Infections of the Female Lower Genital Tract

Infekcije donjeg dijela genitalnog trakta žene i simptomi koje one izazivaju (pojačani iscjedak, svrbež i žarenje ili peckanje) spadaju u najčešće ginekološke probleme i najčešći su razlozi posjeta ginekologu. U infekcije donjeg dijela genitalnog trakta žene ubrajamo cervicitis, vaginitis ili colpitis i vulvitis. Najvažnije infekcije cerviksa danas su klamidijski cervicitis kao ishodišna točka zdjelične upalne bolesti s mogućom posljedičnom neplodnošću te infekcija onkogenim tipovima HPV-a kao nedvojbenim etiološkim čimbenikom karcinoma cerviksa. Ove su infekcije zbog svog izrazitog značenja obrađene u zasebnim poglavljima, a u ovom su radu opisane infekcije rodnice i stidnice koje zajedničkim imenom opisujemo kao vulvovaginitis. Tri najčešće su: infekcija kandidom albikans, trihomonasom vaginalis (TV) i gardnerelom vaginalis (GV). Ove se infekcije mogu dobiti spolnim kontaktom, ali ne nužno. Candida albicans je uvjetno patogena i u 20–25% žena bez simptoma nađe se u rodnici kao saprofi t. Umnoži se i uzrokuje upalu u slučajevima slabosti obrambenog sustava rodnice, odnosno povišenja pH rodnice. Porast pH rodnice je nuždan preduvjet i za infekciju TV-om i GV-om.Infections of the female lower genital tract and the related symptoms (increased discharge, itching, burning) belong to the most common gynecological problems, and they are the most frequent reason to visit a gynecologist. Lower genital tract infections include cervicitis, vaginitis or colpitis, and vulvitis. Nowadays, the most important cervical infections are chlamydial cervicitis, as the primary reason for pelvic infl ammatory disease with possible infertility, and infection with oncogenic types of HPV, being an undoubted ethiologic factor for cervical carcinoma. Due to their importance, these infections are elaborated in separate chapters. This article describes vaginal and vulval infections, i.e. vulvovaginitis. The three most common are Candida albicans, Trichomonas vaginalis (TV) and Gardnerella vaginalis (GV) infections. These infections can be sexually transmitted, but not necessarily. Candida albicans may be pathogen and can be found as saprophyte in the vagina of about 20-25% women without any symptoms. It multiplies and causes infl ammation in the case of the impaired vaginal immune system or increased pH. An increase in vaginal pH is also a prerequisite for TV and GV infections

Importance of Prevention of Sexually Transmitted Diseases

Spolno prenosive bolesti (SPB) zarazne su bolesti koje se prenose bilo kojim oblikom spolnog kontakta. Globalni su javnozdravstveni problem zbog epidemijske proširenosti, mnogobrojnih komplikacija i golemih troškova koje zdravstveni sustav i pojedinci izdvajaju za njihovo liječenje. Prema podacima Svjetske zdravstvene organizacije godišnje se u svijetu registrira oko 250 milijuna novih slučajeva SPB-a od čega oko 7 milijuna novoinficiranih osoba virusom humane imunodeficijencije, oko 50 milijuna novoinficiranih osoba Chlamydiom trachomatis te oko 2,5 milijuna novoregistriranih infekcija virusom B hepatitisa. Najvažnije komplikacije SPB-a su povećana učestalost karcinoma cerviksa, tubarne neplodnosti, urinarnih infekcija i njihovih komplikacija, muške neplodnosti zbog oštećenja spermatogeneze i povećana učestalost kasnih spontanih pobačaja i prijevremenih porođja. Prevencija i kontrola spolno prenosivih infekcija temelji se na edukaciji mladih prije stupanja u spolne odnose te na početku njihova spolnog života, detekciji inficiranih asimptomatskih osoba, efikasnoj dijagnostici i terapiji inficiranih simptomatskih osoba, pronalaženju i liječenju svih spolnih partnera inficiranih osoba i imunizaciji vakcinacijom.Sexually transmitted diseases (STD) are infectious diseases transmitted by any kind of sexual contact. They are a global public health problem, due to epidemiological distribution, manifold complications and enormous costs required from the health system and individuals for their treatment. According to the WHO data, in the world is annually registered about 250 million of new STD cases, out of which 7 million are persons newly infected with human immunodeficiency virus, about 50 million infected with Chlamydia trachomatis, and about 2.5 million of newly registered virus B hepatitis infections. The most important complications of sexually transmitted diseases are: the increased occurencee of cervical carcinoma, tubal infertility, greater incidence of urinary infections and their complications, increased frequency of male infertility due to damaged spermatogenesis, as well as higher frequency of late spontaneous abortions and premature births. Prevention and control of sexually transmitted infections is based on education of the young before entering sexual intercourses and at the beginning of their sexual life, on detection of infected asymptomatic persons, efficacious diagnostics and therapy of infected symptomatic persons, as well as on identifying and treating of all sexual partners of infected patients and immunization by vaccination

