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Diagnostic Accuracy of a Pocket Screening Spirometer in Diagnosing Chronic Obstructive Pulmonary Disease in General Practice: a Cross Sectional Validation Study Using Tertiary care as a Reference
No full textBACKGROUND: COPD-6™ is a lung function testing device for a rapid pre-spirometry testing to screen-out at-risk individuals not having COPD and indicating those at risk. The aim of this study was to validate COPD-6™ lung function testing (index test) in general practice in discriminating patients with COPD out of the population at risk - smokers/ex-smokers with no previous diagnosis of COPD, using measurements at tertiary care as reference standard.
METHODS: Consecutive 227 subjects (115 women, 185 smokers/42 ex-smokers, ≥20 pack-years) with no previous diagnosis of COPD, aged 52.5 (SD 6.8) years from 26 general practitioners (GPs) were recruited, lung function tested with COPD-6™, referred to the tertiary institution for repeated COPD-6™ testing followed by spirometry with a bronchodilator (salbutamol), examination, and pulmonologist consultation for the diagnosis and severity of COPD.
RESULTS: COPD was diagnosed in 43 subjects (18.9 %), with an AUC of 0.827 (95 % CI 0.769-0.875, P < 0.001) for the diagnosis of COPD when lung function was measured using COPD-6™ in GP's office with a specificity of 100 % (95 % CI, 97.95-100 %) but a very low sensitivity of 32.56 % (95 % CI, 20.49-47.48 %). Significant agreement for forced expiratory volume in 1 s measured at GP's office and at lung function lab was found (mean difference 0.01 L, p = 0.667) but not for other measured parameters (p < 0.001 for all).
CONCLUSIONS: Our study results point out that active case finding in a population at risk for COPD should be instituted (almost 20 % of undiagnosed COPD). Based on our results lung function testing with COPD-6™ can substitute spirometry testing in cases where it is not readily available to the patient/physician taken into account that the traditional FEV1/FEV6 cutoff value of <0.7 is not the only criterion for diagnosis and/or further referral
Genetic Variation in Leptin and Leptin Receptor Genes is a Risk Factor for Idiopathic Recurrent Spontaneous Abortion
No full textAim to determine whether maternal leptin (LEP) and leptin receptor (LEPR) gene polymorphisms are associated with idiopathic recurrent spontaneous abortion (IRSA).
Methods: this case-control association study conducted from 2010 to 2012 at the Department of Gynecology and Obstetrics, University Hospital Center Osijek and Clinical Institute of Medical Genetics Ljubljana included 178 women with a history of three or more IRSAs before the 22nd week of gestation and 145 women with at least two live births and no history of pathologic pregnancies during reproductive period. Polymorphisms of maternal LEP (rs7799039, rs2122627, rs11761556, rs10244329) and LEPR (rs1137101, rs7516341, rs1186403, rs12062820) were assessed by allele specific real-time polymerase chain reaction. Genotype distribution, allele frequencies, and frequency of haplotypes at LEP and LEPR genetic loci were determined.
Results: we observed more frequent genotype for rs7516341 (nominal P = 0.034, odds ratio [OR] 0.61, 95% confidence interval [CI] 0.38-0.97) and rs1137101 (nominal P = 0.048, OR 1.66, 95% CI 1.00-2.80) in the LEPR gene in patients than in controls, but these results did not remain significant after correction for multiple testing according to Bonferroni (adjusted P value threshold was set at 0.05). We did not observe differential distribution of genotype frequencies in the LEP gene between cases and controls. In patients with IRSA, GTCC haplotype in the LEPR gene locus was significantly less frequent than in controls (P = 0.00865, OR 0.45), contrary to ACTC haplotype (P = 0.0087, OR 1.98).
