METABOLIC SYNDROME

Metabolički sindrom je skup poremećaja koji uključuje hiprlipidemiju, nedekvatnu otpornost na inzulin, hipertenziju te trbušni tip pretilosti.Bolesnici koji pate od ovog sindroma imaju povećani rizik za bolesti srca i krvnih žila, moždanog udara i dijabetesa tipa II. Vodeće svjetske zdravstvene intitucije se ne slažu o točnom definiranju ovog poremećaja.Američka organizacija NCEP (National Cholesterol Education Program) metabolički sindrom definira kao stanje kod kojega postoje tri ili više od sljedećih kriterija: razina glukoze natašte viša od 6,1 m mol / L , serumski trigliceridi viši od 1,7 mmol / L , serumski HDL kolesterol niži od 1,04 mmol / L , RR veći od 130/85 mmHg, opseg struka od 102 cm ili> od 94 cm u muškaraca neosjetljivih na inzulin. Svjetska zdravstvena organizacija definira metabolički sindrom kao stanje kod kojega povišena razina glukoze u krvi ( razna visa od 6,0 mmol / L) zajedno s dva ili više sljedećih kriterija: pretilost trbušnog tipa , dislipidemija i povišeni krvni tlak. Znanstveno su dokazani nasljedni i stečeni uzroci ovog sindroma. Stečeni uzroci uključuju: prekomjernu tjelesnu težinu, tjelesnu neaktivnost te visok udio ugljikohidrata u prehrani (više od 60%).Genetski uzroci još nisu precizno definirani izuzev diabetes melitusa. Stres se smatra jednim od uzroka jer remeti hormonsku ravnotežu i povećava sklonost akumuliranju masnoće u trbuhu i dislipidemijama. Debljina je karakteristika ovog sindroma, to je tipično, tzv.centralna pretilost, gdje se mast nakuplja uglavnom oko struka.Body indeks mase, BMI(izračunava se dijeljenjem težine u kilogramima i visine u metrima na kvadrat - kg / m2)je kod bolesnika sa metaboličkom sindromom veći od 25. Prva posljedica metaboličkog sindromaje slabiji odgovor stanica na inzulin. Razvija se inzulinska rezistencija, šećer ne može ući u stanice i povećava razinu šećera u krvi, raste i razina inzulina i stvara se začarani krug koji prije ili kasnije dovodi do dijabetesa tipa 2. Metabolički sindrom je postao jedan od najvažnijih uzroka ateroskleroze što rezultira bolestima srca i krvnih žila: angina pektoris, srčani infarkt, moždani udar i periferne vaskularne bolesti. Također je dokazana i značajna povezanost metaboličkog sindroma i mentalnih poremećaja: depresije, anksioznosti i neuroze,a dokazano je da ljudi koji koji pate od mentalnih poremećaja češće razvijaju metabolički sindrom. Prevalencija metaboličkog sindroma u svijetu je visoka i stalno se povećava, među odraslima u National Health and Nutrition USA anketama je iznosila 24,1% između 1988. i 1994. i 34,5% između 1999. i 2002. godine, dok National Cholesterol Education Program Adult Treatment Panel III 2005. godine navodi kako se broj ljudi sa ovim sindromom dramatično povećava na 39% do 46% u svim etničkim i dobnim skupinama. Pola sata vježbanja svaki dan ili sat vremena svaki drugi dan smanjuje rizik od mnogih bolesti,a brzo hodanje, biciklizam i trčanje su aerobne aktivnosti preporučene za prevenciju metaboličkog sindrom uz zdravu prehranu koja uključuje veliki udio vlakana, puno voća i povrća, uz kontrole krvnog tlaka i redovite posjete liječniku. Glavni terapijski ciljevi su: smanjenje prekomjerne tjelesne težine , implementacija kontrolirane fizičke aktivnosti te , liječenje faktora rizika odnosno visokog krvnog tlak,poremećaja zgrušavanja i dislipedemija. Metabolički sindrom je povezan s povećanim rizikom od nastanka moždanog i srčanog udara te bolestim krvnih žila što dokazuju brojne studije. Tako je primjerice u velikom istraživanju Smart study grupe u SAD-u 2004. godine prevalencija metaboličkog sindroma u populaciji ove studije bila kod 45% ispitanika,kod bolesnika sa perifernim arterijskon bolesti u 57%, kod bolesnika sa koronarnom bolešću u 40% ispitanika , a u u bolesnika s moždanim udarom u 43% ispitanika. Zaključno se može reći kako je metabolički sindrom poznat kao neovisni čimbenik rizika za razvoj moždanog udara,a može nastati zbog genetskih čimbenika i nezdravog načina života.Metabolic syndrome is a cluster of disorders that include