Acupuncture for Headache Treatment - Therapy or Placebo?

Akupunktura je starokineska metoda liječenja s pomoću igala koje se zabadaju u točno određene točke na koži. Počela se primjenjivati u Kini, a prva knjiga u kojoj se opisuje datira iz 475. godine pr. Kr. Godine 1979. Svjetska zdravstvena organizacija sastavila je listu od 43 bolesti u kojima se akupunktura pokazala korisnom. Na konferenciji National Institute of Health održanoj 1997. godine pregledano je više od 2000 znanstvenih studija o temi akupunkture te je zaključeno da postoje dokazi koji podupiru primjenu akupunkture kao adjuvantne metode liječenja. Postoji nekoliko različitih teorija o mehanizmima djelovanja akupunkture. Studije sugeriraju da akupunktura dovodi do inhibicije transmisije boli u središnji živčani sustav stimulacijom aferentnih A-delta i C-vlakana te dovodi do neuromodulacije. Također dovodi do otpuštanja antialgogenih tvari uključujući endorfine. Akupunktura je iznimno sigurna metoda. Najčešće su nuspojave blage i uključuju manje modrice ili krvarenje na mjestu uboda, pogoršanje postojećih simptoma, pospanost, opuštanje ili euforiju (koja se često doživljava kao nešto ugodno) i bol na mjestu uboda igle. Godine 2016. objavljeni su u Cochraneovoj bazi pregledni radovi koji su potvrdili učinkovitost akupunkture u profilaksi epizodične tenzijske i migrenske glavobolje. Neupitno je da je akupunktura metoda stara 5000 godina i da se i dalje primjenjuje u terapiji različitih bolnih sindroma te je predmet izučavanja mnogih studija, za razliku od brojnih farmakoloških i nefarmakoloških metoda koje su bile jako popularne nekoliko godina ili desetljeća te su zatim potpuno izbačene iz primjene zbog nedjelotvornosti i nuspojava.Acupuncture is an old Chinese method of treatment with needles that are inserted into designated areas on the skin. The practice of acupuncture began in China and the first book describing the treatment dates back to 475 BC. In 1979 the World Health Organization created a list of 43 diseases that may benefit from acupuncture. After more than 2,000 scientific studies concerning acupuncture were reviewed at the National Institute of Health conference held in 1997, it was concluded that there were sufficient evidence supporting the use of acupuncture as an adjuvant treatment method. Several different theories about the mechanism of action have been identified for acupuncture. Studies suggested that acupuncture could result in inhibition of pain transmission to the central nervous system by stimulation of afferent A-delta and C fibres, as well as in neuromodulation. Acupuncture also facilitates the release of anti-algal agents, including endorphins. It is an extremely safe method of treatment if performed by adequately trained practitioners. The most common side effects are mild and include the following: minor bruising or bleeding where the needles puncture the skin, worsening of pre-existing symptoms, drowsiness, relaxation or euphoria (often experienced as a pleasant feeling) and pain where the needles puncture the skin. The 2016 Cochrane Database of Systematic Reviews includes reviews that demonstrate the effectiveness of acupuncture for the prophylaxis of episodic tension-type headaches (TTH) and migraines. Acupuncture is undoubtedly a 5000-year-old method that continues to be used in the treatment of various pain syndromes. It is the subject-matter of numerous studies, unlike other pharmacological and non-pharmacological methods whose popularity lasted a few years or decades until their complete discontinuation in clinical practice due to their ineffectiveness and adverse effects

Parkinson’s Disease – Challenges in New Drug Development

Idiopathic Parkinson’s disease (IPD) is the second most common neurodegenerative disorder after Alzheimer’s disease. Treatment aims in IPD include the provision of symptomatic relief, reduction of functional disability, halting or slowing of the neurodegenerative process, and the prevention of long-term complications by proper initiation of therapy. At present, pharmacotherapeutic strategies allow the amelioration of motor symptoms of IPD only, whereas non-motor manifestations are not helped by dopamine replacement strategies. In addition, levodopa-induced fluctuation and dyskinesia are still challenging, particularly in long-term treatment. Despite advances in pharmacotherapy that have improved quality of life for these patients, the mortality rate remains largely unchanged. Sustained interest in IPD will hopefully allow increased funding of research to develop new and better treatments

Translation of the HeadacheAttributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire into the Croatian language, and its diagnostic validation

Despite increasing awareness promoted by the Global Campaign against Headache (1,2) and the Global Burden of Disease (GBD) study (3-5), knowledge and understanding of the burdens attributable to headache disorders remain incomplete in many countrie

Je li kardiološka rehabilitacija korisna u bolesnika s koronarnom bolešću starijih od sedamdeset godina?

Elderly patients with coronary heart disease (CHD) are frequently not referred to cardiac rehabilitation programs. The aim of the study was to assess the effect of 3-week inpatient cardiac rehabilitation in CHD patients older than seventy. The study included 103 consecutive CHD patients older than 70 who underwent 3-week inpatient rehabilitation. A history of myocardial infarction was recorded in 77% of patients, whereas 23% had previously undergone coronary artery bypass surgery. The patients who could not perform exercise test or those with congestive heart failure were not included in the study. Functional capacity, lipid profile, blood glucose, body weight and body mass index were determined before and at the end of rehabilitation. After 3-week inpatient cardiac rehabilitation, functional capacity markedly improved (p<0.0001). The levels of cholesterol (p<0.0001), triglycerides (p=0.01), LDL-cholesterol (p<0.0001) and blood glucose (p=0.004) were significantly lower in comparison with initial values. There were no significant differences in HDL-cholesterol, body weight and body mass index between initial values and those measured at the end of rehabilitation. Results of the study suggest that elderly patients with CHD benefit from cardiac rehabilitation and should be routinely referred to cardiac rehabilitation and encouraged to attend these programs.Bolesnici s koronarnom bolešću starije životne dobi često se ne upućuju na kardiološku rehabilitaciju. Cilj ovoga rada bio je procijeniti učinak trotjedne stacionarne kardiološke rehabilitacije u bolesnika s koronarnom bolešću starijih od 70 godina. U studiju je bilo uključeno 103 uzastopnih bolesnika starijih od 70 godina tijekom trotjedne stacionarne kardiološke rehabilitacije. Infarkt miokarda bilo je preboljelo 77% bolesnika, dok ih je 23% bilo prethodno podvrgnuto kirurškoj revaskularizaciji miokarda. Bolesnici koji nisu mogli izvesti ergometrijsko testiranje ili oni s kongestivnim srčanim popuštanjem nisu bili uključeni u studiju. Funkcionalni kapacitet, lipidogram, razina glukoze u krvi, tjelesna težina i indeks tjelesne mase mjereni su prije te odmah nakon završetka rehabilitacije. Nakon trotjedne kardiološke rehabilitacije funkcionalni se kapacitet značajno poboljšao (p<0,0001). Razine kolesterola (p<0,0001), triglicerida (p=0,01), LDL-kolesterola (p<0,0001) i glukoze u krvi (p=0,004) bile su značajno niže u odnosu na početne vrijednosti. Nije bilo značajne razlike u razini HDL-kolesterola, tjelesnoj težini i indeksu tjelesne mase na kraju rehabilitacije u odnosu na početne vrijednosti. Rezultati ovoga rada pokazali su da kardiološka rehabilitacija koristi bolesnicima s koronarnom bolešću starijim od 70 godina, te da ih treba rutinski upućivati i poticati na provođenje ovih programa

The Effect of 3-Weeks Stationary Cardiac Rehabilitation on Plasma Lipids Level in 444 Patients with Coronary Heart Disease

The aim of this study was to investigate the effect of 3- weeks stationary cardiac rehabilitation on plasma lipids level in patients with CHD. The study included 444 consecutive patients (364 male and 80 female, mean age 58±9 year) with CHD who underwent 3-weeks stationary cardiac rehabilitation. Patients were divided into groups depending on their baseline levels of cholesterol and medication therapy: patients with normal ( 5 mmol/L, group II, 315 patients) and subgroups Ia and IIa (with statin in therapy), Ib and IIb (without statin in therapy). After 3-weeks cardiac rehabilitation, the levels of Total cholesterol 5.75±1.34 vs. 5.17±1.08 mmol/l; p<0.001, triglycerides 2.04±1.33 vs. 1.81±1.06 mmol/L; p=0.004, LDL-cholesterol 3.77 ±1.14 vs. 3.21±0.96 mmol/L; p<0.001 were significantly lower while the level of HDL- cholesterol 0.94±0.28 vs. 0.99±0.27 mmol/L; p=0.008 were significantly higher in comparison with the baseline values. Furthermore, we found significant changes in lipid profile at the end of rehabilitation in each group of patients compared with the baseline values. There were no significant differences in plasma lipids level between group of patients with or without statin in therapy at the end of rehabilitation. The results of this study suggest that moderate regular physical activity and diet alone or in combination with hypolipidemic drugs already after 3 weeks have a favourable effect on plasma lipids level and should be propagate in the prevention of CHD

Diagnostic Criteria and Classification of Migraine

Migrena je primarna, funkcionalna, periodična, srednje jaka do jaka glavobolja koja neliječena traje između 4 do 72 sata. Često je praćena mučninom i/ili povraćanjem, fotofobijom i fonofobijom, a za nju je karakteristično pogoršanje simptoma tijekom fizičke aktivnosti. Epidemiološki podatci nedvojbeno pokazuju da je migrena česta bolest s prevalencijom oko 14 % u općoj populaciji. Važno je istaknuti da je broj dijagnosticiranih bolesnika često podcijenjen. Razlozi tomu mogu biti relativno rijetko pojavljivanje napadaja zbog kojih se oboljeli ne javlja liječniku obiteljske medicine ili neurologu, loše uzeta anamneza te druge dijagnostičke poteškoće. Također, neophodno je naglasiti znatan socioekonomski aspekt migrene. Migrena je velik trošak društvu u cjelini, uzimajući u obzir njezinu učestalost te činjenicu da znatan udio bolesnika s migrenom obično ne može normalno funkcionirati za vrijeme trajanja napadaja. Budući da se radi o bolesti u kojoj se dijagnoza postavlja na temelju detaljno uzete anamneze i kliničke slike, Međunarodno društvo za glavobolje objavilo je međunarodnu klasifikaciju glavobolja te ju revidiralo zadnji put 2018. Detaljno poznavanje te klasifikacije neophodno je za svakodnevnu kliničku praksu.Migraine is a primary, functional and recurrent moderate to severe headache which, when untreated, lasts 4-72 hours. It is often associated with nausea and/or vomiting, photophobia and phonophobia. The symptoms of migraine are characteristically aggravated by physical activity. Epidemiological data undoubtedly show that migraine is a common disease with a prevalence of around 14% in the general population. It is important to point out that the number of diagnosed patients is often underestimated. This might be due to the relatively rare occurrence of migraine attacks which do not prompt the patient to consult their family physician or a neurologist, inefficient past patient history taking or other diagnostic difficulties. Furthermore, it is necessary to emphasize the significant socioeconomic aspects of migraine. Migraine is a great burden to society as a whole, considering its frequency and the fact that a considerable portion of patients with migraine cannot function normally during an attack. Since migraine is a disease which is diagnosed based on taking a detailed patient history and clinical presentation, the International Headache Society published The International Classification of Headache Disorders, the latest edition of which dates from 2018. A detailed knowledge of this classification is essential for everyday clinical practice

Povezanost apolipoproteina E ε2 s kasnijim početkom epilepsije temporalnog režnja

The aim of the study was to evaluate the possible association between Apo E polymorphisms and age at seizure onset in patients with non-lesional temporal lobe epilepsy. Eighty patients with non-lesional temporal lobe epilepsy with or without bilateral tonic-clonic propagation were analyzed. Age at seizure onset was defined as age at the first unequivocal seizure (excluding febrile convulsions). ApoE alleles were determined by a procedure where genome DNA was amplified by chain reaction along with polymerase, using the LightCycler kit (Roche) for ApoE mutations on codons 112 and 158. There was a statistically significant difference between the groups of patients with ApoE ε2/3 and ε3/4 genotypes (p=0.03), but not between patients with ApoE ε2/3 and ε3/3, and those with ApoE ε3/4 and ε3/3. In conclusion, the results of our study suggested positive association of a specific ApoE genotype and onset of non-lesional temporal lobe epilepsy.Cilj ovoga istraživanja bio je utvrditi moguću povezanost genskog polimorfizma ApoE s dobno ranijim početkom bolesti kod bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga. U istraživanje je bilo uključeno 80 bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga. Dob početka bolesti definirana je kao dob pojavnosti prvog neprovociranog epilepsijskog napadaja (isključujući febrilne konvulzije). ApoE aleli su određeni postupkom pri kojem je genomska DNA amplificirana lančanom reakcijom uz polimerazu, a korišten je detekcijski kit LightCycler (Roche) za mutacije ApoE na kodomu112 i 158. Utvrđena je značajna statistička razlika između skupina bolesnika s genotipom ApoE ε2/3 i ε3/4 (p=0,03), dok između bolesnika s ApoE ε2/3 i ε3/3 i onih s ApoE ε3/4 i ε3/3 nije bilo značajne statističke razlike. Rezultati istraživanja ukazuju na moguću povezanost specifičnog genotipa ApoE i dobi početka bolesti kod bolesnika s epilepsijom temporalnog režnja i negativnim nalazom magnetske rezonancije mozga