Ventricular tachycardia as heterogenous rhythm disorder with varying prognosis and therapy

Ventrikulska tahikardija poremećaj je ritma srca frekvencije veće od 100/min. Najčešće se javlja u pacijenata koji imaju strukturnu bolest srca, a povezana je s povećanim rizikom od iznenadne srčane smrti. Poznat je i idiopatski oblik koji se javlja na strukturno zdravom srcu. Gledajući etiološki ishemijska bolest srca svakako je najčešći uzrok njezinog nastanka. S obzirom na izgled QRS kompleksa razlikujemo monomorfni i polimorfni oblik. Tri glavna simptoma kojima se prezentiraju pacijenti i koji trebaju daljnju obradu jesu palpitacije, presinkopa i sinkopa. 12-kanalni EKG prva je neinvazivna dijagnostička metoda u evaluaciji ovog poremećaja, a na raspolaganju su nam i ostale neinvazivne kao i invazivne metode. Važno je tražiti etiološku podlogu nastanka aritmije kako bi što ispravnije mogli liječiti bolesnike. Današnja terapija VT-a uključuje i medikamentoznu terapiju antiaritmijskim lijekovima, ali i nefarmakološke mjere poput ugradnje kardioverterskog-defibrilatora te katetersku i kiruršku ablaciju. Odgovarajuća terapija može značajno poboljšati prognozu u odabranih pacijenata. Uz zbrinjavanje akutno nastale ventrikulske tahikardije, važno je prevenirati ponovno javljanje iste i time smanjiti rizik od iznenadne srčane smrti.Ventricular tachycardia is a heart rhythm disorder frequency greater than 100/min. It most commonly occurs in patients with structural heart disease and can be associated with an increased risk of sudden death. There is also a form of idiopathic VT which can occur in the absence of structural heart disease. The most common cause of VT is certainly ishemic heart disease. According to QRS complex, we distinguish monomorphic and polimorphic form. Palpitations, presyncope and syncope are the three most important symptoms that require further investigation. A standard 12-lead ECG is the first non-invasive diagnostic method we can use, but there are also other non-invasive and invasive diagnostic methods. It is important to find out about the etiology of arrhythmia to properly treat patients. Nowadays, the VT therapy includes both medicamentous and non-pharmacological therapy such as implantable cardioverter-defibrillator, catheter and surgical ablation. The appropriate treatment can significantly improve the prognosis in selected patients. The VT treatment involves both emergent management and prevention of recurrence so we could reduce the risk of sudden death

Ventricular tachycardia as heterogenous rhythm disorder with varying prognosis and therapy

Ventrikulska tahikardija poremećaj je ritma srca frekvencije veće od 100/min. Najčešće se javlja u pacijenata koji imaju strukturnu bolest srca, a povezana je s povećanim rizikom od iznenadne srčane smrti. Poznat je i idiopatski oblik koji se javlja na strukturno zdravom srcu. Gledajući etiološki ishemijska bolest srca svakako je najčešći uzrok njezinog nastanka. S obzirom na izgled QRS kompleksa razlikujemo monomorfni i polimorfni oblik. Tri glavna simptoma kojima se prezentiraju pacijenti i koji trebaju daljnju obradu jesu palpitacije, presinkopa i sinkopa. 12-kanalni EKG prva je neinvazivna dijagnostička metoda u evaluaciji ovog poremećaja, a na raspolaganju su nam i ostale neinvazivne kao i invazivne metode. Važno je tražiti etiološku podlogu nastanka aritmije kako bi što ispravnije mogli liječiti bolesnike. Današnja terapija VT-a uključuje i medikamentoznu terapiju antiaritmijskim lijekovima, ali i nefarmakološke mjere poput ugradnje kardioverterskog-defibrilatora te katetersku i kiruršku ablaciju. Odgovarajuća terapija može značajno poboljšati prognozu u odabranih pacijenata. Uz zbrinjavanje akutno nastale ventrikulske tahikardije, važno je prevenirati ponovno javljanje iste i time smanjiti rizik od iznenadne srčane smrti.Ventricular tachycardia is a heart rhythm disorder frequency greater than 100/min. It most commonly occurs in patients with structural heart disease and can be associated with an increased risk of sudden death. There is also a form of idiopathic VT which can occur in the absence of structural heart disease. The most common cause of VT is certainly ishemic heart disease. According to QRS complex, we distinguish monomorphic and polimorphic form. Palpitations, presyncope and syncope are the three most important symptoms that require further investigation. A standard 12-lead ECG is the first non-invasive diagnostic method we can use, but there are also other non-invasive and invasive diagnostic methods. It is important to find out about the etiology of arrhythmia to properly treat patients. Nowadays, the VT therapy includes both medicamentous and non-pharmacological therapy such as implantable cardioverter-defibrillator, catheter and surgical ablation. The appropriate treatment can significantly improve the prognosis in selected patients. The VT treatment involves both emergent management and prevention of recurrence so we could reduce the risk of sudden death

COVID-19 and Pneumonia

Bolest uzrokovana novim koronavirusom 2019 (COVID-19) postala je prijetnja cijeloj svjetskoj populaciji. Njena česta komplikacija je upala pluća. Najčešći simptomi bolesti su povišena tjelesna temperatura, suhi kašalj, umor, iskašljavanje, zaduha. Rjeđi simptomi su glavobolja, suho grlo, probavne tegobe, simptomi gornjega dišnog puta, promjene u osjetu njuha i okusa. Starija dob i komorbiditeti kao što je visoki krvni tlak, šećerna bolest, kronične plućne bolesti, kardiovaskularne bolesti, srčane bolesti, pretilost predstavljaju značajni rizični faktor za bolesnike inficirane koronavirusom SARS-CoV-2. Uobičajeni laboratorijski nalazi uključuju limfopeniju, povišenu razinu C-reaktivnog proteina, feritina, aminotransferaza, laktat dehidrogenaze. Bolesnici koji razviju tešku kliničku sliku obično imaju brojne laboratorijske poremećaje što sugerira da SARS-CoV-2 infekcija može uzrokovati ozljedu stanične imunosti, aktivaciju koagulacije, oštećenje miokarda, jetre i bubrega. Najčešće komplikacije su akutni respiratorni distres sindrom, šok, aritmije, akutna ozljeda miokarda, akutno oštećenje bubrežne funkcije. Kompjuterizirana tomografija (CT) može biti korisna kao komplementarna metoda polimeraznoj lančanoj reakciji u realnom vremenu za dijagnozu COVID-19 pneumonije. Njezine glavne CT karakteristike su infiltrati tipa mliječnog stakla periferne i subpleuralne distribucije. Ova područja uzorka mliječnog stakla mogu se miješati s područjima žarišne konsolidacije i/ili se na njih superponiraju zadebljale intralobularne septe, što daje uzorak ludog popločenja.Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a clinical threat to the general population worldwide. Pneumonia is a common complication of COVID-19. Most common symptoms include fever, dry cough, fatigue, sputum production, dyspnea. Less common symptoms include headaches, sore throat, gastrointestinal symptoms, upper airway symptoms, alterations in smell or taste. Higher age and comorbidities, such as hypertension, diabetes mellitus, chronic lung disease, cardiovascular disease, cerebrovascular disease and obesity, pose significant risk for patients infected with SARS-CoV-2. Common laboratory findings include lymphopenia, elevated C-reactive protein, ferritin, aminotransferase levels and lactate dehydrogenase levels. Patients who develop severe disease typically have numerous laboratory abnormalities, which suggests that SARS-CoV-2 infection may be associated with cellular immune deficiency, coagulation activation, myocardial, hepatic and kidney injury. The most frequent complications include acute respiratory distress syndrome, shock, arrhythmias, acute cardiac injury and acute renal failure. Computed tomography (CT) may prove useful as a complementary method to real-time polymerase chain reaction for diagnosing COVID-19 pneumonia. The main CT feature of COVID-19 pneumonia is the presence of ground-glass opacities (GGO), typically with peripheral and subpleural distribution. These areas of GGO may be admixed with areas of focal consolidation and/or associated with superimposed intralobular reticulations, resulting in a crazy-paving pattern

