Tržište željezničkog teretnog prijevoza Europske unije

Svrha ovoga rada jest analizirati željeznički teretni prijevoz unutar prometnog i gospodarskog sustava država Europske unije te ukazati na stagnaciju željezničkoga teretnog prijevoza mjerenu relativnim tržišnim udjelom i na zanemarivanje uloge željezničkog prometa kao čimbenika integracije europskoga prometnog i gospodarskog sustava. Da bi se dokazala postavljena hipoteza o stagnaciji željezničkog prometa i neiskorištavanju njegovih brojnih konkurentskih prednosti u odnosu na druge prometne grane, primijenjene su metode analize i sinteze te metoda deskriptivne statistike. Glavni nalaz ovoga rada jest taj da su daljnja integracija i liberalizacija željezničkog tržišta teretnog prijevoza država EU-28, međusobna suradnja željezničkih poduzeća i suradnja željeznice s drugim vrstama prometa temeljni preduvjeti za konkurentsko profiliranje željezničkog prometa i njegovo što učinkovitije integriranje u transportne i logističke lance

The Thermohaline Characteristics of the Sea Water in North Western Part of The Vis Channel

Raščlambom vrijednosti termohalinskih jedinica temperature, slanosti i gustoće morske vode u sjeverozapadnom dijelu Viškog kanala, došlo se do novih spoznaja o termohalinskim svojstvima morske vode u tom akvatoriju. Ustanovilo se da je srednja godišnja temperatura morske vode viša od temperature zraka, kao i da je srednja mjesečna temperatura vodenog stupca najviša u studenome. Uočilo se i neka netipična stanja, na primjer okomite termalne inverzije, pojavu ispodpovršinskog minimuma slanosti, kao i tipična, na primjeru krajnjih vrijednosti gustoće, koje prate krajnje termalne i halinske, te pokazuju neposrednu ovisnost.Analysing the values of thermohaline parameters: temperature, salinity and density of sea-water, in north-western part of the Vis Channel new cognitions have been reached at about thermohaline characteristics of sea-water in that area. It has been established that the mean annual temperature of surface layer of sea-water is higher then the air temperature, as well as the mean monthly temperature of water column, which is the highest one in November. Some unusual conditions have been noted, such as vertical thermal inversions, the occurrence of under-surface minimum of salinity, as well as some usual conditions of extreme values of density which have been shown in relation to extreme thermal and salinity values, that have shown an indirect dependence

Flail aortic valve leaflet due to high-voltage electrical injury

Introduction: Electric shock is the set of pathophysiological events resulting from the action of an electric current on the human body1. Electrical injuries involve both direct (caused by contact with electricity arc) and indirect mechanisms (mechanical trauma due to falls). The most common sequels after electrical injury in the heart are arrhythmias and myocardial contusion2. Large arteries like aorta are rarely affected because their rapid flow allows them to dissipate the heat produced by the electric current. However, they are susceptible to medial necrosis, with aneurysm formation and rupture at a later point of time. There is one case in the literature which described aortic valve rupture due to high-voltage electrical injury3. Case report: 47-year-old male patient was admitted to our echo lab for ultrasound examination of the heart. In the last two months he had been complaining about exertional dyspnea. His medical history was quite poor: he had never been admitted to the hospital until two months ago when he had been observed for 24 hours after he had suffered a high-voltage electric injury. The transthoracic echocardiography was performed, and we discovered moderately enlarged left ventricle (LVED volume 180 ml) due to severe aortic regurgitation on bicuspid aortic valve with holo-diastolic retrograde flow. The regurgitation jet that filled the two thirds of left ventricular outflow tract with laceration and flail of bicuspid cusps confirmed on transesophageal ultrasound. The patient underwent surgery. The aortic valve was removed and replaced with a mechanical prosthesis. Conclusion: Cardiac symptoms and echocardiographic findings that initiated two months after a high-voltage electric injury led us to conclusion that bicuspid valve was probably injured by electrical shock. To the authors’ knowledge, this is the first reported case of valvular rupture due to electrical injury in Croatian population

Unruptured non-coronary sinus of Valsalva aneurysm – case report

Introduction: Sinus of Valsalva aneurysm (SVA) is an abnormal dilatation of the aortic root located between the aortic valve annulus and the sinotubular junction. The estimated rate of SVA is approximately 0.09% of the general population and involve up to 3.5% of all congenital heart defects1. Aneurysm predominantly originates from the right coronary sinus and may rupture up to 35% of the time commonly to the right cardiac chambers2. We present an unusual case of a patient with SVA originating from the non-coronary sinus. Case report: 63-old-year male with no history of prior cardiovascular disease was presented to department with shortness of breath and chest pain. Physical examination showed blood pressure of 140/80mmHg, respiratory rate of 18/min and heart rate of 84 beats/min. Electrocardiogram revealed complete right bundle-branch block. A routine transthoracic echocardiography showed the enlargement of the left ventricle with large aneurysm originating from non-coronary sinus measuring 3.6x4cm. Echocardiography also revealed a trileaflet aortic valve with moderate aortic regurgitation and normal systolic function of the left ventricle. TEE demonstrated a non-coronary SAV protruding into the left atrium cavity with no signs of rupture. Selective angiography showed normal epicardial coronary arteries, and SAV with dilatation of ascending aorta measuring up to 40 mm. Moderate aortic insufficiency was also detected. The patient was referred to the cardiothoracic surgery ward for further operative treatment. Conclusion: Although rare, SAV can be a cause of sudden death. Therefore, a combination of transthoracic echocardiography with other imaging techniques, such as TEE, 3D echocardiography, CT angiography and aortic angiography is recommended to obtain comprehensive information and to improve diagnostic accuracy3

Quality of Life after the Sweedish Adjustable Gastric Band Procedure

The term »quality of life« usually describes factors that have an impact on living conditions within the society or on an individual. Generally, the term quality of life refers to the level of the welfare of individuals or group of people. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health and as such is one of the most common pathological conditions of modern society. Almost 10–25% of adult population in Europe, 1/3 population in the USA and 20% of population in Croatia are affected by obesity5,6. In this prospective study we included 30 patients who underwent Sweedish adjustable gastric band procedure (SAGB) (Johnson & Johnson) procedures without complications during the first year of the postoperative period. Body mass index (BMI) was in female patients 40,52174 kg/m2 and in male patients 46,71429 kg/m2. Prior to the surgical procedures 13 patients (43.33%) experienced worse health conditions. Health conditions were equl in 17 patients. The treatment was ineffective in 5 patients (16.67%). In 5 patients health conditions were equal. 6 patients (20%) had good quality of life, 11 patients (36.67%) very good and only 3 patients (10%) had excellent quality of life after the procedure. We noticed body weight reduction in all patients. The quality of life was improved in all patients, except for one 28 years old woman. Body weight loss and quality of life after the procedure are in positive correlation which means that significant body weight loss leads to improved quality of life. Our conclusion is that SAGB is a quality method in obesity treatment which improves quality of life

Percutaneous occlusion of malignant left atrial appendage in patient with recurrent ischemic stroke

Introduction: The left atrial appendage (LAA) is the most common place of thrombosis in patients with atrial fibrillation (AF). Numerous studies have shown that oral anticoagulation (OAC) significantly reduces the risk of thromboembolism. However, there are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated.1-3 Case report: 68-years-old male with permanent non-valvular AF, currently taking apixaban, was hospitalized for the second time due to recurrent ischemic cerebrovascular stroke. At the time of his first presentation six months ago, he was well anticoagulated with warfarin (international normalized ratio was 3.56) and have had a CHA2DS2VASc score 2. He had no significant carotid disease or mobile aortic arch atheroma. Transesophageal echocardiography (TEE) revealed a significantly dilated left atrium (LA) with dense spontaneous echo contrast (SEC). There was no organized thrombus in the LA nor in the LAA. The contractile function of the LAA was severely decreased, with peak systolic velocity of 33 cm/s on Doppler evaluation. Despite taking effective anticoagulant medications for both times our patient experienced recurrent ischemic stroke and yet again had dense SEC in the LA and LAA. In order to prevent upcoming cardioembolic event, we decided to preform percutaneous LAA closure with Amplatzer Amulet device under TEE guidance. Successful LAA closure was confirmed by color Doppler imaging and a single postocclusion angiography. The patient was discharged with OAC (warfarin) in addition of 100 mg/day of acetylsalicylic acid to prevent thrombus formation on device. Follow up TEE was performed one month after the procedure. Good position of LAA occluding device was confirmed with no evidence of thrombus formation on the left atrial face of the device. Conclusion: In general, after implantation of LAA occluding device, OAC is not indicated. However, combination therapy with indefinite OAC plus LAA closure in patients with AF with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke

Zbornik I. skupa hrvatske ranokršćanske arheologije (HRRANA)

Episkopalno središte, tri slavne nekropole Salone i Eufrazijeva bazilika u Poreču su najpoznatiji ranokršćanski lokaliteti u Hrvatskoj. Oni, međutim, nisu i jedini – uz njih su pronađeni brojni drugi, ne manje važni, ranokršćanski objekti, crkve, nekropole i pokretni nalazi. O njihovom značaju govori i činjenica da je više njih relevantno i u međunarodnom istraživanju određenih arheoloških tema. K tomu, nakon gotovo stoljeća i pol arheoloških iskopavanja, znanost uvijek iznova dolazi do novih otkrića. Takva poticajna situacija potaknula je znanstvenike sa Katedre za antičku provincijalnu i ranokršćansku arheologiju Odsjeka za arheologiju Filozofskog fakulteta u Zagrebu na organizaciju prvog nacionalnog ranokršćanskog arheološkog skupa. Slijedom toga je u Zagrebu od 15. do 17. ožujka 2018. održan prvi hrvatski skup ranokršćanske arheologije. Prvi cilj skupa, čiji akronim po početnim slovima naslova glasi HRRANA, je bio prezentiranje aktualnog stanja, i možebitno unaprjeđivanje, te važne znanstvene discipline. Objavom ovog zbornika radova nastoji se promovirati ne samo hrvatske ranokršćanske lokalitete, spomenike, arhitekturu, krajobraze, ikonografiju, epigrafiju i recentna arheološka istraživanja, nego i uputiti na različite istraživačke i metodološke probleme u istraživanju ranokršćanske arheologije u Hrvatskoj kroz rasprave, ispitivanja, znanstvena i praktična pitanja.Episkopalno središte, tri slavne nekropole Salone i Eufrazijeva bazilika u Poreču su najpoznatiji ranokršćanski lokaliteti u Hrvatskoj. Oni, međutim, nisu i jedini – uz njih su pronađeni brojni drugi, ne manje važni, ranokršćanski objekti, crkve, nekropole i pokretni nalazi. O njihovom značaju govori i činjenica da je više njih relevantno i u međunarodnom istraživanju određenih arheoloških tema. K tomu, nakon gotovo stoljeća i pol arheoloških iskopavanja, znanost uvijek iznova dolazi do novih otkrića. Takva poticajna situacija potaknula je znanstvenike sa Katedre za antičku provincijalnu i ranokršćansku arheologiju Odsjeka za arheologiju Filozofskog fakulteta u Zagrebu na organizaciju prvog nacionalnog ranokršćanskog arheološkog skupa. Slijedom toga je u Zagrebu od 15. do 17. ožujka 2018. održan prvi hrvatski skup ranokršćanske arheologije. Prvi cilj skupa, čiji akronim po početnim slovima naslova glasi HRRANA, je bio prezentiranje aktualnog stanja, i možebitno unaprjeđivanje, te važne znanstvene discipline. Objavom ovog zbornika radova nastoji se promovirati ne samo hrvatske ranokršćanske lokalitete, spomenike, arhitekturu, krajobraze, ikonografiju, epigrafiju i recentna arheološka istraživanja, nego i uputiti na različite istraživačke i metodološke probleme u istraživanju ranokršćanske arheologije u Hrvatskoj kroz rasprave, ispitivanja, znanstvena i praktična pitanja

Zbornik I. skupa hrvatske ranokršćanske arheologije (HRRANA)

Episkopalno središte, tri slavne nekropole Salone i Eufrazijeva bazilika u Poreču su najpoznatiji ranokršćanski lokaliteti u Hrvatskoj. Oni, međutim, nisu i jedini – uz njih su pronađeni brojni drugi, ne manje važni, ranokršćanski objekti, crkve, nekropole i pokretni nalazi. O njihovom značaju govori i činjenica da je više njih relevantno i u međunarodnom istraživanju određenih arheoloških tema. K tomu, nakon gotovo stoljeća i pol arheoloških iskopavanja, znanost uvijek iznova dolazi do novih otkrića. Takva poticajna situacija potaknula je znanstvenike sa Katedre za antičku provincijalnu i ranokršćansku arheologiju Odsjeka za arheologiju Filozofskog fakulteta u Zagrebu na organizaciju prvog nacionalnog ranokršćanskog arheološkog skupa. Slijedom toga je u Zagrebu od 15. do 17. ožujka 2018. održan prvi hrvatski skup ranokršćanske arheologije. Prvi cilj skupa, čiji akronim po početnim slovima naslova glasi HRRANA, je bio prezentiranje aktualnog stanja, i možebitno unaprjeđivanje, te važne znanstvene discipline. Objavom ovog zbornika radova nastoji se promovirati ne samo hrvatske ranokršćanske lokalitete, spomenike, arhitekturu, krajobraze, ikonografiju, epigrafiju i recentna arheološka istraživanja, nego i uputiti na različite istraživačke i metodološke probleme u istraživanju ranokršćanske arheologije u Hrvatskoj kroz rasprave, ispitivanja, znanstvena i praktična pitanja.Episkopalno središte, tri slavne nekropole Salone i Eufrazijeva bazilika u Poreču su najpoznatiji ranokršćanski lokaliteti u Hrvatskoj. Oni, međutim, nisu i jedini – uz njih su pronađeni brojni drugi, ne manje važni, ranokršćanski objekti, crkve, nekropole i pokretni nalazi. O njihovom značaju govori i činjenica da je više njih relevantno i u međunarodnom istraživanju određenih arheoloških tema. K tomu, nakon gotovo stoljeća i pol arheoloških iskopavanja, znanost uvijek iznova dolazi do novih otkrića. Takva poticajna situacija potaknula je znanstvenike sa Katedre za antičku provincijalnu i ranokršćansku arheologiju Odsjeka za arheologiju Filozofskog fakulteta u Zagrebu na organizaciju prvog nacionalnog ranokršćanskog arheološkog skupa. Slijedom toga je u Zagrebu od 15. do 17. ožujka 2018. održan prvi hrvatski skup ranokršćanske arheologije. Prvi cilj skupa, čiji akronim po početnim slovima naslova glasi HRRANA, je bio prezentiranje aktualnog stanja, i možebitno unaprjeđivanje, te važne znanstvene discipline. Objavom ovog zbornika radova nastoji se promovirati ne samo hrvatske ranokršćanske lokalitete, spomenike, arhitekturu, krajobraze, ikonografiju, epigrafiju i recentna arheološka istraživanja, nego i uputiti na različite istraživačke i metodološke probleme u istraživanju ranokršćanske arheologije u Hrvatskoj kroz rasprave, ispitivanja, znanstvena i praktična pitanja

