Rano otkrivanje blagog oštećenja spoznajne funkcije u bolesnika s cerebrovaskularnom bolešću

Evaluation of mild cognitive impairment (MCI) is important because it can enable early medical management in order to prevent severe dementia of Alzheimer\u27s or vascular type. In this pilot study, patients admitted to University Department of Neurology for first ever stroke/transient ischemic attacks (patient group, N=81, mean age 56±7.0 years) and control subjects without signs of cerebrovascular disease (CVD) but with vascular risk factors present (control group, N=45, mean age 53±6.0 years) were tested by use of Mini Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) on admission, and retested at three and six months. In all study subjects standard brain computed tomography, color Doppler flow imaging of carotid arteries with intima-media thickness (IMT) measurement and transcranial Doppler sonography (TCD) were performed. Multiple risk factors were present in 56 (69.1%) patients. Arterial hypertension, hyperlipoproteinemia and diabetes mellitus were most common diagnoses in control subjects. All study subjects had normal initial MMSE, whereas MoCA score was decreased (<26 points) in 52 (57.2%) patients and 23 (9.6%) control subjects. Six months later, the mean MoCA score was 18.87 and mean MMSE 25.25 in patient group. Patients with stroke and multiple risk factors showed a statistically significant cognitive decline in comparison to patients with transient ischemic attacks. At six months, the greatest cognitive decline in patient group was recorded in patients with arterial hypertension and increased IMT. In subjects with cerebrovascular risk factors, early signs of cognitive impairment exist even before the cerebrovascular disease becomes clinically evident. MoCA proved to be an appropriate tool for cognitive evaluation of patients with mild cognitive impairment of vascular type.Procjena blagog spoznajnog oštećenja je važna, jer može omogućiti rano medicinsko zbrinjavanje kako bi se spriječila teška demencija Alzheimerova ili vaskularnog tipa. U ovom probnom ispitivanju su bolesnici primljeni na Kliniku za neurologiju zbog prvog moždanog udara/prolaznog ishemijskog ispada (skupina bolesnika, n=81, srednja dob 56±7,0 godina) i kontrolni ispitanici bez znakova cerebrovaskularne bolesti, ali s prisutnim vaskularnim čimbenicima rizika (kontrolna skupina, n=45, srednja dob 53±6,0 godina) ispitani pomoću Mini Mental State Exam (MMSE) i Montreal Cognitive Assessment (MoCA) kod prijma te ponovno nakon tri i šest mjeseci. U svih osoba provedena je standardna kompjutorizirana tomografija mozga, prikaz protoka pomoću obojenog Dopplera u karotidnim arterijama uz mjerenje debljine intime medije te transkranijska Dopplerova sonografija. Višestruki rizični čimbenici bili su prisutni u 56 (69,1%) bolesnika. Kontrolni ispitanici najčešće su imali arterijsku hipertenziju, hiperlipoproteinemiju i šećernu bolest. Svi ispitanici su imali normalan početni MMSE, dok je zbir MoCA bio snižen (<26 bodova) u 52 (57,2%) bolesnika i 23 (9,6%) kontrolne osobe. Nakon šest mjeseci je u skupini bolesnika srednji zbir MoCA bio 18,87, a srednji MMSE 25,25. Bolesnici s moždanim udarom i višestrukim čimbenicima rizika iskazali su statistički značajno spoznajno urušavanje u usporedbi s bolesnicima s prolaznim ishemijskim ispadima. U kontrolnoj skupini je najveće opadanje spoznajnih funkcija nakon šest mjeseci zabilježeno u osoba s arterijskom hipertenzijom i povećanom debljinom intime medije. U osoba s cerebrovaskularnim čimbenicima rizika rani znaci oštećenja spoznajne funkcije postoje čak i prije negoli cerebrovaskularna bolest postane klinički očita. MoCA se je pokazao odgovarajućim pomagalom za spoznajnu procjenu bolesnika s blažim oštećenjem spoznajne funkcije vaskularnog tipa