Pulmonary Embolism in Pneumonia

Plućni embolizam (PE) i pneumonija dijele zajedničke rizične faktore, uzajamno se potenciraju i slično radiološki manifestiraju. Klinička slika pneumonije može u potpunosti maskirati prateću PE što uz porast D-dimera uslijed upalnog zbivanja znatno otežava probir pacijenata koje je potrebno podvrgnuti slikovnim metodama dijagnostike. Još uvijek nije pronađeno neko karakteristično obilježje (niti granična vrijednost D-dimera) koje bi direktno sugeriralo prisutnost PE u osobe s pneumonijom. Prateća PE najčešće se javlja u starijih i bolesnika s komorbiditetima, a bol u prsima, dispneja i sinkopa češće su nego kod pneumonije bez PE. Pojavnost PE u bolesnika s pneumonijom uzrokovanom novim koronavirusom (COVID-19) značajno je veća nego u pneumonija uzrokovanih drugim uzročnicima i povezuje se s rizičnim faktorima poput muškog spola, višim razinama C-reaktivnog proteina te odgodom hospitalizacije. Primjena profilaktičke doze antikoagulantne terapije može reducirati učestalost PE u bolesnika s COVID-19 pneumonijom.Pneumonia and pulmonary embolism (PE) share common risk factors, radiological findings and one disease may induce the development of another. The clinical characteristics of pneumonia can completely mask the concomitant PE, which, along with the increase in D-dimer due to inflammatory events, significantly complicates the screening of patients who need imaging diagnostic methods. A specific feature (including the exact D-dimer cut-off value), which would clearly indicate concomitant PE in pneumonia has not yet been established. However, older age, comorbidities, chest pain, dyspnea and syncope are more common in pneumonia with coexisting PE than in pneumonia alone. In new coronavirus associated pneumonia (COVID-19), PE is far more frequent than in pneumonia caused by other microorganisms. PE in COVID-19 pneumonia is associated with risk factors such as male sex, higher levels of C-reactive protein and delayed hospitalization. Anticoagulant-prophylaxis reduces the incidence of PE in COVID-19 pneumonia

"Women\u27s Sports is Not a Real Sports": Negative Stereotypes about Sportswomen and the Experience of Gender Inequality in Handball in Croatia

Osnovni cilj istraživanja bio je utvrditi koliko se često mladi rukometaši i rukometašice susreću s negativnim stereotipima prema sportašicama. Osim spomenutoga, ispitali smo razlikuju li se sportašice koje su u različitom stupnju izložene negativnim stereotipima u doživljaju rodne neravnopravnosti koja se očituje u nejednakim uvjetima treniranja i nejednakom načinu vrednovanja sportskih postignuća mladića i djevojaka koji treniraju u njihovom sportskom klubu. U istraživanju je sudjelovalo 522 rukometaša/ica (289 mladića i 233 djevojaka) čiji se raspon dobi kretao od 14 do 17 godina (M=14,75; SD=0,96). Prema dobivenim rezultatima, s negativnim se stereotipima prema sportašicama i/ili sportu u kojem sudjeluju djevojke susrelo 94,5% mladića i 95,6% djevojaka. Mlade su sportašice češće izložene stavu prema kojem sport nije aktivnost namijenjena djevojkama (U=28188,00, p<0,05), odnosno stavu koji podrazumijeva da sport u kojem sudjeluju žene nije atraktivan (U=28111,00, p<0,05). Djevojke koje se češće susreću s negativnim stereotipima prema sportašicama statistički značajno češće navode da sportaši i sportašice u njihovom klubu ne treniraju u jednakim uvjetima (U=3551,000, p<0,001) te da se njihovi sportski uspjesi ne vrednuju na isti način (U=3353,500, p<0,001). Dobiveni rezultati upućuju na potrebu za poduzimanjem mjera s ciljem suzbijanja negativnih stereotipa prema sportašicama te omogućavanja jednakih uvjeta treniranja i vrednovanja sportskih rezultata sportaša i sportašica.The main aim of the study was to determine how often young handball players encountered negative stereotypes towards sportswomen. In addition, we examined whether young sportswomen who were differentially exposed to those stereotypes differed in their perception of gender inequality regarding training conditions and sporting achievement appraisal of boys and girls in their sports clubs. The study involved 522 handball players (289 boys and 233 girls) whose ages ranged from 14 to 17 years (M = 14.75; SD = 0.96). The results showed that 94.5 % of boys and 95.6 % of girls who participated in the study have heard negative stereotypes towards sportswomen and/or the sports in which they participate. Young sportswomen were more often exposed to the attitudes according to which sports activities are not suitable for girls (U = 28188,00, p <0,05) as well as to the attitudes implying that women’s sports are not attractive (U = 28111.00, p <0.05). Furthermore, girls who were more often exposed to negative stereotypes towards sportswomen more frequently reported that boys and girls in their club trained in unequal conditions (U = 3551,000, p <0.001) and that their sports achievements were not valued equally (U = 3353,500, p <0,001). The obtained results indicate the need to undertake measures to combat the negative stereotypes towards sportswomen and enable equal training conditions and equal sports achievements evaluation for boys and girls who participate in sports

Neinvazivna mehanička ventilacija u akutnoj respiracijskoj insuficijenciji zbog COVID-19

Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered via a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.Bolest uzrokovana novim koronavirusom 2019 (COVID-19) prezentira se širokim rasponom simptoma, od asimptomatske bolesti do teške i progresivne intersticijske upale pluća. Kao dio intersticijske pneumonije respiracijska insuficijencija tipično je obilježena hipoksijom i najčešći je uzrok hospitalizacije. Kada terapija kisikom ne uspije, kontinuirani pozitivni tlak u dišnim putovima (CPAP) ili neinvazivna mehanička ventilacija (NIV) mjere su respiracijske potpore prvog izbora. Neinvazivna respiracijska potpora (NIRS) primjenjuje se kako bi se uštedjeli resursi jedinica intenzivnog liječenja i izbjegle komplikacije povezane s invazivnom mehaničkom ventilacijom. Uporaba CPAP-a ili NIV-a u liječenju akutne hipoksemične respiracijske insuficijencije kod COVID-19 smanjuje potrebu za intubacijom i smrtnost. Prednost NIRS-a je da se može provoditi na odjelima. NIV se može primijeniti preko maske ili kacige. Kaciga bolje prianja u odnosu na masku i stoga je smanjen gubitak zraka, isporuka pozitivnog tlaka na kraju izdisaja je točnija, a rizik od nozokomijalnog prijenosa infekcija je manji. Bolesnici na NIRS-u moraju se pažljivo nadzirati kako se ne bi previdjelo daljnje respiracijsko pogoršanje i kako bi se mogle provesti dodatne mjere skrbi uključujući pravodobnu intubaciju i invazivnu mehaničku ventilaciju

Impact of Tree Pollen Distribution on Allergic Diseases in Serbia: Evidence of Implementation of Allergen Immunotherapy to Betula verrucosa

Background and objectives: The relationship between air pollen quantity and the sensitization of allergic patients is crucial for both the diagnosis and treatment of allergic diseases. Weather conditions influence the distribution of allergenic pollen and increases in pollen concentration may negatively affect the health of allergic patients. The aim of this study was to analyze the implementation of allergen immunotherapy with regard to air pollen concentration. Material and Methods: Here we examined the relationship between Betula air pollen concentration and the usage of Betula verrucosa allergen immunotherapy in Serbia. Examination covered the period from 2015 to 2018. Measurement of airborne pollen concentration was performed with Lanzoni volumetric pollen traps. The evidence of the usage of sublingual allergen immunotherapy (SLIT) was gathered from patients with documented sensitization to specific pollen. Results: During this period tree pollens were represented with 58% +/- 21% of all measured air pollen species, while Betula pollen represented 15% +/- 8% of all tree pollens. Betula pollination peaked in April. Allergen immunotherapy to Betula verrucosa in Serbia is entirely conducted as sublingual immunotherapy and represents 47.1% +/- 1.4% of issued tree pollen SLIT. The use of pollen SLIT increased by 68% from 2015 to 2018, with an even greater increase in usage recorded for Betula SLIT-80%. Conclusions: This analysis shows a clear causative relationship between pollination and the type/prevalence of applied allergen immunotherapy. Information about the flowering seasons of allergenic plants is very important for people who suffer from allergy, for clinical allergologists, as well as for governing authorities. The presented data is of practical importance to the proper timing of immunotherapy initiation and of importance for urban landscaping. The obtained data can be the starting point for the instatement of a thorough epidemiological study and the inclusion of Serbia on the pollen map of Europe