Conclusions: we showed that genetic variability in the LEPR gene was associated with IRSA, warranting confirmation on a greater number of patients and pathogenesis investigation
Laboratory use of Hepcidin in Renal Transplant Recipients
No full textHepcidin is a small peptide with a critical role in cellular iron homeostasis, as it regulates utilization of stored iron and antimicrobial defense in inflammation (bacterial and fungal). Since it was isolated in 2000, and especially in the last decade, numerous studies aimed to evaluate the clinical use of plasma and urine hepcidin as a marker of anemia, especially anemia of chronic disease and post-transplant anemia (PTA). Hepcidin regulation is delicately tuned by two inflammatory pathways activated by interleukin-6 (IL-6) and bone morphogenic proteins (BMPs) and iron regulated
pathway sensitive to circulating transferin-iron (TR-Fe) complex. BMP-mediated pathway and TR-Fe sensitive pathway seem to be connected by hemojuveline, a BMP co-factor that interacts with transferine receptor 2 (TRF2) in cases of high TR-Fe circulatory concentration. In addition to these regulatory mechanisms other regulators and signaling pathways are being extensively researched. Hepcidin has been identified as an important contributor to morbidity and mortality in end stage renal disease (ESRD) but no such association has jet been found in case of PTA. However, there is an association between higher doses of erythropoiesis-stimulating agents (ESA) and mortality in the posttransplant period and the assumption that hepcidin might play a role in ESA resistance in PTA. Thus the review’s main goal was to summarize
papers published on the association of hepcidin with PTA, give up-to-date information on hepcidin regulation and on potential therapeutics that optimize hepcidin regulation. We also compared the performances of tests for hepcidin determination and reviewed research on immunosuppressants’ (IS) effect on hepcidin concentration
Giant Primary Pleomorphic Adenoma of the Lung Presenting as a Post-traumatic Pulmonary Hematoma: a case Report
No full textBACKGROUND: Pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant transformation. Primary pleomorphic adenomas of the lung are extremely rare tumors with less than 40 cases reported in the literature by now. This is the first case in the literature describing overlapping with a traumatic event and also one of the rare cases describing primary adenoma of the lung reaching this impressive size.
CASE PRESENTATION: We report a rare case of a giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma. A 38-year-old Caucasian male patient came to the Urgent Trauma Center after being hit in the chest by a bull and, after a number of tests, was diagnosed with primary pleomorphic adenoma of the lung. Operative treatment was performed and the surgical excision was successfully done.
CONCLUSIONS: Our conclusion is that the surgical excision is the main treatment for pleomorphic adenoma of the lungs and we recommend lifelong follow-up and regular check-ups. Furthermore, we consider our case an interesting one due to its concurrence with the chest trauma and the dilemma about the optimal approach considering the entity could have been a large interlobular hematoma
Influence of Various Factors on Functional Dyspepsia
No full textAim of the research is to establish the prevalence of dyspepsia in Osjecˇko-baranjska County, to establish its specific characteristics and to determine the effect of demographic, anthropometric, and socioeconomic factors. It is a cross- sectional and case control study conducted in 2010 on systematic sample of 900 subjects between 20 and 69 years of age. Every subject was sent an invitation letter and a Rome III diagnostic questionnaire for one of the disorders. A scoring algorithm was used to confirm or exclude the diagnosis of functional dyspepsia (FD). The chi-square test, t-test and logistic regression were used for analysis. Prevalence of dyspepsia was recorded in 16, 56 %, of subjects. There is no statistically significant difference in prevalence of dyspepsia male and female. The prevalence of dyspepsia increases with age. Correlation with the place of birth was proven. There is no correlation between the current place of residence (rural area and town) and dyspepsia. There is a correlation with marital status. Correlation between stool forms was proven. There were a greater number of subjects that had at least one alarm symptom or some of the psychosocial factors and they often suffered from a chronic disease. The risk for dyspepsia increases with age, body mass index (BMI), and poorer health. Logistic regression showed the following as statistically significant for dyspepsia: place of birth and self-assessment of one’s health. FD presents a significant health problem. Rome III survey questionnaire proved to be an acceptable method for diagnosin this functional disorder in clinical-consilliary and primary health care for persons showing signs of alarm and
needing further diagnostic treatment
Pathologic Patterns of Interleukin 10 Expression – A Review
No full textInterleukin 10 (IL-10) is important pleiotropic immunoregulatory cytokine which gene is located on chromosome 1 at 1q31-32. There are many genetic variants of IL-10 gene. However, the most studied are two dinucleotide repeats (microsatellites), IL10.G and IL10.R, located 1.2 kb and 4 kb upstream of the transcription start site and three single nucleotide polymorphisms (SNPs) -1082(G/A), -819(C/T) and -592(C/A). A large number of studies have shown that IL-10 gene polymorphisms are associated with different diseases and play an important role in pathophysiology and clinical course of these diseases. This review summarizes published literature knowledge about the association of IL-10 polymorphisms and expression patterns with asthma, systemic lupus erythematosus, psoriasis, inflammatory bowel disease, rheumatoid arthritis, tuberculosis and some neoplasms
Comparison of the Hospital Arrival Time and Differences in Pain Quality Between Diabetic and Non-Diabetic STEMI Patients
No full textThe aim of our study was to determine whether diabetic ST segment elevation myocardial infarction (STEMI) patients arrive in the emergency room (ER) later than non-diabetics, compare the differences in pain quality and quantity between those groups, and measure differences in the outcome after an index hospitalization. A total of 266 patients with first presentation of STEMI were included in our study during a period of two years, 62 with diabetes and 204 without diabetes type 2. Pain intensity and quality at admission were measured using a McGill short form questionnaire. Diabetic patients did not arrive significantly later than non-diabetic (χ²; p = 0.105). Most diabetic patients described their pain as "slight" or "none" (χ²; p < 0.01), while most non-diabetic patients graded their pain as "moderate" or "severe" (χ²; p < 0.01). The quality of pain tended to be more distinct in non-diabetic patients, while diabetic patients reported mainly shortness of breath (χ²; p < 0.01). Diabetic patients were more likely to suffer a multi-vessel disease (χ²; p < 0.01), especially in the late arrival group. Therefore, cautious evaluation of diabetic patients and adequate education of target population could improve overall survival while well-organized care like a primary PCI Network program could significantly reduce CV mortalit
Impact of Cardiovascular Treatments and Systolic Dysfunction on Nutritional Risk in Patients with Ischemic and Valvular Heart Disease
No full textObjective: There is a limited knowledge about connections existing between impaired systolic function and nutritional risk. The aim of our study was to evaluate nutritional risk in patients recently treated for valvular or ischemic heart disease, depending on the impairment of left ventricle systolic function and chronic cardiovascular therapy.
Methods: Nutritional risk screening was applied using a nutritional risk screening (NRS)-2002 [1] tool in cross-sectional study settings on patients scheduled for cardiovascular rehabilitation. There were 105 patients with impairment of left ventricle systolic function (LVEF 40) vs 145 consecutive matching peers with preserved LVEF. Percentage weight loss history (WLH) from preceding cardiovascular treatments was available for more than 85% of studied patients.
Results: Mean WLH was 7.7 § 4.6%, and NRS-2002 was 3.6 § 1.5. Significant differences in percentage WLH and NRS-2002 were found for age groups (p 0.05, respectively). Utilization of proton pump inhibitors, loop diuretics, and calcium channel antagonists increased the odds for pronounced nutritional risk, 2.60 (95% confidence interval [CI], 1.23–5.47), p D 0.012, vs 2.15 (95% CI, 1.00–4.62), p D 0.049, vs 2.18 (95% CI, 1.01–4.68), p D 0.046, respectively. Conversely, angiotensin-converting enzyme (ACE) inhibitors exhibited protective effects to the nutritional risk, 0.20 (95% CI, 0.05–0.89), p D 0.035.
Conclusion: Clinically, most evocative connections of nutritional risk screening and unintentional weight loss were found in relation to invasiveness of preceding cardiovascular treatments, rather than preservation of systolic function. Protective effects on nutritional risk were found for ACE inhibitors, whereas loop diuretics and proton pump inhibitors increased the nutritional risk and unintentional loss of weight
Osteoprotegerin and Vascular Calcification : Clinical and Prognostic Relevance
No full textOsteoprotegerin ( OPG ) is a key regulator in bone metabolism, that also has effect in vascular system. Studies suggest that osteoprotegerin is a critical arterial calcification inhibitor, and is released by endothelial cells as a protective mechanism for their survival in certain pathological conditions, such as diabetes mellitus, chronic kidney disease, and other metabolic disorders. That has been shown in studies in vitro and in animal models. The discovery that OPG deficient mice (OPG-/- mice) develop severe osteoporosis and arterial calcification, has led to conclusion that osteoprotegerin might be mulecule linking vascular and bone system. Paradoxically however, clinical trials have shown recently that OPG serum levels is increased in coronary artery disease and correlates with its severity, ischemic cardial decompensation, and future cardiovascular events. Therefore it is possible that osteoprotegerin could have a new function as a potential biomarker in early identification and monitoring patients with cardiovascular disease. Amongst that osteoprotegerin is in association with well known atherosclerosis risc factors: undoubtedly it is proven its relationship with age, smoking and diabetes mellitus. There is evidence regarding presence of hyperlipoproteinemia and increased serum levels of osteoprotegerin. Also the researches have been directed in genetic level, linking certain single nucleotid genetic polymorphisms of osteoprotegerin and vascular calcification appearance. This review emphasises multifactorial role of OPG, presenting numerous clinical and experimental stydies regarding its role in vascular pathology, suggesting a novel biomarker in cardiovascular diseases, showing latest conclusions about this interesting topic that needs to be further explored.Osteoprotegerin (OPG) je važan modulator koštanog metabolizma, koji ujedno manifestira svoj učinak i na krvožilni sustav. Pretpostavlja se da je osteopreotgerin ključni inhibitor arterijskih vaskularnih kalcifikacija, a otpuštaju ga en- dotelne stanice kao protektivni mehanizam za svoje preživljenje u određenim patološkim stanjima, kao u prvom redu šećernoj bolesti, kroničnoj renalnoj insuficijenciji, te metaboličkim premećajima. Navedeno je pokazano u dosadašnjim studijama na animalnim modelima. Suprotno tome, mnoge kliničke studije posljednjih godina povezuju serumsku razinu osteoprotegerina sa postojanjem i težinom koronarne bolesti, ishemijskom kardijalnom dekompenzacijom, te budućih kardiovaskularnih događaja. Zbog navedenoga sve se više spominje njegova uloga kao potencijalnog biomarkera u ranoj identifikaciji i praćenju kardiovaskularnih bolesti. Između ostaloga OPG se na osnovu kliničkih istraživanja dovodi u vezu i sa poznatim faktorima rizika ateroskleroze; nedvojbeno je dokazana njegova pozitivna korelacija sa dobi, te pušenjem. Dokazana je i pozitivna korelacija sa komplikacijama od kardiovaskularnih bolesti u pacijenata sa šećernom bolesti. Postoje i dokazi vezani uz povišenu razinu serumskog OPGa i hiperlipoproteinemije. Istraživanja su vršena i na genetskoj razini, vežući određene genske polimorfizme pojedinih nukleotida osteoprotegerina uz pojavu vaskularnih kalcifikacija. Ovaj članak naglašava multifaktorijalnu ulogu OPGa, prikazujući brojne kliničke i eksperimentalne studi- je glede njegove uloge u vaskularnoj patologiji, predlažući novi biomarker u kardiovaskularnim bolestima, pokazujući nove zaključke u vezi ove zanimljive teme, koja treba daljnja istraživanja
Patient Satisfaction with Regional Anesthesia in Orthopedic Surgery
No full textBackground and Purpose: The patient satisfaction with perioperative care and anesthesia is important indicator of the quality of the health care system. The evaluation of the patient’s satisfaction is a necessity, and the continuous improvement of a quality is important in anesthesia nowadays. It is important to identify the reasons and the risk factors for patients dissatisfaction with anesthesiologic procedures. We conducted this study to asses determinants of regional anesthesia on patient satisfaction.
Materials and methods: This was a prospective observational study which included 164 patients older than 18 years undergoing some orthopedic procedures in regional anesthesia. We noted basic characteristics of patients, important perioperative events and on the following day patients completed a specific questionnaire.
Results: Most patients (152/164) were satisfied or very satisfied with the regional anesthesia. Only 11 patients were unsatisfied, and the most common reasons for dissatisfaction were urinary retention, PONV, the multiple puncture attempts and the pain on the puncture site. About 95% patients would receive regional anesthesia again and recommend this kind of anesthesia to the others. We found statistically significant percent (12%) of increasing satisfaction in previously unsatisfied patients (p < 0,001).
Conclusion: Although, the satisfaction with regional anesthesia in orthopedic surgery in our institution is generally high, there are some factors which can influence on dissatisfaction rate. It is important to identify, monitor and modify them with aim of increasing the overall satisfaction rate