THE OCCURRENCE OF PARANEOPLASTIC SYNDROMES IN PATIENTS WITH POLYMYALGIA RHEUMATICA TREATED AT THE UNIVERSITY HOSPITAL CENTER OSIJEK

Background: Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease that occurs in an elderly person, usually over fifty years of age. Disease is characterized by pain, discomfort, and tenderness of shoulder, throat and hip muscles, elevated erythrocyte sedimentation values, and a fast and effective therapeutic response to the applied glucocorticoid therapy. Clinical image of PMR may resemble the presentation of many malignant diseases, given that it is of great importance to do extensive diagnostic treatment of the patient. Objectives: Th e aim of this study was to investigate the occurrence of paraneoplastic syndromes in patients with PMR, treated at the Department of Rheumatology, Clinical Immunology and Allergology of the University Hospital Center of Osijek (UHCO). Methods: Th e study included PMR patients treated at the UHCO in the period from 1/2013. to 10/2018. A study was conducted using data from the General Practice Research Database of the UHCO. Results: In 46 patients with PMR the occurrence of paraneoplastic syndrome was 8.7% (N=4) with a 95% confidence interval of 2.42%–20.79%. Th e median age of the detection of the paraneoplastic syndrome was 73 (65–85) years, and the mean time of detection of the syndrome since the diagnosis of PMR was 1± 1 years. In total number of diagnosed, there is an equal number of male and female patients (N=2, p>0.999). Among males, the occurrence of paraneoplastic syndrome was 15.38%, and among women 6.02% (p = 0.585). The mean age of discovery of male paraneoplastic syndrome was 75±14.14, and in women 64±7.07 godina (p=0.699). Th ere was no statistically significant difference in the age of PMR patients (76.17±6.93) compared to those with paraneoplastic syndrome (71.5±9.11), p=0.213. Conclusions: According to the results of our research the time to diagnose paraneoplastic syndrome is approximately one year after the diagnosis of PMR. Therefore, more extensive diagnostic processing and disease control during the first year from the diagnosis of the PMR will reduce the risk of non-recognition of malignant disease disguised as a clinical image of PMR. In addition, the occurrence of paraneoplastic syndromes was 8.7% in the population of PMR patients included in this fi ve-year study. References: 1. Muller, Sara, et al. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Practice Research Database. Ann Rheum Dis. 2014;73(10): 1769–73. 2. Muller, S., et al. Th e real evidence for polymyalgia rheumatica as a paraneoplastic syndrome. Reumatismo. 2018; 70(1): 23–34. 3. Ji, Jianguang, et al. Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis: a follow-up study in Sweden. Rheumatology.2010; 49(6): 1158–63. 4. Myklebust, Geirmund, et al. No increased frequency of malignant neoplasms in polymyalgia rheumatica and temporal arteritis. A prospective longitudinal study of 398 cases and matched population controls. J Rheum.2002; 29(10): 2143–7. 5. Mayer, Miroslav, and Branimir Anić. Paraneoplastički sindromi u reumatologiji. Reumatizam.2015; 62(Suppl. 1): 0–0

Selection of the Most Indicative Wavelets for the Multiresolution of the Vowels

The paper describes one approach of the selection of the most indicative wavelets for each of the vowels in the author's native language. Analysis is performed on the correct and incorrect vowels. On each of the sample multiresolution decomposition is applied. For each of the detail and approximation the most indicative wavelet is selected using value of the variance as the criteria. Some interesting results are obtained and biorthogonal wavelets have been select as the most appropriate for the multiresolution of the vowels. Using this criterion, any further analysis of the samples can be done using only coefficients of the discrete wavelet transformation on the level of approximation or any level of the detail, with enough guarantees that they are most appropriate for each vowel

The added value of a European Reference Network on rare and complex connective tissue and musculoskeletal diseases: insights after the first 5 years of the ERN ReCONNET

In order to address the main challenges related to the rare diseases (RDs) the European Commission launched the European Reference Networks (ERNs), virtual networks involving healthcare providers (HCPs) across Europe. The mission of the ERNs is to tackle low prevalence and RDs that require highly specialised treatment and a concentration of knowledge and resources. In fact, ERNs offer the potential to give patients and healthcare professionals across the EU access to the best expertise and timely exchange of lifesaving knowledge, trying to make the knowledge travelling more than patients. For this reason, ERNs were established as concrete European infrastructures, and this is particularly crucial in the framework of rare and complex diseases in which no country alone has the whole knowledge and capacity to treat all types of patients.It has been five years since their kick-off launch in Vilnius in 2017. The 24 ERNs have been intensively working on different transversal areas, including patient management, education, clinical practice guidelines, patients' care pathways and many other fundamental topics. The present work is therefore aimed not only at reporting a summary of the main activities and milestones reached so far, but also at celebrating the first 5 years of the ERN on Rare and Complex Connective Tissue and Musculo-skeletal Diseases (ReCONNET), in which the members of the network built together one of the 24 infrastructures that are hopefully going to change the scenario of rare diseases across the EU.Pathophysiology and treatment of rheumatic disease