctly diagnose the type of tachycardia, which is fundamental for efficient managing and treatment
Tumorska kaheksija kao predskazatelj kemoterapijske toksičnosti i vremena do tumorske progresije u bolesnika s proširenim karcinomom pluća [Cancer cachexia as a predictor of chemotherapy toxicity and time-to-tumor progression in patients with advanced non-small cell lung cancer]
Get PDFBackground. Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival. The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origin, and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer.
The purpose of our prospective study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer (NSCLC) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction. A secondary aim was to compare several biochemical and haematological markers (CRP, IL-6, protein and albumin) with time to tumor progression in order to assess prognostic value or to guide a treatment.
Patients and Methods. Between December 2013 and April 2015, the prospective cohort study of one hundred Caucasian patients with advanced NSCLC stage IIIB or IV, who were referred consecutively to Department for Respiratory Diseases “Jordanovac” was evaluated. Anthropometric measurements and biochemical / haematological data (CRP, albumin, protein, IL-6, haemoglobin) together with body composition measurements (total muscle cross sectional area, lumbar skeletal muscle index) were obtained for each patient before starting with platinum-doublet therapy. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography, and sarcopenia was defined using a previously published cut-off point. Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospectively.
Results. One hundred patients with advanced lung cancer were recruited: 67 were male, median age was 64 years. The median time to disease progression was 187 days. The prevalence of cachexia and sarcopenia in study cohort was 69 %, and 47 %, respectively. CRP, IL-6 and albumin concentration in cachectic, compared to non-cachectic patients demonstrated statistically significant difference (p = 0,020, p = 0,040, p = 0,003). Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor time to tumor progression. On the contrary, albumin concentration with established cut-off point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity (OR (95% CI) = 0.85; p < 0.001) and survival (HR (95% CI) = 0,55).
Conclusion. Albumin level has shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia. This approach in clinical settings can be used to guide the choice of oncologic treatment
Inhaled therapies in patients with moderate COPD in clinical practice: current thinking
Get PDFCOPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups
Rat brain glucose transporter-2, insulin receptor and glial expression are acute targets of intracerebroventricular streptozotocin: risk factors for sporadic Alzheimer's disease?
Get PDFAccumulated evidence suggests that the insulin-resistant brain state and cerebral glucose hypometabolism might be the cause, rather than the consequence, of the neurodegeneration found in a sporadic Alzheimer's disease (sAD). We have explored whether the insulin receptor (IR) and the glucose transporter-2 (GLUT2), used here as their markers, are the early targets of intracerebroventricularly (icv) administered streptozotocin (STZ) in an STZ-icv rat model of sAD, and whether their changes are associated with the STZ-induced neuroinflammation. The expression of IR, GLUT2 and glial fibrillary acidic protein (GFAP) was measured by immunofluorescence and western blot analysis in the parietal (PC) and the temporal (TC) cortex, in the hippocampus (HPC) and the hypothalamus. One hour after the STZ-icv administration (1.5 mg/kg), the GFAP immunoreactivity was significantly increased in all four regions, thus indicating the wide spread neuroinflammation, pronounced in the PC and the HPC. Changes in the GLUT2 (increment) and the IR (decrement) expression were mild in the areas close to the site of the STZ injection/release but pronounced in the ependymal lining cells of the third ventricle, thus indicating the possible metabolic implications. These results, together with the finding of the GLUT2-IR co-expression, and also the neuronal IR expression in PC, TC and HPC, indicate that the cerebral GLUT2 and IR should be further explored as the possible sAD etiopathogenic factors. It should be further clarified whether their alterations are the effect of a direct STZ-icv toxicity or they are triggered in a response to STZ-icv induced neuroinflammation
Antropometrijske posebnosti stopala djece u dobi od druge do sedme godine
Get PDFINTORDUCTION: The anatomical specificity of children’s feet change during their growth and development, and the foot therefore adapts to its static and dynamic function of bearing the body's full weight. When children start walking, their feet begin to change shape and the changes become visible when the natural fat pads on the bottom of each foot begin to disappear. The shape of the foot is determined by many anthropometric measurements. It is during the period of the child’s learning to walk phase that more intense changes to the foot begin, which allow a base of support wide enough for the child to stand and walk, decreasing the temporary weakness of the muscles. The dynamic muscular strength and ligament firmness allow the foot to adapt normally as they bear weight on their legs by the stretching of the feet. Contrary to other body systems, foot length proportionally reaches its adult size.
The length of girls' feet reach half their adult size by the age of 1, while boys' feet reach half their adult size by 18 months. According to various toe lengths and shapes, three types of forefoot shapes can be distinguished: Egyptian, square and Greek. Variations in foot shapes are based on numerous anatomical differences, such as foot arch height, heel width and toe length. Foot length is the basic unit of measurement for monitoring the development and growth of the foot. The foot length of growing children is strictly standardized in certain countries and varies depending on geographical location and ethnic differences.
