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Nepovezanost serumskog statusa vitamina D i erektilne disfunkcije u primatelja bubrežnog presatka
No full textErectile dysfunction (ED) is a highly prevalent disorder among renal transplant recipients. Vitamin D deficiency (VDD) has been associated with several ED risk factors but only recently directly linked to ED. We conducted a study to investigate whether vitamin D serum levels were associated with the presence and severity of ED in 40 male patients that underwent deceased donor kidney transplantation (TX) from 2001 to 2013. Blood samples were collected on two seasonally distinct occasions and 25(OH)D concentration was assessed by radioimmunoassay. A 5-item version of the International Index of Erectile Function (IIEF-5) was used for ED evaluation and group stratification. We found comparable rates of ED (75%) and VDD (42.5%-62.5%) as in previously published studies. Serum levels of 25(OH)D did not differ between patients with and those without ED on both measurements (p=0.656 and p=0.914, respectively), or when comparing different ED severity groups. Duration of renal replacement therapy before TX and graft duration until analysis were longer in patients with ED (p=0.022 and p=0.05, respectively), but with the results being nonsignificant on logistic regression. In conclusion, we found no association of 25(OH)D concentration with the presence and severity of ED in renal transplant recipients. So far, there are no similar published data.Erektilna disfunkcija (ED) je poremećaj visoke učestalosti u bolesnika nakon transplantacije bubrega. Deficijencija vitamina D (VDD) je već ranije povezana s nekoliko rizičnih čimbenika za ED, ali je tek nedavno dovedena u izravnu vezu s ED. U predmetnom smo istraživanju ispitali je li serumska vrijednost vitamina D povezana s prisutnošću i jačinom izraženosti ED u 40 muških ispitanika u kojih je kadaverična transplantacija bubrega (TX) učinjena od 2001. do 2013. godine. Serumsko uzorkovanje je učinjeno u dva sezonski različita razdoblja, uz mjerenje koncentracije vitamina D radioimuno testom. Upitnik International Index of Erectile Function(IIEF-5) korišten je za stratifikaciju bolesnika s obzirom na jačinu ED. Pronašli smo usporedivu učestalost ED (75%) i VDD (42,5%-62,5%) kao u dosad objavljenim istraživanjima. Ni u jednom mjerenju nije utvrđena razlika u serumskim vrijednostima 25(OH)D između ispitanika s ED i bez nje (p=0,656 i p=0,914), kao ni među ispitanicima s različito izraženom ED. Trajanje bubrežne nadomjesne terapije (RRT) prije TX i “trajanje” transplantata do analize bilo je duže za ispitanike s ED (p=0,022 odnosno p=0,05), no samo u univarijatnoj analizi. Zaključno, nismo pronašli povezanost između serumske razine 25(OH)D i prisutnosti te jačine izraženosti ED. Prema našim spoznajama, dosad nema sličnih objavljenih rezultata za navedenu populaciju bolesnika
Are We Compensating for the Lack of Physical Activity in Our Diabetic Patients with Treatment Intensification?
No full textBACKGROUND: We studied the association between leisure time physical activity (LTPA) and glycemic control, body mass index (BMI), and hypoglycemic incidents in type 1 (T1DM) and type 2 diabetes patients (T2DM).
METHODS: This is a cross-sectional study of 198 diabetic patients (60 with type 1 diabetes, 138 with type 2 diabetes). LTPA was assessed by a validated 12-month questionnaire. Patients were grouped as sedentary and moderately to vigorously active. Outcome measures were Hemoglobin A1c (HbA1c), BMI, and hypoglycemic episodes.
RESULTS: LTPA effect on the HbA1c reduction was present in diabetes type 1 patients. Patients who were involved in the moderate to vigorous-intensity physical activity had a greater decrease in the HbA1c (p = 0.048) than patients with low physical activity (p = 0.085). Level of LTPA was neither associated with increased number of hypoglycemic episodes, nor BMI. After an average of 4 years of diabetes, the number of patients requiring more than one antidiabetic agent increased, although the observed difference did not correlate with LTPA level.
CONCLUSIONS: LTPA has an influence on the regulation of diabetes type 1, and intensification of medical treatment is compensating for the lack of lifestyle change-especially in type 2 diabetics
Long-term Predictors of Anxiety and Depression in Adult Patients with Asthma
No full textBACKGROUND: It is well established that anxiety and depression are associated with asthma, but there is limited evidence about the persistence of anxiety/depression in asthma. The aim of our study was to assess the long-term predictors of anxiety and depression in adult asthmatic patients.
