Carotid Endarterectomy Unexpectedly Resulted in Optimal Blood Pressure Control

Resistant hypertension is defined as hypertension that remains above 140/90 mmHg despite the provision of three or more antihypertensive drugs in a rational combination at full doses and including a diuretic. It is associated with adverse clinical outcome and therefore requires aggressive medical treatment. We present a case of 70-year-old woman who was treated for resistant hypertension with a diuretic, ACE-inhibitor, calcium channel blocker, and with centrally acting antihypertensive, moxonodine. Despite of aggressive medical treatment her blood pressure remained above 160/90 mmHg continuously. Large diagnostic workup excluded common causes of secondary hypertension, but revealed significant carotid stenosis present on left internal carotid artery. Carotid endarterectomy was performed in order to improve cerebrovascular prognosis, but unexpectedly resulted in optimal control of her blood pressure. Two months after operation patient was on only one antihypertensive drug, having blood pressure below 130/85 mmHg. We suggest that in selected patients resistant hypertension could be associated with carotid stenosis and carotid sinus baroreceptor dysfunction. For definite conclusions further studies are warranted

Hypertension in the elderly

Arterijska hipertenzija (AH) u starijih osoba predstavlja veliki javnozdravstveni problem zbog visoke prevalencije i trenda starenja svjetske populacije. Najčešće se radi o izoliranoj sistoličkoj hipertenziji (90% bolesnika iznad 70 godina) te se kod osoba starije životne dobi kao najbitniji čimbenici rizika izdvajaju vrijednosti tlaka pulsa i sistoličkog tlaka. Patofiziološki u podlozi su brojne strukturne (gubitak elastičnosti velikih krvnih žila, smanjena rastezljivost, porast brzine pulsnog vala) i funkcionalne (endotelna disfunkcija, smanjena osjetljivost beta receptora, smanjena funkcija baroreceptora, osjetljivost na sol) promjene. Liječenje AH u starijih do sada je bilo veliki izazov jer nije bilo dovoljno studija koje su se bavile tom populacijom, što se promijenilo objavom rezultata studije HYVET. Ova je studija uključila najstarije bolesnike (iznad 80 godina) te je dokazala kako sniženje vrijednosti arterijskog tlaka za 15/6 mmHg dovodi do značajno manje opće smrtnosti (21%), kardiovaskularne smrtnosti (23%), incidencije moždanog udara (30%) i srčanog zatajivanja (64%). Kao lijek prvog izbora u starijoj populaciji izdvojili bismo tijazidski diuretik, a budući ti pacijenti većinom zahtijevaju višestruku terapiju izdvojili bismo blokatore kalcijskih kanala ili ACE inhibitore. Naravno i komorbiditeti određuju osnovnu ili dodatnu terapiju.Hypertension in the elderly is a major public health problem due to high prevalence and the world population ageing trend. Most often it is the isolated systolic hypertension (90% of patients over 70 years of age) that is concerned. Furthermore, pulse pressure and systolic pressure are the most important risk factors in elderly persons. Pathophysiologically, there is a great number of structural (loss of elasticity of large blood vessels, decreased elasticity, increased pulse wave velocity) and functional (endothelial dysfunction, decreased sensitivity of beta receptors, decreased baroreceptor function, sensitivity to salt) changes in the background. Treatment of hypertension in the elderly has so far been a big challenge, because there were not enough studies that have dealt with this population. Now this has changed after results of the HYVET study have been published. HYVET study included the oldest patients (above 80 years of age) and has proven that lowering pressure by 15/6 mmHg, leads to significantly lower overall mortality (21%), cardiovascular mortality (23%), incidence of stroke (30%) and heart failure (64%). We emphasize thiazide diuretic as the first choice drug in the elderly population, and since these patients usually require multiple treatment, we emphasize calcium channel blockers or ACE inhibitors. Comorbidities, naturally, determine the basic or additional therapy

Hypertension in the elderly

Arterijska hipertenzija (AH) u starijih osoba predstavlja veliki javnozdravstveni problem zbog visoke prevalencije i trenda starenja svjetske populacije. Najčešće se radi o izoliranoj sistoličkoj hipertenziji (90% bolesnika iznad 70 godina) te se kod osoba starije životne dobi kao najbitniji čimbenici rizika izdvajaju vrijednosti tlaka pulsa i sistoličkog tlaka. Patofiziološki u podlozi su brojne strukturne (gubitak elastičnosti velikih krvnih žila, smanjena rastezljivost, porast brzine pulsnog vala) i funkcionalne (endotelna disfunkcija, smanjena osjetljivost beta receptora, smanjena funkcija baroreceptora, osjetljivost na sol) promjene. Liječenje AH u starijih do sada je bilo veliki izazov jer nije bilo dovoljno studija koje su se bavile tom populacijom, što se promijenilo objavom rezultata studije HYVET. Ova je studija uključila najstarije bolesnike (iznad 80 godina) te je dokazala kako sniženje vrijednosti arterijskog tlaka za 15/6 mmHg dovodi do značajno manje opće smrtnosti (21%), kardiovaskularne smrtnosti (23%), incidencije moždanog udara (30%) i srčanog zatajivanja (64%). Kao lijek prvog izbora u starijoj populaciji izdvojili bismo tijazidski diuretik, a budući ti pacijenti većinom zahtijevaju višestruku terapiju izdvojili bismo blokatore kalcijskih kanala ili ACE inhibitore. Naravno i komorbiditeti određuju osnovnu ili dodatnu terapiju.Hypertension in the elderly is a major public health problem due to high prevalence and the world population ageing trend. Most often it is the isolated systolic hypertension (90% of patients over 70 years of age) that is concerned. Furthermore, pulse pressure and systolic pressure are the most important risk factors in elderly persons. Pathophysiologically, there is a great number of structural (loss of elasticity of large blood vessels, decreased elasticity, increased pulse wave velocity) and functional (endothelial dysfunction, decreased sensitivity of beta receptors, decreased baroreceptor function, sensitivity to salt) changes in the background. Treatment of hypertension in the elderly has so far been a big challenge, because there were not enough studies that have dealt with this population. Now this has changed after results of the HYVET study have been published. HYVET study included the oldest patients (above 80 years of age) and has proven that lowering pressure by 15/6 mmHg, leads to significantly lower overall mortality (21%), cardiovascular mortality (23%), incidence of stroke (30%) and heart failure (64%). We emphasize thiazide diuretic as the first choice drug in the elderly population, and since these patients usually require multiple treatment, we emphasize calcium channel blockers or ACE inhibitors. Comorbidities, naturally, determine the basic or additional therapy

THE IMPACT OF SOCIO-ECONOMIC PROCESSES ON THE HEALTH OF THE ADULT POPULATION

Background: A cross-sectional study in the Primary Care Medical Centre Mostar and Regional Medical Center "Safet Mujić" was conducted. Family physicians randomly surveyed, examined, and analyzed laboratory tests from 300 subjects divided into three age groups from 20-39, 40-54 and 55-65 years, totally 100 subjects. Data for age, sex, smoking status, alcohol consumption, body mass index, blood pressure, blood glucose, triglycerides and cholesterol, and the presence of chronic non-communicable diseases, including diagnosis of depression and the presence of stress were entered in medical records. Results: Levels of cholesterol were significantly higher in rural population as well as among students, and high triglyceride levels most frequently were presented in the student population. A group of farmers had a significantly higher prevalence of hypertension, DM and CVD compared to other investigated groups. The largest number of smokers and people who drink alcohol was present in group with the highest incomes, while obesity was significantly expressed in people with lower incomes. The group of examinees with the highest incomes had the greatest exposure to stress. Conclusions: Socioeconomic processes have an impact on risk behavior of the adult population, and the presence of a number of chronic diseases that are accompanied with increased laboratory blood glucose, cholesterol and triglycerides levels

TREATMENT OF ANEMIA IN CHRONIC KIDNEY DISEASE – POSITION STATEMENT OF THE CROATIAN SOCIETY FOR NEPHROLOGY, DIALYSIS AND TRANSPLANTATION AND REVIEW OF THE KDIGO AND ERPB GUIDELINES

