16 research outputs found
Utjecaj CagA antigena bakterije Helicobacter pylori u razvoju aterosklerotske karotidne bolesti [Influence of CagA-positive Helicobacter pylori strains on atherosclerotic carotid disease]
Citotoxin-associated gene-A (CagA)-positive Helicobacter pylori strains have been associated with occurrence and destabilization of coronary atherosclerotic plaques. However, data on the relationship between CagA positive H. pylori infection and carotid artery instability are lacking. Thus, the role of CagA antigen in patients with symptomatic and asymptomatic carotid atherosclerotic plaques was investigated. A total of 64 patients with advanced carotid artery stenosis, including 33 patients with symptomatic and 31 patients with asymptomatic internal carotid artery stenosis, verified by duplex ultrasound, all undergoing carotid endarterectomy, were studied. The control group consisted of 65 subjects without a history or presence of vascular diseases. Serology for H. pylori and CagA antigen was assessed in all participants. Specimens of atherosclerotic plaques obtained from all patients during carotid endarterectomy were analyzed immunohistochemically using anti-CagA monoclonal antibodies. The ultrasonographic plaque characteristics were also estimated. CagA antibody titers were significantly higher in symptomatic patients (8.8; range, 5.8ā32.7) compared to asymptomatic patients (4.7; range, 2.1ā8.8; P = 0.005) and the control group (5.0; range 2.2ā7.9; P<0.001). There was significant difference in echolucency (ā„25% soft material) between the symptomatic and asymptomatic groups (P = 0.034) by ultrasonographic evaluation. Positive immunoreactivity between monoclonal CagA antibodies and antigens within atherosclerotic specimens was significantly higher among symptomatic patients compared to asymptomatic patients (97.0 vs. 74.2%; P = 0.009). The results of this study indicate that H. pylori may play a role in the pathogenesis of the atherosclerotic process due to autoimmune mechanisms and even contribute to destabilization of carotid atherosclerotic plaques
Procjena indeksa zadržavanja daha tijekom ortostaze
The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student\u27s t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P=0.81 and P=0.68 for the right and left side, respectively) or between the two sides of the body in supine (P=0.71) and upright posture (P=0.8). in conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress.Cilj ovoga istraživanja bio je ispitati postojanje razlike cerebrovaskularne reaktivnosti u zdravih ispitanika tijekom ortostaze. Metodom transkranijskog doplera pregledano je 20 zdravih ispitanika (11 muÅ”karaca i 9 žena) bez prisutnih Äimbenika rizika za razvoj aterosklerotske bolesti. Vrijednosti indeksa zadržavanja daha (IZD) odreÄene su u ležeÄem i stojeÄem stavu na standardiziran naÄin. Studentov t-test primijenjen je za usporedbu srednjih brzina strujanja krvi i IZD izmeÄu ležeÄeg i stojeÄeg stava te u odnosu strana. Srednja brzina strujanja krvi u srednjoj cerebralnoj arteriji u ležeÄem stavu ispitanika bila je 66,6 cm/s desno i 68,5 cm/s lijevo, a u stojeÄem stavu 60,6 cm/s desno i 62,3 cm/s lijevo. Nije bilo znaÄajne razlike u vrijednosti brzine strujanja krvi izmeÄu ležeÄeg i stojeÄeg stava ispitanika kao niti izmeÄu spolova. ProsjeÄna vrijednost IZD u ležeÄem stavu bila je 1,59 desno, 1,65 lijevo, a u stojeÄem stavu 1,63 desno te 1,7 lijevo, podjednaka za oba spola. StatistiÄkom obradom nije naÄena razlika u vrijednosti IZD usporeÄujuÄi ležeÄi i stojeÄi stav (P=0,81 za desnu stranu, P=0,68 za lijevu stranu), a niti usporeÄujuÄi dvije strane u ležeÄem (P=0,71) i stojeÄem stavu (P=0,8). Nisu zabilježene znaÄajne razlike IZD u procjeni cerebrovaskularne reaktivnosti tijekom ortostatskog stresa
Acute disseminated encephalomyelitis following spider bite
Akutni diseminirajuÄi encefalomijelitis (ADEM) upalna je, demijelinizirajuÄa bolest srediÅ”njeg živÄanog sustava koja se pojavljuje kao imunoloÅ”ki odgovor na virusnu ili bakterijsku infekciju ili cijepljenje. Prikazujemo bolesnika s kliniÄkom prezentacijom i radioloÅ”kim manifestacijama ADEM-a koji je nastao nakon ugriza pauka. Kortikosteroidna terapija nije postigla zadovoljavajuÄi rezultat u lijeÄenju. Bolesnik se oporavio nakon pet dana lijeÄenja imunoglobulinima. Križna reaktivnost izmeÄu paukovog toksina i mijelina mogla bi objasniti patofizioloÅ”ki mehanizam demijelinizacije. O ADEM-u treba razmiÅ”ljati kao moguÄoj komplikaciji ugriza pauka.Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease of the central nervous system that occurs as an immunological response to a viral or bacterial infection or an immunization. We describe a patient with clinical presentation and radiological features of ADEM that appeared after a spider bite. Corticosteroid therapy did not produce satisfied treatment response. The patient recovered after five days of immunoglobulin therapy. The cross-reactivity between spider toxin and myelin could explain pathophysiological mechanism of demyelination. ADEM should be considered as a possible complication of a spider bite
