Anemia in malignant diseas – treatment algorithm

Anemija se u maligno oboljelih javlja s velikom učestalošću te joj se prevalencija kreće od 20 do 60 %. Uzroci nastanka anemije u maligno oboljelih mogu biti mnogostruki, kao što su već sama prisutnost zloćudne bolesti , terapija zloćudne bolesti te različita druga stanja (infekcije, nutriti vni defi cit, prisutnost druge kronične bolesti itd.). Prisutnost anemije kod maligno oboljelih negati vno utječe na sve fi ziološke sustave i njihove funkcije, a naročito na središnji živčani, kardiorespiratorni sustav te na bubrežnu funkciju, stoga se ovi bolesnici osjećaju znatno lošije nego što bi to uzrokovala sama osnovna bolest, a prisutnost, odnosno odsutnost anemije utječe na mogućnosti i izbor načina liječenja te je ujedno i jedan od prognosti čkih čimbenika preživljenja kod brojnih tumora. Iako je vrlo učestala, anemija se kod maligno oboljelih često previđa i podcjenjuje te samo oko 40 % bolesnika koji su anemični, a istodobno imaju zloćudnu bolest, prima terapiju u svrhu liječenja anemije. Za sprječavanje i liječenje anemije prije svega je potrebno liječiti osnovnu bolest. Danas je, prema smjernicama American Society of Clinical Oncology (ASCO) i American Society of Hematology (ASH), na prvom mjestu lijekova za liječenja anemije maligno oboljelih eritropoetin koji se koristi već dugo godina u svijetu, no u Republici Hrvatskoj njegova primjena nije još zaživjela.Anemia in malignant disease occurs with great frequency and its prevalence is 20-60% and depends on a number of diff erent factors. Causes of anemia in malignant disease can be manifold as they are already very presence of malignant disease, therapy of malignant diseases and various other conditi ons (infecti ons, nutriti onal defi cits, the presence of other chronic diseases, etc.). The presence of anemia in malignant disease negatively affects on all physiological systems and their functi ons, especially on the central nervous system, cardiorespiratory system and on renal functi on. Therefore, these patients feel much worse than the disease itself is caused, and the presence or absence of anemia aff ects on the choice of opti ons and ways of treatment and is also one of the prognostic factors for survival in many tumors. Although it is very common, the anemia of malignant disease is often overlooked and underesti mated, and only about 40% of cancer pati ents who have anemia receive therapy for anemia. For the preventi on and treatment of anemia in cancer patients it is necessary to eliminate underlying ethyological factors. Applicati on of erythropoetic agents is strongly recomended according to the guidelines of ASCO and ASH. Altough it has been used for many years in the world, in the Republic of Croatia erythropoetin has not been recognized for that indication

Eticki stav sprema bolno dete od anemija

Болести на крвта можат да настанат кога се менува бројниот однос на крвните зрнца, било да се зголемуваат или намалуваат.Малите деца емоционално се поврзани со својата мајка, па затоа детето кога е болно и кога мора да се одвои од својата мајка предизвикува стрес кај самото дете

Autoimmune diseases

Autoimunosne bolesti su vrlo heterogena skupina bolesti, koje imaju zajedničku karakteristiku, a to je proizvodnja autoreaktivnih T-stanica ili autoreaktivnih antitijela. Svaka autoimunosna bolest zasebno pogađa vrlo mali broj ljudi, ali ukupno oko 5% svjetske populacije boluje od autoimunosnih bolesti, zbog čega su one predmet multidisciplinarnih istraživanja, posebno u posljednjih 50-ak godina. U radu je kratko izložena povijest imunoloških otkrića, te prvih razmišljanja o autoimunosnim bolestima, zatim su radi boljeg razumijevanja sadržaja rada opisane osnove imunoloških procesa. Pažnja je usredotočena na same autoimunosne bolesti, organospecifične i organonespecifične, te je opisano nekoliko primjera da bi se dobio uvid u nekoliko različitih mehanizama kojima dolazi do razvoja autoimunosnih bolesti. Konačno, samo ukratko, opisane su metode istraživanja na životinjskim modelima, te metode liječenja autoimunosnih bolesti.Autoimmune diseases are heterogeneous group of diseases that have a few characteristics in common; they are accompanied by the production of selfreactive T-cells and autoantibodies. Each autoimmune disease individually affects only a small number of people, but approximately 5% of human population suffers of autoimmune diseases. This is the reason why they are subject of multidisciplinary researches, especially in last 50 years. This paper shortly presents history of immunologic researches, and early thoughts about autoimmune diseases. For better understanding of the contents, elemental features of immunologic processes are described. The focuses of this paper are autoimmune diseases themselves, organ-specific and organ-nonspecific, and few of them are described to get a better insight into the mechanisms of autoimmune diseases. Finally, some methods of researches on animal models, and some approaches of autoimmune diseases treatments are described

Chronic renal failure – cardiovascular risk factor.

Cardiovascular diseases are a major cause of morbidity and mortality in patients at the end stage of renal disease. Left ventricular hypertrophy, coronary heart disease and heart failure are the most prevalent cardiovascular diseases in dialysis patients. The patients on chronic dialysis have a 10 to 20-fold higher risk of development of cardiovascular disease than the general population. The aim of this article was to define the frequency of risk factors (traditional and non-traditional) for cardiovascular diseases in dialysis patients. The most frequent traditional factors in this study were hypertension (62%) and hyperlipidemia (60%), while anemia (86%) and hyperhomocysteinemia (82%) were the most frequent non-traditional factors. To present the study and repeat again that dialysis patients have high risk of development of cardiovascular disease and this population should be an ideal target group for primary prevention

Diseases of leukocytes

Leukociti ili bijele krvne stanice su sve stanice periferne krvi s jezgrom čija je glavna uloga obrana organizma od mikroorganizama u kombinaciji sa sposobnošću razlikovanja stranih stanica od vlastitih. Odjeljak leukocita dijeli se na dvije osnovne skupine: fagocite (granulocite, monocite), te stanice imunološkog sustava: limfocite B i T i prirodne ubilačke stanice (NK, engl. natural killer). Cilj ovog rada je pregled kroz najvažnije bolesti leukocita, uzroke, posljedice te mogućnosti liječenja. Bolesti leukocita su izrazito složene bolesti upravo zbog njihove važne funkcije u tijelu. Postoji još jako puno nepoznanica oko uzroka nastanka mnogih bolesti što usporava liječenje i čini ove bolesti jednima od najteže izlječivih.Leukocytes or white blood cells are peripheral blood cells with core whose main role is defense of the organizm against microorganizms in combination with the ability to distinguish foreign cells from their own. Leukocytes can be divided into two basic groups: phagocytes (granulocytes, monocytes) and immune cells: B and T lymphocytes and natural killer cells. The objective of this thesis is to review the most importatnt disease of leukocytes, causes, consequences and treatment options. Diseases of white blood cells are extremely complex disease because of their important function across the body. There is a lot of unknowns about the cause of establishment od many diseases which slows healing and makes this disease one of the hardest curable

Role of the liver in iron metabolism – histochemical iron identification

Željezo je potrebno za osnovno funkcioniranje svih stanica u organizmu sisavaca, ali posebnu važnost ima u stanicama koje proizvode hemoglobin i mioglobin. Sisavci primaju željezo isključivo putem prehrane. Apsorpcija željeza se odvija u proksimalnom dijelu tankog crijeva. Jetra ima veliki kapacitet za pohranu suvišnog željeza. Također ima i regulatornu ulogu u metabolizmu željeza. Specijalizirani makrofazi odstranjuju stare eritrocite iz cirkulacije te imaju ulogu u recikliranju željeza. Hepcidin ima središnju ulogu u regulaciji homeostaze željeza. Postoji nekoliko poremećaja povezanih sa defektnim metabolizmom željeza, npr. hereditarna hemokromatoza, aceruloplazminemija i druge. Postoji nekoliko histokemijskih metoda za dokazivanje željeza u stanicama, a najčešća je Perlova metoda.Iron is necessary for the basal functioning of all mammalian cells but is particularly important in cells producing hemoglobin and myoglobin. Mammals obtain iron exclusively from the diet. Iron absorption takes place in the proximal small intestine. Liver has a large capacity to store excess iron. It also plays regulatory role in iron metabolism. Specialized macrophages remove effete red cells from circulation for iron recycling. Hepcidin is the key regulator in iron homeostasis. There are several disorders attached to defect iron metabolism, e.g. hereditary hemochromatosis, aceruloplasminemia e.t.c. There are several histochemical methods for cellular iron detection and the most common method is Perl's method

Celiac disease in the preschool age

Celijakija je kronična i imunološka bolest odnosno nemogućnost probavljanja glutena, proteina koji se nalaze u nekim žitaricama, uključujući pšenicu. Bolest se još zove i glutenska enteropatija. Sastojak glutena koji se zove glijanid uzrokuje upalu tankog crijeva, crijevna stjenka postaje nadražena što dovodi do malapsorpcije drugih hranjivih tvari. Mnogi smatraju da ovakvo oboljenje uzrokuju genetski i vanjski čimbenici o čemu ću detaljnije pisati u sljedećim poglavljima. Glutenska enteropatija ili celijakija javlja se u nekoliko tipova: tipična, atipična, tiha i potencijalna. Tipovi celijakije koji stvaraju najveći problem su atipični i tihi tip jer ne postoje određeni simptomi prilikom pojavljivanja bolesti. Atipični broj slučajeva celijakije znatno je porastao proteklih godina, a do otkrivanja dolazi slučajno, krvnim testovima. Baš kao svaka bolest i celijakija znatno utječe na život oboljelih, naročito oboljele djece. Bezglutenska prehrana je jedini način držanja bolesti pod kontrolom. Takva prehrana može utjecati na psihičko stanje djeteta. Postoje i određene prateće bolesti koje se mogu javiti kao posljedica upale tankog crijeva radi konzumacije glutenskih proizvoda. Celijakiju treba prvenstveno shvatiti ozbiljno, zatim je kontrolirati i pratiti.Celiac disease is a chronic and immune disease, that is an inability to digest gluten, proteins found in some cereals, including wheat. The disease is also called gluten enteropathy. The part of gluten called gliyanide causes inflammation of the small intestine, the intestinal wall becomes irritated, leading to malabsorption of other nutrients. Many think that such an illness is caused by genetic and external factors, was described in previous chapters.. Glutathione enteropathy or celiac disease has several types: typical, atypical, silent and potential. Types of celiac disease that cause the biggest problem are atypical and silent type because there are no specific symptoms when the disease occurs. The number of atypical celiac cases has increased considerably over the past few years, and it is discovered by chance, when doing blood tests. Just like any disease the celiac disease significantly affects the lives of the diseased, especially the sick children. Gluten-free nutrition is the only way to keep the disease under control. Such nutrition can affect the child's mental state. There are certain accompanying diseases that may occur as a result of inflammation of the small intestine as the result of gluten consumation. Celiac disease has to be taken seriously, then controlled and monitored

Contemporary pharmacotherapy and iatrogenic pathology

During the past few decades, the pharmaceutical industry has developed into a powerful human activity highly influencing modern medicine. Thousands of synthetic therapeuticals have been developed, and these formulations enabled the successful treatment of many diseases, some of which were considered incurable. An increase in drug consumption followed the development of the pharmaceutical industry and the introduction of synthetic drugs. The widespread use of new medicals enabled the collection of data confirming their effectiveness, but also more and more data concerning side and unwanted effects were reported. Frequent side/unwanted effect reports gave rise to development of iatrogenic pathology, a new branch of clinical pathology. The knowledge of the possible unwanted effects of drugs on macro organisms did not enable the effective withdrawal of such formulations from the market. At the beginning, the reports concerning unwanted effects were not verealed. Consequently some potentially harmful formulations were used for years without methodical analyses of their side/unwanted effects. Some potentially dangerous formulations are still on the market such as drugs containing ulcerogenic, hepatotoxic, nephrotoxic substances as well as those inducing bone marrow aplasia. The administration of these potentially dangerous formulations is understandable in the case of clear therapeutic indications allowing no alternatives. In these cases the risk of harmful side effects is greatly overwhelmed by the risk from the primary disease. Otherwise the administration of the potentially harmful drug is unjustified, especially if the indication is not a disease. Many potentially harmful drugs are formulated for use in healthy animals, recommended as growth, laying and milk stimulators, those allowing higher speed and strength in sport and racing horses, estrus inducers and suppressors. The misuse or maluse medication is highly present in sport horses daily treated with vitamin and mineral supplements, analgesics, corticosteroid and anabolic steroids. Unwanted effects of such treatments are evident sometimes shortly after application and sometimes later, influencing reproduction. The same problem is present in small animals

Flavonoids effect on autoimmune diseases

Autoimune bolesti su bolesti u kojima organizam umjesto napadanja stranih antigena napada vlastite. Jako su raznolike, imaju složene mehanizme nastanka i čimbenike koje utječu na njih. Općenito se mogu podijeliti na organospecifične i organonespecifične, ovisno o broju napadnutih organa. Njihovo liječenje danas se uglavnom bazira na općoj imunosupresiji koja reducira simptome, ali ne liječi bolest. Osim toga, ima negativne nuspojave jer inhibiraju i zdravi imunosni odgovor. Potreban je učinkovitiji i specifičniji način liječenja. Flavonoidi su skupina fenolnih spojeva iz biljaka koji su se pokazali učinkovitima u njihovom liječenju. U ovom radu su obrađene autoimune bolesti i flavonoidi kao mogući spojevi u obradi autoimunih bolesti. Mnoga istraživanja su dokazala pozitivan učinak flavonoida na autoimunost što znači da bi se mogli koristiti kao terapija, a i putem prehrane kao prevencija.Autoimmune diseases are diseases that develop when immune system attacks its own cells (autoantigen) instead of foreign antigen. They are very heterogeneous, have complicated mechanisms of development and factors that affect them. Diseases can be divided in organspecific and systemic, depending on number of attacked organs. The treatment of autoimmune diseases is based on immunosuppression, which reduces the symptoms, but it doesn't cure the disease. Besides, this medication has negative side effects because it also decreases normal immune response. More efficient and specific treatment is needed. Flavonoids are group of polyphenolic compounds from plants, and they seem to be effective in treatment of autoimmunity. In this work, the most important facts about autoimmune diseases are shown, together with flavonoids as possible treatment. Many studies have proven positive effects of flavonoids on autoimunity which means they could be used as a treatment, but also as a prevention, in diet

Red blood cell polymorphisms and adaptation to malaria

Malarija je zarazna bolest koju uzrokuju paraziti iz roda Plasmodium, a prenose je komarci iz roda Anopheles. Mortalitet je dosta visok unatoč postojanju lijekova protiv malarije jer si ljudi koji žive u područjima s endemičnom malarijom često ne mogu priuštiti liječenje. Smatra se da je malarija najjača sila prirodne selekcije poznata u novijoj povijesti ljudskog genoma. Pod selekcijskim pritiskom, u različitim populacijama endemičnih područja nastale su brojne genske promjene koje pružaju neku vrstu zaštite od malarije, a najčešće sprječavaju razvoj teškog oblika bolesti. Najpoznatiji primjer je srpasta anemija, nasljedna bolest koja je raširena u područjima s endemičnom malarijom, a heterozigoti nemaju simptome bolesti niti malarije. Crvene krvne stanice, eritrociti, sudjeluju u najvažnijem dijelu životnog ciklusa plazmodija, jer opskrbljuju parazita hranom i kisikom i pružaju mu zaštitu. Zaštitni polimorfizmi najčešće se odnose na gene koji utječu na strukturu ili funkciju eritrocita. To su npr. strukturne varijante hemoglobina: HbS, HbC, HbE; talasemija, ovalocitoza, promjene enzima crvenih krvnih stanica, npr. nedostatak G6PD, i antigeni na površini eritrocita kao što su Duffy-antigen, glikoproteini, receptori za komplemente i PfEMP1. Proučavanje tih genskih varijabilnosti važno je za otkrivanje interakcija između parazita i ljudskih stanica, što bi se u budućnosti moglo iskoristiti za stvaranje učinkovitih i dostupnih cjepiva ili lijekova protiv malarije.Malaria is an infectious disease caused by protozoan parasites of the genus Plasmodium and it is transmitted by musquitoes of the genus Anopheles. Although there are antimalarial drugs, mortality levels are very high because drug treatments are often too expensive for people living in malaria endemic areas. Malaria is probably the greatest selective pressure on the human genome in recent history. This pressure has resulted in number of genetic variants that confer some kind of protection against the malaria, they are mostly protective against severe form of the disease. The most-studied condition is the sickle-cell disease, a hereditary blood disease present in malaria-endemic regions. Heterozygotes have no symptoms of the disease nor severe malaria. Red blood cells are involved in the most important part of plasmodium life cycle because they provide the parasite with food, oxygen and shelter. Malaria resistance genes are mostly those that determine the red blood cell structure or function. Red blood cell polymorphisms associated with some protection are the structural haemoglobin variants like sickle cell trait or disease, HbC and HbE; thalassemia, ovalocytosis, changes in red blood cell enzymes like G6PD deficiency and red blood cell surface antigens like Duffy antigens, glycoproteins, complement receptors and PfEMP1. Studying those genetic variants is important because it can teach us about protective relationship between human cells and malaria. In the future, that knowledge might be used for the development of effective and affordable vaccines or anti-malarial drugs