Urban and Architectural Development of the Children’s Hospital Complex in Klaićeva st. in Zagreb

Kliniku za dječje bolesti Zagreb čini sklop zgrada u zapadnom dijelu bloka Klaićeva, Kačićeva, Deželićeva i Medulićeva ulica. Još od 1951. godine, kada je zgrada Fischerova Sanatorija (1909.) prenamijenjena u Dječju bolnicu, kontinuirano se traži način da se izvorni sadržaji prilagode novim namjenama i novim tehnologijama. Dogradnjama 1956. (V. Turina), 1964. (S. Jovičić) i 1987. (M. Vodička) te nizom sporadičnih adaptacija i rekonstrukcija prostor se pokušava objediniti u tehnološku cjelinu. Formalno je zadržana prepoznatljivost sklopa, ali parcijalne dogradnje i realizirani programi nisu osigurali potpunu funkcionalnost bolnice kao cjeline.The Children’s Hospital in Zagreb is a complex of buildings in the west part of the block surrounded by Klaićeva, Kačićeva, Deželićeva and Medulićeva streets. Since 1951 when the Sanatorium building designed by I. Fischer (1909) was repurposed as the Children’s Hospital, there has been a growing tendency to adapt the original facilities to new purposes and new technologies. New wings added in 1956 (V. Turina), 1964 (S. Jovičić), and 1987 (M. Vodička) as well as a series of occasional interventions and reconstructions were aimed at integrating the entire complex into a technological whole. Various partial a dditions and realized programmes did not fully contribute to its functionality

Prediktivni čimbenici za rano prepoznavanje farmakorezistentne epilepsije

Epilepsy is one of the most common neurologic diseases. Despite improved diagnostic and therapeutic possibilities seizures remain refractory in more than 30% of patients with epilepsy. The aim of this study was to analyze the possible predictive factors for the development of pharmacoresistance in cryptogenic partial complex epilepsy. Patients were divided into two groups based on the number of seizures, clinical response to antiepileptic drugs and duration of the disease. One group consisted of patients resistant to anticonvulsant drugs and the other group of patients with well controlled seizures. Disease onset, electroencephalographic (EEG) findings and frequency of secondary generalization of partial complex seizures were analyzed in both groups. The results obtained showed a statistically significantly earlier occurrence of first epileptic seizure in the group of patients with pharmacoresistant epilepsy. The group of pharmacoresistant patients also had a statistically significantly higher proportion of secondary generalization of complex partial seizures as well as a higher proportion of patients with focal changes in EEG. These findings suggest that the onset of the disease at an earlier age, focal changes in EEG and secondary generalization of partial seizures may be early predictive factors for the development of pharmacoresistance in patients with cryptogenic partial complex epilepsy.Epilepsija je jedna od najučestalijih neuroloških bolesti. Usprkos napretku dijagnostičkih i terapijskih mogućnosti epileptični napadaji ostaju refraktorni u više od 30% bolesnika s epilepsijom. Cilj ovoga istraživanja bio je analizirati moguće prediktivne čimbenike za razvoj farmakorezistencije kod bolesnika s kriptogenom parcijalnom kompleksnom epilepsijom. Na temelju broja napadaja, učinkovitosti antiepileptične terapije te duljine trajanja bolesti bolesnike s parcijalnom kompleksnom epilepsijom podijelili smo u dvije skupine. Jednu skupinu su činili bolesnici s medikamentno rezistentnim oblikom bolesti, dok su drugu skupinu činili bolesnici s dobrim odgovorom na antiepileptičnu terapiju. U obje skupine se ispitivala dob početka bolesti, analizirao se nalaz elektroencefalograma (EEG) te učestalost sekundarne generalizacije parcijalnih kompleksnih napadaja. Dobiveni rezultati su pokazali da je u skupini bolesnika s farmakorezistentnim oblikom bolesti statistički značajna ranija dob pojave prvog napadaja. Također je utvrđeno da je u skupini farmakorezistentnih bolesnika statistički značajno veći udio bolesnika kod kojih dolazi do sekundarne generalizacije parcijalnih kompleksnih napadaja, kao i veći udio bolesnika sa žarišnim promjenama u EEG-u. Dobiveni rezultati ukazuju na to da ranija dob početka bolesti, žarišne promjene u EEG-u i sekundarna generalizacija parcijalnih epileptičnih napadaja mogu biti rani prediktivni čimbenici za razvoj medikamentne rezistencije u bolesnika s kriptogenom parcijalnom kompleksnom epilepsijom

Prediktivni čimbenici za rano prepoznavanje farmakorezistentne epilepsije

Epilepsy is one of the most common neurologic diseases. Despite improved diagnostic and therapeutic possibilities seizures remain refractory in more than 30% of patients with epilepsy. The aim of this study was to analyze the possible predictive factors for the development of pharmacoresistance in cryptogenic partial complex epilepsy. Patients were divided into two groups based on the number of seizures, clinical response to antiepileptic drugs and duration of the disease. One group consisted of patients resistant to anticonvulsant drugs and the other group of patients with well controlled seizures. Disease onset, electroencephalographic (EEG) findings and frequency of secondary generalization of partial complex seizures were analyzed in both groups. The results obtained showed a statistically significantly earlier occurrence of first epileptic seizure in the group of patients with pharmacoresistant epilepsy. The group of pharmacoresistant patients also had a statistically significantly higher proportion of secondary generalization of complex partial seizures as well as a higher proportion of patients with focal changes in EEG. These findings suggest that the onset of the disease at an earlier age, focal changes in EEG and secondary generalization of partial seizures may be early predictive factors for the development of pharmacoresistance in patients with cryptogenic partial complex epilepsy.Epilepsija je jedna od najučestalijih neuroloških bolesti. Usprkos napretku dijagnostičkih i terapijskih mogućnosti epileptični napadaji ostaju refraktorni u više od 30% bolesnika s epilepsijom. Cilj ovoga istraživanja bio je analizirati moguće prediktivne čimbenike za razvoj farmakorezistencije kod bolesnika s kriptogenom parcijalnom kompleksnom epilepsijom. Na temelju broja napadaja, učinkovitosti antiepileptične terapije te duljine trajanja bolesti bolesnike s parcijalnom kompleksnom epilepsijom podijelili smo u dvije skupine. Jednu skupinu su činili bolesnici s medikamentno rezistentnim oblikom bolesti, dok su drugu skupinu činili bolesnici s dobrim odgovorom na antiepileptičnu terapiju. U obje skupine se ispitivala dob početka bolesti, analizirao se nalaz elektroencefalograma (EEG) te učestalost sekundarne generalizacije parcijalnih kompleksnih napadaja. Dobiveni rezultati su pokazali da je u skupini bolesnika s farmakorezistentnim oblikom bolesti statistički značajna ranija dob pojave prvog napadaja. Također je utvrđeno da je u skupini farmakorezistentnih bolesnika statistički značajno veći udio bolesnika kod kojih dolazi do sekundarne generalizacije parcijalnih kompleksnih napadaja, kao i veći udio bolesnika sa žarišnim promjenama u EEG-u. Dobiveni rezultati ukazuju na to da ranija dob početka bolesti, žarišne promjene u EEG-u i sekundarna generalizacija parcijalnih epileptičnih napadaja mogu biti rani prediktivni čimbenici za razvoj medikamentne rezistencije u bolesnika s kriptogenom parcijalnom kompleksnom epilepsijom

Povezanost apolipoproteina E ε2 s kasnijim početkom epilepsije temporalnog režnja

The aim of the study was to evaluate the possible association between Apo E polymorphisms and age at seizure onset in patients with non-lesional temporal lobe epilepsy. Eighty patients with non-lesional temporal lobe epilepsy with or without bilateral tonic-clonic propagation were analyzed. Age at seizure onset was defined as age at the first unequivocal seizure (excluding febrile convulsions). ApoE alleles were determined by a procedure where genome DNA was amplified by chain reaction along with polymerase, using the LightCycler kit (Roche) for ApoE mutations on codons 112 and 158. There was a statistically significant difference between the groups of patients with ApoE ε2/3 and ε3/4 genotypes (p=0.03), but not between patients with ApoE ε2/3 and ε3/3, and those with ApoE ε3/4 and ε3/3. In conclusion, the results of our study suggested positive association of a specific ApoE genotype and onset of non-lesional temporal lobe epilepsy.Cilj ovoga istraživanja bio je utvrditi moguću povezanost genskog polimorfizma ApoE s dobno ranijim početkom bolesti kod bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga. U istraživanje je bilo uključeno 80 bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga. Dob početka bolesti definirana je kao dob pojavnosti prvog neprovociranog epilepsijskog napadaja (isključujući febrilne konvulzije). ApoE aleli su određeni postupkom pri kojem je genomska DNA amplificirana lančanom reakcijom uz polimerazu, a korišten je detekcijski kit LightCycler (Roche) za mutacije ApoE na kodomu112 i 158. Utvrđena je značajna statistička razlika između skupina bolesnika s genotipom ApoE ε2/3 i ε3/4 (p=0,03), dok između bolesnika s ApoE ε2/3 i ε3/3 i onih s ApoE ε3/4 i ε3/3 nije bilo značajne statističke razlike. Rezultati istraživanja ukazuju na moguću povezanost specifičnog genotipa ApoE i dobi početka bolesti kod bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga

Odgođeni učinak VNS-a na interiktalna epileptiformna izbijanja i farmakorezistentnost u bolesnice s refraktornom perinatalnom postishemijskom epilepsijom

A 20-year-old female with refractory perinatal postischemic catastrophic epilepsy and frequent daily generalized atonic, tonic, tonic-clonic and focal seizures was hospitalized in the progressive phase of illness. The diagnosis was confirmed by semiology, interictal electroencephalogram (EEG), long-term video EEG monitoring, and brain magnetic resonance imaging. Repeated interictal EEG findings showed generalized spike and slow wave complexes with a 2-3 Hz frequency. Interictal EEG showed evidence of electroclinical epileptic status on several occasions. She was treated with various antiepileptic drugs without improvement. After verification of her incompetence for normal autonomous living, which resulted in very low quality of life, this patient with refractory epilepsy underwent implantation of vagus nerve stimulator (VNS). In this case report, we present delayed effect of VNS on interictal epileptiform discharges and pharmacoresistance.Mlada žena u dobi od 20 godina s farmakorezistentnom perinatalnom postishemijskom epilepsijom i svakodnevnim učestalim generaliziranim atoničkim, toničkim, toničko-kloničkim te žarišnim napadima hospitalizirana je u pogoršanoj fazi bolesti. Dijagnoza je potvrđena kliničkom slikom, interiktalnim elektroencefalogramom (EEG), video EEG monitoriranjem te magnetskom rezonancom (MR) mozga. Ponavljani interiktalni nalazi EEG-a pokazali su generalizirana izbijanja šiljakval kompleksa frekvencije 2-3 Hz. U više navrata u interiktalnom EEG-u je evidentiran i elektroklinički epileptički status. Bolesnica je liječena različitim antiepilepticima, ali bez poboljšanja stanja. Zbog učestalih napada bolesnica nije bila sposobna za samostalan život, što je rezultiralo vrlo niskom kvalitetom života te je bolesnica podvrgnuta ugradnji vagusnog stimulatora (VNS). U ovom prikazu slučaja opisujemo odgođeni učinak VNS-a na interiktalna epileptiformna izbijanja i farmakorezistentnost

