Prevalencija i načini detekcije fibrilacije atrija u bolesnika hospitaliziranih zbog ishemijskoga moždanog udara i njezin utjecaj na kliničke ishode

SUMMARY: Background: Atrial fibrillation (AF) is one of the preventable risk factors for embolic ischemic stroke. The high prevalence and the possibility of stroke prevention suggest the need for effective screening for AF. The aim of this study was to assess the prevalence of and methods for diagnosing AF in patients with ischemic stroke, compare their clinical characteristics, and subsequently outcomes in the AF and non-AF group. Patients and Methods: This was a retrospective observational study. Medical history of patients with ischemic stroke in 2019 was collected and analyzed. Results: Out of the total number of the patients with ischemic stroke, 39% had AF, which was newly discovered in 50.3% of all patients with AF. Almost three-quarters (73%) of patients with known AF in their medical history were not receiving adequate anticoagulation therapy. Most of the patients with newly discovered AF (87%) were diagnosed using a standard 12-lead ECG, while the rest was diagnosed using 24-hour Holter monitoring (12.5%). AF was associated with mortality as well as with a higher CHA2DS2-VASc score. Conclusion: As many as half of patients with AF in our cohort were diagnosed with AF only after suffering a stroke. In addition, most of the previously diagnosed patients with AF were not receiving adequate anticoagulation therapy. Outcomes were worse in patients with stroke who had concomitant AF, especially those with higher CHA2DS2-VASc scores. Therefore, more frequent screening of patients is encouraged, with continuous monitoring as an ideal solution.Fibrilacija atrija (FA) jedan je od čimbenika rizika za ishemijski moždani udar (MU) koji je moguće prevenirati. Visoka prevalencija te mogućnost prevencije upućuju na potrebu za učinkovitim načinom detekcije FA-a. Cilj ovog istraživanja bio je procijeniti prevalenciju i način dijagnoze FA-a u bolesnika s ishemijskim MU te usporediti njihova klinička obilježja i ishode u skupini s FA i bez nje. Metode: Ovo je bila retrospektivno opservacijsko istraživanje. Prikupljene su i analizirane povijesti bolesti ispitanika s ishemijskim MU u 2019. godini. Rezultati: Među svim ispitanicima njih 39 % imalo je FA, dok je 50,3 % ispitanika s FA-om otkriveno tek nakon ishemijskoga MU-a. Gotovo tri četvrtine (73 %) bolesnika s anamnestičkim podatkom o FA-u nije bilo adekvatno antikoagulirano. Većina novootkrivenih FA (87 %) bila je detektirana standardnim 12-kanalnim EKG-om, dok je ostatak detektiran 24-satnim snimanjem EKG-a (12,5 %). FA je bila statistički značajno povezana sa smrtnim ishodom, kao i s višim vrijednostima na CHA2DS2-VASc bodovnom sustavu. Zaključak: Čak polovica ispitanika s FA-om dijagnosticirana je tek nakon ishemijskoga MU-a. Većina ispitanika s već poznatom FA nije bila adekvatno antikoagulirana. Ishodi su lošiji u bolesnika s pratećom FA, posebice u onih s višim rezultatima na CHA2DS2-VASc bodovnom sustavu. Stoga treba poticati češći probir bolesnika s kontinuiranim monitoriranjem kao idealnom opcijom

Anticonvulsant induced metabolic disorder - case report

Osteomalacija je metabolička bolest odraslih kod koje je poremećena mineralizacija organskog matriksa kosti. Vezana je uz različite poremećaje metabolizma vitamina D, a može se javiti i kod primjene antikonvulzivnih lijekova. Antikonvulzivi ubrzavaju katabolizam vitamina D induciranjem mikrosomskih enzima jetre, smanjuju bubrežnu hidroksilaciju vitamina D, imaju direktan učinak na gastrointestinalnu apsorpciju kalcija i s tim na remodelaciju kosti neovisnu o metabolizmu vitamina D. U radu je prikazana bolesnica u koje je dugotrajna politerapija antikonvulzivima prouzročila osteomalaciju i nepokretnost. Ova nuspojava poznata je u kliničkoj praksi više od trideset godine, ali nema jasnih smjernica za praćenje osteomalacije kao i za primjenu vitamina D i kalcija u bolesnika liječenih antikonvulzivnom terapijom.Osteomalacia, metabolic bone disease in the adults, is disorder in which mineralization of the organic matrix of the skeleton is defective. This disorder is caused by a number of different conditions associated with alterations of vitamin D metabolism. Anticonvulsant therapy can also cause the development of osteomalacia due to alteration of vitamin D metabolism inducing hepatic mycrosomal enzymes, inhibiting 25-hydroxilation of vitamin D. They also inhibit intestinal calcium transport and bone mineral mobilization, independent of effects on vitamin D metabolism. This paper presents a patient who was unable to walk due to anticonvulsants induced osteomalacia. Anticonvulsant use has been implicated as a cause of bone disease for more than 30 years but there is no official recommendation for calcium and vitamin D therapy in anticonvulsant treated individuals

Kompletni atrioventrikulski blok i asistolija tijekom epileptičkog napadaja: prikaz slučaja

Cardiac arrhythmias during or after epileptic seizures are one of the possible pathomechanisms of sudden unexpected death in epilepsy. These arrhythmogenic epilepsies are most commonly associated with sinus tachycardia, but atrioventricular block and asystole can also be seen. Although a rare occurrence, these arrhythmias can lead to significant morbidity and mortality, but also can be potentially preventable with pacemaker implantation. Here we describe a patient with recurrent epileptic seizures, diagnosed with ictal third-degree atrioventricular block and asystole during seizure, which required a permanent cardiac pacemaker.Srčane aritmije tijekom ili nakon epileptičkih napadaja jedan su od mogućih patomehanizama neočekivane smrti u bolesnika s epilepsijom. Ove aritmogene epilepsije najčešće su povezane sa sinus tahikardijom, ali se mogu uočiti i atrioventrikulski blok i asistolija. Iako se rijetko pojavljuju, ove aritmije mogu dovesti do značajnog pobola i smrtnosti, ali se također mogu prevenirati ugradnjom srčanog stimulatora. Ovdje opisujemo bolesnika s ponavljajućim epileptičkim napadajima i dijagnosticiranim atrioventrikulskim blokom trećeg stupnja i asistolijom tijekom napadaja kojemu je bilo potrebno ugraditi trajni srčani stimulator

A STUDY INVESTIGATING THE FACTORS OF INTERNET ADDICTION

Istražene su karakteristike korištenja interneta među učenicima osmih razreda osnovnih škola na području Bjelovarsko-bilogorske županije. Cilj rada bio je utvrditi postojanje razlika između spolova kao i u odnosu na neka sociodemografska obilježja ispitanika te otkriti prediktore koji mogu dovesti do ovisnosti o tom mediju. U istraživanju je sudjelovalo 437 učenika prosječne dobi 13,8 godina. Provedena je logistička regresijska analiza kako bi se utvrdio samostalni doprinos pojedinih čimbenika rizika za razvoj ovisnosti o internetu. Kao značajni čimbenici utvrđeni su smještaj kompjutera u sobi učenika (povećava rizik za 2,8 puta), korištenje interneta od strane roditelja (povećava rizik za 1,9 puta), znanje roditelja o sadržajima koje njihova djeca gledaju (smanjuje šansu za pretjeranim korištenjem interneta za 93 %), zadovoljstvo učenika školom (jako zadovoljni učenici imaju 68 % manju šansu), te znanje roditelja o tome koje stranice djeca gledaju (smanjuje šansu za 53 %). Utvrđeno je da se kod više od polovice ispitanika kompjuter nalazi u njihovoj sobi, a razlika po spolu nije statistički značajna. Djevojkama roditelji znatno češće ugrađuju zaštitu od neželjenih sadržaja, uz dopuštenje pristupa internetu. Svi ispitanici najčešće koriste internet za društvene mreže i slušanje i presnimavanje fi lmova i glazbe, dok mladići uz to nešto češće igraju igrice. Nisu nađene razlike između sela i grada u pogledu uspoređivanih parametara. Preventivne mjere za sprječavanja nastanka internetske ovisnosti trebalo bi usmjeriti prema prediktorima koji su utvrđeni kao značajni u nastanku internetske ovisnosti.The aim of the study was to explore the characteristics of Internet use among elementary school eighth-graders in the Bjelovar-Bilogora County, to evaluate gender and sociodemographic differences, and to examine predictors for Internet addiction. The study included 437 (female 51%) eighth-graders, mean age 13.8±0.5 years. An anonymous questionnaire was used to measure the participants’ Internet use, the functions for which they used Internet, their parents’ attitude towards the child’s Internet use, and their signs of Internet addiction. Logistic regression was conducted to evaluate predictors for Internet addiction. The majority of children (71.5%) reported using Internet every day. Considering important risk factors of Internet addiction development, we found that 32% of children almost always stayed on-line longer than intended, 13% of boys and 4% of girls almost always neglected chores to spend more time on-line and 51.7% of children thought their life would be boring and uninteresting without the Internet. There was no signifi cant difference between urban and rural students. In terms of the function for which they used the Internet, they were mostly engaged in on-line community/chat websites (70%), to listen to music and watch movies (81%), and boys in gaming websites. Most of the students (43.4%) spent 1-2 hours daily on-line, 26.2% of students spent 3-4 hours on-line, and 9% spent more than 5 hours daily on-line. In conclusion, more public health preventive measures should be conducted to raise public awareness and concern about the negative effect of Internet use and Internet addiction, especially in the young population

Sedentary lifestyle and headaches in schoolchildren

Cilj rada je upozoriti na učestalost sjedilačkog ponašanja, odnosno nedovoljne tjelesne aktivnosti školske djece te na povezanostnavike predugog sjedenja i pojave glavobolja. Služili smo se hrvatskom bazom podataka međunarodnog istraživanja Health Behaviourof School-aged Children, 2013./2014. gdine. Za potrebe ovog rada primijenili smo pitanja koja opisuju sjedilačko ponašanje iglavobolje. Statistička obrada je obavljena pomoću IBM SPSS Statistics 24,0 statističkog programa. Za uzorak je uzet 5741 učenik(49,8% Ž, 50,2% M) 5. i 7. razreda osnovne škole te 1. razreda srednje škole (11, 13 i 15 godina), s podjednakom dobnom raspodjelom.Odaziv je bio 85,9%. Svaki dan je tjelesno aktivno 25,3% ispitanika. Dva sata slobodnog vremena uz ekrane dnevno provodi 23,9%ispitanika. Petina ispitanika odgovara kako igra igrice oko ½ sata na dan. Djeca koja su tjelesno aktivnija imaju manje glavobolje(OR 0,0905, p<0,001). Više vremena provedenog uz ekrane povezano je s češćim glavoboljama (OR 1,082, p<0,003), a duže igranjeigrica je povezano sa manje glavobolja (OR=0,890, p<0,001). Analizom upućujemo na povezanost sjedilačko ponašanja i pojavuglavobolja, tako da su tjelesna aktivnost i igranje igrica zaštitni čimbenik, a vrijeme provedeno uz ekrane rizičan.The aim of this paper is to show the prevalence of sedentary lifestyle, i.e. insufficient physical activity in schoolchildren, and theassociationof sedentary lifestyle and headache. We used Croatian database of the international research on Health Behaviour ofSchool-aged Children, 2013/2014. For the purpose of this paper, we used questions that describe sedentary lifestyle and headaches.Statistical processing was done using IBM SPSS Statistics 24.0 statistical program. The sample included 5741 students (49.8% F and50.2% M), primary school 5th and 7th grades and secondary school 1st grade (age 11, 13 and 15 years, respectively), with an equaldistribution. The response rate was 85.9%. Study results showed that 25.3% of students practiced daily physical activity. Spendingtwo hours of free time in front of screens daily was reported by 23.9% of respondents. One-fifth of the students answered that theyplayed games for about half an hour a day. Children who were more physically active had less headaches (OR 0.0905, p<0.001).More time spent in front of a screen was associated with more frequent headaches (OR 1.082, p<0.003), and playing games longerwas associated with less headaches (OR 0.890, p<0.001). Analyzing the relationship between sedentary lifestyle and headachesindicatedphysical activity and playing games as a protective factor, whereas the time spent in front of a screen was a risk facto