Procjena blagog spoznajnog poremećaja kod bolesnika s karotidnom bolešću bez moždanog udara

Carotid disease is a known risk factor for stroke and stroke is a known risk factor for cognitive impairment, but relation between carotid artery stenosis and cognitive function in asymptomatic individuals is less clear. Most patients have only minor complaints of cognitive dysfunction and assessment with usual tests is not sensitive enough. The study included 26 stroke-free patients (15 male and 11 female), mean age 66.3±8.7 years, with advanced internal carotid artery stenosis orland occlusion (ICAs/o). Left lCAs/o was present in 11, right lCAs/o in eight, and bilateral lCAs/o in seven patients. History was taken and assessment of risk factors, brain CT scan and neurologic examination were performed. Cognitive functions were tested by use of Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). All patients were asymptomatic, except for two patients that presented with repeated transient ischemic attack (TIA). In all subjects median MMSE scores were within the normal range (27.5; IQ range 25-29), while mean MoCA scores were abnormal (22.6±3.4). Patients with left lCAs/o scored slightly better on MaCA (22.9±3.3) than patients with right ICAs/o (22.4±4.0). Delayed recall MoCA subtest was impaired in 22/26 patients and visuospatial subtest in 23/26 patients; however, there was no statistically significant difference according to the side of ICAs/o. Patients with the presence of one or two risk factors scored lower on visuospatial/executive MoCA subtests (P=0.018) as compared with patients with multiple risk factors. MoCA proved to be a sensitive tool for assessment of mild cognitive changes in stroke-free patients with advanced lCAs/o. Decline was most pronounced in visuospatial, executive and short-memory functions.Karotidna bolest je prepoznata kao čimbenik rizika za nastanak moždanog udara, a moždani udar kao čimbenik rizika za poremećaj spoznajnih funkcija, no povezanost stenoze karotidnih arterija i spoznajnih funkcija je manje jasna. Većina bolesnika navodi samo blaže spoznajne poteškoće za procjenu kojih uobičajeni testovi nisu dovoljno osjetljivi. Dvadesetšestoro bolesnika s uznapredovalom stenozom i/ili okluzijom unutarnje karotidne arterije (ICA) je uključeno u ispitivanje (srednje dobi 66,3±8,7 godina, 15 muškaraca i 11 žena), jedanaestoro s lijevostranom, 8 s desnostranom i 7 s obostranom stenozom i/ili okluzijom lCA. Uz anamnestičke podatke i neurološki pregled kod svih bolesnika zabilježeni su podaci o vaskularnim čimbenicima rizika i učinjen je CT mozga. Spoznajne funkcije su ispitane primjenom Mini Mental testa (MMSE) i Montrealske ljestvice kognitivne procjene (MoCA). Svi bolesnici su bili asimptomatski, osim dvoje bolesnika koji su imali ponovljene prolazne ishemijske atake (TlA). Kod svih bolesnika vrijednost medijana testa MMSE bila je u granicama normale (27,5; lQ raspon 25-29), dok su srednje vrijednosti testa MoCA bile snižene u odnosu na normalne vrijednosti (22,6±3,4). Bolesnici sa stenozom i/ili okluzijom lijeve ACl imali su nešto bolje rezultate na testu MoCA (22,9±3,3) u odnosu na bolesnike s desnostranom bolešću (22,4±4,0). Kod 22 od 26 bolesnika nađene su snižene vrijednosti na MoCA podtestu odgođenog prisjećanja. a kod 23 od 26 bolesnika snižene vrijednosti na MoCA podtestu ispitivanja vidno-prostornih funkcija, no nisu nađene statistički značajne razlike u odnosu na stranu stenoze i/ili okluzije lCA. Rezultati bolesnika s jednim ili dva vaskularna čimbenika rizika na MoCA podtestu za ispitivanje vidno-prostornih i izvršnih funkcija bili su lošiji u odnosu na rezultate bolesnika s višestrukim čimbenicima rizika (P=0,018). Test MoCA ima dovoljnu osjetljivost za procjenu blagog spoznajnog poremećaja kod bolesnika s uznapredovalom stenozom i/ ili okluzijom karotidnih arterija, bez moždanog udara. Najizraženiji poremećaj zabilježen je u odnosu na vidno-prostorne funkcije te na kratkoročno pamćenje

Advanced Asymptomatic Carotid Disease and Cognitive Impairment: An Understated Link?

Advanced carotid disease is known to be associated with symptomatic cerebrovascular diseases, such as stroke or transient ischemic attack (TIA), as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced carotid disease and possible mechanisms involved in the causal relationship between asymptomatic advanced carotid disease and cognitive decline

GSTP1, GSTM1 and GSTT1 genetic polymorphisms and total serum GST concentration in stable male COPD

The aim of this study was to test the hypothesis that glutathione-S-transferase (GST) genotypes were associated with COPD. GSTP1, GSTM1 and GSTT1 genotypes were determined by DNA methods and GST activity spectrophotometrically in older male Caucasian Croats (non-smokers, ex-smokers, and smokers) with stable COPD (n = 30) and sex/age matched controls (n = 60). The distribution of GSTP1 genotypes and alleles in controls vs. COPD showed a statistical difference (p < 0.05). The odds ratio of CC/CT+TT (wild type GSTP1 exon 6 vs. joint heterozygous and mutant homozygous GSTP1 exon 6) was 10.000 and statistically different (p = 0.002). In this study, the GSTP1 mutant genotype of exon 5 (GG), as well as GSTP1 mutant and heterozygous genotypes of exon 6 (TT and CT), were suggested to be genetic contributors to COPD susceptibility. Null GSTM1, null GSTT1 and joint GSTM1/GSTT1 null genotypes were not disease associated. Serum GST was not associated with GST genotypes and COPD or smoking history in our study subjects. Conclusions drawn from the study should be further supported and clarified by studies with larger sample sizes

Uloga pušenja i uzimanja alkoholnih pića u razvoju i ponavljanju plućne tuberkuloze

During a two-year period (2001-2003), 464 patients were treated for tuberculosis at Jordanovac Department for Lung Diseases in Croatia. Besides pulmonary tuberculosis in 97.7% of patients, patients were also treated for tuberculous pleurisy (0.9%), tuberculous laryngitis (0.6%), tuberculous meningitis (0.2%), tuberculous pericarditis (0.2%) and urogenital tuberculosis (0.4%). Out of the total number of patients, 57.3% declared themselves to be active smokers (men were predominant and made up to 80.8%) and 20.9% to be active alcohol consumers. Both risk factors, i.e. smoking and alcohol consumption, were present in 15.1% of all patients. The most common comorbidities were diabetes mellitus (30.4%), cardiac diseases (11.2%) and chronic obstructive pulmonary disease (8.0%). Lung carcinoma was the most common malignant disease (n=51), with Mycobacterium tuberculosis isolated in 33% of them. Seventy-two of 464 (15.5%) patients had recurrences of tuberculosis. Of these, 30.5% had one of the risk factors (20.8% were smokers and 9.7% consumed alcohol), while 32.5% of patients had both risk factors. In conclusion, cigarette smoking was proved to be the most significant risk factor for development of pulmonary tuberculosis and its recurrence.Tijekom dvije godine (2001.-2003.) u Klinici za plućne bolesti “Jordanovac”, Zagreb, Hrvatska, od tuberkuloze je liječeno 464 bolesnika. Osim najčešće plućne tuberkuloze u 97,7% bolesnika, oboljeli su liječeni i od eksudativnog tuberkuloznog pleuritisa (0,9%), laringealne tuberkuloze (0,6%), tuberkuloznog meningitisa (0,2%), perikardijalne tuberkuloze (0,2%) te tuberkuloze koja je zahvatila urogenitalni sustav (0,4%). Od ukupnog broja bolesnika 57,3% ih se izjasnilo kao aktivni pušači (muškarci 80,8%), dok je 20,9% deklarirano kao aktivni konzumenti alkohola. Ukupno je 15,1% bolesnika imalo oba rizična čimbenika u anamnezi, tj. i aktivno pušenje cigareta i konzumaciju alkohola. Od komorbiditeta najčešća je bila šećerna bolest u 30,4% bolesnika, od srčanih bolesti bolovalo je 11,2% bolesnika, dok je kronična opstruktivna plućna bolest bila prisutna u 8% bolesnika. Karcinom pluća bio je najčešće zastupljen među malignim bolestima. Od ukupnog broja oboljelih od karcinoma pluća (51 bolesnik), Mycobacterium tuberculosis izolirali smo u 33% bolesnika. Recidivi tuberkuloze su zabilježeni u 72 (15,5%) bolesnika. Jedan rizični čimbenik imalo je 30,5% bolesnika: pušača je bilo 20,8%, dok je alkohol konzumiralo 9,7% bolesnika, a 32,5% bolesnika imali su oba rizična čimbenika. Zaključno, pušenje cigareta pokazalo se kao najznačajniji rizični čimbenik za razvoj plućne tuberkuloze, kao i za pojavu recidiva tuberkuloze

