Prehypertension and umod gene polymorphism

Polimorfizam jednog nukleotida rs13333226 gena UMOD koji kodira protein uromodulin povezan je s arterijskim tlakom. Naš cilj bio je analizirati povezanost ovog polimorfizma s predhipertenzijom u općoj populaciji. U istraživanje je uključeno 496 odraslih osoba. Isključujući kriteriji bili su liječena arterijska hipertenzija ili šećerna bolest, preboljeli moždani udar ili infarkt miokarda, srčano zatajenje, kronična bubrežna bolest i ostalo. Osobe s eGFR manjom od 60 mL/min/1,73 m2 i ispitanici oboljeli od endemske nefropatije isključeni su iz istraživanja. Klinički i laboratoroijski podaci dobiveni su rutinskim postupcima i metodama, a polimorfizam gena određen je TaqMan® PCR metodom u stvarnom vremenu. Učestalost genotipova i minor alela G u ukupnoj populaciji bile su A/A 68,5% (N=340), A/G 29,6% (N=147), G/G 1,8% (N=9), minor alel G 16% (N=165). Logističkom regresijskom analizom utvrdili smo da niti jedan od promatranih genotipova nije prediktor predhipertenzije. Uobičajeni čimbenici rizika kao što su spol, dob i indeks tjelesne mase utječu na vrijednosti sistoličkog arterijskog tlaka i procijenjene glomerularne filtracije jednako u svim genotipovima uromodulina. Potrebno je povećati uzorak ispitanika kako bi se lakše uočile manje fenotipske promjene, i nastaviti pratiti klinički tijek skupine predhipertoničara kako bi se dobio podatak o dinamici tijekom duljeg vremena praćenja.Single nucleotide polymorphism rs13333226 of UMOD gene which encodes protein uromodulin is associated with blood pressure. Our goal was to analyze the relationship of this polymorphism with prehypertension in general population. In this study we have enrolled 496 adults. Excluding criteria were treated hypertension or diabetes mellitus type 2, previous stroke or myocardial infarction, heart failure, chronic kidney disease and other. Individuals with eGFR lower than 60 mL/min/1,73 m2 and those suffering from endemic nephropathy were excluded. Clinical and laboratory data were obtained by routine methods and polymorphism was obtained with TaqMan® real time PCR method. Prevalence of genotypes and G minor allele in overall population were A/A 68,5% (N=340), A/G 29,6% (N=147), G/G 1,8% (N=9) and G minor allele 16% (N=165). With logistic regression we have found that none of the observed genotypes are predictors for prehypertension. Common risk factors such as gender, age and body mass index equally affect systolic blood pressure and the estimated glomerular filtration in all genotypes equally. It is necessary to increase the sample of subjects in order to detect small changes in phenotype, and continue to follow the clinical course of the in order to measure the dynamics over an extended time

Osteomyelitis and septic arthritis in children and adolescents

Uzročnici, epidemiologija, dijagnostika pa i liječenje septičkog artritisa i osteomijelitisa u djece su se posljednjih godina promijenili. Najčešći uzročnik ostaju bakterije i to i dalje Staphyloccocus aureus dok je Haemophilus influenzae nakon uvođenja obaveznog cjepiva gotovo nestao. Standardno liječenje je i dalje empirijska antibiotska terapija u kombinaciji s kirurškim zahvatima. Nove sheme antibiotskog liječenja predviđaju samo nekoliko dana parenteralne primjene nakon čega slijedi peroralno liječenje. Kirurški zahvati iako u opadanju i dalje imaju važno mjestu u liječenju i to ponajviše dekompresijske procedure. Danas je smrtnost samo oko 1%, međutim čak i uz adekvatno liječenje, mogu završiti destrukcijom zgloba i ploče rasta, skraćenjem i angularnim deformacijama ekstremiteta i značajnim invaliditetom.Causative pathogens, epidemiology, diagnosis, and treatment of pediatric septic arthritis and osteomyelitis have changed remarkably over the past decade. Bacteria remain the most common pathogens, especially Staphylococcus aureus, while Haemophilus influenzae virtually perished after the introduction of obligatory vaccination. Empiric antibiotic therapy in combination with surgery remains the standard treatment. The trend of short-term course of parenteral antibiotic therapy followed by oral administration is observed in recent literature. Surgeries are still conducted, mostly decompression procedures. The mortality is around 1%, but even if adequate treatment is conducted, infectious diseases of locomotor system may lead to the destruction of the joint and growth plate, shortage and angular deformity of the extremity and substantial disability

