Kronične nezarazne bolesti kod hrvatskih branitelja u odnosu na opću populaciju: 25 godina nakon rata

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1 %), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions.Povećana učestalost kroničnih bolesti među veteranima dokumentirana je kroz brojna istraživanja, no samo ih je nekoliko studija uspoređivalo s općom populacijom. Cilj ovog istraživanja bio je utvrditi razlike u pojavnosti kroničnih bolesti između hrvatskih branitelja i opće populacije. Ovo istraživanje obuhvatilo je dvije skupine ispitanika, 1453 hrvatskih branitelja i 1429 sudionika iz opće populacije. Anamneza, fizikalni pregled, laboratorijske pretrage i specifični dijagnostički postupci provedeni su tijekom sistematskog fizikalnog pregleda u obje skupine. Analizirana je učestalost hipertenzije, šećerne bolesti, hiperlipidemije, hipotireoze i hipertireoze, kronične opstruktivne plućne bolesti, koronarne bolesti, malignih bolesti, psihijatrijskih bolesti, kolelitijaze, nefrolitijaze, pušenja i konzumacije alkohola. Utvrđeno je da hrvatski branitelji imaju veću vjerojatnost za razvoj hipertenzije (29,5% prema 24,3%), dijabetesa (17,3% prema 3,8%), hiperlipidemije (56,4% prema 27,3%), hipertireoze (3,1% prema 0,8%), koronarne bolesti srca (4,3% naspram 1%), zloćudne bolesti (4,1% naspram 2,2%), psihijatrijske bolesti (15,4% naspram 1,1%) i češću konzumaciju alkohola (53% naspram 29%) nego pojedinci u općoj populaciji. Uočena je značajna razlika u korist opće populacije za hipotireozu (14,3% naspram 8%). Nije bilo razlika u učestalosti kronične opstruktivne plućne bolesti, kolelitijaze, nefrolitijaze i pušenja. Naši nalazi potvrdili su hipotezu o višoj učestalosti kardiovaskularnih bolesti, malignih i psihijatrijskih bolesti među hrvatskim braniteljima te naglasili potrebu bolje kontrole njihovog zdravstvenog stanja

Echocardiographic assessment for transcatheter aortic valve implantation

Damage detection in bridges using vibration-based methods is an area of growing research interest. Improved assessment methodologies combined with state-of-the-art sensor technology are rapidly making these approaches applicable for real-world structures. Applying these techniques to the detection and monitoring of scour around bridge foundations has remained challenging; however this area has gained attraction in recent years. Several authors have investigated a range of methods but there is still significant work required to achieve a rounded and widely applicable methodology to detect and monitor scour. This paper presents a novel Vehicle-Bridge-Soil Dynamic Interaction (VBSDI) model which can be used to simulate the effect of scour on an integral bridge. The model outputs dynamic signals which can be analysed to determine modal parameters and the variation of these parameters with respect to scour can be examined. The key novelty of this model is that it is the first numerical model for simulating scour that combines a realistic vehicle loading model with a robust foundation soil response model. This paper provides a description of the model development and explains the mathematical theory underlying the model. Finally a case study application of the model using typical bridge, soil, and vehicle properties is provided

Ventricular Assist Device Support in Advanced Heart Failure Patient with Congenitally Corrected Transposition of the Great Arteries and Dextrocardia- Case Report and Review

Kongenitalno korigirana transpozicija velikih arterija (ccTGA) kongenitalna je srčana malformacija s incidencijom od 0,5% svih bolesnika s urođenim srčanim manama. Dekstrokardija je zabilježena među tim bolesnicima i do 20%. U ovom radu prikazujemo 52-godišnju pacijenticu s ccTGA i dekstrokardijom sa situs solitusom. Zbog kongestivnog zatajenja srca otpornog na lijekove i visokog plućnog vaskularnog otpora multidisciplinarni tim odlučio se za dugoročno rasterećenje s ventrikularnim pomoćnim uređajem kao prijelaznim rješenjem do indikacije za transplantaciju srca. U rujnu 2017. ugrađen je intraperikardijalni ven- trikularni pomoćni uređaj. Precizno slikanje (transtorakalna ehokardiografija s kontrastom, transoezofagična ehokardiografija, MSCT srca) u multidisciplinarnom srčanom timu ključni su za uspješnu implantaciju intraperikardijalnog VAD-a malih dimenzija kod pacijenta sa složenom anatomijom poput one u ccTGA i dekstrokardija. Budući da se postojeća literatura sastoji uglavnom od izvještaja o slučajevima, odluke u liječenju trebale bi uključivati postupno uvođenje modaliteta liječenja i pomno praćenje kliničkog odgovora, kao i multidisciplinarnog tima za rad srca.Congenitally corrected transposition of the great arteries (ccTGA) is congenital cardiac malformation with an incidence of 0.5% of all patients with congenital heart defects. Dextrocardia is reported among these patients up to 20%. We report a 52-year old female patient with ccTGA and dextrocardia with situs solitus. Due to congestive heart failure refractory to medications and high pulmonary vascular resistance multidis- ciplinary team decided for long term unloading with ventricular assist device as a bridge to heart transplant candidacy. In September 2017 intrapericardial ventricular assist device (centrifugal continuous flow, fully magnetically-levitated technology) was implanted in failing systemic ventricle. Accurate imaging (trans- thoracic echocardiography with contrast, transoesophagic echocardiography, cardiac MSCT) in multidis- ciplinary heart team is pivotal in successful implantation of small size intrapericardial VAD in patient with complex anatomy as ccTGA and dextrocardia. Because the existing literature consists mainly of case reports, management should include the stepwise introduction of the treatment modalities and close monitoring of the clinical response as well as heart multidisciplinary team

Echocardiography for the diagnosis of infective endocarditis in heart transplant recipients

Introduction: Post heart transplantation (HTx) infective endocarditis (IE) is unique among endocarditis after solid organ transplantation because it is the transplanted organ that becomes infected. Since 2016 two HTx patients have been successfully treated in University Hospital Dubrava for cardiac allograft infective endocarditis. Case report: The first one, a 77-year-old male patient, who in 2001 underwent orthotopic HTx due to ischemic cardiomyopathy, and who since 2010 was on hemodialysis due to chronic terminal kidney failure, was admitted in June 2016 due to mitral valve endocarditis (Figure 1). The other one was a 29-year-old male patient who in January 2016 had undergone orthotopic heart transplantation due to dilated cardiomyopathy and was diagnosed in June 2017 with tricuspid valve endocarditis (Figure 2). Both patients had atypical presentation, and in both patients transthoracic and transesophageal echocardiography were immediately performed revealing valve vegetations and proving crucial for establishing diagnosis. Empirical antibiotic treatment was initiated at once, and the patients were referred to the endocarditis team. Conclusion: IE is a known, but rare and very often fatal complication of HTx. Frequent central venous catheter access and multiple endomyocardial biopsies appear to predispose to infection1. The prognosis of post-HTx IE remains poor. Atypical presentation is common in these patients2, and therefore a high index of suspicion and low threshold for investigation are appropriate in this group in order to avoid delays in diagnosis3. There are no specific guidelines to diagnostic practice for this particular group, however, echocardiography is the mainstay and essential in diagnosis of endocarditis4, and therefore has to be performed at the earliest possible time