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COVID-19 pandemic has changed everyday life and medical supervision of chronically ill patients. Epidemiological measures, social distancing, and limited access to medical care impair glycemic control in patients with diabetes. Also, type 2 diabetes is a risk factor for more severe form of coronavirus disease. A large proportion of diabetic patients are placed in foster families who also adapt to the new situation. The purpose of this study was to examine the manner and frequency of glycemic control in patients with type 2 diabetes who are placed in foster families in the region of Brod- Posavina County. We established contact with patients suffering from type 2 diabetes situated in foster families and their caregivers. Measurement of glycemia was performed several times a day with regular notes and the data were supplemented by an insight into the medical documentation of patients in the hospital information system. The study included 33 patients with type 2 diabetes. The relationship between HbA1C with fasting and postprandial glycemia was linear. There were no statistically significant differences in HbA1C regulation by type of therapy. There was a significant difference in the number of complications according to the level of HbA1C (Hi square test = 25.982, p

Introduction: Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium. Patient concerns: A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock. Diagnosis: Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy. Interventions: By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound. Outcomes: At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram. Conclusion: Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb ; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID-19 on treatment CVD will be estimated in the following years.

Introduction: The aim of this study was to use cross-sectional research to determine the relationship between serum ferritin levels and arterial hypertension in women who work in shifts and women with regular daytime working hours. Methods: The respondents included 67 female nurses divided into two groups: nurses working in 12-hour shifts (7 am to 7 pm/7 pm to 7 am) were the test group, while nurses regularly working for 8 hours (7 am to 3 pm) were the control group. Data collection included information on associated diseases, chronic medication, last menstruation, duration of menopause, cigarette smoking, number of years of employment in shift work and regular daytime work, laboratory and anthropometric parameters and blood pressure levels. Results: In all respondents, there was a significant and positive relationship between ferritin and CRP levels, i.e. the higher the CRP levels, the higher the ferritin levels (Rho = 0.401 ; P = 0.001). Among respondents who have regular daytime working hours, there was no significant association between ferritin and other indicators, while in the group of those who work in shifts, there was a significant and positive association between ferritin and CRP (Rho = 0.468 ; P = 0.002). Finally, a positive correlation was found between the number of years of employment in shift work and systolic blood pressure levels, i.e. higher systolic pressure was observed in those respondents who worked longer in shifts (Rho = 0.424, P = 0.03). Conclusion: The study demonstrated a significant correlation between the number of years of employment in shift work and systolic blood pressure. A positive correlation between serum CRP and ferritin levels was also observed in all respondents, and especially in shift workers.

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.

The book describes the most important risk factors for the development of cardiovascular incidents in patients with diabetes. CVOT studies and recommendations on the latest therapy of type 2 diabetes mellitus are presented, as well as ways of its prevention and effective treatment.

Cilj: Adolescenciju kao prijelazno razdoblje u odraslu dob, karakterizira tjelesno i psihološko sazrijevanje. Obilježava je i pojava somatskih simptomima koji nemaju uzrok u tjelesnoj bolesti, a odgovor su na stresne trenutke. Istraživanje je imalo za cilj istražiti učestalost somatskih simptoma u adolescenta, rizične činitelje, kao i njihovu kliničku značajnost. Sudionici i metode: Tijekom školske godine 2019./2020. proveli smo istraživanje koje je uključilo učenike prvih i završnih razreda srednjih škola na području grada Slavonskog Broda. Sudionici su ispunili Opći upitnik o sociodemografskim podacima, te Upitnik o psihosomatskim simptomima za djecu i adolescente. Rezultati: Istraživanje je obuhvatilo 402 sudionika, dobi medijana 18 godina (interkvartilnog raspona od 16 do 18 godina), s većom zastupljenošću djevojaka, 289 (71, 9%). Medijan broja samoprijavljenih simptoma u posljednja 3 mjeseca iznosio je 15 (interkvartilni raspon 10-20), samoprocjena učestalosti 54 (interkvartilni raspon 47-63), a samoprocjena ometanja u svakodnevnim aktivnostima 48 (interkvartilni raspon 41-57). Najzastupljeniji simptom je manjak energije/umor (92, 5%). Niža je zastupljenost klinički značajnih somatskih simptoma kojih je prema broju prijavilo 87 ispitanika (21, 6%), prema učestalosti njih 79 (19, 8%), dok je ometanje prijavilo 84 (20, 9%) sudionika. Nije uočena statistički značajna rodna razlika. Zaključak: Istraživanje upućuje na visoku zastupljenost samoprijavljenih somatskih simptoma među adolescentima, no međutim niska je zastupljenost klinički značajnih simptoma prema broju, samoprocjeni učestalosti i ometanja.

