37 research outputs found
Blaskovich J. Anatomy of Deceit. An American Physician\u27s First-hand Encounter with the Realities of the War in Croatia.
The presence of high mobility group box-1 and soluble receptor for advanced glycation end-products in juvenile idiopathic arthritis and juvenile systemic lupus erythematosus
BACKGROUND:
The involvement of high mobility group box-1 (HMGB1) in various inflammatory and autoimmune diseases has been documented but clinical trials on the contribution of this pro-inflammatory alarmin in children with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) are basically absent. To address the presence of HMGB1 and a soluble receptor for advanced glycation end products (sRAGE) in different subtypes of JIA and additionally in children with SLE, we enrolled a consecutive sample of children harvested peripheral blood as well as synovial fluids (SF) at diagnosis and correlated it with ordinary acute-phase reactants and clinical markers. ----- METHODS:
Serum and synovial fluids levels of HMGB1 and sRAGE in total of 144 children (97 with JIA, 19 with SLE and 27 healthy controls) were determined by ELISA. ----- RESULTS:
The children with JIA and those with SLE were characterised by significantly higher serum levels of HMGB1 and significantly lower sRAGE levels compared to the healthy controls. A positive correlation between serum HMGB1 and ESR, CRP, Ī±2 globulin was found while serum sRAGE levels were inversely correlated with the same inflammatory markers in children with JIA. Additionally, high level of serum HMGB1 was related to hepatosplenomegaly or serositis in systemic onset JIA. ----- CONCLUSION:
The inverse relationship of the HMGB1 and its soluble receptor RAGE in the blood and SF indicates that inflammation triggered by alarmins may play a role in pathogenesis of JIA as well as SLE. HMGB1 may serve as an inflammatory marker and a potential target of biological therapy in these patients. Further studies need to show whether the determination of HMGB1 levels in patients with JIA can be a useful guideline for detecting disease activity
High level of alarmin HMGB-1 together with low level of its soluble receptor sRAGE in juvenile systemic erytemic lupus
Childhood-onset systemic lupus erythematosus in Croatia: demographic, clinical and laboratory features, and factors influencing time to diagnosis
OBJECTIVES
Childhood-onset systemic lupus erythematosus (cSLE) presents with diverse clinical features and often with non-classical symptoms that may delay diagnosis and increase risk of morbidity and mortality. This paper aims to analyse incidence, and clinical and laboratory features of cSLE in Croatia between 1991 and 2010, and to identify factors influencing time to diagnosis. ----- RESULTS
Medical records at three university-based tertiary care centres were analysed retrospectively for 81 children with cSLE (68 girls). Mean age at onset was 13.4Ā±2.8 yr (interquartile range 3), and annual incidence varied from 1-15 per million at risk. The most frequent clinical and laboratory features were musculoskeletal symptoms (80%) and increased erythrocyte sedimentation rate (96%). The most frequent immunological laboratory findings were the presence of antibodies against histones (86%), double-stranded DNA (73%), and Sm protein (64%), as well as low levels of C3 complement (69%). Haematuria was present in 58% of children, proteinuria in 56%, and biopsy-confirmed lupus nephritis in 43%. Median time from symptom onset to diagnosis was 2 months (range 0-96). Time to diagnosis was inversely associated with ECLAM score (p<0.001), but it showed no association with age, gender, clinical features or distance from the nearest paediatric centre. ----- CONCLUSIONS
This is the first large-scale, in-depth study of clinical and laboratory features of cSLE in Croatia. Among all demographic, laboratory and clinical features examined, ECLAM score alone was inversely associated with time to diagnosis. This highlights the need to improve detection of children with fewer symptoms early in the course of the disease, therefore serious consequences for prognosis could be avoided
Neopterin Kinetics after Cardiac Surgery with or without Cardiopulmonary Bypass
Cardiac surgery (CS) with cardiopulmonary bypass (CPB) induces systemic inflammatory response by activating plasma proteins and blood cells. Activated monocytes/macrophages produce inflammatory marker neopterin (NP). The aim was to explore the NP kinetics in first 24 hours after CS according to the CPB use. Significant difference between groups was found for NP levels 12 and 24 hrs after CS, being higher in on-pump group. Strong association was found between NP levels 12 hrs after CS and the length of ICU stay for on-pump group (r=0.744, p<0.001). Strong association was found between preoperative NP levels and the length of ICU stay for those on-pump patients with elevated preoperative NP (r=0.855, p=0.001; linear regression equation y=0.50x ā 5.14, p<0.001). Preoperative NP levels higher than 10 nmol/L in on-pump group could predict prolonged ICU stay and outpoint patients at higher risk for developing postoperative complications and, therefore, help to determine the necessary therapeutic interventions
Risk factors for non-melanoma skin cancer development in renal transplant recipients: a 40 year retrospective study in Croatia
Aim To determine the prevalence of non-melanoma skin
cancer (NMSC) and disease-specific risk factors in renal
transplant recipients (RTRs).
Methods This retrospective cohort study enrolled 1232
RTRs (736 men) treated in University Hospital Center Zagreb over 40 years. The effect of sex, age at transplantation, geographic residence, dialysis vintage, and the type
of immunosuppressive therapy on NMSC occurrence was
investigated.
