Conditions associated with increased activity of creatine kinase in children

Kreatin kinaza (CK) je enzim koji katalizira reverzibilnu reakciju kreatina (Cr) i adenozin trifosfata (ATP) u kojoj nastaju energijom bogat kreatin-fosfat (PCr) i adenozin difosfat (ADP), dok suprotna reakcija prijenosa fosfata između PCr i ADP-a omogućuje brzu regeneraciju ATP-a u tkivima s velikim i promjenjivim energetskim potrebama poput skeletnog i srčanog mišića i mozga. Laboratorijsko određivanje aktivnosti CK je jednostavna, neinvazivna i reproducibilna pretraga. U najvećem broju slučajeva, povišena aktivnost CK u djece popraćena je simptomima i znakovima oštećenja odnosno bolesti mišića. Velik broj različitih nasljednih mišićnih bolesti započinje u djetinjstvu, a poznavanje kliničke slike, obrazaca nasljeđivanja i vrijednosti laboratorijskih parametara poput aktivnosti CK može značajno doprinijeti pravovremenom postavljanju ispravne dijagnoze koja je jedini put k ispravnom zbrinjavanju bolesnika. Uz nasljedne, valja voditi računa i o drugim, stečenim uzrocima porasta aktivnosti CK. U radu je dan presjek autoimunih bolesti dječje dobi za koje je karakteristično zahvaćanje skeletnog mišića, ali i pregled spoznaja dobivenih u novijim istraživanjima koja ukazuju na kompleksnost mogućih uzroka rabdomiolize u djece koji obuhvaćaju infektivne agense, elektrolitne i endokrine poremećaje, nuspojave lijekova, učinke toksičnih tvari, traumu i brojne druge. Uz stanja koja dovode do „lažnog“ povišenja aktivnosti CK u serumu, opisano je i stanje u literaturi poznatije kao idiopatska hiperCKemija, u kojem podležeći uzrok nije moguće otkriti niti iscrpnom dijagnostičkom obradom.The creatine kinase (CK) is an enzyme catalizing the reversible reaction between creatine (Cr) and adenosine triphosphate (ATP) that results in the formation of phosphocreatine (PCr) and adenosine diphosphate. Reverse reaction, one in which creatine phosphate transfers a high-energy phosphate to ADP, allows a timely regeneration of ATP in tissues with high and fluctuating energy demands such as the skeletal and cardiac muscle, as well as the brain. Laboratory measurement of the creatine kinase activity is a simple, non-invasive and easily reproducible test. In most cases, increased activity of creatine kinase in children is accompanied with symptoms and signs indicating muscle damage or disease. A large number of various hereditary muscle diseases begin during childhood. Knowledge of the clinical features, patterns of inheritance and expected values of the laboratory parameters such as CK activity may greatly contribute to a timely and correct diagnosis of such diseases which is considered of the upmost importance for providing quality patient care. Clinicians should also take in account other, acquired causes of increased activity of creatine kinase. This thesis provides an overview of childhood autoimmune disease affecting the skeletal muscle, as well as an overview of scientific knowledge gained in recent studies concerning the complexity of possible causes of rhabdomyolysis in paediatric population. This pertains, but is not limited, to infective agents, electrolyte and endocrine disorders, adverse affects to medication, effects of toxins, trauma and more. Part of the thesis is dedicated to conditions which lead to falsely increased activity of creatine kinase, and there is also a mention of a condition widely known as idiopathic hyperCKemia, where the underlaying cause to elevated creatine kinase activity cannot be found despite extensive diagnostic evaluation

Conditions associated with increased activity of creatine kinase in children

Kreatin kinaza (CK) je enzim koji katalizira reverzibilnu reakciju kreatina (Cr) i adenozin trifosfata (ATP) u kojoj nastaju energijom bogat kreatin-fosfat (PCr) i adenozin difosfat (ADP), dok suprotna reakcija prijenosa fosfata između PCr i ADP-a omogućuje brzu regeneraciju ATP-a u tkivima s velikim i promjenjivim energetskim potrebama poput skeletnog i srčanog mišića i mozga. Laboratorijsko određivanje aktivnosti CK je jednostavna, neinvazivna i reproducibilna pretraga. U najvećem broju slučajeva, povišena aktivnost CK u djece popraćena je simptomima i znakovima oštećenja odnosno bolesti mišića. Velik broj različitih nasljednih mišićnih bolesti započinje u djetinjstvu, a poznavanje kliničke slike, obrazaca nasljeđivanja i vrijednosti laboratorijskih parametara poput aktivnosti CK može značajno doprinijeti pravovremenom postavljanju ispravne dijagnoze koja je jedini put k ispravnom zbrinjavanju bolesnika. Uz nasljedne, valja voditi računa i o drugim, stečenim uzrocima porasta aktivnosti CK. U radu je dan presjek autoimunih bolesti dječje dobi za koje je karakteristično zahvaćanje skeletnog mišića, ali i pregled spoznaja dobivenih u novijim istraživanjima koja ukazuju na kompleksnost mogućih uzroka rabdomiolize u djece koji obuhvaćaju infektivne agense, elektrolitne i endokrine poremećaje, nuspojave lijekova, učinke toksičnih tvari, traumu i brojne druge. Uz stanja koja dovode do „lažnog“ povišenja aktivnosti CK u serumu, opisano je i stanje u literaturi poznatije kao idiopatska hiperCKemija, u kojem podležeći uzrok nije moguće otkriti niti iscrpnom dijagnostičkom obradom.The creatine kinase (CK) is an enzyme catalizing the reversible reaction between creatine (Cr) and adenosine triphosphate (ATP) that results in the formation of phosphocreatine (PCr) and adenosine diphosphate. Reverse reaction, one in which creatine phosphate transfers a high-energy phosphate to ADP, allows a timely regeneration of ATP in tissues with high and fluctuating energy demands such as the skeletal and cardiac muscle, as well as the brain. Laboratory measurement of the creatine kinase activity is a simple, non-invasive and easily reproducible test. In most cases, increased activity of creatine kinase in children is accompanied with symptoms and signs indicating muscle damage or disease. A large number of various hereditary muscle diseases begin during childhood. Knowledge of the clinical features, patterns of inheritance and expected values of the laboratory parameters such as CK activity may greatly contribute to a timely and correct diagnosis of such diseases which is considered of the upmost importance for providing quality patient care. Clinicians should also take in account other, acquired causes of increased activity of creatine kinase. This thesis provides an overview of childhood autoimmune disease affecting the skeletal muscle, as well as an overview of scientific knowledge gained in recent studies concerning the complexity of possible causes of rhabdomyolysis in paediatric population. This pertains, but is not limited, to infective agents, electrolyte and endocrine disorders, adverse affects to medication, effects of toxins, trauma and more. Part of the thesis is dedicated to conditions which lead to falsely increased activity of creatine kinase, and there is also a mention of a condition widely known as idiopathic hyperCKemia, where the underlaying cause to elevated creatine kinase activity cannot be found despite extensive diagnostic evaluation

Students creativity in chemistry classes

In this paper the effects of the elaboration of the Stoichiometry by different teaching/learning methods, according to aims to encourage divergent thinking and creativity of primary school students (aged 13), is presented. The pedagogic experiment with parallel groups was carried out within six sessions during the 2010/2011 academic year. Two seventh grade classes (50 students) from Mathematical Grammar School in Belgrade were chosen as a sample. One group (group A) was taught by a combination of the demonstration methods and the stoichiometry calculations. The other group (group B) were divided into several groups and each of them had a few tasks: (i) to conduct experiments and according to results to create stoichiometry problems, and (ii) to read the text and according to the information from text to develop stoichiometry problems. At the pre-test, the group A showed a slightly higher overall result than the group B. The results of posttest show that the great number of different types of responses was given in group B. The obtained results show that an opportunity to create stoichiometry tasks associated with the experimental work or with the texts can contribute to the development of students divergent thinking

