Značenje kontinuiranog mjerenja arterijskog tlaka u djece i adolescenata

The objective of this study was to present our data on ambulatory blood pressure monitoring (ABPM) in children and adolescents referred to our Department because of casual BP elevation over the 95th percentile on at least 3 visits in primary care office. ABPM studies in 139 children, 94 boys and 45 girls, mean age 14.14 (range 4-19) years, were reviewed. A total of 107 (76.98%) children had hypertension according to the ABPM criteria. Primary hypertension (PH) was diagnosed in 89 (64.03%), secondary hypertension (SH) in 18 (12.95%) and white coat hypertension (WCH) in 32 (23.02%) children. In both PH and SH groups, hypertension was predominantly systolic (60.67% and 55.56%, respectively). There was no statistically significant difference in diurnal and nocturnal systolic and diastolic blood pressure (BP) loads between PH and SH groups. The non-dipping phenomenon was detected in 49.44%, 66.66% and 40.62% of children with PH, SH and WCH, respectively. The mean pulse pressure values were 60.41, 58.58 and 52.25 mm Hg in the PH, SH and WCH groups, respectively. A statistically significant difference was found in pulse pressure values between PH and WCH (df=55, t=6.15, p<0.01) groups and between SH and WCH groups (df=31, t=3.18, p=0.001). Target organ damage was diagnosed in 16 (17.98%) children with PH and in 5 (27.78%) children with SH. None of the children with WCH had target organ damage. ABPM is indispensable for establishing the diagnosis of hypertension in children. It is the only reliable method of WCH diagnosis.Cilj istraživanja bio je prikazati naše rezultate kontinuiranog mjerenja arterijskog tlaka (KMAT) u djece i adolescenata upućenih u našu Kliniku zbog povišenog krvnog tlaka (BP) iznad 95. percentile izmjerenog u ordinacijama liječnika primarne zdravstvene zaštite u 3 ili više navrata. Analizirali smo rezultate KMAT-a u 139 djece, 94 dječaka i 45 djevojčica. Srednja dob bila je 14,14 (4-19) godina. Prema nalazu KMAT-a 107 (76,98%) djece imalo je hipertenziju. Primarna hipertenzija (PH) utvrđena je u 89 (64,03%), sekundarna hipertenzija (SH) u 18 (12,95%) i hipertenzija bijele kute (WCH) u 32 (23,02%) djece. I u PH i u SH radilo se većinom o sistoličnoj hipertenziji (60,67% odnosno 55,56%). Nije bilo statistički značajne razlike u vrijednostima postotka povišenog krvnog tlaka iznad 95. centile (engl. BP load) između dnevnog i noćnog sistoličnog i dijastoličnog tlaka između PH i SH. Fenomen non-dipping utvrđen je u 49,44% djece s PH, 66,66% djece sa SH te 40,62% djece s WCH. Srednja vrijednost tlaka pulsa bila je 60,41 mm Hg u PH, 58,58 mm Hg u SH i 52,25 mm Hg u WCH. Statistički značajna razlika nađena je u tlaku pulsa između PH i WCH (df=55, t=6,15, p<0,01), te između SH i WCH (df=31, t=3,18, p=0,001). Oštećenje ciljnih organa ustanovljeno je kod 16 (17,98%) djece s PH i 5 (27,78%) djece sa SH. Oštećenje ciljnih organa nije ustanovljeno kod djece s WCH. KMAT je neophodan za dijagnosticiranje hipertenzije u djece i predstavlja jedinu pouzdanu metodu za dijagnosticiranje WCH

Cardiovascular risk in children and adolescents with restrictive type of anorexia nervosa

Anoreksija nervoza (AN) jedan je od poremećaja jedenja koji danas spada među najčešće kronične bolesti adolescenata s visokom stopom smrtnosti, a najčešće se veže za ženski spol i adolescentsku dob. Retrospektivna studija obuhvatila je 183 djevojčice i adolescentice (od 2005. do 2015. godine) Centra za poremećaje u jedenju djece i adolescenata Kliničkog bolničkog centra Sestre milosrdnice Zagreb. Prosječna dob pacijentica bila je 14,8 ± 2,5 godina (7 do 23 godine) s dijagnozom AN u trajanju od prosječno 12,8 ± 13,9 mjeseci (0,7 do 108 mjeseci). Prosječni indeks tjelesne mase (BMI) je bio 15,8 ± 1,9 kg/m2 s postotkom idealne tjelesne mase (IBW) 77,7 ± 9,9 % i prosječnim gubitkom na masi 21,7 ± 9,9 %. Normalan menstrualni ciklus je bio prisutan kod 20,6 %, a sekundarnu amenoreju je imalo 74,4 % AN pacijentica. Povećan kardiovaskularni (CVD) rizik utvrđen je kod trećine AN pacijentica (35,5 %) i gotovo polovice restriktivnog tipa AN (47,4 %). Povećan kardiovaskularni rizik kod AN pacijentica povezan je s lošijim antropološkim parametrima (p=0,018) i amenorejom (p<0,001). Rezultati potvrđuju povezanost povećanog CVD rizika i endotipa AN te potvrđuju važnost tjelesnog oporavka kod AN pacijenata.Anorexia nervosa (AN), one of the eating disorders that today represents one of the most common chronic disease in adolescents with high mortality rate, is mainly related to female gender and adolescent age. The research was conducted in collaboration with the Centre for eating disorders in children and adolescents, Sestre milosrdnice University Hospital Center Zagreb. Observational retrospective study included 183 girls and adolescents from the Centre's registry (2005 to 2015 period). The average age of patients was 14.8 ± 2.5 years (7 to 21 years), with AN diagnosed for an average of 12.8 ± 13.9 months (0.7 to 108 months). Their average BMI was 15.8 ± 1.9 kg/m2 with IBW of 77.7 ± 9.9% and average weight loss of 21.7 ± 9.9%. Normal menstrual cycle was found in 20.6% patients and secondary amenorrhea in 74.4% of AN patients. The increased cardiovascular (CVD) risk was found in one third of AN patients (35.5%) and almost half in restrictive type AN patients (47.4%). The increased CVD risk correlates with worse anthropometric parameters (p=0.018) and amenorrhea (p<0.001). The results confirm correlation between the increased CVD risk and AN endotype and importance of nutritional recovery and normalization of the menstrual cycle as the main goal of AN treatment

Prediktori rizika za razvoj poremećaja jedenja u adolescentica s anoreksijom nervozom

The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and thin-ideal internalization among adolescents with anorexia nervosa (AN), as compared to a healthy control (HC) group. The Questionnaire of General Data, the Eating Disorders Inventory-3 (EDI-3), the Questionnaire of Sociocultural Attitudes Towards Appearance-3 (SATAQ-3), the Experiences in Close Relationships-Revised (ECR-R) and the Basic Empathy Scale (BES) were administered to 35 female adolescents with AN and 35 HC adolescents. Eating disorder risk was found to be highest in AN females with higher levels of general psychological maladjustment (GPMC), followed by HC females with higher thin-ideal internalization. In the AN group, attachment style and thin-ideal internalization in combination with GPMC were not indicated as significant predictors of eating disorder risk. Study data provide support to conceptualizations of EDs that emphasize the role of general psychological maladjustment in the development of EDs.Cilj ovoga istraživanja bio je ispitati povezanost između rizika za razvoj poremećaja u jedenju (ED), psihološke prilagodbe, empatije, privrženosti i internalizacije mršavosti među adolescentima s anoreksijom nervozom (AN) u odnosu na zdravu kontrolnu skupinu (HC). Upitnik općih podataka, Upitnik o poremećaju jedenja-3 (EDI-3), Upitnik sociokulturnih stavova prema izgledu-3 (SATAQ-3), Revidirani upitnik o iskustvima u bliskim odnosima (ECR-R) i Upitnik o empatiji (BES) ispunilo je 35 adolescentica s dijagnosticiranim poremećajem u jedenju (anoreksija nervoza) i 35 zdravih adolescentica koje su činile kontrolnu skupinu. Rizik za razvoj poremećaja u jedenju se pronašao najvećim u adolescentica s anoreksijom nervozom koje su imale značajne teškoće u općoj psihološkoj prilagodbi, zatim u zdravih adolescentica kod kojih se potvrdila značajna internalizacija ideala mršavosti. U djevojaka s utvrđenom dijagnozom anoreksije nervoze, stil privrženosti i internalizacija ideala mršavosti se nisu pokazali značajnim prediktorom, u kombinaciji s faktorom opće psihološke neprilagodbe, za rizik za razvoj poremećaja u jedenju. Rezultati podupiru konstrukt poremećaja u jedenju koji naglašava ulogu opće psihološke prilagodbe u razvoju poremećaja u jedenju

INDICATORS OF NUTRITIONAL STATUS AND NUTRITIONAL SUPPORT FOR ADOLESCENTS WITH ANOREXIA NERVOSA

Uvod: Anoreksija nervoza (AN) predstavlja trajan poremećaj odnosa prema hrani i izgledu vlastitog tijela koji dovodi do znatnog oštećenja tjelesnog zdravlja i psiho-emocionalnog funkcioniranja. Pridružene metaboličke komplikacije zbog fizioloških osobitosti razdoblja rasta i spolnog razvoja mogu biti potencijalno ireverzibilne, izvjesno i fatalne ukoliko su kasno prepoznate. Cilj: Istražiti vrijednosti antropometrijskih parametara, elektrolitska odstupanja te ispitati trajanje i broj hospitalizacija ovisno o primjeni, trajanju i kalorijskoj vrijednosti nutritivne potpore kod adolescentica oboljelih od AN. Materijali i metode: Retrospektivna studija je provedena na 171 hospitaliziranoj pacijentici Klinike za pedijatriju KBC-a Sestre milostrdnice u Zagrebu, prosječne dobi 14,8 ± 2,5 godina, uvidom u medicinsku dokumentaciju i antropometrijska mjerenja. Rezultati: Neki od parametara poput tjelesne mase, postotka idealne tjelesne mase i indeksa tjelesne mase bili su značajno niži od očekivanih s obzirom na dob, a kod elektrolita nisu pronađena veća odstupanja. Ispitanice koje su dnevno primale 1068,7 ± 425,5 kcal nutritivne potpore provele su duže vrijeme u bolnici, ali su bile manji broj puta hospitalizirane. Zaključak: Pravilnim i odgovarajućim dijagnostičkim pristupom, ovaj poremećaj prehrane moguće je otkriti u ranijoj fazi kada funkcija intervencije i multidisciplinarne stručne pomoći (liječnik specijalist, psihijatar, psiholog, klinički nutricionist) može spriječiti daljnje razvijanje bolesti i popratne zdravstvene komplikacije.Introduction: Anorexia nervosa (AN) is a permanent disorder of attitude towards food and image of own body which leads to a significant damage to physical health and psycho-emotional functioning. Associated metabolic complications due to the physiological characteristics of the period of growth and sexual development can be potentially irreversible, certainly fatal if detected late. Aim: To investigate the value of anthropometric parameters, electrolyte deviations and to examine duration and number of hospitalizations depending on the frequency of application, duration and caloric value of nutritional support in adolescent with AN. Materials and Methods: Retrospective study was conducted on 171 hospitalized patients at the Department of Pediatrics, Sestre milosrdnice University Hospital Centre of Zagreb, average age 14.8 ± 2.5 years, analyzing data from their medical records and anthropometric measurements. Results: Some of the parameters such as body weight, percentage of ideal body weight and body mass index were significantly lower than expected due to age, and for the level of electrolytes-no larger deviations were found. Girls who have received an average 1068.7 ± 425.5 kcal nutritional support per day were longer in the hospital, but fewer times hospitalized. Conclusion: With regular and appropriate diagnostic approach, this eating disorder can be detected at an earlier stage, when the function of intervention and multidisciplinary professional help (specialist doctor, psychiatrist, psychologist, clinical nutritionist) can prevent further development of the disease and consequential health complications

Još jedno lice infekcije Epstein-Barrovim virusom: akutni akalkulozni kolecistitis s kolestazom u prethodno zdrave petogodišnje djevojčice s primarnom infekcijom

Acute acalculous cholecystitis (AAC) is a rare disease, particularly in children. The clinical and laboratory presentation of AAC is variable. The diagnosis is based on radiological criteria. AAC is an atypical and rare complication of Epstein-Barr virus (EBV) infection, therefore we present a girl with AAC and cholestasis due to EBV primary infection. Conservative treatment and careful monitoring was followed by clinical, radiological and laboratory improvement, and finally complete recovery. Our aim was to highlight the importance of recognizing AAC as a differential diagnosis in children with abdominal pain and/or acute cholestasis.Akutni akalkulozni kolecistitis (AAK) je rijetka bolest, osobito u djece. Klinička i laboratorijska slika AAK-a je raznolika, a dijagnoza se temelji na radiološkim kriterijima. AAK je atipična i rijetka komplikacija infekcije Epstein-Barrovim virusom (EBV). Prikazujemo djevojčicu s AAK i kolestazom posljedično primarnoj infekciji EBV-om. Konzervativno liječenje praćeno je kliničkim, radiološkim i laboratorijskim poboljšanjem te na koncu potpunim oporavkom djevojčice. Cilj ovoga prikaza je naglasiti važnost prepoznavanja AAK-a kao diferencijalne dijagnoze u djece s bolovima u trbuhu i/ili akutnom kolestazom

Unusually difficult clinical presentation of an infant suffering from congenital cytomegalovirus (CMV) infection combined with alpha 1-antitrypsin (A1AT) deficiency

Congenital Cytomegalovirus (CMV) infection and alpha 1-antitrypsin (A1AT) deficiency are separately well described entities, but their simultaneous occurrence can pose a special challenge to a clinician, especially dealing with optimal diagnostic as well as therapeutic approach. Congenital CMV infection is the most common vertically transmitted infection in developed countries. In 85-95% of newborns it runs asymptomatic, while in others it is presented with jaundice, petechias, hepatosplenomegaly and central nervous system damage. A1AT deficiency is on the other hand, the most common genetic liver disease in children, and the clinical spectrum varies from the accidentally detected increased levels of transaminases through to the severe infant cholestasis that can progress to cirrhosis. The following case report describes a two-month old male with severe clinical presentation of congenital CMV infection probably exacerbated due to A1AT deficiency comorbidity. The clinical manifestations and unusually difficult clinical signs this infant presented lead to assumption that the additional liver damage exists. Extensive laboratory analyses were performed, including PCR for CMV DNA, A1AT serum concentration, A1AT genotyping, followed and confirmed with phenotyping. Patient was treated parenteral with ganciclovir, what continued with oral valganciclovir and supportive therapy. Intensive and thorough supportive treatment of the infant resulted in satisfactory progress and excellent outcome. Patient was followed-up till the age of 18 months. The presented case provides excellent example about successful overcoming obstacles in differential diagnosis of A1AT in neonates and infants. Medical charts analysis was the methodology used in making this repor