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Does the Efficacy of Semaglutide Treatment Differ between Low-Risk and High-Risk Subgroups of Patients with Type 2 Diabetes and Obesity Based on SCORE2, SCORE2-Diabetes, and ASCVD Calculations?
No full textBackground: Diabetes is the primary contributor to cardiovascular disease risk, and when combined with obesity, it further underscores the significance of cardiovascular risk assessment. Methods: A retrospective study of 64 patients with type 2 diabetes (T2D) and obesity on once-weekly subcutaneous semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes, and ASCVD score calculations. We compare the differences between groups (ASCVD: low + borderline + intermediate versus high-risk group; SCORE2/SCORE2-OP: low + moderate versus high + very high-risk group and SCORE2-Diabetes: low + moderate versus high + very high-risk group) in terms of change from baseline in body mass index (BMI) and HbA1c and weight loss outcomes. Results: Patients in the high-risk group, according to ASCVD risk score, had statistically better results in weight loss ≥ 3%, ≥5%, and ≥10% compared to ASCVD low + borderline + intermediate and without difference regarding HbA1c. According to SCORE2/SCORE2-OP, the high + very high-risk group had statistically better HbA1c and weight loss results but only for ≥5% versus the low + moderate risk group. Based on the score SCORE2-Diabetes, the high + very high-risk group had statistically significant better results in lowering HbA1c and weight loss but only for ≥5% versus the low + moderate risk group. Conclusions: To the best of our knowledge, this study represents the initial investigation linking glycemic control and weight reduction outcomes in individuals with T2D and obesity treated with once-weekly semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes and ASCVD score calculations
Deciphering the Complex Immunopathogenesis of Alopecia Areata
No full textAlopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient’s quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis
Probiotics: Benefits on Skin Health and Therapeutical Potential
No full textThis thesis comprehensively explores the substantial impact of probiotics on skin health and their therapeutic potential across various dermatological conditions. It delves into the historical context of probiotics, tracing their use from ancient fermentation practices to contemporary biomedical research, highlighting their enduring relevance in promoting health and nutrition. The study systematically reviews the effects of different probiotic strains, such as Nitrobacter, Lactobacillus, and Bifidobacterium, on skin health, including their roles in enhancing immune responses, modulating microbial populations, and improving skin barrier functions. A critical analysis of the literature reveals probiotics' multifaceted benefits in treating skin conditions like acne, AD, psoriasis, SD, rosacea, and alopecia. These benefits range from antimicrobial and anti-inflammatory actions to the maintenance of skin barrier integrity and modulation of the skin's immune system. The thesis emphasizes the potential of probiotics to revolutionize skincare and dermatology by offering natural, effective treatment alternatives that leverage the skin-gut axis and the microbiome's health-promoting capabilities. Furthermore, the thesis underscores the need for further research to unravel the complex mechanisms through which probiotics influence skin health, identify optimal strains and formulations, and establish standardized therapeutic protocols. By highlighting the promising yet underexplored potential of probiotics in dermatology, critical appraisal of published research papers in this thesis lays the groundwork for future studies that could lead to innovative, microbiome-friendly skincare solutions and treatments for chronic skin disorders
Hypertrophic pyloric stenosis
No full textHipertrofična stenoza pilorusa je bolest završnog dijela želuca, pri čemu dolazi do zadebljanja mišića pilorusa. Pilorus je sužen i onemogućena je pasaža sadržaja iz želuca u tanko crijevo. To je česta bolest u pedijatriji, primijećeno je da se češće javlja u zapadnim državama i da incidencija u posljednjih godina pada. Etiologija je nepoznata, no češće se javlja u dječaka te se sumnja da je glavni uzrok genska promjena. Glavni simptom je povraćanje u luku bez primjesa žuči, a povraćanje napretkom bolesti postaje učestalije. Dijagnoza se postavlja radiološkom obradom. Kod većine pacijenata se zadebljanje jasno vidi ultrazvukom, rijetko su potrebne dodatne dijagnostičke obrade kao što su CT i fluoroskopija. Nakon postavljanje dijagnoze potrebno je nadoknaditi tekućinu, uspostaviti ravnotežu elektrolita i korigirati acidobazni status. Liječenje je kirurško. Pristup može biti otvoreni ili laparoskopski. Laparoskopski pristup je zastupljeniji jer je brži oporavak, rjeđe su komplikacije i kraći je boravak u bolnici. Intraoperativne komplikacije, kao što su slučajna punkcija ili hemoragija, su češće od postoperativnih. Remisija bolesti je do sada samo dva puta opisana.Hypertrophic stenosis of the pylorus is a disease of the final part of the stomach where the pylorus muscle thickens. The pylorus is narrowed and the passage of contents from the stomach to the small intestine is prevented. It is a common disease in pediatrics, it has been noted that it occurs more often in Western countries and that the incidence has been decreasing in recent years. The etiology is unknown, but it occurs more often in boys, and it is suspected that the main cause is a genetic change. The main symptom is vomiting without admixture of bile, and vomiting becomes more frequent as the disease progresses. The diagnosis is established by radiological processing. In most patients, the thickening is clearly visible on ultrasound, additional diagnostic procedures such as CT and fluoroscopy are rarely needed. After establishing the diagnosis, it is necessary to replace the fluid, restore the electrolyte balance and correct the acid-base status. Treatment is surgical. The approach can be open or laparoscopic. The laparoscopic approach is more common, because recovery is faster, complications are less frequent and the hospital stay is shorter. Intraoperative complications, such as accidental puncture or hemorrhage, are more common than postoperative complications. Remission of the disease has been described only twice so far
MIS TLIF VERSUS OPEN TLIF
No full textThis literature review compares minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with open TLIF procedures across various parameters. Analyzing ten publications, it highlights consistent findings regarding reduced blood loss and shorter hospitalization durations associated with MIS TLIF. While operation times are often longer for MIS TLIF, attributed to the learning curve, the overall complication rates do not significantly differ between the two techniques. However, the variability in complication definitions underscores the need for detailed considerations. Cost analyses suggest potential cost savings with MIS TLIF, though careful examination is essential. Overall, while MIS TLIF offers quantitative advantages, individualized treatment approaches based on comprehensive clinical assessments remain crucial for optimizing patient outcomes
Transcatheter Aortic Valve Implantation in Low Perioperative Risk Patients
No full textAortalna stenoza je suženje aortalne valvule uslijed promjena na listovima aortalnog zaliska, a koja posljedično dovodi do otežanog sistoličkog pražnjenja lijeve klijetke. Razlikujemo tri primarna uzroka aortalne stenoze, a to su kongenitalno abnormalna valvula, kalcificirana aortalna valvula i reumatska bolest aortalne valvule. Kada nastupe simptomi zaduhe, grudne boli i sinkope, prognoza je loša. Zamjena aortalnog zaliska je jedina dugoročna terapijska opcija, a izvodi se kirurškom operacijom ili transkateterskom implantacijom aortalnog zaliska (TAVI). Prema trenutačnim američkim i europskim smjernicama dozvoljava se upotreba TAVI kod bolesnika visokog perioperativnog rizika. Budući da je prevalencija aortalne stenoze u stalnom porastu, razmatra se mogućnost uvođenja transkateterske implantacije aortalnog zaliska kao opcije za liječenje bolesnika niskog perioperativnog rizika. U tijeku su randomizirane studije koje bi trebale postaviti temelje za nove smjernice.Aortic stenosis is a narrowing of the aortic valve caused by changes in the leaflets of the aortic valve, which consequently leads to difficulty in systolic emptying of the left ventricle. We distinguish three primary causes of aortic stenosis, namely congenitally abnormal valve, calcified aortic valve and rheumatic aortic valve diseases. When symptoms of shortness of breath, chest pain and syncope occur, the prognosis is poor. Aortic valve replacement is the only long-term therapeutic option, and it is performed by surgery or transcatheter aortic valve implantation (TAVI). Current American and European guidelines allow the use of TAVI in patients with high perioperative risk. Since the prevalence of aortic stenosis is constantly increasing, the possibility of introducing transcatheter aortic valve implantation as an option for the treatment of patients with low perioperative risk is being considered. Randomized studies are underway that should lay the groundwork for new guidelines
HIDRADENITIS SUPPURATIVA: Epidemiology, clinical presentation and pathogenesis
No full textHidradenitis Suppurativa je kronično upalno stanje kože koje karakteriziraju bolni noduli. Ti noduli nerijetko stvaraju apscese što s vremenom dovodi do sinusnih puteva i ožiljaka. Uobičajena zahvaćena područja su aksila, ingvinalna regija, perianalna i analna te inframamarna regija (intertriginozna područja). Etiologija još nije u potpunosti razjašnjena, ali je česta obiteljska predispozicija što ukazuje na genetsku komponentu. Često počinje nakon puberteta i može biti pod utjecajem hormonalnih promjena. Trenje, znojenje i pretilost mogu pogoršati stanje i biti uzročni čimbenici. Simptomi su bolni noduli, apscesi koji mogu drenirati gnoj, sinusni putevi (tuneli ispod kože), ožiljci i zadebljanje kože. Dijagnoza se postavlja na temelju kliničke procjene karakterističnih lezija i njihovih položaja. Često se pogrešno dijagnosticira zbog sličnosti s drugim kožnim infekcijama. Liječenje mora biti sveobuhvatno, antibiotici za smanjenje infekcije i upale, protuupalni lijekovi, hormonska terapija (npr. oralni kontraceptivi, antiandrogeni), biološki lijekovi te kirurške metode liječenja. HS je složeno, kronično stanje koje zahtijeva višestruki pristup liječenju, uključujući medicinsko liječenje, kirurške opcije i prilagodbe načina života. Rana dijagnoza i holistički plan liječenja ključni su za poboljšanje ishoda i kvalitete života bolesnika.Hidradenitis Suppurativa is a chronic inflammatory skin condition characterized by painful nodules. These nodules often form abscesses, which eventually leads to sinus tracts and scars. Commonly affected areas are the axilla, inguinal region, perianal and anal, and inframammary region (intertriginous areas). The etiology has not yet been fully elucidated, but it is a frequent family predisposition, which indicates a genetic component. It often starts after puberty and can be influenced by hormonal changes. Friction, sweating and obesity can worsen the condition and be causative factors. Symptoms include painful nodules, abscesses that can drain pus, sinus tracts (tunnels under the skin), scarring and thickening of the skin. The diagnosis is made on the basis of clinical evaluation of the characteristic lesions and their positions. It is often misdiagnosed due to similarities with other skin infections. Treatment must be comprehensive, antibiotics to reduce infection and inflammation, anti-inflammatory drugs, hormonal therapy (eg oral contraceptives, antiandrogens), biological drugs and surgical methods of treatment. HS is a complex, chronic condition that requires a multifaceted treatment approach, including medical treatment, surgical options, and lifestyle adjustments. Early diagnosis and a holistic treatment plan are key to improving patient outcomes and quality of life
Nanomedicine in Neuroprotection, Neuroregeneration, and Blood–Brain Barrier Modulation: A Narrative Review
No full textNanomedicine is a newer, promising approach to promote neuroprotection, neuroregeneration, and modulation of the blood–brain barrier. This review includes the integration of various nanomaterials in neurological disorders. In addition, gelatin-based hydrogels, which have huge potential due to biocompatibility, maintenance of porosity, and enhanced neural process outgrowth, are reviewed. Chemical modification of these hydrogels, especially with guanidine moieties, has shown improved neuron viability and underscores tailored biomaterial design in neural applications. This review further discusses strategies to modulate the blood–brain barrier—a factor critically associated with the effective delivery of drugs to the central nervous system. These advances bring supportive solutions to the solving of neurological conditions and innovative therapies for their treatment. Nanomedicine, as applied to neuroscience, presents a significant leap forward in new therapeutic strategies that might help raise the treatment and management of neurological disorders to much better levels. Our aim was to summarize the current state-of-knowledge in this field
Real-World Data with CDK4/6 Inhibitors—A Single Center Experience from Croatia
No full textBackground: There are limited real-world data (RWD) regarding the use of cyclin-dependent kinase (CDK) 4/6 inhibitors in western Balkan. The aim of our study was thus to analyze factors influencing progression-free survival (PFS) and overall survival (OS), along with the differences in adverse effects of CDK 4/6 therapy in a tertiary healthcare center in Croatia. Methods: We evaluated medical and demographic data for 163 consecutive patients with metastatic breast cancer treated with CDK4/6 inhibitors for at least one month, from October 2018, after the drug became available in Croatia. Eligible patients in our study were those patients who were treated with palbociclib, ribociclib, or abemaciclib. Results: The median PFS of CDK4/6 inhibitors treatment was 2.2 years (95% CI 1.8–3.3), with the longest ongoing treatment for 5.4 years. Treatment with CDK4/6 inhibitors in the first line was associated with a longer PFS compared to the second line or beyond (HR 0.50, 95% CI 0.3–0.9), and patients without liver metastasis exhibited longer survival compared to patients with liver metastasis (HR 0.46, 95% CI 0.2–0.8) (both p 0.05). In a multivariate analysis, only the presence of liver metastasis (p = 0.0003) and time to metastasis under 5 years from primary breast cancer (p = 0.03) were associated with a worse OS. Conclusion: Our study provides the RWD with the use of CDK4/6 inhibitors in the treatment of metastatic HR+/HER2− breast cancer. To our best knowledge, there are limited RWD regarding CDK 4/6 inhibitors use in western Balkan; thus, our study provides valuable data from everyday clinical practice for this region of Europe, bridging the gap between randomized clinical trials and clinical reality in western Balkan