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Assessment of Environmental and Hereditary Influence on Development of Pituitary Tumors Using Dermatoglyphic Traits and Their Potential as Screening Markers
No full textThe aim of this study was to assess environmental and hereditary influence on development of pituitary tumors using dermatoglyphic traits. The study was performed on 126 patients of both genders with pituitary tumors (60 non-functional and 66 functional pituitary tumor patients) in comparison to the control group of 400 phenotypically healthy individuals. Statistical analysis of quantitative and qualitative traits of digito-palmar dermatoglyphics was performed, and hormonal
status was determined according to the standard protocols. Although we did not find markers that could specifically distinguish functional from non-functional tumors, we have found markers predisposing to the development of tumors in general (a small number of ridges between triradius of both hands, a smaller number of ridges between the triradius of c–d rc R), those for endocrine dysfunction (increased number of arches and reduced number of whorls, difference of pattern
distribution in the I3 and I4 interdigital space), and some that could potentially be attributed to patients suffering from pituitary tumors (small number of ridges for variables FRR 5, smaller number of ridges in the FRL 4 of both hands and difference of pattern distribution at thenar of I1 and I2 interdigital space). The usage of dermatoglyphic traits as markers of predisposition of pituitary tumor development could facilitate the earlier detection of patients in addition to standard methods, and possibly earlier treatment and higher survival rate. Finally, our results are consistent with the hypothesis about multifactorial nature of pituitary tumor etiology comprised of both gene instability and environmental factors
The first Croatian guidelines for diagnosis, treatment and follow-up of persons with premature ejaculation
No full textPrijevremena ejakulacija (PE) čest je seksualni poremećaj, definiran trima obilježjima: kratkim vremenom intravaginalne latencije ejakulacije, slabom kontrolom nad mogućnošću odgađanja ejakulacije i patnjom osobe i/ili partnerice. Dijagnoza se postavlja na temelju dobre i sveobuhvatne anamneze, koja treba uključiti i prisutnost/odsutnost drugih često komorbidnih stanja (npr. erektilne disfunkcije, anksioznosti) te utvrđivanje vrste PE (primarna, sekundarna, promjenjiva, subjektivna). Važno je savjetovanje bolesnika (i po mogućnosti partnerice) o ovom stanju i mogućnostima liječenja. Prva linija liječenja su selektivni inhibitori ponovne pohrane serotonina (dapoksetin, koji jedini ima odobrenu službenu indikaciju, paroksetin, sertralin, fluoksetin, citalopram, escitalopram). U prvoj su liniji liječenja i psihološko/seksološke metode liječenja, kao što su bihevioralne metode (tehnika stani-kreni i tehnika stiskanja) te novo funkcionalno seksološko liječenje. Izbor metode ovisi o vrsti PE i o izboru bolesnika. U drugoj liniji liječenja jesu klomipramin i lokalni anestetici, a u trećoj tramadol.Premature ejaculation (PE) is a sexual disorder with high prevalence, defined by three characteristics: short intravaginal ejaculation latency time, poor control over delaying ejaculation and personal and/or partner distress. The diagnosis is reached by a thorough and comprehensive history taking, which should include presence/absence of other co-morbid conditions (e.g. erectile dysfunction, anxiety), and assessing the type of PE (primary, secondary, variable, subjective). It is important to counsel the patient (and, if possible, the partner) about this condition and treatment options. The first line of treatment is selective serotonin reuptake inhibitors (dapoxetine, which is the only drug with an official label for this indication, paroxetine, sertraline, fluoxetine, citalopram, escitalopram). The first line of treatment also includes psychological/sexological treatment methods, such as behavioural methods (stop-start and squeeze techniques), and new functional sexological treatment. The choice of the method depends on the type of PE and on the patient preference. The second line of treatment are clomipramine and local anaesthetics, and the third line is tramadol
Slična pojavnost Dupuytrenove kontrakture i haplogroupe I na Y kromozomu u suvremenih Europljana sugerira istodobno širenje ovih značajki prije 40 do 10 tisuća godina
