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Estimated glomerular filtration rate (eGFR) is one of the best-performing methods in evaluating kidney function. There are limited data regarding the estimated glomerular filtration rate in children and young adults with hemophilia. The aim of this study was to determine the difference between three commonly used estimated glomerular filtration rate equations in the pediatric population in a cohort of patients with hemophilia. Our prospective study included 36 pediatric patients with moderate or severe hemophilia. eGFR was calculated for each patient using the original creatinine-based “bedside Schwartz” equation, the cystatin C-based equation and the creatinine-cystatin C-based equation. The difference between the equations, calculated using the one-way repeated ANOVA test, was statistically significant (p, Procjena glomerularne filtracije jedna je od najboljih metoda ocjene bubrežne funkcije. Postoje oskudni podaci o procjeni glomerularne filtracije u djece i mladih odraslih oboljelih od hemofilije. Cilj našeg istraživanja je utvrditi razliku između tri često korištene metode za procjenu glomerularne filtracije u pedijatrijskoj populaciji u skupini pacijenata oboljelih od hemofilije. U naše prospektivno istraživanje uključili smo 36 djece s hemofilijom umjerenog ili teškog stupnja. Svakom pacijentu procijenjena je glomerularna filtracija koristeći jednostavnu, kreatinin baziranu jednadžbu po Schwartzu, cistatin C baziranu jednadžbu i kreatinin - cistatin C baziranu jednadžbu. Razlika između tri jednadžbe koristeći jednosmjerni ANOVA test bila je statistički značajna (p

Blood pressure variability (BPV) is a complex physiological phenomenon and it is known that increased BPV exacerbates the progression of hypertension and correlates with adverse cardiovascular outcomes. However, there is paucity of data regarding factors influencing BPV in pediatric population. This study aimed to analyze blood pressure (BP) pattern and assess blood pressure variability and its possible determinants in untreated children with essential hypertension. The study group included 132 children, average age 15 y (7- 18 y), 84 boys and 48 girls with essential hypertension and no use of antihypertensive therapy. Anthropometric parameters, serum glucose level (sG), serum uric acid (sUA), serum creatinine (sCr), total cholesterol (TCh), HDL cholesterol (HDL), LDL cholesterol (LDL) and triglycerides (TG) were measured in all participants. Office blood pressure (BP) and ambulatory blood pressure (AMBP) was measured according to recent European Society of Hypertension (ESH) guidelines. BPV was defined as value of the standard deviation of blood pressure for day and night time periods. In addition to the classical statistical analysis, an unsupervised machine learning approach using the expected maximization algorithm was implemented to find groups of patients with similar characteristics. The average age was 14.98 ± 2.1 years. Comparing sex-specific BP parameters, boys had higher daytime and nighttime systolic BP, although the difference was not statistically significant (p = 0.067 and p = 0.583). Girls had significantly higher daytime and nighttime diastolic BP values (p=0.017 ; p=0.027). There was no difference in BPV according to gender while boys have higher values of sCr, sG, and sUA despite similar body mass index (BMI) [27.18±5.27 kg/m2 (males) vs 27.94±5.27 kg/m2 (females), p= 0.427]. A statistically significant positive correlation was found between the Z-score for BMI and daytime systolic BPV, nighttime systolic BP and total cholesterol, nighttime diastolic BPV and sUA (r= 0.19, r= 0.28 and r = 0.26, respectively). Within the male population two clusters were found. The subjects in cluster 2 had higher daytime and nighttime systolic and diastolic BP values, higher total cholesterol and triglycerides and significantly higher night time systolic and diastolic BPV. Understanding potential determinants of BPV in hypertensive children could help identify patients with increased cardiovascular risk earlier. Our results suggest that clustering of metabolic factors influence BPV in untreated children with essential hypertension which could also be gender specific for male subjects.

