Calcitonin gene related peptide induced changes of internal homeostatic body model; translation from TCD studies

Intravenously introduced Calcitonin gene-related peptide (αCGRP) induces CGRP- induced headache (CGRP-IH) as well cerebral and systemic hemodynamic changes detectable with transcranial Dop- pler sonography (TCD). Therefore, elevation of CGRP in the systemic blood can evoked headache in predisposed subjects, especially in migrainours. Thus, increase of CGRP during migraine episode might be source of nociceptive sensation. Following predictive coding and interoception, this could induce painful prediction error and updates the internal homeostatic model, inducing headache, and turn subject into no fit to purpose mode which leads to disability during migraine episode. The CGRP provocation might be used for discrimination of CGRP sensitive from insensitive migraine using TCD and predict CGRP antagonism effect in migraine treatment

Calcitonin gene related peptide induced changes of internal homeostatic body model; translation from TCD studies

Intravenously introduced Calcitonin gene-related peptide (αCGRP) induces CGRP- induced headache (CGRP-IH) as well cerebral and systemic hemodynamic changes detectable with transcranial Dop- pler sonography (TCD). Therefore, elevation of CGRP in the systemic blood can evoked headache in predisposed subjects, especially in migrainours. Thus, increase of CGRP during migraine episode might be source of nociceptive sensation. Following predictive coding and interoception, this could induce painful prediction error and updates the internal homeostatic model, inducing headache, and turn subject into no fit to purpose mode which leads to disability during migraine episode. The CGRP provocation might be used for discrimination of CGRP sensitive from insensitive migraine using TCD and predict CGRP antagonism effect in migraine treatment

Complementary and Alternative Medicine - some Public Health Views

CAM is, from the point of view of public health, a phenomenon that should be followed, analysed and controlled. Noxious as well as protective factors which accompany the implementation of CAM methods should be recognised so as to be able to inform the public of the results in a timely and accurate manner. The case study analyses the viewpoints of medical doctors, patients and the state of the phenomenon of CAM in Slovenia. A declinatory attitude of conventional medicine to CAM is present. In contrast, population express a favourable opinion on alternative methods of treatment, and more than a third of them actually make use of them

''Health Needs'' Concept

The concept of ''health needs'' is one of key concepts in public health. From the public health standpoint, the most important perspective on this concept is the perspective of a population, or an individual respectively. But along this perspective there exist several other perspectives, which can be to the certain extent similar, but also could be also very different. All this enters an enormous confusion in its understanding, and consecutively this concept seems rather elusive. This confusion originates from the fact that the concept of “health needs” is very difficult to define exactly, like it is also very difficult to define exactly the concept of “health itself”, since both concepts are extremely complex entities. The module is trying to enlighten some problems concerning the “health needs” concept”

Lipidi u krvi i karotidni plak

Increased lipids in the blood could be associated with an increased lipid core of atherosclerotic plaque and plaque echolucency on the B-mode image. The hypothesis that plasma levels of blood lipids predict the echolucency of carotid atherosclerotic plaques on B-mode imaging was tested. A total of 237 outpatients, mean age 62.9±10.2 years, were enrolled in the study. There were 189 symptomatic and 48 asymptomatic patients. All of them underwent duplex sonography of carotid arteries and lipidogram in the last year, and had plaques in common or internal carotid arteries. Other risk factors, i.e. arterial hypertension, diabetes mellitus, aging and gender, were also evaluated. In the model of logistic regression, the type of plaque (hypoechogenic, echogenic) was introduced as a dependent variable, with LDL, HDL and triglycerides as independent variables. The model fitted the data moderately well (r2=0.19, p<0.001). LDL and HDL appeared to be significant predictors (p<0.01). The association of plaque type with arterial hypertension, diabetes mellitus, aging and gender was tested by logistic regression. The model fitted the data moderately well (r2=0.24, p<0.001). Arterial hypertension and age were significant (p<0.01) predictors for echogenic plaques, whereas cigarette smoking was indicative of hypoechogenic plaques (p=0.01). In conclusion, LDL and HDL appeared to be associated with hypoechogenic plaques. LDL showed positive, and HDL negative association. Among other risk factors, aging and arterial hypertension showed positive association with echogenic plaques, whereas cigarette smoking showed positive association with hypoechogenic plaques.Povišeni lipidi u krvi mogli bi biti udruženi s povećanom lipidnom jezgrom aterosklerotskog plaka i eholucencijom plaka na prikazu u B-modu. Ispitana je pretpostavka da plazmatske razine lipida u krvi predskazuju eholucenciju karotidnih aterosklerotskih plakova na prikazu u B-modu. U studiju je bilo uključeno ukupno 237 ambulantnih bolesnika srednje dobi od 62,9±10,2 godina, 189 od njih simptomatskih i 48 asimptomatskih. Svi su bolesnici u protekloj godini podvrgnuti pretrazikarotidnih arterija pomoću dupleks sonografije. Svi su bolesnici imali plakove u skupnoj ili unutarnjoj karotidnoj arteriji i u svih je učinjen lipidogram. Procjenjivani su i drugi rizični čimbenici kao to su arterijska hipertenzija, šećerna bolest, starenje i spol. U model logistične regresije uvedena je vrst plaka (hipoehogeni ili ehogeni) kao zavisna varijabla, uz LDL, HDL i trigliceride kao nezavisne varijable. Model je umjereno dobro odgovarao podacima (r2=0,19; p<0,001). LDL i HDL pokazali su se značajnim predskazateljima (p<0,01). Udruženost vrste plaka s arterijskom hipertenzijom, šećernom bolešću, starenjem i spolom ispitana je logističnom regresijom. Model je umjereno odgovarao podacima (r2=0,24; p<0,001). Arterijska hipertenzija i starosna dob bile su značajni (p<0,01) predskazatelji ehogenih plakova, dok je pušenje ukazivalo na hipoehogene plakove(p=0,01). zaključeno je kako su LDL and HDL udruženi s hipoehogenim plakovima. LDL je pokazao pozitivnu, a HDL negativnu udruženost. Među ostalim čimbenicima rizika starenje i arterijska hipertenzija pokazali su pozitivnu udruženost s ehogenim plakovima, a pušenje pozitivnu udruženost s hipoehogenim plakovima

Karotidna angioplastika s cerebralnom zaštitom

Carotid endarterectomy (CEA) is widely used in the management of high grade carotid stenosis. It is a surgical procedure requiring general anesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It has complications, including stroke, death, cranial nerve palsies, wound hematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in the presence of cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anesthesia and carries a lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal embolization of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure and it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. In Slovenia, we have also started with carotid angioplasty by the study Slovenian Carotid Angioplasty Study (SCAS). According to our initial experience in 17 patients, CAS could gain more importance in stroke prevention with proper selection of patients with brain ischemia and improved cerebral protection during the procedure.Karotidna endarterektomija (CEA) u širokoj je uporabi pri liječenju karotidne stenoze visokog stupnja. Kirurški zahvat obavlja se u općoj anesteziji, a primjenjuje se samo pri oštećenjima na račvištu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaćaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srčane komplikacije. Rizik komplikacija povećan je u bolesnika s recidivirajućom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u području vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su liječnike da potraže alternativne načine liječenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za liječenje recidivirajućih stenoza nakon prethodne CEA te za liječenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opća anestezija, a u bolesnika s teškom kardiopulmonalnom bolesti pobol i smrtnost su manji. U komplikacije CAS pripadaju moždani udar zbog distalne embolizacije plaka ili odvajanja tromba tijekom postupka, nagla okluzija krvne žile zbog tromboze, disekcija ili vazospazam te ponovna stenoza zbog hiperplazije intime. CAS je razmjerno nov postupak, pa je nužno utvrditi njegovu djelotvornost i sigurnost prije nego što se uvede u široku kliničku uporabu. U Sloveniji smo započeli s istraživanjem karotidne angioplastike u okviru projekta “Slovenian Carotid Angioplasty Study (SCAS)”. Prema našim prvim iskustvima u 17 bolesnika, CAS bi se mogao pokazati važnim u prevenciji moždanog udara, uz dobar odabir bolesnika s moždanom ishemijom i uz bolju cerebralnu zaštitu tijekom postupka