Use of Cone Beam Computed Tomography for Studying Temporomandibular Joint Morphology

The aim of the present study was to investigate morphology of temporomandibular joint using cone beam computer tomography. Study included 45 adults (32 females and 13 males). Articular eminence inclination, glenoid fossa width, glenoid fossa depth, condylar mediolateral distance, condylar anteroposterior distance and condylar type were determined for each temporomandibular joint. Since independent samples t-test did not show significant differences between left and right sides for all of observed parameters (p≥0.05), left and right side values were treated as one sample. The determined glenoid fossa depth was 7.11±2.23, glenoid fossa width 19.22±2.58, condylar anteroposterior distance 7.54±1.59, condylar mediolateral distance 17.95±2.81 and articular eminence inclination was 34.59±7.35 degrees. Most of condyles were classified as convex type (32.5%), followed by flattened (23.8%), rounded (11.3%) and angled (10%). Undefined (other type) were classified 22.5% of condyles. Cone beam computer tomography measurements of temporomandibular joint bone structures in present study showed similarities to most of previous research (with different populations studied). Still, the prevalence of different condylar types differs from those obtained by most of previous studies. Interindividual differences in temporomandibular joint morphology are expected

Mucoepidermoid Carcinoma Misdiagnosed as Palatal Odontogenic Infection: An Overview on the Differential Diagnosis of Palatal Lesions

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors’ knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC’s differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list

Analysis of Croatian wild and cultivated grapevine diversity by genotyping by sequencing

Minor varieties represent a significant part of the grapevine germplasm (Vitis vinifera L. subsp. vinifera) in Croatia. During the long history of grape cultivation in insular, coastal and continental Croatia, numerous local varieties were cultivated, many of which are still used today. There are also several populations of wild grapevine (Vitis vinifera subsp. sylvestris Hegi Gmel) that have survived until the present in natural sites. Here, we developed a single primer enrichment technology (SPET) panel consisting of 61,308 probes for targeted sequencing of the V. vinifera gene space. In doing so, we examined a total of 28,092 gene models, 88.2% of all predicted genes, interrogating an average of 19 Mb nucleotides per individual genome, which corresponds to 4% of the haploid genome length. This is the first time that SPET-based sequencing has been applied to Croatian grapevine germplasm to generate multilocus genotype data of 126 cultivated accessions and 50 wild specimens. We identified 531,900 variants sites, 208,802 of which reside in coding sequences, 140,836 in introns, 118,416 in UTRs, and 63,424 in the nearby intergenic space that revealed the presence of 33 clonally propagated specimens representing both synonymies and clones within local varieties (22) as well as synonymies between local and international varieties (11), mostly from neighbouring countries. To investigate possible contribution of wild grapevine (Vitis vinifera subsp. sylvestris Hegi Gmel) to the development of present cultivars, four wild grapevine populations were included. None of the cultivated varieties showed close kinship with local wild specimens. This study opens new possibilities for studying the genetic diversity of Croatian grapevine germplasm and provides additional information with respect to SSR genotyping and phenotyping

Long-term outcomes in patients with aortic regurgitation in the Zagreb University Hospital Centre