METHODS: A total of 90 adult asthma patients (63 women, age 18-50 years) with different levels of disease control (28 uncontrolled and 34 partially controlled) were assessed at baseline and at follow-up after 7 years for anxiety, depression and asthma control. The same work-up on both occasions included: demographics, living conditions, medical history (e.g. comorbidities, adherence and exacerbations), Hospital Anxiety and Depression Scale (HADS), Asthma Quality of Life Questionnaire (AQLQ), disease control and lung function. Persistence was defined as the HADS scores for anxiety and depression present at baseline and follow-up.
RESULTS: The HADS results at follow-up visit showed 36 (40%) asthma patients with anxiety and 13 (14%) with depression, with the persistence of anxiety in 17 (19%) and of depression in 7 (8%) patients. Significant predictors of anxiety at follow-up were HADS and AQLQ results at baseline and several parameters of asthma control at follow-up (area under the curve AUC 0.917, 95% confidence interval CI 0.829-0.969, p < 0.001) and for depression AQLQ mood disorder domain, asthma control and lung function (AUC 0.947, 95% CI 0.870-0.986, p < 0.001).
CONCLUSION: Anxiety and depression persist over years in some patients with asthma. The association between mood disorders and asthma suggests potential mutual treatability
Distribution of Ki-67 Values within HER2 & ER/PgR Expression Variants of Ductal Breast Cancers as a Potential Link Between IHC Features and Breast Cancer Biology
No full textBACKGROUND: Unexpected differences in Ki-67 values among HER2 & ER/PgR defined subgroups were found. This study aims to detect possible subdivisions beyond the conventional breast cancer types.
METHODS: One thousand one hundred eighty consecutive patients with invasive ductal breast carcinoma were included and distributed in 16 subgroups (four HER2 phenotypes (0+, 1+, 2+ and 3+) times four ER/PgR phenotypes). Complex distributions of Ki-67 values were tested by expectation maximization (EM) clustering.
RESULTS: Pooled Ki67 values of all patients showed the presence of three EM clusters (defined as LMA-low mitotic activity, IMA-intermediate mitotic activity and HMA-high mitotic activity) with expected mean Ki-67 values of 1.17%, 40.45% and 77.79%, respectively. Only ER-PgR- tumors significantly dispersed in three clusters (29.75% tumors in LMA, 46.95% in IMA and 23.30% in the HMA cluster), while almost no detected HMA tumors were of ER + PgR+ or ER + PgR- phenotypes. Among 799 ER + PgR+ patients distribution in clusters was HER2 dependent (p = 0.000243), due to increased number of IMA HER2 3+ tumors on the expense of LMA HER2 3+ tumors (52 IMA out of 162 HER2 3+ patients versus113 IMA out of 637 HER2 < 3+ patients). This was not found among ER + PgR- patients (p = 0.186968). Among ER-PgR- patients, HER2 overexpression also increased number of IMA tumor, but by reducing the number of HMA tumors (p < 0.000001). Here, difference between HER2 absent (0+) and HER2 3+ patients was evident (10 HMA out of 125 HER2 3+ patients versus 42 HMA out of 103 HER2 0+ patients).
CONCLUSIONS: Results suggest that distributions of breast cancers in three clusters of mitotic activity depend on different mechanisms for ER + PgR+ and ER negative tumors. Although HER2 overexpression increases number of IMA tumors in both settings, in the former it is done by reducing number of LMA tumors, while in the latter it reduces the number of HMA tumors. Mitotic activity of ER + PgR- tumors seems unrelated to the HER2 status, possibly as an indicator that ER dysfunctionality in cancers that lack PgR expression. Among ER negative tumors, the absence of HER2 (0+) might be as important as the HER2 overexpression
Long-term Effectiveness of Liraglutide in Association with Patients' Baseline Characteristics in Real-life Setting in Croatia: an Observational, Retrospective, Multicenter Study
No full textINTRODUCTION: Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are recommended therapy for type 2 diabetes (T2DM) and liraglutide is the most used worldwide. We assessed the glycemic efficacy and extra-glycemic effects of liraglutide during 36 months' follow-up of individuals with poorly regulated T2DM under routine clinical practice and sought to identify the phenotype of treatment responders.
METHODS: A total of 207 individuals were included. The primary endpoint was the proportion of participants with HbA1c < 7.0% and/or weight reduction. Secondary endpoints included changes in lipids, blood pressure, fasting c-peptide, and antidiabetic treatment during follow-up of 3 years.
