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The Effects of Transition from Bedtime to Morning Glargine Administration in Patients with Poorly Regulated Type 1 Diabetes Mellitus: Croatian Pilot Study
No full textINTRODUCTION: The objective of this study was to compare differences in glucoregulation, frequency of hypoglycemic episodes, glucose variability and lipid profiles of inpatients with poorly regulated type 1 diabetes mellitus (T1DM) after evening versus morning glargine application.
METHODS: Eighteen patients with poorly regulated T1DM, glycated hemoglobin (Hba1c) levels ≥7% and frequent nocturnal and/or morning hypoglycemic episodes were included in this study. There was a 12-week screening phase where patients continued their usual insulin regimen and were encouraged to achieve optimal glycemic control; however, all patients maintained HbA1c values ≥7% and continued to have frequent nocturnal and/or morning hypoglycemic events and were therefore transitioned to morning application of insulin glargine for 12 weeks. The primary outcome was to investigate changes in HbA1c values 12 weeks after the transition. The secondary outcome was to evaluate the effect of transition on glucose variability, incidence of hypoglycemic episodes, insulin doses, lipid profile and weight. Data were analyzed using paired Student's t test and Pearson correlation.
RESULTS: After the transition, there was no significant change in total daily dose of basal insulin (p 0.114) and the average body weight remained unchanged, while significant reduction of HbA1c was present (8.02 ± 0.5 vs. 7.4 ± 0.3%) (p < 0.01) resulting in a decrease in nocturnal and daytime hypoglycemic episodes per month per person (p < 0.01). Parameters of glucose variability (glycemic standard deviations and J-index) were also improved after transition period (p < 0.01). As for the lipid profile, increase of high-density lipoprotein cholesterol and decrease of triglycerides (p < 0.01) were noticed, while other lipid parameters remained unaffected. Furthermore, insignificant association of basal insulin dose with HbA1c values regardless of the time of administration was observed.
CONCLUSION: In patients with poorly regulated T1DM, transition to morning application of glargine improved glucoregulation (including a decrease in HbA1c, glucose variability and number of nocturnal hypoglycemic episodes), followed by favorable changes in lipid profile without affecting body weight. These effects were associated with the time of application, but not with the insulin dose
Eruptive Syringoma in the Elderly: a case Report
No full textSyringomas are benign tumors of adnexal origin, and eruptive syringoma is an extremely rare subtype. In this paper, we present a case of a unusual occurrence of eruptive syringoma in 66-year old woman that includes clinical and pathohistological findings and the review of the clinical picture, diagnosis, and treatment options
Effect of Environmental Factors on Prenatal Development
No full textŽena je naročito osjetljiva na nepovoljne čimbenike okoliša tijekom trudnoće, dijelom zbog toga što njezino tijelo mora obavljati metaboličke funkcije za dva organizma, a dijelom jer većina kemijskih i fizikalnih štetnih tvari ima jači učinak na ženu tijekom trudnoće te na fetus jer je to organizam u razvoju. Na ishod trudnoće djeluju genetski čimbenici, prehrambene navike majke, uteroplacentarni krvotok te funkcija posteljice. Nepovoljni čimbenici okoline mogu oštetiti dijete intrauterino djelujući na sve prethodno navedeno. Posljedice mogu biti akutne i fatalne; nakon nekoliko godina mogu dovesti do veće učestalosti malignih bolesti, a mogu izazvati i kronične promjene: trajnu sklonost djeteta hipertenziji, gojaznosti, dijabetesu, koronarnoj bolesti srca.