Diabetes and its complications causes up to 9% of total mortality worldwide. Peripheral arterial disease is, in addition to cardiovascular diseases, the most common complication of diabetes with a prevalence that increases with age and the duration of diabetes. The specificity of peripheral artery disease in diabetics is the diffuse involvement of the arterial system, especially the popliteal arteries. Consequently, diabetes is still the main cause of small and large limb amputations, which, in addition to a reduction in the quality of life, significantly affects the survival of patients. Since the developed of atherosclerotic disease involves a number of complications from the professional domain of various subspecialties, such as diabetic foot, it is necessary to organize multidisciplinary teams for the diagnostic and therapeutic purposes. For this purpose, the General Hospital “Dr. Josip Benčević” in Slavonski Brod organized a multidisciplinary team with the goal of early recognition of peripheral artery disease and application of timely treatment. Experience from everyday clinical practice indicates that proper functioning of the team requires an accurate diagnostic and therapeutic algorithm to avoid long waiting lists for imaging, which includes Color Doppler and multislice computed tomography. The diagnostic algorithm was based on the ankle-brachial index, and its value and clinical picture guided and determined the degree of urgency and the type of image processing. By integrating the algorithm into the online database registry, we were able to more easily monitor the incidence rate, treatment success, and dependence on the entered variables. We hope that this approach will result in earlier detection of symptomatic disease and thus a significant reduction in lower limb amputations and, ultimately, mortality., Šećerna bolest sa svojim komplikacijama uzrokuje 9 % ukupne smrtnosti diljem svijeta. Periferna arterijska bolest, uz kardiovaskularne bolesti, najčešća je komplikacija šećerne bolesti, čija prevalencija raste s dobi i duljinom trajanja dijabetesa. Specifičnost periferne arterijske bolesti u dijabetičara jest difuzno zahvaćanje arterijskog sustava, poglavito potkoljeničnih arterija. Posljedično tomu, dijabetes je i dalje glavni uzrok malih i velikih amputacija ekstremiteta, što, uz smanjenje kvalitete života, znatno utječe i na preživljenje bolesnika. Budući da razvijena aterosklerotska bolest uključuje niz komplikacija iz stručne domene različitih užih specijalnosti, poput dijabetičkog stopala, u dijagnostici i liječenju nužno je organizirati multidisciplinarne timove. U tu svrhu u Općoj bolnici „Dr. Josip Benčević“ u Slavonskom Brodu organiziran je multidisciplinarni tim sa svrhom ranog prepoznavanja periferne arterijske bolesti te pravodobnog liječenja. Dosadašnje iskustvo iz svakodnevne kliničke prakse pokazuje da je za pravilno funkcioniranje tima nužno imati precizan dijagnostičko-terapijski algoritam kako bi se izbjegle duge liste čekanja za slikovnu obradu koja uključuje dupleks ultrazvuk i višeslojnu kompjutoriziranu tomografiju. Dijagnostički algoritam temeljio se na vrijednostima gležanjskog indeksa, a njegova vrijednost i klinička slika usmjeruju i određuju stupanj hitnosti i tip slikovne obrade. Integriranjem algoritma u on-line registar baze podataka dobili smo mogućnost lakšeg praćenja stope učestalosti, uspješnosti liječenja i ovisnosti o unesenim varijablama. Nadamo se da će takav način rada rezultirati ranijim otkrivanjem simptomatske bolesti, a time i znatnim smanjenjem amputacija donjih ekstremiteta te naposljetku i smrtnosti.

Aim: Takotsubo cardiomyopathy is a transient dysfunction of the heart muscle that occurs in response to a stressful event. A working diagnosis is mostly made for acute ischemic heart disease due to similar clinical presentation and differential diagnostic doubts. Although it is a reversible disorder of cardiac contractility, mortality rate is similar to that of an acute coronary syndrome due to the development of complications. We report the case of a patient with chronic kidney disease and the consequent development of Takotsubo cardiomyopathy, a possible pathophysiological link that has not been reported in the significant number in literature so far. Case report: An 83-year-old patient on a chronic hemodialysis program, due to the development of anginal symptoms specific for the acute coronary syndrome and with a significant increase in cardiospecific enzymes, was transferred to the Coronary care unit for the necessary invasive cardiac treatment. Echocardiographic and coronarographic findings confirmed the diagnosis of Takotsubo cardiomyopathy, which was the first case in a patient on chronic hemodialysis program in our institution. Conslusions: According to available data, about 30 cases of Takotsubo cardiomyopathy have been reported so far, indicating that transient myocardial dysfunction is a rare cardiomyopathy in patients with chronic kidney disease. A small number of literature-recorded cases do not support the similar pathophysiological basis of increased sympathetic activity present in Takotsubo cardiomyopathy and chronic kidney disease., Sažetak. Cilj: Takotsubo kardiomiopatija prolazna je disfunkcija srčanog mišića koja nastaje kao odgovor organizma na stresorni događaj. Radna se dijagnoza većinom postavlja za akutnu ishemijsku bolest srca radi slične kliničke prezentacije i diferencijalnih dijagnostičkih dvojbi. Iako se radi o reverzibilnom poremećaju srčane kontraktilnosti, smrtnost je slična akutnom koronarnom sindromu uslijed razvoja komplikacija. Izvještavamo slučaj pacijentice s kroničnom bubrežnom bolesti i posljedičnim razvojem Takotsubo kardiomiopatije, moguće patofiziološke poveznice koja do sada literaturno nije zabilježena u značajnom broju. Prikaz slučaja: 83-godišnja pacijentica na programu kronične hemodijalize, uslijed razvoja anginoznih tegoba specifičnih za akutni koronarni sindrom te uz značajan porast kardiospecifičnih enzima, premještena je u koronarnu jedinicu radi potrebne invazivne kardiološke obrade. Ehokardiografski i koronarografski nalaz potvrdio je dijagnozu Takotsubo kardiomiopatije, što je ujedno prvi zabilježen slučaj u pacijenta na programu kronične hemodijalize u našoj ustanovi. Zaključci: Prema dostupnim podatcima, do sada je zabilježeno oko 30 slučajeva Takotsubo kardiomiopatije kod bubrežnih bolesnika, što pokazuje da je prolazna disfunkcija miokarda rijetka kardiomiopatija u pacijenata s kroničnom bubrežnom bolesti. Mali broj literaturno zabilježenih slučajeva ne ide u prilog sličnoj patofiziološkoj osnovi povećane simpatičke aktivnosti prisutne kod Takotsubo kardiomiopatije i kronične bubrežne bolesti.