Mario Mihalj | University hospital Split (original) (raw)

Papers by Mario Mihalj

Acta medica Croatica, Dec 5, 2019

Međunarodno udruženje za glavobolju (International Headache Society, IHS) defi niralo je klasifi ... more Međunarodno udruženje za glavobolju (International Headache Society, IHS) defi niralo je klasifi kaciju glavobolja, koja se temelji na kliničkoj slici, etiologiji i patogenezi glavobolja. Glavobolje se dijele na primarne i sekundarne glavobolje te kranijske neuralgije, centralni i primarni bol lica i druge glavobolje. U skupinu primarnih glavobolja pripadaju: migrena, glavobolja tenzijskog tipa, klaster glavobolja i ostale trigeminalne autonomne cefalgije i ostale primarne glavobolje (1). Migrenska glavobolja (MG) je česta, onesposobljavajuća primarna glavobolja. MG se smatra trećim najčešćim poremećajem, te sedmim najčešćim specifi čnim uzrokom onesposobljenosti u svijetu (2). Prevalencija migrene u Europi iznosi 15 % kreće se ovisno o poje-dinim zemljama od 12 % do 27,5 %. Prema Svjetskoj zdravstvenoj organizaciji (SZO) prevalencija migrene u svijetu je 15 % u općoj populaciji (1). U različitim populacijama prevalencija MG kreće se od 4 % do 10 % za muškarce, odnosno 16 % do 25 % za žene. Žene obolijevaju češće od muškaraca, i to u odnosu 2:1, a osobito u fertilnoj dobi (3). MG je obično karakterizirana unilateralnim, a katkad i bilateralnim glavoboljama u području čela, oka i sljepoočnice. Bol je pulsirajućeg karaktera, često počinje u zatiljku te se širi prema čelu, gdje doseže vrhunac. Popraćena je mučninom, povraćanjem, preosjetljivošću na svjetlo (fotofobija) i zvuk (fonofobija) i aure (1). Aura je fokalni neurološki simptom, obično vidni, koji se nalazi u 20 % ataka. Visoka prevalencija ove glavobolje uz njeno učestalo ponavljanje značajno umanjuje kvalitetu života bolesnika (3).

Acta Clinica Croatica, Nov 3, 2014

The aim of the present study was to determine the prevalence of depression among low back pain (l... more The aim of the present study was to determine the prevalence of depression among low back pain (lbP) patients and to investigate the sociodemographic characteristics of patients with lbP and relationship between depression and pain intensity in lbP patients. The study was conducted on 99 patients treated at Clinical department of neurology, Split University Hospital Center. There were 36 (36%) men and 63 (64%) women. Some degree of depression was present in 73 (74%) study patients, including all patients with severe lbP. in the group of patients with severe lbP, the rate of moderate, severe and very severe depression was 1.36-fold that recorded in the group of patients with moderate lbP and 2.58-fold that found in the group of patients with mild lbP (χ 2 =16.2; p=0.003). The most common symptoms were general physical symptoms 70 (71%), psychic anxiety 69 (70%) and depressed mood 66 (67%). it is concluded that depression was more severe in lbP patients with severe disease compared to patients with mild or moderate lbP.

Nature and Science of Sleep, 2020

Purpose: An increase in resting motor threshold (RMT), prolonged cortical silent period duration ... more Purpose: An increase in resting motor threshold (RMT), prolonged cortical silent period duration (CSP), and reduced short-latency afferent inhibition (SAI), confirmed with previous transcranial magnetic stimulation (TMS), suggest decreased cortical excitability in obstructive sleep apnea syndrome (OSAS). The present study included MRI of OSAS patients for navigated TMS assessment of the RMT, as an index of the threshold for corticospinal activation at rest, and SAI as an index of cholinergic neurotransmission. We hypothesize to confirm findings on SAI and RMT with adding precision in the targeting of motor cortex in OSAS. Subjects and Methods: After acquiring head MRIs for 17 severe right-handed OSAS and 12 healthy subjects, the motor cortex was mapped with nTMS to assess the RMT and SAI, with motor evoked potentials (MEPs) recorded from the abductor-pollicis brevis (APB) muscle. The 120%RMT intensity was used for the SAI by a paired-pulse paradigm in which the electrical stimulation to the median nerve is followed by magnetic stimulation of the motor cortex at inter-stimulus intervals (ISIs) of 18-28 ms (ISIs 18-28). The SAI control condition included a recording of MEPs without peripheral stimulation. Latency and amplitude of MEP at RMT at 120%RMT for eleven different at ISIs 18-28 were analyzed. Results: The study showed a significantly lower percentage deviation of MEP amplitude at ISIs (18-28ms) from the control condition between OSAS and healthy subjects (U=44.0, p=0.01). The intensity of stimulation at RMT was significantly higher in OSAS subjects (U=55.0, p=0.04*). Correlation analysis showed that BMI significantly negatively correlated (ρ=−0.47) with MEP amplitude percentage deviation in OSAS patients. Conclusion: The nTMS study results in increased RMT, and reduced cortical afferent inhibition in OSAS patients for SAI at ISIs 18-28 , confirming previous findings of impaired cortical afferent inhibition in OSAS. Future nTMS studies are desirable to elucidate the role of RMT and SAI in diagnostics and treatment of OSAS, and to elucidate the usefulness of nTMS in OSAS research.

European Journal of Neurology, 2018

Background and aims: We investigated annual trends regarding the prevalence and incidence of deme... more Background and aims: We investigated annual trends regarding the prevalence and incidence of dementia based on the National Health Insurance System database covering the entire Korean population. In addition, we assessed a cutoff age for dementia diagnosis, and the risk factors for Alzheimer's dementia(AD) and vascular dementia(VD). Methods: The prevalence and incidence of dementia of the entire Korean population aged ≥40 years was investigated using a database covering 2006 to 2015. The diagnosis was classified by the ICD-10 codes. The Youden index was estimated to determine optimal cutoff age for dementia diagnosis. Results: The prevalence and incidence of AD showed increasing trends. The age-standardized prevalence of AD

HPA-1 polymorphism of αIIbβ3 modulates platelet adhesion onto immobilized fibrinogen in an in-vit... more HPA-1 polymorphism of αIIbβ3 modulates platelet adhesion onto immobilized fibrinogen in an in-vitro flow system

The Thoracic and Cardiovascular Surgeon, 2018

The incidence of acquired von Willebrand syndrome (AvWS) in patients with heart disease is common... more The incidence of acquired von Willebrand syndrome (AvWS) in patients with heart disease is commonly perceived as rare. However, its occurrence is underestimated and underdiagnosed, potentially leading to inadequate treatment resulting in increased morbidity and mortality.In patients with cardiac disease, AvWS frequently occurs in patients with structural heart disease and in those undergoing mechanical circulatory support (MCS).The clinical manifestation of an AvWS is usually characterized by apparent or occult gastrointestinal (GI) or mucocutaneous hemorrhage frequently accompanied by signs of anemia and/or increased bleeding during surgical procedures. The primary change is loss of high-molecular weight von Willebrand factor multimers (HMWM). Whereas the loss of HMWM in patients with structural heart disease is caused by increased HMWM cleavage by von Willebrand factor (vWF)-cleaving protease, ADAMTS13, AvWS in MCS patients is predominantly a result of a high shear stress coupled ...

$Research paper thumbnail of MIPO of proximal humerus fractures through an anterolateral acromial approach. Is the axillary nerve at risk?$

Injury, 2017

It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious ... more It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious complication, but there is little evidence to indicate whether the axillary nerve is at risk of injury during an anterolateral acromial approach for minimally-invasive plate osteosynthesis (MIPO) of proximal humerus fractures. We hypothesised that this surgical method is safe for the axillary nerve and would preserve it from iatrogenic injury. We conducted a prospective follow-up cohort study on 49 consecutive patients with proximal humerus fractures who were managed with MIPO through an anterolateral approach. All patients underwent standardised electroneurographic testing, with assessment of amplitudes of evoked compound muscle action potentials (CMAP) and distal motor latencies (DML) of the axillary nerves, pre- and post-operatively. Six weeks after injury, all patients underwent needle electromyographic (EMG) testing of anterior, middle, posterior deltoid, teres minor and paraspinal ...

European Journal of Neurology, 2016

Acta Clinica Croatica, 2016

-Schwannomas are benign encapsulated tumors arising from the sheaths of peripheral nerves. Th ey ... more -Schwannomas are benign encapsulated tumors arising from the sheaths of peripheral nerves. Th ey present as slowly enlarging solitary lumps, which may cause neurological defects. Multiple schwannomas in non-neurofi bromatosis type 2 patients are extremely rare. We report a case of a 60-year-old female patient, without any family history of neurofi bromatosis or schwannomatosis, presented with trigeminal neuralgia and progressive facial nerve palsy. Magnetic resonance imaging revealed the presence of acoustic schwannoma involving facial nerve and trigeminal schwannoma of the cisternal part of the nerve involving gasserian ganglion (Meckel's cave). After gamma knife radiosurgery, trigeminal neuralgia was relieved completely with improvement of facial nerve palsy.

3. kongres Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječeničkog zbora i Hrvatskog društva za prevenciju moždanog udara sa međunarodnim sudjelovanjem _knjiga sažetaka ; u: Liječnički vjesnik 128 (2006) (S), 2006

3. hrvatrski kongres iz neurorehabilitacije i restauracijske neurologije : knjiga sažetaka ; u: Neurologia Croatica, 2010

3. hrvatski kongres iz neurorehabilitacije i restauracijske neuralgije : knjiga sažetaka ; u: Neurologia Croatica, 2010

Abstracts of the 23rd Congress of the European Sleep Research Society (ESRS) ; u: Journal of Sleep Research 25 (2016) (S1) 1-401, 2016

Tenzijska glavobolja spada u skupinu primarnih glavobolja, nedovoljno poznatog uzroka. Rizik nast... more Tenzijska glavobolja spada u skupinu primarnih glavobolja, nedovoljno poznatog uzroka. Rizik nastanka ove primarne glavobolje nije jasno defi niran kao ni tijek bolesti. Internacionalno udruženje za glavobolju klasifi ciralo je glavobolje u primarne i sekundarne. Posebnu pažnju pridaje klasifi kaciji tenzijskih glavobolja, tzv. Tension-Type Headache (TTH). Prema toj klasifi kaciji TTH se s obzirom na učestalost pojavljivanja dijeli na epizodne tenzijske glavobolje, učestale-epizodične tenzijske glavobolje te kronične tenzijske glavobolje. Nadalje, epizodične TTH dijele se s obzirom na perikranijsku napetost. Epizodične tenzijske glavobolje mogu biti rijetke (do 12 dana/godišnje) i učestale epizodične TTH koje se češće javljaju i duže traju (<15 dana/mjesec). Kronične TTH traju 15 ili više dana/ mjesec (tablica 1). Kronična TTH značajno umanjuje kvalitetu života (QOL) oboljelog zbog intenziteta boli kao i trajanja bolnog sindroma. Uz to, diferencira se i moguća TTH kao epizodična ...

Tenzijska glavobolja (TTH) spada u skupinu primarnih glavobolja. Nastanak boli nije posve jasan k... more Tenzijska glavobolja (TTH) spada u skupinu primarnih glavobolja. Nastanak boli nije posve jasan kao ni patofiziološki proces nastanka boli. Glavobolja može biti epizodična (trajanje boli do 15 dana) ili kroničnog (trajanje boli 15 ili više dana) tipa. Cilj: Cilj ovog rada je procjena javnozdravstvenog problema tenzijske glavobolje kao i mogućnosti adekvatnog liječenja i profilakse tenzijske glavobolje. Metode: Za ovo ispitivanje koristili smo bazu podataka Pub med uzimajući pojmove; tenzijska glavobolja, prevalencija i liječenje (tension type headache, prevalence, therapy). Rezultati: Učestalost TTH značajno oscilira u ovisnosti o socioekonomskim uvjetima, a moguće i o rasnim razlikama. Učestalost raste sa životnom dobi. Češće se javlja kod žena. Liječi se analgeticima i nesteroidnim antireumaticima. Profilaksa kronične TTH provodi se primjenom amitriptilina, mirtazapina, venlafaksina. U slučaju potrebe uključuje se druga linija profilakse koja obuhvaća klomipramin, maprotilin i mianserin. Uz to koriste se i nemedikamentne mogućnosti liječenja kao što su akupunktura, biofeedback metode, kognitivno-bihevioralno liječenje, relaksacijski treninzi. Rasprava: Tenzijska glavobolja je relativno čest javno-zdravstveni problem u suvremenom svijetu čiji patofiziološki mehanizam nije posve rasvijetljen. Smatra se da je ova glavobolja multifaktorski uvjetovana. Osim epizodične glavobolje značajno veći problem je kronična tenzijska glavobolja koja zahtijeva kontinuiranu profilaksu. Nemedikamentne metode profilakse TTH su nedovoljno istražene i zahtijevaju kliničko-znanstvenu evaluaciju. Zaključak: U suvremenom svijetu tenzijska glavobolja, posebno kronična TTH, je javnozdravstveni problem koji treba zbrinjavati na adekvatan način. Uz široku lepezu medikamentne terapije nameću se i pomoćne metode liječenja koje treba dodatno evaluirati.