Impact of Angiotensin-Converting Enzyme Gene Polymorphism on Proteinuria and Arterial Hypertension

Proteinuria is the hallmark of renal disease. In essential hypertension the onset of de novo proteinuria is associated with faster rate of progression of disase. Some authors have suggested that the DD genotype of the angiotensin-convert- ing enzyme (ACE) gene would be an adverse renal prognosis factor. It may also have different effects on the reduction of proteinuria by ACE inhibitors in patients with proteinuria. Observations on the association between the ACE gene poly- morphism and hypertension have been inconsistent, which might be due to ethnic and geographical variations. In this study was to investigated the relationship between ACE gene polymorphism and antiproteinuric effect of ACE inhibitors (ramipril) and to evaluate the possible association between I/D polymorphism and hypertension. We recruited 66 hyper- tensive patients (male 42, female 24) with overt proteinuria (urinary protein excretion over 500 mg/day). Patients were classified into three groups in accordance with ACE genotypes (17 DD; 35 ID; 14 II). They were treated with ramipril and prospectively followed up for one year. Various clinical parameters including age, body mass index (BMI), 24-h urine protein, creatinine, creatinine clearance (Ccr), systolic and diastolic blood pressure (SBP and DBP), mean arterial pres- sure (MAP) were measured in the pre- and post-treatment periods. The ACE gene insertion/deletion(I/D) polymorphisms in intron 16 were determined by PCR. Results showed that there were no significant differences in the clinical parame- ters such as age, gender, serum creatinine, Ccr, SBP , DBP , MAP , and daily urinary excretion of protein among three groups (P>0.05). ID genotype patients were found to have lower BMI (p=0.031). ACE inhibition significantly reduced proteinuria in all genotype groups (p<0.05). The percentage reductions of 24-h urinary excretion of protein were signifi- cantly different between the genotype groups (p=0.042) and for DD genotype were significantly greater than in ID (79.2± 28.9% vs 49.2±64.8%, P=0.015). The slope of SBP was the main factor related to the slope of the percentage reduction of proteinuria, however, a significant negative correlation coefficient between these parameters was found (rs=–0.382, p= 0.002). We failed to find significant difference in outcomes of treatments with ACE inhibitor between male and female ac- cording the I/D polymorphism of the ACE gene. D allele in the ACE genotype could be a useful genetic marker with im- portant clinical, therapeutic and prognostic implications in recognizing patients with proteinuria that are at greater risk of renal damage

Povijest Opće bolnice Virovitica (History of Virovitica General hospital)

Povijest zdravstva u Virovitici započinje vrlo rano. Tragovi nas vode u davnu 1234.godinu, kada se i ime Virovitica po prvi put spominje. Liječničku pomoć narodu pružaju franjevci. Akcija za podizanje bolnice u Virovitici započinje vrlo rano, 1841.godine kada se osniva dobrotvorno bolničko društvo. Ideja bolnice u Virovitici lagano je sazrijevala, no postojeće financijske poteškoće priječile su izgradnju iste. Godine 1901. graditelj Pavao Rokobacker preuzima izgradnju bolnice u Virovitici. Bolnica započinje s radom 17.10.1902.godine i njen prvi upravitelj postaje dr. Matković. Tijekom narednog perioda bolnica se razvija, ali i prolazi kroz teška i krizna razdoblja tijekom I. i II. svjetskog rata. Godine 1958. osniva se Zdravstveni centar integracijom bolnice i Doma zdravlja. 1962. preimenuje se u Medicinski centar, a 1994. dijeli se na Opću bolnicu Virovitica i Dom zdravlja. Bolnica igra važnu ulogu u vrijeme domovinskog rata. Tijekom 1991./1992. u bolnici se liječe 463 žrtve rata

CLASSIFICATION OF GLOMERULOPATHIES

Postoje brojne klasifikacije glomerulonefritisa prema kojima se oni dijele na akutne i kronične, primarne i sekundarne, nasljedne i stečene, proliferativne i neproliferativne i dr. U kliničkoj praksi najčešće se služimo klasifikacijom prema patohistološkom nalazu. Za mnoge glomerulonefritise histološka slika, kao i klinička prezentacija, jako variraju. Nijedna podjela glomerulonefritisa nije utemeljena na razumijevanju patogeneze pojedinih oblika bolesti glomerula. Kako nova znanstvena otkrića rasvjetljavaju patogenetske mehanizme, tako se mijenjaju i klasifikacije pojedinih glomerulopatija. Najbolji primjer za to je membranoproliferativni glomerulonefritis.Glomerular diseases may be classified as acute or chronic, primary or secondary, hereditary or acquired, proliferative or non-proliferative etc. The most commonly used is the classification according to the histopathological finding. For certain types of glomerulonephritides histopathological image, as well as clinical presentation, may vary widely. A while ago there was no classification based on the pathogenesis of certain types of glomerular diseases. However, as scientists ellucidate the underlying pathogenetic mechanism, current classifications change. The latter is best shown at the example of membranoproliferative glomerulonephritis

Atypical clinical presentation of an acute abdomen

Prikazali smo slučaj šezdesetogodišnjeg bolesnika s atipičnom kliničkom slikom akutnog abdomena. Bio je bezbolnog trbuha, uz očuvano, spontano pražnjenje crijeva. Atipičnoj prezentaciji akutnog abdomena kod našeg bolesnika mogli su pridonijeti prethodno preboljeli moždani udar i šećerna bolest.We have presented a case of a sixty-year-old patient with atypical clinical manifestations of acute abdomen: the abdomen was painless with preserved spontaneous bowel movement. Stroke and diabetes could contribute to such an atypical presentation

A PLATFORM FOR A SMART LEARNING ENVIRONMENT

In this paper, a modular platform which provides student services for smart educational environment is described. The platform represents a point of mutual integration of various services, such as hosting platform for students’ projects, platform for integrating SMS service with students’ web applications, Internet of Things platform which enables acquiring data from sensors distributed within the University building and controlling various actuators. Platform is deployed as a part of Smart Learning environment. It is integrated with single sign on service and it uses CAS and Oauth2. REST API is also provided. PHP Symfony framework, relational and non-relational databases are used for deploying the platform. The platform was evaluated and tested

Ishod starijih bolesnika s ANCA glomerulonefritisom liječenih imunosupresivnom terapijom

The most common cause of rapidly progressive glomerulonephritis in elderly, antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN), demands immunosuppressive therapy (IS) regimen in a multi-morbid disease burdened population. Our aim was to assess outcome differences in two age groups. The study included a total of 38 ANCA-GN renal limited patients (18 men) treated from 1990 to 2018, of which 11 were 65 years of age and older (median 70, min. - max. 66 - 79 years), and 27 younger than 65 (median 55, min. - max. 23 - 64 years). All patients were treated with mono/combination of IS. Most commonly applied IS in elderly was combination of IV cyclophosphamide and corticosteroids (CS) (in 9 [81.8%]), while in younger it was a combination of CS and cyclophosphamide or rituximab (59.2%). Older patients had comparable mortality (3, [14.8%] vs. 4, [27.3%]; P = 0.369), malignancies (1, [3.7%] vs. 1, [9.1%]; P = 0.5) and infectious complications (10, [46.7%] vs. 7, [63.6%]; P = 0.388). Ten patients at the end of the follow up were at renal replacement therapy (RRT ), with no difference between age groups (6, [22.2%] vs. 4, [36.4%]; P = 0.369). Interestingly, from initial need for RRT , half of the younger and older patients recovered with IS. Our findings give more credit to the current paradigm to treat elderly ANCA-GN patients with IS therapy due to the similar outcome of elderly as younger ones.Najčešći uzrok brzoprogresivnog glomerulonefritisa u starijih je glomerulonefritis s antineutrofilnim citoplazmatskim protutijelima (ANCA-GN, od eng. antineutrophil cytoplasmic antibody related glomerulonephritis), a s obzirom na komorbiditete predstavlja izazov u odluci oko primjene imunosupresivne terapije (IS). Cilj ovog istraživanja je usporediti razlike u ishodu dvije dobne skupine bolesnika. Istraživanje je obuhvatilo slučajeve ANCA-GN ograničenih na bubrege, liječene od 1990. do 2018. godine, njih 38 (18 muških), od kojih 11 ima 65 ili više godina (medijan 70, min.-max. 66 - 79 godina) a 27 mlađih (medijan 55, min. - max. 23 - 64 godina). Svi bolesnici su liječeni monoterapijom ili kombinacijom IS-a. Najčešće primjenjena IS u starijoj populaciji bila je kombinacija intravenskog ciklofosfamida i kortikosteroida (KS) (u 9 (81,8%)), u mlađoj kombinacija KS s ciklofosfamidom ili rituksimabom (59,2%). Stariji pacijenti imali su sličnu učestalost smrtnosti (3, 14,8% vs 4, 27,3%; P = 0.369), zloćudnih bolesti (1, 3,7% vs 1, 9,1%; P = 0.5) i infektivnih komplikacija (10, 46,7% vs 7, 63,6%); P = 0.388). Deset bolesnika je na kraju praćenja bila ovisno o nadomještanju bubrežne funkcije (NBF) bez razlike u dobnoj skupini (6, 22,2% vs 4, 36,4%; P = 0.369). Međutim, od inicijalne potrebe NBF-om se uz IS oporavila polovica starijih i mlađih bolesnika. Naši rezultati su u skladu trenutačnim stajalištima koja podupiru primjenu IS terapije kod starijih bolesnika sa ANCA-GN zbog usporedivih ishoda i rizika komplikacija kao u mlađih bolesnika

Renovascular hypertension due to Takayasu arteritis - a case report

U radu je prikazana 18-godišnja bolesnica s obostranom stenozom bubrežnih arterija i renovaskularnom hipertenzijom u sklopu Takayasu arteritisa. Takayasu arteritis kronični je arteritis nepoznate etiologije koji zahvaća aortu i njene ogranke. Bolest se javlja u mladih žena, češće u zemljama istočne Azije nego u zemljama Zapada. Takayasu arteritis je često teška i smrtonosna bolest, a mortalitet i morbiditet ovisi o proširenosti vaskularnih lezija sa sljedstvenim ishemijama. U liječenju se primjenjuju glukokortikoidi sami ili u kombinaciji sa citostaticima (ciklofosfamid, azatioprin, metotreksat). U većine bolesnika pravovremenom primjenom tih lijekova postiže se djelomična remisija.A 18-year old women with bilateral renal artery stenosis and renovascular hypertension as a part of Takayasu’s disease is presented. Takayasu’s disease is a chronic arteritis of unknown origin, primary affecting aorta and its branches. The disease is the most common in young women and is more common in the countries of eastern Asia in comparison with Western countries. Takayasu’s disease can be severe and lifetreating disease. Mortality and morbidity depend on both the direct effect of the vascular lesions and the complications od disease. The mainstay of Takayasu’s disease is based on the use of glucocorticoids alone or in association with cytotoxic drugs (cyclofosfamid, azatioprin, metotrexate). In the majority of cases, the partial control of disease is obtained

Humanism and tolerance as the value of early childhood education

U djetinjstvu se stvaraju temelji za daljnji život i zato je važno kod djece poticati i razvijati prihvaćanje i poštivanje različitosti. Svako dijete ima prava bez obzira na njegov spol, nacionalnu pripadnost, rasu, jezik i vjeru. Važno je poticati djetetov razvoj i pomoći da stekne moralne vrijednosti pomoću kojih će izrasti u odgovornog pojedinca. Odgovorna djeca postaju odgovorni građani, a u tome veliku ulogu imaju roditelji i odgojitelji. Nacionalni kurikulum za rani i predškolski odgoj i obrazovanje (2015) promiče planiranje i djelovanje odgoja i obrazovanja utemeljenog na različitim vrijednostima među kojima je jedna od temeljnih vrijednosti humanizam i tolerancija. U ovom radu analizom suvremene literature definirani su pojmovno i sadržajno pojmovi humanizma i tolerancije kao odgojnih vrijednosti u suvremenom kurikulumu ranoga i predškolskog odgoja i obrazovanja.In childhood, the foundations are laid for further life and that is why it is important to encourage and develop acceptance and respect for diversity. Every child has rights regardless of his gender, nationality, race, language and religion. It is important to encourage the child’s development and help that acquires moral values by which he will grow into a responsible individual. Responsible children become responsible citizens, with parents and preschool teacher playing a major role. The National Curriculum for Early and Preschool Education (2015) promotes planning and the action of upbringing and education based on different values among which is one of the fundamental values of humanism and tolerance. In this paper the analysis of contemporary literature, the concepts of humanism and tolerance as educational are defined conceptually and substantively values in the modern curriculum of early and preschool education