The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure

Introduction: Chronic kidney disease (CKD) and osteoporosis are important health problems. There is an interrelationship between osteoporosis and CKD. Bone densitometry is the “gold” standard in the diagnosis of osteoporosis. Unfortunately, there are some problems with the interpretation of bone densitometry in CKD patients. The goal of this study was to determine bone mineral density (BMD) in CKD patients, to assess the difference between genders and different sites of bone densitometry correlation between BMD and laboratory parameters, and to assess the most optimal measuring site. Methods: We studied 134 hemodialysis (HD) patients (62 females, 72 males). The mean age was 56.4 ± 12.4 years and the mean duration of HD was 54.4 ± 60 months. BMD of the lumbar spine (posterior–anterior projection and lateral projection), hip (femoral neck, trochanter, intertrochanter, total femur, the Ward's Triangle), and forearm (ultradistal (UD), middistal (MID), distal third portion, and total forearm) was measured using dual X-ray absorptiometry (DXA) (Hologic Delphi apparatus). Values were expressed as BMD, T-score, and Z-score. Results: Females had lower values of BMD in all measurement points. There were no significant differences in T- and Z-scores of forearm between males and females. Age was in a positive correlation with lumbar spine BMD in males and females. There was a negative correlation with neck and forearm BMD in both groups. Serum parathyroid hormone (PTH) was also in negative correlation with hip and forearm BMD in both groups. The best correlation of BMD in different sites was between forearm and neck. Conclusion: BMD data in CKD patients should be interpreted with caution and appendicular skeletal sites should be included in the evaluation

Osteoporosis in children with inflammatory bowel disease

Upalna bolest crijeva obuhvaća Crohnovu bolest, ulcerozni kolitis i nediferencirani kolitis, a u 25 % oboljelih javlja se prije 20. godine života. Osteoporoza je komplikacija upalne bolesti crijeva čija je glavna klinički važna manifestacija povećan rizik za prijelome. U bolesnika dječje i odrasle dobi s upalnom bolešću crijeva učestalost osteopenije i osteoporoze je do 70 %. Gustoću kostiju procjenjujemo kvantitativnom kompjutoriziranom tomografijom, kvantitativnom ultrasonografijom i osteodenzitometrijom. Osteodenzitometrija je zlatni standard u procjeni koštane gustoće. U djece s upalnom bolesti crijeva osnovni uzroci osteoporoze su pothranjenost, kortikosteroidna terapija i povišena razina proupalnih čimbenika. Liječenje osteoporoze u djece temelji se na smanjenju ili eliminaciji faktora rizika na koje se može utjecati. To su adekvatan, za dob odgovarajući unos kalcija i vitamina D, optimalna tjelesna masa, dostatno kretanje, ispravak svakog hormonalnog poremećaja te ublažavanje podliježeće bolesti. Farmakoterapija se koristi onda kada opće mjere liječenja nisu dovele do poboljšanja, a u djece u obzir dolaze samo bisfosfonati. Odluka o farmakoterapiji uvijek je individualna.Inflammatory bowel disease (IBD) consists of Crohn disease, ulcerative colitis and indeterminate colitis and 25 % of patients present before 20 years of age. Osteoporosis is a well known complication of inflammatory bowel disease, the main clinically important manifestation of which is fracture. In children and adults with inflammatory bowel disease the rate of osteopenia and osteoporosis is up to 70 %. Bone mineral density is evaluated by quantitative computed tomography, quantitative ultrasonography and dual-energy X-ray absorptiometry (DEXA). Dual-energy X-ray absorptiometry is the „golden standard” in bone mineral density evaluation. In children with IBD main causes of osteoporosis are malnutrition, corticosteroid therapy and elevated levels of proinflammatory factors. The principles of osteoporosis treatment in children are minimizing or eliminating changeable risk factors. These are adequate calcium and vitamin D uptake according to the patient’s age, optimal body mass, adequate exercise, and correction of hormonal imbalance and treatment of underlying disease. Pharmacotherapy is used only when general measures were not successful, and only bisphosphonates can be used in children. The approach to the pharmacotherapy is always individual

Current trends in the pharmacotherapy for obesity

Obesity represents a major global challenge from both healthcare and economic perspectives. Although lifestyle modifications aimed at reducing calorie intake and increasing energy expenditure remain the cornerstone of obesity management, pharmacotherapy can serve as a useful adjunct. Until recently, orlistat was the only medication registered for the treatment of obesity in the European Union (EU). A deeper understanding of the complexity of energy homeostasis has resulted in new pharmacological options for weight reduction. In 2015, two new antiobesity drugs were approved in the EU. These are a fixed combination of naltrexone/bupropion (Mysimba®) and liraglutide at a dose of 3.0 mg (Saxenda®). In addition, lorcaserin (Belviq®) and a fixed combination of phentermine/topiramate (Qsymia®) were introduced into the US market in 2012. However, the European Medicines Agency did not approve their use in the EU. The burden of previous weight loss agents that have been withdrawn due to safety concerns underlines the need for caution and close follow-up of patients undergoing pharmacological interventions for obesity treatment. This article provides an overview of the efficacy and safety of currently available weight loss pharmacotherapies

Camurati-Engelmann Disease in a Family from Croatian Island: An Old Bone Scan Confirmed Pattern of Inheritance

34-year old patient had history of muscular wasting, easy fatigability, pain in extremities and waddling gait since age of four. During the time, neuromuscular disease was suspected, but not confirmed. Elevated bone alkaline phosphatase as well as other bone turnover markers (osteocalcin, procollagen, telopeptide) indicated further skeletal evaluation. Symmetrical enhanced uptake on technetium methylene diphosphonate [99mTc]MPD bone scintigraphy at diaphyses of longitudinal bones and scull matched cortical thickening of long bones and sclerosis of the scull seen at radiograms. Those findings pointed to Camurati-Engelmann disease misdiagnosed for the long time. This rare genetic autosomal dominant disorder was retrospectively diagnosed in asymptomatic father too on the basis of bone scans done long time ago. Old family member scans confirmed heredity pattern of the disease

The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

VITAMIN D: VITAMIN FROM THE PAST AND HORMONE OF THE FUTURE

Rastuća je spoznaja o brojnim važnim fiziološkim učincima vitamina D u zadnjih desetak godina. Vitamin D regulira funkciju oko 3% ljudskog genoma. S druge strane prevalencija nedostatka vitamina D visoka je u različitim populacijama diljem svijeta uključujući i Hrvatsku. Članak daje prikaz metabolizma vitamina D te današnje spoznaje o učinku vitamina D na metabolizam kalcija, mišićnu funkciju, prevenciju infekcija, malignih bolesti, autoimunosnih i kardiovaskularnih bolesti. Objašnjavaju se razlozi pandemije nedostatka vitamina D te daju smjernice za njegovu nadoknadu.In the last decade there has been a rising recognition of potential clinical significance of the vitamin D. Vitamin D regulates about 3% of the human genome. Thus, vitamin D deficiency is common and high in various populations across the world including Croatia. In this paper vitamin D metabolism and up to date knowledge of vitamin D function in calcium metabolism, muscular function and in prevention of infection, malignancy, autoimmune and cardiovascular diseases is presented. Reasons for pandemic vitamin D deficiency and guidelines for vitamin D supplementation are given

VITAMIN D: VITAMIN FROM THE PAST AND HORMONE OF THE FUTURE

Rastuća je spoznaja o brojnim važnim fiziološkim učincima vitamina D u zadnjih desetak godina. Vitamin D regulira funkciju oko 3% ljudskog genoma. S druge strane prevalencija nedostatka vitamina D visoka je u različitim populacijama diljem svijeta uključujući i Hrvatsku. Članak daje prikaz metabolizma vitamina D te današnje spoznaje o učinku vitamina D na metabolizam kalcija, mišićnu funkciju, prevenciju infekcija, malignih bolesti, autoimunosnih i kardiovaskularnih bolesti. Objašnjavaju se razlozi pandemije nedostatka vitamina D te daju smjernice za njegovu nadoknadu.In the last decade there has been a rising recognition of potential clinical significance of the vitamin D. Vitamin D regulates about 3% of the human genome. Thus, vitamin D deficiency is common and high in various populations across the world including Croatia. In this paper vitamin D metabolism and up to date knowledge of vitamin D function in calcium metabolism, muscular function and in prevention of infection, malignancy, autoimmune and cardiovascular diseases is presented. Reasons for pandemic vitamin D deficiency and guidelines for vitamin D supplementation are given