AIMS: The aim of this thesis is to first determine the foot shapes (Egyptian, Greek, square) and anthropometric measurements of the foot (foot length, metatarsus width, heel width, metatarsus height, heel, instep and metatarsus circumference and big toe height among a representative sample of preschool aged girls and boys of different age groups. Second, to study the changes which occur in the shapes and sizes of feet on a representative sample of preschool children in Croatia, and then to determine the regional differences in the measured foot shapes and sizes among the representative sample. And finally, to create reference tables of foot sizes among girls and boys of different age groups.
MATERIALS AND METHODS: The research for this thesis was conducted as a cross sectional, multicenter study and was approved by the Ethical Committees of the
Children's Hospital in Zagreb and the School of Medicine in Zagreb. The study included Croatian preschool children that live in both the Zagreb and Split-Dalmatia Counties. The sample includes preschool children between the ages of 2 (1.50-2.49) and 7 (6.50-7.49), divided in to 6 age groups. Measurements were performed on a sample size of 2745 children, totalling to 5490 feet, including 1375 boys and 1370 girls. The first age group (two-year-olds) included 242 girls and 149 boys; the second age group (three-year-olds) included 214 girls and 181 boys; the third age group (four-year-olds) included 221 girls and 263 boys; the fourth age group (five-year-olds) included 196 girls and 245 boys; the fifth age group (six-year-olds) included 259 girls and 288 boys; and the sixth age group (seven-year-olds) included 238 girls and 249 boys. Children with congenital and acquired foot deformities were not a part of the research group. The measuring technique was standardized and the children were measured while standing on their feet. The feet were measured barefoot and were fitted in a specially designed measuring device with an index of measurements. To obtain other anthropometric measurements we used a measuring tape and a pedometer with a movable goniometer.
RESULTS: In children between the ages of 2 and 7, on average 80.3% of boys and 78.8% of girls had an Egyptian-shaped foot. The Greek foot was found in 14.7% of boys and 17.6% of girls, while the square-shaped foot was found in 5% of boys and 3.6% of girls. No significant differences were found in foot shapes between boys and girls. The annual foot growth in length measures approximately 1 cm, except at age 2 when the foot grows an average 1.6 cm annually. An annual growth of approximately 1.3 cm was measured among girls between the ages of 3 and 6. The foot grows most rapidly in length between the ages of 2 and 3 in both of the sexes, while the slowest growth rate was measured between the ages of 6 and 7, more so among girls (0.65 cm). While more profound differences in foot length and circumference of the metatarsus, heel and instep were found in the anthropometric measurements between boys and girls, boys were measured to have only slightly wider heels than girls between the ages of 2 and 7, and the heel was found to be only 0.1 cm wider among boys than the girls at the age of 7. Similarly, the big toe was measured 0.1 cm higher among boys at the age of 7, while metatarsus height was found to be equal among both sexes.
CONCLUSION: The existing standards of foot length and shape are not suitable for children in Croatia. The Egyptian foot was found to be most common throughout all age and sex groups, more than 80% of boys and girls. When analysing all anthropometric foot measurements of boys and girls, the most significant growth could be measured between the ages of 2 and 3, followed by a period of rather steady growth between the ages of 3 and 6. The smallest foot growth values could be measured at 7 years old. Boys were found to have slightly longer feet, as well as a larger circumference than girls, but the difference in certain age groups was not measured to be larger than 0.6 cm. No significant differences in anthropometric measures between the right and the left foot were found in any of the age groups
Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project
Get PDFThe clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non-ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the ICU
Sistemska izloženost i nuspojave, te mjere smanjenja rizika nakon bevacizumaba primijenjenoga intravitrealno u liječenju senilne makularne degeneracije [Systemic exposure, systemic adverse reactions and risk minimization measures of bevacizumab applied intravitreally in senile macular degeneration treatment]
Get PDFThe main objective of this doctoral dissertation is risk minimisation measures of systemic
adverse events of IVT bevacizumab in AMD treatment. We did a systematic review of all
published clinical studies and, based on the results, we cannot determine whether IVT
bevacizumab affects cardio-/cerebrovascular risk and in which direction. Treated patients
were evaluated through a 3-year period at University Hospital Sveti Duh with selection
protocol applied. Adverse cardio-/cerebrovascular events and non-ocular bleeding events
occurred each in 4.1% patients (vs. 12.4% patients in bibliographic control). Higher serum
creatinine levels and longer IVT bevacizumab treatment were independently associated with
higher cardio-/cerebroascular adverse event risk. Higher serum creatinine and D-dimer levels
were independently associated with higer bleeding risk. Longer treatment exposure was
independetly associated with higher serum creatinine and D-dimer levels in time. VEGF and
bevacizumab plasma concentrations, measured by PEA, were associated in linear relationship
– increase in bevacizumab concentration decreased VEGF concentration. This is in
accordance with the known mechanism of action, but achieved after intravitreal application of
only 1.25 mg bevacizumab. VEGF had shown complex relationship with measured laboratory
parameters, which mirrors complex (patho)-physiological and molecular biology, yet to be
elucidated. The recommended selection protocol is the risk minimisation measure for IVT
bevacizumab and could be a useful tool for patients with positive benefit/risk ratio in off-label
setting