Sijamski blizanci – od slučaja do slučaja

Sijamski se blizanci rađaju spojeni različitim dijelovima tijela. U nekim je slučajevima kirurško razdvajanje moralno dopustivo, a u nekim slučajevima nije. Zato svaki slučaj treba promatrati zasebno i donositi odluke za upravo taj slučaj. Ponekad je odluka jednostavna, ali u nekim slučajevima nije. Uvijek se donosi nakon konzultacija s roditeljima i medicinskim osobljem uključenim u rješavanje problema, vodeći računa o poštovanju ljudskog života. Donošenje odluka kompliciraju i etički problemi koji uključuju privatnost bolesnika, razmještaj organa koji su zajednički za oba blizanca i, u nekim slučajevima, nužnost žrtvovanja jednog blizanca da bi se spasio život drugom. U radu je prikazano nekoliko slučajevima koji vrlo dobro osvjetljavaju moralne i etičke nedoumice vezane uz razdvajanje sijamskih blizanaca

Sijamski blizanci – od slučaja do slučaja

Sijamski se blizanci rađaju spojeni različitim dijelovima tijela. U nekim je slučajevima kirurško razdvajanje moralno dopustivo, a u nekim slučajevima nije. Zato svaki slučaj treba promatrati zasebno i donositi odluke za upravo taj slučaj. Ponekad je odluka jednostavna, ali u nekim slučajevima nije. Uvijek se donosi nakon konzultacija s roditeljima i medicinskim osobljem uključenim u rješavanje problema, vodeći računa o poštovanju ljudskog života. Donošenje odluka kompliciraju i etički problemi koji uključuju privatnost bolesnika, razmještaj organa koji su zajednički za oba blizanca i, u nekim slučajevima, nužnost žrtvovanja jednog blizanca da bi se spasio život drugom. U radu je prikazano nekoliko slučajevima koji vrlo dobro osvjetljavaju moralne i etičke nedoumice vezane uz razdvajanje sijamskih blizanaca

Increased Responsiveness of Human Coronary Artery Endothelial Cells in Inflammation and Coagulation

The effects of anti-inflammatory plant extracts, such as black tea extract (BTE) and resveratrol (RSV) could modulate cell activation leading to atherosclerosis, however there is little comparative information about how different endothelial cell types are affected by these compounds. In order to compare human endothelial cells derived from different origins (umbilical vein or HUVEC, coronary artery or HCAEC, microvascular or HMVEC) and their interleukin-1β (IL-1β) responsiveness, IL-6 ELISA, RT-PCR, tissue factor assay, and prostacyclin responses using 6-keto PGF1α ELISA were determined. The IL-1β-induced IL-6 levels were dose-dependent with highest responses seen in HCAEC. Significant inhibition of IL-1β responses was achieved with BTE and RSV, with the largest decrease of IL-6 and TF seen in HCAEC. Prostacyclin levels were highest in HUVEC and were inhibited by RSV in all cell types. The differences between the endothelial cell types could account for greater susceptibility of coronary arteries to inflammation and atherogenesis

De Novo NEMO Gene Deletion (D4–10) – A Cause of Incontinentia Pigmenti in a Female Infant: A Case Report

Incontinentia pigmenti (IP) is a rare, inherited, multisystem genodermatosis. It is transmitted as an X-linked dominant trait. The disorder is a consequence of mutations in the NEMO gene (Xq28) that completely abolish expression of the NF-kappaB essential modulator. Here we present a female infant of healthy nonconsanguinous, young parents with a clinically evident first phase of IP. PCR analysis of patient’s peripheral blood lymphocytes DNA was done for detection of NEMO D4–10 deletion. Skin changes present at birth appertain to first inflammatory stage. However, a pathohistological feature of the skin biopsy showed second phase of disease. Genetic testing of diseased child revealed D4–10 in NEMO gene. However, the assumption that the female child has familial IP was rejected as PCR performed on the mother’s leukocytes did not record the presence of the same mutation. Moreover, the existence of a healthy male infant of the same mother as well as the lack of any phenotypic signs of the disease in other family members additionally support that IP was not inherited, but it was a consequence of de novo NEMO gene mutation. In conclusion, here we describe a Croatian female with clinical IP phenotype having de novo genomic rearrangements in the NEMO gene

THE PARADIGM OF A SECOND OPINION IN THE FIELD OF PAEDIATRIC MEDICINE

Možda će roditelji bolesnog djeteta prije započetog liječenja izraziti želju da drugi liječnik pregleda postavljenu dijagnozu i plan liječenja. Drugo mišljenje omogućava roditeljima da budu sigurniji u točnost postavljene dijagnoze, ali ono ujedno olakšava razmatranje i donošenje odluke o najboljoj opciji tretmana. Neki su liječnici “konzervativniji”, neki “agresivniji”. Kad se od roditelja očekuje da odluče o tretmanu svoga djeteta, kliničar treba razjasniti nesigurnosti i evenutalne dvojbe. Prije ili tijekom liječenja roditelje je potrebno ohrabriti i podržati njihovu želju za dobivanjem drugog mišljenja - bez obzira na liječnički stav o nužnosti takvog postupanja. Načini dobivanja drugog stručnog mišljenja su različiti. Djelokrug tog područja nije u potpunosti rasvijetljen. Također nije jasno jamči li taj postupak pouzdanost. Ipak, drugo mišljenje katkad može značiti razliku između života i smrti.Before starting treatment, the parents of a sick child may want another doctor to review the diagnosis and treatment plan. Getting a second opinion allows them not only to confirm the diagnosis, but also to gain a different perspective on the child’s treatment options. Some doctors are more conservative and others more aggressive. When parents are invited to make choices their clinicians need to explain about clinical uncertainty and how individual values and preferences may relate to treatment decisions for their child. The options should be communicated in a clear manner, differences in opinion should be acknowledged and the doctor\u27s own preference stated. Parents need to be encouraged and supported to make their decision—whether or not it reflects their doctor\u27s preference. There are a number of ways to find specialists to consult for a second opinion: The scope of this phenomenon is not well understood . Also it is not clear whether it is warranted or not. However sometimes second opinions can mean the difference between life and death

Codi-strat - an interdisciplinary network geared towards sustainable management of chronic and infective diseases

A collaborative effort of clinicians, infectologists, molecular biologists, pharmacologists, veterinarians, bioinformaticians, management and education specialists is united in order to develop novel strategies of detecting early stages of chronic and infective diseases, their prevention and therapy. CODI-STRAT integrates 15 centers conducting leading–edge research of chronic inflammatory/infective diseases from seven European (five Mediterranean) countries and the USA, with specific aims to: i) establish long-standing partner center cross-disciplinary collaborations for clinical studies and research, ii) provide young investigators with broad and content-driven training and employability and iii) promote scientists up-skilled in genomics, transcriptomics, tissue expression, human serological and genetic studies, bioinformatics, chip technology, cell cultures and animal models, all directed toward clinical translation and chronic/infective disease management. This manuscript outlines the goals, partner roles and development of CODI-STRAT and its programme.peer-reviewe

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