Fighting Obesity with Physical Activity

Prevalencija prekomjerne tjelesne težine i pretilosti znatno je porasla u svim društvima diljem svijeta tijekom posljednja tri desetljeća, djelomično i zbog snižavanja ukupne razine tjelesne aktivnosti, a svi su pokazatelji da će se taj trend vjerojatno nastaviti s dalekosežnim negativnim javnozdravstvenim učincima. Redovito tjelesno vježbanje, aerobnog i anaerobnog tipa reducira rizik od niza kroničnih bolesti pa tako i pretilosti, a sedentarni način života dodatni je i neovisni rizični čimbenik. Tjelesna aktivnost u slobodno vrijeme barem submaksimalne razine u trajanju od 250 ili više minuta na tjedan uz prehrambene intervencije poboljšava smanjenje i održavanje tjelesne težine u optimalnim granicama. Preporučeno tjelesno vježbanje mora biti u skladu s potrebama, ciljevima, preferencijama i početnom sposobnošću osobe koja ga provodi, propisivanje mora biti individualno s maksimalnom koristi uz minimalni rizik, a mora se postići i povišenje razine ukupne svakodnevne tjelesne aktivnosti.Over the past three decades, prevalence of overweight and obesity has increased considerably in the societies throughout the world, partly also due to the decreasing overall physical activity levels. All indicators suggest that this trend will probably continue with far-reaching adverse effects on public health. Regular physical exercise, either aerobic or anaerobic one, reduces the risk of a series of chronic diseases, including obesity, especially with sedentary lifestyle that is an additional and independent risk factor. Improved weight loss and weight maintenance within optimal limits is achieved with leisure-time physical activity in the form of at least submaximal graded exercising for 250 or more minutes per week, including dietary interventions. Recommended physical exercise has to be in accordance with the needs, goals, preferences and initial ability of the person exercising and exercise prescription has to be individualized, maximizing the benefits and minimizing the risks. Overall levels of daily physical activity have to be increased as well

The Importance of Valsartan in the Treatment of Hypertonic Patients with Erectile Dysfunction

Erektilna se disfunkcija, prema više autora, pojavljuje u više od 50 % muškaraca, napose srednje i više dobi, koji boluju od arterijske hipertenzije. Arterijska hipertenzija, ali i neki lijekovi koji se uporabljuju u njezinu liječenju, mogu nizom patofizioloških mehanizama (ateroskleroza na krvnim žilama koje opskrbljuju tkiva odgovorna za erekciju, simpatikotonija i disregulacija vaskularnog tonusa erektilnog aparata, loša remodelacija i sniženje elastičnosti krvnih žila erektilnog aparata, promjene u strukturi kavernoznog tijela te povećanje koncentracije slobodnih radikala i peroksidacije lipida u penilnome tkivu) uzrokovati poremećaje erekcije. Nasuprot tomu, ima više istraživanja u posljednjih petnaestak godina koja dokazuju pozitivan utjecaj valsartana u poboljšanju erektilne disfunkcije, pa i orgazmične funkcije, spolne želje i zadovoljstva spolnim odnosom te u povećanju njihova broja u bolesnika koji boluju od arterijske hipertenzije. Osnovni mehanizam toga djelovanja jest inhibicija lokalnog angiotenzin- konvertirajućeg enzima, ali postoje i drugi posredni mehanizmi. Stoga se može zaključiti da valsartan, uz dobru antihipertenzivnu učinkovitost, tolerabilnost i organoprotektivni učinak, ima naglašeni proerektilni učinak te je dobar izbor u bolesnika s arterijskom hipertenzijom i erektilnom disfunkcijom, osobito ako je riječ o pretilim bolesnicima i bolesnicima sa šećernom bolešću. Istraživanjima na životinjskom modelu pokazano je da bi valsartan mogao biti i dobro terapijsko sredstvo za erektilnu disfunkciju u dijabetičara, no za potvrdu takve tvrdnje potrebna su dodatna istraživanja na humanom modelu.According to multiple authors, erectile dysfunction manifests in over half of the male population with arterial hypertension, especially in middle-aged or older men. Arterial hypertension, but also some of the medication used to treat it, can lead to erectile dysfunction through a number of pathophysiological mechanisms (atherosclerosis in the blood vessels supplying the tissue responsible for the erection, sympathicotonia and dysregulation of the vascular tonus of the erectile organ, poor remodeling and lowered elasticity of blood vessels in the erectile organ, changes in the structure of the cavernous body, and increased concentration of free radicals and lipid peroxidation in the penile tissue). On the other hand, several studies over the recent 15 years have found a positive influence of valsartan on the improvement of erectile dysfunction, as well as orgasmic function, sex drive, and intercourse satisfaction and frequency in patients with arterial hypertension. The basic mechanism that leads to these effects is inhibiting the local angiotensin converting enzyme, but other indirect mechanisms are at play as well. We can thus conclude that valsartan, in addition to good antihypertensive effectiveness, tolerability, and organoprotective effects, has a pronounced pro-erectile effect and is a good treatment choice in patients with arterial hypertension and erectile dysfunction, especially in patients with obesity and diabetes; confirming this hypothesis, however, will require further studies in a patient model

Acetylsalicylic Acid in Acute Coronary Syndrome

Akutni koronarni sindrom akutna je ishemija i/ili infarkt miokarda koji su uzrokovani naglom redukcijom koronarnog protoka krvi, a može se prezentirati kao nestabilna angina pektoris ili infarkt miokarda s elevacijom ST-spojnice ili bez nje. Sindrom najčešće karakterizira anginozna prekordijalna bol uz odgovarajuće promjene u EKG-u i biomarkerima. U terapiji navedenog stanja rabe se analgetici, antiagregacijska, antiishemijska, antikoagulantna i reperfuzijska (fibrinolitička i/ili perkutana koronarna intervencija) terapija. Antiagregacijska terapija acetilsalicilnom kiselinom osnovna je terapija u akutnome koronarnom sindromu i nakon njega, najčešće u kombinaciji s drugim lijekovima i procedurama i s nizom specifičnosti ovisno o individualnim karakteristikama bolesnika.Acute coronary syndrome is acute ischemia and/or myocardial infarction caused by abrupt reduction in coronary blood flow. It may manifest as unstable angina or myocardial infarction with or without ST segment elevation. The syndrome is usually characterized by anginal precordial pain with the corresponding changes in the ECG and biomarkers. Analgesic, antiplatelet, anti-ischemic, anticoagulant and reperfusion (fibrinolytic and/or percutaneous coronary intervention) therapies are used in the treatment of the above conditions. Antiplatelet therapy with acetylsalicylic acid is the basic therapy of acute coronary syndrome and the post coronary syndrome period, usually in combination with other drugs and procedures, and depending on individual patient characteristics

Značenje registara akutne skrbi kardioloških bolesnika na nacionalnoj razini

Improving organization and patient care quality in intensive care units is increasingly important as intensive care unit diagnostic and therapeutic procedures account for a growing proportion of hospital services. We identified the lack of comprehensive national and international registries available in the contemporary literature. This paper aims to describe and analyze cardiac intensive care unit (CICU) network at the national level in Croatia and its comparison with more developed countries. Thirty-four representatives from all Croatian acute hospitals (response rate of 100%) filled in a web based questionnaire on CICU organization and competence during September and October 2016. Organization and available technical procedures for health care in general, and especially in very expensive CICU treatment, highly depends on gross domestic product (GDP) per capita. That is why one could expect that Croatia, with the second lowest GDP among European Union countries and 4.7 CICU per million inhabitants will have worse results in this field in comparison with most of these countries. Results such as one nurse responsible for a mean of 2.7 CICU patients, 52% of cardiologists among physicians during working hours but 37% during night shifts, 24/7 transesophageal echocardiography in only 26.5% of CICUs, one-third without therapeutic hypothermia, and 23.5% without extracorporeal membrane oxygenation treatment are some of these results, revealing much room for improvement. This representative, nationwide sample of Croatian CICUs also demonstrated considerable variation of key elements of structures with respect to hospital size, academic status and financial issues, as well as a trend towards current guidelines. This kind of investigation is very important for proposing standards, reimbursement master plan, or quality assessment of the national health system.Unaprjeđenje organizacije i kvalitete skrbi o bolesnicima u jedinicama intenzivne skrbi postaje sve važnije zbog rastućeg opsega dostupnih metoda liječenja i skrbi. Suvremena literatura ukazuje na nedostatak odgovarajućih nacionalnih i internacionalnih registara. Cilj ovog istraživanja bio je analiza organizacije jedinica intenzivne kardijalne skrbi (JIKS) u Hrvatskoj i usporedba s ekonomski razvijenijim zemljama. Liječnici iz 34 hrvatske akutne bolnice (100%-tni odgovor) ispunili su e-poštom poslan upitnik o organizaciji skrbi i metodama liječenja akutnih kardioloških bolesnika. Odgovori su prikupljeni i analizirani tijekom rujna i listopada 2016. godine. Hrvatska ima oko 5 JIKS na milijun stanovnika (raspon od 1 do 9, većinom 5-6 kreveta). Jedna medicinska sestra skrbi za prosječno 2,7 bolesnika (u jutarnjim satima za 2,3 bolesnika, u poslijepodnevnim satima 2,3 bolesnika, noću 3,3 bolesnika) uz varijabilnost ovisno o veličini bolnice (u manjim bolnicama prosječno za 2,9 bolesnika, u sveučilišnim bolnicama za 2,1 bolesnika, p<0,001). Gotovo dvije trećine JIKS sadrži manje od 4 kreveta na jednog liječnika, dok kardiolozi čine 52% liječnika tijekom radnog dana, ali samo 37% liječnika tijekom dežurstva. Utvrdili smo značajnu varijabilnost u dostupnosti ultrazvuka srca tijekom radnog dana u odnosu na dežurstvo (76,5% JIKS ima 24-satnu dostupnost transtorakalne ehokardiografije, ali samo 26,5% za transezofagusnu ehokardiografiju). Trećina ispitivanih centara nije uvela terapijsku hipotermiju, a 23,5% centara ne radi izvantjelesnu membransku oksigenaciju niti premješta bolesnike u odgovarajuće ustanove. Organizacija i dostupne metode liječenja u JIKS ovise i o bruto društvenom proizvodu. Ovo istraživanje, prvo takve vrste u Republici Hrvatskoj, ukazuje na značajnu varijabilnost ključnih dijelova zdravstvene skrbi akutnih kardioloških bolesnika ovisno o veličini bolnice, ali i ukupni trend prema postojećim smjernicama. Ukazujući na prostor za napredak, ono može poslužiti kao polazna točka u postizanju željenog standarda, planiranju financija te procjeni i praćenju kvalitete nacionalnog zdravstvenog sustava

Sport activity at patients with myocarditis and pericarditis

Mycarditis and pericarditis may be related with sudden cardiac death/cardiac arrest (SCD/CA) in athletes, not exclusively in those with reduced left ventricular systolic function, but also in subjects with normal cardiac function related to arrhythmias generated in the area of myocardial necrosis and scar. The diagnosis is based on a complete cardiac evaluation (12-lead ECG, echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy). In this review, we outline the latest recommendations published by the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC) on sport activity with these patients. It offers recommendations for practicing cardiologists and sport physicians for safe participation in competitive sport at professional and amateur level. Participation in competitive sport should be considered on an individual basis, after the evaluation of the disease characteristics and risk determinants, and complete resolution of the inflammatory process

Sport i slobodno vrijeme u bolesnika s kardiomiopatijom

Cardiomyopathy (hypertrophic, dilated, left ventricular non-compaction and arrhythmogenic cardio- myopathy) is primarily a genetic disease associated with an increased risk of potentially fatal cardiac arrhythmias and sudden death/cardiac arrest during exercise. The diagnosis of cardiomyopathy is based on complete cardiac evaluation with detailed personal and family history, 12-lead ECG, echocardiogram, cardiac magnetic resonance imaging (CMRI), stress-test- ing, genetic testing and counseling. The differentiation between the physiological adaptation to exercise and cardiomyopathy is of the mutual importance. In this review, we outline the latest recommendations published by the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC) on sport and leisure-time physical activity in patients with cardiomyopathy. It offers recommendations for practicing cardiologists and sport physi- cians managing athletes with cardiomyopathies and provides advice for safe participation in competitive sport at professional and amateur level, as well as in a leisure-time physical activity.Kardiomiopatija (hipertrofijska, dilatacijska, hipertrabekulirana lijeva klijetka, aritmogena kardio- miopatija) je primarno genetska bolest povezana s povećanim rizikom potencijalno fatalnih kardijal- nih aritmija i iznenadnom smrću/kardijalnim arestom tijekom vježbanja. Dijagnoza kardiomiopatije bazirana je na kompletnoj kardiološkoj obradi s detaljnom osobnom i obiteljskom anamnezom, učinjenim elektrokardiogramom, ultrazvukom srca, magnetskom re- zonancijom srca, stres testiranjem, genetskim testiranjem i savjetovanjem. Razlikovanje fiziološke prilagodbe srca na vježbanje od kardiomiopatije je od neobične važnosti. U ovom pregledu donosimo najnovije preporuke Sekcije za sportsku kardiologiju pri Europskom drušvu za preventivnu kardiologiju (engl. EAPC) o sportskoj i rekreativnoj fizičkoj aktivnosti u bolesnika s kardiomiopatijom. Ona sadrži preporuke za kardiologe i sportske liječnike koji se bave sportašima s kardiomiopatijama i donosi savjete o sigurnom participiranju u kompetitivnom sportu na profesionalnoj i amaterskoj razini, kao i kod rekreativne fizičke aktivnosti