PHYSICAL ACTIVITY AND DIABETES MELLITUS

Sve veća učestalost šećerne bolesti povezuje se s prihvaćanjem netradicionalnih načina prehrane i prakticiranjem „sjedilačkog načina života“. Liječenje šećerne bolesti sastoji se od promjene životnog stila što uključuje promjenu fizičke aktivnosti, tipa i učestalosti prehrane te uzimanje specifi čne terapije. Fizička aktivnost je dio temeljnog liječenja dijabetesa; ima dokazane koristi u smanjenju inzulinske rezistencije, poboljšanju glikemijske kontrole, lipidnog profi la, u normalizaciji tjelesne mase i povećanju kardiorespiracijske sposobnosti. Vježbanje može smanjiti potrebu za lijekovima i usporiti razvoj nekih dijabetičkih komplikacija. U osoba koje se liječe od šećerne bolesti postoje i određena ograničenja, što se uglavnom odnosi na one s prisutnim komplikacijama. Prije započinjanja programa fizičke aktivnosti preporučuje se učiniti medicinsku evaluaciju te dati adekvatne upute. Tjelovježba se prakticira uz spoznaju da za vrijeme i poslije intenzivnih vježbi glukoza u plazmi pada zbog njene povećane potrošnje, ali i povećane inzulinske osjetljivosti. Bolesnici koji su liječeni inzulinom ili inzulinskim sekretagozima imaju veći rizik od hipoglikemije pa se količina unesenih kalorija prilagođava tipu i intenzitetu fzičke aktivnosti, daju se jasne upute glede prilagodbe terapije prije i/ili nakon tjelovježbe. Šećerna bolest nije prepreka za bavljenje sportom, no zahtijeva angažiranost i znanje, kako medicinskog tima koji prati bolesnika, tako i bolesnika s šećernom bolešću samog.The increasing incidence of diabetes is associated with constant lifestyle changes including non-traditional dietary patterns and lack of physical activity, i.e. sedentary lifestyle. Basic treatment of diabetes involves healthy eating (modification of type and frequency of meals), regular exercise and, in some cases, diabetes medication or insulin therapy. Physical activity is always part of the basic treatment of diabetes. It is also important as a specific aspect of health promotion and disease prevention. There are many proven benefits of exercise in diabetes, e.g., reduction of insulin resistance, improvement of glycemic control and lipid profile. Exercise also reduces body weight and increases cardiorespiratory capacity. The benefi ts of physical activity improve most of the metabolic abnormalities in type 2 diabetes. Exercise can even reduce the demand for drugs and slow development of some diabetic complications. One of the easiest and most appropriate types of physical activity is walking. It is recommended that individuals perform moderate physical activity for 30 minutes daily, i.e. moderate-to-vigorous intensity aerobic exercise at least 5 days a week, or a total of 150 minutes per week. Even small increases in physical activity show benefit. Prior to starting an exercise program, diabetic patients should be screened for the presence of macro- and microvascular complications. Some chronic complications may worsen with exercise and these patients have some limitations regarding duration and type of physical activity. There is specific activity limitation in diabetic retinopathy, ischemic heart disease and for diabetic patients with loss of protective sensation. Patients should be instructed to wear proper footwear and examine their feet daily for lesions. During and after intense exercise, plasma glucose falls due to the increased glucose utilization and increased insulin sensitivity. Hypoglycemia can occur during, immediately after, or hours after exercise. With proper instructions, hypoglycemia can be avoided. Patients treated with insulin or insulin secretagogues have a risk of hypoglycemia. Such patients should be instructed to modify the amount of calories according to the type of activity and body weight. It is necessary to give instructions about customization of therapy before and/or after exercise. For people with type 1 diabetes willing to exercise (especially those planning professional sports or extreme exercise), it is important to balance insulin doses with food and activity. Blood glucose must be self-monitored and response to physical activity evaluated; if blood glucose is initially too low or too high, exercise must be delayed. For such patents, insulin pump therapy is a good solution; a number of professional athletes are treated with insulin pumps. The majority of people with diabetes can exercise safely as long as certain precautions are taken. Patients with diabetes should be able to enjoy sports and many benefits of physical activities. Finally, diabetes is not an obstacle to participation in sports, although it requires commitment and knowledge of both the medical team and the patient. When choosing the type of physical activity, personal preference must be also taken in consideration