Protective and Risk Factors in Adjusting to the Covid-19 Pandemic in Croatia

Sukladno do sada provedenim istraživanjima u svijetu i Europi pandemija koronavirusa (COVID-19) izazvala je u samo nekoliko tjedana znatne negativne utjecaje na mentalno zdravlje stanovnika zahvaćenih zemalja. Ovaj je rad dio većeg istraživačkog projekta „Neki aspekti mentalnog zdravlja za vrijeme pandemije COVID-19“ provedenog u Hrvatskoj. U istraživanju je sudjelovalo 1482 sudionika prosječne dobi 33,3 godine (SD= 12,2). Ispitana je povezanost različitih aspekata pandemije s rizičnim i zaštitnim čimbenicima mentalnog zdravlja sudionika. Kao instrumenti korišteni su Upitnik o određenim aspektima pandemije i Upitnik o sociodemografskim podatcima. Rezultati pokazuju da se sudionici razlikuju u procjenama rizičnosti, ozbiljnosti, praćenju medijskih novosti, percipiranom strahu od zaraze i elementima zdravstvene pismenosti s obzirom na opće demografske varijable (spol, bračni status, broj djece, broj članova kućanstva), ali i s obzirom na karakteristike koje ih stavljaju u rizik kao što su dob, mjere samoizolacije te prisutnost kronične bolesti. U radu su detaljno raspravljeni rezultati i praktične implikacije.According to studies conducted so far both in Europe and globally, the coronavirus pandemic (COVID-19) produced a significant negative impact on population mental health in the affected countries within just a few weeks. This paper is part of a larger research project conducted in Croatia titled Some aspects of mental health during the COVID-19 pandemic. The study was conducted on a sample of 1482 respondents with an average age of 33.3 years (SD = 12.2). The focus of this paper was the correlation between various aspects of the pandemic and risk vs. protective factors for population mental health. The Pandemic Aspects Questionnaire and Questionnaire of Sociodemographic Data were used as research instruments. The results showed that respondents significantly differed in their assessments of risk and severity and in how closely they followed the updates in the media, in their perceived fear of infection, and in health literacy levels with regard to general demographic variables (sex, marital status, number of children, number of household members), but also in their risk characteristics such as age, self-isolation measures, and chronic disease. The results and practical implications are discussed in detail

Prevalence of incidental chronic kidney disease and patient characteristics - results of the EH-UH 2 study and the ENAH project

Introduction: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular (CV) disease and premature deaths. The worldwide prevalence of CKD in 2017 in the general population is 9.1%. In this paper our primary aim was to present preliminary data on incidental, i.e., newly discov- ered CKD and the overall prevalence of CKD in the adult population in Croatia. Secondary aim was to compare these data with the data of the CKD prevalence of the adult population from the rural part of Croatia (results of the ENAH study). Materials and Methods: This cross-sectional observational study included random, representative sample of general adults in Croatia, 781 subjects who were part of the large cohort from the EH-UH 2 study. The eGFR was calculated by creatinine-based CKD EPI equation. Albuminuria was determined from the albumin to creatinine ratio in urine (ACR) in 691 subjects. Results: The overall prevalence of CKD in Croatia was 12.7%, of which 9.5% were newly discovered CKD, and only 3.2% were subjects with previously known CKD. According to the albuminuria level, 30.7% of the adult population belonged to the group with a moderate risk of CKD progression, and 7% had a high risk, while 2.5% of the study subjects had a very high risk. Predictors for newly discov- ered CKD are older age, higher urate and potassium, antihypertensive therapy, angina pectoris, atrial fibrillation, lower hemoglobin level. Conclusions: These results continue in a pilot project of the Croatian Kidney Society and the Croatian Hypertension League on the implementation of an action plan to detect new kidney disease in the general population in real life, in a collaboration of primary care physicians and nephrologists

