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Glucagon-like peptide-1 infusion suppresses aldosterone levels in healthy normal-weight individuals: double-blind, placebo-controlled crossover study
Get PDFINTRODUCTION:
Glucagon-like peptide-1 (GLP-1) has many effects on the human body, but its glucose-lowering effect through its stimulation of insulin secretion is the most significant. GLP-1 also acts on renal function and hemodynamics. The antihypertensive and renoprotective effects of GLP-1 receptor agonists are partly explained by their vasoactive effect and increased natriuresis, but their positive influences on blood pressure and the development and progression of kidney disease are attributed to many effects beyond glycemic control. The aim of this study was to determine how the native gut hormone GLP-1 influences the renin-angiotensin-aldosterone system (RAAS). -----
METHODS:
Fourteen healthy participants (6 males and 8 females) were included in a double-blind, placebo-controlled crossover study. After overnight fasting and oral sodium loading, participants were randomly assigned to receive either placebo (500 ml of 0.9% saline) or GLP-1 infusion (1.5 pmol/kg/min dissolved in 500 ml of 0.9% saline) over a 3-h period. After 3 and 6 h, the following parameters were measured: glucose, insulin, plasma renin activity, aldosterone, GLP-1, and antidiuretic hormone. After 7 days, the protocol was repeated, except that those who had previously received placebo now received GLP-1 infusion, and those who had previously received GLP-1 now received placebo. -----
RESULTS:
Three hours after GLP-1 infusion, aldosterone had decreased by a statistically significant amount (p < 0.008) compared to the baseline level. -----
CONCLUSION:
The present study showed that native GLP-1 can decrease aldosterone secretion in a group of healthy individuals, supporting the idea of beneficial outcomes of GLP-1-activating agents on blood pressure and the RAAS
Higher blood pressure duringeEndovascular thrombectomy in anterior circulation stroke is associated with better outcomes
Get PDFBACKGROUND AND PURPOSE:
Reports investigating the relationship between in-procedure blood pressure (BP) and outcomes in patients undergoing endovascular thrombectomy (EVT) due to anterior circulation stroke are sparse and contradictory. -----
METHODS:
Consecutive EVT-treated adults (modern stent retrievers, BP managed in line with the recommendations, general anesthesia, invasive BP measurements) were evaluated for associations of the rate of in-procedure systolic BP (SBP) and mean arterial pressure (MAP) excursions to >120%/<80% of the reference values (serial measurements at anesthesia induction) and of the reference BP/weighted in-procedure mean BP with post-procedure imaging outcomes (ischemic lesion volume [ILV], hemorrhages) and 3-month functional outcome (modified Rankin Scale [mRS], score 0 to 2 vs. 3 to 6). -----
RESULTS:
Overall 164 patients (70.7% pharmacological reperfusion, 80.5% with good collaterals, 73.8% with successful reperfusion) were evaluated for ILV (range, 0 to 581 cm3) and hemorrhages (incidence 17.7%). Higher rate of in-procedure SBP/MAP excursions to >120% was independently associated with lower ILV, while higher in-procedure mean SBP/MAP was associated with lower odds of hemorrhages. mRS 0-2 was achieved in 75/155 (48.4%) evaluated patients (nine had missing mRS data). Higher rate of SBP/MAP excursions to >120% and higher reference SBP/MAP were independently associated with higher odds of mRS 0-2, while higher ILV was associated with lower odds of mRS 0-2. Rate of SBP/MAP excursions to <80% was not associated with any outcome. -----
CONCLUSION:
s In the EVT-treated patients with BP managed within the recommended limits, a better functional outcome might be achieved by targeting in-procedure BP that exceeds the preprocedure values by more than 20%
Multiple myeloma treatment in real-world clinical practice: results of a prospective, multinational, noninterventional study
Get PDFBACKGROUND:
The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. ----- PATIENTS AND METHODS:
Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. ----- RESULTS:
A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. ----- CONCLUSION:
The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits
Prevalence of diabetes five years after having gestational diabetes during pregnancy — Croatian national study
Get PDFAIMS:
The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. ----- METHODS:
This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. ----- RESULTS:
Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p=0.587), level of education (p=0.549) or marital status (p=0.849) except that the diabetes group was significantly more obese than the group without diabetes (p=0.002). ----- CONCLUSIONS:
Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings
Methodology challenges in studying human gut microbiota – effects of collection, storage, DNA extraction and next generation sequencing technologies
Get PDFThe information on microbiota composition in the human gastrointestinal tract predominantly originates from the analyses of human faeces by application of next generation sequencing (NGS). However, the detected composition of the faecal bacterial community can be affected by various factors including experimental design and procedures. This study evaluated the performance of different protocols for collection and storage of faecal samples (native and OMNIgene.GUT system) and bacterial DNA extraction (MP Biomedicals, QIAGEN and MO BIO kits), using two NGS platforms for 16S rRNA gene sequencing (Ilumina MiSeq and Ion Torrent PGM). OMNIgene.GUT proved as a reliable and convenient system for collection and storage of faecal samples although favouring Sutterella genus. MP provided superior DNA yield and quality, MO BIO depleted Gram positive organisms while using QIAGEN with OMNIgene.GUT resulted in greatest variability compared to other two kits. MiSeq and IT platforms in their supplier recommended setups provided comparable reproducibility of donor faecal microbiota. The differences included higher diversity observed with MiSeq and increased capacity of MiSeq to detect Akkermansia muciniphila, [Odoribacteraceae], Erysipelotrichaceae and Ruminococcaceae (primarily Faecalibacterium prausnitzii). The results of our study could assist the investigators using NGS technologies to make informed decisions on appropriate tools for their experimental pipelines
Laparoscopic transhiatal resection of a large mid-esophageal diverticulum: a case report
Get PDFThis is a description of transhiatal laparoscopic approach for mid-esophageal diverticulum. Traditionally mid-esophageal diverticula are approached by thoracotomy or thoracoscopy, with the laparoscopic technique being reserved for epiphrenic diverticula. A 78-year-old Caucasian female with a secondary dilatative ischemic cardiomyopathy presented with dysphagia, tenderness in the epigastrium and a considerable weight loss. A large mid-esophageal diverticulum was found on barium swallow and confirmed by CT scan. Underlying achalasia was recorded on manometry. The patient underwent diverticulectomy via transhiatal approach, followed by Heller myotomy and Dor fundoplication. Throughout the procedure auxiliary, esophagoscopic image was provided by interventional gastroenterologist due to a very narrow operating field and lack of orientation points. Based on our experience with this case, we propose transhiatal approach as a feasible alternative to thoracoscopy, in particular with patients who suffer from cardiac or pulmonary co-morbidities which make traditional techniques of high risk
Partial adoption of ‘minimal core curriculum’ in undergraduate teaching of family medicine: a cross-sectional study among Central and South-Eastern European medical schools
Get PDFBACKGROUND:
In 2011, Tandeter et al. published a list of 15 themes, based on a Delphi survey among representatives of the European Academy of Teachers in General Practice and Family Medicine (EURACT), and suggested this be the 'minimal core curriculum' (MCC) for undergraduate education in family medicine. ----- OBJECTIVES:
To determine: (1) if medical schools in the former Yugoslavia region are familiar with the MCC; and (2) to what degree it is being taught to medical students. ----- METHODS:
In July 2015, a questionnaire was distributed to 19 medical schools in the former Yugoslavia region. A copy of the description of the curriculum for GP/FM was requested from participants. Two researchers conducted content analysis of the curricula according to the 15 predefined MCC themes, independently. ----- RESULTS:
Thirteen (68%) medical schools responded. Of these, 10 (77%) stated that they were familiar with the MCC. Not a single institution encompassed all 15 MCC themes. The number of themes included by individual medical schools ranged from 6/15 (40%) to 13/15 (87%).The following themes were covered by 12 of 13 (92%) medical schools: Introduction to GP/FM; communication skills; prevention and health promotion; and management of chronic diseases. The three themes most poorly covered were: consulting skills (5/13), management of diseases at an early, undifferentiated stage (2/13) and decision-making based on prevalence and incidence (1/13). ----- CONCLUSION:
Despite familiarity with EURACT's MCC among medical schools in the former Yugoslavia region, significant variation in curricula content exists, and no curriculum covered all MCC themes
Bendamustim umjesto karmustina pri kondicioniranju kod autologne transplantacije krvotvornih matičnih stanica - usporedba toksičnosti i infektivnih komplikacija [Use of bendamustin instead of carmustin in autologous stem cell transplantation conditioning – toxicity and infectious complications comparison]
Get PDFInadequate supply of „old and less interesting“ chemotherapeutic agents is becoming a global issue in hemato-
oncology today. In 2016 we were faced with occasional carmustin shortage, one of the most commonly used in
autologous transplant conditioning regimens for lymphoma in our centre, so we decided to use bendamustin instead. We
performed a retrospective analysis of 41 patients treated at our centre who had received bendamustin within BeEA M
protocol and compared them with 40 patients who had received carmustin within BEA M protocol. Both protocols were
used as conditioning protocols before autologous stem cell transplantation. Neutrophil recovery median following
transplantation (AN C>0,5x109/l) was 11 days in the bendamustin group in comparison to 10 days in the carmustin
group.Platelets recovery median following transplantation (PLT >20x109/l) was longer in the bendamustin group (16
vs.13 days) as was blood transfusion dependency (7 vs. 5 days). Infectious complications were not more frequent after
bendamustin, but grade II–III mucositis was more frequent in patients who received carmustin (35% vs.12%). Following bendamustin we had one reported case of nephrotoxicity and cardiac toxicity, not reported with carmustin. Bendamustin
has shown similar hematologic toxicity compared to carmustin but a longer platelet recovery period and a
lower mucositis incidence
Spolne razlike u osteotropnim elementima u ljudskoj kosi i krvi [Gender dependent differences in osteotrophic elements in human hair and blood]
Get PDFMetabolic changes related to age and gender are becoming a public health
and clinical problem. Reliable bioindicators for individual assessment of bioelement
metabolic status are needed. Blood and hair are two easily accessible tissues
suitable for metabolic status assesment.
The study included 192 subjects (83 men, 109 women). The samples were
analyzed with the ICP-MS highlighting the osteotrophic elements (B, Ba, Ca, Mg, P,
Si, Sr, and Zn) as the primary research objectives. The accumulation of bioelements
(Ca>Zn>P>Mg>Si>Sr>B>Ba) appeared significantly higher in the hair than the blood.
This fact makes hair a more suitable biological matrix for chemical analysis of the
studied elements than whole blood.
For the first time the normal concentration ranges of bioelements were defined
by analyzing the frequency distribution properties in the hair and whole blood. At the
same time, the concentration limits for bioelement deficiency and excess were
defined.
Especially significant is the finding of higher concentrations of elements
belonging to the 2A group of the Periodic table of elements (Ca>Mg>Sr>Ba) in
women's hair compared to men's. The ratio of osteotrophic bioelements within the
same gender remained unchanged. Evidently, the metabolic control of mineralization
of the organic biological matrix differs substantially between the genders. No such
differences were observed in the whole blood
Rezultati liječenja 3D-terapijom i model eliminacije infekcije HCV-om u Republici Hrvatskoj [Results of the 3D treatment and model of elimination of HCV infection in Croatia]
Get PDFChronic hepatitis C (CHC) has been recognized as a global health problem. World health organization (WHO) has set a goal to reduce new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Achievement of this goal became possible by the discovery of direct acting antiviral agents (DAA). The aim of this paper is to describe the first Croatian experience in the treatment of CHC with the ombitasvir/paritaprevir/ritonavir + dasabuvir (PrOD) ± ribavirin (RBV) combined therapy. Mathematical model was used to estimate the prevalence and number of complications depending on the number of treated patients annually. Overall, 117 patients with HCV genotype 1 and 4 infection were treated with PrOD±RBV. Sustained virological response was achieved in 97% of treated patients without significant side effects and therapy discontinuation. The goal of reducing deaths by 65% can be achieved if 450 patients are treated annually. With epidemiological effort in early diagnosis combined with timely treatment, Croatia can be among first countries that would achieve WHO goals in the control of chronic viral hepatitis