Klinički i elektrofiziološki znaci dijabetične polineuropatije – utjecaj glikemije i trajanja šećerne bolesti

Diabetic polyneuropathy occurs in around 50% of diabetic patients. Its pathophysiological mechanism is not completely clarified and major occurrences boil down to the change in neural phenotype and vasa nervorum. As glucose neurotoxicity has been suggested by plenty of evidence, the aim of the study was to assess the effect of glycemia on the severity of diabetic polyneuropathy. Considering that some practical experiences point to serious complications in patients suffering from diabetes of shorter duration, another aim was to assess the effect of diabetes duration on the severity of related neuropathy. Clinical and electromyoneurographic examinations were performed in 100 patients with diabetic polyneuropathy free from any laboratory signs of renal failure. The effect of HbA1c value and duration of disease on clinical symptoms, signs and electrophysiological indicators of polyneuropathy was analyzed. Study results indicated that 78% of patients with diabetic polyneuropathy did not have well-regulated glycemia. Diabetes duration was associated with a growing number of sensory symptoms, among which the sensation of pain similar to electric shock was present in 63% of patients. In addition, it also had negative impact on the sensory and motor nerve conduction velocity. HbA1c influenced the whole range of electrophysiological indicators of diabetic polyneuropathy.Dijabetična polineuropatija javlja se u oko 50% bolesnika s dijabetesom. Njezin patofiziološki mehanizam nastanka nije u potpunosti razjašnjen, a glavna zbivanja svode se na promjenu neuralnog fenotipa i vasa nervorum. Kako postoje mnogi dokazi o neurotoksičnosti glukoze, cilj studije bio je ispitati utjecaj glikemije na težinu dijabetične polineuropatije. Budući da neka iskustva u praksi upućuju na prisutnost teških komplikacija u bolesnika koji imaju dijabetes kraćeg trajanja, ispitao se utjecaj dužine trajanja dijabetesa na težinu pridružene neuropatije. Klinički i elektromioneurografski je ispitano 100 bolesnika s dijabetičnom polineuropatijom. Uvjet je bio da bolesnici nemaju laboratorijske znakove bubrežnog oštećenja, a analizirao se utjecaj vrijednosti HbA1c i trajanja bolesti na kliničke simptome, znakove i elektrofiziološke pokazatelje polineuropatije. Rezultati su pokazali da 78% bolesnika s dijabetičnom polineuropatijom nema dobro reguliranu glikemiju. Trajanje dijabetesa utječe na pojavu većeg broja senzornih simptoma, od kojih se osjećaj boli poput udara struje javlja u 63% bolesnika, a utječe i na pogoršanje brzine provodljivosti senzornih i motornih živaca. HbA1c utječe na čitav niz elektrofizioloških pokazatelja dijabetične polineuropatije

Vertiginous syndrome - transcranial doppler analysis of the vertebrobasilar circulation

Svrha ove studije, kao preliminarnog istraživanja, je utvrđivanje utjecaja radiološki vidljivih promjena vratne kralježnice i transkranijskim dopplerom izmjerene brzine protoka u vertebralnim i bazilarnoj arteriji u bolesnika sa vertiginoznim smetnjama. U rad je uključeno 33 bolesnika (16 muškaraca i 17 žena), od kojih je 12 bilo bez, a 21 bolesnik sa radiološki vidljivim promjenama vratne kralježnice. Računata je točnost, te pozitivna prediktivna vrijednost (PPV) radiološkog nalaza vratne kralježnice u razlučivanju bolesnika s normalnom i alteriranom brzinom protoka kao optimalni raspon brzina protoka. Za desnu vertebralnu arteriju točnost radiološkog nalaza je iznosila 0.66, PPV 0.71, fiziološki raspon brzine protoka krvi iznosio je 36±6 cm/s. Za lijevu vertebralnu arteriju točnost radiološkog nalaza bila je 0.60, PPV 0.47, fiziološki raspon brzine protoka 36 ±10 cm/s. Za bazilarnu arteriju točnost radiološkog nalaza je bila 0.66, PPV 0.52 s fiziološkim rasponom brzine protoka krvi 42 ±13 cm/s.The aim of this preliminary study is to estimate the relationship between radiologically visualized changes of the cervical spine and the haemodynamical changes in vertebral and basilar arteries measured by transcranial Doppler in patients suffering from vertiginous syndrome. The report reviewed 33 patients (16 male and 17 female), 12 of whom had no radiologically diagnosed changes of the servical spine, whereas 21 had such changes. Overall accuracy (ACC) and positive predictive value (PPV) of the radiological diagnosis were calculated to determinate the difference between the patients with normal and changed circulation. Overall accuracy of the radiological diagnosis for the right vertebral artery was 0.66, PPV was 0.71, and the physiological mean velocity range was 36+/-6 cm/sec. ACC for the left vertebral artery was 0.60, with PPV being 0.47 and the physiological mean velocity range 36+/-10cm/sec. Additionally, ACC for the basilar artery was 0.66, PPV was 0.52 and the mean velocity range was 42 + /-13cm/sec

Vertiginous syndrome - transcranial doppler analysis of the vertebrobasilar circulation

Svrha ove studije, kao preliminarnog istraživanja, je utvrđivanje utjecaja radiološki vidljivih promjena vratne kralježnice i transkranijskim dopplerom izmjerene brzine protoka u vertebralnim i bazilarnoj arteriji u bolesnika sa vertiginoznim smetnjama. U rad je uključeno 33 bolesnika (16 muškaraca i 17 žena), od kojih je 12 bilo bez, a 21 bolesnik sa radiološki vidljivim promjenama vratne kralježnice. Računata je točnost, te pozitivna prediktivna vrijednost (PPV) radiološkog nalaza vratne kralježnice u razlučivanju bolesnika s normalnom i alteriranom brzinom protoka kao optimalni raspon brzina protoka. Za desnu vertebralnu arteriju točnost radiološkog nalaza je iznosila 0.66, PPV 0.71, fiziološki raspon brzine protoka krvi iznosio je 36±6 cm/s. Za lijevu vertebralnu arteriju točnost radiološkog nalaza bila je 0.60, PPV 0.47, fiziološki raspon brzine protoka 36 ±10 cm/s. Za bazilarnu arteriju točnost radiološkog nalaza je bila 0.66, PPV 0.52 s fiziološkim rasponom brzine protoka krvi 42 ±13 cm/s.The aim of this preliminary study is to estimate the relationship between radiologically visualized changes of the cervical spine and the haemodynamical changes in vertebral and basilar arteries measured by transcranial Doppler in patients suffering from vertiginous syndrome. The report reviewed 33 patients (16 male and 17 female), 12 of whom had no radiologically diagnosed changes of the servical spine, whereas 21 had such changes. Overall accuracy (ACC) and positive predictive value (PPV) of the radiological diagnosis were calculated to determinate the difference between the patients with normal and changed circulation. Overall accuracy of the radiological diagnosis for the right vertebral artery was 0.66, PPV was 0.71, and the physiological mean velocity range was 36+/-6 cm/sec. ACC for the left vertebral artery was 0.60, with PPV being 0.47 and the physiological mean velocity range 36+/-10cm/sec. Additionally, ACC for the basilar artery was 0.66, PPV was 0.52 and the mean velocity range was 42 + /-13cm/sec

Clinical sensitivity and specificity of multiple T2- hyperintensities on brain magnetic resonance imaging in diagnosis of neurofibromatosis type 1 in children: diagnostic accuracy study

Aim To determine the prevalence, number, and location of multiple (≥2) T2-hyperintensities on brain magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1) and their correlation with age, and to establish their sensitivity, specificity, and accuracy for the diagnosis of NF1 in children, especially in the early age (2-7 years). Methods We performed a cross-sectional study of 162 patients with NF1 from Croatian Neurofibromatosis Association Database and 163 control children between the ages of 2 and 18 years who underwent brain MRI between 1989 and 2009. Results Multiple T2-hyperintensities were present in 74% of NF1 patients and 1.8% of controls. They were mainly located in the basal ganglia, brainstem, and cerebellum and were significantly decreased in prevalence and number in the older age. T2-hyperintensities had excellent diagnostic accuracy with the area under the receiver operating characteristic (ROC) curve of 0.849 and 95% confidence interval (CI) of 0.805-0.886. The diagnostic sensitivity, specificity, and accuracy rate of T2-hyperintensities for NF1 were highest in the youngest age (2-7 years): 81% (95% CI 71%- 89.1%), 99% (95% CI 92.3%-100%), and 85.8 (95% CI 83.3- 93.8), respectively. Conclusion This study strongly suggests the inclusion of T2-hyperintensities on brain MRI on the list of diagnostic criteria for NF1, especially in children of early age, when the clinical penetration of the NF1 gene has not yet been completely finished

Specifičnosti hematoloških laboratorijskih nalaza kod velikih zahvata tumora glave i vrata

The aim of the study was to determine the incidence of coagulation disorders and possible differences between patients operated on for head and neck tumors with and without blood transfusion treatment. The study included 31 patients divided into two groups: 16 patients with and 15 patients without intraoperative administration of blood transfusion. The following laboratory parameters were monitored: leukocyte count, erythrocyte count, hemoglobin, hematocrit, platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen, thrombin time, and fibrinolysis. Data were statistically analyzed by Student’s t-test for dependent and independent samples, and by simple correlation. The results showed prothrombin time to be statistically significantly reduced postoperatively in both patient groups, while fibrinolysis was statistically significantly accelerated in the group of patients who received intraoperative blood transfusion. Accordingly, in patients administered blood transfusion during the surgery, fibrinolysis was statistically significantly accelerated in comparison with their preoperative values. In the group of patients who did not receive intraoperative blood transfusion, fibrinolysis remained within the physiological range.Cilj ispitivanja bio je utvrditi učestalost poremećaja zgrušavanja krvi u bolesnika operiranih zbog tumorskog procesa glave i vrata, te moguću razliku između bolesnika koji su tijekom operacije primali transfuziju i onih koji to nisu. Ukupno je 31 bolesnik bio obuhvaćen ispitivanjem. Bolesnici su bili podijeljeni u dvije skupine: 16 bolesnika je primalo transfuziju tijekom operacijskog zahvata, a 15 bolesnika nije primalo transfuziju. Praćeni su sljedeći laboratorijski parametri: broj leukocita, broj eritrocita, hemoglobin, hematokrit, broj trombocita, aktivirano parcijalno tromboplastinsko vrijeme, protrombinsko vrijeme, fibrinogen, trombinsko vrijeme i fibrinoliza. Podaci su bili statistički obrađeni Studentovim t-testom za zavisne i nezavisne uzorke, te jednostavnom korelacijom. Rezultati su pokazali statistički značajno skraćenje protrombinskog vremena nakon operacije u objema skupinama, dok je fibrinoliza bila statistički značajno ubrzana u skupini bolesnika koji su primali transfuziju. Dakle, u skupini bolesnika koji su primali transfuziju zabilježeno je statistički značajno ubrzanje fibrinolize nakon operacije u usporedbi s prijeoperacijskim vrijednostima. U bolesnika koji nisu primali transfuziju fibrinoliza je ostala u fiziološkim granicama

UPDATE ON GUIDELINES FOR ACUTE STROKE TREATMENT BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND THE CROATIAN STROKE SOCIETY

Cilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.The aim of these guidelines is to provide an update and comprehensive review of the recent literature for clinicians treating adult patients with acute stroke. We translated American guidelines for the acute ischemic stroke treatment, published in 2018 by the American Heart Association and American Stroke Association, and adapted these guidelines to the Croatian legislation, health insurance policy and standards of health care in Croatia. Members of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society writing group evaluated and adjusted American guidelines to specifi cities of the Croatian health care system in order to improve the quality of stroke management in Croatia. These guidelines include pre-hospital care, urgent evaluation and treatment with intravenous and intra-arterial therapy, as well as the secondary prevention measures during initial hospitalization in adult acute stroke patients

UPDATE ON GUIDELINES FOR ACUTE STROKE TREATMENT BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND THE CROATIAN STROKE SOCIETY

Cilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.The aim of these guidelines is to provide an update and comprehensive review of the recent literature for clinicians treating adult patients with acute stroke. We translated American guidelines for the acute ischemic stroke treatment, published in 2018 by the American Heart Association and American Stroke Association, and adapted these guidelines to the Croatian legislation, health insurance policy and standards of health care in Croatia. Members of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society writing group evaluated and adjusted American guidelines to specifi cities of the Croatian health care system in order to improve the quality of stroke management in Croatia. These guidelines include pre-hospital care, urgent evaluation and treatment with intravenous and intra-arterial therapy, as well as the secondary prevention measures during initial hospitalization in adult acute stroke patients

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines