The novelty of the coronavirus disease 2019 (COVID-19) pandemic is that it is occurring in a globalized society enhanced by digital capabilities. Our aim was to analyze the psychological and ...emotional states of participants in different pandemic-related contexts, with a focus on their digital and physical distancing behaviors. The online survey was applied during the ascending phase of the pandemic in March 2020 in two neighboring EU countries: Italy and Croatia. The study subjects involved four groups, two directly affected by epidemiological measures and two serving as controls-(1) participants from Italy who were in lockdown (Italy group), (2) participants from Croatia who were not in lockdown but who were in direct contact with an infected person and underwent epidemiological measures (CRO-contact group), (3) participants from Croatia who were in an analogous situation but not near the same infected person (CRO-no contact group), and (4) participants from Croatia who were not aware of any infected person (CRO-unrelated group). The survey consisted of validated scales of psychological and emotional states, and custom-made questionnaires on the digital (online) and physical (off-line) behavior of the participants. The Italy group in lockdown had higher self-perceived scores for depression, stress, post-traumatic intrusion, and avoidance, as well as the highest digital activity and physical distancing than the not-in-lockdown Croatian groups. The insight into the extent of online activities and off-line isolation allowed for the introduction of Digital Activity and Physical Distancing Scores. Self-perceived post-traumatic avoidance was higher in both the Italy and CRO-contact groups than the control CRO-no contact and CRO-unrelated groups, and higher avoidance correlated with higher Digital Activity and Physical Distancing Scores. Being in direct contact with the infected person, the CRO-contact group had no other alterations than unexpectedly lower post-traumatic hyperarousal when compared with the Italy group. The Italy group in lockdown demonstrated higher self-perceived psychological toll together with higher digital activity and physical distancing than Croatian groups not in lockdown, even when compared with the affected CRO-contact group. The study outcomes suggest that the general emergency measures influenced citizens in lockdown more than exposure to the virus through direct contact with an infected person.
Patofiziologija migrene Ivkić, Goran
Medicus (Zagreb, Croatia : 1992),
05/2021, Letnik:
30, Številka:
1 Migrena
Journal Article
Recenzirano
Odprti dostop
Migrena je tisućljetni, do danas neriješen problem, čiji se patofiziološki mozaik još uvijek slaže. Migrena predstavlja teški i onesposobljavajući neurološki poremećaj, prema Svjetskoj zdravstvenoj ...organizaciji globalno pozicioniran na šesto mjesto po stupnju onesposobljavanja. Zbog svoje pulsirajuće prirode, donedavno je shvaćana isključivo kao vaskularni poremećaj, no akumulirana znanja, dobivena brojnim znanstvenim istraživanjima, dovela su s vremenom do koncepta migrene kao neurovaskularnog poremećaja, koji ima genetsku osnovu, odnosno poremećaja cijelog mozga. Danas je fokus migrenskih istraživanja na molekularnim mehanizmima i kompleksnoj signalizaciji između različitih moždanih područja, čime se stvara sve jasniji patofiziološki mozaik migrene, a time i novi ciljevi liječenja. Iako danas imamo mnogo novih lijekova za liječenje migrene, a dolaze i neki novi, migrena i dalje ostaje neriješena enigma. Možda je vrijeme za mijenjanje kuta gledanja?
As expected, since we recently celebrated the 250th anniversary of birth of Wolfgang Amadeus Mozart, there has been again a renewal of interest in his short but intensive life, as well as in the true ...reason of his untimely dead. Mozart lived and died in time when the medical knowledge was based mostly on subjective observations, without the established basics of standardized medical terminology and methodology. This leaves a great space for hypothesizing about his health problems, as well as about the cause of his death. The medical academic community attributed to Mozart approximately 150 different medical diagnoses. There is much speculation on the possible causes of Mozart's death: uremia, infection, rheumatic fever, trichinellosis, etc. Recently some authors have raised the question about a possible concomitant neurological disease. According to available records, Mozart has shown some elements of cyclotimic disorder, epilepsy and Gilles de la Tourette syndrome. Furthermore, the finding of a temporal fracture on (allegedly) Mozart's skull, gives a way to speculations about the possibility of a chronic subdural hematoma and its compressive effect on the temporal lobe. Despite numerous theories on Mozart's pathography that also include a concomitant neurological disorder, the medical and history records about Mozart's health status indicate that he probably had suffered from an infective illness, followed most likely by the reactivation of rheumatic fever, which was followed by strong immunologic reaction in the last days of his life. Taking all the above into consideration, it is reasonably to conclude that Mozart's neurological disturbances were caused by the intensity of the infective disease, and not primarily by a neurological disease.
The model showing lymphatic vessels covering the surface of the brain is an obvious example of overinterpretation in anatomy (model 251; figure 1). The lymphatic system was the focus of Paolo ...Mascagni's scientific interest, and the Josephinum collection was the first to include his findings.9-11 He made 28 models dealing with lymphatic drainage, including three full-size body models. He also developed mercury injections as a new technique to visualise lymph vessels.9 Mascagni was probably so impressed with the lymphatic system that he saw lymph vessels even where they did not exist-in the brain.12 The lack of lymphatic circulation in the brain was first described in detail in the late 19th century.13 Mascagni could have been seduced by the appearance of the arachnoid, whose thread-like structures resemble lymph vessels. Also, he could have extended his finding of lymphatic drainage in every body organ to the conclusion that the brain should not be an exception. His preparations of the lymphatic vessels were so intricate and rich that they confused restorers: on a full-body model currently on display, the deferent duct connects to the inguinal lymph vessels.
Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized clinically by autonomic dysfunction, Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any ...combination. Parkinsonism is present in the majority of patients (80%). Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients, while the domination of cerebellar symptoms is present in 20% of all patients. According to second consensus statement on diagnosis of MSA, to make the diagnosis of possible MSA, except Parkinsonism or a cerebellar syndrome, there must be one feature involving autonomic dysfunction plus one other additional that can include findings on history, clinical examination or changes in structural or functional imaging. We present a case of 60-year old male with Parkinsonism and cerebellar symptoms accompanied with signs of autonomic nervous system involvement. Level of autonomic dysfunction was not the level required for the diagnosis of probable MSA. On initially performed 1.5T MRI, the most prominent neurodegenerative feature of brain stem, cerebellum and basal ganglia was atrophy, however features like "hot-cross bun" sign, "slit-like" putaminal rim and middle cerebellar peduncle hyperintensities were detected only after MR imaging on higher resolution (3T) device. Our case points to the possibility that some typical structural changes that can help in diagnostic process may not be clearly visible on 1.5 T MRI devices. In such cases we suggest using 3T MRI device, if feasible, in order to demonstrate findings that may help in establishing the diagnosis of possible MSA.
Nitric oxide (NO) has been implicated in the pathogenesis of migraine and treatment with its exogenous donor glyceryl trinitrate (GTN) represents widely accepted experimental "migraine model". In ...this study, glyceryl trinitrate was administered intraperitoneally to carps, serum nitrite and nitrate levels were determined, permeability of blood-brain barrier was investigated, and histological changes of brain tissue were analyzed. Serum nitrite and nitrate levels displayed characteristic biphasic pattern with moderate initial increase and maximal terminal increase, suggesting the GTN-induced endogenous NO synthesis. Increased permeability of the blood-brain barrier in GTN-treated animals was determined based on Evans blue capillary leakage into the brain tissue. Histological analysis revealed changes consistent with vasodilatation and oedema. Our study strongly supports the importance of the NO role in the pathogenesis of migraine attacks and increase in blood-brain barrier permeability during the attack. The study has also provided evidence that this mechanism of action is conserved to the lower vertebrate.
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.
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