Carcinoma of the parathyroid gland: a case report

Carcinoma of the parathyroid gland causes 0.005% of all malignancies. Although the etiology remains unknown, possible contributing factors include neck radiation, chronic secondary hyperparathyroidism due to kidney failure, and vitamin D deficiencies. It occurs in syndromes such ahyperparathyroidism-jaw tumor syndrome, multiple endocrine neoplasia types 1 and 2A, and familial isolated hyperparathyroidism

Information Retrieval and Terminology Extraction In Online Resources for Patients with Diabetes

Terminology use, as a mean for information retrieval or document indexing, plays an important role in health literacy. Specific types of users, i.e. patients with diabetes need access to various online resources (on foreign and/or native language) searching for information on self-education of basic diabetic knowledge, on self-care activities regarding importance of dietetic food, medications, physical exercises and on self-management of insulin pumps. Automatic extraction of corpus-based terminology from online texts, manuals or professional papers, can help in building terminology lists or list of “browsing phrases” useful in information retrieval or in document indexing. Specific terminology lists represent an intermediate step between free text search and controlled vocabulary, between user’s demands and existing online resources in native and foreign language. The research aiming to detect the role of terminology in online resources, is conducted on English and Croatian manuals and Croatian online texts, and divided into three interrelated parts: i) comparison of professional and popular terminology use ii) evaluation of automatic statistically-based terminology extraction on English and Croatian texts iii) comparison and evaluation of extracted terminology performed on English manual using statistical and hybrid approaches. Extracted terminology candidates are evaluated by comparison with three types of reference lists: list created by professional medical person, list of highly professional vocabulary contained in MeSH and list created by non-medical persons, made as intersection of 15 lists. Results report on use of popular and professional terminology in online diabetes resources, on evaluation of automatically extracted terminology candidates in English and Croatian texts and on comparison of statistical and hybrid extraction methods in English text. Evaluation of automatic and semi-automatic terminology extraction methods is performed by recall, precision and f-measure

Medical students\u27 attitudes towards terminology of obesity

Introduction: Obesity, one of the most common health problems encountered in medicine with implications in various other health issues, is nowadays omnipresent. Terminology describing diagnosis of obesity might be considered rude or offensive. Since perception of obese people is sometimes associated with negative attitudes and stereotypes, proper terminology used by physicians is crucial

Insulinoma as a rare cause of hypoglycemia - a case report

Insulinoma is a rare neuroendocrine tumor originating from pancreatic β- cells. Hypoglycemia is seen in patients with diabetes treated with insulin and sulfonylureas, alcohol abuse, and starvation. Severe spontaneous hypoglycemia is uncommon and can be caused by this rare tumor

Information Retrieval and Terminology Extraction In Online Resources for Patients with Diabetes

Terminology use, as a mean for information retrieval or document indexing, plays an important role in health literacy. Specific types of users, i.e. patients with diabetes need access to various online resources (on foreign and/or native language) searching for information on self-education of basic diabetic knowledge, on self-care activities regarding importance of dietetic food, medications, physical exercises and on self-management of insulin pumps. Automatic extraction of corpus-based terminology from online texts, manuals or professional papers, can help in building terminology lists or list of “browsing phrases” useful in information retrieval or in document indexing. Specific terminology lists represent an intermediate step between free text search and controlled vocabulary, between user’s demands and existing online resources in native and foreign language. The research aiming to detect the role of terminology in online resources, is conducted on English and Croatian manuals and Croatian online texts, and divided into three interrelated parts: i) comparison of professional and popular terminology use ii) evaluation of automatic statistically-based terminology extraction on English and Croatian texts iii) comparison and evaluation of extracted terminology performed on English manual using statistical and hybrid approaches. Extracted terminology candidates are evaluated by comparison with three types of reference lists: list created by professional medical person, list of highly professional vocabulary contained in MeSH and list created by non-medical persons, made as intersection of 15 lists. Results report on use of popular and professional terminology in online diabetes resources, on evaluation of automatically extracted terminology candidates in English and Croatian texts and on comparison of statistical and hybrid extraction methods in English text. Evaluation of automatic and semi-automatic terminology extraction methods is performed by recall, precision and f-measure

GLYCEMIC CONTROL IN DIABETES MELLITUS PATIENTS WITH CHRONIC KIDNEY DISEASE – HOW TO CHOOSE HYPOGLYCEMIC AGENT?

Liječenje hiperglikemije kod bolesnika s kroničnom bubrežnom bolešću je kompleksno, a ciljevi i načini postizanja glikemijske kontrole nisu jasno definirani. Iako je agresivno sniženje hiperglikemije korisno u ranim stadijima dijabetičke nefropatije, podatci o jasnoj koristi ovakvog liječenja u uznapredovaloj bubrežnoj bolesti nedostaju. Poseban izazov u liječenju ovih bolesnika su zahtjevne i učestale kontrole koje su neophodne kod ovih bolesnika, ali i kompleksnost dostupnih metoda liječenja. U ovom osvrtu učinjen je pregled svih trenutno dostupnih hipoglikemijskih lijekova, opisan je njihov mehanizam djelovanja s osvrtom na indikacije i kontraindikacije s obzirom na stadij bubrežnog oštećenja. Cilj rada je pomoći liječniku obiteljske medicine u donošenju ispravne terapijske odluke sukladno postavljenom glikemijskom cilju i stanju bubrežne funkcije.The management of hyperglycemia in patients with chronic kidney disease (CKD) is complex, and the goals and methods regarding glycemic control are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD are lacking. Challenges in the management of such patients include monitoring diffi culties and the complexity of available treatments. In this article, we review the current treatment options for patients with diabetes and CKD discussing all hypoglycemic agents that currently are available, as well as insulin, along with their indications and contraindications. The aim is to provide useful information to family physicians when deciding on individualized glycemic goals and appropriate therapy for patients with early or end stages of CKD

Miastenična kriza kao nuspojava liječenja metimazolom: Prikaz slučaja

Myasthenia gravis and Graves’ disease are two autoimmune diseases with a similar mechanism, both having circulating organ autoantibodies and cell specific autoantibodies. It is not unusual for these diseases to occur together. There is a large body of data proving that antithyroid drugs such as methimazole and propylthiouracil have an immunomodulatory effect in addition to their thyrosuppressant action. This case report describes a 34-year-old woman hospitalized for just diagnosed myasthenic crisis (Osserman IV). She had a prior history of hyperthyroidism and treatment with methimazole was initiated. However, improvement in thyroid disease led to the burst of myasthenia. The phenomenon described as worsening of one disease while improving the other, the so-called ‘see-saw’ relationship, occurred in this case. The question is whether antithyroid drugs improve hyperthyroidism while unveiling or worsening myasthenia. Is the ‘see-saw’ relationship actually a therapeutic side effect of antithyroid drug? The proposed mechanism of methimazole action is intracellular: it lowers the level of proliferating cell nuclear antigen (PCNA). PCNA pro¬motes selective apoptosis in some T lymphocyte clones. In this way, CD4+CD25+ regulatory T cells might ‘skip’ immune self-tolerance and autoantibodies against acetylcholine receptor may occur. Do antithyroid drugs actually create an immune ‘thymic surrounding’?Miastenija gravis i Gravesova bolest su dvije autoimune bolestI sa sličnim mehanizmom nastanka, u objema se nalaze cirkulirajuća antitijela te stanično specifična autoantitijela. Pojava navedenih bolesti zajedno nije neuobičajena. Postoji mnogo podataka koji pokazuju da antitireoidni lijekovi kao što su metimazol i propiltiouracil uz tireosupresivno djelovanje imaju i imunomodulacijski učinak. Opisuje se slučaj 34-godišnje bolesnice koja je hospitalizirana zbog prvi puta dijagnosticirane miastenije sa slikom miastenične krize (Osserman IV.). U njenoj ranijoj povijesti bolesti navodila se hipertireoza, zbog čega je započeto liječenje metimazolom. Međutim, uz poboljšanje bolesti štitnjače došlo je do pojave miastenije. Fenomen “klackalice”, tj. see-saw relationship, je pojava opisana kao poboljšanje jedne bolesti za vrijeme pogoršanja druge. Pitanje je poboljšavaju li antitireoidni lijekovi hipertireozu, u isto vrijeme razotkrivajući ili pogoršavajući miasteniju?. Jeli fenomen “klackalice” zapravo nuspojava tireostatika? Pretpostavljeni učinak metimazola je unutarstanični: on snižava razinu nuklearnog antigena stanične proliferacije (PCNA). PCNA potiče selektivnu apoptozu u nekim klonovima T limfocita. Na taj bi način CD4+CD25+ regulatorni T limfociti mogli ‘zaobići’ imunu toleranciju prema vlastitom tkivu te dovesti do pojave autoantitijela protiv acetilkolinskog receptora. Stvaraju li zapravo doista antitireoidni lijekovi okruženje slično onome u timusu