35 research outputs found
ZnaÄenje 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 naÅ”e rezultate kontinuiranog mjerenja arterijskog tlaka (KMAT) u djece i adolescenata upuÄenih u naÅ”u Kliniku zbog poviÅ”enog krvnog tlaka (BP) iznad 95. percentile izmjerenog u ordinacijama lijeÄnika primarne zdravstvene zaÅ”tite u 3 ili viÅ”e navrata. Analizirali smo rezultate KMAT-a u 139 djece, 94 djeÄaka i 45 djevojÄica. Srednja dob bila je 14,14 (4-19) godina. Prema nalazu KMAT-a 107 (76,98%) djece imalo je hipertenziju. Primarna hipertenzija (PH) utvrÄena 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 veÄinom o sistoliÄnoj hipertenziji (60,67% odnosno 55,56%). Nije bilo statistiÄki znaÄajne razlike u vrijednostima postotka poviÅ”enog krvnog tlaka iznad 95. centile (engl. BP load) izmeÄu dnevnog i noÄnog sistoliÄnog i dijastoliÄnog tlaka izmeÄu PH i SH. Fenomen non-dipping utvrÄen 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. StatistiÄki znaÄajna razlika naÄena je u tlaku pulsa izmeÄu PH i WCH (df=55, t=6,15, p<0,01), te izmeÄu SH i WCH (df=31, t=3,18, p=0,001). OÅ”teÄenje ciljnih organa ustanovljeno je kod 16 (17,98%) djece s PH i 5 (27,78%) djece sa SH. OÅ”teÄenje 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 poremeÄaja jedenja koji danas spada meÄu najÄeÅ”Äe kroniÄne bolesti adolescenata s visokom stopom smrtnosti, a najÄeÅ”Äe se veže za ženski spol i adolescentsku dob. Retrospektivna studija obuhvatila je 183 djevojÄice i adolescentice (od 2005. do 2015. godine) Centra za poremeÄaje u jedenju djece i adolescenata KliniÄkog bolniÄkog centra Sestre milosrdnice Zagreb. ProsjeÄna dob pacijentica bila je 14,8 Ā± 2,5 godina (7 do 23 godine) s dijagnozom AN u trajanju od prosjeÄno 12,8 Ā± 13,9 mjeseci (0,7 do 108 mjeseci). ProsjeÄni indeks tjelesne mase (BMI) je bio 15,8 Ā± 1,9 kg/m2 s postotkom idealne tjelesne mase (IBW) 77,7 Ā± 9,9 % i prosjeÄnim gubitkom na masi 21,7 Ā± 9,9 %. Normalan menstrualni ciklus je bio prisutan kod 20,6 %, a sekundarnu amenoreju je imalo 74,4 % AN pacijentica. PoveÄan kardiovaskularni (CVD) rizik utvrÄen je kod treÄine AN pacijentica (35,5 %) i gotovo polovice restriktivnog tipa AN (47,4 %). PoveÄan kardiovaskularni rizik kod AN pacijentica povezan je s loÅ”ijim antropoloÅ”kim parametrima (p=0,018) i amenorejom (p<0,001). Rezultati potvrÄuju povezanost poveÄanog CVD rizika i endotipa AN te potvrÄuju 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 Ā± 2.5 years (7 to 21 years), with AN diagnosed for an average of 12.8 Ā± 13.9 months (0.7 to 108 months). Their average BMI was 15.8 Ā± 1.9 kg/m2 with IBW of 77.7 Ā± 9.9% and average weight loss of 21.7 Ā± 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 poremeÄaja 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 izmeÄu rizika za razvoj poremeÄaja u jedenju (ED), psiholoÅ”ke prilagodbe, empatije, privrženosti i internalizacije mrÅ”avosti meÄu adolescentima s anoreksijom nervozom (AN) u odnosu na zdravu kontrolnu skupinu (HC). Upitnik opÄih podataka, Upitnik o poremeÄaju 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 poremeÄajem u jedenju (anoreksija nervoza) i 35 zdravih adolescentica koje su Äinile kontrolnu skupinu. Rizik za razvoj poremeÄaja u jedenju se pronaÅ”ao najveÄim u adolescentica s anoreksijom nervozom koje su imale znaÄajne teÅ”koÄe u opÄoj psiholoÅ”koj prilagodbi, zatim u zdravih adolescentica kod kojih se potvrdila znaÄajna internalizacija ideala mrÅ”avosti. U djevojaka s utvrÄenom dijagnozom anoreksije nervoze, stil privrženosti i internalizacija ideala mrÅ”avosti se nisu pokazali znaÄajnim prediktorom, u kombinaciji s faktorom opÄe psiholoÅ”ke neprilagodbe, za rizik za razvoj poremeÄaja u jedenju. Rezultati podupiru konstrukt poremeÄaja u jedenju koji naglaÅ”ava ulogu opÄe psiholoÅ”ke prilagodbe u razvoju poremeÄaja u jedenju
INDICATORS OF NUTRITIONAL STATUS AND NUTRITIONAL SUPPORT FOR ADOLESCENTS WITH ANOREXIA NERVOSA
Uvod: Anoreksija nervoza (AN) predstavlja trajan poremeÄaj odnosa prema hrani i izgledu vlastitog tijela koji dovodi do znatnog oÅ”teÄenja tjelesnog zdravlja i psiho-emocionalnog funkcioniranja. Pridružene metaboliÄke komplikacije zbog fizioloÅ”kih 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, prosjeÄne dobi 14,8 Ā± 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 znaÄajno niži od oÄekivanih s obzirom na dob, a kod elektrolita nisu pronaÄena veÄa odstupanja. Ispitanice koje su dnevno primale 1068,7 Ā± 425,5 kcal nutritivne potpore provele su duže vrijeme u bolnici, ali su bile manji broj puta hospitalizirane. ZakljuÄak: Pravilnim i odgovarajuÄim dijagnostiÄkim pristupom, ovaj poremeÄaj prehrane moguÄe je otkriti u ranijoj fazi kada funkcija intervencije i multidisciplinarne struÄne pomoÄi (lijeÄnik specijalist, psihijatar, psiholog, kliniÄki nutricionist) može sprijeÄiti 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 Ā± 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 Ā± 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
JoÅ” jedno lice infekcije Epstein-Barrovim virusom: akutni akalkulozni kolecistitis s kolestazom u prethodno zdrave petogodiÅ”nje djevojÄice 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. KliniÄka i laboratorijska slika AAK-a je raznolika,
a dijagnoza se temelji na radioloÅ”kim kriterijima. AAK je atipiÄna i rijetka komplikacija infekcije Epstein-Barrovim virusom
(EBV). Prikazujemo djevojÄicu s AAK i kolestazom posljediÄno primarnoj infekciji EBV-om. Konzervativno lijeÄenje praÄeno
je kliniÄkim, radioloÅ”kim i laboratorijskim poboljÅ”anjem te na koncu potpunim oporavkom djevojÄice. 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