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Disease characteristics and causes of early and late death in a group of Croatian patients with systemic lupus erythematosus deceased over a 10-year period
Get PDFAIM:
To assess the causes of early death (ED) and late death (LD) in patients with systemic lupus erythematosus (SLE) and determine the features of deceased SLE patients followed-up in a single Croatian tertiary hospital center, because little if any data on causes of death (CODs) in SLE patients are available for Croatia. -----
METHOD:
We identified SLE patients regularly followed-up at the Division of Clinical Immunology and Rheumatology, University Hospital Center Zagreb, who died from 2002 to 2011. Death was ascertained by matching our institutional records with the Croatian National Death Database. Patients were grouped according to their disease duration to ED and LD and compared by demographic characteristics, classification criteria, organ damage, and CODs. -----
RESULTS:
We identified 90 patients (68 women), who died at the age of 58±15 years. The most frequent COD category was cardiovascular diseases (40%), followed by infections (33%), active SLE (29%), and malignancies (17%). No significant difference was found between the frequencies of causes of ED and LD, except for stroke, which caused only LD≥10 years after the diagnosis. SLE was reported in death certificates of only 41 of 90 patients. -----
CONCLUSION:
Although stroke occurred both in the early and late disease course, it was primarily associated with LD. Given the low proportion of SLE recorded in death certificates of deceased SLE patients, matching of institutional and vital statistics records may be required to assess the true impact of SLE on mortality
Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina
Get PDFMultidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically
ill patients. It can infect the respiratory tract, blood, soft tissues, urinary tract and central
nervous system. Recently, carbapenem-resistance was observed in A. baumannii clinical
isolates from Bosnia and Herzegovina. This prompted us to analyze these isolates with
regards to genotypic diversity, antibiotic susceptibility and occurrence of acquired
carbapenem resistance genes. Twelve carbapenem-resistant isolates were collected at a
University hospital during two different periods of 2011 and 2015-2016: four isolates in
2011 and eight isolates 2015-2016 and compared to determine the dynamic changes in
carbapenemase resistance mechanisms and population structure. All twelve isolates were
positive for intrinsic blaOXA-51-like, nine for blaOXA-40-like and one for the blaOXA-23-like gene.
ISAba1 was found upstream of blaOXA-51 in all and upstream of blaOXA-23-like gene in one
isolate. Sequencing of the selected PCR products revealed the presence of OXA-72 β-\ud
lactamase (strain 1) and OXA-23 β-lactamase (strain 41). WGS of the selected isolate (AB 5)
revealed the presence of blaOXA-72, chromosomal genes blaOXA-69 and blaADC. Moreover, the
aac (3)-1a and aadA1 genes encoding aminoglycoside resistance, and sul1encoding
sulphonamide resistance were identified. PFGE and rep-PCR revealed two clones containing
highly similar isolates positive for OXA-40-like; one from 2011 and the other from 2015-
2016.
Implementation of hospital hygiene measures, screening of the patients on admission for
carriage of MDR-AB, and the early and accurate detection, with restriction of antibiotic use
should be recommended to control the spread of these important hospital pathogenes. To our
knowledge, this is the first report of A. baumannii isolates producing carbapenem-hydrolyzing
oxacillinases (CHDL) from Bosnia and Herzegovina
Prognostic factors in head and neck mucoepidermoid carcinoma: experience at a single institution based on 64 consecutive patients over a 28-year period
Get PDFMucoepidermoid carcinoma (MEC) is the most common malignancy of the salivary glands. The clinical behaviour of MEC is largely unpredictable, ranging from indolent tumour growth to highly aggressive metastatic spread. The objective of this study was to determine the clinicopathological predictors of recurrence and survival in patients with head and neck MEC. The medical records of 64 patients who underwent surgical treatment for head and neck MEC between 1982 and 2010 were reviewed. The main outcome measures were disease-free survival (DFS) and overall survival (OS). Clinicopathological parameters evaluated were age, sex, anatomical subsite, histological grade, tumour stage, tumour size, adjuvant therapy, and nodal and margin status. For the entire cohort, the 5-year DFS was 82.8% and the 5-year OS was 67.2%. Histological grade and tumour subsite were statistically significant predictors of OS. Furthermore, tumour stage and nodal status were statistically significant predictors with respect to OS. Advanced tumour stage, high histological grade, submandibular/sublingual localization, and positive nodal status were independent predictors of the prognosis in patients with head and neck MEC. Further studies into the molecular biology of MEC are needed in order to provide new therapeutic strategies for patients with locally aggressive and highly metastatic carcinomas
Expression and immunolocalization of metallothioneins MT1, MT2 and MT3 in rat nephron
Get PDFRodent kidneys exhibit three isoforms of metallothioneins (MTs), MT1, MT2 and MT3, with poorly characterized localization along the nephron. Here we studied in adult male Wistar rats the renal expression of MTs mRNA by end-point RT-PCR and MT proteins by immunochemical methods The expression pattern of MT1 mRNA was cortex (CO)>outer stripe (OS)=inner stripe (IS)=inner medulla (IM), of MT2 mRNA was IM>CO>IS=OS, and of MT3 mRNA was IM>CO=OS=IM. MT1/2-antibody stained with heterogeneous intensity the cell cytoplasm and nuclei in proximal tubule (PT) and thin ascending limb, whereas MT3-antibody stained weakly the cell cytoplasm in various cortical tubules and strongly the nuclei in all nephron segments. However, the isolated nuclei exhibited an absence of MT1/2 and presence of MT3 protein. In MT1/2-positive PT cells, the intracellular staining appeared diffuse or bipolar, but the isolated brush-border, basolateral and endosomal membranes were devoid of MT1/2 proteins. In the lumen of some PT profiles, the heterogeneously sized MT1/2-rich vesicles were observed, with the limiting membrane positive for NHE3, but negative for V-ATPase, CAIV, and megalin, whereas their interior was positive for CAII and negative for cytoskeleton. They seem to be pinched off from the luminal membrane of MT1/2-rich cells, as also indicated by transmission electron microscopy. We conclude that in male rats, MTs are heterogeneously abundant in the cell cytoplasm and/or nuclei along the nephron. The MT1/2-rich vesicles in the tubule lumen may represent a source of urine MT and membranous material, whereas MT3 in nuclei may handle zink and locally-produced reactive oxygen species
Prikaz bolesnice s reumatoidnim artritisom i višestrukim osteoporotskim prijelomima [Patient with rheumatoid arthritis and multiple osteoporotic fractures - a case report]
Get PDFPatients with rheumatoid arthritis have increased risk for the development of osteoporosis and osteoporotic
bone fractures. There are several risk factors, including chronic ongoing infl ammation, glucocorticoid therapy, and
immobility due to joint deformations. Here we present a patient with longstanding rheumatoid arthritis that developed
spontaneous rib fractures. The patient was previously treated with methotrexate, sulfasalazine, glucocorticoids, and
lastly with a biologic disease-modifying antirheumatic drug infl iximab. After the exclusion of malignant etiology of
multiple fractures we concluded that the patient had osteoporotic fractured ribs and we continued treatment of osteoporosis
and treatment of rheumatoid arthritis. This shows the importance of employing the treat-to-target strategy while
treating patients with rheumatoid arthritis to prevent the infl uence of active disease on osteoporosis formation and
prevent joint damage and immobility to overall prevent or postpone the development of osteoporosis
Uloga metaloproteinaza matriksa i njihovih inhibitora u razvoju vratnih metastaza papilarnoga karcinoma štitne žlijezde [Role of matrix metalloproteinases and their inhibitors in the development of cervical metastases in papillary thyroid cancer]
Get PDFPapillary carcinoma is the most common thyroid cancer with the incidence increasing worldwide. It is characterized by a high number of cervical metastases. Research of the invasiveness and metastatic processes identified matrix metalloproteinases (MMP) as a key enzyme family in tumor progression, especially MMP-1, -2 and -9. MMP activity can be modulated by tissue inhibitors of matrix metalloproteinase (TIMP 1-4). This research retrospectively investigated the expression of MMP-1, -2 and -9, as well as TIMP-1 and -2 in papillary thyroid carcinoma tissue. The aim of the study was to determine the association of MMP and TIMP with papillary thyroid cancer metastasis pattern by immunohistochemistry. The results obtained showed highest expression of MMP-1 and TIMP-1 in cancer tissue of patients with metastasis in the lateral region, while MMP-2, MMP-9 and TIMP-2 did not differ statistically according to the metastasis pattern. Comparing clinical features with expression data, MMP-1 significantly correlated with the disease stage and number of positive lymph nodes, TIMP-1 with number of positive lymph nodes and tumor stage, and TIMP-2 with tumor size and number of positive lymph nodes. According to this study, MMP-1 and TIMP-1, unlike other proteins analysed, appear to be associated with the papillary thyroid cancer metastasis patter
F-18 FDG PET/CT in pulmonary artery sarcoma: clinical vignette
Get PDFPulmonary artery sarcomas (PAS's) are extremely rare malignant tumors that arise from the endothelial lining of the pulmonary arteries. On CT scans PAS's appear as intraluminal filling defects in the pulmonary arteries, mimicking pulmonary embolism (PE). Due to the similarities in radiographic features as well as in clinical presentation, PAS's are usually misdiagnosed as pulmonary embolism. Since PASs are F-18 FDG avid, F-18 FDG PET/CT scan is a useful imaging tool for differentiating between these two conditions, as shown in this case report. We report a case of a 60-year-old woman presented with a 6-month history of chest pain, dyspnea on exertion, non-productive cough and weight loss. The initial CT pulmonary artery angiography showed extensive intraluminal mass in the pulmonary trunk and left pulmonary artery, diagnosed as massive pulmonary embolism. Since there was no clinical improvement after anticoagulant therapy, CT pulmonary angiography was repeated, and with no change observed in the intraluminal filling defect in pulmonary trunk, the possibility of tumor was raised. For further evaluation of a possible malignancy, F-18 FDG PET/CT was performed. It showed increased FDG uptake, suspicious for an aggressive tumor, in the intraluminal lesion of the pulmonary trunk and along the wall of the left pulmonary artery. There was no extrathoracic abnormality seen on PET/CT scan. Histopathological finding after complete pulmonary artery resection showed high grade undifferentiated pleomorphic sarcoma. F-18 FDG PET/CT is a useful tool for differentiating between pulmonary embolism and malignant intraluminal mass, and at the same time it enables the proper staging of the malignancy.
Utjecaj izvantjelesne cirkulacijske potpore na viskoelastična svojstva krvnoga ugruška i funkcije trombocita [Impact of extracorporeal life support on blood clot viscoelastic properties and platelet aggregation]
Get PDFExtracorporeal life support based on extracorporeal membrane oxygenation is the end-stage treatment of heart failure or cardiogenic shock. Systemic anticoagulation is mandatory, and most of the complications such as thrombosis and bleeding, which are also the most common causes of mortality, are often the result of incompatibility of the extracorporeal system and blood. Routinely performed laboratory blood clotting tests and platelet number do not offer sufficient understanding whether qualitative platelet dysfunction is present in a particular patient nor does it denote hypercoagulability, hyper or hypofibrinololysis. The aim of this prospective study on 28 patients is to evaluate the effect of extracorporeal life support on blood clotting viscoelastic properties and platelet function through specific coagulation and aggregation tests. Data obtained by this study indicate that significant bleeding can be predicted by certain ROTEM® analysis tests, such as INTEM CT, EXTEM CT and FIBTEM MCF. It is more accurate and available in a shorter unit of time compared to the prediction of routine tests that study the coagulation status of the patient. The results of these tests have a practical value in treating patients on ECMO / ECLS support. Literature citations and current research clearly call for the formulation of standardized protocols for conducting anticoagulant therapy during ECMO / ECLS support. It is necessary to assess whether these tests are truly superior to available laboratory tests
Inducibilnost paroksizmalne fibrilacije atrija nakon krioablacije plućnih vena [Induction studies after cryoablation therapy for atrial fibrillation]
Get PDFAims: To analyze the clinical value of AF induction in patients treated by second
generation CB for paroxysmal AF.
Methods: Seventy patients underwent isoproterenol challenge after pulmonary vein
isolation to assess AF induction and early PV reconnections (EPVR). Patients without
EPVR were evaluated for premature atrial contraction (PAC) induction; atrial ectopy
was considered frequent (PAC+) if >1/10 cycles or >6/min. After isoproterenol
protocol, rapid atrial pacing (RAP) was performed.
Results: AF induction by isoproterenol occurred only in 3/70 (4%) patients of whom
2/3 (66%) patients with an EPVR of a triggering vein. In the 62 patients without EPVR,
PAC+ occurred in 17 patients (27%). RAP could induce AF in 23/70 (33%) patients. At
a mean follow-up of 11.5 months, there were 11/70 (16%) AF recurrences. There was
no significant difference in the AF recurrence rate in RAP inducible versus noninducible
patients (log-rank p=0.33). A 41% recurrence rate (7/17 patients) was seen in
the PAC+ group with significantly different AF-free survival for PAC+ vs PACpatients
(log rank p < 0.0001). PAC+ was the only independent determinant to predict
AF recurrence after multivariate analysis.
Conclusion: PAC occurrence in response to isoproterenol could predict AF recurrence
after PV isolation by CB, while RAP showed no prognostic implication