Railway System in Physical Plans of Zagreb

Razvoj modernog Zagreba vezan je za razvoj željeznice koja je svojim polož ajem direktno sudjelovala u usmjeravanju prostornog širenja i oblikovanja grada. Način rješavanja željezničkog pitanja, kao predmeta državnog ili nekoga višeg interesa, hijerarhijski je uvijek bio ispred interesa grada. Željeznica je bila datost kojoj su se grad i njegovi prostorni planovi prilagođavali. Budući razvoj željeznice mora se prilagoditi ne samo zahtjevima suvremene željezničke tehnologije nego i potrebama grada. Posljedica bi trebala biti promjena načina i intenziteta korištenja površina željezničkih postrojenja i zemljišta uz prugu. U konačnici, ti bi procesi trebali rezultirati potpunom funkcionalnom i prostornom integracijom željeznice i grada.The development of modern Zagreb has always been tied up with the development of the railway which had a direct impact on the expansion and formation of the city. The railway issue as a matter of government\u27s particular interest has always been given priority. The town itself as well as its physical plans have been adapted to the railway system requirements. The future development of the railway has to be adjusted not only to the requirements of modern rail technology but also to the city\u27s needs. Consequently, the way and the intensity of using railway facilities and the surrounding land should be modified. Ultimately, these processes should result in a complete functional and spatial integration of the railway and the town

Sleep disorders in COVID-19 patients: a monocentric prevalence study conducted on 337 patients

Introduction : Our study analysed the prevalence of sleep disorders (primarily insomnia and hyper- somnia) in patients who tested positive for Covid 19, as well as the distribution of insomnia/hyper- somnia in different subgroups of these patients (according to their age, gender, BMI, disease severity). Materials and methods: This prospective, noninvasive, cross sectional study was conducted at the Emergency department, Respiratory Center, and Respiratory Intensive care Center of University Hospital Dubrava from December 2020. until March 2021. It included patients whose tested posi- tive for Covid 19 and who reported at least one neurological symptom. Patients were examined, and interviewed face to face using a web – based structured questionnaire designed for the purposes of this study. Results: Of the 337 participants, 109 (32,34%) reported one of two possible symptoms associated with sleep disorder, primarily difficulty sleeping/insomnia ( dubbed „sleep disorder“) or sleepiness/ hypersomnia. Of the 337 participants, 61 (18%) reported sleep disorder while 48 (14%) reported hypersomnia. There was no statistically significant difference in prevalence of sleep disorder between men and women (ꭓ2 = 0,113, p = 0,737). Hypersomnia was more prevalent in women (ꭓ2 = 8,125, p = 0,004). Patients who had sleep disorder had a lower median age by 5 years compared to patients who did not have a sleep disorder (z = 2,6, p = 0,009). Patients who had hypersomnia had a median of age lower for 9 years than patients who did not have hypersomnia (z = 4,3, p = <0,001). There was no significant difference in BMI between patients with and without hypersomnia (z = 0,157, p = 0,875). There was no association of hypersomnia with the presence of pneumonia (ꭓ2 = 0,000, p =1,000). In our study sleep disorder was associated with pneumonia (ꭓ2 = 6.4, p = 0.012). Of the patients with a sleep disorder, 59% of them reported dispnea, 78% had pneumonia and72% were hospitalized. Of the admitted patients, only two of them were transferred to the Respiratory intensive care and were treated using mechanical ventilation. In the patient group with hypersomnia, 46% of patients reported dispnea, 64% had pneumonia and 48% were hospitalized, of which one patient was hospitalized in Respiratory intensive care, and did not require treatmeant with mechanical ventilation. Conclusion: Sleep disorders are prevalent in one form or the other in little over a third of patients with a Covid infection. Age, gender, and the presence of pneumonia are associated with different types of sleep disorders. More studies are needed to investigate the potential effect of sleep on the outcome of patients with COVID 19