hyperlipidemia, inadequate insulin resistance, hypertension, and abdominal type obesity. Patients who suffer from this syndrome have an increased risk for heart disease and blood vessel disease, stroke and type II diabetes. The world\u27s leading healthcare institutions also disagree on the exact definition of this organization poremećaja. NCEP (National Cholesterol Education Program) defines metabolic syndrome as a situation in which there are three or more of the following criteria: fasting plasma glucose greater than 6.1 m mol / L , serum triglycerides higher than 1.7 mmol / L, serum HDL cholesterol less than 1.04 mmol / L, RR greater than 130/85 mmHg, waist circumference of 102 cm or> 94 cm in men insensitive to insulin. The World Health Organization defines the metabolic syndrome as a condition in which elevated levels of blood glucose (various higher than 6.0 mmol / L) together with two or more of the following: abdominal obesity type, dyslipidemia and hypertension. Scientifically proven genetic and acquired causes of this syndrome. Acquired causes include obesity, physical inactivity and a high proportion of carbohydrates in the diet (more than 60%). The genetic causes have not been precisely defined with the exception of diabetes mellitus. Stress is considered one of the causes as it disturbs the hormonal balance and increases the tendency to accumulate fat in the abdomen and dyslipidemia. The thickness of the characteristics of this syndrome, it is typical, central or abdominal obesity, where fat accumulates mainly around struka.Body mass index, BMI (calculated by dividing weight in kilograms and height in meters squared - kg / m2) in patients with metabolic syndrome increased from 25 first consequence of metabolic syndrome is weaker response of cells to insulin. It develops insulin resistance, sugar can not enter the cells and increases the level of sugar in the blood, increasing the level of insulin and creates a vicious circle, which sooner or later leads to type 2 diabetes. Metabolic syndrome has become one of the most important cause of atherosclerosis, resulting in heart disease and vascular diseases: angina pectoris, myocardial infarction, stroke and peripheral vascular disease. He also demonstrated a significant association of metabolic syndrome and mental disorders: depression, anxiety and neurosis, and it has been proven that people who suffer from mental disorders more likely to develop metabolic syndrome. The prevalence of metabolic syndrome in the world is high and continues to grow, among adults in the National Health and Nutrition Surveys USA amounted to 24.1% between 1988 and 1994 and 34.5% between 1999 and 2002, while the National Cholesterol Education Program Adult Treatment Panel III of 2005 states that the number of people with Down syndrome increases dramatically to 39% to 46% in all ethnic and age groups. Half an hour of exercise every day or an hour every other day reduces the risk of many diseases, and brisk walking, cycling and running are aerobic activity recommended for prevention of metabolic syndrome, along with a healthy diet that includes a large proportion of fiber, lots of fruits and vegetables, along with blood pressure control and regular visits to the doctor. The main therapeutic goals are: reducing excess weight, the implementation of a controlled physical activity and, treating risk factors or high blood pressure, clotting disorders and dislipedemija. Metabolic syndrome is associated with increased risk of stroke and heart attack and vascular disease as evidenced by numerous studies. For example, in a large study Smart Study Group in the United States in 2004, the prevalence of the metabolic syndrome in this study population was 45% of patients, in patients with peripheral arterijskon disease in 57% of patients with coronary heart disease in 40% of subjects, auu patients with stroke in 43% of patients. It can be concluded that the metabolic syndrome known as an independent risk factor for stroke, and may be due to genetic factors and unhealthy lifestyles

