Obstruction of left ventricular outflow tract by a calcified mass at mitral valve.

A case of an unusual left ventricular outflow tract obstruction by mitral valve pathology in a 35-year old female with diabetes and end-stage renal disease is presented in the study. The patient suffered from fever of an unknown origin after lower-leg amputation. Although the wound healed well, fever persisted for three weeks despite a triple antibiotic treatment until the infection was resolved with vancomycin. Three months later echocardiography displayed a floating mass attached to mitral valve, producing a newly developed systolic murmur and a mild haemodynamic obstruction of the left ventricular outflow tract. The calcified vegetation was probably formed during an unrecognized subacute infective endocarditis.

[Natriuretic peptides in clinical practice]. / Natriuretski peptidi u klinickoj praksi.

The natriuretic peptide (NP) system is primarily an endocrine system that maintains fluid and pressure homeostasis in healthy humans. The cardiac NP, ANP (atrial natriuretic peptide) and BNP (brain natriuretic peptide) are secreted by the heart in proportion to cardiac transmural pressures. The relationship between plasma levels of these peptides and "cardiac load" has led to their use as biomarkers of cardiac health with diagnostic and prognostic applications in a variety of disorders affecting the cardiovascular system. Elevated NP levels may serve as an early warning sign to help identify patients at a high risk of cardiac events. BNP and its N-terminal fragment (NT-BNP) are especially sensitive indicators for cardiac dysfunction and remodeling (correlate with severity) and play a role in the detection of coronary artery disease. The favorable biological properties of NP have also led to their use as therapeutic agents. Recombinant human ANP (carperitide) and BNP (nesiritide) are useful in the management od acutely decompensated heart failure.

[Obesity--a global public health problem]. / Pretilost--globalni javnozdravstveni problem.

Obesity and overweight, as a part of the metabolic syndrome, are well known risk factors for the development of diabetes, hypertension, coronary heart disease, hyperlipidemia, stroke, sleep apnea syndrome, osteoarthritis and certain forms of cancer. Cardiovascular disease remains the leading killer in industrialized countries, where it accounts for 40% of deaths. Obesity is defined either by increased waist circumference, waist to hip ratio, or body mass index. Obesity results from an interaction of genes and lifestyle. As people in both developed and developing countries eat more and more energy dense food, and have ever less physical activity, the number of overweight and obese people increases to epidemic proportions. Abdominal obesity plays a key role in the pathophysiology of metabolic disorders, is associated with insulin resistance, and predicts the development of type 2 diabetes and subsequent coronary artery disease. In the general population, obesity is associated with an increased mortality, but paradoxically, a positive correlation between body mass index and survival in congestive heart failure has been reported. In secondary prevention, obesity is underrecognized, underdiagnosed and undertreated in persons with cardiovascular diseases. Weight loss and prevention of weight gain have to be considered one of the most important strategies to reduce the incidence of cardiovascular disease. Increased physical activity and appropriate diet are the cornestones of treatment. Considering the high prevalence of overweight and obesity in Croatia, there is urgent necessity to improve the level of knowledge and skills in understanding obesity by health care services, and to implement appropriate professional strategy to achieve the desired lifestyle modifications.

[Erectile dysfunction and cardiovascular disease]. / Erektilna disfunkcija u kardiovaskularnih bolesnika.

Erectile dysfunction (ED) is a highly prevalent disorder worldwide. ED and cardiovascular disease (CVD) share many risk factors, the former often being the presenting symptom. The knowledge of the relationship between CVD and ED, the cardiovascular implications of phosphodiesterase type 5 inhibitors for the treatment of ED can help improve the quality of life of patients with both conditions. Cardiologists have a prominent role in treating ED.

Burnout syndrome--assessment of a stressful job among intensive care staff.

The purpose of the study was to investigate the degree of burnout experienced by intensive care staff particularly, in Medical (MICU) and Surgical Intensive Care Units (SICU) General Hospital "Sveti Duh", Zagreb. A sample group of 41 emergency physicians and nurses from MICU and 30 from SICU was tested. The survey included demographic data and Maslach Burnout Inventory (MBI) scoring test identified by the three main components associated with burnout: emotional exhaustion (MBI-EE), depersonalization (MBI-DEP), and personal accomplishment (MBI-PA) were assessed using 22-item questionnaire. The degrees of burnout were stratified into low, moderate, and high range. Mean total MBI (X +/- SD) were high in both groups: higher for the MICU (65.5 +/- 6.7) than for SICU staff (55.7 +/- 3.8, p < 0.05). MICU staff showed moderate degree of MBI-EE (24.9 +/- 11.2), MBI-DEP (6.0 +/- 5.6), and as well as MBI-PA (34.4 +/- 8.8). The same parameters showed better results among SICU staff: low degree of MBI-EE (17.1 +/- 5.2), as well as low level of MBI-DEP (5.2 +/- 5.0), and moderate degree of MBI-PA (33.7 +/- 9.8). The differences between the groups was statistically significant only for the total MBI, and for MBI-EE (p < 0.05). There were no significant differences between MICU and SICU staff for MBI-DEP or MBI-PA parameters. Overall job burnout represented in a moderate degree. The presence of burnout is a serious phenomenon, because it can lead to psychosomatic complaints, work-associated withdrawal behaviour, and a lower quality of care at intensive care units. Early recognition of burnout phenomenon as a result of prolonged stress and frustration among intensive care staff, contributes to better professional behavior, organizational structure changes in the work environment and better health care quality for critically ill patients.

[Specific characteristics of hypertension in postmenopausal women]. / Posebnosti arterijske hipertenzije zena u postmenopauzi.

Sex-specific differences in the incidence of cardiovascular diseases have long been known, and estrogens have been considered responsible for this dissimilarity. After the menopause, the consequences of hypertension in women change. Their risks of myocardial infarction and stroke rise, which has in part been ascribed to the loss of estrogen and onset of menopausal metabolic syndrome. Sex differences in the components of the renin-angiotensin system have been shown to exist, and may play a central role in the blood pressure control. Hypertensive menopausal women do not receive optimal treatment. They have poorer prognosis than men of the same age. Therefore, their antihypertensive management calls for special attention.

Effect of educational programs on asthma control and quality of life in adult asthma patients.

This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent asthma we tested the benefit of individual verbal instructions (IVI), written information ("asthma booklet", B), and integrated asthma classes ("asthma school", AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.

[Primary pulmonary hypertension in pregnancy: case report]. / Primarna plucna hipertenzija u trudnoci: prikaz bolesnice.

Primary pulmonary hypertension (PPH) is a rare, progressive and currently incurable disease characterised by an increase in pulmonary artery pressure without a demonstrable cause. When associated with pregnancy, the maternal mortality ranges from 30 to 50%. In this report we present a 26-year old patient diagnosed with primary pulmonary hypertension during her twenty-first week of gestation. She was treated with a low-molecular-weight heparin and sedatives and underwent pregnancy termination without complications. Although cases have been reported with positive maternal and fetal outcome, the available evidence suggests that pregnancy with primary pulmonary hypertension should be avoided. Thus, in cases of pregnancy occurring, a therapeutic abortion is indicated.