Uvod: Henoch Schönleinova purpura ili IgA vaskulitis (IgAV) najčešći je vaskulitis dječje dobi. Iako etiologija bolesti i dalje nije poznata, čini se da u nastanku sudjeluju geni i okoliš. Dosadašnje prostorne analize uglavnom su korištene u promatranju širenja zaraznih bolesti, međutim novija istraživanja pokazuju i obećavajuću primjenu kod nezaraznih bolesti u koje ubrajamo i reumatske bolesti. Cilj ovog rada jest opisati incidenciju i prostornu raspodjelu raširenosti IgAV-a te istražiti mogu li se geoprostorni analitički modeli primijeniti i na neku reumatsku bolest. Ispitanici i metode: Prikupljeni su podaci o bolesnicima iz pet tercijarnih centara u Hrvatskoj u razdoblju od 2009. do 2019. godine. Prosječna godišnja incidencija IgAVa izračunata je prema podacima o broju stanovnika iz 2011. godine. Izrađena je koropleta karta za promatranje prostorne raspodjele i interpolaciju koristeći prostornoempirijsko Bayesijansko zaglađivanje. Postojanje lokalne prostorne autokorelacije procijenjeno je Moranovim I koeficijentom, a značajnost ispitana pomoću parametara lokalnih pokazatelja prostornog povezivanja. Rezultati: Uključeno je 596 pacijenata, 52, 52% muškog i 47, 48% ženskog spola prosječne dobi od 6, 42 (4, 42 – 8, 84) godine. Procijenjena prosječna godišnja incidencija IgAV-a bila je 7, 47 na 100 000 djece s 95%-tnim intervalom pouzdanosti između 6, 88 i 8, 98. Primarni podaci očekivano su pokazali da najveći broj slučajeva dolazi iz gradova s većim brojem stanovnika. Međutim, Bayesijanskom metodom pokazalo se da je prosječna godišnja incidencija IgAV-a zapravo grupirana oko velikih gradova. Dobiveni Moranov koeficijent bio je 0, 493, što ukazuje na značajnu pozitivnu prostornu autokorelaciju IgAV-a. Izdvojene su tri statistički značajne grupacije: dvije u mediteranskom i jedna u kontinentalnom dijelu Hrvatske. Naknadno su ta mjesta definirana kao žarišta s većom incidencijom od ostalih mjesta jer je procijenjena prosječna godišnja incidencija IgAV-a tamo bila više od 13 oboljelih na 100 000 djece. Zaključak: Ovo istraživanje pokazalo je da postoji prostorno grupiranje incidencije IgAV-a. Međutim, potrebne su daljnje geostatističke analize kako bi se procijenila značajnost stvaranja takvih vremensko-prostornih grupacija kod nezaraznih bolesti, uključivo i reumatskih. Potpora: Projekt Hrvatske zaklade za znanost, IP- 2019-04-8822

This pilot study investigated the usefulness in expanding the epidemiological toolbox with applying spatial analyses. The results of this study suggested that the IgAV incidence might be clustered in space. However, for a more definitive conclusion, a geostatistical analytical approach is needed to evaluate the significance of observed clusters.

Heart rate variability (HRV) has been analyzed using linear and nonlinear methods. In the framework of a controlled neonatal stress model, we applied Tone-Entropy (T-E) analysis at multiple lags to understand the influence of external stressors on healthy term neonates. Forty term neonates were included in the study. HRV was analyzed using multi-lag T-E at two resting and two stress phases (heel stimulation and a heel stick blood drawing phase). Higher mean entropy values and lower mean tone values when stressed showed a reduction in randomness with increased sympathetic and reduced parasympathetic activity. A ROC analysis was utilized to estimate the diagnostic performances of tone and entropy and combining both features. Comparing the resting and simulation phase separately, the performance of tone outperformed entropy, but combining the two in a quadratic linear regression model, resting from stress phases in neonates could be distinguished with high accuracy. This raises the possibility that when applied across short time segments, multi-lag T-E becomes an additional tool for more objective assessment of neonatal stress.

