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Ethical Aspects of Anencephalic Infants as Organ Donors
No full textSve su uspješniji kirurški postupci transplantiranja organa, kao i skrbi primatelja i transplantacijske imunologije kada su u pitanju dojenčad i dijeca primatelji. Uspjeh transplantacijske medicine, općenito, neovisno o dobi, ograničen je brojem kvalitetnih doniranih organa. Dijete primalac ima čimbenik fi zičkog ograničenja određen prikladnom veličinom organa. S toga se vrlo rano još 80-tih godina prošlog stoljeća pokrenulo razmatranje o djeci donorima s proširenim kriterijima smrti iz čega bi slijedilo donorstvo organa dojenčadi s potvrđenom kongenitalnom abnormalnosti anencefalije. Mnoge su etičke, zakonske i medicinske dvojbe u odluci i raspravi može li se i kada pristupiti doniranju organa i tkiva od djeteta s anencefalijom.Organ transplantation and other related procedures in newborns and children are becoming ever more advanced and successful. Generally, success of transplantation medicine is limited by the availability of donated organs, irrespective of age. Appropriately sized donated organs pose physical limitation for children recipients. Therefore, since the early 1980s, consideration has been given to infant donors with modifi ed death criteria that would result in organ donation from newborns with confi rmed congenital anencephaly. Numerous ethical, regulatory and medical ambiguities surround discussion and decision making process if and when it is possible to donate organs of anencephalic infants
Anxiety and Depression Scores in Patients with Burning Mouth Syndrome
No full textBackground: Burning mouth syndrome is a condition of unknown etiology, characterized by burning symptoms on the otherwise clinically healthy oral mucosa. Central and/or peripheral neuropathy is one of the proposed causes for this condition. Psychological component in these patients is also very present, as it is known that BMS patients exhibit high levels of pain, anxiety, and depression. The aim of this study was to evaluate anxiety and depression among patients with burning mouth syndrome and a control group. We also further review and discuss the literature available on this subject.
Subjects and methods: A total of 93 subjects, divided into two groups, participated in this study. The group of patients with BMS included 43 participants, while the control group consisted of 50 participants. Self-reported STAI (State anxiety and Trait anxiety) and BDI questionnaires were used to evaluate anxiety and depression in subjects in both groups.
Results: BMS group had higher average total scores of state anxiety, trait anxiety and depression. The difference between the BMS group and control group was statistically significant for state anxiety scores and BDI scores.
Conclusion: We might conclude that BMS patients are more anxious (state) and depressed when compared with the control group. However, they do not differ from the control group regarding anxiety as a trait. Thus we might conclude that feeling of anxiety in general starts after the BMS symptoms first occur and last for a longer period of time
Ratio of End-systolic Volume to left Atrial area is a Solid Benchmark of Systolic Dysfunction in Non-ischemic Cardiomyopathies
No full textBackground: Impairment of systolic function and late gadolinium enhancement (LGE) are well-known negative prognostic
markers in non-ischemic cardiomyopathies (NICMPs). There is limited knowledge of the geometrical rearrangements
of the ventricle volumes over size of the left atrium and their connections with systolic dysfunction and existence of LGE.
Material/Methods: Consecutive cases of NICMPs with impaired systolic function and controls were included from a computerized database of cardiac magnetic resonance exams for a 2.5-year period. Ratios made from volumetric parameters over left atrial area (LAA) area were calculated.
Results: Our study included 205 cases referred to cardiac magnetic resonance (CMR); age was 48.7±17.0 years (range
15.2–80.4), male-to-female ratio 137 (66.8%): 68 (33.2%), (both p>0.05). LGE was significantly correlated with impairment of systolic function (Rho CC=0.395; p<0.001). For detection of systolic impairment, a critical value of end-systolic-volume (ESV)/LAA of ³2.7 had an area under curve (AUC) of 0.902 (0.853–0.939), p<0.001; strokevolume (SV)/LAA £3.0 had AUC=0.782(0.719-0.837), p<0.001, and end-diastolic volume (EDV)/LAA <7.4 had an AUC of 0.671 (0.602–0.735); p<0.001. In analyses of LGE, a value of SV/LAA of ≤3.0 had an AUC of 0.681 (0.612– 0.744), p<0.001; while ESV/LAA and EDV/LAA were not significant (both p<0.05). ESV/LAA was correlated with systolic dysfunction (Rho-correlation-coefficient: 0.688; p<0.001) and existence of linear midventricular LGE stripe (Rho-CC=0.446; p<0.001).
Conclusions: ESV/LAA was the most effective for detection of systolic impairment and was associated with the existence of
LGE. Prospective validation for clinical applicability and prognostic relations are warranted in future studies
Extremely Well-differentiated Gastric Adenocarcinoma Arising in Pylorus with Minor Diffuse Adenocarcinoma Component
No full textGastric adenocarcinoma is generally a disease of the middleaged and elderly with a peak incidence in patients over
65 years. The highest rates in the world are reported in Eastern Asia. Based on Lauren classification, gastric adenocarcinomas have been classified into two types, intestinal and diffuse types. A subset of gastric adenocarcinomas has been described under the name of Bextremely well-differentiated gastric adenocarcinoma (EWDGA). It is defined as a neoplastic lesion composed of highly differentiated neoplastic epithelium which mimics the normal gastric mucosa or intestinal metaplastic mucosa with mild nuclear atypia. It is considered a low-grade carcinoma accounting for around 0.1 % of all
gastric tumours. We report a case of EWDGA that differs from previously described cases in order that there was a presence of a minor intramucosal diffuse adenocarcinoma component, which has not been reported up to date in patients with EWDGA
Time of Anderson-Fabry Disease Detection and Cardiovascular Presentation
No full textBACKGROUND: Anderson-Fabry disease is an X-linked inherited disease, which manifests in a different manner depending on gender and genotype. Making a working diagnosis of Anderson-Fabry disease is difficult because of several reasons: (a) that it is a multiorgan disease with wide variety of phenotypes, (b) different timelines of presentation, (c) gender differences, and (d) possible coexistence with other comorbidities. Late-onset/cardiac type of presentation with minimal involvement of other organs can additionally make diagnosis difficult.
AIM: To describe different cardiac manifestations at different time points in the course of the disease: (1) 72-year-old female (echocardiography detection), heterozygote, significant left and mild right ventricular hypertrophy; (2) 62-year-old male (echocardiography detection), hemizygote, left ventricular hypertrophy, implanted cardiac pacemaker, a performed percutaneous coronary intervention after myocardial infarction, degenerative medium degree aortic valve stenosis; (3) 45-year-old female (asymptomatic/family screening), heterozygote, thickened mitral papillary muscle, mild left ventricular hypertrophy, first degree diastolic dysfunction; and (4) 75-year-old female (symptomatic/family screening), heterozygote, cardiomyopathy with reduced left ventricular ejection fraction after heart surgery (mitral valve annuloplasty and plastic repair of the tricuspid valve).
CONCLUSION: All patients have Anderson-Fabry disease but with different clinical presentations depending on the gender, the type of mutation, and the time of detection. All these features can make the patients' profiles unique and delay the time of detection
Impact of Pharmacotherapeutic Education on Medication Adherence and Adverse Outcomes in Patients with type 2 Diabetes Mellitus: a Prospective, Randomized Study
No full textAIM: To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM).
METHODS: The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge.
RESULTS: The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P=0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P=0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group.
CONCLUSION: Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes
Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different age Groups
No full textOBJECTIVE: To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence.
METHODS: We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel’s criteria), pain
intensity, and neurologic status were analyzed.
RESULTS: The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n [ 22; moderate, n [ 9; severe, n [ 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis.
CONCLUSIONS: Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery
Izražaj TFF gena i proteina u tumorima dojke
No full textThe objective of this study was to determine diff erential expression of TFF1, TFF2 and TFF3 genes and proteins in breast tumor subtypes. In addition, we investigated the correlation between TFF genes within tumor subgroups, and TFF genes with clinical and pathologic characteristics of the tumor. Study group included 122 patients with surgically removed breast tumors. Samples were investigated using qRT-PCR and immunohistochemistry. TFF1 and TFF3 genes and proteins were expressed in breast tumors, while the levels of TFF2 gene and protein expression were very low or undetectable. TFF1 was signifi cantly more expressed in benign tumors, while TFF3 was more expressed in malignant tumors. Gene and protein expression of both TFF1 and TFF3 was greater in lymph node-negative tumors, hormone positive tumors, tumors with moderate levels of Ki67 expression, and in grade II tumors. A strong positive correlation was found between TFF1 and TFF3 genes, and the expression of both negatively correlated with Ki67 and the level of tumor histologic diff erentiation. Our results suggest that TFF1 and TFF3, but not TFF2, may have a role in breast tumor pathogenesis and could be used in the assessment of tumor diff erentiation and malignancy.Cilj ovoga istraživanja bio je utvrditi razlike u izražaju gena i proteina TFF1, TFF2 i TFF3 u različitim vrstama tumora dojke te ispitati korelacije između gena TFF i vrsta tumora te gena TFF i kliničko-patoloških karakteristika tumora. U studiju su bile uključene 122 ispitanice kojima je kirurški odstranjen tumor dojke. Uzorci su obrađeni metodom qRT-PCR i metodom imunohistokemije. Geni i proteini TFF1 i TFF3 bili su izraženi u tumorima dojke, dok izražaj gena i proteina TFF2 nije otkriven u tumorskom tkivu. TFF1 je bio izraženiji kod dobroćudnih tumora, dok je TFF3 bio izraženiji kod zloćudnih tumora. TFF1 i TFF3 su bili izraženiji u hormonski ovisnim tumorima, tumorima bez metastaza u limfnim čvorovima, tumorima s umjereno visokim izražajem Ki67 i umjereno diferenciranim tumorima. Jaka pozitivna korelacija uočena je između gena TFF1 i TFF3, a oba su negativno korelirala s faktorom Ki67 i stupnjem diferenciranosti tumora. Dobiveni rezultati pokazuju kako bi TFF1 i TFF3 mogli imati ulogu u patogenezi tumora dojke te bi se potencijalno mogli rabiti za određivanje tumorskog statusa i procjenu malignosti tumora
Impact of Reslizumab on Outcomes of Severe Asthmatic Patients: Current Perspectives
No full textApproximately 5%-10% of asthmatics suffer from severe asthma. New biological treatments represent a great opportunity to reduce asthma burden and to improve asthma patients' lives. Reslizumab will soon be available in several European countries. This anti-IL-5 IgG4/κ monoclonal antibody, administered intravenously at a dose of 3 mg/kg over 20-50 minutes every 4 weeks, has been shown to be safe and effective in patients with 400 eosinophils/μL or more in their peripheral blood. The clinical effects in reducing asthma exacerbations and in improving the quality of life and lung function are clear, but further research is needed to determine the best biological compound for a specific cluster of patients. Research data have shown that in patients who were expressing other clinical features of eosinophilic inflammation over asthma (rhinosinusitis and nasal polyposis), the clinical benefit of reslizumab was greater. Furthermore, it has also been observed that in patients with unsatisfactory response to mepolizumab, reslizumab is able to significantly improve the clinical and biological parameters. The aim of personalized medicine is to provide the right drug to the right patient at the right dose at the right moment. The biological treatments that were developed to modify specific pathological pathways not only provide us with the tools for the management of asthma patients but also clarify the biological mechanisms involved in its pathogenesis
Outcomes of Very low Birth Weight Infants Born by Vaginal Delivery Versus Cesarean Section
No full textThe optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Despite lacking evidence of
benefts regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, particularly in early gestational ages. In our retrospective, multicentr study data were collected for very low birth weight infants born in two Croatian perinatal regions in a 3 – year period (2014. – 2016.). The fnal cohort consisted of 255 very low birth weight infants. The rate of delivery via cesarean section was 74.1% (189/255) and is one of the highest reported in the literature so far. Infants born vaginally were born at an lower gestational age, had lower 1- and 5-minute Apgar scores, lower birth weights, and prognosis as expressed by higher Clinical risk index for babies (CRIB) scores and were more ofen born following chorioamnionitis and had higher mortality rate until 7 days of hospitalization. Univariate logistic regression analysis showed that cesarean section reduced the risk of death before 7 days of life (OR 0.34 95% CI 0.182-0.667). This signifcance was lost afer multivariate analysis. In infants surviving afer 7 days of hospitalization, rates of short-term neonatal morbidity (severe intracranial hemorrhage, cystic periventricular leukomalacia (cPVL), late-onset sepsis, necrotizing enterocolitis, kidney injury and retinopathy of prematurity requiring interventions) were not signifcant when comparing infants born vaginally and those born following cesarean section