The Risk of Developing Endemic Nephropathy in Subjects with Proteinuria

Endemic nephropathy is a chronic tubulointerstitial disease characterized by early damage to the proximal tubule, with low-molecular weight proteinuria being an important hallmark and possible tool for early diagnosis. The aim of this retrospective cohort study was to assess the risk of developing endemic nephropathy in subjects with proteinuria from the endemic region in Croatia. The cohort study included subjects with proteinuria determined by the sulfosalicylic acid method (after 1988 with strip method), involved in the field survey conducted in the Croatian endemic village of Kaniža in 1975 and followed up until 1997. Subjects with endemic nephropathy established at the first visit and patients that failed to present for follow up visits after 1975. were excluded. In the field survey group that consisted of 624 subjects (286 male and 338 female), proteinuria was established in 157 subjects. Upon the application of exclusion and inclusion criteria, the study cohort included 111 of 157 subjects. The mean follow up was 7.26 years (95% confidence interval 4.06-10.46 years). During the follow up period, 19 (17%) subjects with initial proteinuria developed endemic nephropathy. The incidence density of endemic nephropathy among subjects with proteinuria was 1.3 per 100 persons/year. Estimated risk was 0.0137 (confidence interval 0.0087-0.0214) per year of exposure. The presence of proteinuria determined by the sulfosalicylic acid or test strip in subjects from the endemic village indicated that endemic nephropathy would develop in 1.3 of 100 subjects with proteinuria per year

The perception and knowledge of cardiovascular risk factors among medical students

Aim To assess perceptions, knowledge, and awareness of cardiovascular disease (CVD) risk factors among medical students (freshmen and graduating students). Methods A descriptive cross-sectional survey based on an anonymous self-administered questionnaire was conducted in 2008 on 443 medical students – 228 freshmen on their enrollment day and 214 students on the day of their final exam at the University of Zagreb School of Medicine, Croatia. Results The perception and knowledge of some CVD risk factors, eg, dyslipidemia, arterial hypertension, and metabolic syndrome as well as of lipid-lowering therapy important for CVD prevention was significantly better among graduating students but was still not sufficient. Only 66% of graduating students reported that they would prescribe lipid-lowering therapy to high risk patients. Disappointingly, many graduating students were smoking (30.4%) and had low-awareness of obesity as an important CVD risk factor. Conclusion These results suggest an urgent need to improve medical students’ knowledge of obesity and low physical activity as important CVD risk factors and of the methods for increasing low high-density lipoprotein-cholesterol and for smoking cessation. All this provides a rationale for modifying the university core curriculum to include more information concerning these issues

The Risk of Developing Endemic Nephropathy in Subjects with Proteinuria

Endemic nephropathy is a chronic tubulointerstitial disease characterized by early damage to the proximal tubule, with low-molecular weight proteinuria being an important hallmark and possible tool for early diagnosis. The aim of this retrospective cohort study was to assess the risk of developing endemic nephropathy in subjects with proteinuria from the endemic region in Croatia. The cohort study included subjects with proteinuria determined by the sulfosalicylic acid method (after 1988 with strip method), involved in the field survey conducted in the Croatian endemic village of Kaniža in 1975 and followed up until 1997. Subjects with endemic nephropathy established at the first visit and patients that failed to present for follow up visits after 1975. were excluded. In the field survey group that consisted of 624 subjects (286 male and 338 female), proteinuria was established in 157 subjects. Upon the application of exclusion and inclusion criteria, the study cohort included 111 of 157 subjects. The mean follow up was 7.26 years (95% confidence interval 4.06-10.46 years). During the follow up period, 19 (17%) subjects with initial proteinuria developed endemic nephropathy. The incidence density of endemic nephropathy among subjects with proteinuria was 1.3 per 100 persons/year. Estimated risk was 0.0137 (confidence interval 0.0087-0.0214) per year of exposure. The presence of proteinuria determined by the sulfosalicylic acid or test strip in subjects from the endemic village indicated that endemic nephropathy would develop in 1.3 of 100 subjects with proteinuria per year

COMMUNICATION WITH SURGICAL PATIENTS OF OLDER AGE ON THE INTERNET

U novijoj literaturi postoje brojni podaci o sve većem zanimanju opće populacije za traženje informacija o zdravlju putem interneta, a sve je više i internetskih stranica posvećeno zdravlju. Štoviše, internet postaje sve popularniji način komuniciranja između zdravstvenih radnika i pacijenata. To je dovelo do mnogih pokušaja određivanja vrlo specifičnih smjernica o kvaliteti informacija za pacijente na internetu, uključujući i različite aspekte pristupačnosti zdravstvenih informacija. U ovom se radu prikazuju rezultati istraživanja koje je proučavalo strukturu izvora informacija za kirurške pacijente. Analiza profila pacijenata pokazuje da su pacijenti starije životne dobi rijetko tražili na internetu informacije o kirurškom zahvatu, a uglavnom su se oslanjali na komunikaciju sa svojim liječnikom. U radu se nude različiti načini kako ovaj medij učiniti što privlačnijim pacijentima te kako iskoristiti bogato iskustvo starije generacije pacijenata za poboljšanje kvalitete komunikacije između liječnika i pacijenta.A growing interest of general population to seek health information on the Internet and a growing body of health websites have been well documented in the recent health literature. Moreover, the Internet has become a popular mode of communication between healthcare providers and patients. This has resulted in many efforts to set specific quality guidelines for development of information for patients on the Internet, including different aspects of access to health information. This paper presents results of a study that explored the structure of information sources of surgical patients. Analysis of patient profiles shows that older patients rarely sought surgical information on the Internet, and mostly relied on communication with their doctors. This paper discusses various options of how to make this medium more attractive to patients and how to use the rich experience of the older patient generations to improve the quality of doctor-patient communication

How much do Croatian Physicians and Croatian Population Know about Risk Factor for Cadiovascular Diseases?

The results of two studies about knowledge and awareness of risk factors for cardiovascular diseases (CVD) of 1382 Croatian primary care physicians, internists and cardiologists as well as 882 citizens have been presented. The results show that although a great majority of physicians think that the guidelines for the prevention of CVD are useful, only more than a half of them use them in their daily work. Although more than four-fifths of physicians think that they provide good treatment to their patients suffering from dyslipidemia, only a half of them know what are the LDL target values in the patients with a high risk for CVD and which HDL concentration is risky for CVD. Although the population die because of CVD twice as much than of malignant disease, the respondents in the group of general population are much more afraid of malign diseases, although many of them know that CVD are the main cause of death. Only more than one fifth of patients have received advice from their physician in connection with lipid disorders as the CVD risk factor, while more than a half of respondents have received no instructions about the risk factors. We may conclude that physicians should know more about risk factors and guidelines for prevention of CVD and that the awareness of and knowledge about these factors in Croatian population should also be improved. The transfer of information about CVD risk factors between physicians and patients should be improved as well

Može li dugotrajna velika depresija izazvati osteoporozu?

A marked clinical, physiologic, and biochemical connection between osteoporosis and major depressive disorder (MDD) is described. There are numerous states and diseases associated with osteoporosis. The aim of the study was to assess the presumed association between hypercortisolism and osteoporosis. Some recent studies provided evidence for association between previous history of MDD and marked osteoporosis. In MDD, there are two well documented biochemical abnormalities, hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 male and 12 female), mean age 37±1.3, age range 29-41 years, and 17 healthy male volunteers mean age 39±1.6, age range 34-45 years. The levels of free cortisol in 24-h urine, serum cortisol at 8 a.m. and 5 p.m., and cortisol in dexamethasone suppression test as well as bone mineral density were measured in all study subjects. The results obtained were analyzed by use of Spearman\u27s nonparametric rank correlation, rho=-0.805, with a statistical significance level of p<0.01 (2-tailed). Study results suggested that patients with a long-term history of depression may develop a severe form of osteoporosis. Also, a severe form of osteoporosis has been known to develop in patients with untreated Cushing\u27s syndrome.Opisana je klinička, fiziološka i biokemijska povezanost osteoporoze i velike depresije. U oba stanja dolazi do hiperaktivnostiosi HPA, sustava LC/NE, te povišenog lučenja CRH, kortizola i katekolamina. Mnoga stanja i bolesti povezane su s osteoporozom, uključujući hiperkorticizam. Novija istraživanja povezuju raniju povijest velike depresije s osteoporozom. U velikoj depresiji zabilježene su dvije biokemijske abnormalnosti: hiperkorticizam i rezistencija na supresiju deksametazonom. U naše je istraživanje bio uključen 31 bolesnik s velikom depresijom (19 muškaraca i 12 žena) prosječne dobi od 37±1,3 godine, te 17 muških dobrovoljaca u dobi od 34 do 45 godina, prosječne dobi od 39±1,6 godina. U svih je bolesnika određivana razina kortizola u 24-satnoj mokraći, serumski kortizol, kortizol u testu supresije deksametazonom, a gustoća kostiju je određivan adenzitometrijski. Bila je to skupina mlađih muškaraca i žena s održanim menstruacijskim ciklusom, u početku bez osteoporoze, ali godinama pod antidepresivnom terapijom. Analiza rezultata pokazala je povišene vrijednosti kortizola, te pojavu osteoporoze razvoj koje je bio posljedica povišene razine kortizola. U analizi rezultata primijenjena je neparametrijska korelacija rangova, pri čem je Spearmanov rho bio -0,805 uz statistiku značajnost od p<0,01. Na temelju rezultata ispitivanja zaključeno je da bolesnici liječeni zbog depresije imaju povišenu razinu kortizola u 24-satnoj mokraći. Bolesnici koji su duže bolovali od depresije imali su jače izraženu osteoporozu. Kortizol vjerojatno ima značajnu ulogu u nastanku osteoporoze u bolesnika s depresijom, a poznato je da se u bolesnika s neliječenim Cushingovim sindromom također razvija jak oblik osteoporoze

Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study.

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery. DESIGN: Prospective, observational, blinded study. SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room. PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years. INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal phase (days 16 to end of cycle; n = 37). Anesthetic, postoperative pain management, and antiemetic regimens were standardized. MEASUREMENTS: Frequency of nausea, vomiting, or both were assessed for early (0-2 hrs). Late PONV (2-24 hrs) along with the use of rescue antiemetic, severity of nausea, and pain. MAIN RESULTS: In the follicular (n = 34), ovulatory (n = 40) and luteal phase (n = 37) groups, the frequencies of PONV over 24 hours were 35%, 38%, and 14% (P = 0.04), respectively. This was due to differences in the early postoperative period where the frequencies were 21%, 25%, and 3% (P = 0.02), respectively, as frequencies were similar in the late period (15%, 20% and 14%, P = 0.71), respectively. Nausea scores, rescue antiemetic usage, pain scores, and opioid consumption were similar in the groups. CONCLUSION: Patients in the luteal phase of their menstrual cycle may have a decreased risk of PONV after laparoscopic gynecological surgery in the early postoperative period

MYOFASCIAL PAIN OF THE HEAD AND NECK AMONG CROATIAN WAR VETERANS TREATED FOR DEPRESSION AND POSTTRAUMATIC STRESS DISORDER

Background: During the Croatian War of Independence, 1991-1995, Croatian soldiers were exposed to traumatic and stressful events. Certain number of soldiers who took part in the war, developed depression and posttraumatic stress disorder (PTSD). Stress is one of the etiological factors in the development of myofascial pain (MPS), although the mechanism of these processes is not entirely understood. The aims of this study were to determine the frequency of myofascial pain among Croatian war veterans with depression and PTSD, association between MPS and severity of depression, to describe the most common locations of trigger points in the region of head and neck, and to find out if there is any association in frequency between MPS and endotracheal intubation. Subjects and methods: A total of 101 Croatian war veterans suffering from PTSD and depression participated in the current study. Diagnosis of myofascial pain was based on detailed anamnestic history and careful clinical examination. Results: Our findings showed a high rate of myofascial pain among Croatian war veterans, with occipital region and right temporal region as the most common places of trigger points. Higher severity of depression was accompanied by a higher percentage of subjects with MPS. Finally, there was no significant association between endotracheal intubation and development of MPS among the war veterans. Conclusions: It can be concluded that the rate of myofascial pain among Croatian war veterans is high and therefore it must be considered in patients with depression and PTSD. Moreover, the severity of depressive symptomatology seems to be related to the presence of myofascial pain