Sažetak: Adekvatnom osobnom higijenom te higijenom i sanitacijom prostora doprinijeli bi manjem broju dijarealnih oboljenja u svijetu. Prema Svjetskoj zdravstvenoj organizaciji (SZO), u Europi dnevno umire 14 ljudi od dijareje [1]. Parmskom deklaracijom obratila se pažnja na higijenu i sanitaciju u školama implementacijom Regionalnog prioritetnog cilja 1 [2]. Suradnjom SZO i Zavoda za javno zdravstvo Osječko-baranjske županije, 2012. proveo se pilot projekt u dvije srednje škole u Osijeku o higijenskim navikama učenika, higijeni sanitarnih čvorova i sanitaciji [3-4]. Nakon pilot projekta, od 2012. do 2016. pristupilo se nacionalnom programu Ministarstva zdravstva, Ministarstva znanosti i obrazovanja te Hrvatskog zavoda za javno zdravstvo uz potporu SZO u 200 osnovnih škola [5-6]. U Osječko-baranjskoj županiji (OBŽ) sudjelovalo je 606 učenika, pri čemu je obuhvaćeno 10 osnovnih škola (5 urbanih i 5 ruralnih) u kojima je proveden inspekcijski pregled 56 sanitarna čvora. U 2016. nastavljeno je istraživanje u OBŽ u 7 urbanih i 8 ruralnih osnovnih škola (anketirano 350 učenika i pregledano 74 sanitarna čvora). Rezultati istraživanja ukazali su na nedostatak toalet papira i sapuna u sanitarnim čvorovima i na neprovođenje adekvatne edukacije o higijeni. Posebni problem predstavlja što pojedina djeca ne obavljaju nuždu tijekom školskog dana zbog neodgovarajuće higijene i opreme sanitarnih čvorova.

We aim at detecting stress in newborns by observing heart rate variability. Thanks to an asymmetric detrended fluctuation analysis (ADFA), we determine the fractal structure of the series of interbeat intervals, in which we distinguish the periods of acceleration of the heart rate from decelerations. Thus, two scaling exponents, α+ and α-, representing decelerations, and accelerations, respectively, are obtained. Forty healthy term newborns were included in this study, undergoing two different types of stress stimuli, using routine heel lance blood sampling for metabolic screening purposes and its simulation applying dull pressure on the heel. It appears that, when newborns face stress, the scaling exponent related to accelerations significantly increases and becomes higher than the deceleration scaling exponent. To test the diagnostic properties of the scaling exponents, a ROC curve analysis was applied. α- showed good diagnostic performance with an AUC of 0.826 and 0.796 respectively, although having a lower sensitivity, it showed a high specificity of 84.62% for both stress phases. This work thus stresses the relevance of ADFA and particularly of the acceleration scaling exponent as a diagnostic tool for neonatal stress.

Traditional views on neonatal pain neglected long neglected the neonates’ capability of feeling pain. Newborn infants experience at least one painful procedure during their first days of life, but with a lower gestational age, invasive procedures become more frequent and invasive. The modulation of the autonomic nervous system (ANS) is significantly changed during painful procedures. The analysis of the heart rate variability is shown to be a reliable tool in analyzing the ANS. In this study, the dynamic of the system has been examined by applying the Poincaré plot analysis, a primer of nonlinear methods used in the analysis of the ANS. The aim of this study is to assess the occurrence of changes in linear heart rate variability parameters, to determine the changes in the Poincaré plot indices and to evaluate the correlation between their differences in healthy newborns. The results have shown a significant increase in the heart rate, a reduction of the duration of RR intervals, and the square root of the mean squared differences between successive RR intervals (RMSSD), as well as a decrease in the short-term variability (SD1) of the Poincare plot. The results highlight the need for studying the application of nonlinear analyses of the HRV on the effects of pain on the ANS and its long-term effects on the infant.

The neonate must make a transition after birth from intrauterine continuous transplacental supply of oxygen and glucose to different extra uterine conditions. In healthy neonate the period of adaptation almost finished in the perinatal period and newborn can be safely discharged after this time. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 26% of neonates were admitted in NICU because of the prolonged adaptation to extra uterine life. It was their main diagnosis. The majority of them have been polycytemic, had early jaundice and a part of them had bradycardia. Mother’s illnesses as a possible cause of prolonged neonatal adaptation were found in 21.7%. About 58.3% of newborns with prolonged adaptation have had problems during mother’s pregnancy and delivery. Hypertrophic as well as hypotrophic neonates were risk neonates for prolonged postnatal adaptation, as well as newborns gender. Mode of delivery takes a big role in the neonatal adaptation. Induction and augmentation of the labor acts as a possibly stress factor. Main symptoms among those newborns were: plethora, cyanotic crises, bradicardia, dystonia, irritability, jaundice and respiratory distress. Most of the investigated newborns need oxygen 6-10 days. The majority of them stay in the hospital up to 10 days. Prolonged adaptation has almost equally been found in the first, second and third pregnancy.

