The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism.

OBJECTIVE: Subclinical hypothyroidism (SH) is associated with a moderately elevated risk of heart failure events among older adults. The objective of our prospective study was to assess the impact of thyroid hormone replacement therapy (HRT) with low doses of L-thyroxine (6.25-25 µg/day) on left ventricular diastolic function in patients with SH. MATERIALS AND METHODS: 33 patients with SH and 25 healthy controls were involved. All participants underwent standard echocardiography and Doppler imaging at baseline and, the patient group, also after a course of HRT. RESULTS: At baseline, patients with SH showed significantly lower E (0.79 ± 0.22 vs. 0.93 ± 0.19, p < 0.001), E/A ratio (1.19 ± 0.29 vs. 1.31 ± 0.25, p < 0.003), and higher intraventricular septum thickness (IVST) (0.99 ± 0.14 vs. 0.89 ± 0.18, p < 0.001) in comparison with healthy controls. After 6 months of therapy, the E/A ratio underwent significant increase (1.28 ± 0.21 vs. 1.19 ± 0.29, p < 0.001), while the IVS displayed a robust reduction (0.92 ± 0.16 vs. 0.99 ± 0.14, p < 0.001). CONCLUSIONS: HRT with low-dosed L-thyroxine may improve left ventricular diastolic function in patients with SH.

Attitudes, behaviour and knowledge on sexuality among female adolescents in Zagreb, Croatia.

The aim of this study was to estimate the level of knowledge about sexuality, attitudes and sexual behaviour of female adolescents. The study included 194 female students, 117 from Medical High School (MHS) and 77 from General High School (GHS) in Zagreb. Data was collected using an anonymous self-administered questionnaire. In addition to items on personal data (age, parental education etc.), the participants were asked to define terms about sexuality (e.g. menstruation, puberty) the definitions of which are found in biology textbooks for the fifth and eighth grade of primary school. The aim of the third part of the survey was to collect information about attitudes and behaviour of female adolescents. The results showed a low level of knowledge in students of both schools. General High School students showed a higher level of knowledge than their Medical High School peers. One fifth of General High School students and 1/3 of Medical High School students were unable to define the term "menstruation". The majority of adolescents talk about sexuality with their friends, 92.1% of General High School and 81.2% of Medical High School students. Almost 50% of students of both schools would like to talk about sexuality with their school doctor. 6.9% of Medical High School students had at least one sexual intercourse while none of the General High School students had been sexually active at the time of the survey. As the majority of students were not sexually active and results showed a rather low level of knowledge, this seems to be the ideal period for the implementation of educational programs aimed at increasing the level of knowledge, and thus preventing unwanted consequences (STD, pregnancy, abortion, infertility).

[Assessment of heart rate variability in patients after myocardial infarct]. / Procjena varijabilnosti srcanog ritma kod bolesnika s preboljelim infarktom miokarda.

Heart rate variability (HRV) is used for stratification of risk for sudden death due to malignant arrhythmias after myocardial infarction (MI). HRV was analysed in 221 consecutive patients who underwent cardiac rehabilitation within 4 weeks to 3 months after acute MI. Patients with MI had significantly lower all measures of HRV in comparison with control group (SDNN 125 +/- 37 vs. 152 +/- 38 ms, p < 0.0001). Patients with anterior MI had lower overall HRV (SDNN 116 +/- 35 vs. 132 +/- 37 ms, p = 0.001) and higher heart rate than those with inferior MI. Diminished HRV persists 3 months after MI. It is assumed that patients with anterior MI had higher potential risk of malignant arrhythmias and sudden death than those with inferior MI.

[Reversible impairment of renal function during treatment with lisinopril, an ACE-inhibitor (case report)]. / Reverzibilno ostecenje bubrezne funkcije tijekom lijecenja ACE-inhibitorom lizinoprilom (Prikaz bolesnika).

ACE inhibitors are group of drugs whose use over the last ten years has largely expanded. New members of this group of drugs are developed and registered and today in Croatia exist a dozen ACE inhibitors from different pharmaceutical companies like lisinopril, cilazapril, ramipril, trandolapril, enalapril etc. Notable side effects of ACE inhibitors are: hypotension, dry cough, rash, angioneurotical edema, impaired renal function and acute renal failure. The aim of the article was to present a 72 year old patient with reversible impairment of renal function during treatment with ACE inhibitor lisinopril.

The dynamics of soluble Fas/APO 1 apoptotic biochemical marker in acute ischemic stroke patients.

PURPOSE: Until recently, neuronal death in ischemic stroke infarction was ascribed exclusively to necrotic process. However, experimental animal models of cerebral ischemia suggest apoptosis to play a role in the pathogenesis of cerebral infarction. The aim of this study was to determine the level and monitor the dynamics of soluble Fas/APO 1 (sFas/APO 1) in serum and cerebrospinal fluid of acute ischemic stroke patients. MATERIAL AND METHODS: This prospective study included 23 patients with first ever, computed tomography verified acute ischemic stroke and 20 control subjects with other functional neurologic disorders. Serum and cerebrospinal fluid sFas/APO 1 levels were determined on several occasions. Blood samples were obtained on day 1, 3 and 12, and lumbar puncture on day 3 and 12 of disease onset. Quantitative sandwich ELISA method was used on sFas/APO 1 determination. RESULTS: On day 1 of disease onset, serum and cerebrospinal fluid sFas/APO 1 levels were significantly higher in stroke patients as compared to control subjects, and then gradually declined during the period of monitoring. CONCLUSION: Study results confirmed the dynamic pattern of sFas/APO 1 in serum and cerebrospinal fluid of patients with acute ischemic stroke, suggesting the possible role of apoptosis in the pathogenesis of cerebral infarction.

Different cut-off points of decreased heart rate variability for different groups of cardiac patients.

BACKGROUND: Heart rate variability (HRV) differs by the type and stage of the disease, by age, by environment, and so on. Criteria for normal, moderately changed and pathologic values of HRV lack for routine clinical work with different groups of cardiac patients. METHODS: Twelve time and frequency domain HRV variables were analysed from 24-h Holter ECG monitoring in 2578 consecutive patients of both sexes (57% male) aged 15-91 (mean 54 +/- 13) years. Fifty-nine per cent of the patients were hospital out-patients, 15% came from the cardiac unit of an internal medicine department and 26% were undergoing stationary cardiac rehabilitation. Arrhythmias of aetiology other than coronary artery disease predominate in out-patients and coronary artery disease in in-patients. Limits of moderately and pathologically changed values were determined according to biostatistical principles. RESULTS: HRV differed by the age, sex and type of patients (MANOVA P < 0.001). Heart rate and all HRV measures decreased with age. Females had a higher heart rate but more pronounced vagally modulated activity than males. Out-patients had better HRV than in-patients. The cut-off level for a pathologic standard deviation of the normal R-R interval (a measure of overall HRV) ranged from 75 ms in female out-patients to 44 ms in male patients from the cardiac unit. Different cut-points for 12 HRV measures were obtained for 12 sub-groups of patients. CONCLUSION: In view of the HRV differences between different cardiac patients, different limits of normal and decreased HRV are proposed for daily practice.