RESULTS: Liraglutide was prescribed to 89.8% of participants already on at least two antidiabetic medications and 18% on insulin. Subject's mean age was 53.28 ± 9.42 years with duration of diabetes 8.29 ± 4.89 years. Baseline HbA1c was 8.5 ± 1.3% and body mass index (BMI) was 39 ± 4.5 kg/m2. Reduction of HbA1c was observed in 84.4% of participants, and 89.2% experienced average weight reduction of 5 kg. A composite outcome (reduction of HbA1c with any weight loss) was achieved in 76.2% of patients. After 6 months on liraglutide treatment, 38.1% of participants achieved target HbA1c level < 7%. This effect was maintained for 36 months in 50.8% of subjects. Increase in c-peptide was evident after 24 months (p = 0.030). Participants experienced a significant reduction in systolic blood pressure (BP) (p = 0.003), while there was no effect on diastolic BP, lipid profile, or liver enzymes. The number of participants treated with sulfonylurea decreased from 60.8% to 17.5%, while the number treated with insulin and sodium-glucose co-transporter-2 (SGLT-2) inhibitor increased (17.6% to 24.6% and 2.5% to 36.8%, respectively). Independent predictors of durability of HbA1c reduction were initial BMI (p = 0.004), HbA1c (p < 0.001), systolic BP (p = 0.007), and cholesterol (p = 0.020). Moreover, female gender and shorter duration of diabetes were independent predictors for HbA1c reduction.
CONCLUSION: Liraglutide shows sustained glycemic and extra-glycemic effects when used for treatment of obese poorly regulated individuals with T2DM
Rights of jehovah's witnesses on surgical health care in the republic of Croatia - De lege lata
No full textPrava Jehovinih svjedoka (JS) na zdravstvenu zaštitu u Republici Hrvatskoj (RH) moraju biti jednaka kao za ostalu populaciju. Odbijanje transfuzije krvi (TK) koje nalaže religijski svjetonazor JS-a prepreka je ostvarivanju pojedinih rizičnih oblika liječenja u RH. Krvarenje kao komplikacija nekih oblika liječenja može ugroziti život bolesnika. Izbjegavanje TK postupcima pripreme može u određenom opsegu u pojedinačnim slučajevima spriječiti posljedice, no „zamjenska krv“, zvana tako u laičkim medijima, zapravo ne postoji. U RH je zakonom zajamčeno postupanje u skladu s bolesnikovim pristankom ili odbijanjem određenih postupaka liječenja. U svakome pojedinačnom slučaju potrebno je procijeniti rizik od krvarenja te, ako on nije izrazit, omogućiti bolesniku takvo liječenje. Ako liječnik ili zdravstvena ustanova ne mogu prihvatiti ni manji rizik, potrebno je uputiti bolesnika liječniku ili ustanovi koja može provesti takvo liječenje. Pristanak bolesnika na postupak liječenja bez pristanka na TK ne obvezuje liječnika na sudjelovanje u takvom zahvatu samo kada postoji velik rizik od krvarenja, a bolesnik odbija TK. Zakon o zdravstvenoj zaštiti pacijenata u RH obvezuje liječnika na spašavanje života pa je TK u životno ugroženog bolesnika koji krvari ili je iskrvario u takvoj situaciji jedina opcija, što može dovesti do liječenja protivno volji pacijenta. S obzirom na legislativnu nedorečenost i proturječnost te na obvezu RH prema poštovanju prava Europske unije odnosno slijeđenja Europske konvencije za zaštitu ljudskih prava (EKZLJP), u slučaju, premda etički opravdanog i obveznog TK protiv bolesnikova pristanka u slučaju spašavanja života, možemo i moramo računati da takvim postupanjem EKZLJP može biti povrijeđen.Jehovah’s Witnesses’ (JW) rights must be the same as for the rest of the citizens. Blood transfusion (BT) refusal, as ordered by JW’s religion presents an obstacle for accomplishment some risky treatment modalities. Bleeding that could complicate some medical procedures could jeopardize patient’s life. Avoiding BT by preceeding procedures could prevent consequences to certain extent, but there is not substitute for blood as such, as it is common met in lay media. The Law in Croatia guarantees that a treatment must be in accordance with patient’s approval or refusal of specific medical procedure. In every particular case there is a need for assessment of the bleeding risk, and if the risk is not significant, the treatment should be performed. If the physician or the institution were not able to accept even that lower risk, the patient should be redirected and offered the treatment by another physician or institution, capable for such treatment modality. Patient’s consent for that treatment without consent to BT does not oblige physician to participate in the treatment only if there is a substantial risk for bleeding. On the other hand, Act on Medical Practice in the Republic of Croatia prescribes that saving life is mandatory for a physician, rendering BT in a patient with major bleeding the sole option. Having in mind that the relevant Law is not complete and that the regulations are contradictory, and that the Republic of Croatia must accept the European Union legislation and is bound by Europaen Convention on Human Rights, in the case of giving BT against a patient’s will physicians must count on being considered as violating the Convention
Auxiliary Diagnostic Potential of Ventricle Geometry and late Gadolinium Enhancement in left Ventricular Non-compaction; Non-randomized case Control Study
No full textBackground: There are still ambiguities existing in regard to left ventricular non-compaction (LVNC) diagnostic imaging. The aim of our study was to analyze diagnostic potential of late gadolinium enhancement (LGE) and ventricle geometry in patients with LVNC and controls.
