Association of early menarche age and overweight/obesity.

AIM: The aim of the study is to assess the association of overweight/obesity and early menarcheal age. PATIENTS AND METHODS: The study comprised 2127 healthy girls aged 9 to 16 years. Menarcheal age was estimated by status quo method. The girls' body weight and height were measured and their body mass index (BMI) calculated. The diagnostic criteria of the WHO were used to define overweight and obesity. Girls with a BMI in the range of 1-2 for age and sex were considered overweight. Girls with a BMI >2 standard deviation (SD) for age and sex were considered obese. Girls with a BMI >1 SD for age and sex were considered overweight/obese. Social and economic status was analyzed according to years of education completed, parents' occupations, and the number of children in the family. RESULTS: Median menarcheal age was 12.83 years; 25% girls had menarche before 11.98 years and 75% by 13.69 years. By 11.21 years, 10% of girls had had menarche, and 95% by 14.91 years. Girls who had menarche before 11.98 years had higher body weight values (48.5 vs. 40.2 kg) (p<0.001), height (159.3 vs. 149.2 cm) (p<0.001), and BMI (18.9 vs. 17.8 kg/m2) (p=0.003) than their peers without menarche. Girls with menarche before 11.98 years had significantly higher BMI values than girls with menarche after 13.69 years (18.94 vs. 17.84 kg/m2) (p=0.008). Girls with menarche before 11.98 years and those after 13.69 years differ significantly in distribution of thinness (3.4% vs. 2.54%), normal weight (85.3% vs. 91.8%), and overweight/obesity (11.2% vs. 5.7%) (p=0.002). CONCLUSIONS: Girls who experienced early menarche are significantly more often overweight/obese. Overweight/obesity may be considered as one of the predictors for the early occurrence of menarche.

Central type of chondrosarcoma with a fulminant course--a case report.

Primary chondrosarcoma is a rare malignant tumor. The five types of chondrosarcomas are: central, peripheral, mesenchymal, differentiated and clear cell. The classic chondrosarcomas are central (arising within a bone) or peripheral (arising from the surface of a bone). We describe a patient with central chondrosarcoma of the humerus who underwent surgery and only two weeks later presented with multiple metastases of the lung and small pulmonary tumor embolisms mimicking bilateral pneumonic infiltrates. Therefore, such a fulminant course of central chondrosarcoma, which is not described so far, must be taken into consideration during the treatment of patients with primary chondrosarcoma.

Growth and obesity in 7-year-old Croatian children: secular changes from 1991 to 2008.

The study analyses secular changes in body weight, height and body mass index (BMI) in children in the Splitsko-dalmatinska County, Croatia, in the period from 1991 to 2008. The overweight/obesity trends from 1991 to 1999 and from 2000 to 2008 are assessed. The study included three cohorts of healthy 7-year-old children, measured during their regular medical examination before enrolment at school: 1991 (n = 514), 1999 (n = 428) and 2008 (n = 452), in a total of 1,394 children, 686 (49.21%) of whom were girls. Overweight/obesity was defined according to the International Obesity Task Force criteria. From 1991 to 2008, there was a statistically significant rise in body weight and BMI in boys and girls (1.47 vs 1.50 kg; 0.55 vs 0.75 kg) and height in boys (1.4 cm). In 2008, the girls were 0.14 kg heavier and 0.39 cm taller than the girls of the same age measured in 1999, but their BMI was lower by 0.02 units. The frequency of obesity rose from 1991 to 2008 by 1.4 times in boys and 1.7 times in girls. The prevalence of obesity in girls rose from 1991 to 1999 (from 4.3% to 8.6%), but in 2008, it fell (7.1%). The prevalence of obesity in boys fell in 1999 (from 4.3% to 3.9%) but rose in 2008 (6.2%). The values of body weight, height and BMI in the observed population moved from 1991 to 2008 towards higher WHO standard values, which is descriptive of the problem of obesity and supports the need to consider the choice of cut-off points for obesity/overweight in local and national studies. In conclusion, the slowdown noticed in secular changes in body weight and BMI is encouraging and shows the importance of continuous paediatric health care for children, combined with an altered attitude in society towards obesity in children.