FENOTIPSKA RAZNOLIKOST GERMPLAZME LUCERNE (MEDICAGO SATIVA L.)

The objective of this study was to evaluate phenotypic diversity in the alfalfa germplasm collections using multivariate analysis to examine the extent of genetic diversity and contribution of selected characters to the total diversity and finally to select the most promising clusters/populations for further breeding work. Forty alfalfa populations/cultivars of different geographical origin were evaluated for 12 agro-morphological characters during two consecutive years. The populations/ cultivars were grouped into six clusters. In most cases populations/cultivars within clusters were not associated with their geographical origin. Intercluster distances were larger than the intracluster ones. This research revealed a broad phenotypic diversity within and between the alfalfa germplasm collections. The following characters contributed most to the total phenotypic diversity: dry matter yield in the first production year, plant height and length of central leaflet. Based on the mean value of the evaluated characters and determined distances between clusters, the most promising populations/cultivars belong to the clusters IV and V. Selected populations/cultivars could be considered as a valuable genetic material for the yield and quality improvement of alfalfa in our breeding programme.Cilj ovog istraživanja bio je procijeniti fenotipsku raznolikost u kolekciji germplazme lucerne pomoću multivarijatne analize, utvrditi doprinos izabranih svojstava u ukupnoj raznolikosti i izabrati najzanimljivije grupe/populacije za daljnji oplemenjivački rad. Tijekom dvogodišnjega razdoblja analizirano je 12 agromorfoloških svojstava kod 40 populacija/sorti lucerne različitoga geografskoga porijekla. Proučavane populacije/sorte bile su grupirane unutar šest grupa. U najvećem broju slučajeva grupiranje populacija/sorti nije bilo povezano s njihovim geografskim porijeklom. Udaljenost između grupa bila je veća u odnosu na udaljenost između populacija/sorti unutar grupe. U provedenom istraživanju otkrivena je velika fenotipska raznolikost u proučavanoj kolekciji germplazme lucerne. Najveći doprinos u ukupnoj fenotipskoj raznolikosti imala su svojstva prinos suhe tvari u prvoj vegetacijskoj godini, visina biljaka i dužina srednjeg listića. Na osnovi ostvarenih prosječnih vrijednosti ispitivanih svojstava te utvrđene udaljenosti između grupa, najperspektivnije populacije/sorte pripadaju grupama IV i V. Izabrane populacije/sorte predstavljaju vrijedan genetski materijal za poboljšanje prinosa i kvalitete lucerne u okviru našega oplemenjivačkoga programa

Metabolic syndrome and C-reactive protein in patients with depressive disorder on antidepressive medication

Introduction. Recurrent depression is a psychiatric disorder of which etiology and pathogenesis might be related to immune response. Metabolic Syndrome (MetS) and its components are also strongly associated with elevated inflammatory indicators, as so as the body mass index (BMI) and total cholesterol levels. Objective. Objective of this study was to investigate if there was any difference in C-reactive protein (CRP) levels in patients with recurrent depressive disorder, treated with antidepressants, compared to a healthy control group of subjects and if there was an association between increased CRP levels and the presence of MetS in these two groups. Methods. Sixty subjects entered the study; of these 35 patients with the diagnosis of recurrent depressive disorder, while the healthy control group included 25 subjects. MetS was defined according to the NCEP ATP III criteria. The cut-off point for CRP was set at >5 mg /L. Results. There was no statistically significant difference in the prevalence of MetS and CRP values between the studied groups. Waist circumference and total cholesterol levels were significantly higher in the experimental group. Patients that fulfilled the criteria for MetS showed significantly higher values of central obesity and arterial hypertension in the experimental group as well. The elevated CRP levels were associated with increased frequency of MetS in depressed patients. Conclusion. Both CRP levels and metabolic risk profile screening, according to the international criteria, may be beneficial in order to obtain better assessment for depressive long term medicated patients

Newly designed hemagglutinin-Der p 2 chimera is a potential candidate for allergen specific immunotherapy

Aim To investigate the immunomodulatory potential of a chimera composed of the receptor-binding domain of hemagglutinin 1 (H1s) from Influenza virus and Der p 2 (D2) allergen for allergen-specific immunotherapy of house-dust mite allergy (HDM). Main methods: H1sD2 chimera and D2 allergen were produced by genetic engineering in E. coli. Recombinant antigens were extracted from inclusion bodies by urea, then refolded and purified by immobilized-metal affinity chromatography (IMAC). Purity was verified by 2D-PAGE and secondary structures were assessed by CD spectroscopy. IgE reactivity of H1sD2 and D2 was tested in western blot with sera from 8 persons with clinical history of HDM allergy. Immunogenicity of H1sD2 and D2 were analyzed in Balb/c mice. Cytokine profile was analyzed by ELISA after stimulation of mouse spleen cells with H1sD2 and D2. Leukocyte population abundance of cells isolated from spleen and lymph node was assessed by flow cytometry. Key findings: Purified recombinant proteins H1sD2 (42 kDa) and D2 (15 kDa) revealed well defined secondary structures, and preserved IgE reactive epitopes. Analysis of supernatants of mouse spleen cells after stimulation with H1sD2 and D2, revealed a qualitatively different cytokine profile from H1sD2 immunized mouse cells (increase in IL10). CD8+ cells were decreased in the lymph node of D2 immunized mice, whereas H1sD2 immunization led to an increase of CD8+ cells in both the lymph node and the spleen. Significance: H1sD2 chimera attenuates Der p 2-inherent Th2 response and directs the immune response toward Th1 and Treg phenotype

The importance of bank credits for agricultural financing in Serbia

Agricultural loans present unutilized bank credit market segment in Serbia. This is not only missed profit opportunity for banks, but also serious deficiency that slows down the development of agriculture and rural areas. Paper uses FADN, NBS and bank balance sheet data in order to analyse supply and demand side of this credit market segment, with the aim to better understand the conditions for its development. Paper recommends better education of producers and lenders. Banks should better understand the requirements of agricultural producers and risks of the production to be able to create tailored credits. Insurance has very important role in specific risk hedging and can facilitate agricultural loans. There is also a need to adjust the conditions for obtaining subsidized loans, while the land size is considered as a key prerequisite for obtaining loans in the situation of large fragmentation of properties