Results The prevalence of NMSC was 6.81%. Overall,
60.7% of patients developed basal cell carcinoma (BCC)
and 30.9% of patients developed cutaneous squamous
cell carcinoma (cSCC). Only 8.3% developed both tumors.
The BCC:cSCC ratio was 1.76:1. The risk for NMSC was 50%
higher in men. Patients older than 50 years at transplantation were at greater risk for NMSC development. Residence
in an area with higher ultraviolaet radiation (UV) exposure
and dialysis vintage before transplantation did not influence NMSC development. Cyclosporine and azathioprine
treatment conferred a greater risk for NMSC than tacrolimus or mycophenolate mofetil treatment.
Conclusion RTRs are at high risk for NMSC development.
Sex, age at transplantation, and type of immunosuppressive therapy play a role in tumor development
Termografija skrotuma u procjeni ishoda operacije varikokele: prikaz sluÄaja
Scrotal thermography is a diagnostic method for varicocele. In short, there are five
diagnostic thermographic criteria for varicocele, i.e., pattern of scrotal thermographic image indicative
of varicocele, temperature at pampiniform plexus ā„34 CĀ°, temperature difference between left and
right pampiniform plexus ā„0.5 CĀ°, enhancement of image during Valsalva maneuver, and temperature
at pampiniform plexus ā„ temperature at ipsilateral thigh. Three or more positive signs are indicative of
varicocele. The aim of this report is to present the use of digital thermography as a diagnostic method
to evaluate the outcome of varicocele repair. We present a case of a student diagnosed with varicocele
grade III, and assessed preoperatively and followed up postoperatively by scrotal thermography. According
to thermographic indicators, our patient was positive for varicocele diagnosis before surgical
treatment. Three months after varicocele repair, the patient did not show positive thermographic indicators
of varicocele while physical examination and color Doppler ultrasound were equivocal. This case
report suggests that infrared digital thermography of scrotum could be very valuable for monitoring
patients in the period after surgery for varicocele, however, it should be confirmed in a larger number
of patients.Termografija skrotuma je metoda dijagnostike varikokele. Postoji pet termografskih dijagnostiÄkih kriterija za dijagnozu
varikokele: termografski prikaz karakteristiÄan za varikokelu, temperatura pampiniformnog pleksusa ā„34 CĀ°, razlika temperature
izmeÄu lijevog i desnog pampiniformnog pleksusa ā„0,5 CĀ°, indikativna promjena slike prilikom Valsalvina manevra
i temperatura pampiniformnog pleksusa koja je ā„ temperaturi ipsilateralne natkoljenice. Tri ili viÅ”e pozitivnih znakova predstavlja
pozitivan nalaz u sluÄaju dijagnostike varikokele. Cilj ovoga rada je prikazati primjenu termografije skrotuma kao
dijagnostiÄke metode u procjeni ishoda operacije varikokele. Prikazat Äemo sluÄaj studenta koji je imao dijagnozu varikokele
III. stupnja te je prijeoperacijski dijagnosticiran, a poslijeoperacijski praÄen termografijom skrotuma. Prema termografskim
kriterijima ovaj bolesnik je prijeoperacijski imao varikokelu. Tri mjeseca nakon operacije bolesnik nije imao pozitivne termografske
znakove za varikokelu, meÄutim, kliniÄki pregled i obojeni doppler nisu bilo tako uvjerljivi. Ovaj prikaz sluÄaja
pokazuje moguÄnost primjene termografije skrotuma u praÄenju bolesnika nakon operacije varikokele, no ovo svakako treba
potvrditi na veÄem broju ispitanika
Mehanizmi nastanka koÅ”tanog fenotipa u generaliziranom limfoproliferativnom poremeÄaju u miÅ”a [ Mechanism of development of bone phenotype in murine generalised lymphoproliferative disorder ]
Mice with mutation in the Fas-ligand gene develop generalised lymphoproliferative disorder (gld mice), characterised by accumulation of double negative (DN) T cells (CD4āCD8ā), as well as higher bone mineral density and more trabecular bone. To evaluate the role of immune system in the development of bone phenotype of gld mice, we parabiotically joined the wild-type (C57BL/6, B6) with gld mice. The mice were sacrificed weekly for four weeks. Additionally, the mice were separated after four weeks and sacrificed two weeks after separation. Lymphoproliferative disorder was suppressed in gld mice during the first week and the suppression was evident even after the animals were separated. The proportion of DN T cells in the lymphoid tissues of B6 increased during parabiosis, suggesting that the immune phenotype of B6 mice became similar to that of gld mice. At the same time, the bone phenotype of B6 animals shifted towards the gld bone phenotype. The number of osteoclast precursors in the cell culture of B6 bone marrow decreased at one and four weeks, while the number of osteoblast precursors increased at four weeks after parabiosis. The alterations of B6 bone marrow during parabiosis were paralleled by increased expression of cytokine osteoprotegerin in the bone, both at the gene and the protein levels, suggesting that osteoprotegerin was the link between the bone and immune phenotype. Simultaneous transfer of both immune and bone phenotype from gld to B6 mice point to the immune component of gld bone phenotype. On the other hand, lack of changes in the bone marrow of gld mice during parabiosis indicated that Fas-ligand has a direct role in the formation of bone phenotype of gld mice