Methods: Data on cardiac magnetic resonance imaging (CMR) studies for LVNC were reassessed from the hospital’s database (3.75 years; n=1975 exams). Matching sample of controls included cases with no structural heart disease, hypertrophic or dilative cardiomyopathy, arrhythmogenic right ventricular dysplasia or subacute myocarditis. Eccentricity of the left ventricle was measured at end diastole in the region with pronounced NC and maximal to minimal ratio (MaxMinEDDR) was calculated.
Results: Study included 255 patients referred for CMR, 100 (39.2%) with LVNC (prevalence in the studied period 5.01%)
and 155 (60.8%) controls. Existing LGE had sensitivity of 52.5% (95%-CI:42.3–62.5), specificity of 80.4% (95%-CI:73.2–86.5) for LVNC, area under curve (AUC) 0.664 (95%-CI:0.603–0.722);p1.10 had sensitivity of 95.0% (95%- CI:88.7–98.4), specificity of 82.6% (95%-CI: 75.7–88.2) for LVNC, AUC 0.917 (95%-CI:0.876–0.948); p<0.001. LGE correlated with Max-Min-EDD-R (Rho=0.130; p=0.038) and there was significant difference in ROC analysis ΔAUC0.244 (95%-CI:0. 175–0.314); p<0.001. LGE also correlated negatively with stroke volume and systolic function (both p<0.05, respectively).
Conclusions: LGE was found to be frequently expressed in patients with LVNC, but without sufficient power to be used as a discriminative diagnostic parameter. Both LGE and eccentricity of the left ventricle were found to be relatively solid diagnostic landmarks of complex infrastructural and functional changes within the failing heart
Epicardial Fat Tissue and Coronary Artery Disease
No full textEpikardijalno masno tkivo (EMT) ekstraabdominalno je visceralno masno tkivo smješteno između miokarda i visceralnog lista perikarda s kojima je embriološki, anatomski i funkcionalno povezano. Debljina epikardijalnoga masnog tkiva danas je prepoznata kao nezavisni rizični čimbenik koronarne bolesti srca (KBS), o čemu svjedoči sve veći broj kliničkih studija. Povećani volumen epikardijalnoga masnog tkiva povezan je s kroničnom upalom i povećanim lučenjem proupalnih citokina koji pogoduju i promoviraju proces aterogeneze. Standardiziranim postupkom ultrazvučnog mjerenja debljine epikardijalnoga masnog tkiva lateralnog zida desnog ventrikula može se s velikom sigurnošću predvidjeti postojanje KBS-a, a uz pomoć kompjutorizirane tomografije ili magnetske rezonancije predvidjeti i rizik od mogućega koronarnog događaja. Povezanost debljine i upale epikardijalnoga masnog tkiva s KBS-om nameće ideju o potencijalnim terapijskim intervencijama radi usporavanja procesa aterogeneze.Epicardial fat tissue is extraabdominal visceral fat tissue located between the myocardial muscle and the visceral pericard and connected to it embryonally and functionally. A large number of clinical studies support the claim that the epicardial adipose tissue thickness is an independent risk factor for coronary disease. The enlarged volume of the epicardial fat tissue is connected to chronical inflammation and strong production of anti inflammatory cytokines which entice the atherogenesis. Coronary disease can be predicted by standard measurement of the epicardial fat thickness of the right ventricle lateral wall. Thus it is possible to predict the risk of a coronary incident by conducting a CT or MR scan. The correlation between epicardial fat thickness and inflammation of the fat tissue suggests the possibility of potential therapeutical interventions with the aim to delay aterogenesis
Poincaré Plot Indices as a Marker for Acute Pain Response in Newborns
No full textTraditional views on neonatal pain neglected long neglected the neonates’ capability of feeling pain. Newborn infants experience at least one painful procedure during their frst 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 signifcantly 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 diferences in healthy newborns. The results have shown a signifcant increase in the heart rate, a reduction of the duration of RR intervals, and the square root of the mean squared diferences between successive RR intervals (RMSSD), as well as a decrease in the short-term variability (SD1) of the Poincare plot. Te results highlight the need for studying the application of nonlinear analyses of the HRV on the efects of pain on the ANS and its long-term efects on the infant
Acute Postoperative pain in Trauma Patients - the Fifth Vital sign
No full textAIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment.
PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain.
RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally.
CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment