SAŽETAK
Međunarodne smjernice za farmakološko liječenje epilepsija općenite su, sveobuhvatne i ne prepoznaju lokalne specifičnosti poput ekonomskih i tehničkih mogućnosti u pojedinim državama, ...dostupnosti pojedinih antiepileptika ili drugih metoda liječenja i slično. Stoga se nameće potreba izrade nacionalnih smjernica, čiji su zapravo temelj međunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakološko liječenje epilepsija plod su suradnje svih relevantnih stručnih društava i referentnih centara u RH, na čelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neurološkim društvom i Hrvatskim društvom za dječju neurologiju Hrvatskoga liječničkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifičnosti u našoj zemlji, najnovije spoznaje farmakoloških profila i učinkovitosti pojedinih antiepileptika kao i ekspertna mišljenja. Antiepileptička terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktička primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, mogućnostima liječenja i samopomoći, životnim ograničenjima te mogućim neželjenim događajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljšanje kvalitete života. Zlatni standard liječenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za liječenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifičnim čimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestičkih i dijagnostičkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika različitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, različitog profila nuspojava i sinergističkog ili aditivnog djelovanja. Zamjena generičkih ili originalnog i generičkog oblika lijeka nije preporučljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptičke terapije treba biti postupno i sporo, u slučaju politerapije jedan po jedan lijek, a u donošenju odluke o ukidanju, kao i o uvođenju antiepileptika, mora biti uključen bolesnik i njegova obitelj.
The aim of this population based neuroepidemiological study was to establish the real incidence rates of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the ...Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.65, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100,000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.
Traumatic brain injury (TBI) is the most common cause of acquired disability and death in children. Retrospective analysis showed 350 children, 128 (36.6%) girls and 222 (63.4%) boys who were ...hospitalized for injury of neurocranium in a 5 year-period in Dr. Josip Bencević General Hospital in Slavonski Brod. Most of them had both contusion and commotion (46.8%), followed by just contusion of the head (12.5%) and fractures of the skull (10.5%). The haemorrhages and hemathomas were less common (epidural, subdural, SAH) (3.2%). The procedures performed showed that in almost all children X-rays had been performed (99.7%). The most commonly X-rays performed were those of the head (craniogram) and/or cervical spine, followed by CT, EEG, ultrasound and NMR. The occurence of complications was recorded in only 2% of injured children (seizure, syncopa, febrile convulsions). Analysis of treatment methods showed that in most children (89.6%) therapy was conservative. The injured children were hospitalizated mostly for 2 days (34.5%) or 3 days (32.5%), while longer hospitalization was less common. Regarding extra consultation of other specialists (besides neurosurgeons), the most commonly consulted were pediatrician, surgeon/traumatologist, specialist of ENT/maxilofacial surgery, neuropediatrician, pediatric surgeon, ophthalmologist and others. It can be said that the prognosis of TBI in children depends on the age, neurological status and kind of injury, and on the quality of care, which involves availability of neurosurgeons and other specialists.
Epidemiology of stroke KADOJIĆ, DRAGUTIN; DIKANOVIĆ, MARINKO; BITUNJAC, MILAN ...
Periodicum biologorum,
09/2012, Letnik:
114, Številka:
3
Journal Article
Odprti dostop
The epidemiology of stroke may be changing over time as a result of a
number of factors, including an aging population and advances in the prevention and treatment of stroke. Epidemiological ...indicators and research of stroke have great significance in estimating the impact of this disease on the population. Such research states the distribution of this illness and factors by which it is influenced, follows short-term and long-term consequences, as well as socio-economic burden of stroke for the whole community.
Data on stroke prevalence is important for creating the right strategies for health care in a specific area. Stroke-relatedmortality in any population is dependent upon three main factors: the incidence of stroke in the population, quality ofmedical care available, and the prevalence of cardiovascular diseases and comorbidities that can affect the likelihood of surviving stroke events. The quality of medical care available influences both the number of individuals suffering from stroke and the proportion of case-fatality among them.
Epidemiological data shows that stroke is one of the leading causes of
death and long-term disability in most industrialized populations, and the
same is true for Croatia. The existing systemof health care for stroke patients does not meet the needs and is not in accordance with latest trends in developed countries.Hence, there is a need for its reorganization and design of the national project for stroke prevention and treatment similar to those in European countries with favorable epidemiological data.
The aim of the study was to assess the correlation between the levels of catecholamines and cerebral hemodynamics in patients with chronic post-traumatic stress disorder (PTSD). The study included 50 ...patients with chronic PTSD hospitalized for psychiatric treatment for the first time, and 50 healthy control subjects. All study subjects were in the 30-50 age group. In PTSD group, determination of vanllylmandelic acid (VMA), an epinephrine and norepinephrine metabolite, in 24-h urine and transcranial Doppler (TCD) sonography of the circle of Willis vasculature were performed on the first day of hospital stay. The same diagnostic procedures were repeated upon the completion of 21-day medicamentous psychiatric treatment. Initial analysis revealed concurrently elevated 24-h VMA in 29 (58.00%) patients and increased values of the mean blood flow velocity (MBFV) in the circle of Willis vasculature in 34 (68.00%) patients, indicating a high correlation of the respective parameters (p = 0.3290). Second analysis performed after 21-day psychiatric treatment showed concurrently elevated 24-h VMA in eight (16.00%) patients and increased MBFV in the circle of Willis vasculature in nine (18.00%) patients, also pointing to a high correlation of the parameters observed (p = 0.7906). In the control group, only two (4.00%) subjects had elevated MBFV in the circle of Willis vessels, whereas the level of 24-h VMA was normal in all control subjects. Study results pointed to a significant association between elevated levels of stress hormones and increased MBFV in the circle of Willis vasculature caused by cerebral vasospasm. Medicamentous psychiatric treatment for PTSD administered for three weeks significantly reduced the proportion of PTSD patients with elevated levels of the catecholamine metabolite and cerebral vasospasm. Study results showed a high correlation between diurnal VMA level and elevated MBFV in the circle of Willis vessels, clearly demonstrating the effect of prolonged elevation of catecholamine levels on cerebral hemodynamics.