Glavobolje kod adolescenata - učestalost, rizični čimbenici i druge zdravstvene poteškoće: hrvatsko presječno istraživanje

Headaches are very common in school population. The aim of this study was to determine epidemiological data on headaches among Croatian schoolchildren and their connection to risk factors and other health complaints. In the study, we used the Croatian database of the international research entitled Health Behavior in School-aged Children for 2013/2014. It is a cross-sectional study conducted every four years in 44 countries among children aged 11-16. The students were interviewed using an anonymous standardized questionnaire. The Croatian sample consisted of 5741 students, of which 2857(49.8%) girls and 2884 (50.2%) boys. The response rate was 85.9%. Headaches were reported to be often (once a week to daily) by 23.5% of students and were more often in girls and in higher school grades. They were positively linked to cigarette smoking and health complaints such as back pain and stomachache, bad mood, nervousness, irritability, difficulties with sleeping and dizziness. Headaches are associated to many health problems and can cause difficulties in student functioning. This could be a serious problem. This study pointed to connection of headaches with cigarette smoking and importance to underpin the smoking prevention programsGlavobolje su vrlo česte kod školske djece. Cilj ovoga rada bio je utvrditi epidemiološke karakteristike glavobolja kod školske djece i njihovu povezanost s rizičnim čimbenicima i drugim zdravstvenim tegobama. Koristili smo hrvatsku bazu podataka međunarodnog istraživanja Health Behavior in School-aged Children za 2013./2014. godinu. To je presječno istraživanje koje se provodi svake četiri godine u 44 zemlje, a uključuje školsku djecu u dobi od 11 do 16 godina. Učenici se ispituju standardiziranim, anonimnim upitnikom. Uzorkom je u Hrvatskoj obuhvaćeno 5741 učenika, od kojih je bilo 49,8% učenica (n=2857) i 50,2% učenika (n=2884), uz odziv od 85,9%. Glavobolje je imalo često (od jednom tjedno do svakodnevno) 23,5% učenika i to češće kod učenica u višim razredima. Utvrđena je pozitivna povezanost s pušenjem cigareta i drugim zdravstvenim tegobama poput bolova u leđima i trbuhu te lošim raspoloženjem, nervozom, iritabilnosti, poteškoćama spavanja i vrtoglavicama. Glavobolje su povezane s mnogim zdravstvenim tegobama i mogu utjecati na funkcioniranje učenika, što može biti ozbiljan problem. Ovaj rad je ukazao na povezanost glavobolja i pušenja cigareta te na važnost jačanja preventivnih programa u tu svrhu

Jesmo li spremni za intravensku trombolizu u liječenju akutnog moždanog udara u našoj regiji?

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.Akutni moždani udar je vodeći uzrok invalidnosti u današnjem društvu. Rano liječenje je bitno za što veću učinkovitost akutnog liječenja. Učinkovita tromboliza rekombiniranim aktivatorom tkivnog plazminogena ovisi o vremenu i preporukama da se provede unutar 3 sata od nastanka simptoma moždanog udara. Cilj ove studije bio je utvrditi jesmo li spremni za uvođenje trombolize u našu regiju. Retrospektivno se promatralo vrijeme od nastanka simptoma do dolaska u bolnicu (vrijeme kašnjenja) bolesnika s akutnim moždanim udarom. Promatrale su se povijesti bolesti svih bolesnika primljenih u bolnicu u 2006. godini. U statističkoj obradi primijenjen je program SigmaStat (verzija 2.0). Utvrđen je vrlo visok postotak (35%) bolesnika koji su došli nakon 24 sata od nastanka moždanog udara; 15% svih bolesnika primljenih s akutnim ishemijskim moždanim udarom (AIMU) došlo je unutar 3 sata. Uzimajući u obzir i ostale kriterije isključivanja samo je 4% svih bolesnika primljenih s AIMU moglo primiti sistemsku trombolizu. Većina bolesnika je stigla prekasno da bi imala maksimalnu korist od hitne terapije moždanog udara. Uzrok je možda nepoznavanje znakova i simptoma ili nedovoljna saznanja o korisnosti ovog liječenja. Potrebno je i dalje se truditi i poboljšavati poznavanje znakova i simptoma moždanog udara, kao i smanjiti vrijeme kašnjenja

