Migraine and Stroke

Glavobolja je čest simptom moždanog udara, a primarne glavobolje javljaju se kao čest komorbiditet. Migrena je primarna glavobolja od koje pate uglavnom mlađe žene i čija se prevalencija povećava do 50. godine života. Vjerojatnost razvoja ishemijskoga moždanog udara veća je u mlađih žena koje boluju od migrena s aurom. Genetika igra bitnu ulogu u patofiziologiji migrene i ishemijskoga moždanog udara (IMU), prvenstveno kodirajući proteine koji reguliraju funkciju endotela krvnih žila i produkciju čimbenika zgrušavanja krvi. Od rizičnih čimbenika valja spomenuti pretilost, hiperlipidemiju, hiperglikemiju i pušenje, kao i primjenu oralnih kontraceptiva. Neki kardijalni čimbenici, kao što je perzistentni foramen ovale, povećavaju rizik za razvoj migrene s aurom i ishemijskoga moždanog udara. Kako svi ovi nabrojani čimbenici utječu na samu patofiziologiju migrene i IMU, još je predmet istraživanja. Od ostalih vrsta cerebrovaskularnih bolesti postoje naznake da je i hemoragijski cerebrovaskularni inzult češći u mlađih žena s migrenom, iako su istraživanja još uvijek kontradiktorna. Ono što je ipak vidljivo je da žene koje imaju migrenu s aurom, te dobiju neki oblik hemoragijskoga cerebrovaskularnog inzulta, imaju i veću vjerojatnost lošijeg ishoda u vidu smrtnosti ili značajne invalidnosti. Migrene su češće i u nekim drugim cerebrovaskularnim bolestima, kao što su disekcija cervikalnih arterija, te u bolestima malih krvnih žila mozga, gdje presudan utjecaj imaju genetske promjene. Prisutnost vaskularne bolesti ograničava primjenu akutne i profilaktičke terapije migrene zbog vazokonstrikcijskog učinka. Mjere za sprječavanje moždanog udara u bolesnika s migrenom usmjerene su na kontroliranje čimbenika rizika.Headache is a common symptom of stroke, and primary headaches occur as a common comorbidity. Migraine is a primary headache that mainly affects younger women and whose prevalence increases up until the age of 50. The likelihood of developing an ischemic stroke is higher in younger women who suffer from migraines with aura. Genetics also plays an important role in the pathophysiology of migraine and stroke, primarily encoding proteins that regulate vascular endothelial function and the production of blood clotting factors. Risk factors include obesity, hyperlipidemia, hyperglycemia and smoking, as well as the use of oral contraceptives. Some cardiac factors, such as persistent foramen ovale, increase the risk of developing migraine with aura and cerebrovascular disease. How all these factors affect the very pathophysiology of migraine and cerebrovascular disease is still the subject of research. There are indications that hemorrhagic stroke is also more common in younger women with migraine, although research is still contradictory. What is evident, however, is that women who have a migraine with aura, and suffer a form of hemorrhagic stroke, are also more likely to have a worse outcome in terms of mortality or significant disability. Migraines are more common in some other cerebrovascular diseases such as dissection of the cervical arteries, and in cerebral small blood vessel diseases, where genetic changes are of major influence. The presence of vascular disease limits the use of acute and prophylactic migraine therapy due to its vasoconstrictive effect. Measures to prevent stroke in migraine patients are aimed at controlling risk factors

Migraine and Stroke

Glavobolja je čest simptom moždanog udara, a primarne glavobolje javljaju se kao čest komorbiditet. Migrena je primarna glavobolja od koje pate uglavnom mlađe žene i čija se prevalencija povećava do 50. godine života. Vjerojatnost razvoja ishemijskoga moždanog udara veća je u mlađih žena koje boluju od migrena s aurom. Genetika igra bitnu ulogu u patofiziologiji migrene i ishemijskoga moždanog udara (IMU), prvenstveno kodirajući proteine koji reguliraju funkciju endotela krvnih žila i produkciju čimbenika zgrušavanja krvi. Od rizičnih čimbenika valja spomenuti pretilost, hiperlipidemiju, hiperglikemiju i pušenje, kao i primjenu oralnih kontraceptiva. Neki kardijalni čimbenici, kao što je perzistentni foramen ovale, povećavaju rizik za razvoj migrene s aurom i ishemijskoga moždanog udara. Kako svi ovi nabrojani čimbenici utječu na samu patofiziologiju migrene i IMU, još je predmet istraživanja. Od ostalih vrsta cerebrovaskularnih bolesti postoje naznake da je i hemoragijski cerebrovaskularni inzult češći u mlađih žena s migrenom, iako su istraživanja još uvijek kontradiktorna. Ono što je ipak vidljivo je da žene koje imaju migrenu s aurom, te dobiju neki oblik hemoragijskoga cerebrovaskularnog inzulta, imaju i veću vjerojatnost lošijeg ishoda u vidu smrtnosti ili značajne invalidnosti. Migrene su češće i u nekim drugim cerebrovaskularnim bolestima, kao što su disekcija cervikalnih arterija, te u bolestima malih krvnih žila mozga, gdje presudan utjecaj imaju genetske promjene. Prisutnost vaskularne bolesti ograničava primjenu akutne i profilaktičke terapije migrene zbog vazokonstrikcijskog učinka. Mjere za sprječavanje moždanog udara u bolesnika s migrenom usmjerene su na kontroliranje čimbenika rizika.Headache is a common symptom of stroke, and primary headaches occur as a common comorbidity. Migraine is a primary headache that mainly affects younger women and whose prevalence increases up until the age of 50. The likelihood of developing an ischemic stroke is higher in younger women who suffer from migraines with aura. Genetics also plays an important role in the pathophysiology of migraine and stroke, primarily encoding proteins that regulate vascular endothelial function and the production of blood clotting factors. Risk factors include obesity, hyperlipidemia, hyperglycemia and smoking, as well as the use of oral contraceptives. Some cardiac factors, such as persistent foramen ovale, increase the risk of developing migraine with aura and cerebrovascular disease. How all these factors affect the very pathophysiology of migraine and cerebrovascular disease is still the subject of research. There are indications that hemorrhagic stroke is also more common in younger women with migraine, although research is still contradictory. What is evident, however, is that women who have a migraine with aura, and suffer a form of hemorrhagic stroke, are also more likely to have a worse outcome in terms of mortality or significant disability. Migraines are more common in some other cerebrovascular diseases such as dissection of the cervical arteries, and in cerebral small blood vessel diseases, where genetic changes are of major influence. The presence of vascular disease limits the use of acute and prophylactic migraine therapy due to its vasoconstrictive effect. Measures to prevent stroke in migraine patients are aimed at controlling risk factors

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope

Influence of Nodal Yield in Individual Neck Dissection Levels on the Survival of Patients With Oral and Oropharyngeal Cancer

Introduction: Nodal yield (NY), or the number of collected and analysed lymph nodes in neck dissection, is one of the variables that could supplement the existing TNM classification in order to better stratify patients and their needs for further treatment. The purpose of this paper was to investigate the importance of NY in individual neck dissection levels and its relation to survival. Materials and methods: A retrospective analysis of medical records of 133 patients regarding primary tumour excision and neck dissection from 2002 to 2013. Seventy-nine patients had a neck dissection divided by levels at the time of surgery and 54 patients had an en bloc resection. Results: In the group of all patients, there was no correlation between NY and survival. In the group of patients who underwent a selective neck dissection, a NY above the median was an indicator of a better disease-specific survival (5-year DSS median NY 95.2%, p = 0.037 log-rank test). The NY of specimens separated by level was significantly higher than the NY of specimens analysed en bloc (median 33 vs 16; p < 0.001, median test). In the group of specimens separated by level, the NY in levels I-II was not associated with survival, but a high NY in levels III-IV in selective neck dissections was an indicator of an improved overall survival (p = 0.05), disease-specific survival (p = 0.022) and disease-free survival (p = 0.05). Conclusion: High NY in patients with specimens separated by levels could be caused by a more precise pathohistological analysis of a smaller sample. A high NY in levels III-IV can be an indicator of a well-performed selective neck dissection and sufficiently treated regional disease and therefore lead to better survival rates. (Kvolik A, Butković J, Zubčić V, Popović Z, Leović* D. Influence of Nodal Yield in Individual Neck Dissection Levels on Survival of Patients With Oral and Oropharyngeal Cancer, Comorbidity and Chronic Therapy. SEEMEDJ 2020; 4(1); 14-24

Levels of LDL-cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus

Aim: The study aimed to examine LDL cholesterol, triglyceride and urate levels in patients of both sexes with type 2 diabetes mellitus (DM2T) in family medicine offices and to examine whether there is a difference in these parameters between obese patients and patients with normal body weight with DM2T, and between patients with and without manifest cardiovascular diseases. Participants and methods: The study was organized as a cross-sectional study. It included 136 participants of both sexes diagnosed with DM2T, who were divided into groups of patients with or without adiposity and into groups of patients with or without experience of cardiovascular event. General and demographic data were collected, as well as data on experiencing cardiovascular events and levels of LDL cholesterol, triglycerides and urates. Results: The average LDL cholesterol level was 2.93 mmol/L, the average triglyceride level was 1.65 mmol/L and the average urate level was 326.36 µmol/L. Only 12.5% of participants reached target LDL cholesterol levels, while levels of triglycerides and urates were within recommended limits. 24.3% of participants had experienced cardiovascular events and 39.7% of participants were obese. There was no significant difference in levels of LDL cholesterol, triglycerides and urates in participants who had experienced a cardiovascular event and those who had not. There was a significantly higher concentration of triglycerides in obese patients than in patients with normal body weight (p = 0.005). Conclusion: In addition to regulation of glycaemia in patients with DM2T, statin doses should be increased in order to reach the target levels of LDL cholesterol. When it comes to obese patients, education courses on physical activity and diet should be conducted more often and, if necessary, fibrates should be included in therapy in order to reduce additional cardiovascular risks. (Šojat* D, Pirić M, Klarić M, Šapina M, Popović Z, Bačun T. Levels of LDL Cholesterol, Triglyceride and Urate in Patients With Type 2 Diabetes Mellitus. SEEMEDJ 2020; 4(1); 32-39

Učestalost deformiteta stopala u djece mlađe školske dobi u Slavoniji

The aim of this study was to determine the occurrence of foot deformity in urban children, as well as possible generational and gender differences using graphic and angular methods. The sample of study subjects included 426 1st to 4th grade schoolchildren (7 to 10 years of age). Out of the total number of schoolchildren, 181 children (88 boys and 93 girls) were measured in 2005, and 244 children (122 boys and 123 girls) in 2011. The results indicated that the largest number of children had no noticeable foot deformity, flat foot in particular. Likewise, there were no gender differences in the occurrence of flat foot and no statistically significant differences in the incidence between the children measured in 2005 and 2011. Due to the problems that foot deformities could cause, it is necessary to continue monitoring foot arches of young schoolchildren in order to intervene on time and prevent the occurrence of deformities by appropriate therapeutic procedures.Cilj istraživanja bio je odrediti pojavu deformacije stopala djece u urbanoj sredini, kao i moguće razlike prema dobi i spolu primjenom grafičke i kutne metode za mjerenje deformacije stopala. Uzorak ispitanika obuhvatio je 426 djece 1. do 4. razreda, od čega je 181 (88 dječaka i 93 djevojčice) ispitano u 2005. godini, a 244 djece (122 dječaka i 123 djevojčice) u 2011. godini. Rezultati su pokazali da najveći broj djece nije imao vidljive deformacija stopala, osobito spušteno stopalo. Nisu pronađene statistički značajne razlike u visini lukova stopala između dječaka i djevojčica niti između dvije godine mjerenja. Zbog ozbiljnih medicinskih problema koje mogu uzrokovati deformacije stopala kao što je spušteno stopalo potrebno je kontinuirano mjeriti lukove stopala djece mlađe školske dobi kako bi se pravodobno moglo intervenirati i spriječiti nastanak deformacija odgovarajućim terapeutskim postupcima

Do Nutrition Habits Influence on Parkinson`\u27s Disease Clinical Presentation?

Introduction: Parkinson\u27s disease (PD) is the second most common neurodegenerative disorder characterized with alpha-synuclein pathology. For the majority of patients, except for some genetic forms, etiology is still unknown. There are some implications that food intake and gut microbiota could contribute to PD. Aim: The aim of this paper is to analyze the influence of protein, fruit and vegetable intake on the clinical presentation of idiopathic Parkinson disease Patients and methods: Patients with idiopathic PD were surveyed for demographic data and nutritional habits in regards to protein, fruit and vegetable intake. Motor symptoms were evaluated using the Unified Parkinson Disease Rating Scale (UPDRS) part III and IV, cognitive impairment using Mini Mental State Examination (MMSE) and depression using Beck Depression Inventory (BDI). Results: We have analyzed data of 96 patients. Patients using fewer dairy products have more often tremor type of PD (p<0.040). We did not find any differences in severity of motor symptoms, disease stage, age when disease start, frequency of motor complications and fluctuation of therapy, depression and cognitive impairment according to protein, fruit and vegetable ingestion. Conclusion: Higher intake of dairy products could influence the appearance of less favorable forms of Parkinson\u27s disease (rigor type). Protein, fruit and vegetable intake do not influence the disease appearance, severity of motor symptoms, motor fluctuation and complication of therapy, disease stage, the appearance of cognitive impairment nor depression in Parkinson\u27s disease patients. (Tomic S, Pekic V, Popijac Z, Pucic T, Petek Vinkovic M, Popovic Z, Resan B, Gilman Kuric T. Do Nutrition Habits Influence the Clinical Presentation of Parkinson’s Disease?. SEEMEDJ 2019; 3(2); 11-21

Sleep Disorders in Cervical Dystonia, Parkinson’s Disease and Depression – What Is the Difference?

Introduction: Sleep disorders are among the most common non-motor symptoms in patients with cervical dystonia (CD), Parkinson\u27s disease (PD), and depression. The study aimed to assess the prevalence and characteristics of sleep disorders in patients with cervical dystonia compared to healthy controls, patients with Parkinson\u27s disease, and patients with depression. Methods: In this cross-sectional study, we evaluated 122 patients (30 control patients, 30 with cervical dystonia, 32 with Parkinson\u27s disease, and 30 with depression). Demographic data were collected. All of them, except for the depression group, were tested for depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Sleep disorders were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Statistical significance was defined at α=0.05. Results: Patients with cervical dystonia differed from the healthy control group in terms of PSQI score and some subscales. The depression group differed in most PSQI subscales when compared to the patients with Parkinson\u27s disease and cervical dystonia, while the latter two groups of patients differed only in the duration subscale. Patients with Parkinson\u27s disease differed from other groups of patients only in one subscale - daytime sleepiness. Conclusion: Cervical dystonia patients suffer from more sleep disturbances when compared to healthy controls. There are differences in the frequency and extent of sleep disturbances with less pronounced symptoms in patients with cervical dystonia and Parkinson\u27s disease, while patients with depression present the most pronounced symptoms. Symptoms of depression and anxiety correlate with sleep disturbances in patients with Parkinson\u27s disease and cervical dystonia. Patients with cervical dystonia do not experience daytime sleepiness problems. (Tomic S, Degmecic D, Gjoni F, Dumencic I, Milanovic S, Gilman Kuric T, Popovic Z, Mirosevic Zubonja T. Sleep Disorders in Cervical Dystonia, Parkinson’s Disease and Depression – What is the Difference? SEEMEDJ 2020; 4(2); 35-47

Utjecaj zračnog prijevoza na kvalitetu uzoraka krvi

The aim of this study was to establish the impact of air transport on blood samples packaged with and without cooling elements and effect of outdoor temperature on sample quality. Venous samples from 38 blood donors in winter and 36 in summer were tested for hemolysis and complete blood count. One tube per subject was kept in controlled conditions at +4 °C. Two sets of tubes were sent by plane from Zagreb to Brussels, one with and one without cooling elements, and another two sets were sent to London following the same principle. Packages with cooling elements were stored in controlled warehousing conditions at airports (+2 °C to +8 °C), whereas packages without cooling elements were stored in ambient warehouse conditions. Data loggers were used for temperature monitoring. Our research revealed statistically significant differences in several hematologic parameters when comparing the samples stored in controlled laboratory conditions and those transported by plane. These differences were more pronounced in the samples transported during the summer. Transport conditions without cooling elements had additional negative impact on the sample quality. Transport of samples using cooling elements and controlled warehousing conditions at airports are sometimes not sufficient to maintain laboratory storage conditions.Cilj ovog istraživanja bio je utvrditi utjecaj zračnog prijevoza na uzorke krvi pakirane s rashladnim elemenatima i bez njih, kao i utjecaj vanjske temperature na kvalitetu uzorka. U venskim uzorcima 38 darivatelja krvi tijekom zime i njih 36 tijekom ljeta određeni su stupanj hemolize i kompletna krvna slika. Jedan uzorak po ispitaniku ostavljen je u kontroliranim uvjetima na +4 °C. Dva seta uzoraka poslana su zrakoplovom iz Zagreba u Bruxelles, jedan s rashladnim elemenatima i jedan bez njih, a druga dva seta poslana su u London po istom načelu. Pakovanja s rashladnim elementima čuvana su u kontroliranim skladišnim uvjetima u zračnim lukama (+2 °C do +8 °C), dok su pakovanja bez rashladnih elemenata čuvana u ambijentnim skladišnim uvjetima. Uređaji za kontinuirano mjerenje temperature korišteni su za nadzor temperature tijekom transporta. Naše istraživanje otkrilo je statistički značajne razlike u nekoliko hematoloških parametara kada se uspoređuju uzorci pohranjeni u kontroliranim laboratorijskim uvjetima i oni koji se transportiraju zračnim prijevozom. Te su razlike bile izraženije u uzorcima transportiranim tijekom ljeta. Uvjeti transporta bez rashladnih elemenata imali su dodatni negativni utjecaj na kvalitetu uzoraka. Transport uzoraka pomoću rashladnih elemenata i kontrolirani uvjeti skladištenja u zračnim lukama ponekad nisu dovoljni za održavanje laboratorijskih uvjeta skladištenja