Fabry disease is an X-linked recessive glycolipid storage disease. It is caused by deficiency of the lysosomal enzyme alpha-galactosidase A and leads to the accumulation of the enzyme substrate, ...globotriasylceramide (Gb3) in many tissues including endothelial cells, pericytes and smooth muscle cells of blood vessels, renal epithelial cells, cardiac myocytes and numerous neuronal cells. In this report, we present 20-year-old male patient with ischemic stroke in pons. The case had previously been misdiagnosed as polimyositis and vasculitis. Angiokeratomas, neuropathic pain and ischemic stroke in young age suggested a Fabry disease. The diagnosis was confirmed biochemically and genetically. All young adults with stroke, especially if they have additional symptoms like angiokeratomas, proteinuria, neuropathic pain in toes and fingers should be tested for Fabry disease.
Neuropathic pain refers to pain that originates from pathology of the nervous system. Common causes of neuropathic pain are diabetes mellitus, reactivation of herpes zoster, nerve compression or ...radiculopathy, alcohol, chemotherapy or abuse of some drugs, and trigeminal neuralgia. Specific symptoms of neuropathic pain are mechanical allodynia and cold hyperalgesia. Drugs to treat neuropathic pain can be divided into adjuvant analgesics (antidepressants and anticonvulsants), opioids and topical agents. The use of multiple drug therapies is common in practice. Despite considerable increase in the number of randomized placebo-controlled trials in neuropathic pain in the last few years, the medical treatment of neuropathic pain is still far from being satisfactory, with less than half of patients achieving significant benefit with any pharmacological drug.
This is case report of a bilateral multifocal carcinoma of the breast containing two different histological subtypes of carcinoma. A 68-year-old woman initially presented with tumour mass in the ...upper outer quadrant in the left breast. Subsequent clinical investigation, x-ray mammography and ultrasonography showed tumour masses in both breasts. Fine needle aspiration biopsy was performed and cytological examinations were revealed carcinoma of ductal type in the left breast and well different carcinoma in the right breast.
Hypertension is not considered to be a characteristic of endemic nephropathy (EN). Recent observations suggested that it might be more prevalent than it was reported before.
The aim of our study was ...to analyze prevalence, treatment and control of hypertension in a Croatian endemic area.
In the present cross-sectional study, 1,602 farmers were enrolled, 1,246 from EN and 356 from control villages. Epidemiological and medical histories were taken and clinical and laboratory examinations performed for kidney function. Blood pressure was measured following the ESH/ESC guidelines.
The prevalence of hypertension in EN villages was higher than in control (50.8 vs. 46.5%, p = 0.005). There was no difference in overall treatment, control of all and treated hypertensives between the villages. In all villages, women were treated more than men (EN 41.6 vs. 28.4%, p < 0.001; control 46.4 vs. 27.3%, p < 0.001), but better control of treated was achieved in men (EN 24.7 vs. 17.4%, p = 0.002; control 29.6 vs. 15.5%, p = 0.002). Women had lower income and level of education than men (p < 0.01).
Hypertension is highly prevalent in endemic villages. In all villages, men had better blood pressure control despite being treated less. This finding could be explained by poorer education and income in women.
Ocular dirofilariasis: a case report Janjetović, Zeljka; Arar, Zeljka Vuković; Paradzik, Maja Tomić ...
Acta medica Croatica
64, Številka:
1
Journal Article
A case of ocular dirofilariasis in a female patient is presented. The zoonosis caused by parasites of the genus Dirofilaria is relatively rare in humans, with a higher incidence in south and central ...Europe, Asia and Africa. In Europe, dirofilariasis is mostly caused by the species Dirofilaria repens. In the past 50 years, the number of individuals involved has been on an increase, with about 780 cases reported in the literature to date. Dirofilaria is a parasite found in the dog, cat, racoon and bear. The parasite replicates in the animal's body and enters circulation in the form of microfilariae. These microfilariae reach the insect's digestive tract and are transmitted to another animal or human with subsequent mosquito bites. When transmitted to humans, the parasite is found in the skin and subcutaneous tissue, mucous membranes, and less frequently visceral organs. Concerning ocular involvement, infections of the eye and adnexa oculi and tumorous noninfectious growth of eyelid or orbit have been described to date. The symptoms of the disease vary and include local pain, proptosis, diplopia, palpebral and conjunctival edema, redness, feeling of foreign body, and impaired vision. The diagnosis is generally made by histologic identification of the parasite micro- and macroscopic characteristics, Dirofilaria DNA analysis by the method of polymerase chain reaction, and serology (ELISA) demonstrating the presence of Dirofilaria antibodies in serum. Treatment includes surgical excision of the parasite as an appropriate and efficient therapeutic procedure. A 76-old-female patient presented to outpatient ophthalmology clinic for occasional sensation of pain, rubbing and redness in her right eye. Initial therapy was introduced, resulting in short-lasting improvement. In two weeks, the patient was re-examined for recurrence of discomforts. Slit lamp examination performed temporally revealed a whitish motile, live parasite under the injected and chemotic bulbar conjunctiva. Upon surgical extirpation of the parasite, the diagnosis of dirofilariasis was verified by microbiologic identification.
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