Albeit the aetiology of the respiratory distress syndrome (RDS) is well known, the paper shall demonstrate that the causes of RDS changed over the years 2006 and 2010. This retrospective study comprises analysis of the data collected from 60 newborns of over 32 weeks gestation with RDS in the Neonatal Intensive Care Unit at the Clinical Hospital Centre in Osijek. The focus of the paper lies in the difference in the incidence of RDS over two research periods (2006 and 2010), the most common and possible causes of RDS in newborns of over 32 weeks gestation as well as in the potential changes in the aetiology over the two research periods. An increase in the incidence of RDS was established in 2010, but it was statistically significant only for newborns of gestational age of 35 1/7 to 36 6/7 weeks. The most common cause of RDS in both research periods was sepsis, which decreased in its share in 2010, whereas the incidence of asphyxia and complications during pregnancy increased. The new potential cause in 2010 was maternal thrombophilia. The share of unknown causes of RDS decreased, although not significantly so. The results of the research indicate that the causes of RDS changed over the observed periods and that further research should focus on thrombophilia and other complications during pregnancy with the aim of reducing morbidity and improving neonatal outcomes as well as further reducing the incidence of RDS with unknown causes in newborns

In this early pilot study, we sought to determine if the alteration in these physiologic effects in premature infants in response to ambient noise in the NICU could be assessed evaluating cerebral blood saturation. Three premature infants, on high flow nasal cannula oxygen support (HFNC), at less than 34 weeks of gestation were included in the study. Three variables were used to evaluate sound levels due to AAP and EPA guidelines ; Leq, 1h, L10, 1h and Lmax, 1min. All of the patients studied were found to be exposed to statistically significant noise levels (above recommendation) throughout all of the time periods measured. Noise levels were found to be similarly elevated during the 1 am and 3 pm time periods as well, though not as much as compared to the 7 am measure. A statistically significant difference was found within every patient’s rSO2 levels in both hemispheres, but also in the absolute differences of rSO2. Positive significant statistical correlations were found between the average rSO2 and Leq, 1h (ρ=0.14), Lmax, 1min (ρ=0.18), L10, 1h (ρ=0.15). Significant negative correlations were found between the absolute difference levels and Lmax, 1min (ρ=-0.3), and L10, 1h (ρ=-0.18) This data highlights the need for further study as to the potential impact of noise on the cerebral physiology of premature infants. Further research is needed to assess the potential long-term side effects of environmental noise on the premature infant’s brain.

Indeks vitalnosti po Apgarovoj jednostavan je sustav bodovanja vitalnosti novorođenčeta temeljen na pet kriterija: boji kože, frekvenciji srca, refleksnoj podražljivosti, mišićnom tonusu i disanju. Liječnik neposredno nakon poroda, u prvoj i petoj minuti, vrši procjenu djeteta kako bi odredio eventualnu potrebu za hitnom dodatnom medicinskom obradom. Indeks može imati vrijednost u rasponu od nula do 10, na način da se zbroje vrijednosti pet kriterija. Ovaj način ocjenjivanja je subjektivna procjena liječnika kao stručnjaka, koja ovisi o njegovom iskustvu, razini umora, utjecajima okoline i slično. Algoritam za evidensijsko zaključivanje se koristi za procjenu stanja tehničkog sustava izračunom subjektivnih ocjena stručnjaka te objektivnih mjerenih vrijednosti. Cilj ove studije je pokazati kako se primjenom navedenog algoritma prilikom određivanja indeksa uz pomoć prijenosnika sa pripadajućim programom može minimalizirati subjektivnost, povećati točnost i ubrzati proces bodovanja.

U radu nastojimo dotaknuti širinu sestrinskog pristupa kako u prepoznavanju tako i u rješavanju problema iz područja zdravstvene njege u bolesnika s infarktom miokarda, s osvrtom na primjenu cjelovitog i individualiziranog pristupa. Prikazani su bolesnici približno iste životne dobi, sličnih simptoma i znakova bolesti. Namjernim odabirom bolesnika sa sličnim karakteristikama, nastojimo pokazati potrebu za detaljnom, temeljenu na sustavnom pristupu. Dakle, bez obzira na sve navedene sličnosti, za svakog bolesnika posebno utvrđujemo potreb za zdravstvenom njegom, planiramo, provodimo i evaluiramo postignuto. Podatci za procjenu prikupljani su intervjuom, trajnim promatranjem, mjerenjem i analizom medicinske dokumentacije.