Bubrežna anemija nastaje kao posljedica kronične bolesti bubrega (KBB), a pogoršava se s napredovanjem bolesti. Anemija može biti prvi znak bolesti bubrega. Sve bolesnike s KBB i anemijom potrebno je dijagnostički obraditi čime se može otkloniti druge uzroke bolesti. Dokazana je direktna povezanost koncentracije hemoglobina i stadija zatajenja bubrežne funkcije, a ranija pojava anemije učestalija je u dijabetičara. Rano liječenje anemije moglo bi usporiti napredovanje KBB. Anemija je neovisan činitelj rizika za razvoj srčano-žilnih bolesti u bolesnika s KBB. Liječenje anemije u bolesnika s KBB temelji se na smjernicama. Nedavno je skupina KDIGO (Kidney Disease: Improving Global Outcomes) objavila nove smjernice za liječenje anemije u KBB, a skupina ERBP (European Renal Best Practice) osvrt na te smjernice. Hrvatsko društvo za nefrologiju, dijalizu i transplantaciju (HDNDT) već godinama objavljuje vlastite smjernice koje se temelje na preporukama i pozitivnim iskustvima europskih i svjetskih stručnih društava, kao i na vlastitim iskustvima. Posljednja inačica hrvatskih smjernica objavljena je 2008. godine. Od tada do danas, temeljem brojnih istraživanja i kliničke prakse, došlo je do brojnih izmjena u suvremenom shvaćanju liječenja anemije u KBB. Slijedom navedenog, HDNDT objavljuje osvrt na posljednje preporuke međunarodnih stručnih društava, izražava svoj stav za liječenje anemije u KBB kao osnovu za nove smjernice prilagođene sadašnjem trenutku.Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Society of Nephrology, Dialysis and Transplantation (HDNDT) has already published its own guidelines based on the recommendations and positive experience of European and international professional societies, as well as on own experience. The latest version of Croatian guidelines was published in 2008. Since then, on the basis of research and clinical practice, there have been numerous changes in the modern understanding of the treatment of anemia in CKD. Consequently, HDNDT hereby publishes a review of the recent recommendations of international professional societies, expressing the attitude about treating anemia in CKD as a basis for new guidelines tailored to the present time

Izrada aplikacije upravljanja knjižnicom u Java programskoj okolini

Cilj rada je opisati i objasniti aplikaciju za upravljanje knjižnicom napisan u Java programskom jeziku. Korisnici aplikaciju mogu nakon prijave pristupiti svim knjigama i korisnicima knjižnice, dodavati, brisati te ih ažurirati. U sklopu izrade aplikacije korišten je NetBeans IDE za Javu, XAMPP za stvaranje baze podataka, phpMyAdmin alat za pregled i upravljanje bazom podataka.The goal of this thesis is to describe and explain a library management application written in the Java programming language. After logging in, users can access all books and library users, add, delete and update them. The application was developed using the NetBeans IDE for Java, XAMPP for database creation, phpMyAdmin tool for viewing and managing the database

Izrada aplikacije upravljanja knjižnicom u Java programskoj okolini

Cilj rada je opisati i objasniti aplikaciju za upravljanje knjižnicom napisan u Java programskom jeziku. Korisnici aplikaciju mogu nakon prijave pristupiti svim knjigama i korisnicima knjižnice, dodavati, brisati te ih ažurirati. U sklopu izrade aplikacije korišten je NetBeans IDE za Javu, XAMPP za stvaranje baze podataka, phpMyAdmin alat za pregled i upravljanje bazom podataka.The goal of this thesis is to describe and explain a library management application written in the Java programming language. After logging in, users can access all books and library users, add, delete and update them. The application was developed using the NetBeans IDE for Java, XAMPP for database creation, phpMyAdmin tool for viewing and managing the database

Volumetric properties of solutions of 1-methylimidazolium acetate ionic liquid in water, dimethyl sulfoxide, N,N-dimethylacetamide and N,N-dimethylformamide at different temperatures : master thesis

U ovom radu sintetizirana je ionska tekućina 1-metilimidazolijev acetat, MimAc, reakcijom 1- metilimidazoliuma i octene kiseline. Potom su mjerene gustoće otopina MimAc u vodi, DMSO, DMA i DMF pri različitim molalitetima i temperaturama. Iz dobivenih gustoća, izračunata su razna volumetrijska svojstva: prividni molarni volumen, parcijalni molarni volumen otapala, parcijalni molarni volumen MimAc, granični prividni molarni volumen, granična prividna molarna ekspanzibilnost i Hepplerov koeficijent. Valjanost Massonove jednadžbe je provjerena te je utvrđena linerana ovisnost prividnog molarnog volumena o koncentraciji pri svim radnim temperaturama. Iz te su ovisnosti određeni veoma važni volumetrijski parametri: granični prividni molarni volumen i Massonov interakcijski koeficijent. Konačno, raspravljena su svojstva promoviranja strukture s pozitivnim koeficijentom (eng. „structure-maker“) ili rušenja strukture s negativnim koeficijentom (eng. „structure-breaker“) ispitivane ionske tekućine u raznim otapalima. Prema vrijednostima Hepplerovog koeficijenta, MimAc u DMF, DMA i DMSO se može opisati kao „structure-breaker“, a u vodi kao granični s koeficijentom blizu nule (eng. „borderline“).Ionic liquid, MimAc was obtained in our laboratory from 1-methylimidazole and acetic acid. The densities of the solutions of MimAc in water, DMSO, DMA and DMF were measured at different molalities and temperatures. The obtained density data calculates volumetric properties (apparent molar volume, standard partial molar volumes, apparent molar volume at infinite dilution, limiting apparent molar expansibilities and Heppler's coefficient). The validity of Masson's equation was checked and applied to describe the evident molar volume dependence on molarity. The apparent molar volume at infinite dilution and interaction coefficient were obtained from this dependence at each temperature. Finally, structure-maker or structure-breaker properties of investigated IL in various solvents are discussed. According to the values of Heppler’s coefficients, MimAc IL, in DMF, DMA, and DMSO could be described as structure-breakers. Values of the Heppler’s coefficient for MimAc in water medium is around zero, so this investigated IL is classified as the borderline

Volumetric properties of solutions of 1-methylimidazolium acetate ionic liquid in water, dimethyl sulfoxide, N,N-dimethylacetamide and N,N-dimethylformamide at different temperatures : master thesis

U ovom radu sintetizirana je ionska tekućina 1-metilimidazolijev acetat, MimAc, reakcijom 1- metilimidazoliuma i octene kiseline. Potom su mjerene gustoće otopina MimAc u vodi, DMSO, DMA i DMF pri različitim molalitetima i temperaturama. Iz dobivenih gustoća, izračunata su razna volumetrijska svojstva: prividni molarni volumen, parcijalni molarni volumen otapala, parcijalni molarni volumen MimAc, granični prividni molarni volumen, granična prividna molarna ekspanzibilnost i Hepplerov koeficijent. Valjanost Massonove jednadžbe je provjerena te je utvrđena linerana ovisnost prividnog molarnog volumena o koncentraciji pri svim radnim temperaturama. Iz te su ovisnosti određeni veoma važni volumetrijski parametri: granični prividni molarni volumen i Massonov interakcijski koeficijent. Konačno, raspravljena su svojstva promoviranja strukture s pozitivnim koeficijentom (eng. „structure-maker“) ili rušenja strukture s negativnim koeficijentom (eng. „structure-breaker“) ispitivane ionske tekućine u raznim otapalima. Prema vrijednostima Hepplerovog koeficijenta, MimAc u DMF, DMA i DMSO se može opisati kao „structure-breaker“, a u vodi kao granični s koeficijentom blizu nule (eng. „borderline“).Ionic liquid, MimAc was obtained in our laboratory from 1-methylimidazole and acetic acid. The densities of the solutions of MimAc in water, DMSO, DMA and DMF were measured at different molalities and temperatures. The obtained density data calculates volumetric properties (apparent molar volume, standard partial molar volumes, apparent molar volume at infinite dilution, limiting apparent molar expansibilities and Heppler's coefficient). The validity of Masson's equation was checked and applied to describe the evident molar volume dependence on molarity. The apparent molar volume at infinite dilution and interaction coefficient were obtained from this dependence at each temperature. Finally, structure-maker or structure-breaker properties of investigated IL in various solvents are discussed. According to the values of Heppler’s coefficients, MimAc IL, in DMF, DMA, and DMSO could be described as structure-breakers. Values of the Heppler’s coefficient for MimAc in water medium is around zero, so this investigated IL is classified as the borderline

Data protection and information management of retail chains

U ovom radu obrađena je tematika trgovačkih lanaca te primjene GDPR-a, odredbe o zaštiti i sigurnosti podataka svakog pojedinca (kupca). Prilikom izrade rada pokušalo se objasniti kako prodajni (poslovni) procesi utječu na trgovačke lance, a i ostale sudionike u okolini organizacije, koje su pozitivne a koje negativne strane GDPR-a. Implementacijom kvalitetnog sustava unutar trgovačkih lanaca dolazi do olakšanog poslovanja kao i upravljanja zaštitom podataka prema direktivi GDPR-a. GDPR je donesen kao rješenje za zlouporabu osobnih podataka svakog pojedinca.This paper deals with the topic of retail chains and the application of the GDPR, the provisions on data protection and security of each individual (customer). During the preparation of the paper, an attempt was made to explain how sales (business) processes affect retail chains, as well as other participants in the organization's environment, whic are the positive and which are the negative side of GDPR. The implementation of a quality system within retail chains facilitates business as well as data protection management according to the GDPR directives. The GDPR was enacted as a solution to the misuse of each individual’s personal data