Neonatal birth weight variations between inland and littoral Croatia.

The aim of the study was to assess neonatal birth weight (BW) differences between inland and littoral Croatia, to identify BW groups with most pronounced differences, and possible variations in the rate of BW > or = 4000 g between Sibenik area and the rest of littoral (counties with access to the Adriatic Sea) and inland Croatia. The study included data on 99.42% of 200,740 live births recorded in 37 Croatian maternity hospitals during the 2001-2005 period. Distribution of 500-g BW groups was analyzed irrespective of neonatal sex and gestational age. Differences were found between the inland and littoral parts of Croatia according to distribution of the BW groups of < 2500 g (5.4% vs. 4.4%), 2500-3999 g (84% vs. 80.2%) and > or = 4000 g (10.6% vs. 15.4%) (chi2 = 882; p < 0.001).The highest rate of BW > or = 4000 g was recorded in Sibenik-Knin County (5-year mean 18.32%) and was greater throughout the littoral as compared with inland Croatia (5-year mean 14.99% vs. 9.58%). A shift towards higher BWgroups recorded throughout littoral as compared with inland Croatia supports the hypothesis on variation in anthropologic characteristics in the respective populations to be pronounced as early as at birth. Study results confirmed fetal macrosomia not to be exclusively characteristic of Sibenik-Knin County, since the rate of neonatal BW > or =4000 g was significantly higher in the entire littoral as compared with inland Croatia.

Lower lobe pulmonary tuberculosis in immunocompetent male.

We present a case of 23-year-old student misdiagnosed for two months. Radiological finding showed a pneumonial infiltrate of left lung lower lobe. Antibiotical therapy was not resulting in a radiological regression. Biopsy of the lung infiltrate by transthoracic computed tomography guided histology needle, showed granulomatous inflammation with necrosis. Bronchial aspirate received by bronchoscopy was positive in culture on Mycobacterium tuberculosis. After 6 months of antituberculotic therapy advance the complete regression of lung infiltrate. Tuberculosis of lower lung lobe is difficult to diagnose, particularly in persons who are not immunocompromised or without associated diseases. Lower lobe localization of tuberculosis is between 0.6 to 10.5% in all cases. Early diagnosis and therapy of pulmonary tuberculosis depends on bronchoscopic samples. The biopsy of the lung infiltrate by transthoracic computed tomography guided histology needle in histopathological and bacteriological diagnosis of tuberculosis was also useful.

Differences in eating and lifestyle habits between first- and sixth-year medical students from Zagreb.

Eating and lifestyle habits of first (n=169) and sixth (n=272) year students, aged 18 to 26 years, attending a Medical School in Zagreb, were compared related to the years of study. A self-administered questionnaire created for this study incorporated a food frequency questionnaire. Both year students reported similar number of meals per day, irregular consumption of meals, skipping breakfast, frequency of vegetables, fruits, cereals, sweets, milk and dairy products consumption, body mass index (BMI) calculated from self-reported weight and height and alcohol consumption. Significant differences between groups were observed in consuming supper (p = 0.001), being on diet (p = 0.032), intake of supplements (p = 0.041), meat (p < 0.001), dried meat (p = 0.027), coffee and tea consumption (p = 0.016), physical activity (p = 0.041; p = 0.016), and smoking (p = 0.029). This study showed non-healthy eating arid lifestyle behavior among Medical School students. We observed association between the year of study, and some of the eating habits and lifestyle factors.

Primary lung cancer and TNF-alpha gene polymorphisms: a case-control study in a Croatian population.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) is a multifunctional cytokine involved in the pathogenesis of various inflammatory and malignant diseases. Previous studies investigating the role of the TNF-alpha gene polymorphisms in lung cancer have generated contradictory results. The present study investigated whether the TNF-alpha-308 and TNF-alpha-238 polymorphisms are associated with risk and/or severity of disease in Croatian lung cancer patients. This is the first study in a Caucasian population to analyze the influence of these two polymorphisms on multiple types of lung cancer. MATERIAL/METHODS: In a case-control study, lung cancer patients (n=230) and appropriate age- and sex-matched controls (n=230) were genotyped by the polymerase chain reaction/restriction fragment length polymorphism method. Allele and genotype frequencies were estimated by gene counting. The chi-squared test was used to compare the observed numbers of different TNF-alpha genotypes for the population with those predicted by Hardy-Weinberg equilibrium. Differences in genotype and allele distributions in the patient and control groups were analyzed for statistical significance using the chi-squared test or Fisher's exact test as appropriate. RESULTS: There were no significant differences in the genotype and allele frequencies for the TNF-alpha-308 and TNF-alpha-238 polymorphisms between lung cancer patients and controls. Furthermore, no association between the genotypes and different stages of lung cancer was detected. CONCLUSIONS: This study indicates that the TNF-alpha-308 and TNF-alpha-238 polymorphisms do not influence susceptibility to or severity of lung cancer in a Croatian population.

Multiple recurrence of hydatid disease lasted 19 years.

Hydatid disease (echinococcosis) is a potentially fatal parasitosis caused by tapeworm larvae of the genus Echinococcus which affects primarily the liver and the lungs. However, despite effective medical and surgical treatment, risk of recurrence remains the main problem in the treatment of the disease. We describe here a rare case of multiple recurrence of hydatid disease that lasted more than 19 years. The patient presented with multiple cysts of the liver and dissemination to the lung. The way of dissemination remained unclear and speculative. Despite surgical and intensive medical treatment the disease progressed and the patient died in septic shock.

Influence of urbanization level and gross domestic product of counties in Croatia on access to health care.

AIM: To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care. METHODS: Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100,000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data. RESULTS: There was no significant difference in the total number of physicians per 100,000 inhabitants between predominantly urban and predominantly rural counties (206.9+/-41.0 vs 175.4+/-30.3; P=0.067, t test) nor between richer and poorer counties (194.5+/-49.8 vs 187.7+/-25.3; P=0.703, t test). However, there were significantly fewer GPs per 100,000 inhabitants in rural than urban counties (49.0+/-5.5 vs 56.7+/-4.6; P=0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8+/-172.8 vs 1.540.7+/-106.3; P=0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. CONCLUSION: The lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP.

[Guidelines for diagnosis and management of asthma in adults of the Croatian Respiratory Society]. / Smjernice Hrvatskoga pulmoloskog drustva za dijagnosticiranje i lijecenje astme u odraslih.

The global use of guidelines for proper diagnosis and management of asthma was worldwide aimed toward obtaining effective control of asthma. Until now, the most often used guidelines in Croatia were the ones issued by the Global Initiative for Asthma (GINA). Their implementation significantly improved and uniformed the diagnosis and management of asthma at different levels of the national health system. The obtained level of knowledge has enabled the making of local guidelines which acknowledge economic, cultural and even traditional specificities of Croatia. It was supposed that Croatian medical professionals would more effectively use guidelines they actively supported to prepare and which were appropriated to local work environment and medicines available. Therefore, based on current scientific evidence, the Croatian Respiratory Society has prepared Croatian Guidelines for Diagnosis and Management of Asthma in Adults purposed for wide use among Croatian doctors and other health professionals.

Dietary habits and folate status in women of childbearing age in Croatia.

Folic acid and folates have an important role in prevention of neural tube defect that appears in the first weeks of pregnancy, when women are still not aware of their pregnancy, especially when pregnancy is not planned. Since ensuring sufficient quantities of folates and folic acid in this period is essential, dietary habits of childbearing age women are very important. In line with that the intake of folates and folic acid in nutrition of women age group 20-30 years is examined, as well as the frequency of consumption of foodstuffs rich in vitamins and folic acid supplements. Values of folates in serum are presented, dependent on their nutritional habits. Obtained results indicate that in spite of inadequate intake of folates and folic acid from foodstuffs, clinical deficit is not recorded, which is the result of frequent consumption of dietary supplements. In accordance with these dietary habits, differences in the folates status of examinees were observed.

[Growth in macrosomic neonates during the first year]. / Rast makrosomne novorodencadi tijekom prve godine.

Growth of macrosomic newborns (birth weight 4000 grams and more) and control group newborns (birth weight from 2500 to 3999 grams) in the course of their first year of life has been compared. Although the absolute growth in weight and length is higher in macrosomic boys and girls, the relativity in their growth in the course of the first year of their life is higher among the control group infants. Boys from the control group have increased their birth weight for 203%, while macrosomic infants for 177% (control group girls 196% against macrosomic 159%). The relative difference in weight between the groups of macrosomic and control group boys decreased from 26% (at delivery) to 14% in the course of their first year of life, and in girls from 23% to 8%. Control group boys have increased their birth length for 53%, while macrosomic for 49% (girls: control group 52% against macrosomic 47%). The observed tendency to decrease the difference in antropometric characteristics between the macrosomic and control groups of newborn children of both sexes, probably may be explained by the weakening of the influence of prenatal factors which have resulted in macrosomy and strengthening of the influences of postnatal factors (socio-economic) by which the groups didn't differ significantly.

Effect of preoperative feeding on gastric emptying following spinal anesthesia: a randomized controlled trial.

BACKGROUND: Preoperative fasting is associated with various untoward postoperative health problems. Previous studies have stressed the advantages of preoperative feeding with a carbohydrate-rich drink 2 hours before surgery; this protocol does not increase the risk of gastric-content aspiration but reduces the level of anxiety and thirstiness during the perioperative period. Spinal anesthesia with the local anesthetic bupivacaine can decrease gastric emptying in the early postoperative period. However, the effect of spinal anesthesia on the gastric emptying rate following preoperative feeding is unknown. The aim of this study was to determine the impact of preoperative feeding with a clear carbohydrate-rich drink on gastric emptying early after orthopedic surgery under spinal anesthesia. METHODS: A total of 110 patients scheduled for semi-elective orthopedic surgery under spinal anesthesia were included in a randomized controlled trial. Patients were randomly assigned to two groups: group 1 (56 patients) received a standardized 200 ml of clear carbohydrate-enriched drink orally 2 hours before surgery; group 2 (54 patients) acted as a control group with no preoperative feeding. Gastric emptying was evaluated with a paracetamol test at five time points: 15 min, 30 min, 60 min, 90 min and 120 min after administration of paracetamol. RESULTS: No significant differences were observed between the two groups in paracetamol plasma concentrations or area under the curve during the early postoperative period. CONCLUSION: In patients undergoing spinal anesthesia, preoperative feeding 2 hours before surgery had no influence on the gastric emptying rate, indicating that preoperative feeding does not increase the risk of gastric-content aspiration and can be given safely.

Education about pharmacotherapy and psychotherapy of anxiety among primary care physicians in Croatia: Balint group approach.

AIM: Balint groups help general practitioners to be sensitive to the psychological needs of anxiety patients and cope with their stress and mental health. We evaluated knowledge about pharmacotherapy and psychotherapy of anxiety among Croatian primary care physicians before and after a course based on Balint group methodology. METHODS: There were 111 primary care physicians (general practitioners and specialists in general practice) who attended the Balint course as a part of their continuous education during 2003. Course participants answered questions on pharmacotherapy and psychotherapy of anxiety before and after the course. RESULTS: At the beginning of the course, there were significantly more specialists in general practice who gave correct answers on definition of anxiolytics and about their side effects (chi-square test, p=0.046 and p=0.030, respectively). Before the course, high number of physicians in both groups agreed that psychotherapy could be used by non-psychiatrists (70-80%, no significant difference), but after the course significantly more specialists in general practice were aware that supportive psychotherapy could be used in general practice (chi-square test, p=0.002). Before the course significantly more specialists in general practice knew that only supportive psychotherapy can be used in general practice (chi-square test, p=0.010), but after the course general practitioners' correct answers increased and the difference was not significant. Daily usage of psychotherapy before the course was significantly more frequent among specialists (chi-square test, p<0.001), but this difference disappeared after the course. Number of general practitioners who never used psychotherapy decreased after the course (chi-square=4.83, d.f.=1, p=0.028). Linear regression analysis revealed female sex to be a significant predictor for the positive effects of the course (B=0.71, p=0.025). CONCLUSION: The Balint course significantly reduced differences in knowledge of pharmacotherapy and psychotherapy of anxiety between specialists in general practice and general practitioners and improved prospects for the practice of psychotherapy among general practitioners.