Prevalence of incidental chronic kidney disease and patient characteristics - results of the EH-UH 2 study and the ENAH project

Introduction: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular (CV) disease and premature deaths. The worldwide prevalence of CKD in 2017 in the general population is 9.1%. In this paper our primary aim was to present preliminary data on incidental, i.e., newly discov- ered CKD and the overall prevalence of CKD in the adult population in Croatia. Secondary aim was to compare these data with the data of the CKD prevalence of the adult population from the rural part of Croatia (results of the ENAH study). Materials and Methods: This cross-sectional observational study included random, representative sample of general adults in Croatia, 781 subjects who were part of the large cohort from the EH-UH 2 study. The eGFR was calculated by creatinine-based CKD EPI equation. Albuminuria was determined from the albumin to creatinine ratio in urine (ACR) in 691 subjects. Results: The overall prevalence of CKD in Croatia was 12.7%, of which 9.5% were newly discovered CKD, and only 3.2% were subjects with previously known CKD. According to the albuminuria level, 30.7% of the adult population belonged to the group with a moderate risk of CKD progression, and 7% had a high risk, while 2.5% of the study subjects had a very high risk. Predictors for newly discov- ered CKD are older age, higher urate and potassium, antihypertensive therapy, angina pectoris, atrial fibrillation, lower hemoglobin level. Conclusions: These results continue in a pilot project of the Croatian Kidney Society and the Croatian Hypertension League on the implementation of an action plan to detect new kidney disease in the general population in real life, in a collaboration of primary care physicians and nephrologists

Prehypertension and umod gene polymorphism

Polimorfizam jednog nukleotida rs13333226 gena UMOD koji kodira protein uromodulin povezan je s arterijskim tlakom. Naš cilj bio je analizirati povezanost ovog polimorfizma s predhipertenzijom u općoj populaciji. U istraživanje je uključeno 496 odraslih osoba. Isključujući kriteriji bili su liječena arterijska hipertenzija ili šećerna bolest, preboljeli moždani udar ili infarkt miokarda, srčano zatajenje, kronična bubrežna bolest i ostalo. Osobe s eGFR manjom od 60 mL/min/1,73 m2 i ispitanici oboljeli od endemske nefropatije isključeni su iz istraživanja. Klinički i laboratoroijski podaci dobiveni su rutinskim postupcima i metodama, a polimorfizam gena određen je TaqMan® PCR metodom u stvarnom vremenu. Učestalost genotipova i minor alela G u ukupnoj populaciji bile su A/A 68,5% (N=340), A/G 29,6% (N=147), G/G 1,8% (N=9), minor alel G 16% (N=165). Logističkom regresijskom analizom utvrdili smo da niti jedan od promatranih genotipova nije prediktor predhipertenzije. Uobičajeni čimbenici rizika kao što su spol, dob i indeks tjelesne mase utječu na vrijednosti sistoličkog arterijskog tlaka i procijenjene glomerularne filtracije jednako u svim genotipovima uromodulina. Potrebno je povećati uzorak ispitanika kako bi se lakše uočile manje fenotipske promjene, i nastaviti pratiti klinički tijek skupine predhipertoničara kako bi se dobio podatak o dinamici tijekom duljeg vremena praćenja.Single nucleotide polymorphism rs13333226 of UMOD gene which encodes protein uromodulin is associated with blood pressure. Our goal was to analyze the relationship of this polymorphism with prehypertension in general population. In this study we have enrolled 496 adults. Excluding criteria were treated hypertension or diabetes mellitus type 2, previous stroke or myocardial infarction, heart failure, chronic kidney disease and other. Individuals with eGFR lower than 60 mL/min/1,73 m2 and those suffering from endemic nephropathy were excluded. Clinical and laboratory data were obtained by routine methods and polymorphism was obtained with TaqMan® real time PCR method. Prevalence of genotypes and G minor allele in overall population were A/A 68,5% (N=340), A/G 29,6% (N=147), G/G 1,8% (N=9) and G minor allele 16% (N=165). With logistic regression we have found that none of the observed genotypes are predictors for prehypertension. Common risk factors such as gender, age and body mass index equally affect systolic blood pressure and the estimated glomerular filtration in all genotypes equally. It is necessary to increase the sample of subjects in order to detect small changes in phenotype, and continue to follow the clinical course of the in order to measure the dynamics over an extended time

Osteomyelitis and septic arthritis in children and adolescents

Uzročnici, epidemiologija, dijagnostika pa i liječenje septičkog artritisa i osteomijelitisa u djece su se posljednjih godina promijenili. Najčešći uzročnik ostaju bakterije i to i dalje Staphyloccocus aureus dok je Haemophilus influenzae nakon uvođenja obaveznog cjepiva gotovo nestao. Standardno liječenje je i dalje empirijska antibiotska terapija u kombinaciji s kirurškim zahvatima. Nove sheme antibiotskog liječenja predviđaju samo nekoliko dana parenteralne primjene nakon čega slijedi peroralno liječenje. Kirurški zahvati iako u opadanju i dalje imaju važno mjestu u liječenju i to ponajviše dekompresijske procedure. Danas je smrtnost samo oko 1%, međutim čak i uz adekvatno liječenje, mogu završiti destrukcijom zgloba i ploče rasta, skraćenjem i angularnim deformacijama ekstremiteta i značajnim invaliditetom.Causative pathogens, epidemiology, diagnosis, and treatment of pediatric septic arthritis and osteomyelitis have changed remarkably over the past decade. Bacteria remain the most common pathogens, especially Staphylococcus aureus, while Haemophilus influenzae virtually perished after the introduction of obligatory vaccination. Empiric antibiotic therapy in combination with surgery remains the standard treatment. The trend of short-term course of parenteral antibiotic therapy followed by oral administration is observed in recent literature. Surgeries are still conducted, mostly decompression procedures. The mortality is around 1%, but even if adequate treatment is conducted, infectious diseases of locomotor system may lead to the destruction of the joint and growth plate, shortage and angular deformity of the extremity and substantial disability

Djeca iza zatvorenih vrata COVID-19 izolacije: zlostavljanje, zanemarivanje i nasilje u obitelji

Abuse and neglect of children is a public health issue at a global, European, and Croatian level, with significant rates of morbidity and mortality. Actual circumstances of a health crisis generate and aggravate a series of risk factors for child abuse and neglect at the level of the child and parent characteristics, family dynamics and the wider social environment. Isolation and quarantine possibly leading to social exclusion, represent a serious risk for child abuse and neglect, possibly also being the reason for fewer reports. This paper reviews clinical and empirical studies related to the rates of abuse and neglect of children during health and other crises in other countries. It also analyses trends of recent data of the Ministry of Interior with practical guidelines for improved child protection in this period.Zlostavljanje i zanemarivanje djece predstavlja javnozdravstveni problem na razini svijeta, Europe i Hrvatske sa značajnim stopama morbiditeta i mortaliteta. Aktualne okolnosti zdravstvene krize generiraju i potenciraju cijeli niz rizičnih čimbenika za zlostavljanje i zanemarivanje djece na razini karakteristika djeteta, roditelja, obiteljske dinamike i šire društvene zajednice. Za zlostavljanje i zanemarivanje djece posebno je rizična socijalna isključenost, do koje može doći uslijed mjera izolacije i karantene, a koja istovremeno može utjecati na smanjen broj prijava. Ovaj rad predstavlja pregled dosadašnjih kliničkih i empirijskih iskustava drugih zemalja vezano za stope zlostavljanja i zanemarivanja djece u vrijeme zdravstvenih i drugih kriza, kao i analizu trendova recentnih podataka Ministarstva unutarnjih poslova, s praktičnim smjernicama za pojačanu zaštitu djece u ovom periodu

Mehanizam nastanka prijeloma nadlaktične kosti zagrebačke djece

Prijelomi humerusa vrlo su česti. Većinom zahtijevaju bolničko liječenje, prate ih komplikacije i loši ishodi. Smanjenje pojavnosti prevencijom moguće je poznavanjem mehanizama nastanka prijeloma. Mehanizam nastanka uvjetovan je tjelesnim aktivnostima, životnom dobi i socijalnim okruženjem. U radu se analiziraju uzroci, aktivnosti i mjesta nastanka prijeloma humerusa u zagrebačke djece. Od 2015. do 2019. godine u KBC-u Zagreb zbog prijeloma nadlaktične kosti liječeno je 301 dijete, a u radu je analizirano 243 djece. Bilo je 143 dječaka (58,8%) i 100 djevojčica (41,2%). Prosječna starost bila je 7,5 godina, dječaka 7,9, a djevojčica 7,0 godina. Najviše djece, njih 147 (60,5%) bilo je u dobi od 5 do 9 godina. Češće je lomljena lijeva ruka (62%). Od 243 djece, njih 22 (9%) zadobilo je prijelom gornjeg, petero (2%) srednjeg i 216 (88%) donjeg dijela nadlaktične kosti. Bolnički je liječeno 223 (91,8%) djece s prijelomom humerusa. Druge teške ozljede imalo je 29 (12%) djece (6% ozljeda ulnarnog i po 3% medinusa i radijalnog živca). Uzrok prijeloma u 224 (92,2%) djece bio je pad, prometne nesreće u 5 (2,1%), a u 3 (1,2%) djece prijelom je nastao zbog direktnog udarca. Od svih prijeloma padom u razini, njih 22,4% su padovi s bicikla i 13% u igri nogometa. Kod padova s bicikla najčešća su djeca dobne skupine 5–9 godina (60%). Kod padova s male visine najčešći su pad s ljuljačke, s tobogana i trampolina (60%). S tobogana i trampolina padaju djeca predškolske dobi, a s ljuljačke u svim dobnim skupinama. Kod kuće nastaje četvrtina svih prijeloma (26,7%), na rekreacijskim terenima 28,8%, u školi 14,4%, a u prometu 14%. U zagrebačke djece najčešći mehanizmi ozljede su pad u istoj razini (kod vožnje bicikla i u igri nogometa) te padovi s male visine (trampolin, tobogan, ljuljačka).Humeral fractures in children are very common. In most cases hospital treatment is necessary, with complications and poor outcome sometimes occurring. To reduce the incidence of humeral fractures, it is necessary to know the mechanisms of injury and circumstances in which they occur. The aim of this paper is to analyze activities and locations related to humeral fracture occurrences. The paper analyzed 243 children treated at the University Hospital Center Zagreb for fractures of the upper arm in the period from 2015 to 2019. There were 143 (58.8%) boys and 100 (41.2%) girls. Mean age was 7.5 years (boys 7.9, girls seven years). Most children, 147 (60.5%) of them, were between ages five and nine. Left-sided fractures were more common (62%). Of 243 humeral fractures, 22 (9%) were proximal fractures, five (2%) were shaft fractures, and 216 (88%) were located in the distal humerus. Hospitalization was required in 223 patients (91.8%). Associated nerve injuries were present in 29 (12%) patients (ulnar nerve 6%, median nerve 3%, radial nerve 3%). The fractures were caused by falling in 224 patients (92.2%), traffic accident in five patients (2.1%), and direct blow in three patients (1.2%). Of same level falls, 22.4% were falls of bicycle and 13% occurred while playing football. Falls of bicycle were most common in children between ages five and nine (60%). Falls from height mostly occur from swing, slide and trampoline (60%), with falls from slide and trampoline being more common in pre-school children, and falls from swing occurring in all age groups. Injuries occurred at home in 26.7% of patients, on sports/recreation grounds in 28.8%, at school in 14.4%, and in traffic in 14% of children. The most common causes of injury were same level falls (from bicycle and during football), and falls from height (swing, slide, and trampoline)