Acta Medica Croatica最新文献

{"title":"[PATHOPHYSIOLOGY OF THE CARDIORENAL SYNDROME].","authors":"I Balint,&nbsp;J Vučak,&nbsp;N Bašić-Marković,&nbsp;D Klarić,&nbsp;V Amerl Šakić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiorenal syndrome, a complex pathophysiological disorder of both the heart and kidneys, is a condition in which acute\u0000or chronic damage to one organ can lead to acute or chronic dysfunction of the other organ. Depending on primary organ\u0000dysfunction and disease duration, there are five different types of cardiorenal syndrome. Type 1 cardiorenal syndrome\u0000(acute cardiorenal syndrome) is defined as acute kidney injury caused by sudden decrease in heart function. Type 2\u0000cardiorenal syndrome (chronic cardiorenal syndrome) refers to chronic kidney disease linked to chronic heart failure. Type\u00003 cardiorenal syndrome (acute renocardial syndrome) is caused by acute kidney injury that leads to heart failure. Type 4\u0000cardiorenal syndrome (chronic renocardial syndrome) includes chronic heart failure due to chronic kidney disease. Type\u00005 cardiorenal syndrome (secondary cardiorenal syndrome) is reversible or irreversible condition marked by simultaneous\u0000heart and kidney insufficiency, as a result of multiorgan disease such as sepsis, diabetes mellitus, sarcoidosis, amyloidosis,\u0000etc. The pathophysiological patterns of cardiorenal syndrome are extremely complicated. Despite numerous publications,\u0000perplexed physiological, biochemical and hormonal disturbances as parts of the main pathogenic mechanisms of\u0000cardiorenal syndrome remain obscure. Even though there are guidelines for the treatment of patients with heart failure\u0000and chronic kidney disease, similar guidelines for the treatment of cardiorenal syndrome are lacking. In everyday practice,\u0000it is crucial to diagnose cardiorenal syndrome and use all diagnostic and therapeutic procedures available to prevent or\u0000alleviate kidney and heart failure.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35559234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[USE OF STATINS IN PATIENTS WITH CHRONIC KIDNEY DISEASE TO PREVENT\u0000CARDIOVASCULAR DISEASE].","authors":"T Zavidić,&nbsp;B Lodeta,&nbsp;Đ Lovrinić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is one of the leading public health issues due to frequent and serious complications. Once\u0000the function of kidneys is disrupted, regardless of etiology, there are numerous factors that can speed up decrease of\u0000glomerular filtration rate, including hypertension, proteinuria and dyslipidemia. Statins are widely used in primary and\u0000secondary prevention of cardiovascular diseases in general population. Clinical advantages of statins in CKD patients\u0000are not as clear. The aim of this paper is to present lipid status in CKD patients and indications for statin therapy with the\u0000aim to reduce cardiovascular risk in this group of patients. CKD is a well-known independent risk factor in cardiovascular\u0000events, but professional associations issuing guidelines differ in the approach to treatment of dyslipidemia. The results\u0000of some studies indicate that treatment with statins may slow down the rate of kidney function reduction in patients with\u0000mild to moderate kidney damage, whereas other studies deny this effect. Furthermore, CKD patients have a higher risk\u0000of side effects, in part due to the reduced kidney excretion, polypharmacy, and numerous other comorbidities. Family\u0000physician has the role of providing preventive measures, with focus on appropriate treatment of patients with hypertension\u0000or diabetes, as the most common cause of CKD, and timely detection of CKD in initial stage.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CARDIORENAL SYNDROME: CLINICAL FEATURES, EARLY DIAGNOSIS AND\u0000TREATMENT AT FAMILY MEDICINE].","authors":"B Bergman Marković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The interdependent damage to the heart and kidney organ systems is defined as cardiorenal syndrome, a complex\u0000pathophysiological disorder of the heart and kidney in which acute or chronic dysfunction of one organ can lead to acute\u0000or chronic damage to the other. Identification and early diagnosis of some subtypes of cardiorenal syndrome very often\u0000begin at family physician office, however, the use of simple and reliable diagnostic procedures such as MICE score using\u0000ECG and biomarkers has not been implemented yet. The clinical picture, diagnosis and treatment vary according to the 5\u0000cardiorenal syndrome subtypes, as described herein. Rational diagnosis of heart failure at family medicine office should\u0000include biomarkers (BNP and NT-pro BNP) before performing ultrasound of the heart, while for kidneys creatinine and\u0000estimated glomerular filtration rate are still in use, but not cysteine C and NGAL. Diagnostic procedure for suspected heart\u0000failure at family medicine office should include kidney function estimate and vice versa. Access to treatment of cardiorenal\u0000syndrome differs depending on the specialty to which the patient is referred first, i.e. consultant examination, cardiologist\u0000or nephrologist. A multidisciplinary approach to treatment of cardiorenal syndrome is still lacking.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[DIAGNOSTIC APPROACH TO PATIENTS WITH CHRONIC KIDNEY DISEASE].","authors":"J Vučak,&nbsp;E VučK,&nbsp;I Balint","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>According to consensus definition, chronic kidney disease (CKD) includes urinary excretion of albumin >30 mg/day and/\u0000or reduction in kidney function defined as a decrease in estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2\u0000for a period longer than three months, in the presence of kidney tissue damage verified by imaging or histologic methods.\u0000In developed world, the first cause of CKD is diabetes, followed by arterial hypertension, and the less frequent causes\u0000are inflammatory disease (glomerulonephritis, interstitial nephritis) and congenital condition (polycystic kidney disease).\u0000Currently, there is valid classification under the acronym CGA, where C stands for the cause, G for glomerular filtration rate\u0000(GFR category) and A for the level of albuminuria category. In early stages, patients usually have no symptoms but there are\u0000changes in creatinine values, estimated GFR (eGFR) reduction and presence of albuminuria, especially in patients at risk.\u0000Determining the grade of renal impairment is important because of different approaches to treatment, monitoring, expected\u0000complications, and patient education. Due to improved diagnostic methods and population aging, CKD is diagnosed ever\u0000more increasingly. Family physicians should be familiar with the basic principles of screening and diagnosis of CKD to\u0000provide them with appropriate care in collaboration with secondary and tertiary health care.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[END-STAGE RENAL DISEASE, DIALYSIS TREATMENT AND MANAGEMENT OF\u0000COMORBIDITY].","authors":"D Klarić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic kidney disease is clearly defined as a state of damaged kidney function lasting for more than three months.\u0000Changes manifest in serum and urine pathological findings with frequent morphological changes in the kidneys and\u0000reduction in glomerular filtration. The aim is to show the possibilities of renal replacement therapy and waste related\u0000disease during dialysis treatment. The methods are based on strong evidence and guidelines. Glomerular filtration is\u0000the basis in evaluating the stage of chronic kidney disease. Based on the measures of glomerular filtration reduction,\u0000chronic kidney disease is classified into five stages, thus facilitating approach to treatment of particular groups of patients\u0000depending on the level of glomerular filtration damage. Kidney function can be replaced by dialysis or transplantation and\u0000in certain cases symptomatically if the patient refuses dialysis treatment. Malnutrition, hypertension, kidney anemia and\u0000bone-mineral disease are often present in patients with higher stages of chronic kidney disease, particularly stage 5 and\u0000kidney function replacement by dialysis. In conclusion, timely treatment reduces morbidity and mortality in patients with\u0000chronic kidney disease.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35562510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[PECULIARITIES OF CARE FOR PATIENTS WITH TRANSPLANTED SOLID ORGAN IN\u0000FAMILY MEDICINE].","authors":"I Katić Milošević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transplantation is sometimes the only therapeutic option to treat acute or chronic organ failure. In the care of transplant\u0000patients, there are numerous complications that are caused by powerful immunosuppressive drugs, cardiovascular,\u0000metabolic, and neoplastic diseases. These diseases are associated with significant morbidity and mortality in patients\u0000after transplantation, which will become an important part for supporting the transplant patient care. In the first year\u0000after transplantation, patients have regular contact with transplant center, and family doctor acts as a contact connecting\u0000patients with specialized centers, while also detecting and managing health problems and issues that are not related only\u0000to transplantation. After that, the role of family physicians is becoming ever more important and active in the prevention\u0000of morbidity and mortality in transplant patients by appropriate and timely intervention in detection of side effects of\u0000immunosuppressive therapy and threatening metabolic disorders. The aim of this article is to show the role of family\u0000physician in tracking the welfare of organ transplant patient.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35562513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[URATE AS A POTENTIAL RISK FACTOR OF CARDIOVASCULAR AND RENAL DISEASES].","authors":"M Butković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although asymptomatic hyperuricemia is rather often in laboratory reports, it cannot be considered a disease. Despite the\u0000high prevalence of hyperuricemia in patients with arterial hypertension (AH), chronic kidney disease (CKD), cardiovascular\u0000disease (CVD) or metabolic syndrome, hyperuricemia is not confirmed as a causative factor of these disorders. The aim is\u0000to point to the latest studies of the importance of urate as a possible cardiorenal risk factor. The literature published in 2015\u0000and 2016 was searched for the possible impact of urate level on the development of cardiorenal diseases. The PubMed,\u0000Cochrane, Medline, and UpToDate databases were searched for the literature published between November 2009 and\u0000October 2016 using the following key words: urate, hyperuricemia, cardiovascular disease, and chronic kidney disease.\u0000Causative correlation of hyperuricemia is confirmed only in disorders where deposits of monosodium urate crystals are\u0000present. Results of recent studies do not justify routine use of xanthine oxidase inhibitors in asymptomatic hyperuricemia.\u0000Some studies with small numbers of patients and short follow up report on endothelial function improvement on therapy\u0000with xanthine oxidase inhibitors. Nonpharmacological intervention by changing unhealthy lifestyle is preferred. Treatment\u0000of asymptomatic hyperuricemia in CKD is still debated, and additional studies are necessary to demonstrate the benefit\u0000of lowering urate level in CKD. Family doctors (general practitioners) should be familiar with the recommended approach\u0000to patients with asymptomatic hyperuricemia. Evidence based medicine still does not recommend target determination\u0000of serum urate level for identifying CVD and CKD risk factors. Recent studies suggest the possible effect of uric acid in\u0000cardiorenal diseases and that treatment of asymptomatic hyperuricemia with xanthine oxidase inhibitors may also be\u0000useful in CVD prevention. Additional studies are needed to prove this statement.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35507720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[QUALITY OF LIFE OF DIALYSIS PATIENTS].","authors":"N Mrduljaš-Dujić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Measuring the Health Related Quality of Life (HRQOL) is part of the general concept of quality of life. According to the\u0000survey, quality of life in dialysis patients is significantly lower as compared to general population. The aim is to show the\u0000importance and impact of the quality of life in dialysis patients on treatment outcomes. In October 2016, the MEDLINE\u0000and EBSCO databases were searched for the 2005-2016 period. Kidney transplantation offers better HRQOL as compared\u0000to dialysis, since there is no significant difference in HRQOL between patients on hemodialysis and those on peritoneal\u0000dialysis. Good clinical practice in the treatment of dialysis patients is based on individual approach and on improving the\u0000quality of life, for which collaboration of family doctors and consultant nephrologists is necessary. In daily practice, using\u0000questionnaires on the quality of life of dialysis patients would increase the awareness of this very important segment of\u0000care for dialysis patients because quality of life is an outcome measure of treatment in these patients.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[PARENT’S AND CHILDREN’S BEHAVIOR AND KNOWLEDGE ABOUT ORAL HEALTH].","authors":"M Beljan,&nbsp;Z Puharić,&nbsp;M Žulec,&nbsp;D Borić,&nbsp;K Radičanin Neumuller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Responsible health behavior plays an important role in every individual. Oral health quality results from the level of\u0000information available, attitudes, habits and nutrition. Family is the most important environment where children can acquire\u0000knowledge, attitudes and habits related to oral health. The aim of the study was to compare the habits of parents and\u0000children related to their oral health, and to conclude how parental behavior influences oral health of their children. The\u0000study included 101 parent-child pairs (age 11-15 years), their knowledge and behavior according to their oral hygiene,\u0000fluoro-prophylaxis and nutrition assessed by anonymous questionnaire. Oral health of parents was estimated according to\u0000their tooth loss and compensation, while oral health of children was assessed by dental examination. A total of 101 child-parent\u0000pairs were included. Most children were excellent pupils (43.56%). In the group of parents, most participants were\u0000mothers (73.27%). Most parents had high school education (65.35%) and were employed (61.62%), and most perceived\u0000themselves to be living with average financial situation (86%). A comparable proportion of parents (95%) and children\u0000(87%) believed that it was necessary to wash teeth at least twice a day (p=0.125) and most of them thought it necessary to\u0000brush teeth for 1-3 minutes (57% of children and 57.43% of parents; p=0.599). The majority of children (56%) and parents\u0000(72%) considered it necessary to use dental floss with a toothbrush and toothpaste (p=0.065), while 63% of children and\u000071.72% of parents believed that toothpaste contained fluoride (p=0.156). Most of the parents (72.3%) and children (65.35%)\u0000brushed teeth in the morning and at bedtime (p=0.167) for 1-3 minutes (p=0.098). About 30% of parents and children used\u0000the handler for brushing teeth (p=1). Most children (86.32%) and parents (92.1%) had 3-5 meals a day (p=0.181), and 80%\u0000of them had their teeth examined by a dentist the year before (p=0.658). The children believing that teeth should be brushed\u0000only in the morning have a 3.38-fold greater chance to develop tooth disorders (DMFT >0; p=0.004). Those that do not\u0000know that caries and periodontal diseases can be prevented have a 26.3-fold greater chance to develop caries compared\u0000to those who are aware of it. Children of parents who only brush their teeth in the morning have a 25 times higher chance\u0000of developing CEP >0 as compared with those that brush their teeth after each meal (p=0.016). Children of parents who\u0000give them money to buy snacks are 2.9 times more likely to develop CEP >0 (p=0.01) compared to children without money\u0000for snack. Children of parents who feel that their health is not good have 3.9 times higher chance of developing CEP >0\u0000as compared to those whose parents think they have a neat bite (p=0.017). Oral hygiene in Croatia is still not at a level of\u0000the standards in Western countries. Ignorance about oral hygiene and irresponsible health behavior are the","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39984376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[SURGICAL TREATMENT OF THYROID GLAND IN ELDERLY PATIENTS: OUR EXPERIENCES].","authors":"I Kovačić,&nbsp;M Kovačić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatment\u0000are increasing and so is the number of published papers on the safety and success of some surgical procedures performed\u0000in these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid gland\u0000diseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine between-group\u0000differences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, number\u0000of comorbid diseases and postoperative complications. Analysis of the results justified our decision to divide our patients\u0000into two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%),\u0000whereas malignant, verified and suspected disease was considerably more frequent in group 2 (21.8%), with a significantly\u0000higher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperative\u0000physical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1,\u000056.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical and\u0000non surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrent\u0000laryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can be\u0000considered safe and successful in older age groups, regardless of the between-group differences observed.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39983417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}