Importance, incidence and treatment of bacterial vaginosis during pregnancy

Cilj ovog rada je podsjetiti na bakterijsku vaginozu (BV) kao jedan od mogućih uzroka prijevremenog prsnuća plodovih ovoja i prijevremenog poroda, te njeno liječenje u svrhu poboljšanja ukupnog perinatalnog ishoda, odnosno daljeg snižavanja perinatalnog mortaliteta koji je u Republici Hrvatskoj za 2008. god. iznosio 4,6‰ i ima stalni trend snižavanja od 2001. godine. BV je najžešći uzročnik pojačanog iscjetka bez drugih simptoma upale kao što su peckanje, žarenje i svrbež i ne uzrokuje dizurične tegobe. Dijagnosticira se tijekom pregleda u zrcalu prema Amselovim kriterijima, a lijek izbora u liječenju je metronidazol u drugom i trećem trimestru trudnoće. U radu je prikazana epidemiološka studija provedena u ginekološkoj ambulanti Doma zdravlja Zagreb- -Centar na 123 trudnice u kojih je na|ena ukupna učestalost BV od 21,14% (26 ispitanica) od čega simptomatskih BV kod 17 ispitanica (13,82%) i asimptomatskih kod 9 ispitanica (7,31%). Prema CDC smjernicama trudnice sa simptomatskom BV su u drugom i trećem trimestru trudnoće liječene metronidazolom, a asimptomatske nisu pripadale skupini visokorizičnih trudnica za prijevremeni porod i kod njih nije uključena terapija.The paper aims to examine bacterial vaginosis (BV) as one of the possible causes of premature rupture of membranes and preterm delivery in order to improve the overall perinatal outcome by further reducing the perinatal mortality rate. In the Republic of Croatia this rate equalled 4.6 ‰ in 2008 and has been on a downward trend ever since 2001. BV is the most frequent cause of increased discharge that is not accompanied by other inflammation symptoms, such as burning and itching, and it causes no urinary problems. The diagnosis is made through speculum examination according to Amsel\u27s criteria, and metronidazole is the drug of choice for treatment in the second and third trimester of pregnancy. This paper presents an epidemiological study conducted on 123 pregnant women at the gynaecology department of the Health Centre Zagreb. The study showed that the overall incidence of BV was 21.14% (26 subjects), of whom 17 subjects (13.82%) had symptomatic BV and 9 subjects (7.31%) had asymptomatic BV. According to the CDC guidelines, pregnant women with symptomatic BV were treated with metronidazole in the second and third trimester of pregnancy, while asymptomatic patients who were not at high risk for preterm delivery were therefore not treated

Menstrual Cycle Characteristics and Disorders

Poremećaji menstruacijskog ciklusa najčešći su ginekološki problemi u adolescentno doba. Prva menstruacija (menarche) najočitiji je znak uspostavljanja funkcije jajnika, odnosno osi hipotalamus–hipofiza–jajnici. Ako se prva menstruacija ne pojavi do 16. godine života uz razvijene spolne osobine ili se ne pojavi do 14. godine života uz odsutnost svih spolnih osobina, govorimo o primarnoj amenoreji i treba ispitati njezin uzrok. Povremeni izostanak menstruacije tijekom spolnog sazrijevanja, koje traje 5 godina od prve menstruacije, normalna je pojava i ne traži posebno ispitivanje i liječenje. Davanje hormonskih kontracepcijskih tableta u tom razdoblju je pogrešno, jer se time uplećemo u fiziološki proces uspostavljanja osi hipotalamus– hipofiza–jajnici. Rezultat nekritički propisanih hormonskih kontracepcijskih tableta u adolescentno doba mogu biti dugotrajne, tzv. “post pill amenorrhoeae”. Za regulaciju ciklusa je bolje, ako je uopće potrebno, propisati samo gestagenski preparat. Adolescentno doba je doba spolnog, ali i psihičkog sazrijevanja, doba kada se na stresne događaje reagira burnije, a jak stres može biti razlogom poremećaja menstruacijskog ciklusa. To je doba kada je mlada žena često prenaglašeno usredotočena na vanjski izgled te se podvrgava iscrpljujućim dijetama ili napornim treninzima, a i jedno i drugo može uzrokovati poremećaj ciklusa, najčešće amenoreju. Stoga tijekom spolnog sazrijevanja ako postoji poremećaj ciklusa, trebamo tražiti uzrok poremećaja, a ne uvoditi olako hormonsku terapiju. Katkad je dovoljno mladoj pacijentici objasniti uzrok problema ili ju uputiti psihologu. Izuzetak je juvenilna menometroragija kada visokim dozama estrogensko-progesteronskih tableta moramo zaustaviti krvarenje.Menstrual cycle disorders are the most common gynecological problem in adolescence. The first menstruation (menarche) is the most obvious sign of ovarian function, i.e. the hypothalamic-pituitary-gonadal interaction. Evaluation is indicated in primary amenorrhea, i.e. in case of the absence of menarche by age 16 in girls with evidence of puberty or in case of its absence by age 14 in those with no evidence of puberty. The occasional absence of menstruation during sexual maturation, a period which lasts for five years following menarche, is normal and does not require any evaluation or treatment. The administration of hormonal contraceptives is wrong in this period, because it interferes with the physiological establishment of the hypothalamic-pituitary-gonadal interaction. The uncritical administration of hormonal contraceptives in adolescence may result in long-term amenorrhea, i.e. the so-called post pill amenorrhea. If necessary, it is more advisable to administer gestagens to regulate the menstrual cycle. Adolescence is a period of both sexual and mental development. Adolescents react more strongly to stressful events, and a strong stress may be a reason for menstrual cycle disorders. This is a period when a young woman is too focused on her physical appearance, or follows an exhausting diet or a strenuous exercise program, which may both cause cycle irregularities and most often amenorrhea. Therefore, the cause of any cycle disorder during sexual maturation should be investigated, rather than introducing hormonal therapy. Sometimes it is sufficient to explain a young patient the cause of the problem or refer her to a psychologist. Juvenile menometrorrhagia is an exception because menstrual bleeding must be stopped by the administration of high doses of estrogen-progesterone tablets

Current Status of Iodine Intake in Croatia – The Results of 2009 Survey

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program formonitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 mg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7–10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N=101) and the village of Rude (N=56). In the time period 2002–2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 mg/L. Median UIC in pregnant women was 159 mg/L, with 50% of samples below and under 150 mg/L. Median UIC in women of child-bearing age was 136 mg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn’t corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of »silent prophylaxis« in order to avoid iodine excess

Current Status of Iodine Intake in Croatia – The Results of 2009 Survey

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program formonitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 mg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7–10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N=101) and the village of Rude (N=56). In the time period 2002–2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 mg/L. Median UIC in pregnant women was 159 mg/L, with 50% of samples below and under 150 mg/L. Median UIC in women of child-bearing age was 136 mg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn’t corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of »silent prophylaxis« in order to avoid iodine excess

Infections of the Female Lower Genital Tract

Infekcije donjeg dijela genitalnog trakta žene i simptomi koje one izazivaju (pojačani iscjedak, svrbež i žarenje ili peckanje) spadaju u najčešće ginekološke probleme i najčešći su razlozi posjeta ginekologu. U infekcije donjeg dijela genitalnog trakta žene ubrajamo cervicitis, vaginitis ili colpitis i vulvitis. Najvažnije infekcije cerviksa danas su klamidijski cervicitis kao ishodišna točka zdjelične upalne bolesti s mogućom posljedičnom neplodnošću te infekcija onkogenim tipovima HPV-a kao nedvojbenim etiološkim čimbenikom karcinoma cerviksa. Ove su infekcije zbog svog izrazitog značenja obrađene u zasebnim poglavljima, a u ovom su radu opisane infekcije rodnice i stidnice koje zajedničkim imenom opisujemo kao vulvovaginitis. Tri najčešće su: infekcija kandidom albikans, trihomonasom vaginalis (TV) i gardnerelom vaginalis (GV). Ove se infekcije mogu dobiti spolnim kontaktom, ali ne nužno. Candida albicans je uvjetno patogena i u 20–25% žena bez simptoma nađe se u rodnici kao saprofi t. Umnoži se i uzrokuje upalu u slučajevima slabosti obrambenog sustava rodnice, odnosno povišenja pH rodnice. Porast pH rodnice je nuždan preduvjet i za infekciju TV-om i GV-om.Infections of the female lower genital tract and the related symptoms (increased discharge, itching, burning) belong to the most common gynecological problems, and they are the most frequent reason to visit a gynecologist. Lower genital tract infections include cervicitis, vaginitis or colpitis, and vulvitis. Nowadays, the most important cervical infections are chlamydial cervicitis, as the primary reason for pelvic infl ammatory disease with possible infertility, and infection with oncogenic types of HPV, being an undoubted ethiologic factor for cervical carcinoma. Due to their importance, these infections are elaborated in separate chapters. This article describes vaginal and vulval infections, i.e. vulvovaginitis. The three most common are Candida albicans, Trichomonas vaginalis (TV) and Gardnerella vaginalis (GV) infections. These infections can be sexually transmitted, but not necessarily. Candida albicans may be pathogen and can be found as saprophyte in the vagina of about 20-25% women without any symptoms. It multiplies and causes infl ammation in the case of the impaired vaginal immune system or increased pH. An increase in vaginal pH is also a prerequisite for TV and GV infections

Importance, incidence and treatment of bacterial vaginosis during pregnancy

Cilj ovog rada je podsjetiti na bakterijsku vaginozu (BV) kao jedan od mogućih uzroka prijevremenog prsnuća plodovih ovoja i prijevremenog poroda, te njeno liječenje u svrhu poboljšanja ukupnog perinatalnog ishoda, odnosno daljeg snižavanja perinatalnog mortaliteta koji je u Republici Hrvatskoj za 2008. god. iznosio 4,6‰ i ima stalni trend snižavanja od 2001. godine. BV je najžešći uzročnik pojačanog iscjetka bez drugih simptoma upale kao što su peckanje, žarenje i svrbež i ne uzrokuje dizurične tegobe. Dijagnosticira se tijekom pregleda u zrcalu prema Amselovim kriterijima, a lijek izbora u liječenju je metronidazol u drugom i trećem trimestru trudnoće. U radu je prikazana epidemiološka studija provedena u ginekološkoj ambulanti Doma zdravlja Zagreb- -Centar na 123 trudnice u kojih je na|ena ukupna učestalost BV od 21,14% (26 ispitanica) od čega simptomatskih BV kod 17 ispitanica (13,82%) i asimptomatskih kod 9 ispitanica (7,31%). Prema CDC smjernicama trudnice sa simptomatskom BV su u drugom i trećem trimestru trudnoće liječene metronidazolom, a asimptomatske nisu pripadale skupini visokorizičnih trudnica za prijevremeni porod i kod njih nije uključena terapija.The paper aims to examine bacterial vaginosis (BV) as one of the possible causes of premature rupture of membranes and preterm delivery in order to improve the overall perinatal outcome by further reducing the perinatal mortality rate. In the Republic of Croatia this rate equalled 4.6 ‰ in 2008 and has been on a downward trend ever since 2001. BV is the most frequent cause of increased discharge that is not accompanied by other inflammation symptoms, such as burning and itching, and it causes no urinary problems. The diagnosis is made through speculum examination according to Amsel\u27s criteria, and metronidazole is the drug of choice for treatment in the second and third trimester of pregnancy. This paper presents an epidemiological study conducted on 123 pregnant women at the gynaecology department of the Health Centre Zagreb. The study showed that the overall incidence of BV was 21.14% (26 subjects), of whom 17 subjects (13.82%) had symptomatic BV and 9 subjects (7.31%) had asymptomatic BV. According to the CDC guidelines, pregnant women with symptomatic BV were treated with metronidazole in the second and third trimester of pregnancy, while asymptomatic patients who were not at high risk for preterm delivery were therefore not treated

Azithromycin in Treatment of Urogenital and Sexually Transmitted Infections in Women

Azitromicin (Sumamed®, PLIVA) antibiotik je proizveden u Plivinu Istraživačkom institutu. Zahvaljujući svojim iznimnim svojstvima, postao je danas najprodavaniji antibiotik u svijetu i svakako najpropisivaniji antibiotik za liječenje najčešćih bakterijskih spolno prenosivih i urogenitalnih infekcija, jednokratno u dozi od 1 g po. Lijek je izbora za liječenje akutne infekcije Chlamydijom trachomatis, Ureaplasmom urealyticum i Mycoplasmom genitalium. Kliničkom primjenom azitromicina postignut je u svjetskim razmjerima bitan napredak u liječenju SPI. Danas je međutim jasno da u SPI postoje indikacije u kojima je jednokratna primjena 1 g azitromicina nedostatna te se doze i duljina primjene moraju mijenjati. Tako se u liječenju perzistentne klamidijske infekcije primjenjuje u dozi 1x1 g na tjedan tijekom 3 tjedna. I u liječenju zdjelične upalne bolesti preporučuje se terapija tijekom 3 tjedna, najčešće 1x1 g na tjedan tijekom 3 tjedna ili 1x500 mg u iv. infuziji tijekom 1-2 dana, a zatim 250 mg po. do ukupno 7 dana liječenja. U produljenoj primjeni 1x1 g na tjedan tijekom 3 tjedna primjenjuje se i kod postveneričnoga reaktivnog artritisa i Reiterova sindroma.A zithromycin (Sumamed, PLIVA) is an antibiotic discovered in PLIVA’s Research Institute. Thanks to its exceptional properties, it has become the best-selling antibiotic worldwide and the most prescribed antibiotic for the treatment of the most common bacterial sexually transmitted and urogenital infections. Administered in a single 1 g oral dose, azithromycin is a drug of choice for acute infections due to Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma genitalium. At the global level, considerable progress has been made in the treatment of sexually transmitted infections thanks to the clinical use of azithromycin. However, it is clear today that there are some indications where a single 1 g dose is insufficient and that azithromycin strengths and the duration of treatment should be changed. Therefore, azithromycin is administered in a dose of 1 g/week over three weeks in persistent chlamydial infection. A three-week therapy is also recommended in pelvic inflammatory disease, most often 1 g/week over three weeks or 500 mg/day IV over 1 – 2 days, followed by oral 250 mg doses up to 7 days. The long-term administration of 1 g/week over three weeks is also indicated in postvenereal reactive arthritis and Reiter’s syndrome

Current status of iodine intake in Croatia--the results of 2009 survey [Stanje unosa joda u Hrvatskoj - rezultati istraživanja provedenog 2009 godine]

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program for monitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 microg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7-10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N = 101) and the village of Rude (N = 56). In the time period 2002-2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 microg/L. Median UIC in pregnant women was 159 microg/L, with 50% of samples below and under 150 microg/L. Median UIC in women of child-bearing age was 136 microg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn't corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of "silent prophylaxis" in order to avoid iodine excess