Procjena indeksa zadržavanja daha tijekom ortostaze
The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student\u27s t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P=0.81 and P=0.68 for the right and left side, respectively) or between the two sides of the body in supine (P=0.71) and upright posture (P=0.8). in conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress.Cilj ovoga istraživanja bio je ispitati postojanje razlike cerebrovaskularne reaktivnosti u zdravih ispitanika tijekom ortostaze. Metodom transkranijskog doplera pregledano je 20 zdravih ispitanika (11 muÅ”karaca i 9 žena) bez prisutnih Äimbenika rizika za razvoj aterosklerotske bolesti. Vrijednosti indeksa zadržavanja daha (IZD) odreÄene su u ležeÄem i stojeÄem stavu na standardiziran naÄin. Studentov t-test primijenjen je za usporedbu srednjih brzina strujanja krvi i IZD izmeÄu ležeÄeg i stojeÄeg stava te u odnosu strana. Srednja brzina strujanja krvi u srednjoj cerebralnoj arteriji u ležeÄem stavu ispitanika bila je 66,6 cm/s desno i 68,5 cm/s lijevo, a u stojeÄem stavu 60,6 cm/s desno i 62,3 cm/s lijevo. Nije bilo znaÄajne razlike u vrijednosti brzine strujanja krvi izmeÄu ležeÄeg i stojeÄeg stava ispitanika kao niti izmeÄu spolova. ProsjeÄna vrijednost IZD u ležeÄem stavu bila je 1,59 desno, 1,65 lijevo, a u stojeÄem stavu 1,63 desno te 1,7 lijevo, podjednaka za oba spola. StatistiÄkom obradom nije naÄena razlika u vrijednosti IZD usporeÄujuÄi ležeÄi i stojeÄi stav (P=0,81 za desnu stranu, P=0,68 za lijevu stranu), a niti usporeÄujuÄi dvije strane u ležeÄem (P=0,71) i stojeÄem stavu (P=0,8). Nisu zabilježene znaÄajne razlike IZD u procjeni cerebrovaskularne reaktivnosti tijekom ortostatskog stresa
Monotherapy with infusion therapies - useful or not?
Infusion pump-based therapies are an effective treatment option for patients with advanced ParkinsonĀ“s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies
A case of āSpectacular Shrinking Deficitā ā case report and short review of elusive clinical phenomena
Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 ā year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta ā 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring
A case of āSpectacular Shrinking Deficitā ā case report and short review of elusive clinical phenomena
Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 ā year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta ā 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring
Incidencija akutnih simptomatskih napadaja kod bolesnika s COVID-19: monocentriÄno istraživanje
The most common neurological symptoms in patients with SARS-CoV-2 infection
are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90
percent of neurological manifestations of COVID-19. Other neurological manifestations such as
stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible
lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic
seizures among COVID-19 patients, while secondary aim was to determine their possible etiology.
Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November
1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38
patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy
history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are
an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly
in the group of patients with a severe course of the disease. Accumulation of proinflammatory
cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may
also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.NajÄeÅ”Äi neuroloÅ”ki simptomi kod bolesnika s infekcijom SARS-CoV-2 su glavobolja, mialgija, encefalopatija, vrtoglavica,
disgeuzija i anosmija, a Äine viÅ”e od 90% neuroloÅ”kih manifestacija ove bolesti. Ostala neuroloÅ”ka zbivanja poput moždanog
udara, poremeÄaja pokreta ili epileptiÄkih napada nisu Äesta, ali su potencijalno teÅ”ke komplikacije s moguÄim smrtnim
ishodom. Primarni cilj ove studije bio je procijeniti uÄestalost akutnih simptomatskih napadaja kod bolesnika s COVID-19,
dok je sekundarni cilj bio utvrditi njihovu moguÄu etiologiju. Od ukupno 5382 bolesnika hospitaliziranih u KliniÄkoj bolnici
Dubrava od 1. studenoga 2020. godine do 1. lipnja 2021. njih 38 (0,7%) je imalo akutne simptomatske napadaje. Od tih
38 bolesnika 29 (76,3%) ih je imalo novonastale epileptiÄke napadaje bez ranije anamneze epilepsije, dok je njih 9 (23,7%)
imalo anamnezu dobro kontrolirane epilepsije uz pojavu epileptiÄkih napadaja tijekom bolesti COVID-19. Iako su akutni
simptomatski napadaji rijetka komplikacija bolesti COVID-19, treba razmiÅ”ljati o epileptiÄkim napadajima kod ovih bolesnika,
osobito kod onih s teŔkim oblikom bolesti. Nakupljanje proupalnih citokina može doprinijeti pojavi napadaja u bolesnika
s COVID-19, ali napadaji mogu takoÄer biti posljedica primarnog zbivanja na mozgu uslijed bolesti COVID-19,
poput moždanog udara ili encefalitisa