ADHERENCE IN METFORMIN TAKING AND OCCURRENCE OF SIDE EFFECTS IN PATIENTS WITH TYPE 2 DIABETES

Ciljevi istraživanja: Cilj ovog istraživanja je utvrditi adherenciju pri uzimanju metformina i pojavnost nuspojava kod bolesnika sa šećernom bolešću tipa 2 u ovisnosti o adherenciji te utvrditi povezanost učestalosti nuspojava s propisivačem terapije, informiranosti o šećernoj bolesti, regulaciji glikemije te vrsti pripravka metformina. Ispitanici i metode: U svrhu ovog presječnog istraživanja ispitanici su anketirani u izravnom fizičkom kontaktu u čekaonici Regionalnog centra za endokrinologiju, dijabetologiju i poremećaje metabolizma KBC-a Split, dijelu ispitanika podaci su uzeti iz registra Centra te su zatim anketirani telefonom, a manji dio ispitanika prikupljen je iz ordinacija obiteljske medicine. U ovo istraživanje uključeno je 107 bolesnika. Rezultati: Gledajući vrijeme uzimanja terapije u odnosu na jelo, najviše ispitanika 70 (65%) uzima terapiju poslije jela (ispravno), 12% uz jelo (prihvatljivo), 20% ispitanika uzima prije jela, a 3% u isto vrijeme neovisno o jelu (neispravan način uzimanja). Ukupno 74 (69%) ispitanika pravilno uzima i ne preskače lijek te su u potpunosti adherentni, dok 33 (31%) ispitanika ne uzima pravilno lijek ili ga preskače. Dvadeset osam (26,2%) ispitanika je navelo da ima nuspojave prilikom uzimanja koje vezuju uz uzimanje aktualne terapije dok kod preostalih 79 (73,8%) ispitanika nije bilo nikakvih nuspojava. Od adherentnih bolesnika (ukupno 74, odnosno 69%) njih 8 (10%) ima prisutne nuspojave. U skupini neadherentnih (ukupno 33, odnosno 31%) nuspojave se javljaju u 20 (60%) bolesnika) (p<0.001). Postoji značajna povezanost pojavnosti nuspojava s informiranošću bolesnika: informiranost o šećernoj bolesti (p=0,009) informiranost o svrsi liječenja (p=0,036), informiranost o načinu uzimanja terapije (p=0,005). Informiranost o nuspojavama nije statistički značajno povezana s nuspojavama (p=0,092). Značajna povezanost nuspojava primjećuje se i u odnosu na prosječne i zadnje izmjerene vrijednosti glukoze u plazmi natašte (p=0,049, odnosno 0,030) i postprandijalno (p=0,030, odnosno 0,031), dok vrijednost HbA1c (p=0,106) nije pokazala statistički značajnu razliku u odnosu na učestalost nuspojava. Nema značajne povezanosti nuspojava s vrstom lijeka koji sadržava metformin i propisivačem terapije. Zaključak: Adherencija u uzimanju terapije metforminom ili pripravcima koji sadržavaju metformin je relativno loša (69%). Bolesnici koji neredovito i nepravilno uzimaju terapiju imaju veću učestalost nuspojava i to za 6 puta. Ne postoji statistički značajna učestalost nuspojava u ovisnosti o propisivaču terapije te o pripravku metformina, neovisno o dozi. Učestalost nuspojava je češća kod bolesnika koji su lošije informirani o šećernoj bolesti te kod onih čija je regulacije glikemije loša.Research objectives: This study aimed was to determine the adherence of metformin and the incidence of side effects in patients with type 2 diabetes depending on adherence and to determine the relationship between the frequency of side effects with the prescriber, diabetes awareness, glycemic control and the type of metformin. Subjects and methods: For this cross-sectional study, respondents were interviewed in direct physical contact in the waiting room of the Regional Center for Endocrinology, Diabetology and Metabolic Disorders, University Hospital of Split, some respondents were taken from the Center's register and then interviewed by phone, a smaller proportion of respondents were taken from a family medicine practice. 107 patients were included in this study. Results: Looking at the time of taking therapy in relation to the meal, most respondents 70 (65%) take therapy after meals (correctly), 12% with meals (acceptable). 20% of respondents take before meals, and 3% at the same time regardless of meals (incorrect way). A total of 74 (69%) respondents take and do not skip the medication correctly and are completely adherent, while 33 (31%) respondents do not take the medication correctly or skip it. Twenty-eight (26.2%) subjects reported having side effects when taking a therapy while the remaining 79 (73.8%) subjects had no side effects. Of the adherent patients (a total of 74 and 69%, respectively), 8 (10%) had side effects. In the group of non-adherent (33 and 31%, respectively) side effects occur in 20 (60%) patients) (p <0.001). There is a significant correlation between the occurrence of side effects and patient information: information about diabetes (p = 0.009), information about the purpose of treatment (p = 0.036), information about how to take therapy (p = 0.005). Conclusion: Adherence to metformin therapy or metformin-containing preparations is relatively poor (69%). Patients who take therapy irregularly and incorrectly have a higher frequency of side effects by 6 times. There is no statistically significant difference in frequency of adverse reactions depending on the prescriber and the formulation of metformin. The incidence of side effects is more common in patients who are less informed about diabetes and in those whose glycemic regulation is poor