Učinak antiepileptika na kognitivne evocirane potencijale P300 u bolesnika s epilepsijom

Epilepsy is one of the most prevalent chronic neurological diseases, affecting about 70 million people worldwide. Patients with epilepsy often encounter cognitive dysfunction, which is influenced by different factors including age at the onset of epilepsy, etiology of epilepsy, type of seizures, seizure frequency and duration, psychiatric comorbidity, and antiepileptic drug (AED) therapy. Event-related potentials are useful, noninvasive, objective clinical and research instrument for evaluation of cognitive functions in patients. The aim of this study was to investigate and determine the effect of AED monotherapy and polytherapy on cognitive changes in patients with epilepsy, detected with P300 event-related potentials and compared with age- and gender-matched healthy individuals. The study was conducted in 82 patients with generalized and focal epilepsy and 82 healthy individuals aged 18-65 years. Cognitive evoked P300 potentials were recorded in all study subjects using auditory ‘oddball’ paradigm. The results showed the patients taking AED polytherapy to have a significantly longer P300 latency and significantly lower N200-P300 amplitude. These results indicate that AED polytherapy might worsen cognitive impairment in patients with epilepsy.Epilepsija je jedna od najčešćih kroničnih neuroloških bolesti od koje boluje oko 70 milijuna ljudi diljem svijeta. Bolesnici s epilepsijom često imaju poremećaj kognitivnih funkcija uzrokovan početkom bolesti, vrstom epileptičkih napadaja, trajanjem bolesti i antiepileptičkim lijekovima. Kognitivni evocirani potencijali P300 su korisna, neinvazivna, objektivna klinička i istraživačka metoda za ispitivanje kognitivnih funkcija. Cilj ovoga istraživanja bio je ispitati i utvrditi učinak antiepileptičkih lijekova (AEL) u monoterapiji i politerapiji na kognitivne promjene u bolesnika s epilepsijom uz pomoć kognitivnih evociranih potencijala P300 i usporediti ih sa zdravim pojedincima usklađenim prema dobi i spolu. U ispitivanju je sudjelovalo 82 bolesnika s generaliziranom i žarišnom epilepsijom i 82 zdrava pojedinca u dobi od 18-65 godina. Kognitivni evocirani potencijali P300 su snimani koristeći slušnu oddball paradigmu. Rezultati ove studije ukazuju na to da bolesnici na politerapiji AEL imaju značajno produženu latenciju vala P300 i značajno nižu amplitudu N200-P300. Prema rezultatima ove studije može se zaključiti kako politerapija AEL u bolesnika s epilepsijom može dovesti do pogoršanja kognitivnog poremećaja

Utjecaj terapije kontinuiranim pozitivnim tlakom u dišnim putevima na kognitivne evocirane potencijale P300

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by obstructions of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen desaturation and arousal from sleep. OSA can be successfully treated with continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, hypoglossal nerve stimulation, and surgical procedures. It has been observed that untreated OSA is related to chronic disorders including hypertension, arrhythmias, congestive heart failure, coronary heart disease, diabetes mellitus, hyperlipidemia, stroke, depression, and cognitive decline. Event-related potentials (ERPs) is the procedure that has been widely used for evaluating cognitive brain functions. Using auditory event-related potentials (P300), this study aimed to examine the effect of CPAP therapy on cognitive functions in patients with moderate and severe OSA. The results of the study showed improvement in P300 latency and amplitude after 3 months of CPAP therapy, indicating a positive effect of CPAP therapy in the prevention of cognitive decline in patients with OSA.Opstruktivna apneja u spavanju (OSA) je poremećaj disanja u spavanju karakteriziran opstrukcijom gornjih dišnih puteva tijekom spavanja koji dovodi do prestanka disanja u spavanju, desaturacije krvi kisikom i buđenja. OSA se uspješno liječi uređajima za potpomognuto disanje s neprekinutim pozitivnim tlakom (CPAP), gubitkom tjelesne težine, pozicijskom terapijom, oralnim udlagama, stimulacijom živca hipoglosusa i operativnim liječenjem. Opaženo je da je neliječena OSA povezana s kroničnim poremećajima, uključujući arterijsku hiperteziju, aritmije, kongestivno zatajenje srca, koronarnu srčanu bolest, šećernu bolest, hiperlipidemiju, moždani udar, depresiju i kognitivno propadanje. Kognitivni evocirani potencijali se koriste za proučavanje kognitivnih funkcija. Cilj ovog rada je ispitati učinak terapije CPAP-om na kognitivne funkcije bolesnika s umjerenom i teškom OSA-om koristeći slušne kognitivne evocirane potencijale. Rezultati ove studije su pokazali poboljšanje P300 latencija i amplituda, ukazujući na pozitivni učinak terapije CPAP – om u prevenciji kognitivnog poremećaja u bolesnika s OSA-om

Carbon nanofibers and graphene application in development of a new sensor for nepafenac analysis

Nepafenak je nesteroidni protuupalni lijek koji se koristi za prevenciju i liječenje postoperativne boli i upale povezane s operacijom katarakte te smanjenje rizika za pojavu makularnog edema nakon operacije katarakte kod bolesnika s dijabetesom. U eksperimentalnom dijelu rada, proveden je niz pokusa koji čine dio razvoja nove voltametrijske metode za određivanje nepafenaka. Ispitan je utjecaj modifikacije radne elektrode od staklastog ugljika na voltametrijski odziv nepafenaka pri čemu su korištene grafen nanopločice i/ili ugljikova nanovlakna u otopini kitozana ili nafiona. Napravljen je probir pH vrijednosti Britton-Robinson pufera koji je služio kao elektrolit za mjerenja. Jedan od koraka u radu bila je optimizacija parametara pravokutnovalne voltametrijske metode. Cikličkom voltametrijom utvrđeno je da je oksidacija nepafenaka na modificiranoj elektrodi adsorpcijski kontrolirana elektrodna reakcija te da bi se adsorpcija lijeka mogla koristiti u razvoju osjetljive stripping voltametrijske metode za analizu nepafenaka. Određeno je optimalno vrijeme i potencijal akumulacije za ukoncentriravanje analita na površini modificirane elektrode. Naposljetku, nakon što su parametri i uvjeti metode bili u potpunosti definirani, odrađen je jedan dio validacije metode. Naime, proveden je pokus koji je za cilj imao utvrditi područje linearnosti i dati eksperimentalne kalibracijske krivulje koje bi se mogle koristiti kod određivanja sadržaja nepafenaka.Nepafenac is a nonsteroidal anti-inflammatory drug and is used for prevention and treatment of pain and inflammation after the cataract surgery. It is also used as a prophylactic drug for prevention of macular oedema after the cataract surgery in patients with diabetes. In the experimental part of this thesis, a number of experiments were carried out as a part of development of a new voltametric method for the determination of nepafenac.The influence of surface modification of working glassy carbon electrode on nepafenac response was investigated and the graphene nanoplatelets and/or carbon nanofibers in solutions with chitosan or nafion were used. The selection of a pH values of Britton-Robinson buffer solution which was used as an electrolyte solution during measurements was made. The optimization of the parameters of a method for a square-wave voltammetry was one of the steps in an experimental procedure. Cyclic voltammetry has shown that the oxidation of nepafenac on modified electrode is an adsorption-controlled electrode reaction. Furthermore, adsorption of nepafenac could be used in development of a sensitive stripping voltametric method for analysis of nepafenac. Duration of accumulation and deposition potential were determined. Last but not least, after all the parameters of the new voltammetric method for determination of nepafenac were entirely defined one part of validation of the new method was carried out. In short, an experiment which had to determine the linearity range was performed. That same experiment gave a calibration curve that could be used for a quantitative determination of nepafenac

Acute glaucoma: diagnosis and treatment

Glaukom je drugi uzrok nepovratnog gubitka vida u svijetu. Predviđa se da će 2020. oboljelih od glaukoma biti 80 milijuna, od čega 20 milijuna bolesnika sa zatvorenim kutem. Prema gonioskopskom nalazu razlikujemo glaukom otvorenog kuta i zatvorenog kuta. U ovom radu je dan osvrt na podjelu glaukoma zatvorenog kuta, među kojima je najvažnije razlikovati PACS (suspektno zatvaranje kuta), ACC (akutno zatvaranje kuta/akutni glaukom) i CAGS (kronični glaukom zatvorenog kuta). ----- Prikazani su čimbenici rizika za razvoj glaukoma zatvorenog kuta, kao što su starija dob, ženski spol, azijska rasa, dalekovidnost, pozitivna obiteljska anamneza, zahvaćeno kontralateralno oko, plitka prednja očna sobica, prednji položaj ili povećana debljina leće, dilatacija zjenice, te položaj tijela u kojem je glava dugo nagnuta prema naprijed. Prikazana su i 4 mehanizma nastanka zatvorenog kuta, od kojih je najčešći pupilarni blok (75-90%), zatim plateau iris, promjene na razini leće ili promjene u prostoru iza leće. Često je zatvaranje kuta izazvano jatrogeno primjenom određenih lijekova. Poseban naglasak je stavljen na akutni glaukom i njegovo dijagnosticiranje i liječenje. ACC je hitno stanje, koje ukoliko se ne liječi, vrlo brzo dovodi do gubitka vida. Pacijent sa ACC se žali na smanjenu vidnu oštrinu, zamagljenost, haloe oko izvora svjetla, glavobolju, mučninu, povraćanje te jako bolnu očnu jabučicu. Pregledom nalazimo često dramatično povišen IOT, nereaktivnu zjenicu u srednjoj midrijazi, edem rožnice, kongestiju očnih vena, plitku prednju očnu sobicu te bradikardiju ili aritmiju. ----- U nastavku su pojašnjene 3 najčešće upotrebljavane klasifikacije za opisivanje zatvorenosti kuta temeljem gonioskopskog nalaza (Schafferova, Spaethova i Scheieova klasifikacija) te ostale metode kojima se koristimo u dijagnosticiranju ACC-a (aplanacijskatonometrija, biomikroskopija, fundoskopija, perimetrija, uz moguću primjenu novijih metoda poput ultrazvučne biomikroskopije ili AS-OCTa). Liječenje ACC-a se započinje medikamentoznom terapijom sa ciljem smanjenja IOT i postizanja bistrine rožnice, nakon čega slijedi laserska periferna iridotomija. Ukoliko ne dobijemo zadovoljavajuće rezultate može se pristupiti laserskoj perifernoj iridoplastici, nekoj od kirurških metoda za liječenje kroničnog glaukoma zatvorenog kuta ili trajnoj medikamentoznoj terapiji.Glaucoma is the second cause of irreversible vision loss in the world. It is anticipated that in 2020 there will be 80 million patients with glaucoma, out of which 20 million patients with closed angle glaucoma. According to gonioscopy findings, open angle glaucoma and closed angle glaucoma are distinguished. This paper describes the classification of angle closure glaucoma, including the most important division into PACS (suspect closing angle), ACC (acute angle closure / acute glaucoma) and CAGS (chronic glaucoma of closed angle). ----- The risk factors for the development of angle-closure glaucoma, such as older age, female gender, Asian race, foresight, and family history, affected contralateral eye, shallow eye front cabin, the front position or increased thickness of the lens, dilatation of pupils, and the position of the body in which the head is long tilted forward, are shown. The 4 mechanism of angle closure are displayed. Pupillary block is the most common mechanism (75-90%), followed by plateau iris, then changes in the lens level or changes in the space behind the lens. Angle closure is often caused by iatrogenic application of certain drugs. Special emphasis is placed on acute glaucoma and its diagnosis and treatment. ACC is an emergency situation, which if left untreated, rapidly leads to vision loss. A patient with ACC complains of reduced visual acuity, blurring, halos around light sources, headache, nausea, vomiting and very painful eyeballs. Reviewing the patient often shows dramatically elevated IOP, non-reactive pupil in high mydriasis, corneal edema, congestion, eye veins, shallow anterior chamber and bradycardia or arrhythmia. ----- 3 commonly used classifications for describing the angle closure, based on the goniscopy findings, are explained below (Schaffer, Spaeth and Scheie classification) as well as other methods that we use in the diagnosis of ACC (applanation tonometry, biomicroscopy, fundoscopy, perimetry, and possible application of new methods such as ultrasound biomicroscopy or AS-OCT) Treatment of ACC starts with medical therapy to decrease IOP and to achieve the clarity of the cornea, followed by laser peripheral iridotomy. If we do not get satisfactory results, laser peripheral iridoplasty can be accessed, or one of the surgical methods for the treatment of chronic angle-closure glaucoma or long-term medical therapy

Antitumor activity of plant Camellia sinensis

Camellia sinensis pripada biljnoj porodici Theaceae te postoji u obliku zimzelenog grmlja ili malih stabala čiji se listovi i pupoljci koriste za proizvodnju čaja.Ukoliko ih se promatra s obzirom na "fermentaciju", postoje tri glavne skupine čajeva: nefermentirani (zeleni i bijeli čaj), djelomično fermentirani (oolong čaj) i potpuno fermentirani (crni čaj). S obzirom na to da se Camellia sinensisubraja u ljekovito bilje, ova biljka čajevca, zbog svojih kemijskih spojeva,ima važnu ulogu u prevenciji i liječenju tumora. Polifenolzelenog čaj EGCGuspješno obustavlja proliferaciju linije tumorskih stanica dojkeMCF-7/BOS stimuliranu djelovanjem okolišnog estrogena PCB 102. TakoĎer je ispitivan potencijalni citotoksični i prooksidativni učinak ekstrakta zelenog čaja i dva glavna flavonoida, epigalokatehin galata(EGCG) i epikatehin galata (ECG), na tumorskestanične linije grkljana (HEp2) i njezinu križno-rezistentnu staničnu liniju CK2. EGCG i ekstrakt zelenog čaja povećavaju oštećenje DNA u staničnoj liniji CK2 tijekom kratkog izlaganja. Citotoksičnost EGCG i ECG se povećava s vremenom inkubacije, dok je ekstrakt zelenog čaja izazvao peroksidaciju lipida ustaničnoj liniji CK2. Ispitivan je i ekstrakt bijelog čaja koji inhibira proliferaciju stanica tumora debelog crijeva HT-29, a štiti normalne stanice 3T3-L1 od oštećenja DNA vodikovim peroksidom. U ovom radu se nastoje istaknuti mogući korisni ljekoviti učinci biljke Camellia sinensis u kemoprevenciji i kemoterapiji različitih tipova stanica raka.Camellia sinensis is a species of evergreen shrub or small tree whose leaves and leaf buds are used to produce tea. Concerning to the level of “fermentation”, it can be categorized into three major types: not fermented (green and white tea), partially fermented (oolong tea) and completely fermented (black tea). Camellia sinensis is a medicinal herb that plays an important role in prevention and treatment of tumors. Green tea polyphenol EGCG, suppressed the proliferation-stimulating activity of the environmentalestrogen PCB 102 on MCF-7/BOS breast cancer cells. Potential cytotoxic and prooxidative effects of green tea extract and its two main flavonoid constituents epigallocatechin gallate (EGCG) and epicatechin gallate (ECG) were also observed when tasted on human laryngeal carcinoma cell line (HEp2) and it's crossresistant CK2 cell line. The results showed that EGCG and green tea extract increased the DNA damage in the CK2 cell line during short exposure. The cytotoxicity of EGCG and ECG increased with the time of incubation. Green tea extract induced lipid peroxidation in the CK2 cell line. White tea extract, that inhibits the proliferation of HT-29 colon tumor cells and protects normal 3T3-L1 cells from DNA damage by hydrogen peroxide, was also explored. This paper presents a brief overview of beneficial therapeutic effects of Camellia sinensis in chemoprevention and chemotherapy of different cancer cells types

Hiperferitinemija u bolesnika s presatkom bubrega

The principal iron storage protein is ferritin, which is primarily present in cytoplasm. The most common cause of hyperferritinemia is iron overload, which is either primary or secondary. Hyperferritinemia is commonly found in patients with chronic kidney disease regardless of their hemoglobin level and is often considered to be related to chronic inflammatory status as well as malnutrition and neoplasias. We present a case of a kidney transplant patient that developed severe hyperferritinemia associated with liver dysfunction. In our patient, high hyperferritinemia was detected a year after transplantation, when she had no signs of inflammation. Malignancies, chronic viral hepatitis, and chronic inflammatory disease were also excluded as the causes of hyperferritinemia. Since high serum ferritin levels were combined with increased transferrin saturation and mildly elevated plasma iron concentrations, we presume that the most probable cause of hyperferritinemia in our patient was iron overload.Feritin je glavni protein za skladištenje željeza i prvenstveno je prisutan u citoplazmi. Najčešći uzrok hiperferitinemije je preopterećenje željezom, koje može biti primarno ili sekundarno. Hiperferitinemija se često nalazi u bolesnika s kroničnom bubrežnom bolesti bez obzira na razinu njihovog hemoglobina i smatra se da je povezana s kroničnom upalom, pothranjenošću i novotvorinama. Prikazujemo slučaj bolesnice s transplantiranim bubregom u koje se razvila teška hiperferitinemija povezana s jetrenom disfunkcijom. U naše bolesnice hiperferitinemija je otkrivena godinu dana nakon transplantacije, kada u nje nije bilo znakova upale. Zloćudne bolesti, kronični virusni hepatits i kronična upalna bolest su također isključeni kao uzroci hiperferitinemije. Kako je visoka koncentracija feritina bila udružena s povišenom zasićenošću transferina i umjereno povišenom koncentracijom željeza u plazmi, pretpostavljamo da je najvjerojatniji uzrok hiperferitinemije bilo preopterećenje željezom

INFEKCIJA MOKRAĆNIH PUTOVA UZROKOVANA NETIFOIDNOM SALMONELOM UZ NEGATIVAN NALAZ KOPROKULTURE – NETIFOIDNA SALMONELA: IZNIMNO RIJEDAK, ALI MOGUĆ UZROK INFEKCIJE MOKRAĆNIH PUTOVA U BOLESNIKA S TRANSPLANTIRANIM BUBREGOM

Non-thyphoidal Salmonella usually presents as gastroenteritis while extra-intestinal manifestations are rare and mostly occur in patients with predisposing conditions such as chronic illness, urinary tract abnormalities, and immunosuppression. Urinary tract infection is the most common infectious complication in kidney transplant recipients. There are very few cases of urinary tract infections caused by non-thyphoidal Salmonella in kidney transplant recipients in the English literature, and to the best of our knowledge, only nine cases being stool negative. Although being extremely rare, non-thyphoidal Salmonella should be considered as one of the possible causes of urinary tract infections in kidney transplant recipients even without concomitant or preceding gastrointestinal symptoms. Bacteriuria can be present for some time after treatment requiring prolonged treatment and urine culture surveillance.Gastroenteritis je najčešća posljedica infekcije netifoidnom salmonelom. Ekstraintestinalne manifestacije su iznimno rijetke i najčešće se viđaju u bolesnika s predisponirajućim stanjima kao što su kronične bolesti, bolesti urotrakta i stanja povezana s imunosupresijom. Infekcije mokraćnih putova su najčešća infektivna komplikacija u bolesnika s transplantiranim bubregom. U literaturi je do sada opisano svega nekoliko slučajeva infekcija mokraćnih putova uzrokovanih netifoidnom salmonelom, a u samo devet slučajeva bakterija nije dokazana i u uzorcima stolice. Netifoidna salmonela je iznimno rijedak, no moguć uzročnik infekcija mokraćnih putova u bolesnika s transplantiranim bubregom, čak i u slučajevima bez pridružene ili prethodne kliničke slike gastroenteritisa. Nakon provedenog liječenja može zaostati asimptomatska bakteriurija pa je nakon završetka liječenja potrebno redovito uzimati nadzorne urinokulture

New Variant of Unknown Significance found in ERCC6 gene -Cerebro-oculo-facio-skeletal syndrome

INTRODUCTION/OBJECTIVES: Cerebro-oculo-facio-skel- etal syndrome (COFS) is a genetic disorder caused by a mutation of the DNA repair genes presenting with severe sensorineural involvement. The aim was to present a possible new pathogen mutation in the ERCC6 gene responsible for the clinical presentation of COFS

Monitoring and Treatment of Renal Transplant Patients During the COVID-19 Pandemic

Pandemija COVID-19 paralizirala je transplantacijske programe širom svijeta, uz visoke stope smrtnosti u populaciji bolesnika s transplantiranim bubregom. Suočeni s nepoznatim patogenom svjedočimo čitavom nizu manje ili više uspješnih pokušaja liječenja. Bolesnici s transplantiranim bubregom su posebno ugrožena skupina s obzirom na kronično stanje imunosupresije. Dodatan problem u liječenju COVID-19 predstavlja problem mogućih interakcija lijekova koji se rabe u liječenju SARS-CoV-2 s imunosupresivima, kao i rizik akutnih odbacivanja prilikom značajnih smanjivanja imunosupresije. Ponovno oživljavanje transplantacijskih programa zahtijevat će pažljivu procjenu rizika i dobrobiti za svakoga pojedinog bolesnika uz promišljanje načina uspostave međunarodne razmjene organa. Potrebna su daljnja istraživanja kako bi se odredio optimalan način liječenja SARS-CoV-2 u bolesnika s transplantiranim bubregom.The COVID-19 pandemic has paralyzed renal transplant programs worldwide, with high mortality rates in renal transplant patients. Faced with an unknown pathogen, we have witnessed numerous treatment attempts that have been more or less effective. Renal transplant recipients are at increased risk for morbidity and mortality from COVID-19 given their chronic immunocompromised state. Additional complications are potential interactions in drugs used for treatment of SARS-CoV-2 and immunosuppressive medications, as well as risk of acute allograft rejection associated with reduction of immunosuppression. The revival of renal transplant programs will require careful assessment of individual risk-to-benefit ratio for each patient, with step-by-step reintroduction of international organ exchange. Further studies are needed to determine optimal treatment of SARS-CoV-2 in renal transplant recipients

DJELOTVORNOST RAZLIČITIH PREVENTIVNIH POSTUPAKA U KONTROLI KARIOGENIH RIZIČNIH ČIMBENIKA U DJECE

Caries risk assessment is a valuable clinical procedure that in many ways facilitates implementation of preventive procedures in children with high risk of caries. The aim of this study was to investigate the effectiveness of five different caries preventive procedures in vivo. One hundred children, aged 4-5 and 10-12 years, were divided into five groups (20 per group) and treated with different preventive procedures (amine fluoride solution, professional prophylactic paste, chewing gum containing xylitol and fluoride, chlorhexidine solution, or chlorhexidine-fluoride gel). During a period of two months, five measurements were performed and the following variables evaluated: Streptococcus (S.) mutans and lactobacilli count (LB), oral hygiene index (OHI), and amount of stimulated saliva. Results showed the highest reduction in the number of bacteria to be achieved by the application of professional prophylactic tooth paste and daily use of chewing gum containing xylitol and fluoride (p<0.001). In these children, S. mutans count was reduced by class 1 and LB to <104 CFU/mL after two months. In conclusion, professional tooth cleaning and use of chewing gum with xylitol and fluorides on a daily basis could be very effective protocol in controlling caries risk factors in children.Procjena rizika za razvoj karijesa vrijedan je klinički postupak koji u mnogočemu olakšava uvođenje preventivnih postupaka u visokorizične djece za karijes. Cilj ovog istraživanja bio je ispitati djelotvornost pet različitih karijes preventivnih postupaka in vivo. Stotinu djece, razdijeljene u pet skupina, od kojih je u svakoj bilo 20-ero (u dobi od 4-5 i od 10-13 godina) tretirano je različitim preventivnim postupcima (amin fluoridnom otopinom, profesionalnom profilaktičkom pastom, žvakaćom gumom koja sadrži ksilitol i fluorid, otopinom klorheksidina, gelom koji sadrži klorheksidin i fluor). Tijekom dvomjesečnog razdoblja obavljeno je pet mjerenja i evaluirane su sljedeće varijable: broj Streptococcus mutans (SM) i Lactobacilli (LB), indeks oralne higijene (OHI) i količina stimulirane sline. Rezultati su pokazali da je najveće smanjenje broja bakterija postignuto primjenom profesionalne profilaktičke paste i svakodnevnim žvakanjem žvakaće gume koja sadrži ksilitol i fluorid (p<0.001). Kod te djece nakon dva mjeseca broj SM-a smanjen je na klasu 1 i LB-a na <104 CFU/ml. Zaključno, profesionalno čišćenje zuba i upotreba žvakaće gume s ksilitolom i fluoridima na dnevnoj bazi mogla bi biti vrlo djelotvorni način za kontrolu rizičnih čimbenika za nastanak karijesa u djece