Recent views on cytohistological characteristics and pathogenic mechanisms of atherosclerotic lesions types I, II and III

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Inflammation, nutritional status, pufa profile and outcome in hemodialysis patients

Patients with end-stage renal disease (ESRD) include a significant percentage of malnourished patients with other risk factors: dyslipoproteinemia, insulin resistance, increased oxidative stress and inflammation that together impair endothelial function. Abnormal polyunsaturated fatty acids (PUFA) patterns are reported in patients with ESRD. The basic mechanisms of these disorders are connected with changes in cell functions at the membrane level. Vascular smooth muscle cell proliferation plays an important role in the pathogenesis of atherosclerosis. We have examined the association between atherosclerotic risk factors and nutritional status in hemodialysis (HD) patients. Mortality was followed for up to 18 month. Forty-three HD patients were examined (20 males, 23 females, ages 55±12 years). Nutritional and inflammatory markers, including serum concentrations of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6), were measured. There was significant positive correlation between the plasma albumin level and CRP. Significant correlation was found between plasma the cholesterol level and some PUFA. Increasing inflammation and endothelial dysfunction predict the development of vascular disease. We report on the relationship between inflammatory markers and nutritional parameter, indices of atherosclerosis and other cardiovascular risk factors in patients on hemodialysis

8-Iso-prostaglandin F2α as a potential biomarker in patients with unipolar and bipolar depression

Objective: Previous studies have shown that the disturbance of redox homeostasis plays a role in the pathogenesis of mood disorders. It is currently unclear whether oxidative stress parameters can be used as biomarkers (state vs. trait). The aim of the present study was to investigate oxidative stress markers in patients with major depressive disorder (MDD) and bipolar disorder (BP) in acute depressive episodes and remission, and healthy individuals. Patients and methods: Thirty-two patients with a diagnosis of MDD, 32 patients with a diagnosis of BP and 32 matched healthy controls were included in the study. We measured the serum levels of markers of oxidative damage, including 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-Iso-prostaglandin F2α (8-iso-PGF2α; 8-isoprostane), and malondialdehyde (MDA), and also serum activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and glutathione reductase (GR) in both acute and remission phase, and in control group. Results: After controlling for the effects of age, sex, body mass index, and smoking status, serum 8-iso-PGF2α levels were significantly higher in both patient groups compared to controls, regardless of disease phase. The activities of GPX and GR were significantly lower in the acute phase in MDD patients compared to controls. Serum GR activity was lower in both acute and remission phase in MDD compared to BP. Conclusions: Our results suggest that both MDD and BP are associated with a disturbed redox balance with a particularly pronounced increase in serum 8-iso-PGF2α levels in both groups and the presence of glutathione metabolism disorders in MDD patients. Further research is needed to confirm the importance of oxidative stress parameters as potential biomarkers of MDD and BP

Acute myocardial infarction and diabetes mellitus

Akutni infarkt miokarda (AIM) je klinički oblik koronarne bolesti srca, koji nastaje pri okluziji koronarne arterije, a ireverzibilna ishemija progredira do nekroze miokarda. Morbiditet i mortalitet od kardiovaskularnih komorbiditeta, uključujući AIM, je kod obolelih od insulin-nezavisnog dijabetesa veći nego kod nedijabetičara iste životne dobi. Jedan od razloga za veći mortalitet od infarkta miokarda kod dijabetičara može biti i srčana insuficijencija. Bolesnici sa diajbetesom i AIM imaju povećan rizik od lošeg ishoda terapije AIM u odnosu na nedijabetičare, a osnovni razlozi su endotelna disfunkcija, protrombotično stanje, veća mogućnost restenoze, negativnog vaskularnog remodelovanja, povećane glikolizacije proteinai depozicije vaskularnog matriksa. U okviru ovog preglednog članka, dat je prikaz najnovijih literaturnih podataka i praktičnih saznanja o AIM kod dijabetičnih bolesnika.Acute myocardial infarction (AMI) is a clinical form of coronary heart disease, which occurs after coronary arteries' occlusion and irreversible ischemia progression leads to myocardial necrosis. Morbidity and mortality caused by cardiovascular comorbidities, including AIM, are greater in patients with insulin - dependent diabetes than in non - diabetes patients of the same age. One of the reasons for a higher mortality rate from AMI in patients with diabetes may be heart failure. In addition, patients with diabetes and AMI have an increased risk for poor therapy outcomes of AMI compared with non - diabetes patients, and the main reasons are endothelial dysfunction, prothrombotic state, a greater possibility of restenosis, negative vascular remodelling, increased protein glycosylation, and vascular matrix deposition. In this review, we provide an overview of recent literature data and practical knowledge related to the AMI in diabetic patients