Conditions associated with increased activity of creatine kinase in children

Kreatin kinaza (CK) je enzim koji katalizira reverzibilnu reakciju kreatina (Cr) i adenozin trifosfata (ATP) u kojoj nastaju energijom bogat kreatin-fosfat (PCr) i adenozin difosfat (ADP), dok suprotna reakcija prijenosa fosfata između PCr i ADP-a omogućuje brzu regeneraciju ATP-a u tkivima s velikim i promjenjivim energetskim potrebama poput skeletnog i srčanog mišića i mozga. Laboratorijsko određivanje aktivnosti CK je jednostavna, neinvazivna i reproducibilna pretraga. U najvećem broju slučajeva, povišena aktivnost CK u djece popraćena je simptomima i znakovima oštećenja odnosno bolesti mišića. Velik broj različitih nasljednih mišićnih bolesti započinje u djetinjstvu, a poznavanje kliničke slike, obrazaca nasljeđivanja i vrijednosti laboratorijskih parametara poput aktivnosti CK može značajno doprinijeti pravovremenom postavljanju ispravne dijagnoze koja je jedini put k ispravnom zbrinjavanju bolesnika. Uz nasljedne, valja voditi računa i o drugim, stečenim uzrocima porasta aktivnosti CK. U radu je dan presjek autoimunih bolesti dječje dobi za koje je karakteristično zahvaćanje skeletnog mišića, ali i pregled spoznaja dobivenih u novijim istraživanjima koja ukazuju na kompleksnost mogućih uzroka rabdomiolize u djece koji obuhvaćaju infektivne agense, elektrolitne i endokrine poremećaje, nuspojave lijekova, učinke toksičnih tvari, traumu i brojne druge. Uz stanja koja dovode do „lažnog“ povišenja aktivnosti CK u serumu, opisano je i stanje u literaturi poznatije kao idiopatska hiperCKemija, u kojem podležeći uzrok nije moguće otkriti niti iscrpnom dijagnostičkom obradom.The creatine kinase (CK) is an enzyme catalizing the reversible reaction between creatine (Cr) and adenosine triphosphate (ATP) that results in the formation of phosphocreatine (PCr) and adenosine diphosphate. Reverse reaction, one in which creatine phosphate transfers a high-energy phosphate to ADP, allows a timely regeneration of ATP in tissues with high and fluctuating energy demands such as the skeletal and cardiac muscle, as well as the brain. Laboratory measurement of the creatine kinase activity is a simple, non-invasive and easily reproducible test. In most cases, increased activity of creatine kinase in children is accompanied with symptoms and signs indicating muscle damage or disease. A large number of various hereditary muscle diseases begin during childhood. Knowledge of the clinical features, patterns of inheritance and expected values of the laboratory parameters such as CK activity may greatly contribute to a timely and correct diagnosis of such diseases which is considered of the upmost importance for providing quality patient care. Clinicians should also take in account other, acquired causes of increased activity of creatine kinase. This thesis provides an overview of childhood autoimmune disease affecting the skeletal muscle, as well as an overview of scientific knowledge gained in recent studies concerning the complexity of possible causes of rhabdomyolysis in paediatric population. This pertains, but is not limited, to infective agents, electrolyte and endocrine disorders, adverse affects to medication, effects of toxins, trauma and more. Part of the thesis is dedicated to conditions which lead to falsely increased activity of creatine kinase, and there is also a mention of a condition widely known as idiopathic hyperCKemia, where the underlaying cause to elevated creatine kinase activity cannot be found despite extensive diagnostic evaluation

VIOLATION OF LINGUISTIC NORMS IN IDIOMATIC EXPRESSIONS

Our goal is to relate the central idea of thematic issue, the violence, with the lexical and phraseological level of language systems in three contrasted languages: Spanish, Serbian and Croatian. In this paper, violation is understood as irregularity or anomaly within a linguistic system and we intend to offer a description of different kinds of violation, identifying two major types: formal irregularities and semantic or logical irregularities. The first type is represented in idiomatic or phraseological expressions through constructions that exhibit non-compliance with grammar rules (for example number and gender concordance: a pie juntillas, a ojos vistas). Its form and performance is strongly related to the high level of stability of the constituent elements. The second type is represented by idioms that manifest inconsistency with semantic regulations as well as with linguistic and extra-linguistic knowledge (ES cuando las ranas críen pelos, SR HR kad na vrbi rodi grožđe). This type of irregularities originates from a high level of expressiveness, strong emotional charge and picturesque image schema in these idiomatic constructions. Within them, comparative constructions are more frequent, often based on humour, irony, hyperbole (SR HR bistar kao boza, ES más corto que las mangas de un chaleco), than expressions whose components exhibit phonic and lexical deviations (SR HR nema cile-mile, biti tata-mata, ES no decir ni mu, por fas o por nefas, a la topa tolondro, a todo full), and also reduplicative or binomial structures (ES dimes y diretes, sin oficio ni beneficio, ni rey ni roque, SR HR bacati drvlje i kamenje, navrat-nanos, živ i zdrav). Our corpus is excerpted from phraseographic sources of the three languages, the method is based on lexical, semantic and contrastive analysis, and theoretical framework includes investigations on form, semantic classification and pragmatics of phraseological units (Mršević-Radović 1987, Fink-Arsovski 2002, Mellado Blanco 2004, García-Page 2008, Dobrovol’skij 2016).Publishe

Gut Microbiota Composition Changes following Discontinuation of Exclusive Enteral Nutrition in Children with Crohn’s Disease

This study aims to determine changes in the intestinal microbiota of children with Crohn’s disease (CD) before and during exclusive enteral nutrition (EEN) and after its discontinuation. A total of 14 newly diagnosed children with CD (median age 16.0 years; 43% female) were included in this study. Patients were initially treated with EEN and were followed for one year after EEN discontinuation. Stool samples were taken at the time of diagnosis (before EEN introduction), the second day of EEN, the last day of EEN, and every two months for one year after the discontinuation of EEN. A molecular approach targeting 16S ribosomal RNA was used for analysing the gut microbiota. No change was found in the Shannon diversity index before, during, and after EEN cessation (HhaI-digestion p = 0.82; MspI-digestion p = 0.87). According to the PCO, on the basis of the dissimilarity matrices of OTUs, a clear separation of patients at different time points, forming two clusters (before and during EEN as opposed to after EEN), was evident. No clear separation was noted between patients who achieved sustained remission as opposed to those who did not achieve sustained remission during EEN and at the follow-up. In conclusion, a distinct change in the microbiota composition already occurred after two months of EEN discontinuation and remained mostly unchanged over a year of follow-up

Adherence to the Mediterranean Diet in Children and Adolescents in the Mediterranean and Continental Regions of Croatia

Adherence to the Mediterranean diet (MD) has been found beneficial for the prevention and treatment of various chronic non-communicable diseases; however, adherence to MD is declining, especially in the Mediterranean countries. Croatia is characteristic for having both traditionally continental and Mediterranean regions, with distinct dietary features. The aim of this study was to compare difference in adherence to MD and overall dietary intake between children and adolescents from continental and Mediterranean part of Croatia. Participants were randomly recruited children and adolescents (n=838, mean age 9.96 ± 2.09 years) located in continental and Mediterranean parts of Croatia. Three different questionnaires were distributed and collected: general questionnaire (age and gender), the Mediterranean Diet Quality Index for children and adolescents (KIDMED) and 3-day food records (3DFR). Statistical analysis was performed using SPSS 260 (IBM Corporation, Chicago, Illinois, USA) statistical software. P values less than 0.05 were considered significant. Overall, low adherence to MD was evident in 23.1% of participants, while only 15.8% of children and adolescents had good compliance with MD. A significant difference in KIDMED score has been found between the continental (mean score 4.91 ± 2.33) and Mediterranean (mean score 5.57 ± 2.12) part of Croatia (p<0.001), as well as in the intake of energy and some nutrients. Moreover, participants from the Mediterranean part of Croatia had better compliance with D-A-CH recommendations for some nutrients compared to those from the continental part. Although children and adolescents from the Mediterranean part of Croatia had better adherence to MD than those from the continental part, overall, relatively poor adherence to MD was evident for both regions. Therefore, a healthy, balanced diet should be encouraged in both regions, preferably taking into account traditionally consumed and locally available foods

IBD phenotype at diagnosis, and early disease-course in pediatric patients in Croatia: data from the Croatian national registry

Background: Pediatric inflammatory bowel disease (IBD) presents with extensive phenotype. The aim of this study was to determine the phenotype of pediatric IBD patients in Croatia at diagnosis and follow-up. Methods: Children were prospectively recruited into Croatian IBD national registry. Data on diagnostic evaluation, therapy and 1-year follow-up were collected. Results: A total of 51 newly diagnosed patients were recruited (19 Crohn's disease (CD), 28 ulcerative colitis (UC) and 4 IBD-unclassified (IBD-U)). Most common location in CD was ileocolonic disease (52.6%), and pancolitis in UC (53.6%). The recommended complete diagnostic algorithm was performed only in 29.4% of patients. First-line therapy used in CD was exclusive enteral nutrition for remission induction (84.2%) and azathioprine for maintenance (73.7%). In patients with UC, aminosalicylates were the most common drug used (89.3%). By the end of the first year 41.2% of CD and 53.9% of UC patients had one or more relapses and required treatment escalation. Conclusion: Our data confirm extensive intestinal involvement in pediatric IBD and relatively high relapse rate during the first year of follow-up. More effort should be invested on the national level to implement more stringent adherence to the current European guidelines. Impact: The key message of our article is that pediatric IBD in Croatia shows extensive intestinal involvement with high relapse rates in first year of follow-up. It is the first cohort study reporting on the phenotype of pediatric IBD in Croatia, but also investigates adherence to diagnostic and therapeutic European guidelines which is not commonly reported. The study is national based, thus having the greatest impact on Croatian health care,stressing out that more effort should be invested on the national level to implement more stringent adherence to the current European guidelines

Parents' attitudes toward childhood COVID-19 immunization in Croatia: a multicenter cross-sectional study

Aim: To assess parents' attitudes toward childhood COVID-19 immunization in Croatia. Methods: In this multicenter cross-sectional study, we collected data from four tertiary care facilities in Zagreb, Split, and Osijek between December 2021 and February 2022. During the visit to the Pediatric Emergency Departments, parents were asked to fill out a highly-structured questionnaire about their attitudes toward COVID-19 immunization in children. Results: The sample consisted of 872 respondents. A total of 46.3% of respondents were hesitant about vaccinating their child against COVID-19, 35.2% definitely did not intend to vaccinate their child, and 18.5% definitely intended to vaccinate their child. Parents who were themselves vaccinated against COVID-19 were more likely than unvaccinated parents (29.2% and 3.2%, P<0.001) to vaccinate their children. Parents agreeing with the epidemiological guidelines were more inclined to vaccinate their children, as were parents of older children and parents of children vaccinated according to the national program schedule. Child comorbidities and respondents' history of COVID-19 were not associated with childhood vaccination intention. Ordinal logistic regression revealed that the most important predictors for a positive parents' attitude toward vaccinating their child were parents' vaccination status and regular vaccination of their child according to the national immunization program schedule. Conclusion: Our results demonstrate Croatian parents' mostly hesitant and negative attitudes toward childhood COVID-19 immunization. Future vaccination campaigns should target unvaccinated parents, parents with younger children, and parents of children with chronic diseases