Introduction: Age and gender may influence the incidence of aortic regurgitation (AR) and its severity. Significant aortic regurgitation (sAR) is often treated surgically especially when symptomatic or when systolic function declines.1 The aim of this study was to evaluate the outcomes in patients with sAR according to treatment strategy, age and gender differences in our study population. Patients and Methods: In this retrospective descriptive single-centre study an overall of 107 patients (22 female, 85 male) with significant AR in the last 5 years were analyzed. Patients were treated according to valid recommendations, surgically (SUR) or conservatively (CON), except for 5 patients who refused surgery. Baseline and follow up (FU) data (AR severity, left ventricle ejection fraction (LVEF), ascending aorta diameter (AA), treatment, comorbidities and major adverse cardiovascular events (MACE) during FU), from documented medical history and digital imaging data were collected and analysed. Additional sub-analysis was performed according to sex and age differences (above vs. below the age of 50). For statistical analysis a Chi-Square test was used. Results: In the overall study population, during an average FU of 3.8 years, 16 patients (15%) developed MACE with no statistically significant difference between gender (p=0.846). Forty-six (43%) patients were surgically treated (87% male, 13% female) and 61 (54%) conservatively. LVEF did not worsen in FU period (54.1%, vs. 53.8%). In SUR, median age was 54 years, severe AR was present in 93%, incidence of MACE was 21.7%, 80.4% patients were symptomatic and 14.5% had dilatation of AA more than 50 mm. In CON, MACE was present in 9.8% during FU (p=0.87), median age was 64 years. Moderate AR (48% vs 6.5%) and AA from 40-49 mm (80 vs 35%) was present more frequently as well as arterial hypertension (82 vs 70%) and chronic renal disease (23.2 vs 16.6%). The incidence of MACE was not found to be agerelated (p=0.426). Conclusion: In patients with sAR treated by either surgery or medication therapy only, during 3.8 years of FU, LVEF remained unchanged, while incidence of MACE was not found to be related to treatment strategy nor gender. In surgically treated patients, as expected, AR was more severe and AA was more dilated, while neither age nor gender had an impact on the incidence of MACE

The associations of age, sex, and comorbidities with survival of hospitalized patients with coronavirus disease 2019: data from 4014 patients from a tertiary-center registry

Aim To investigate how age, sex, and comorbidities affect the survival of hospitalized coronavirus disease 2019 (COVID-19) patients. Methods We retrospectively analyzed the records of 4014 consecutive adults hospitalized for COVID-19 in a tertiarylevel institution from March 2020 to March 2021. Results The median age was 74 years. A total of 2256 (56.2%) patients were men. The median Charlson-comor - bidity-index (CCI) was 4 points; 3359 (82.7%) patients had severe or critical COVID-19. A significant interaction be - tween age, sex, and survival ( P <0.05) persisted after ad - justment for CCI. In patients <57 years, male sex was re - lated to a favorable (odds ration [OR] 0.50, 95% confidence interval [CI] 0.29-0.86), whereas in patients ≥57 years it was related to an unfavorable prognosis (OR 1.19, 95% CI 1.04- 1.37). Comorbidities associated with inferior survival inde - pendently of age, sex, and severe/critical COVID-19 on ad - mission were chronic heart failure, atrial fibrillation, acute myocardial infarction, acute cerebrovascular insult, history of venous thromboembolism, chronic kidney disease, ma - jor bleeding, liver cirrhosis, mental retardation, dementia, active malignant disease, metastatic malignant disease, autoimmune/rheumatic disease, bilateral pneumonia, and other infections on admission. Conclusion Among younger patients, female sex might lead to an adverse prognosis due to undisclosed reasons (differences in fat tissue distribution, hormonal status, and other mechanisms). Patient subgroups with specific co - morbidities require additional considerations during hos - pital stay for COVID-19. Future studies focusing on sex differences and potential interactions are warranted

Epidemiological characteristics, baseline clinical features, and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

Aim To describe epidemiological characteristics and base - line clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coro - navirus disease 2019 (COVID-19) patients treated at a ter - tiary institution specialized for COVID-19 patients. Methods This retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbid - ities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors. Results The median age was 72 (64-78) years. The median body mass index was 29.1 kg/m 2 . The most relevant comor - bidities were diabetes mellitus (32.6%), arterial hyperten - sion (71.2%), congestive heart failure (19.1%), chronic kid - ney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dim - er, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, Pa O 2 /FiO 2 ratio, and glomerular filtration rate at ad - mission. Length of ICU stay was 9 days. The median surviv - al was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated. Conclusion The parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify in - dividual mortality risk factor

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes