Atrioventrikularni blok srca trećeg stupnja u djece

Atrioventricular (AV) block is defined as a delay or interruption in the transmission of an impulse from the atria to the ventricles due to an anatomical or functional impairment in the conduction system. The conduction disturbance can be transient or permanent. In third degree AV block, also referred to as complete heart block, there is complete dissociation of the atrial and ventricular activity. Atrioventricular block is considered to be “congenital” when it occurs spontaneously in a fetus or young child. In children, the most common cause of permanent acquired complete AV block is surgery for congenital heart disease. Injury to fetal conduction tissues caused by transpla- cental exposure to maternal autoantibodies related to systemic lupus erythematosus or Sjogren’s syndrome is responsible for 60 to 90 percent of cases of congenital CHB overall1-3. As many as 40 percent of cases of congenital CHB do not present until later in childhood (mean age five to six years). Only rarely do these patients (5 percent) have proven autoimmune etiology. The increased risk of sudden death is associated with the onset of deep bradycardia or ventricular arrhythmia. A routine electrocardiogram is sufficient to diagnose the disease. A 15-year-old girl has been examined at the emergency pediatric outpatient clinic of the University Hospital Centre “Sestre Milosrdnice” for recurrent episodes of presyncope. Physical examination revealed no major devia- tions other than bradycardia. Her vital signs were within the reference range, with the exception of a pulse of about 44 beats per minute. The electrocardiogram showed atrioventricular dissociation consistent with third degree atrioventricular block. The echocardiogram showed a structurally normal heart except for sinus bradycardia. The girl underwent permanent epicardial pacemaker implantation after which there were no symptoms.Atrioventrikularni (AV) blok je definiran kao kašnjenje ili prekid u prijenosu impulsa iz atrija u ven- trikule zbog anatomskih ili funkcionalnih oštećenja u provodnom sustavu srca. Poremećaj provodl- jivosti može biti prolazan ili trajan. U AV bloku trećeg stupnja, koji se još naziva i kompletni srčani blok, dolazi do potpune disocijacije atrijske i ventrikularne aktivnosti. Atrioventrikularni blok se smatra “kongenitalnim” kada se pojavljuje spontano kod fetusa ili malog djeteta. Stečeni permanent- ni kompletni AV blok kod djece najčešće je posljedica kirurške korekcije prirođenih srčanih grešaka. Ozljeda fetalnog provodnog srčanog tkiva uzrokovana transplacentarnom izloženošću majčinim autoantitijelama povezanim sa sistemskim eritematoznim lupusom ili Sjogrenovim sindromom odgovorna je za 60 do 90 posto slučajeva kongenitalnog srčanog bloka1-3. Čak 40 posto slučajeva kongenitalnog srčanog bloka se javlja kasnije u djetinjstvu (prosječna dob od pet do šest godina). Od navedenih samo rijetki pacijenti (5 posto) imaju dokazanu autoimunu etiologiju. Povećan rizik iznenadne smrti se veže uz nastup duboke bradikardije ili ventrikulske aritmije. Za dijagnozu bolesti je dovoljan rutinski elektrokardiogram. Djevojčica od 15 godina je pregledana u hitnoj pedijatrijskoj ambulanti kliničkog bolničkog centra “Sestre Milosrdnice”, zbog ponavljajućih epizoda presinkopa. Tjelesnim pregledom se nije utvrdilo većih odstupanja, osim bradikardije. Njeni vitalni znakovi su bili unutar referentnog raspona, s izuzetkom pulsa koji je iznosio oko 44 otkucaja u minuti. Elektro- kardiogram je pokazao atrioventrikularnu disocijaciju u skladu s atrioventrikularnim blokom trećeg stupnja. Ehokardiogram je izuzev sinusne bradikardije pokazao strukturno normalno srce. Djevojka je podvrgnuta ugradnji trajnog epikardijalnog pacmakera nakon čega više nije imala simptoma i tegoba u budućnosti

The dynamics of Poincaré's diagrams in assessing newborn infirmity

Cilj istraživanja: Istražiti dinamiku analize RR intervala pomoću Poincaréovih dijagrama u modelu kontroliranog novorođenačkog stresa. Nacrt studije: Istraživanje je postavljeno kao nerandomizirano kontrolirano kliničkog ispitivanje s ponovljenim mjerenjima. Ispitanici i metode: Metodom jednostavnog slučajnog uzorkovanja 40 zdrave terminske novorođenčadi kronološke dobi od 72 sata, rođenih u rodilištu Klinčkog bolničkog centra Osijek uključeno je u istraživanje. Protokol istraživanja sastojao se od četiri faze: faza 1 – mirovanje, faza 2 – simulacija bolnog podražaja pritiskom na petu novorođenčeta, faza 3 – mirovanje i faza 4 – uzorkovanje krvi iz pete novorođenčeta. Tijekom provođenja protokola istraživanja, kontinuirano je monitoriran zapis RR intervala, koji je nakon primarne obrade korišten u daljnjoj analizi. Analiza srčane varijabilnosti rađena je koristeći se analizom Poincaréovih dijagrama, unutar koje je uz standardne deskriptore korišten multi-lag pristup, asimetrija i entropija Poincaréovih dijagrama. Rezultati: Rezultati istraživanja su pokazali kako se u svim fazama istraživanja dobiveni signali značajno razlikuju od surogat modela. Značajna je redukcija parametra SD1 za sve lagove u fazama stresa, dok se parametar SD2 nije značajno mijenjao. Pronađena je i značajna redukcija asimetrije Poincaréovih dijagrama, a u skladu s njom je opisana i povećana entropija. ROC analizom univarijatnih i multivarijatnih single- i multi-lag modela, pronađeno je kako zasebno standardni deskriptori imaju vrijednosti AUC u pravilu veći od 0,7, a u kombiniranom modelu od 0,878 do 0,989. Analizom Poincaréovih dijagrama moguće je točnije razlikovati kontinuirani stres u odnosu na intermitentni. Zaključak: Dinamika analize Poincaréovih dijagrama predstavlja novitet u neinvazivnoj analizi novorođenačkog stresa. Na temelju provedenog istraživanja u kontroliranom modelu novorođenačkog stresa moguće je zaključiti kako se rezultati analiziranog fiziološkog signala mogu koristiti kao biomarkeri za razlikovanje novorođenčeta u mirovanju i u stresu.Objectives: To investigate the changes in the heart rate variability applying the Poincaré plot method in a controlled neonatal stress model. Study design: The study was designed as a non-randomized controlled clinical trial with repeated measurements. Patients and methods: Using simple random sampling, 40 healthy term newborns with a chronological age of 72 hours, born in the University Hospital Osijek, were included in the study. The research protocol consisted of for consecutive phases: phase 1 - first baseline phase, phase 2 - dull pain heel stimulation phase, phase 3 - second baseline phase, and phase 4 - sharp pain heel stick blood drawing phase. RR intervals were recorded during the entire protocol. After preprocessing, the heart rate variability analysis was done using the Poincaré plot method, which was extended to a multi-lag approach, along with Poincaré plot asymmetry and its entropy. Results: The results of the study showed that the RR interval signals in all the phases of the study protocol significantly differed from the surrogate model. A significant reduction of SD1 was observed at all lags within the stress phases, while SD2 did not significantly change. When stressed, a reduction of Poincaré plot asymmetry, followed with an increase of entropy was observed. The results ROC analysis for univariate and multivariate single- and multi-lag models showed AUC values of more than 0.7 for a single parameter, while when combined the AUC values increased up to 0.787 and 0.989. The proposed models were able to distinguish continuous stress more accurately than intermittent stress from resting. Conclusion: The Poincaré plot analysis is a novel and non-invasive method for assessing newborn stress. Based on the results of the study, it can be concluded that the results obtained from the physiological time series can be used as biomarkers for differentiating newborn stress from resting states