No full textA proposition is made that when two independent traits show similar regional patterns of incidence among modern European regions, a plausible expectation is that these two, otherwise unrelated traits, have simultaneously been spread by migration of our ancestors. As a potential example for the proposed concept, distribution of patients with Dupuytren's contracture is here compared with the reported European distribution of Y-Chromosome Haplogroup I, a genetic marker linked to the last glaciation period.U radu se pretpostavlja da ukoliko dvije neovisne nasljedne značajke pokazuju sličnu regionalnu razdiobu u pučanstvu suvremene Europe, može se očekivati da su se istodobno širile migracijama naših predaka. Kao mogući primjer opisana je sličnost razdiobe Dupuytrenove kontrakture i Haplogrupe I na Y kromozomu, prije opisanog genetskog markera koji se širio tijekom zadnjeg Ledenog doba
Diuretics – More Than Just Treatment for Oedema
No full textDiuretici su dugi niz godina prisutni kao lijekovi za liječenje arterijske hipertenzije i simptomatska terapija srčanog zatajivanja. Tijekom proteklih godina pozicija diuretika u navedenim indikacijama dodatno je analizirana pa je temeljem brojnih studija zaključeno da je opravdana primjena tiazidskih diuretika u monoterapiji i u kombinacijama s drugim skupinama antihipertenziva kao vodeće skupine lijekova u liječenju hipertenzije, prevenciji moždanog udara, hipertenzivnoga srčanog zatajivanja te kod osoba starije životne dobi. Diuretici Henleove petlje i dalje su temelj terapije akutnog i kroničnoga srčanog zatajivanja, dok su novija istraživanja pozicionirala selektivne blokatore mineralokortikoidnih receptora u liječenju kroničnoga srčanog zatajivanja s utjecajem na tijek kardiovaskularnih ishoda. Lijekovi iz skupine osmotskih diuretika koji blokiraju glukoza / natrij kotransporter 2 (SGLT2) izazivajući glukozuriju efikasno snižavaju hiperglikemiju i HbA1c te su dio moderne terapije šećerne bolesti tipa 2 s mogućim dodatnim pozitivnim učincima u redukciji kardiovaskularnih neželjenih događaja.Diuretics have been present for many years as drugs for the treatment of arterial hypertension and as a symptomatic treatment of heart failure. Over the years, the position of diuretics for these indications has further been analysed. Numerous studies have shown that it is justified to use the thiazide diuretic as monotherapy and in combination with other antihypertensive drugs, as the leading group in the treatment of hypertension, stroke prevention, hypertensive heart failure and in the elderly. Loop diuretics remain the cornerstone of treating acute and chronic heart failure, while recent research has positioned selective mineralocorticoid receptor blockers in the treatment of chronic heart failure with an impact on the course of cardiovascular outcomes. Osmotic diuretics that block glucose / sodium cotransporter 2 (SGLT2) causing glucosuria and effectively reducing hyperglycemia and HbA1c are a part of modern therapy of type 2 diabetes mellitus with additional positive effects in the reduction of cardiovascular adverse events
The Influence of Early Nutrition on the Nutrition Status and Course of Disease in Patients With Acute Pancreatitis
No full textCilj: Evaluirati utjecaj rane enteralne prehrane (EP) i totalne parenteralne prehrane (TPP) na nutricijski status i tijek bolesti u oboljelih od akutnog pankreatitisa.
Ispitanici i metode: U randomizirani kontrolirani pokus uključeno je 35 bolesnika sa srednje teškim akutnim pankreatitisom, podijeljenih u dvije skupine, ovisno o tipu nutritivne potpore. Bolesnici u skupini na EP dobivali su Alitraq, Abbott, 25-30 kcal/kg putem nazojejunalne sonde, uz opće mjere liječenja. Druga skupina pacijenata na TPP primala je totalnu parenteralnu prehranu u kontinuiranoj infuziji putem venskog katetera, također uz opće mjere liječenja.
Rezultati: Srednja vrijednost CRP-a u ispitanika na EP pokazivala je veći pad 7. dana liječenja u odnosu na TPP (101,5:142,6). Pad indeksa tjelesne mase (ITM) bio je veći u ispitanika na TPP u odnosu na početne vrijednosti (7,4%), dok se kod ispitanika na EP nakon početnoga pada ITM-a, vrijednost istoga na kraju liječenja približavaju početnima. Vrijednosti kalcija brže su se oporavljale i dosegle su krajnje više vrijednosti u skupini na EP (2,11 ± 0,11 mmol/L) u odnosu na ispitanike na TPP (2,06 ± 0,16 mmol/L). Porast vrijednosti serumskih albumina bio je u EP 6,5%, a u TPP 0,2% u odnosu na početne vrijednosti. Trajanje hospitalizacije bilo je u prosjeku dva dana kraće u skupini ispitanika na EP. Učestalost kompli-kacija bila je podjednaka u obje skupine.
Zaključak: EP je jednako učinkovita i sigurna u liječenju akutnog pankreatitisa kao i uobičajeno korištena TPP.Aim. The aim of this study was to evaluate the effects of early enteral nutrition (EN) and total parenteral nutrition (TPN) to nutritional status and development of the disease in patients suffering from acute pancreatitis.
Patients and methods. 35 patients suffering from average severe acute pancreatitis were included in this randomized controlled trial. The patients were divided into two groups, according to the type of nutritional support. Those receiving enteral nutrition were given Alitraq, Abbott, 25-30 kcak/kg via nasojejunal tube with general supportive treatment. Other patients receiving total parenteral nutrition were given this nutrition in continuous infusion through the central venous catheter with general supportive treatment.
Results. Mean value of CRP in patients on EN demonstrated more pronounced decrease on day 7 of the treatment vs. TPN (101.5 : 142.6). A decrease in the body mass index (BMI) was higher in the TPN group when compared to initial values (7.4%), whereas in patients on EN group after initial decrease, the values approached baseline values. The values of serum calcium recovered faster and reached higher values in the EN group (2.11 ± 0.11mmol/L) vs. patients in TPN group (2.06 ± 0.16 mmol/L). An increase in the serum albumin levels in comparison to baseline values was 6.5% in EN group vs. 0.2% in TPN group of patients.
The length of hospitalization was on average two days shorter in patients receiving EN. Complication incidence was similar in both groups.
Conclusion. EN is equally efficient and safe in treatment of acute pancreatitis as standard nutritional support i.e. total parenteral nutrition
Is Shorter Transient Middle Cerebral Artery Occlusion (t-MCAO) Duration Better in Stroke Experiments on Diabetic Female Sprague Dawely rats?
No full textAIM: To determine optimal duration of transient middle cerebral artery occlusion (t-MCAO) for a stroke model in female diabetic Sprague-Dawley (SD) rats.
METHODS: Streptozotocin-induced type-1 diabetic SD female rats (n = 25, 12 weeks old, five groups; n = 5 per group) were subjected to different duration of t-MCAO (20, 30, 45, 60 and 90 minutes) followed by reperfusion. A control group of rats without diabetes (n = 5) was subjected to 30 minutes of t-MCAO followed by reperfusion. Twenty-four hours after reperfusion, infarct volumes were evaluated by 2,3,5-triphenyltetrazolium chloride (TTC) staining.
RESULTS: Intra-ischaemic reductions of regional cerebral blood flow (rCBF) were similar in all groups (68-75% of baseline values). Reperfusion was significantly impaired in the 90-minute ischaemia group (56-62% vs 80-125% in other groups). Twenty minutes of t-MCAO induced a small infarct (3 ± 5% of ischaemic hemisphere). Thirty minutes of ischaemia produced a significantly larger infarct (46 ± 6%). In the 45 and 60 minute groups, ischaemia infarct was 52 ± 5% and 59 ± 3% of the ischaemic hemisphere, respectively. Ischaemia of 90' led to a massive stroke (89 ± 6% of ischaemic hemisphere encompassing the whole striatum (22 ± 3%) and almost the whole MCA irrigated cortex area (67 ± 6%)). Thirty minutes of t-MCAO did not produce stroke in the control group.
CONCLUSION: The diabetic rat stroke model should be different from the non-diabetic, because female type-1 diabetic SD rats are highly sensitive to brain ischaemia and it is necessary to significantly shorten the duration of t-MCAO, optimally to 30 minutes
Clinical Entities and Characteristics of Pain in Patients With Rheumatic Diseases
No full textMišićno-koštana bol najčešći je simptom prisutan u gotovo svim reumatskim bolestima. Reumatske bolesti obuhvaćaju više od 150 kliničkih entiteta. Nema jedinstvene klasifikacije reumatskih bolesti. Općenito ih dijelimo na upalne reumatske bolesti, neupalne bolesti zglobova degenerativnog karaktera, sustavne bolesti vezivnog tkiva, metaboličke poremećaje s manifestacijom na zglobovima, regionalne i proširene bolne sindrome. Bol je prema Međunarodnom udruženju za proučavanje boli (IASP) definirana kao neugodan osjećaj povezan s oštećenjem tkiva ili opisan u vrijeme takvog oštećenja. Ona ima svoju tjelesnu, duševnu i socijalnu komponentu. Najčešće se u reumatskim bolestima radi o kroničnoj boli koja može narušiti opće stanje organizma, traje duže od 3 ili 6 mjeseci, a prema nekim definicijama, već i ako postoji duže od 6 tjedana. Uglavnom je nociceptivna, a rjeđe neuropatska. Mišićno-koštana bol, osobito kronična, globalni je javnozdravstveni problem zbog svoje učestalosti, nerijetko oštećenja funkcije i razvoja kroničnoga bolnog sindroma koji se može smatrati zasebnim kliničkim entitetom i zahtijeva biopsihosocijalni pristup u liječenju bolesnika.Musculoskeletal pain is the most common symptom present in almost all rheumatic diseases. Rheumatic diseases include more than 150 clinical entities. There is no uniform classification of rheumatic diseases. In general, we distinguish inflammatory rheumatic diseases, non-infl ammatory degenerative articular diseases, systemic connective tissue diseases, metabolic disorders with articular manifestations, and regional and extended pain syndromes. According to the International Association for the Study of Pain (IASP), pain is defined as an unpleasant sensation associated with tissue damage or reported simultaneously with such damage. Pain has a physical, mental, and social component. In rheumatic diseases the pain is mostly chronic and may severely impair the patient’s general condition. The defining criteria involve a period of more than 3 or 6 months, and according to some definitions more than 6 weeks. In most cases the pain is nociceptive rather than neuropathic. Musculoskeletal pain, especially chronic pain, is a global public health problem because of its prevalence, as well as the frequently associated muslculoskeletal function impairment and development of chronic pain syndrome, which can be considered as a separate clinical entity and requires a biopsychosocial treatment approach
Comparison of the Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Glasgow Prognostic Score in Diffuse Large B-Cell Lymphoma
No full textBackground: Given the role of inflammation in tumor progression, as well as in diffuse large B-cell lymphoma (DLBCL), researchers are trying to identify easily applicable, easy accessible prognostic markers for individual risk assessment. The most frequently used inflammatory prognostic markers are the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR),andthe Glasgow prognostic score (GPS).
Objectives: To determine and compare the prognostic value of the baseline inflammatory biomarkers NLR, PLR, and GPS in patients with DLBCL.
Methods: We retrospectively analyzed data from 103 DLBCL patients treated with R-CHOP or R-CHOP-like regimens. We evaluated the significance of NLR, PLR, and GPS as a predictor of response to treatment, overall survival (OS), and event-free survival (EFS).
Results: Higher NLR levels were found in patients with a poorer response to therapy (median [range] 2.87 [0.56 - 26.33] vs. 4 [0.62 - 29.66], P = 0.026). Patients with NLR values of > 2.63 (cutoff value calculated by receiver-operating characteristic) had significantly worse two-year OS (65.1% vs. 87.2%, P = 0.002) and two-year EFS (59.8% vs. 87.1%, P = 0.001). PLR values were not significant for survival. The two-year OS rates for patients with GPS = 0, GPS = 1, and GPS = 2 were 93.3%, 63.9%, and 33.3%, respectively (P 2.63 were an independent prognostic factor for OS (hazard ratio [HR] = 2.857; 95% confidence interval [CI] 1.022 - 8.699; P = 0.048] and EFS (HR = 4.06; 95% CI 1.357 - 12.151; P = 0.012).
Conclusions: Our research confirmed NLR as useful independent prognostic marker for survival. PLR and GPS did not show independent prognostic value, although they were also associated with the patients’ clinical features. The easy availability and inexpensiveness of inflammatory biomarkers should encourage their use in clinical practice
Somatic Comorbidities are Independently Associated with the Poor Health-Related Quality of Life in Psychiatric Patients
No full textBackground: Despite the increased risk, the quality of somatic healthcare is lower for patients with mental illnesses. Currently dominant approach separates physical and mental, primary and secondary healthcare. Objective of our study was to explore whether somatic comorbidities are associated with a poor HRQoL independently of some sociodemographic and clinical factors. Majority of studies have explored particular somatic and psychiatric illnesses. Therefore we decided to access the problem from the general perspective of the universe of somatic and mental illnesses in the large psychiatric institution. Subjects and methods: This nested cross-sectional study was done during May 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 506 patients diagnosed with psychiatric illnesses (ICD-10: F00-F99). Key outcome was the lowest 25% results on the SF-36 General health sub-scale, indicating the worst HRQoL. Predictors were all detected somatic illnesses. By multivariate logistic regression we controlled different sociodemographic, vital and clinical factors.
Results: After adjustment for different sociodemographic and clinical factors, three somatic comorbidities remained independently associated with the worst HRQoL: endocrine, nutritional and metabolic diseases (E00-E90), diseases of respiratory system (J00-J99) and diseases of musculoskeletal system and connective tissue (M00-M99)
Conclusions: Somatic comorbidities in psychiatric patients are associated with the poor HRQoL independently of different sociodemographic, vital and clinical factors and they should be treated seriously and integrally with mental aspects of HRQoL. Early comorbidities detection and adequate pharmacological and psychotherapeutic treatment, as well as the prevention of risk factors, may improve the quality of life and reduce morbidity and mortality of psychiatric patients
Intraoperative Transfusion Practices in Europe
No full textBACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe.
METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013.
RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2).
CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold