124 research outputs found
UÄinci olova na bubrežnu funkciju
The late effects of lead on kidney function and blood pressure were studied in 38 persons occupationally poisoned in the past and in 23 workers exposed to lead. Parameters evaluated in all subjects were: creatinine clearance, hippuran renal flow, blood lead, erythrocyte protoporphyrin, aminolevulinic acid dehydratase, and blood pressure. Out of 11 combined variables, four significant factors were identified by factor analysis. The results showed the presence of the delayed adverse effect of previous occupational lead poisoning on kidney function and blood pressure. This phenomenon is a complex interplay of lead poisoning in the past, overall duration of lead exposure, and age as a major confounding variable related to aging process ot the kidneys.Kasni uÄinci olova na bubrežnu funkciju i krvni tlak ispitani su u 38 osoba izloženih i prethodno otrovanih olovom te u 23 osobe izložene olovu, ali bez prethodnog trovanja tim metalom. U svih smo ispitanika odredili kreatininski klirens, bubrežni protok bipurana, olovo u krvi, eritrocitni protoporfirin, dehidratazu aminolevulinske kiseline i krvni tlak. Primjenom faktorske analize na 11 ispitanih varijabla utvrdili smo njihovo grupiranje u Äetiri znaÄajna faktora. Rezultati faktorske analize potvrdili su pretpostavku o odgoÄenim Å”tetnim uÄincima prethodnog trovanja olovom u obliku pada funkcionalnog kapaciteta bubrega i porasta krvnoga tlaka. Opisana pojava posljedica je složene meÄuovisnosti izmeÄu prethodnog trovanja olovom, cjelokupnog vremena provedenog u izloženosti olovu, kao i životne dobi ispitanika koja je, zbog normalnih procesa starenja bubrega, osnovni ometajuÄi Äimbenik svake analize o kasnim uÄincima toksiÄnih tvari na bubrege
Qvar ā Ultrafi ne BDP Particles ā Safety and Efficiency
Astma je kroniÄna upalna bolest diÅ”nih putova koja zahvaÄa i male diÅ”ne putove. Inhalacijski kortikosteroidi uÄinkoviti su lijekovi u lijeÄenju astme, meÄutim slabo dopiru u male diÅ”ne putove. Nove formulacije inhalacijskih kortikosteroida s vrlo sitnim Äesticama, manjim od 5 Ī¼m, znaÄajno se bolje odlažu u male diÅ”ne putove i alveole. Qvar HFA-beklometazon dipropionat, nova je formulacija beklometazona s vrlo sitnim Äesticama, Å”to omoguÄava da se viÅ”e od 50% lijeka raspodijeli u pluÄa te je na taj naÄin potrebna 2,6 puta niža doza kortikosteroida da bi se ostvario jednak uÄinak u usporedbi s klasiÄnim inhalacijskim beklometazon dipropionatom. Pored toga Autohaler se vrlo jednostavno upotrebljava jer se aktivira udahom te eliminira problem koordinacije pritiska na inhaler i udaha. Qvar ostvaruje jednaku ili bolju uÄinkovitost uz znaÄajno manje lokalnih nuspojava u usporedbi s klasiÄnim inhalacijskim kortikosteroidima te podjednaku uÄestalost sistemskih nuspojava. Zbog dobre raspodjele u pluÄima i djelovanja na male diÅ”ne putove te zbog inhalera koji se jednostavno upotrebljava, Qvar Autohaler omoguÄuje bolju kontrolu astme.Asthma is a chronic inflammatory airway disease that also affects small airways. Inhaled corticosteroids are effective in the treatment of asthma; however, their deposition in small airways is weak. Deposition of new formulations of inhaled orticosteroids with ultrafi ne particles, smaller than 5 Ī¼m, in small airways and alveoli is significantly better. Qvar, HFA - beclomethasone dipropionate, is a new formulation of beclomethasone with ultrafine particles. Qvar allows for more than 50% of the drug to be deposited in the lungs, and 2.6 times lower steroid doses are required to achieve the same effect in comparison with conventional inhaled corticosteroids. Qvar achieves equal or better effects with significantly fewer local side eff ects and similar incidence of systemic side effects compared with conventional inhaled corticosteroids
Uvodnik: Astma i KOPB
U ovom broju MEDICUSA predstavljamo struÄne novosti te znanstvene spoznaje na podruÄju astme i kroniÄne opstruktivne bolesti pluÄa. Opstruktivne bolesti pluÄa u cijelom svijetu pokazuju trend poveÄanja pojavnosti pa se tako pretpostavlja da je prevalencija astme od 2 % do 21 % odrasle populacije, a u mediteranskoj regiji oko 9 %.
UnatoÄ visokoj prevalenciji populacijske studije ukazuju da znaÄajan dio ljudi s astmom ostaje nedijagnosticiran. Pojavnost KOPB-a je oko 6 % u odrasloj populaciji s tendencijom porasta i prevalencije i smrtnosti. Razlog tome je Äinjenica da veÄina bolesnika ima srednje teÅ”ku opstrukciju i njih oko 50 % uÄestale egzacerbacije. Smatra se da je KOPB danas na treÄem mjestu najÄeÅ”Äih uzroka mortaliteta te Äini Äak 6 % svih smrtnih ishoda u svijetu.
Opstruktivne bolesti pluÄa osim visoke pojavnosti karakterizira i prisutnost brojnih pridruženih bolesti bilo da su to komorbiditeti ili se radi o oÅ”teÄenju drugih ciljnih organa uzrokovanom inflamatornim sistemskim procesom. Danas su veÄ dobro poznati patofizioloÅ”ki mehanizmi koji dovode do pro-inflamatornog, pro-koagulantnog stanja te endotelne disfunkcije ne samo pluÄnih kapilara veÄ i drugih organskih sustava. NajÄeÅ”Äe pridružene bolesti su: arterijska hipertenzija, GERB, bolesti srca, razliÄita depresivna stanja, osteoporoza itd.
Jedan od temeljnih joÅ” uvijek nerijeÅ”enih problema je kasno otkrivanje opstruktivnih bolesti pluÄa. Zbog toga jedna od pažljivo obraÄivanih tema je dijagnosticiranje bolesti malih diÅ”nih putova koji su mjesto patoloÅ”kog zbivanja i u astmi i u KOPB-u. Osim funkcionalne dijagnostike važno je naglasiti i znaÄaj radioloÅ”ke, osobito CT dijagnostike.
Nekoliko radova u ovom broju posveÄeno je i pitanju uÄinkovitosti inhalacijskih lijekova s naglaskom na nove kombinirane pripravke. Kao zasebni problemi obraÄeni su adherencija i suradljivost s inhalacijskom terapijom, uspostavljanje partnerskog odnosa s pacijentima te novosti vezane uz bolju edukaciju o samim lijekovima i o inhalacijskim tehnikama. Prikazani su i novi tehnoloÅ”ki pomaci u dizajniranju inhalacijskih lijekova, a posebno poglavlje posveÄeno je bioloÅ”koj terapiji (anti-IgE i anti-IL-5 lijekovima) koja je postala standard lijeÄenja teÅ”ke astme.
Vjerujemo da Äe vam ovaj broj MEDICUSA s atraktivnim temama koje su prikazali vodeÄi respiratorni struÄnjaci iz zemalja regije biti koristan podsjetnik na novosti u podruÄju opstruktivnih bolesti pluÄa te istovremeno biti koristan putokaz u kliniÄkoj praksi
Primjena mezo-2,3-dimerkaptojantarne kiseline u radnika profesionalno izloženih olovu
The aim of this study was to evaluate the efficacy of (DMSA) meso-2,3-dimercaptosuccinic acid treatment in workers with increased lead absorption and no overt symptoms of lead poisoning. Seven occupationally lead exposed male workers with blood lead concentrations (PbB) exceeding 50 Āµg/100 ml and a positive (EDTA) calcium disodium ethylenediaminetetraacetate lead mobilization test were treated with DMSA for 19 days. Individual doses were 700 mg DMSA, three times a day from day one to five, and twice a day from day six to 19. The treatment intensified urinary lead excretion, most rapidly during the first five days. The increased elimination was followed by a decline of mean PbB to 15% of the pretreatment values. However, 15 days after the treatment, the PbB concentrations rebounded, yet kept below the baseline values and did not exceed 40 Āµg/100 ml. After repeated EDTA lead mobilization test, urine lead was 23ā68% of that before DMSA treatment. It can be concluded that DMSA can effectively reduce chelatable lead in occupationally exposed workers.Svrha ovog istraživanja bila je ustanoviti uÄinkovitost mezo-2,3-dimerkaptojantarne kiseline (DMSA) u tretiranju radnika s poveÄanom apsorpcijom olova, a bez znakova trovanja olovom. Danas se DMSA smatra jednim od najboljih kelatirajuÄih sredstava, koje se pokazalo uÄinkovitim posebno u djece otrovane olovom. U Hrvatskoj, meÄutim, do sada joÅ” nije bilo primjenjivano.
Sedam radnika profesionalno izloženih olovu bilo je tretirano s DMSA. Radnici nisu imali kliniÄkih simptoma otrovanja olovom, koncentracija olova u krvi bila je viÅ”a od 50 Āµg/100 ml, a mobilizacijski test s kalcij dinatrij etilendiamintetraacetatom (EDTA) bio je pozitivan. Postupak je trajao 19 dana u pojedinaÄnim dozama od 700 mg DMSA tri puta na dan od prvog do petog dana i dva puta na dan od Å”estog do devetnaestog dana.
Rezultati su pokazali da je izluÄivanje olova urinom za vrijeme primjene DMSA bilo poviÅ”eno, i to najviÅ”e prvih pet dana. Nakon toga se smanjilo do 15% od poÄetne vrijednosti. Koncentracije olova u krvi, meÄutim, povisile su se 15 dana nakon zavrÅ”etka tretmana, ali nisu premaÅ”ile vrijednost od 40 Āµg/100 ml. Nakon ponovljenog testa mobilizacije EDTA-om, olovo u urinu iznosilo je 23ā68% od one vrijednosti koja je dobivena prije primjene DMSA. IzluÄivanje cinka i bakra urinom bilo je za vrijeme terapije poviÅ”eno 2ā3 puta, a nije bilo promjena u izluÄivanju željeza, kalcija i magnezija.
Može se zakljuÄiti da DMSA uÄinkovito smanjuje koncentracije olova u radnika profesionalno izloženih tom toksiÄnom metalu
Transplantacija pluÄa u Hrvatskoj
Lung transplantation was first performed in 1963, but the real increase in performed transplantations occurred in the last twenty years. Leading indications for lung transplantation are: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension, and sarcoidosis. Careful selection of donors is extremely important for prognosis after transplantation. Physicians should consider lung transplantation as a therapeutic option and follow the guidelines on the indications for transplantation so patients could be sent on time to a referral center for all the necessary examinations and preparation for recruiting to the waiting list. Department for Lung Diseases Jordanovac, University Hospital Centre Zagreb, is a referral center for lung transplantation in Croatia. The Department is performing processing and preparing patients for transplantation as well as follow them during post-transplantation period.Transplantacija pluÄa prvi puta je uÄinjena 1963. godine, no pravi uzlet doživjela je tek unazad dvadeset godina. VodeÄe indikacije za transplantaciju pluÄa su: kroniÄna opstruktivna pluÄna bolest, idiopatska pluÄna fibroza, cistiÄna fibroza, pluÄna arterijska hipertenzija te sarkoidoza. Pažljiv odabir donora iznimno je važan za prognozu i ishod postupka. LijeÄnici bi trebali razmiÅ”ljati o transplantaciji pluÄa kao terapijskoj opciji te pratiti smjernice o indikacijama za transplantaciju kako bi bolesnike na vrijeme uputili u referalni centar radi pripreme i obrade. Klinika za pluÄne bolesti Jordanovac, KliniÄkog bolniÄkog centra Zagreb, referalni je centar za transplantaciju pluÄa u Hrvatskoj. U Klinici se provodi obrada i priprema bolesnika za transplantaciju te posttransplantacijsko lijeÄenje i praÄenje
Trends in lung cancer incidence and mortality in Croatia, 1988-2008
Aim To describe and interpret lung cancer incidence and
mortality trends in Croatia between 1988 and 2008.
Methods Incidence data on lung cancer for the period
1988-2008 were obtained from the Croatian National Cancer
Registry, while mortality data were obtained from the
World Health Organization mortality database. Population
estimates for Croatia were obtained from the Population
Division of the Department of Economic and Social Affairs
of the United Nations. We also calculated and analyzed
age-standardized incidence and mortality rates. To describe
time incidence and mortality trends, we used joinpoint
regression analysis.
Results Lung cancer incidence and mortality rates in men
decreased significantly in all age groups younger than 70
years. Age-standardized incidence rates in men decreased
significantly by -1.3% annually. Joinpoint analysis of mortality
in men identified three trends, and average annual percent
change (AAPC) decreased significantly by -1.1%. Lung
cancer incidence and mortality rates in women increased
significantly in all age groups older than 40 years and decreased
in younger women (30-39- years). Age-standardized
incidence rates increased significantly by 1.7% annually.
Joinpoint analysis of age-standardized mortality rates
in women identified two trends, and AAPC increased significantly
by 1.9%.
Conclusion Despite the overall decreasing trend, Croatia
is still among the European countries with the highest
male lung cancer incidence and mortality. Although the
incidence trend in women is increasing, their age standardized
incidence rates are still 5-fold lower than in men.
These trends follow the observed decrease and increase in
the prevalence of male and female smokers, respectively.
These findings indicate the need for further introduction
of smoking prevention and cessation policies targeting
younger population, particularly women
COVID-19 and Pneumonia
Bolest uzrokovana novim koronavirusom 2019 (COVID-19) postala je prijetnja cijeloj svjetskoj populaciji. Njena Äesta komplikacija je upala pluÄa. NajÄeÅ”Äi simptomi bolesti su poviÅ”ena tjelesna temperatura, suhi kaÅ”alj, umor, iskaÅ”ljavanje, zaduha. RjeÄi simptomi su glavobolja, suho grlo, probavne tegobe, simptomi gornjega diÅ”nog puta, promjene u osjetu njuha i okusa. Starija dob i komorbiditeti kao Å”to je visoki krvni tlak, Å”eÄerna bolest, kroniÄne pluÄne bolesti, kardiovaskularne bolesti, srÄane bolesti, pretilost predstavljaju znaÄajni riziÄni faktor za bolesnike inficirane koronavirusom SARS-CoV-2. UobiÄajeni laboratorijski nalazi ukljuÄuju limfopeniju, poviÅ”enu razinu C-reaktivnog proteina, feritina, aminotransferaza, laktat dehidrogenaze. Bolesnici koji razviju teÅ”ku kliniÄku sliku obiÄno imaju brojne laboratorijske poremeÄaje Å”to sugerira da SARS-CoV-2 infekcija može uzrokovati ozljedu staniÄne imunosti, aktivaciju koagulacije, oÅ”teÄenje miokarda, jetre i bubrega. NajÄeÅ”Äe komplikacije su akutni respiratorni distres sindrom, Å”ok, aritmije, akutna ozljeda miokarda, akutno oÅ”teÄenje bubrežne funkcije. Kompjuterizirana tomografija (CT) može biti korisna kao komplementarna metoda polimeraznoj lanÄanoj reakciji u realnom vremenu za dijagnozu COVID-19 pneumonije. Njezine glavne CT karakteristike su infiltrati tipa mlijeÄnog stakla periferne i subpleuralne distribucije. Ova podruÄja uzorka mlijeÄnog stakla mogu se mijeÅ”ati s podruÄjima žariÅ”ne konsolidacije i/ili se na njih superponiraju zadebljale intralobularne septe, Å”to daje uzorak ludog poploÄenja.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
- ā¦