Correlation between Cholelithiasis and Gallbladder Carcinoma in Surgical and Autopsy Specimens

Gallbladder (GB) cancer is the most common malignant lesion of the biliary tract. The decision for a cholecystectomy in asymptomatic cholelithiasis as a measure of the secondary prevention of gallbladder cancer is based on the data of incidence and selected predictive factors for a specific population. A consecutive series of 3351 cholecystectomies in five year period was reviewed. That data was compared with the data from 2395 consecutive autopsies from the same period. Possible risk factors for gallbladder cancer were analysed. In surgical specimens, the incidence of gallbladder carcinoma was 0.62%. Of those, 24% were in patients younger than 60 years and 95.24% were associated with cholelithiasis. In autopsy material, in cases in which cholelithiasis was present, the incidence of gallbladder carcinoma was 3.4%. All cases were in patients older than 60 years and all were associated with cholelithiasis. Correlation between cholelithiasis and gallbladder carcinoma was most significant for women in the surgical group while it was not as strong for men or in the autopsy group. The results vary whether we analyse surgical or autopsy material, but in both cases female gender and the duration of cholelithiasis were significant risk factors. In our population GB cancer is not uncommon in elderly women with gall stones and is diagnosed in advanced stage if one waits for symptoms

PRECIPITATING FACTORS AND CLINICAL FEATURES OF DIABETIC KETOACIDOSIS

vod: Dijabetička ketoacidoza (DKA) jedna je od najozbiljnijih akutnih komplikacija šećerne bolesti (ŠB). Pojedina istraživanja su pokazala da su infekcije precipitirajući čimbenik u polovice ispitanika. Nekoliko novijih istraživanja naglašava da je loše pridržavanje liječenja također česti uzrok DKA. Cilj: Identifi cirati najčešće precipitirajuće čimbenike za DKA u Republici Hrvatskoj. Ispitanici i postupci: Ovo retrospektivno multicentrično istraživanje uključivalo je bolesnike sa ŠB-om tipa 1 ili tipa 2 s dijagnozom DKA između 1. siječnja 2014. i 31. prosinca 2018. i liječenih u 5 različitih središta za liječenje ŠB-a: Dubrovnik, Našice, Split, Zagreb i Osijek. U analizu je uključena samo prve epizoda DKA. Pacijenti koji boluju od steroidnog ŠB-a i ŠB-a zbog endokrinih poremećaja kao što su akromegalija i Cushingov sindrom bili su isključeni. Rezultati: Istraživanjem je obuhvaćeno 160 bolesnika (55 % muškaraca), od kojih je 68% imalo ŠB tip 1. Srednja dob ispitanika bila je 42 godine (od 18 do 89). Najčešći uzrok DKA bila je infekcija (57 %), zatim slabo kontrolirani ŠB (37 %) i prva prezentacija ŠB-a (9 %), dok je u 7% bolesnika DKA bila uzrokovana ostalim uzrocima kao što su kvar inzulinske pumpe, moždani ili srčani udar. U skupini bolesnika s infekcijama najčešće su bile infekcije mokraćnog sustava (30 %), probavne infekcije (30 %) i infekcije respiratornog trakta (19 %), dok je 21 % bolesnika imalo druge izvore infekcije. U 36 ovih bolesnika uz infekciju je bio prisutan i prethodno loše kontroliran ŠB, a u 12 % DKA uzrokovana infekcijom bila je prvo očitovanje bolesti. U bolesnika sa ŠB-om tipa 2 infekcije su češće bile uzrok DKA nego u bolesnika sa ŠB-om tipa 1 (P < 0,05). U bolesnika sa ŠB-om tipa 1, slabo regulirana glikemija je češće uzrok DKA (31%) nego u bolesnika sa ŠB-om tipa 2 (18 %). Zaključak: Najčešći precipitirajući čimbenici za razvoj DKA su infekcije i loša regulacija ŠB-a. Potrebna je bolja edukacija bolesnika o važnosti redovite primjene inzulina i korekcije terapije tijekom akutne bolesti.Introduction: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus (DM). In some studies, infections have been found to be a precipitating factor in more than half of the subjects. On the other hand, several recent studies emphasize that poor treatment adherence is also a common cause of DKA. Objective: To identify the most common precipitating factors for DKA in Croatia. Patients and Methods: This retrospective, multicenter study included DM type 1 or DM type 2 patients diagnosed with DKA between January 1, 2014 and December 31, 2018, and treated in 5 different DM treatment centers, i.e., Dubrovnik, Našice, Split, Zagreb and Osijek. Only the fi rst episode of DKA was included in the analysis. Patients receiving steroids and DM due to endocrine disorders such as acromegaly and Cushing\u27s syndrome were excluded. Results: The study included 160 patients (55% of men), of whom 68% had DM type 1. The mean age of the respondents was 42 (18-89) years. The most common cause of DKA was infection (57%), followed by poorly controlled DM (37%) and fi rst presentation of DM (9%), while in 7% of patients DKA was due to other causes such as insulin pump failure, stroke or myocardial infarction. In the group of patients with infections, urinary tract infections (30%), gastrointestinal infections (30%) and respiratory tract infections (19%) were most common, whereas 21% of patients had other sources of infection. In 36% of these patients, the infection was associated with previously poorly controlled diabetes, and in 12% of them, DKA caused by the infection was the fi rst manifestation of the disease. In patients with type 2DM, infections were more often the cause of DKA than in patients with type 1DM (p<0.05).Poorly controlled glycemia appeared to be a more frequent cause of DKA in patients with type 1 DM (31%) than in patients with type 2 DM (18%). Conclusion: The most common precipitating factors for the development of DKA were infections and poor diabetes management. Better education of patients about the importance of regular insulin administration and correction of therapy in acute illness could reduce the risk of DKA

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

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

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