Utjecaj trajanja i tipa šećerne bolesti na moždanu hemodinamiku

A group of 100 patients aged 48-67 years, with a diagnosis of diabetes mellitus, and control group of 100 healthy subjects were examined by transcranial Doppler sonography, a modern and sophisticated diagnostic method for visualization of hemodynamic changes in basal cerebral arteries in real time. The aim of the study was to determine hemodynamic changes in cerebral arteries in diabetic patients, and to analyze the effect of duration and type of diabetes on cerebrovascular disease. The rate of transcranial Doppler sonography abnormalities was statistically significantly higher in diabetic patients than in control subjects (55% vs. 11%, 2=, p<0.05). The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes. Hemodynamic impairments were more common in type 1 than in type 2 diabetes patients (72.5% vs. 43.3%). The study suggested the duration of diabetes to predict for the development of atherosclerotic processes in cerebral vessels. Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and ≥5 years, respectively. In all diabetic patients, signs of cerebral microangiopathy were significantly more commonly recorded than those of cerebral macroangiopathy.Transkranijska Doplerska sonografija, vrhunska dijagnostička metoda za prikaz hemodinamskih promjena u bazalnim moždanim arterijama u stvarnom vremenu, primijenjena je u 100 bolesnika u dobi između 48 i 67 godina s dijagnozom šećerne bolesti, te u kontrolnoj skupini od 100 zdravih ispitanika. Cilj istraživanja bio je utvrditi hemodinamske promjene u moždanim arterijama u dijabetičnih bolesnika, te utjecaj trajanja i tipa šećerne bolesti na razvoj cerebrovaskularne bolesti. Nađena je statistički značajno veća zastupljenost patoloških nalaza transkranijske doplerske sonografije u dijabetičnoj skupini negoli u kontrolnoj skupini (p<0,05). Utvrđeno je da trajanje i tip dijabetesa utječu na razvoj patoloških promjena na moždanim arterijama. Bolesnici s dijabetesom tip 1 češće su imali hemodinamske promjene negoli oni s dijabetesom tip 2 (72,5% prema 43,3%). S druge strane, istraživanje je pokazalo da je trajanje šećerne bolesti značajan predskazatelj razvoja cerebrovaskularne bolesti. Aterosklerotske promjene nađene su u 34% dijabetičara koji su bolovali od dijabetesa kraće od 5 godina, te u 71,4% onih koji su od dijabetesa bolovali 5 godina i duže. U svih dijabetičnih bolesnika znatno su češće nađeni znaci cerebralne mikroangiopatije negoli makroangiopatije

Epidemiology of stroke

The epidemiology of stroke may be changing over time as a result of a number of factors, including an aging population and advances in the prevention and treatment of stroke. Epidemiological indicators and research of stroke have great significance in estimating the impact of this disease on the population. Such research states the distribution of this illness and factors by which it is influenced, follows short-term and long-term consequences, as well as socio-economic burden of stroke for the whole community. Data on stroke prevalence is important for creating the right strategies for health care in a specific area. Stroke-relatedmortality in any population is dependent upon three main factors: the incidence of stroke in the population, quality ofmedical care available, and the prevalence of cardiovascular diseases and comorbidities that can affect the likelihood of surviving stroke events. The quality of medical care available influences both the number of individuals suffering from stroke and the proportion of case-fatality among them. Epidemiological data shows that stroke is one of the leading causes of death and long-term disability in most industrialized populations, and the same is true for Croatia. The existing systemof health care for stroke patients does not meet the needs and is not in accordance with latest trends in developed countries.Hence, there is a need for its reorganization and design of the national project for stroke prevention and treatment similar to those in European countries with favorable epidemiological data

NEUROGENIC PULMONARY EDEMA IN CLINICAL PRACTICE

Neurogeni edem pluća (NEP) je relativno rijedak oblik plućnog edema koji se razvija nekoliko minuta do nekoliko sati od nastanka neurološkog oštećenja. Smatra se da je povišeni intrakranijski tlak (IK) osnovni razlog nastanka NEP-a. Najčešća stanja koja dovode do povećanja IK-a, a samim time i NEP-a su intracerebralna krvarenja bilo kojeg uzroka, subarahnoidalna hemoragija i epileptički status. Iako patogeneza NEP-a nije u cijelosti razjašnjenja nedvojbeno je kako poremećaji u jezgrama i putovima medule oblongate i hipotalamusa uz povišenje IK-a dovode povišene aktivnosti simpatoadrenergičkog sustava te posljedično razvoja NEP-a. Najčešće se NEP klinički prezentira dispnejom i nerijetko blagom hemoptizom. Ne postoji specifična niti radiološka dijagnostika koja bi potvrdila NEP. Terapija NEP-a je simptomatska, a uz adekvatno liječenje osnovne neurološke i neurokiruške bolesti u većine bolesnika simptomi nestaju unutar 48-72 sata.Neurogenic pulmonary edema (NEP) is a relatively rare form of pulmonary edema develops a few minutes to several hours from the onset of neurological damage. It is believed that the increased intracranial pressure (IC) has given birth to the NEP. The most common conditions leading to an increase in IC\u27s, and thus the NEP are intracerebral bleeding from any source, subarachnoid hemorrhage and epileptic status. The pathogenesis of the NEP is not entirely clarify unambiguously that disturbances in the nuclei of the medulla oblongata and the ways and hypothalamus with the increase IC and bring increased activity simpatoadrenergičkog system and the consequent development of the NEP. The most common clinical NEP presents dyspnea and often mild hemoptysis. There is no specific nor radiological diagnostics that would confirm the NEP. Therapy NEP is symptomatic and adequate treatment with basic neurological and Neurosurgical disease in most patients, symptoms disappear within 48-72 hours