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Setting up research infrastructure for secondary use of routinely collected health care data in Croatia
Get PDFMandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature
Get PDFOBJECTIVE:
Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw. -----
CASE REPORT:
We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and bethamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and sutures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of microorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely. -----
CONCLUSION:
This case highlights the fact that in some patients bone exposure might develop due to the pulpal-periodontal syndrome i.e. pulp necrosis
Distribution of Ki-67 values within HER2 & ER/PgR expression variants of ductal breast cancers as a potential link between IHC features and breast cancer biology
Get PDFBACKGROUND:
Unexpected differences in Ki-67 values among HER2 & ER/PgR defined subgroups were found. This study aims to detect possible subdivisions beyond the conventional breast cancer types. -----
METHODS:
One thousand one hundred eighty consecutive patients with invasive ductal breast carcinoma were included and distributed in 16 subgroups (four HER2 phenotypes (0+, 1+, 2+ and 3+) times four ER/PgR phenotypes). Complex distributions of Ki-67 values were tested by expectation maximization (EM) clustering. -----
RESULTS:
Pooled Ki67 values of all patients showed the presence of three EM clusters (defined as LMA-low mitotic activity, IMA-intermediate mitotic activity and HMA-high mitotic activity) with expected mean Ki-67 values of 1.17%, 40.45% and 77.79%, respectively. Only ER-PgR- tumors significantly dispersed in three clusters (29.75% tumors in LMA, 46.95% in IMA and 23.30% in the HMA cluster), while almost no detected HMA tumors were of ER + PgR+ or ER + PgR- phenotypes. Among 799 ER + PgR+ patients distribution in clusters was HER2 dependent (p = 0.000243), due to increased number of IMA HER2 3+ tumors on the expense of LMA HER2 3+ tumors (52 IMA out of 162 HER2 3+ patients versus113 IMA out of 637 HER2 < 3+ patients). This was not found among ER + PgR- patients (p = 0.186968). Among ER-PgR- patients, HER2 overexpression also increased number of IMA tumor, but by reducing the number of HMA tumors (p < 0.000001). Here, difference between HER2 absent (0+) and HER2 3+ patients was evident (10 HMA out of 125 HER2 3+ patients versus 42 HMA out of 103 HER2 0+ patients). -----
CONCLUSIONS:
Results suggest that distributions of breast cancers in three clusters of mitotic activity depend on different mechanisms for ER + PgR+ and ER negative tumors. Although HER2 overexpression increases number of IMA tumors in both settings, in the former it is done by reducing number of LMA tumors, while in the latter it reduces the number of HMA tumors. Mitotic activity of ER + PgR- tumors seems unrelated to the HER2 status, possibly as an indicator that ER dysfunctionality in cancers that lack PgR expression. Among ER negative tumors, the absence of HER2 (0+) might be as important as the HER2 overexpression
Anthropometric and laboratory variables related to weight loss-comparison of heart failure patients with tumor patients and control population
Get PDFBACKGROUND:
Body weight loss is an important feature of heart failure (HF) and tumors. It is related to both reduced survival and adverse reactions to therapy in both of these conditions. The mechanisms of body weight loss in patients with HF and tumors are considered to be similar. Yet, studies comparing those two populations are generally lacking. The aim of this study was to compare anthropometric and laboratory data, related to weight loss, between patients with chronic HF and patients with different tumors as well as control population. -----
METHODS:
Laboratory and anthropometric data on 143 consecutive patients with chronic HF and malignant diseases as well as data for 20 controls were collected. -----
RESULTS:
Patients with HF had lower levels of C-reactive protein (CRP) and albumin compared to controls. Anthropometric measurements revealed lower body mass index (BMI), muscle strength, mid-arm circumference, and waist circumference in patients with HF compared to controls. Measurements of biceps, triceps, subscapular, and suprailiac skinfolds were also lower in HF group. Compared to solid tumor group, HF patients had lower levels of CRP and higher levels of hemoglobin. Solid tumor patients had lower values of BMI and subscapular skinfold thickness, as well as higher muscle strength compared to HF group. Finally, compared to patients with solid hematological tumors, HF group had lower levels of albumin, lower muscle strength, as well as lower mid-arm circumference. -----
CONCLUSION:
We found differences in anthropometric and laboratory features, related to weight loss, in patients with HF compared to control population that were expected. On the other hand, observed differences in HF group compared to patients with various tumors could imply different pathophysiological mechanisms of weight loss between those groups. Such data could serve as a cornerstone for studies with larger numbers of patients and deeper pathophysiological insight
Serum concentration of HDL particles predicts mortality in acute heart failure patients
Get PDFClinical studies have shown that assessing circulating concentrations of high-density lipoprotein (HDL) particles by nuclear magnetic resonance (NMR) spectroscopy is superior to HDL-cholesterol in predicting cardiovascular risk. We tested the hypothesis that circulating concentrations of HDL particles predict 3-month mortality of patients with acute heart failure (AHF). Out of 152 included patients, 52% were female, additionally the mean patient age was 75.2 ± 10.3 years, and three-month mortality was 27%. Serum lipoprotein profile at admission was determined by NMR spectroscopy. Univariate logistic regression analyses revealed a significant inverse association of total (odds ratio (OR) 0.38 per 1-SD increase, 95% confidence interval (CI) 0.23-0.60, p < 0.001) and small HDL particle concentrations (OR 0.35 per 1-SD increase, 95% CI 0.19-0.60, p < 0.001) with 3-month mortality, whereas concentrations of large HDL particles (p = 0.353) or HDL-cholesterol (p = 0.107) showed no significant association. After adjustment for age, sex, mean arterial pressure, low-density lipoprotein cholesterol, glomerular filtration rate, urea, and N-terminal pro-brain natriuretic peptide, both the total and small HDL particle concentrations remained significantly associated with 3-month mortality. Based on our results, we conclude that total and small HDL particle concentrations strongly and independently predict 3-month mortality in AHF patients
Kliničko značenje nalaza kompjutorizirane tomografije paranazalnih sinusa u bolesnika s kroničnim rinosinuitisom [Clinical significance of paranasal sinus computed tomography findings in chronic rhinosinusitis]
Get PDFIntroduction: Subjective severity of chronic rhinosinusitis (CRS) is commonly measured by validated disease-specific instruments, while “objective” severity may be assessed with endoscopy and/or CT scores.
Aim: This study evaluated the correlation between subjective symptom severity and disease severity on CT scan in different clinical CRS phenotyps, compared to control patients and evaluated association between symptom scores and anatomical variations.
Patients and methods: Total 160 patients were included in the study, 50 CRS patients without nasal polyps, 50 CRS patients with nasal polys and 60 control patients. Each patient was completed two questionnaires to grade their subjective symptoms, the visual analog scale (VAS) and Sino-Nasal Outcome test-22 questionnaire. The extent of sinus opacification was graded according to the Lund-Mackay staging system. Radiologic evidence of osteitis was assessed by Global Osteitis Scoring Scale (GOSS). The correlations between VAS symptom scores, CT score, and osteitis score were calculated. Differences in symptom scores between groups with and without anatomic variations were evaluated.
Results: In CRS group without nasal polyps, significant positive correlation was found between Lund-Mackay score and smell impairment and cough. In CRS group with nasal polyps significant correlation was found between Lund-Mackay score and smell impairment and nasal obstruction. In CRS group with nasal polyps, patients with Haller cell had significantly higher facial fullness. In CRS group without nasal polyps, patients with paradoxical middle turbinate had significantly higher postnasal secretion.
Conclusion: Smell impairment, nasal obstruction and cough are symptoms that shows positive correlation with CT score in CRS patients. Some anatomic variations may be associated with symptom burden in CRS patients
Ispitivanje statusa željeza u dobrovoljnih davatelja krvi u Republici Hrvatskoj [Investigation of iron status in Croatian blood donors]
Get PDFIntroduction: With each donation of whole blood, healthy blood donor loses 200 – 250 mg of iron. This loss is compensated by the mobilization of stored iron. Several studies showed that blood donors may be at risk of iron deficiency/depletion and the development of anemia. This risk is particularly pronounced in female donors of childbearing age and frequent blood donors. Therefore, implementation of numerous measures are considered in order to prevent iron deficiency and improve the safety of blood donors.
Aim: The aim of this study was to evaluate the iron status of voluntary blood donors in Croatia, primarily by measuring ferritin level in donors with different donation freqency, to assess the diagnostic value of RBC parameters, as well as combined cell index (CCI) in detecting reduced iron stores, to evaluate the blood donor safety in relation to the iron stores using current selection criteria and to consider the implementation of measures to prevent iron deficiency, particularly the introduction of ferritin testing in blood donors.
Methods: The study involved 1,084 male and 792 female whole blood donors, accepted for blood donation. In addition to the short questionnaire about general data and lifestyle, two additional samples were collected: one for the determination of complete blood count (CBC) and one for the determination of ferritin, serum iron, UIBC/TIBC. Statistical analysis was performed using the MedCalc software and Excel 2016. Results: In male donors, linear drop of serum ferritin was demonstrated with increasing frequency of blood donations:from the median of 129 μg/L in the control group to 43 μg/L in those with 7 – 8 donations in two years. In control group of female donors, the median value of ferritin was 33 μg/L, while in test groups the median ferritin was within a narrow range between 22 μg/L and 29 μg/L, and in correlation with the menstrual status. Depleted iron stores (ferritin ˂12 μg/L) were found in males with the frequency of 0% in the control group and 1.95% in those with 1 – 8 donations in two years. Depleted iron stores were found in 6.7% females of the control group and in 17.2% of female donors with 1 – 6 donations in two years. Combined Cell Index (CCI) showed satisfactory diagnostic value in the assessment of depleted iron stores in both sexes.
Conclusion: In addition to more intense education of blood donors on the importance of iron and its loss during the blood donation, we propose the implementation of quantitative method for haemoglobin determination, along with the gradual introduction of ferritin test
Kemokini CXCL10, CXCL11 i CXCL13 u aseptičnom meningitisu, neuroboreliozi i akutnom diseminiranom encefalomijelitisu u djece [Chemokines CXCL10, CXCL11 and CXCL13 in aseptic meningitis, neuroborrelioses and acute disseminated enchephalomyelitis in children]
Get PDFAim: To define the role of CXCL10, CXCL11 and CXCL13 and CSL/serum chemokine concentration gradient in NPEV AM, NB and ADEM in children and to find laboratory marker or a cut-off concentration of specific chemokine to differentiate between these groups.
Patients and methods: Study included 84 pediatric patients; 23 with ADEM, 20 with NPEV AM, 21 with NB and 20 controls (CNS infection excluded).
Results: CXCL10 and CXCL11 concentrations in CSF of children with NPEV AM were higher from serum values and when compared to control group. CSF CXCL10 and CXCL13 were higher in patients with NB. CSF/serum gradient of CXCL10 and CXCL11 in NPEV AM and CXCL10 and CXCL13 in NB was determined. Positive correlation was found between CSF CXCL10 and CXCL13 concentration and CXCL10 CSF/plasma gradient and CSF pleocytosis in NB, as well as CSF CXCL10 concentration and CXCL10 and CXCL11 CSF/plasma gradient in ADEM. Serum concentrations of chemokines were lower in patients with CNS involvement. Males were shown to had higher concentrations and CSF/serum gradient of all chemokines. Longer preadmission period was associated with lower chemokines level. ADEM patients had lower CSF cell count number. Higher amount of polymorphonuclears and elevated level of CXCL10 and CXCL11 was found in CSF of NPEV AM patients. CSF CXCL10 cut-off level of 5.64 μg/L was determined as excellent in discrimination between these groups of patients. Conclusion: Chemokines CXCL10, CXCL11 and CXCL13 participate in pathogenesis of NPEV AM, NB and ADEM in children. Most prominent correlation was found between CXCL10 and NPEV AM. The existence of chemokine CSF/plasma gradient is one of many factors involved in the recruitment of T and B-cells into the CNS
Povezanost polimorfizama citokinskih gena TNFalpha (-308G>A, -238G>A), IL1alpha (-889C>T) i IL10 (-1082G>A) s atopijskim respiracijskim bolestima [Associations between cytokine gene polymorphisms TNFalpha (-308G>A, -238G>A), IL1alpha (-889C>T) and IL10 (-1082G>A)]
Get PDFThe aim of this research was to assess the associations between polymorphisms in the genes for tumour necrosis factor (TNF)-α –308G>A and –238G>A, interleukin(IL)-10-1082G>A and IL-1α-889C>T and atopic asthma, rhinitis and dermatitis (AD), with adjustment for confounding personal (gender, BMI, parental history of atopic diseases), lifestyle, and environmental factors (smoking, continental/Mediterranean and urban/rural residency, exposure to pets).
The initial phase included 356 freshmen students from the University of Zagreb who underwent collecting a questionnaire, skin prick testing with common inhalatory allergens, total serum IgE measurement, spirometry with a bronchodilation test, and genotyping. A follow-up study, conducted 4-5 years later, included 121 subjects who repeated the protocol either completely or partially.
TNF-α –308G>A polymorphism was found in around 30%, IL-1α –889C>T in around 40%, TNF-α -238G>A in A in >75% of subjects. These results point to a negative association between TNF-α –308G>A polymorphism and AD and skin symptoms, adjusted for personal, lifestyle, and environmental factors. TNF-α –308G>A polymorphism stimulates the production of TNF-α, which can be beneficial for the clinical course of AD, since part of AD pathogenesis is related to defective TNFα production and activity in the skin. There were no significant associations between the analysed polymophisms and time-related changes in the presence of atopic diseases, symptoms, and markers during the follow-up period
Atrial fibrillation and risk of cardiovascular events and mortality in patients with symptomatic peripheral artery disease: A meta-analysis of prospective studies
Get PDFBACKGROUND:
Atrial fibrillation (AF) is associated with adverse outcomes in terms of survival and morbidity. Peripheral artery disease (PAD) and AF share several common risk factors and often coexist. Whether AF has a prognostic role in patients with PAD has not been extensively studied. -----
HYPOTHESIS:
AF is associated with major adverse cardiac events (MACE) and mortality in symptomatic PAD patients. -----
METHODS:
Using MEDLINE and Scopus, we searched for studies published before December 2016 that evaluated cardiovascular outcomes based on the presence/absence of AF in a prospective manner with a follow-up period of ≥12 months. The outcomes were reported using a random-effects model, and heterogeneity was assessed using the I2 statistic. Sensitivity analyses were performed to test the contribution of each study to the overall results. -----
RESULTS:
Six prospective studies (Newcastle-Ottawa score range, 7-9) with 14 656 patients were included in the final analysis (age range, 66-70 years; median follow-up, 1.4 years). Our pooled analysis found a significant association between AF and mortality (odds ratio: 2.52, 95% confidence interval: 1.91-3.34, I2 = 32.6%), without evidence of publication bias (P = 0.63). Meta-analysis showed a significant impact of AF on MACE (odds ratio: 2.54, 95% confidence interval: 1.78-3.63, I2 = 74.3%), without detected publication bias (P = 0.08). -----
CONCLUSIONS:
AF is associated with increased risk of mortality and MACE in symptomatic PAD