Primary hypothyroidism quality of life assessment by application of different questionnaires and its different processing

Primarni hipotireoidizam negativno utiče na kvalitet života obolelih. Poboljšanje kvaliteta života očekuje se uspostavljanjem eutireoidnog stanja primenom levotiroksina. Kvalitet života se može "proceniti" primenom različitih upitnika, poput upitnika opšteg zdravlja (GHQ12; engl. General Health Questionnaire) i tireoidno specifičnog upitnika (TSQ; engl. Thyroid Symptom Questionnaire). Ciljevi ovog rada su: sumiranje standardno i modifikovano rangiranih odgovora oba upitnika u skorove; ispitivanje postojanja razlika u apsolutnim vrednostima skorova među grupama ispitanika; svrstavanje dobijenih skorova u različite klastere (bez poremećaja, manji poremećaj, veliki poremećaj), i ispitivanje postojanja razlika u distribuciji frekvencija ispitanika među njima. Studija preseka je sprovedena u KBC Zemun i obuhvatila je 90 ispitanica, koje su bile podeljene u tri jednake grupe (30 po grupi): hipotireoidnu bez terapije, eutiroidnu sa levotiroksinom i kontrolnu, eutireoidnu grupu bez terapije. Ispitanice su zaokruživale svoj odgovor na postavljena pitanja upitnika, koji je potom rangovno transformisan pomoću dva modelastandardnog i modifikovanog, a potom zbirno sumiran. Za statističku analizu korišćen je softver SPSS for Windows 18.0. Prosečan nivo tireostimulišućeg hormona (TSH) u ispitivanoj populaciji je iznosio 1,3±0,3 (1,1-2,2) mU/L. Prosečni TSQm, TSQs, GHQm and GHQs skorovi su bili 14±7, 13±6, 11±7, i 11±6 i razlikovali su se među grupama. Najniži skorovi su registrovani u grupi levotiroksinom-tretiranih, nezavisno od modela rangiranja, pri čemu je nivo TSH ukazivao na adekvatnu supstituciju levotiroksinom. Prosečni TSQs/TSQm i GHQs/GHQm skorovi pokazuju međusobnu statističku korelaciju. Skorovi i skorom-definisani klasteri oba primenjena upitnika odgovaraju kliničkoj prezentaciji prikazanoj kroz grupe ispitivane populacije. S obzirom da se prosečni skorovi upitnika međusobno razlikuju, a da oba modela rangovne transformacije istog upitnika daju sličan skor, zaključujemo da je dovoljno koristiti po jedan upitnik iz obe kategorije instrumenata za ispitivanje kvaliteta života. Jednostavnost primene ovih upitnika, nezavisno od modela transformacije dobijenih odgovora u rangove, omogućava njihovu primenu pri započinjanju supstitucije levotiroksinom, ali takođe i proceni efikasnosti primenjene terapije.Primary hypothyroidism negatively affects patients' quality of life. Improving the quality of life is expected by establishing eutyreoid state using levothyroxine therapy. The quality of life can be "assessed" by applying various questionnaires, such as the general health questionnaire (GHQ12) and thyroid symptom questionnaire (TSQ). The aims of present study were to: sum standard and modified-ranked answers of both questionnaires, rank the scores, test differences in the absolute values of the scores between the groups, classify obtained scores in different clusters (no distress, a minor, and major distress), and test differences in the distribution of frequencies of the respondents among them. Cross-sectional study was conducted in Zemun Clinical Hospital and it included 90 subjects. The subjects were divided into three equal groups (30 subjects per group): hypothyroid without treatment, euthyroid with levothyroxine, and control, euthyroid group without treatment. The subjects answered the questions in the questionnaire, and the answers were then transformed into the ranking of two modelsstandard and modified, and then summarized. Statistical analysis was performed using the SPSS for Windows 18.0. The average level of thyroid stimulating hormone (TSH) in the study population was 1.3 ± 0.3 (1.1-2.2) mU/L. Average TSQm, TSQs, GHQm and GHQs scores were 14±7, 13±6, 11±7 and 11±6 and differed between groups. The lowest scores were registered in the group of levothyroxine-treated, regardless of the ranking models, with the level of TSH that indicates an adequate substitution levothyroxine. Average TSQs/TSQm and GHQs/GHQm scores show a statistical correlation with each other. Scores and scores-defined clusters of both questionnaires are appropriate for clinical presentation shown by specific groups of the population. Considering that the average scores of the questionnaire differ from each other, and that both models rank-transformation of the same questionnaire give a similar score, it is sufficient to use one questionnaire from both categories of instruments for testing the quality of life. The ease of applying these questionnaires, independent of the transformation obtained in response ranges and their application when starting levothyroxine substitution, were used to assess the effectiveness of the therapy

Azot-monoksid- biomarker u dijagnostici tiroidnih nodusa

Definisanje malignog potencijala tiroidnih nodusa (TN) je najznačajnija odrednica u njihovoj evaluaciji. Primena imidžing metoda, kao i biohemijskih, citoloških i molekularno bioloških alata doprinosi razlikovanju benignih od malignih TN i tako delimično smanjuje broj nepotrebno tiroidektomsanih pacijenata. Jasno je da idealni biomarker ili metoda za definisanje prirode TN ne postoji, ali smo svedoci nastojanja kliničara da detektuju biomarker ili biomarkere koji bi samostalno ili u kombinaciji sa drugim alatima omogućili još kvalitetniju regrutaciju ispitanika kojima je tiroidektomija zaista potrebna. Studija Samardžića i aut. je analizirala biomarkere u ispirku bioptata TN i pokazala da nivo tiroglobulina u ispirku (TGw) pozitivno koreliše sa Bethesda kategorijom citološkog nalaza bioptata TN, dok nivo NOw pozitivno koreliše sa EU-TIRADS kategorijama. Tako se kod četvoro od petoro tiroidektomisanih ispitanika registrovala pripadnost EU-TIRADS kategorijama 4 i 5. Potencijal NOw i TGw kao pomoćnog alata za preciziranje prirode TN je nedvosmislen, te u budućim kliničkim studijama treba analizirati njihovu pojedinačnu i pridruženu prediktivnost u definisanju malignih TN na većoj populaciji ispitanika.7. Srpski kongres o štitastoj žlezdi : Finalni program i Zbornik sažetaka : Oktobar 13-14, 2022, Beogra

Chronic idiopathic portal vein thrombosis: A case study

Tromboza portne vene (TPV) je retko oboljenje splanhničke cirkulacije, koje najčešće nastaje sadejstvom više lokalnih i/ili sistemskih faktora. Ukoliko TPV komplikuje osnovnu bolest, ona pogoršava njenu prognozu, a konkomitantno se leče obe. Iako se najčešće javlja u sklopu ciroze jetre, malignih bolesti abdominalnih organa i nekih hemopatija, postoji i idiopatska TPV, koja se definiše ekskluzijom svih poznatih uzroka TPV. U ovom radu je prikazan slučaj hronične idioptaske TPV.Portal vein thrombosis (PVT) is a rare disorder of splanchnic circulation, frequently caused by concomitant presence of local and/or systemic factors. When portal vein thrombosis complicates causative diseases, it will worsen their prognosis, and in such a case, the causative disease and PVT are treated concomitantly. Despite the fact that PVT frequently complicates liver cirrhosis, intraabdominal malignancies, and some hematological diseases, after all causes are excluded, one can define idiopathic portal vein thrombosis. In this study we have described the case of idiopathic chronical portal vein thrombosis

Uhvaćen je stari lisac - stafilokokni toksični šok sindrom kod odraslog muškarca - prikaz slučaja

Staphylococcal toxic shock syndrome (STSS) is typically detected in newborns and children but can be seen in adults occasionally. In such a case, it points out usually on some immune system dysfunction. We present a case of a critically-ill adult male with STSS and symptoms and signs of serious systemic infection (hemodynamic instability, acute renal failure, mental confusion). After the completion of applied treatment (antistaphylococcal antimicrobials, hemodialysis, vasopressor, supportive, and symptomatic therapy), complete restoration of presented patients' derangements was achieved. Timely diagnosis and appropriate treatment is the mainstay in the management of STSS in adults.Stafilokokni toksični šok sindrom (STŠS) se obično javlja kod novorođenčadi i dece, ali se povremeno može javiti i kod odraslih. U tom slučaju, obično ukazuje na disfunkciju imunog sistema. Prikazan je slučaj kritično-obolelog odraslog muškarca sa STŠS i simptomima i znacima životno-ugrožavajuće sistemske infekcije (hemodinamska nestabilnost, akutna insuficijencija bubrega, konfuzija). Nakon završenog lečenja (anti-stafilokoni antibiotici, hemodijaliza, vazopresori, suportivna i simptomatska terapija), postignuta je potpuna remisija kod obolelog. Pravovremena dijagnostika i adekvatan tretman je glavno uporište u lečenju STŠS kod odraslih

Malignancy-related hyponatremia: Case report

Hiponatrijemija je čest elektrolitski poremećaj kod hospitalizovanih bolesnika. Nakon potvrđivanja laboratorijskog nalaza, potrebno je pojavu hiponatrijemiju etiološki razjasniti. Prikaz bolesnika: Bolesnica stara 56 godina, hospitalizovana je zbog evaluacije grčeva nogu i malaksalosti. U biohemijskim nalazima se registruje hipotona hiponatrijemija, te je posumnjano na SIADH (engl. Syndrome of Inappropriate Antidiuretic Hormone Secretion). Evaluacijom SIADH-a, nije nađen uzrok hiponatrijemije. Primenom simptomatske terapije i korekcijom hiponatrijemije, pacijentkinja je otpuštena lako poboljšana. Četiri meseca nakon hospitalizacije, javlja se konfuzna, sa gušenjem, sindromom hiperglikemije i teškim opštem stanjem. Pored toga, kod pacijentkinjw su laboratorijski potvrđene hipotone hiponatrijemije, ultrasonografijom abdomena su viđene metastatske promene na jetri. Ubrzo nakon prijema, dolazi do smrtnog ishoda. Rodbina je odbila obdukciju, te primarno ishodište malignoma nije utrvđeno. Hipotona hiponatrijemija zahteva ozbiljnu kliničku evaluaciju. SIADH je najčešći uzrok hipotone hiponatrijemije, a najvažniji uzrok SIADH-a je maligna bolest. Pažljiva korekcija hiponatrijemije i lečenje osnovne bolesti je osnova lečenja SIADH-a.Hyponatremia is a common electrolyte disorder in hospitalized patients. In the case of repetitive biochemically confirmed hyponatremia, it is necessary to find its cause. Case report: a 56-year-old woman was admitted to hospital due to leg cramps and malaise. Routine biochemical analysis revealed hypotonic hyponatremia and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) was suspected. The cause of hyponatremia was not discovered by means of evaluating SIADH. The patient was simptomatically treated, and discharged in better general condition, with partially corrected hyponatremia. She was advised to restrict water intake and to repeat serum electrolytes and BUN regularly. Four months later, she presented with dyspnea and hyperglycemic syndrome, she was confused and her life was threatened. Beside severe hyponatremia and hyperglycemia, an urgent abdominal ultrasonography showed liver secondaries. Shortly after admission, the patient passed away. Unfortunately, the patient's family refused an autopsy, so the origin of neoplasia has remained unknown. It is necessary to do a thorough clinical evaluation of hypotonic hyponatremia. SIADH, as the most frequent cause of hypotonic hyponatremia, is often a paraneoplastic syndrome. Careful correction of hypotonic hyponatremia and management of the underlying disease is the mainstay of SIADH treatment