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Leptin/adiponectin Ratio in Overweight Patients - Gender Differences
No full textOBJECTIVE: Obesity-related atherosclerosis is a systemic disease with a background connected to multiple metabolic-neurohumoral pathways. The leptin/adiponectin ratio has been suggested as an atherosclerotic marker in obese patients. The aim of this study was to assess (1) the significance of the L/A ratio in overweight subjects, (2) the relation with anthropometric/metabolic parameters and (3) gender difference.
METHOD: The study included 80 adult males and females, overweight, non-diabetic patients. Biochemical blood analysis and anthropometric and cardiovascular measurements were performed. Serum leptin levels were measured with a radioimmunoassay test and total adiponectin levels with enzyme-linked immunosorbent assay. Leptin/adiponectin ratios were calculated as ratios between total serum concentrations of leptin and adiponectin.
RESULTS: Differences between leptin, adiponectin serum levels and leptin/adiponectin ratios are presented in overweight persons, where females have a significantly higher leptin/adiponectin ratio than men ( p < 0.001). In men, the leptin/adiponectin ratio showed a positive correlation with total cholesterol levels ( p = 0.011), low-density lipoprotein ( p = 0.013) and triglycerides ( p = 0.032). In females, the leptin/adiponectin ratio correlated with anthropometric parameters of visceral obesity: waist circumference ( p = 0.001) and waist-to-hip ratio ( p = 0.025).
CONCLUSION: The leptin/adiponectin ratio could represent an atherosclerotic risk marker of the early stage of obesity. Gender plays a significant role in pathophysiological changes, with different clinical manifestations, where sex hormones have a crucial effect on neurohumoral adipose tissue activity
Spontaneous hepatitis B surface antigen seroconversion after long lasting hepatitis B virus infection in a chronic hemodialysis patient
No full textCilj: Cilj je prikazati neobičan spontani nestanak HBsAg nakon dugotrajne infekcije.
Prikaz slučaja: Dvadesetšestogodišnji muškarac započeo je kroničnu hemodijalizu (HD) 1994. godine zbog kroničnog glomerulonefritisa. Serološka analiza bila je pozitivna na infekciju virusom hepatitisa B (VHB). Tijekom sljedećih godina liječen je HD-om i njegovi su biljezi VHB ostali nepromijenjeni (HBsAg pozitivnost). Kada je antivirusna terapija postala dostupna, pacijent je odbio liječenje. HBsAg postao je 2006. negativan po prvi put u 12 godina, dok su anti-HBs i anti-HBc postali pozitivni, što bi upućivalo na to da je nakon prirodne infekcije razvio imunost. Do sada su sve ponovljene pretrage negativne za HBsAg. 2008. godine transplantiran mu je bubreg od mrtvog darovatelja i uvedena terapija imunosupresivima (IS). Tijekom liječenja IS-om, koja je u tijeku, bio je stabilan i bez HBV viremije (HBsAg negativno).
Zaključak: Još uvijek nije jasno kako se spontana HBsAg serokonverzija dogodila u našeg bolesnika nakon dugotrajne infekcije. Također je zanimljivo da su i 11 godina nakon serokonverzije njegovi biljezi VHB-a još uvijek nepromijenjeni (HBsAg negativnost) i pokazuju znakove preboljele infekcije VHB-om, unatoč devetogodišnjem IS-u zbog bubrežnog presađivanja. Moguće je da su njegove razine anti-HBs dovoljno visoke da ga zaštite i inhibiraju reaktivaciju VHB-a ili virus uopće nije prisutan u njegovim hepatocitima.Aim: The aim was to present an unusual spontaneous disappearance of HBsAg after a long-lasting infection.
Case report: A 26-year-old man started chronic hemodialysis (HD) in 1994 for chronic glomerulonephritis. Serological analysis was positive for hepatitis B virus (HBV) infection. During the following years he was treated with HD and his HBV markers remained unchanged (HBsAg positivity). When antiviral therapy became available the patient refused to be treated. In 2006 his HBsAg became negative for the first time in 12 years, while anti-HBs and anti-HBc became positive, which would indicate that he became immune late after a natural infection. To date, all repeated check-ups have been negative for HBsAg. In 2008 he received a kidney transplant from a deceased donor and was put on immunosuppressive (IS) therapy. During the IS treatment, which is ongoing, he has been stable and without HBV viremia (HBsAg-negative).
Conclusion: It has still remained unclear how spontaneous HBsAg seroconversion did happen in our patient after long lasting infection. It has also been interesting that 11 years after seroconversion his HBV markers have still been unchanged (HBsAg negativity) and show signs of a resolved HBV infection, even though he has been immunosuppressed due to kidney transplantation for already 9 years. It is possible that his anti-HBs levels are high enough to protect him and inhibit HBV reactivation or the virus has not been dormant in his hepatic cells at all
Glycosylation of Random IgG Distinguishes Seropositive and Seronegative Rheumatoid Arthritis
No full textThe N-glycosylation of human immunoglobulins, especially IgGs, plays a critical role in determining affinity of IgGs towards their effector (pro- and anti-inflammatory) receptors. However, it is still not clear whether altered glycosylation is involved in only antibody-dependent disorders like seropositive rheumatoid arthritis (RA) or also in pathologies with similar clinical manifestations, but no specific autoantibodies like seronegative RA. The clarification of that uncertainty was the aim of the current study. Another study aim was the detection of specific glycan forms responsible for altered exposure of native glycoepitopes. We studied sera from seropositive RA (n = 15) and seronegative RA (n = 12) patients for exposure of glycans in native IgG molecules, followed by determination of specific glycans by capillary electrophoresis with laser-induced fluorescent detection (CE-LIF). Aged-matched groups of normal healthy donors (NHD) and samples of intravenous immunoglobulin IgG preparations (IVIG) served as controls. There was significantly stronger binding of Lens culinaris agglutinin (LCA) and Aleuria aurantia lectin (AAL) lectins towards IgG from seropositive RA compared to seronegative RA or NHD. CE-LIF analysis revealed statistically significant increases in bisecting glycans FA2BG2 (p = .006) and FABG2S1 (p = .005) seropositive RA, accompanied by decrease of bisecting monogalactosylated glycan FA2(6)G1 (p = .074) and non-bisecting monosialylated glycan FA2(3)G1S1 (p = .055). The results suggest that seropositive RA is distinct from seronegative RA in terms of IgG glycan moieties, attributable to specific immunoglobulin molecules present in seropositive disease. These glycans were determined to be bisecting GlcNAc-bearing forms FA2BG2 and FABG2S1, and their appearance increased the availability of LCA and AAL lectin-binding sites in native IgG glycoepitopes
Jačina upalnog odgovora nakon periferne endovaskularne intervencije ovisi o opsegu periproceduralnog oštećenja arterijske stijenke
No full textThe aim was to examine whether the postprocedural change in C-reactive protein (CRP) and fibrinogen levels was associated with the extent of periprocedural arterial injury caused by endovascular treatment (EVT). The study recruited 71 patients undergoing EVT. Eighty-four patients that underwent angiography served as a control group. CRP and fibrinogen were measured at baseline, and at 8, 24 and 48 hours following the procedure. In all experimental group patients, lesion complexity, percutaneous transluminal angioplasty (PTA) treated segment length, balloon inflation time and stented segment length were recorded. There was significant increase in plasma CRP and fibrinogen levels 48 hours following EVT (p<0.001). There was no significant difference in CRP and fibrinogen levels among different TASC groups. CRP levels were significantly higher in stent subgroup compared to PTA subgroup. Significant positive correlation was found between PTA treated segment length and CRP increase between 8 and 24 hours following EVT (r=0.313, p=0.02), balloon inflation time and CRP increase in the aforementioned time frame (r=0.270, p=0.03), as well as between CRP increase at 8 hours and stented segment length (r=0.535, p=0.01). This study showed that the arterial injury caused by EVT reflected on the level of inflammatory biomarkers.Cilj je bio istražiti postoji li povezanost između poslijeproceduralnog porasta serumske razine C-reaktivnog proteina (CRP) i fibrinogena ovisno o opsegu periproceduralnog oštećenja arterijske stijenke tijekom endovaskularne intervencije. Ispitanici kojima je učinjena dijagnostička angiografija (84 ispitanika) činili su kontrolnu skupinu. Ispitanici kojima je učinjena endovaskularna intervencija na perifernim arterijama (71 ispitanik) činili su eksperimentalnu skupinu. Svakom ispitaniku su prije zahvata te 8, 24 i 48 sati nakon zahvata izmjereni CRP i fibrinogen iz venske krvi. Za svakog su ispitanika bilježeni tip i duljina tretirane lezije, vrijeme inflacije balona te duljina stentiranog segmenta. Značajan porast CRP i fibrinogena uočen je 48 sati nakon intervencije (p<0,001). Nije bilo značajne razlike u porastu CRP i fibrinogena ovisno o tipu lezije. U skupini bolesnika kojima je postavljen stent 48 sati nakon intervencije uočen je značajan porast CRP, usporedno s ispitanicima kojima je učinjena angioplastika balonom. Nađena je pozitivna povezanost porasta CRP između 8 i 24 sata nakon intervencije i duljine balonom tretiranog segmenta (r=0,313, p=0,02), kao i vremena inflacije balona (r=0,270, p=0,03). Uočena je pozitivna povezanost porasta CRP prvih 8 sati nakon intervencije i duljine stentiranog segmenta (r=0,535, p=0,01). Ovo je istraživanje pokazalo utjecaj opsega periproceduralne lezije arterijske stijenke na poslijeproceduralni porast upalnih biomarkera
Pulmonary Contusions After Blunt Chest Trauma: Clinical Significance and Evaluation of Patient Management
No full textINTRODUCTION: A pulmonary contusion is an entity defined as alveolar haemorrhage and pulmonary parenchymal destruction after blunt chest trauma. According to the literature, most pulmonary contusions can only be seen on a chest CT. The aim of this study was to evaluate the patients with pulmonary contusions, as well as their management, considering diagnostic and therapeutic options related to their outcomes, since we assumed, based on everyday clinical practice, that an 'overdiagnosing' and 'overtreatment' attitude towards this injury could be present.
PATIENTS AND METHODS: The research was a retrospective study including 5042 patients admitted to the Department of Traumatology in the Clinical Hospital Centre Osijek, during a 3-year period. The medical data of the patients who suffered pulmonary contusion were evaluated considering significant characteristics, known risk factors, procedures undergone, and outcomes.
RESULTS: During the 3-year period, 2% of all the admitted patients were diagnosed with a pulmonary contusion. In 54% of the cases, the patient suffered polytraumatic injuries. The pulmonary contusion was an isolated injury in 7% of the patients. In 31% of the cases, there was no liquidothorax or pneumothorax (isolated pulmonary contusion). In 89% of the patients the pulmonary contusion was diagnosed using a CT scan. In 68% of the patients there were no interventions regarding the thorax; thoracocentesis was performed in 25% of the cases, and pleural punction in 14% of the cases. 25% of the patients developed respiratory insufficiency and 16% required mechanical ventilation. Regarding isolated pulmonary contusions, respiratory insufficiency was present in 8% of the cases.
CONCLUSIONS: We suggest that a pulmonary contusion seen on CT only has limited clinical significance and that the use of CT scans in diagnosing and follow-up of these patients should be re-evaluated. Further prospective and randomised studies should be conducted and the patients should be clinically evaluated, with the administration of supportive and antibiotic therapy, maintaining the fluid balance, the administration of diuretics, supportive oxygen therapy, pulmonary toilet, and physical therapy
Metabolic Syndrome in Hypertensive Women in the age of Menopause: a case Study on data from General Practice Electronic Health Records
No full textBACKGROUND: There is potential for medical research on the basis of routine data used from general practice electronic health records (GP eHRs), even in areas where there is no common GP research platform. We present a case study on menopausal women with hypertension and metabolic syndrome (MS). The aims were to explore the appropriateness of the standard definition of MS to apply to this specific, narrowly defined population group and to improve recognition of women at high CV risk.
METHODS: We investigated the possible uses offered by available data from GP eHRs, completed with patients interview, in goal of the study, using a combination of methods. For the sample of 202 hypertensive women, 47-59 years old, a data set was performed, consisted of a total number of 62 parameters, 50 parameters used from GP eHRs. It was analysed by using a mixture of methods: analysis of differences, cutoff values, graphical presentations, logistic regression and decision trees.
RESULTS: The age range found to best match the emergency of MS was 51-55 years. Deviations from the definition of MS were identified: a larger cut-off value of the waist circumference measure (89 vs 80 cm) and parameters BMI and total serum cholesterol perform better as components of MS than the standard parameters waist circumference and HDL-cholesterol. The threshold value of BMI at which it is expected that most of hypertensive menopausal women have MS, was found to be 25.5. The other best means for recognision of women with MS include triglycerides above the threshold of 1.7 mmol/L and information on statins use. Prevention of CVD should focus on women with a new onset diabetes and comorbidities of a long-term hypertension with anxiety/depression.
CONCLUSIONS: The added value of this study goes beyond the current paradigm on MS. Results indicate characteristics of MS in a narrowly defined, specific population group. A comprehensive view has been enabled by using heterogenoeus data and a smart combination of various methods for data analysis. The paper shows the feasibility of this research approach in routine practice, to make use of data which would otherwise not be used for research
Propolis Ethanolic Extracts Reduce Adenosine Diphosphate Induced Platelet Aggregation Determined on Whole Blood
No full textBACKGROUND: Propolis is a well-known bee product containing more than 2000 identified compounds. It has many beneficial effects on human health that include antibacterial, antiviral, anticancer and hepatoprotective justifying its use as a dietary supplement. Platelet aggregation plays crucial role in thrombus formation that can cause stroke or heart attacks. As cardiovascular diseases, including those caused by thrombus formation, are related to 50% of deaths of Western population, the objective of this study was to determine antiaggregatory activity of propolis on platelet aggregation on the whole blood samples.
METHODS: Twenty one propolis samples from Southeast Europe were characterized by spectrophotometric methods to determine content of the total flavonoids and phenolic acids. High performance liquid chromatography coupled with diode array detection was used to identify and quantify individual polyphenols. Platelet aggregation was tested by impedance aggregometry on the whole blood samples of ten healthy volunteers.
RESULTS: The mean content of total polyphenols was 136.14 mg/g and ranged from 59.23 to 277.39 mg/g. Content of total flavonoids ranged between 6.83 and 55.44 mg/g with the mean value of 19.28 mg/g. Percentage of total phenolic acids was in the range 8.79 to 45.67% (mean 26.63%). Minimal antiaggregatory concentration, representing the lowest concentration of propolis extract sample that can cause statistically significant reduction of aggregation, ranged from 5 μM to 10.4 mM. Samples of propolis with lower content of luteolin and higher content of pinocembrin-7-methyleter showed better antiplatelet activity i.e. lower values of minimal antiaggregatory concentration.
CONCLUSIONS: This is the first study that shows antiaggregatory potential of propolis ethanolic extracts on the whole blood samples in the low micromolar concentrations suggesting that propolis supplementation may influence platelet aggregation and consequently thrombus formation. Further in vivo studies are needed to confirm the beneficial effects in prevention of cardiovascular diseases
The Effectiveness of Lixisenatide as an add on Therapy to Basal Insulin in Diabetic type 2 Patients Previously Treated with Different Insulin Regimes: a Multi-center Observational Study
No full textINTRODUCTION: This observational study aimed to assess the effectiveness of lixisenatide as add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes.
METHODS: Patients with diabetes type 2, prescribed with lixisenatide and basal insulin were divided in three groups (premixed insulin, basal bolus insulin and basal oral therapy (BOT). Difference in mean change in HbA1c, body mass index, total insulin doses, fasting blood glucose (FPG) and prandial blood glucose (PPG) were assessed after 3-6-months of follow-up.
RESULTS: The primary outcomes were assessed in 111 patients. Lixisenatide added to basal insulin, reduced HbA1c and body weight significantly in all three groups of patients (p < 0.001 for all), with the most prominent reduction in the basal bolus group of patients which had the highest baseline HbA1c compared to premix and BOT treatment groups. Regarding a difference in total insulin dose the reduction was statistically significant in the basal bolus (p = 0.006) and premix group (p < 0.001). FPG and PPG were also significantly reduced over time in all three groups (p < 0.001 for all). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with any weight loss) was achieved in 27% of total patients included in the study, reduction of HbA1c below 7% was observed in 30% of patients, while 90% of patients experienced weight reduction.
CONCLUSION: These results indicate that lixisenatide add on basal insulin treatment (BIT) can improve glycemic control in a population with long-standing type 2 diabetes and previously uncontrolled on other insulin therapy
Pojavnost intramiokardijalnih masnih stanica u stijenci desne pretklijetke i desne klijetke – postmortalna humana analiza
No full textHistologic and radiologic studies describe intramyocardial fat tissue as a normal finding or as part of cardiac pathology. The role of fat cells within the myocardium is not fully understood. The aim of this study was to assess fat tissue distribution in the myocardium of right atrium (RA) and right ventricle (RV) and age differences in subjects free from cardiac disease. The study included 10 males without cardiac disease divided into two groups according to age (below/above 50 years). Three cross sections were performed (RV free wall and apex and RA free wall) with histomorphological analysis on digital photographs. The shares of total myocardial fat (TMF), perivascular fat (PVF) and non-perivascular (nPVF) fat were calculated. Samples from the older group had larger amounts of fat in the epicardium and myocardium, without statistically significant difference (TMF p=0.847, PVF p=0.4 and nPVF p=0.4). The largest quantities of fat tissue were found in the RV apex samples (14.9%), followed by RV free wall (7.5%) and RA (4.5%), where total apical RV fat share was significantly larger than in RA sample (p=0.044). Intramyocardial fat cells were present within the non-diseased RA and RV in all samples, mostly in the apex. Further investigations on age difference, effect of visceral obesity and sex differences are needed.Dosadašnja histološka i radiološka istraživanja opisuju pojavnost intramiokardijalnog masnog tkiva kao dio normalnog nalaza ili kao dio patološkog nalaza srca. Uloga intramiokardijalnih masnih stanica nije još razjašnjena. Cilj ovoga istraživanja bio je utvrditi raspodjelu masnog tkiva u miokardu desne pretklijetke (DP) i desne klijetke (DK) ovisno o dobi i lokalizaciji kod ispitanika bez kardijalnog morbiditeta. Patohistološka postmortalna studija uključila je 10 muškaraca bez kardijalnih bolesti podijeljenih u dvije skupine prema dobi (ispod/iznad 50 godina). Uzorci su uzeti u tri presjeka (projekcija slobodnog zida DK, slobodni zid vrha DK te stijenka DP) s histomorfološkom analizom na digitalnim fotografijama. Izračunati su udjeli ukupnog masnog tkiva unutar srčanog mišića (UMT), perivaskularnog masnog tkiva (PMT) i ne-perivaskularnog masnog tkiva (nPMT). U uzorcima starijih ispitanika prisutna je veća količina masnog tkiva u epikardu i miokardu, bez statistički značajne razlike (UMT p=0,847, PMT p=0,4, nPMT p=0,4). Najveće količine masnog tkiva pronađene su u uzorcima vrha DK (14,9%), nakon čega slijedi stijenka slobodnog zida DK (7,5%) i DP (4,5%), gdje je ukupni udio masnog tkiva DK bio znatno veći nego kod uzorka DP (p=0,044). Intramiokardijalne masne stanice sastavni su dio histološkog nalaza DP i DK u svim uzorcima bez prisutnih kardijalnih bolesti, dominantno u vrhu DK. Neophodna su daljnja istraživanja utjecaja dobi, spola i visceralne pretilosti na pojavnost intramiokardijalnih masnih stanica unutar stijenke desnog srca
Rak dojke u mladih žena: patološka i imunohistokemijska obilježja
No full textA young woman with breast cancer is considered to be a woman younger than 40. According to the literature, breast cancer in the population of young women usually is of a higher histologic grade, unfavorable hormonal status, and overall higher mortality rate when compared with breast cancer occurring in older population. We compared pathologic and immunohistochemical features of breast carcinoma in women under 40 years of age with the respective features in women over 60 years of age. The following parameters were observed in these two groups: tumor size, lymph node status, histologic grade, hormonal receptor status, Ki-67 prognostic index, Her2/neu status, and histologic type of the tumor. Early onset breast carcinoma was found to have a higher frequency of tumor grade 3 (29% vs. 17%) and estrogen receptor negativity (45% vs. 23%). In the group of young women, breast carcinoma was mostly multicentric (23% vs. 5%), triple-negative (32% vs. 10%), and was found to have higher proliferation index Ki-67 (25% vs. 10%). Our results confirmed differences between the young and older groups of patients. In the group of young women, we found predominantly unfavorable prognostic parameters of the disease.Mladom ženom s rakom dojke smatra se žena mlađa od 40 godina. Prema literaturi rak dojke u populaciji mladih žena ima obično viši histološki stupanj i nepovoljan hormonski status. Puno je veći postotak smrtnosti u mladoj populaciji nego kada se karcinom javlja u starijoj životnoj dobi. Usporedili smo patološka i imunohistokemijska obilježja karcinoma dojke kod žena ispod 40 godina s odgovarajućim obilježjima među ženama iznad 60 godina. Sljedeći parametri su promatrani kod ove dvije skupine: veličina tumora, stanje limfnih čvorova, histološki gradus, status hormonskih receptora, prognostički indeks Ki-67, status Her2/neu i histološki tip tumora. Za karcinom dojke kod mladih žena utvrđeno je da ima veću učestalost tumora histološkog gradusa 3 (29% prema 17%) i negativnog statusa estrogenskih receptora (45% prema 23%). U skupini mladih žena rak dojke je uglavnom multicentričan (23% prema 5%), trostruko negativan (32% prema 10%) i ustanovljeno je da ima veći proliferacijski indeks Ki-67 (25% prema 10%). Naši rezultati potvrđuju razlike između mlade i starije skupine bolesnica. U skupini mladih žena utvrđeni su pretežito nepovoljni prognostički parametri bolesti