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Urični artritis - može li promjena prehrambenih navika smanjiti potrebu za farmakoterapijom? : diplomski rad
No full textUrični artritis je kronična metabolička bolest uzrokovana nakupljanjem UA u tijelu što dovodi do hiperuricemije i taloženja urata u različitim tkivima. Prehrambene navike imaju ključnu ulogu u prevenciji i kontroli bolesti. Prehrana s niskim sadržajem purina, mediteranska prehrana, prehrana bogata vitaminom C i prehrana bazirana na namirnicama biljnog podrijetla uz ad-ekvatnu hidraciju i umjerenu konzumaciju čaja i kave mogu pomoći u kontroli hiperuricemije te u blažim slučajevima bolesti smanjiti potrebu za farmakološkim liječenjem. Promjenom prehrambenih navika možemo značajno smanjiti učestalost napadaja gihta, djelovati na kardio-vaskularne čimbenike rizika te poboljšati kvalitetu života naših bolesnika. Stoga adekvatna prehrana ima važnu ulogu u cjelovitom pristupu liječenju uričnog artritisa te je koristan saveznik u njegovom dugoročnom zbrinjavanju.Uric arthritis is a chronic metabolic disorder caused by accumulation of UA in the body,
resulting with hyperuricemia and deposition of urate crystals in various tissues. Dietary habits
have a pivotal role in prevention and management of the disease. A low purine diet,
mediterranean diet, nutrition with high intake of vitamin C, plant-based diet together with
adequate hydration and moderate intake of tea or coffee can help control hyperuricemia. These
dietary measures in milder cases of uric arthritis can reduce the need for pharmacological
intervention. Modifying dietary patterns, it is possible to significantly decrease the frequency
of gout attacks, influence on cardiovascular risk factors, and improve patients’ overall quality
of life. Consequently, appropriate nutrition is an important component of a comprehensive
approach in the treatment of uric arthritis and serves as a useful tool in its long-term
management
The Impact of Weighting Factors on Dual-Energy Computed Tomography Image Quality in Non-Contrast Head Examinations: Phantom and Patient Study
No full textBackground: This study aims to evaluate the impact of various weighting factors (WFs) on the quality of weighted average (WA) dual-energy computed tomography (DECT) non-contrast brain images and to determine the optimal WF value. Because they simulate standard CT images, 0.4-WA reconstructions are routinely used. Methods: In the initial phase of the research, quantitative and qualitative analyses of WA DECT images of an anthropomorphic head phantom, utilizing WFs ranging from 0 to 1 in 0.1 increments, were conducted. Based on the phantom study findings, WFs of 0.4, 0.6, and 0.8 were chosen for patient analyses, which were identically carried out on 85 patients who underwent non-contrast head DECT. Three radiologists performed subjective phantom and patient analyses. Results: Quantitative phantom image analysis revealed the best gray-to-white matter contrast-to-noise ratio (CNR) at the highest WFs and minimal noise artifacts at the lowest WF values. However, the WA reconstructions were deemed non-diagnostic by all three readers. Two readers found 0.6-WA patient reconstructions significantly superior to 0.4-WA images (p < 0.001), while reader 1 found them to be equally good (p = 0.871). All readers agreed that 0.8-WA images exhibited the lowest image quality. Conclusions: In conclusion, 0.6-WA reconstructions demonstrated superior image quality over 0.4-WA and are recommended for routine non-contrast brain DECT
Karakterizacija prirođenog imunosnog odgovora na citomegalovirus u jajniku (CIRCO) : Plan upravljanja istraživačkim podacima
No full textHyperreactive B cells instruct their elimination by T cells to curb autoinflammation and lymphomagenesis
No full textB cell immunity carries the inherent risk of deviating into autoimmunity and malignancy, which are both strongly associated with genetic variants or alterations that increase immune signaling. Here, we investigated the interplay of autoimmunity and lymphoma risk factors centered around the archetypal negative immune regulator TNFAIP3/A20 in mice. Counterintuitively, B cells with moderately elevated sensitivity to stimulation caused fatal autoimmune pathology, while those with high sensitivity did not. We resolved this apparent paradox by identifying a rheostat-like cytotoxic T cell checkpoint. Cytotoxicity was instructed by and directed against B cells with high intrinsic hyperresponsiveness, while less reactive cells were spared. Removing T cell control restored a linear relationship between intrinsic B cell reactivity and lethal lymphoproliferation, lymphomagenesis, and autoinflammation. We thus identify powerful T cell-mediated negative feedback control of inherited and acquired B cell pathogenicity and define a permissive window for autoimmunity to emerge
Treatment of the Patient with Brugada Syndrome – a Case Report
No full textCilj: Brugadin sindrom predstavlja rijedak genetski poremećaj koji se može prepoznati po karakterističnim promjenama EKG zapisa. Sindrom je češći u zemljama jugoistočne Azije u odnosu na ostatak svijeta. S obzirom na sve veću prisutnost stranih radnika iz područja jugoistočne Azije u Europi, cilj je ovoga rada skrenuti pozornost zdravstvenih djelatnika na sindrom i educirati ih radi ranog prepoznavanja i pravovremene stratifikacije rizičnih bolesnika. Prikaz slučaja: Ovim radom prikazuje se slučaj bolesnika hospitaliziranog zbog izvanbolničkog srčanog zastoja. Nakon hemodinamske stabilizacije na hitnom prijamu učinjen je EKG kojim su uočene promjene indikativne za Brugadin obrazac tipa 1. Tijekom obrade ubrzo je ponovno došlo do srčanog aresta uslijed polimorfne ventrikularne tahikardije. Ovoga puta, usprkos brojnim defibrilacijama i terapiji, inicijalno nije postignut povratak spontane cirkulacije. Električna oluja okončana je tek primjenom izoproterenola, agonista β-adrenoreceptora preporučenog smjernicama Europskog kardiološkog društva u slučaju električne oluje u bolesnika s Brugadinim sindromom. U daljnjem tijeku prikaza opisuje se boravak u bolnici i liječenje bolesnika, razvoj komplikacija, njihovo zbrinjavanje i implantacija kardioverter-defibrilatora u sekundarnoj prevenciji. Zaključak: Specifičnost ovog sindroma je povećan rizik iznenadne srčane smrti u zdravih i relativno mladih ljudi, većinom muškaraca. Smjernice daju jasne preporuke o zbrinjavanju simptomatskih bolesnika, kao i onih s Brugadinim obrascem tipa 1. Za obrasce tipa 2 i 3 nisu dane jasne smjernice, stoga za stratifikaciju rizika i daljnje postupanje može poslužiti konsenzus eksperata izražen u Šangajskom bodovnom sustavu. Od velike je važnosti prepoznati EKG zapise s Brugadinim obrascem te pravovremeno uputiti bolesnika na daljnju obradu u cilju primarne prevencije iznenadne srčane smrti.Aim: Brugada syndrome is a rare genetic disorder that can be recognized by characteristic changes in ECG records. The syndrome is more common in Southeast Asian countries than in the rest of the world. Considering the increasing presence of foreign workers from Southeast Asia in Europe, this work aims to draw attention of healthcare professionals and educate them on early recognition and prompt stratification of patients at risk. Case report: This paper presents the case of a patient hospitalized due to out-of-hospital cardiac arrest. After hemodynamic stabilization at the emergency department, ECG showed changes indicative of Brugada pattern type 1. Cardiac arrest soon occurred again due to polymorphic ventricular tachycardia. This time, despite numerous defibrillations and therapy, the return of spontaneous circulation was not achieved initially. The electrical storm was finally terminated by the administration of isoproterenol, a β-adrenoreceptor agonist recommended by the Guidelines of the European Society of Cardiology. In the further course, the hospital stay, development of complications, their treatment, and the implantation of a cardioverter defibrillator in secondary prevention are described. Conclusion: The specificity of this syndrome is the increased risk of sudden cardiac death in healthy and young individuals, mostly men. The Guidelines give clear recommendations on the management of symptomatic patients, as well as those with Brugada pattern type 1. No clear guidelines are given for pattern types 2 and 3. Therefore, the consensus of experts expressed in the Shanghai scoring system can be used for risk stratification and further treatment. It is of great importance to recognize ECG records with the Brugada pattern and to promptly refer the patient for further evaluation with the aim of primary prevention of sudden cardiac death
Characterization and differentiation of beech and chestnut honeydew honeys: A comparative study
No full textThis study compares beech (Fagus sylvatica) and chestnut (Castanea sativa) honeydew honeys through analyses of
physicochemical properties, pollen composition, phenolic and volatile compounds, and bioactivity. Beech honey
exhibited higher antioxidant activity (up to 1.81 mmol TE/kg) compared to chestnut honey (0.79 mmol TE/kg),
though both had similar total phenolic and flavonoid content. A total of 37 phenolic compounds, including
propolis-derived flavonoids, were detected, with taxifolin and phenylamides as potential markers of botanical
origin. Volatile profiles distinguished the types, with beech honey rich in 2-furanmethanol and nonanal, while
chestnut honey had unique benzaldehyde and furfural notes. Both honeys demonstrated strong antimicrobial
activity, with inhibition zones up to 20 mm and effective MICs (0.025–0.2 g/mL). Although not currently
classified by botanical origin in EU regulations, the study highlights distinctive polyphenol and volatile profiles,
as well as bioactive properties, between beech and chestnut honeydew honeys
How do community pharmacists perceive practice-based research?
No full textObjectives Practice-based research (PBR) is an integral part of community pharmacy practice. The results obtained from PBR allow community pharmacists to gain the knowledge necessary to develop new patient services and acquire strategies to strengthen their role in the health system. The study aimed to assess pharmacists' attitudes and barriers towards PBR and investigate the factors that prevent or motivate community pharmacists from participating.Methods The cross-sectional study was conducted in May to Jun 2023 via an online structured pretested questionnaire. All licensed pharmacists registered in the Registry of Pharmacists of the Croatian Pharmaceutical Chamber, who listed community pharmacy as a place of work participated, i.e. 500 community pharmacists. The questionnaire consisted of two sections. Section A collected the respondents' sociodemographic characteristics. Section B contained two groups of relevant statements on a 5-point Likert scale divided into two sections: pharmacists' attitudes towards research in PBRs and barriers to participation in PBRs.Key findings The results showed that 97% of community pharmacists considered PBR important for developing new pharmacy services, and almost two-thirds considered participation in research to be part of pharmacy practice. The most often perceived barrier to research participation was the workload of daily tasks necessary for normal pharmacy functioning, recognized by 68% of community pharmacists.Conclusion This study revealed community pharmacists' perception of the importance of PBR for the pharmacy profession. Involvement in PBR was important for the community pharmacists. The motivation for the PBR was present, despite the detected barriers. The results indicate the directions the community pharmacists should inspire
Thyroid Autoimmunity Impairs Oocyte Maturation, Fertilization, and Embryo Development in Assisted Reproductive Technology in Euthyroid Infertile Patients
No full textBackground: Thyroid autoimmunity (TAI) has been widely associated with reduced fertility; however, its impact on assisted reproductive technology (ART) outcomes in euthyroid women remains controversial. Ovarian reserve (OR) and anti-Müllerian hormone (AMH) are considered to be the most reliable predictors of controlled ovarian hyperstimulation (COH) and ART outcome. This study aims to evaluate whether TAI affects COH outcomes depending on the OR, or if TAI is an independent negative factor affecting COH outcomes. Methods: This study includes 341 infertile euthyroid participants under 38 years old undergoing ART at a single reproductive medicine center. The serum concentrations of sex hormones, thyrotropin (TSH), AMH, and antithyroid antibodies (ATAbs) were measured before COH. Ovarian response to COH, assessed by oocyte number and maturation (percentage of mature MII oocytes), fertilization rate (FR), and early embryo development (cleavage and blastocyst rate), were assessed in 191 participants with TAI and 150 TAI negative age-matched controls with normal ORs. The TAI group was further divided into two subgroups: the TAI1 group with normal OR (n = 120) and the TAI2 group with diminished ORs (n = 71). Results: The mean of the retrieved oocytes was significantly lower in TAI1 (p = 0.015) and expectedly significantly lower in TAI2 (p < 0.001) compared to the control. The percentage of MII oocytes was significantly lower in the TAI1 (p < 0.001) and TAI2 (p = 0.009) groups compared to the control group. We observed significantly lower FR (p = 0.002), cleavage rate (p = 0.020), and blastocyst rate (p < 0.001) in the TAI1 group compared to control. In the TAI2 group, there was a lower cleavage rate (p < 0.001) and blastocyst rate (p < 0.001) compared to the control. There was no difference in the mean percentage of MII oocytes, FR, and cleavage rate between the TAI1 and TAI2 groups, but the blastocyst rate was significantly lower (p < 0.001) in the TAI2 group. Conclusions: TAI may represent a negative predictor of in vitro fertilization outcomes by impairing oocyte maturation, fertilization rate, and embryo development in ART cycles, regardless of ORs
A Narrative Review on the Risk Factors and Healthcare Disparities of Type 2 Diabetes
No full textType 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved
THE ROLE OF NEURONS AND GLIAL CELLS IN PRODUCTIVE AND LATENT CYTOMEGALOVIRUS INFECTION
No full textCilj istraživanja: Humani citomegalovirus (HCMV) je vodeći uzročnik prirođenih virusnih infekcija koji često uzrokuje trajna oštećenja živčanog sustava u djece. Tipovi stanica i mehanizmi uključeni u uspostavljanje cjeloživotne latencije citomegalovirusa (CMV) u mozgu još uvijek su nepoznati. Glavni cilj ovog istraživanja je razjasniti diseminaciju virusa i stanični tropizam, te imunološke mehanizme koji nadziru infekciju i uspostavljanje latencije CMV-a u mozgu. Materijali i metode: U ovom istraživanju koristili smo mišji model prirođene CMV infekcije, u kojem su novookoćeni miševi inficirani mišjim citomegalovirusom (MCMV). Kako bismo izučavali biologiju infekcije MCMV-om u mozgu, koristili smo rekombinantne reporterske viruse i transgenične miševe koji ispoljavaju rekombinazu Cre ili im nedostaju ključni elementi efektorskih funkcija limfocita T. Tropizam, anatomska lokacija i reaktivacija virusa određeni su imunohistokemijskim metodama. Kako bismo testirali ulogu imunoloških medijatora u sprečavanju infekcije neurona HCMV-om, koristili smo staničnu liniju humanog neuroblastoma SH-SY5Y i organotipsku kulturu tkiva ljudskog fetalnog mozga (hfOBSC). Rezultati: Pokazali smo da je tijekom akutne faze infekcije u novookoćenih miševa hipokampus glavno mjesto produktivne infekcije MCMV-om. Infektivni virus prvo su proizveli astrociti, zatim mikroglije i konačno neuroni, koji su bili glavna mjesta replikacije virusa tijekom kasne faze akutne infekcije. Pokazali smo da su CD4+ limfociti T i citokin IFN-γ potrebni za razrješenje produktivne infekcije u neuronima. Citokin IFN-γ također može spriječiti infekciju stanica SH SY5Y i neurona u hfOBSC HCMV-om. Konačno, pokazali smo da MCMV uspostavlja latenciju u neuronima i da su CD4+ limfociti T ključni za sprječavanje reaktivacije virusa iz neurona. Zaključak: Rezultati ovog istraživanja po prvi put pokazuju da CMV uspostavlja latenciju u neuronima, te da su CD4+ limfociti T i citokin IFN-γ ključni za nadzor produktivne i latentne infekcije u neuronima. Ova studija ima važan translacijski potencijal s obzirom da ukazuje na to da bi poticanje odgovora posredovanog CD4+ limfocitima T moglo spriječiti neurološke posljedice uzrokovane prirođenom CMV infekcijom.Objectives: Human cytomegalovirus (HCMV) is the leading cause of congenital viral infections, frequently accompanied with long-term neurological sequelae in children. The cell types and mechanisms involved in establishing lifelong CMV latency in the brain, from which the virus reactivates intermittently, remain enigmatic. This research aims to elucidate viral dissemination and cell tropism, immune mechanisms controlling the infection, and the establishment of MCMV latency in the brain. Materials and methods: In this research, we used mouse model of congenital CMVinfection, in which newborn mice are infected with MCMV postnatally. To study the biology of MCMV infection in the brain, we utilized recombinant reporter viruses and transgenic mouse lines that express Cre recombinase or lack critical elements of T-cell effector functions. Viral tropism, anatomical location, and reactivation were determined with immunohistochemical methods. We employed human cell line SH-SY5Y and human fetal organotypic brain slices cultures (hfOBSCs) to test the role of immune mechanisms in preventing HCMV infection of neurons. Results: We found that the hippocampus is a major site of productive MCMV infection during the acute phase in newborn mice. Infectious virus was first produced by astrocytes, then microglia, and finally by neurons, which were the major sites of viral replication during the late phase of infection. CD4+ T-cells and IFN-γ were pivotal in resolving a productive infection in neurons. IFN-γ can also suppress HCMV infection of SH-SY5Y cell line and neurons in hfOBSCs. Finally, we show that MCMV establishes latency in neurons and that CD4+ T-cells are crucial to prevent virus reactivation. Conclusion: This research shows for the first time that neuron-restricted cytomegalovirus latency in the central nervous system is regulated by CD4+ T cells and IFN-γ. This study has important translational potential as it demonstrates that boosting CD4+ T-cell-mediated immunity could prevent neurological sequelae following congenital CMV infection