Ventricular tachycardia as heterogenous rhythm disorder with varying prognosis and therapy

Ventrikulska tahikardija poremećaj je ritma srca frekvencije veće od 100/min. Najčešće se javlja u pacijenata koji imaju strukturnu bolest srca, a povezana je s povećanim rizikom od iznenadne srčane smrti. Poznat je i idiopatski oblik koji se javlja na strukturno zdravom srcu. Gledajući etiološki ishemijska bolest srca svakako je najčešći uzrok njezinog nastanka. S obzirom na izgled QRS kompleksa razlikujemo monomorfni i polimorfni oblik. Tri glavna simptoma kojima se prezentiraju pacijenti i koji trebaju daljnju obradu jesu palpitacije, presinkopa i sinkopa. 12-kanalni EKG prva je neinvazivna dijagnostička metoda u evaluaciji ovog poremećaja, a na raspolaganju su nam i ostale neinvazivne kao i invazivne metode. Važno je tražiti etiološku podlogu nastanka aritmije kako bi što ispravnije mogli liječiti bolesnike. Današnja terapija VT-a uključuje i medikamentoznu terapiju antiaritmijskim lijekovima, ali i nefarmakološke mjere poput ugradnje kardioverterskog-defibrilatora te katetersku i kiruršku ablaciju. Odgovarajuća terapija može značajno poboljšati prognozu u odabranih pacijenata. Uz zbrinjavanje akutno nastale ventrikulske tahikardije, važno je prevenirati ponovno javljanje iste i time smanjiti rizik od iznenadne srčane smrti.Ventricular tachycardia is a heart rhythm disorder frequency greater than 100/min. It most commonly occurs in patients with structural heart disease and can be associated with an increased risk of sudden death. There is also a form of idiopathic VT which can occur in the absence of structural heart disease. The most common cause of VT is certainly ishemic heart disease. According to QRS complex, we distinguish monomorphic and polimorphic form. Palpitations, presyncope and syncope are the three most important symptoms that require further investigation. A standard 12-lead ECG is the first non-invasive diagnostic method we can use, but there are also other non-invasive and invasive diagnostic methods. It is important to find out about the etiology of arrhythmia to properly treat patients. Nowadays, the VT therapy includes both medicamentous and non-pharmacological therapy such as implantable cardioverter-defibrillator, catheter and surgical ablation. The appropriate treatment can significantly improve the prognosis in selected patients. The VT treatment involves both emergent management and prevention of recurrence so we could reduce the risk of sudden death

Sexual Harassment of Young Athletes by Their Coaches and Depression, Anxiety, and Stress in Later Life

Cilj istraživanja bio je ispitati učestalost seksualnog uznemiravanja od strane trenera u sportskim aktivnostima u kojima sudjeluju djeca i adolescenti te povezanost tog iskustva s depresivnosti, anksioznosti i stresom u kasnijoj životnoj dobi. U istraživanju su sudjelovali mladići i djevojke (n = 501; Mdob = 20,86, SD = 1,81) koji su se prije 18. godine bavili sportom. Prema dobivenim rezultatima, 25 % sudionika je u vrijeme dok su bili maloljetni doživjelo neki oblik seksualnog uznemiravanja od strane trenera. Sudionici koji posjeduju takvo iskustvo postigli su više rezultate na ljestvicama depresivnosti, anksioznosti i stresa. Rezultati upućuju na potrebu za poduzimanjem mjera prevencije i suzbijanja seksualnog uznemiravanja u sportu mladih.The aim of the study was to determine the frequency of sexual harassment perpetrated by coaches in youth sports activities and to examine the association of those experiences with depression, anxiety, and stress in later life. Study participants were young men and women (n = 501; Mage = 20,86, SD = 1,81) who participated in sports before they turned 18 years old. The results showed that 25 % of participants experienced some form of sexual harassment by coaches while they were minors. Participants who had this kind of experience obtained higher results on depression, anxiety, and stress scales. The results indicate the need to undertake measures aimed at preventing and stopping sexual harassment in youth sport