Štetni čimbenici okoliša sigurno utječu na fetalno programiranje i dovode do veće ekspresije bolesti kojoj je dijete genetski sklono. Mogu trajno utjecati na reprodukciju i plodnost.A woman is especially sensitive to negative environmental factors during pregnancy, partially because her body needs to perform metabolic functions of two organisms, and partially because most chemically and physically harmful substances have stronger effects on a woman during the perinatal period, and on the fetus because of organ development and growth. Many factors are responsible for the outcome of pregnancy: genetic factors, dietary habits of the mother, uteroplacental bloodstream and placental function. Negative environmental factors can damage the fetus by affecting everything aforementioned. Consequences can be acute and fatal; after a few years they can lead to greater frequency of malignant diseases, and cause chronic changes: permanent tendency to hypertension, obesity, diabetes, and coronary heart disease. Negative environmental
factors certainly influence the fetal programming and lead to greater expression of the disease to which the child is genetically predisposed. Reproduction and fertility can be permanently damage
Mirror Neurons and Their Potential role in Psychopathology
No full textZrcalni neuroni predstavljaju skupinu neurona slučajno otkrivenih u ventralnom premotornom korteksu mozgu macaca majmuna (Macaca nemistrina i Macaca mulatta) čije je postojanje u mozgu čovjeka još uvijek dvojbeno zbog niza tehnoloških i bioetičkih poteškoća u njihovom proučavanju na ljudima. Zrcalne neurone karakterizira aktivacija pri vršenju određene radnje, ali i pri promatranju radnje osobe koja navedenu radnju čini. Elektrofiziološki obrasci funkcije mozga pri tome nalikuju onome pri stvarnom vršenju promatrane radnje. Potencijalne uloge zrcalnih neurona obuhvaćaju širok spektar kognitivnih i emocionalnih radnji i procesa kao što su razumijevanje značenja i namjere promatranih radnji, učenje imitacijom, osjećanje empatije, formiranje „teorije uma“, kao i učenje i razumijevanje govora. Posebno je zanimljiva njihova potencijalna uloga u empatiji. Zbog značajne uloge poteškoća u ostvarivanju empatije u podlozi psihopatije i poremećaja autističnog spektra, intuitivno se došlo do hipoteze kako zrcalni neuroni mogu imati ulogu u patofiziologiji navedenih poremećaja. Dosadašnja istraživanja zrcalnih neurona nisu dala adekvatnu potporu takvim hipotezama.Mirror neurons represent a population of neurons discovered by accident in the ventral premotor cortex of the macaca monkeys (Macaca nemistrina and Macaca mulatta), but a consensus is yet to be made on whether they exist in the human brain because of several technical and bioethical difficulties in mirror neuron research on human subjects. Mirror neurons are characterized by activation during an execution, but also during an observation of an action performed by another individual. Electrophysiological patterns of brain function mirror those of an actual execution of the action. Potential roles of mirror neurons include a wide spectrum of cognitive and emotional actions and processes such as the understanding of meaning and intention of an observed action, learning by imitation, empathy, forming of the “mind theory”, as well as language learning and comprehension. Its potential role in empathy is especially interesting. Due to the significant role of empathy dysfunction in the basis of antisocial personality disorder and the disorders of the autistic spectrum, it was intuitively hypothesized that mirror neurons might have a role in the pathophysiology of these disorders. Current research have yet to give adequate support for such hypotheses
Uloga tonzilektomije u prevenciji infekcije s Helicobacter pylori
No full textThe incidence of Helicobacter pylori infection varies globally and depends on the socioeconomic situation of a location. In the territory of Croatia, the incidence rate among the populace is 40-50% in persons with normal gastroscopic findings, whereas it is increased in persons with the pathohistological finding of the ulcus disease1. This study examines the potential preventive role of tonsillectomy with regard to H. pylori infection in later stages of life. The survey was conducted on a sample of 115 examinees (63 male, 52 female), aged between 19 and 86. The survey included examinees who underwent esophagogastroscopy at the Institute of Gastroenterology of the University Hospital Centre Osijek based on indication by a gastroenterology specialist. The survey has shown that of the total of 115 examinees, 28 of them had been tonsillectomised, and 87 had not been tonsillectomised. In the examinees who had not been subjected to tonsillectomy, positive H. pylori result was found in 63,2%, and 53,6% of those who had been tonsillectomised at a young age were positive to H.pylori. The results have shown that H. pylori infection was equally represented in all age groups, and the rate varies at 52.9 – 64.8%. Hence, the final conclusion was reached that tonsillectomy has no preventive role with regard to H.pylori infection.Učestalost Helicobacter infekcije je različita diljem svijeta i ovisi o socijalno-ekonomskom položaju sredine. U našim je krajevima učestalost u populaciji 40-50 % u osoba s urednim gastroskopskim nalazom, dok se povećava kod osoba sa patohistološkim nalazom ulkusne bolesti. U ovoj studiji ispituje se moguća preventivna uloga tonzilektomije, na infekciju H. pylori u kasnijoj životnoj dobi. Istraživanje je provedeno na uzorku od 115 ispitanika (63 muškarca, 52 žene), u dobi od 19 do 86 godine. U istraživanje su uključeni ispitanici koji su pristupili ezofagogastroskopiji na Zavodu za gastroenterologiju KBC Osijek na temelju indikacije specijalista gastroenterologa. Istraživanje je pokazalo da je od ukupno 115 ispitanika bilo tonzilektomirano 28, a 87 ispitanika nije tonzilektomirano. Kod ispitanika koji nisu tonzilektomirani, pozitivan nalaz na H. pylori imalo je 63,2 % ispitanika, a 53,6 % onih koji u mladosti tonzilektomirani je pozitivno na H. pylori. Rezultati su pokazali jednaku zastupljenost infekcije H. pylori u svim dobnim skupinama, a ona iznosi između 52,9 – 64,8 %. Time se na posljetku došlo do zaključka da tonzilektomija nema preventivnu ulogu kod infekcije s H. pylori
Prognostic Value of Galectin-3 in Patients with Heart Failure
No full textGalectins are a family of soluble β-galactoside-binding lectins that have important role in inflammation, immunity, and cancer. Galectin-3 as a part of this lectin family plays a very important role in development of heart failure. According to recent papers, galectin-3 plasma level correlates with heart failure outcome, primarily with rehospitalisation and death from heart failure. This paper summarizes the most recent advances in galectin-3 research, with the accent on the role of galectin-3 in pathophysiology of myocardial remodelling and heart failure development--with preserved and reduced ejection fraction, and some implication on development of new disease modifying drugs
Characteristics and Incidence of Head and Neck Skin Malignant Neoplasms in the Population of the Osijek-Baranja County 2004-2012
No full textCilj studije bio je istražiti učestalost i karakteristike malignih neoplazmi kože glave i vrata područja Osječko-baranjske županije u razdoblju od 2004. do 2012, u odnosu na spol, dob, mjesto boravka, radno mjesto, zanimanje, tip i lokaciju neoplazme te fenotipske odlike oboljelih. Istraživanje je obuhvatilo sve ispitanike kojima je PHD nalazom potvrđena dijagnoza, a stanovnici su Osječko-baranjske županije. Obrađena su ukupno 2.952 oboljela od kojih je bilo 1.487 (50,4 %) muškaraca i 1.465 (49,6 %) žena, što čini približnu godišnju incidenciju od 104/100 000. Srednja dob ispitanika bila je 72 godine. Ispitanici su većinom sa sela, 1952 (66,2 %). Na otvorenom je radilo 2.137 (72,4 %) ispitanika. Najčešće su to poljoprivrednici, 907 (42,4 %) i građevinski radnici (889 ili 41,6 %). S obzirom na tip neoplazme, najčešći je bio bazocelularni tip (2.160 - 73,2 %) oboljelih. Maligni melanom imala su 93 (3,1 %) ispitanika. Lokalizacija maligne neoplazme je najčešće lice (839 - 28,7 %) i nos (643 - 22,0%) ispitanika. Muškaraci su imali značajno više (341 - 56,6 %) planocelularih malignih neoplazmi od žena (262 - 43,4 %) (p=0,005). Značajno su bili mlađi ispitanici s malignim melanomom (medijan dobi 67 godina). Nema značajne razlike vrste maligne neoplazme i mjesta stanovanja, radnog mjesta i zanimanja s obzirom na rad na otvorenom ili zatvorenom prostoru. Dokazano je, s obzirom na lokalizaciju, na uhu i na usni značajno više planocelularnih malignih neoplazmi (p=0,039; p<0,001), na vratu, oku i na glavi malignih melanoma (p=0,004; p<0,001; p=0,026), a na nosu bazocelularih neoplazmi (p=0,002). Nema značajne razlike u vrsti i učestalosti malignih neoplazmi povezano s bojom kose i očiju ispitanika. Očito je da bolest nastaje nakon višedesetljetne inkubacije te kumulativnog učinka izloženosti rizičnim faktorima, pri čemu direktna izloženost suncu, čini se, ima značajnu ulogu. Potrebna su daljnja istraživanja.The aim of this study was to investigate the incidence and characteristics of malignant neoplasms of the skin of the head and neck region in the Osijek-Baranya County during the 2004-2012 period according to gender, age, place of residence, place of work, occupation, type and location of the neoplasm, and phenotypic characteristics of patients. Subjects: The study included all subjects with the diagnosis confirmed by histopathology finding and residents of the Osijek-Baranya County. The study included a total of 2952 persons, 1487 (50.4%) male and 1465 (49.6%) female, yielding an approximate annual incidence of 104/100,000. Mean age was 72 years. Respondents were mostly from rural areas (n=1952, 66.2%). There were 2137 (72.4%) of respondents mostly working outdoors, mainly farmers (n=907, 42.4%) and construction workers (n=889, 41.6%). Results: According to the type of neoplasm, the basal cell type was most common with 2160 (73.2%) patients. Ninety-three (3.1%) patients had malignant melanoma. According to localization, face was the most common site of malignant neoplasms with 839 (28.7%) and nose with 643 (22.0%) patients. Squamous cell carcinoma was significantly more common in men (n=341, 56.6%) as compared with women (n=262, (43.4%; p=0.005). Subjects with malignant melanoma were significantly younger, with median age of 67 years. There were no signifi cant differences according to the type of malignant neoplasms and place of residence, place of business, and occupation with regard to working outdoors or indoors. According to localization, significantly more squamous cell malignancies were found on the ears and lips (p=0.039 and p<0.001, respectively), malignant melanomas on the neck, head and eyes (p=0.004, p<0.001 and p=0.026, respectively), and basal cell neoplasms on the nose (p=0.002). There were no significant differences in the type and frequency of malignant neoplasms according to hair and eye color. Conclusion: It is obvious that the disease occurs after a decades-long incubation period and the cumulative effect of exposure to risk factors, with direct sun exposure, seems to have a significant role. Additional research is needed
Potentially Inappropriate Prescribing to the Elderly: Comparison of new Protocol to Beers Criteria With Relation to Hospitalizations for ADRs
No full textScreening tools for detecting potentially inappropriate medications (PIMs) represent an important way to assess drug prescribing in the elderly. Recently, we introduced a new comprehensive tool to detect both PIMs and clinically important drug-drug interactions (DDI). The aim of the study was to assess the applicability of the new tool.The new tool was used to detect PIMs and DDI and to assess their relation to morbidity and hospital admissions. It was also compared to the widely used Beers criteria. The study population included 454 consecutive patients aged ≥65 years who were acutely admitted to the Department of Internal Medicine of the University Hospital of Osijek. The Naranjo protocol was used to analyze the causal relationship between a drug and an adverse event.According to the new protocol, 44 % patients were taking PIMs, while 33 % patients were taking drugs with potentially serious DDIs. In 11 % of the overall number of patients, the cause of admission was adverse drug reaction (ADR), and among contributing drugs, 44 % were potentially inappropriate according to our protocol. Gastrointestinal bleeding was the most common diagnosis causing ADR-associated admission, and in 72 % cases, either PIM or a potentially serious DDI was involved.The new Croatian tool detected a high number of patients taking PIMs and/or having potentially important drug-drug interactions. The tool also detected almost half of the drugs contributing to ADR-associated admission. We expect the tool to be useful in prescription evaluation for the elderly inpatient and outpatient population
Ispitivanje povezanosti polimorfizma citokroma p450 1a1*2a s rizikom od karcinoma prostate i agresivnošću u hrvatskoj populaciji
No full textCytochrome P450 1A1 (CYP1A1) is an enzyme participating in the bioactivation of various endogenous and environmental reactive compounds that can bind to DNA and thus induce cancerogenesis. Gene encoding the enzyme is expressed in the prostate tissue and is polymorphic. CYP1A1*2A gene polymorphism is associated with elevated enzyme activity and/or inducibility which can lead to accumulation of genotoxic compounds and consequently to cancerogenesis. We examined the association of this polymorphism with prostate cancer (PCa) risk and aggressiveness. The case-control study consisted of 120 PCa patients and 120 benign prostatic hyperplasia (BPH) controls, in Croatian population. Regarding aggressiveness, PCa patients were grouped according to the Gleason score (GS), tumor stage (T) and existence of distant metastasis (M). The polymorphism was analyzed using real-time polymerase chain reaction (PCR). We did not observe association of mutated allele with PCa risk, neither with PCa aggressiveness. Furthermore, frequency of polymorphic genotype was slightly higher in BPH group (16.6% vs. 14.2%, respectively) and also in less aggressive form of PCa (20.4% vs. 9.6% for GS<7; 15.6% vs. 9.1% for T<3; 16.7% vs. 10.0% for no distant metastasis). Comparing our findings with other published results, we can assume that the ethnicity influence the genotype distribution and thus may affect the etiology of PCa, even possibly in the way to cause an opposite effect among different ethnic groups. Given the small number of participants, results should be validated on the larger sample size.Citokrom P450 1A1 (CYP1A1) je enzim koji sudjeluje u bioaktivaciji raznih endogenih i egzogenih reaktivnih spojeva koji se mogu vezati na DNA i tako izazvati karcinogenezu. Gen koji kodira taj enzim je eksprimiran u tkivu prostate i polimorfan. CYP1A1*2A genski polimorfizam je povezan s povišenom aktivnošću i/ili inducibilnoću enzima što može dovesti do nakupljanja genotoksičnih spojeva i posljedično do karcinogeneze. Ispitali smo povezanost tog polimorfizma s rizikom od karcinoma prostate i agresivnošću. Studija ispitivanja parova sastojala se od 120 pacijenata s karcinomom prostate (PCa) i 120 kontrola s benignom hiperplazijom prostate (BPH), stanovni{tva Hrvatske. Obzirom na agresivnost, PCa pacijenti su grupirani prema Gleason zbroju (GS), stadiju tumora (T) i postojanju udaljenih metastaza (M). Polimorfizam je analiziran pomoću lanžane reakcije polimeraze (PCR). Nismo uočili povezanost između mutiranog alela i rizika od PCa, niti s bilo kojim ispitivanim parametrom agresivnosti. Štoviše, frekvencija polimorfnog genotipa bila je viša u skupini BPH (16,6% naspram 14,2%) i u manje agresivnom obliku PCa (20,4% naspram 9,6% za GS<7; 15,6% naspram 9,1% za T<3; 16,7% naspram 10,0% za M0). Uspoređujući naše rezultate s drugim objavljenim rezultatima možemo pretpostaviti da etni~ka pripadnost mo`e utjecati na distribuciju i tako utjecati na etiologiju PCa, čak možda i na način da izazove suprotan učinak kod različitih etničkih skupina. Obzirom na mali broj ispitanika, rezultate bi trebalo potvrditi na većem uzorku
Citodijagnostika karcinoma malih stanica pluća
No full textSmall cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosis was SCLC. The value of cytological diagnosis was determined by comparing it with histological findings obtained from a biopsy sample during bronchoscopy or on a resection specimen in 50 patients. In the remaining 77 patients, histological verification of cytological diagnosis was not made and the patients were treated based on cytological diagnosis of small cell carcinoma. In 76% of cases (38/50) cytological diagnosis of small cell lung carcinoma was also confirmed histologically. In 8% of cases (4/50) adenocarcinoma was histologically confirmed, in 10% (5/50) of the cases the squamous carcinoma was confirmed, and there was one case of urothelial carcinoma, one case of sarcoma and one undifferentiated carcinoma. Cytological diagnosis of SCLC was made in all cases in a brush smear while the catheter aspirate was positive in only 32 cases (25,8%). Median survival in the group of patients with histologically confirmed small cell cancer was 238 days, for women 250 days, and for men 237 days. Cumulative survival was 63,2% for 6 months, 26,3% for 12 months, 13,2% for 18 months and 7,9% for two years. In conclusion, cytology is a reliable and relatively non-invasive method for patients. Our results confirm that there is a good correlation between cytology and histology diagnoses, especially when it comes to malignant lesions. In determining the type of tumor cytology must be supported with additional methods, especially in cases when it is not possible to take samples for histological verification.Karcinom malih stanica pluća (SCLC) klasificira se u skupinu neuroendokrinih tumora pluća. Iako su kriteriji za njegovo morfološko odjeljivanje od ostalih tumora pluća dobro definirani, u praksi to može predstavljati problem, kako u citologiji tako i na histološkim uzorcima. Važnost točnog i ranog diferenciranja karcinoma malih stanica leži u njegovom agresivnom ponašanju, rapidnom rastu i stvaranju udaljenih metastaza, ali jednako tako i njegovoj osjetljivosti na kemoterapiju i zračenje. U studiju je uključeno 127 pacijenata kojima je u razdoblju od početka 2003. do kraja 2007. godine učinjen bronhoskopski pregled ili transtorakalna punkcija te je citološka dijagnoza bila karcinom malih stanica. Vrijednost citološke dijagnoze karcinoma malih stanica utvrđena je usporedbom s histološkom dijagnozom donesenom na bioptičkom ili resekcijskom materijalu. U 76% slučajeva (38/50) citološka dijagnoza SCLC je potvrđena i histološki. U 8% slučajeva (4/50) histološki je potvrđen adenokarcinom, 10% slučajeva (5/50) pločasti karcinom, a u po jednom slučaju metastaza karcinoma prijelaznih stanica i sarkoma te nediferencirani karcinom. U ostalih 77 pacijenata (77/ 127; 60,6%) nije učinjena patohistološka verifikacija te su oni liječeni u skladu s kliničkom prosudbom i citološkom dijagnozom SCLC. Citološka dijagnoza SCLC postavljena je kod svih slučajeva na brisu četkicom dok je kateter aspirat bio pozitivan samo u 32 slučaja (26%). Prosječno preživljenje pacijenata od prve citološke dijagnoze u grupi pacijenata s histološki potvrđenim SCLC iznosilo je 238 dana, za žene prosječno 250 dana, a za muškarce prosječno 237 dana. Zaključno, citologija je jednako vrijedna metoda kao i histologija u određivanju prisustva maligne bolesti, ali u određivanju tipa tumora potrebno ju je nadopuniti dodatnim metodama, prije svega imunocitokemijom, osobito u slučajevima kada nije moguće dobiti histološki uzorak