Effect of Iron Deficiency Anemia and Other Clinical Conditions on Hemoglobin A1c Levels

Iron deficiency anemia is the most common type of anemia in the world, the most common form of malnutrition deficit with a prevalence of 50% affecting the developed countries as well as developing countries with a strong influence on social and economic development. According to current guidelines of the American Diabetes Association (2019.) glycated hemoglobin (HbA1c) is a reflection of the patient\u27s glycemic status in the last three months and is used for monitoring of therapeutic effect as well as for diagnostic purposes. Previous studies have proven that not only iron deficiency anemia but also a range of other clinical conditions can affect the level of HbA1c independent of glycemic status. The exact mechanism of the effect of iron deficiency on glycated hemoglobin levels remains unknown and is still at the hypothesis level. Studies have proven that treatment of iron deficiency anemia leads to better control of HbA1c level, regardless of whether the patient is diabetic or not. A small number of studies have noted a correlation between iron deficiency and levels of glycated hemoglobin, thus further research on larger number of patients is certainly necessary in order to improve the therapeutic possibilities for patients with diabetes, more accurately diagnose and understand the pathophysiology of formation and influence on glycated hemoglobin levels. (Vučić D, Veselski K, Bosnić Z. Effect Of Iron Deficiency Anemia And Other Clinical Conditions On Hemoglobin A1c Levels. SEEMEDJ 2019; 3(2); 76-81

Specifics of Sex Life and Methods of Birth Control among Students at the University of Osijek

The aim of this study is to define specifics of sex life and methods of birth control among students at University of Osijek. Participants were students who study at Josip Juraj Strossmayer University of Osijek. A newly formed questionnaire containing 31 question was used to for this purpose. The study included 549 voluntairly students, 54,3% of students had first sexual experience between 16 and 18 of age. Most of them were long- term couples, who are managing better with sexual activities then students in short term relationships, who are more stressed because of their studies. When it comes to the type of contraceptives, 71, 9 % of students used some of birth control methods, and most common is condom (75,9 %). However, 27, 9 % of students believe that natural methods of birth are safe enough. There are no significant differences in age at the time of first sexual activity considering gender, year at university and residency. The biggest reason for not using contraception is long-term relationship in which students do not feel fear of sexually transmitted diseases and pregnancy

Assessment of Nutritional Status of Elderly People in a Practice of Family Medicine in Relation to MNA Test, Comorbidity and Chronic Therapy

Introduction: Nutrition assessment is one of the biggest challenges in family medicine practice because of the increasing number of older people with more comorbidities and chronic therapy. The MNA(Mini Nutritional Assessment) test has proven to be the most sensitive and exact tool for this type of research. The aim of this study was to assess whether there is a difference in the nutritional status of elderly people, over 65 years of age, with respect to sociodemographic characteristics, number and type of chronic diseases, and number of medications used in chronic therapy. Materials and methods: Research subjects were 207 patients at the age of 65 treated at the Medical Centre Slavonski Brod during a period of 3 months. During the visit, the nutritional status was examined by using the MNA test. The information on chronic diseases and number of medications the patients were using has been collected from the Medicus computer program. Results: According to the MNA test results, 62 subjects (30%) showed risk of malnutrition, average age of the subjects was 72 years and the median of MNA test results was 25.50. Also, multimorbidity is present in 64.73% of the subjects and 42% of them take more than three medications in chronic therapy. No statistically significant difference was found in the results of the MNA test regarding the number of chronic diseases (p =0.89) and number of medications (p = 0.87). Conclusion: It is important to regularly monitor the nutritional status in order to prevent progression of chronic diseases and reduce additional cost of treatment. (Bosnić Z, Miškić M, Veselski K, Vučić D, Trtica Majnarić Lj. Assessment of Nutritional Status of Elderly People in a Family Medicine Practice in Relation to MNA Test, Comorbidity and Chronic Therapy. SEEMEDJ 2019; 3(2); 1-10

Relationship Between Serum Ferritin Levels, Arterial Hypertension and Shift Work in Women. A Cross-sectional Analysis

Introduction: The aim of this study was to use cross-sectional research to determine the relationship between serum ferritin levels and arterial hypertension in women who work in shifts and women with regular daytime working hours. Methods: The respondents included 67 female nurses divided into two groups: nurses working in 12-hour shifts (7 am to 7 pm/7 pm to 7 am) were the test group, while nurses regularly working for 8 hours (7 am to 3 pm) were the control group. Data collection included information on associated diseases, chronic medication, last menstruation, duration of menopause, cigarette smoking, number of years of employment in shift work and regular daytime work, laboratory and anthropometric parameters and blood pressure levels. Results: In all respondents, there was a significant and positive relationship between ferritin and CRP levels, i.e. the higher the CRP levels, the higher the ferritin levels (Rho = 0.401; P = 0.001). Among respondents who have regular daytime working hours, there was no significant association between ferritin and other indicators, while in the group of those who work in shifts, there was a significant and positive association between ferritin and CRP (Rho = 0.468; P = 0.002). Finally, a positive correlation was found between the number of years of employment in shift work and systolic blood pressure levels, i.e. higher systolic pressure was observed in those respondents who worked longer in shifts (Rho = 0.424, P = 0.03). Conclusion: The study demonstrated a significant correlation between the number of years of employment in shift work and systolic blood pressure. A positive correlation between serum CRP and ferritin levels was also observed in all respondents, and especially in shift workers

Cardiovascular Disease C Continuum – Peripheral Artery Disease Versus Coronary Heart Disease

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID-19 on treatment CVD will be estimated in the following years

Treatment of a true CXA-OM bifurcation lesion using a one stent drug coated balloons provisional technique

Background: Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable.1,2 Case report: 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2,75/33mm in CxA-OM2 with POT 3,25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2,5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion: Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen

The Correlation between Iron Deficiency and Recurrent Aphthous Stomatitis: A Literature Review

Aphthous lesions of the oral mucosa are a very common symptom and can be seen in both family medicine practice, dental medicine practice, and dermatology or otorhinolaryngology clinics. Some patients develop a chronic recurrent condition, which is clinically known as recurrent aphthous stomatitis (RAS). These ulcers are round, clearly defined, and can be visible on the movable part of the oral mucosa, with variations in size. A prodromal symptom like the burning or stinging sensation can precede the appearance of lesions. The main reason why patients seek medical help is oropharyngeal pain with lack of appetite. The exact etiopathogenesis of RAS remains unknown. Immune disorders, nutritional deficiencies, allergies, mechanical injuries, and even psychological disorders are being studied as potential causes of this condition. Some authors claim that iron deficiency may be a possible causative factor of RAS due to its role in DNA synthesis, mitochondrial function, and enzymatic activity. In iron deficiency, epithelial cells turn over more rapidly and produce an immature or atrophic mucosa. Such mucosa is vulnerable and can be a fertile soil for chronic inflammation and development of aphthae. Finally, our goals were to describe the clinical aspects and etiology of RAS, as well as to determine whether RAS may be related to iron deficiency, in order to identify potential patients with iron deficiency in everyday work