Procjena glomerularne filtracije u djece s hemofilijom

Estimated glomerular filtration rate (eGFR) is one of the best-performing methods in evaluating kidney function. There are limited data regarding the estimated glomerular filtration rate in children and young adults with hemophilia. The aim of this study was to determine the difference between three commonly used estimated glomerular filtration rate equations in the pediatric population in a cohort of patients with hemophilia. Our prospective study included 36 pediatric patients with moderate or severe hemophilia. eGFR was calculated for each patient using the original creatinine-based “bedside Schwartz” equation, the cystatin C-based equation and the creatinine-cystatin C-based equation. The difference between the equations, calculated using the one-way repeated ANOVA test, was statistically significant (p <0.001), and post hoc analysis found differences between each method. Correlation analysis showed the strongest positive correlation between the bedside Schwartz equation and creatinine-cystatin C-based equation (r=0.866) among the three methods examined. A correlation between the three eGFR methods was present, but with significant differences between them. Due to the observed differences between eGFR in pediatric patients with hemophilia, further research is needed to find the optimal measurement method for eGFR. Nevertheless, we recommend implementing eGFR equations in routine clinical monitoring of pediatric patients with hemophilia.Procjena glomerularne filtracije jedna je od najboljih metoda ocjene bubrežne funkcije. Postoje oskudni podaci o procjeni glomerularne filtracije u djece i mladih odraslih oboljelih od hemofilije. Cilj našeg istraživanja je utvrditi razliku između tri često korištene metode za procjenu glomerularne filtracije u pedijatrijskoj populaciji u skupini pacijenata oboljelih od hemofilije. U naše prospektivno istraživanje uključili smo 36 djece s hemofilijom umjerenog ili teškog stupnja. Svakom pacijentu procijenjena je glomerularna filtracija koristeći jednostavnu, kreatinin baziranu jednadžbu po Schwartzu, cistatin C baziranu jednadžbu i kreatinin - cistatin C baziranu jednadžbu. Razlika između tri jednadžbe koristeći jednosmjerni ANOVA test bila je statistički značajna (p <0.001), a post hoc analiza pokazala je razliku između svake od navedenih metoda. Korelacijska analiza pokazala je najjače pozitivne korelacije između jednostavne jednadžbe po Schwartzu i kreatinin - cistatin C jednadžbe (r=0.866) promatrajući tri navedene jednadžbe. Korelacija između tri opisane jednadžbe za procjenu glomerularne filtracije postoji, ali sa značajnim neslaganjem. Zbog primijećenog neslaganja između procijenjene glomerularne filtracije u pacijenata s hemofilijom daljnja istraživanja su potrebna s ciljem pronalaska optimalne jednadžbe za procjenu glomerularne filtracije. Štoviše, preporučujemo uključivanje jednadžba za procjenu glomerularne filtracije u rutinsko praćenje djece oboljele od hemofilije

Early Vital Indicators of Newborns Born After Medically Assisted Reproduction

Aim: In this case-control study we wanted to compare the perinatal outcome of naturally conceived newborns to those born after in vitro fertilization (IVF). Methods: At the University Hospital Centre Osijek, in the period from January 2014 to December 2016, we analysed 120 in vitro fertilization pregnancies and compared to 120 natural conception pregnancies. Characteristics of mothers, birth method, perinatal outcome, and vital characteristics of newborns were analysed. Results: IVF-ET pregnancies included 70.0% singleton pregnancies, 28.3% twin and 1.7% triplet pregnancies, while all naturally conceived pregnancies were singletons. When pregnancies were compared between IVF-ET and naturally conceived groups, the following characteristics of mothers were established: age 34.83 (5.8):30.39 (3.9); previous pregnancy 13.3%:56.7%; complications in pregnancy 50.0%:25.0%; Caesarean section (CS) 69.2%:35.8%. All of these were statistically significant (p < 0.001). Comparison of newborns between those two groups established the following: prematurity 39.5% vs. 12.7%; lowest BW 2,114 vs. 3,000 grams; lowest GA 22.29 vs. 28.71 weeks. In the IVF-ET group, 5.7% of newborns had a gestational age of 22-25 weeks, but there were no newborns of that gestational age among the naturally conceived newborns. These were also statistically significant differences (p < 0.001). Apgar score was 10 for both groups, but the difference was in the interquartile range, the values of which were lower in the IVF-ET group. Conclusion: In vitro fertilization pregnancies are high risk due to the characteristics of both the mother and the infant and, as such, require special attention and care. (Milas AM, Pušeljić S, Arambašić J, Šapina M, Tomac V. Early Vital Indicators of Newborns Born After Medically Assisted Reproduction. SEEMEDJ 2020; 4(2); 88-96

Levels of LDL-cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus

Aim: The study aimed to examine LDL cholesterol, triglyceride and urate levels in patients of both sexes with type 2 diabetes mellitus (DM2T) in family medicine offices and to examine whether there is a difference in these parameters between obese patients and patients with normal body weight with DM2T, and between patients with and without manifest cardiovascular diseases. Participants and methods: The study was organized as a cross-sectional study. It included 136 participants of both sexes diagnosed with DM2T, who were divided into groups of patients with or without adiposity and into groups of patients with or without experience of cardiovascular event. General and demographic data were collected, as well as data on experiencing cardiovascular events and levels of LDL cholesterol, triglycerides and urates. Results: The average LDL cholesterol level was 2.93 mmol/L, the average triglyceride level was 1.65 mmol/L and the average urate level was 326.36 µmol/L. Only 12.5% of participants reached target LDL cholesterol levels, while levels of triglycerides and urates were within recommended limits. 24.3% of participants had experienced cardiovascular events and 39.7% of participants were obese. There was no significant difference in levels of LDL cholesterol, triglycerides and urates in participants who had experienced a cardiovascular event and those who had not. There was a significantly higher concentration of triglycerides in obese patients than in patients with normal body weight (p = 0.005). Conclusion: In addition to regulation of glycaemia in patients with DM2T, statin doses should be increased in order to reach the target levels of LDL cholesterol. When it comes to obese patients, education courses on physical activity and diet should be conducted more often and, if necessary, fibrates should be included in therapy in order to reduce additional cardiovascular risks. (Šojat* D, Pirić M, Klarić M, Šapina M, Popović Z, Bačun T. Levels of LDL Cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus. SEEMEDJ 2020; 4(1); 32-39

Respiratory manifestation of SARS CoV-2 infection in children

Koronavirusna bolest je pogodila mnoge segmente civilizacije. Od 11. ožujka 2020. Svjetska zdravstvena organizacija proglasila je pandemiju. Većina mladih ljudi i djece ima blage simptome, s upalom pluća ili bez nje, ili prođe asimptomatski. Bolest je u dječjoj dobi blažeg tijeka nego u odraslih. Teški oblici bolesti zabilježeni su u 4,4% djece. Incidencija koronavirusne bolesti u djece do 18 godina od ukupnog broja oboljelih iznosi 2,1%. Simptomi infekcije kod djece manifestiraju se većinom blažim respiratornim simptomima, no zabilježeni su i slučajevi multisistemskog upalnog odgovara u djece oboljele od infekcije COVID-19. Dijagnoza se postavlja dokazom virusnoga genetičkog materijala u respiratornim uzorcima (uglavnom brisevi nazofarinksa i orofarinks). Važno je provoditi preventivne postupke u borbi protiv širenja bolesti te uočiti prve simptome bolesti zbog pravovremenog započinjanja liječenja.The coronavirus disease has affected many segments of civilization. From 11 March 2020 The World Health Organization has declared a pandemic. Most young people and children have mild symptoms, with or without pneumonia, or are asymptomatic. The disease has a milder course in children than in adults. Severe forms of the disease were recorded in 4.4% of children. The incidence of coronavirus disease in children up to 18 years of age is 2.1% of the total number of patients. The symptoms of infection in children are mostly manifested by mild respiratory symptoms, but cases of multisystemic inflammatory response have also been recorded in children suffering from COVID 19 infection. The diagnosis is established by evidence of viral genetic material in respiratory samples (mainly swabs of the nasopharynx and oropharynx). It is important to carry out preventive procedures in the fight against the spread of the disease, and to notice the first symptoms of the disease due to the timely initiation of treatment

AFLATOXIN CONTAMINATION IN EDIBLE NUTS IN CROATIA

Cilj ovog istraživanja bio je utvrditi prisutnost te količinu prisutnih ukupnih aflatoksina u različitim vrstama koštunjičavog voća koje se konzumira na području Republike Hrvatske. Tijekom 2007. godine s hrvatskog je tržišta prikupljeno ukupno 106 uzoraka različitog koštunjičavog voća (badema, lješnjaka, pistacija i oraha). U svim je uzorcima pomoću imunoenzimskog testa (ELISA testa) utvrđena prisutnost te količina prisutnih ukupnih aflatoksina. Istraživanje je pokazalo da su u 91,5% (97/106) analiziranih uzoraka koštunjičavog voća utvrđene razine ukupnih aflatoksina bile unutar, dok su u 8,5% (9/106) analiziranih uzoraka koštunjičavog voća utvrđene razine ukupnih aflatoksina bile iznad, maksimalno dopuštenih vrijednosti u Europskoj Uniji od 4,0 μgkg-1. Sukladno preporukama nutricionista, posljednjih je godina zamijećena povećana konzumacija koštunjičavog voća u svakodnevnoj prehrani opće populacije u Republici Hrvatskoj zbog čega kontinuirano praćenje te nadzor nad prisutnosti aflatoksina u spomenutim namirnicama ima veliko javnozdravstveno značenje.The aim of the study was to analyze the presence and the quantity of aflatoxin levels in various types of commonly consumed nuts in Croatia. The total amount of 106 nut samples (almonds, hazelnuts, pistachios and walnuts) were collected on the Croatian market during the year 2007, after which the total aflatoxin content was determined using the enzyme linked immunosorbent assay (ELISA) test. The results showed that 91.5% (97/106) of the analyzed samples contained the total aflatoxin levels within the permitted range, while in 8.5% (9/106) of nut samples the aflatoxin levels were above the maximum permitted level of 4.0 μgkg-1, set by the European Union. Following nutritionists\u27 recommendation, the nut consumption in daily nutrition in the Croatian general population has recently increased, thus continuous monitoring and control of aflatoxin levels in nuts is of great public health importance

AFLATOXIN CONTAMINATION IN EDIBLE NUTS IN CROATIA

Cilj ovog istraživanja bio je utvrditi prisutnost te količinu prisutnih ukupnih aflatoksina u različitim vrstama koštunjičavog voća koje se konzumira na području Republike Hrvatske. Tijekom 2007. godine s hrvatskog je tržišta prikupljeno ukupno 106 uzoraka različitog koštunjičavog voća (badema, lješnjaka, pistacija i oraha). U svim je uzorcima pomoću imunoenzimskog testa (ELISA testa) utvrđena prisutnost te količina prisutnih ukupnih aflatoksina. Istraživanje je pokazalo da su u 91,5% (97/106) analiziranih uzoraka koštunjičavog voća utvrđene razine ukupnih aflatoksina bile unutar, dok su u 8,5% (9/106) analiziranih uzoraka koštunjičavog voća utvrđene razine ukupnih aflatoksina bile iznad, maksimalno dopuštenih vrijednosti u Europskoj Uniji od 4,0 μgkg-1. Sukladno preporukama nutricionista, posljednjih je godina zamijećena povećana konzumacija koštunjičavog voća u svakodnevnoj prehrani opće populacije u Republici Hrvatskoj zbog čega kontinuirano praćenje te nadzor nad prisutnosti aflatoksina u spomenutim namirnicama ima veliko javnozdravstveno značenje.The aim of the study was to analyze the presence and the quantity of aflatoxin levels in various types of commonly consumed nuts in Croatia. The total amount of 106 nut samples (almonds, hazelnuts, pistachios and walnuts) were collected on the Croatian market during the year 2007, after which the total aflatoxin content was determined using the enzyme linked immunosorbent assay (ELISA) test. The results showed that 91.5% (97/106) of the analyzed samples contained the total aflatoxin levels within the permitted range, while in 8.5% (9/106) of nut samples the aflatoxin levels were above the maximum permitted level of 4.0 μgkg-1, set by the European Union. Following nutritionists\u27 recommendation, the nut consumption in daily nutrition in the Croatian general population has recently increased, thus continuous monitoring and control of aflatoxin levels in nuts is of great public health importance

Koncentracije ugljikova dioksida u učionicama hrvatskih osnovnih škola tijekom sezone grijanja

Aware that exposure to stuffy indoor air with high levels of carbon dioxide (CO2) is associated with higher absenteeism and reduced academic performance in school pupils, the World Health Organization (WHO) Regional Office for Europe initiated indoor air quality surveys in schools, including CO2 monitoring, to assess ventilation and exposure to stuffy air. Here we report the findings of the first such survey in Croatia. It was conducted in 60 classrooms of 20 urban and rural elementary schools throughout the country during the heating season. Measurements of CO2 levels showed that all 60 classrooms exceeded the international guidelines of 1938 mg/m3. Mean CO2 concentrations ranged from 2771 to 7763 mg/m3. The highest concentration measured in urban schools was 7763 mg/m3 and in rural schools 4771 mg/m3. Average CO2 levels were higher in continental schools (3683 mg/m3) than the coastal ones (3134 mg/m3), but all demonstrate poor ventilation during the heating season all over Croatia.Izloženost zagušljivom zraku u zatvorenom prostoru s visokim razinama ugljikova dioksida (CO2) povezano je s izostancima s nastave i lošijim uspjehom u školi. Regionalni ured Svjetske zdravstvene organizacije (WHO) za Europu razvio je provedbu istraživanja o kvaliteti zraka u zatvorenim prostorima u školama, uključujući praćenje CO2 kako bi se procijenila ventilacija i izloženost zagušljivom zraku. Ovo je bilo prvo istraživanje o kvaliteti zraka u zatvorenim prostorima u hrvatskim osnovnim školama uz praćenje CO2 kao pokazatelja kvalitete zraka i ventilacije. Istraživanje je provedeno u 60 učionica u 20 urbanih i ruralnih osnovnih škola diljem zemlje tijekom sezone grijanja. Razine CO2 mjerene su s intervalom od jedne minute tijekom jednoga školskoga tjedna u svakoj učionici. Međunarodne smjernice od 1938 mg/m3 premašene su u svih 60 učionica. Srednje koncentracije CO2 tijekom nastave bile su u rasponu od 2771 do 7763 mg/m3. Najveća srednja koncentracija u urbanim školama iznosila je oko 7763 mg/m3, a najveća srednja koncentracija CO2 u ruralnim školama oko 4771 mg/m3. Prosječne razine CO2 bile su veće u školama u kontinentalnim područjima (3683 mg/m3) u usporedbi s obalnim područjima (3134 mg/m3). Rezultati upozoravaju na slabu ventilaciju u učionicama tijekom hladne sezone kao široko rasprostranjen problem u Hrvatskoj