Amiodaron i tiroidna disfunkcija

Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves’ (Basedow’s) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto’s thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.Štitna žlijezda zauzima ključno mjesto u održavanju homeostaze cijeloga organizma. Temeljni hormon koji luči je tiroksin, a učinak se dominantno ostvaruje nakon unutarnje konverzije tiroksina u aktivniji oblik, trijodotironin, koji pokazuje veći afinitet za receptorski kompleks te time modificira gensku ekspresiju ciljnih stanica. Amiodaron je jedan od najčešće upotrebljavanih antiaritmika i rabi se u liječenju širokog spektra aritmija, najčešće tahiaritmija. U svom sastavu sadrži velik udio joda, što je, uz intrinzični učinak lijeka, temelj utjecaja na tireoidnu funkciju. Smatra se kako 15%-20% bolesnika liječenih amiodaronom razvija neki oblik tireoidne disfunkcije. Amiodaron može biti uzrokom razvoja amiodaronom izazvane hipotireoze (amiodarone-induced hypothyroidism, AIH) ili amiodaronom izazvane tireotoksikoze (amiodarone-induced thyrotoxicosis, AIT). AIT se češće razvija u područjima sa smanjenim, dok se AIH razvija u područjima s dovoljnim unosom joda. Razlikujemo dva tipa AIT; tip 1 je češći u bolesnika s podležećom tireoidnom patologijom, najčešće nodoznom strumom ili latentnom Gravesovom (Basedowljevom) bolešću, dok se tip 2 najčešće razvija u prethodno zdravoj štitnjači. AIH je znatno češća u bolesnika s otprije poznatim Hashimotovim tireoiditisom. Opisani su i miješani oblici bolesti. Bolesnike liječene amiodaronom potrebno je redovito pratiti, laboratorijski i klinički, kako bi se pravodobno otkrila bilo kakva odstupanja u tireoidnoj funkciji. Temelj liječenja AIH-a je nadomjesna terapija levotiroksinom. Često u tim slučajevima nije potrebno izostavljati amiodaron iz terapije. AIT tipa 1 liječi se tireostaticima, kao i ostale tireotoksikoze. Ako je moguće, preporuča se prekinuti podležeća amiodaronska terapija. Nasuprot AIT tipa 1, temeljni patofiziološki supstrat kojega je povećana sinteza i otpuštanje tireoidnih hormona, u AIT tipu 2 osnova je destruktivni tireoiditis uzrokovan amiodaronom, dezetilamiodaronom kao njegovim glavnim metabolitom i povećanim unosom joda. Osnova liječenja tog tipa bolesti je glukokortikoidna terapija

Insulin Resistance and Diabetic Autonomic Neuropathy

Autonomna dijabetička neuropatija važna je kronična komplikacija šećerne bolesti koja se očituje u više organskih sustava, a udružena je s padom kvalitete života te povećanim mortalitetom i morbiditetom osoba oboljelih od šećerne bolesti. Točan patološki mehanizam odgovoran za ovo oštećenje nije poznat. Epidemiološka ispitivanja upozorila su na povezanost hiperinzulinemije i povećane aktivnosti simpatičkog dijela autonomnoga živčanog sustava. Na temelju rezultata više ispitivanja potomaka osoba oboljelih od tipa 2 šećerne bolesti (koji su često rezistentni na inzulin uz još uvijek urednu toleranciju glukoze) smatra se da su inzulinska rezistencija i kompenzatorna hiperinzulinemija rane patofi ziološke promjene vezane uz razvoj autonomne disfunkcije koja pak kasnije utječe na razvoj arterijske hipertenzije i tipa 2 šećerne bolesti. U ispitivanjima srčane autonomne regulacije na istome modelu uočeno je statistički značajno povišenje srčane frekvencije uz povišenje omjera simpato-vagalnog kardijalnog tonusa. Rezultati navedenih ispitivanja govore u prilog ranijem pojavljivanju autonomne disfunkcije nego što se do sada smatralo, vežući ju uz parenteralni tip 2 šećerne bolesti. Pokušaji liječenja autonomne dijabetičke neuropatije nisu zadovoljili. Inzistiranje na poboljšanju glukoregulacije najčešće nije praćeno poboljšanjem simptoma dijabetičke neuropatije. Osnovu liječenja ovog poremećaja čine izbjegavanje neurotoksina (alkohola), primjena antioksidansa i simptomatska terapija, a opisan je i mogući povoljan učinak liječenja metforminom.Diabetic autonomic neuropathy is an important chronic complication of diabetes that affects many physiological systems and is associated with a signifi cant deterioration in the quality of life and increased morbidity and mortality. The exact pathological mechanism responsible for this damage is unknown. Epidemiological studies have shown that insulin resistance and hyperinsulinism are associated with an increased sympathetic nervous system activity. Based on the results of research in children of type 2 diabetic patients (who are often insulin resistant despite normal glucose tolerance), it is considered that insulin resistance and compensatory hyperinsulinemia represent early pathophysiological changes related to the development of autonomic dysfunction. The latter is responsible for the subsequent development of hypertension and/or type 2 diabetes. In autonomic cardiac regulation studies performed on the same model, a statistically signifi cant increase in heart rate and sympatho-vagal cardiac tone ratio was observed. The results of these studies suggest that autonomic dysfunction develops earlier than previously thought, connecting it to parenteral type 2 diabetes. The treatment of diabetic neuropathy is less than satisfactory. Most often, the improved glycemic control is not accompanied with the improvement in diabetic neuropathy symptoms. The mainstays of therapy are avoidance of neurotoxins (alcohol), administration of antioxidants and symptomatic treatment. Possible favorable effects of metformin were also described

Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study

AIM: To validate Systemic Lupus International Collaborating Clinics (SLICC)-12 and American College of Rheumatology (ACR)-97 classification criteria on a patient cohort from the University Hospital Center Zagreb. ----- METHODS: This retrospective study, conducted from 2014 to 2016, involved 308 patients with systemic lupus erythematosus (SLE) (n=146) and SLE-allied conditions (n=162). Patients' medical charts were evaluated by an expert rheumatologist to confirm the clinical diagnosis, regardless of the number of the ACR-97 criteria met. Overall sensitivity and specificity, as well as the sensitivity and specificity according to disease duration, were compared between ACR-97 and SLICC-12 classifications. Predictive value for SLE for both classifications was assessed using logistic regression and receiver operating characteristic (ROC) curves. ----- RESULTS: The SLICC-12 criteria had significantly higher sensitivity in early disease, which increased with disease duration. The ACR-97 criteria had higher specificity. The specificity of the SLICC-12 criteria was low and decreased with disease duration. Regression analysis demonstrated the superiority of the SLICC-12 classification criteria over the ACR-97 criteria, with areas under the ROC curve of 0.801 and 0.780, respectively. ----- CONCLUSION: Although the SLICC-12 criteria were superior to the ACR-97 and were more sensitive for diagnosing early SLE, their specificity in our population was too low. The sensitivity of the SLICC-12 classification is increased by better defined clinical features within each criterion. Our results contribute to the current initiative for developing new criteria for SLE

The diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study

Introduction: The evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon’s definite decision. Materials and methods: The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip. Results: The control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P = 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip). Conclusions: Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value

Laparoskopski pristup u liječenju morgagnijeve hernije: tri prikaza slučaja

We report on three cases of diaphragmatic (Morgagni) hernia with different clinical presentation. It is important to consider the possibility of this rare but potentially very dangerous condition in patients with respiratory problems and pain in the upper abdomen. Before laparoscopy, two different approaches were used in diaphragmatic hernia operations (abdominal and thoracic approach). Laparoscopy has brought significant changes in the treatment of diaphragmatic hernia. It is important to stress that laparoscopic diaphragmatic surgical therapy uses stronger mesh than the mesh used to repair an inguinal hernia.Prikazuju se tri bolesnika s dijafragmalnom, Morgagnijevom hernijom, ali s različitim kliničkim slikama. Važno je posumnjati na ovu rijetku, ali potencijalno vrlo opasnu bolest kod bolesnika s respiracijskim problemima i bolovima u gornjem dijelu trbuha. Prije uvođenja laparoskopije postojala su dva otvorena pristupa liječenju dijafragmalnih hernija, abdominalni i torakalni. Laparoskopija je donijela znatne promjene u liječenju dijafragmalne kile. Treba naglasiti da se u laparoskopskom pristupu koriste čvršće mrežice za pokrivanje kilnog otvora nego za preponske kile

Recommendations of the Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association for people with diabetes and healthcare professionals in the Republic of Croatia during COVID-19 pandemic

Radna skupina Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora pripremila je smjernice za postupanje u pandemiji COVID-19 za osobe sa šećernom bolešću i za zdravstvene djelatnike. U preporukama su naglašeni razmjeri pandemije i moguće posljedice za oboljele od šećerne bolesti. Opisana je klinička slika i ponovljene smjernice Nacionalnog stožera civilne zaštite kako se osobe od šećerne bolesti mogu zaštititi i što trebaju činiti za dobru regulaciju glikemije. Predložene su mjere koje trebaju provoditi zdravstvene ustanove koje skrbe o bolesnicima sa šećernom bolešću i načela zbrinjavanja glikemije u hitnom prijemu i tijekom hospitalizacije.The Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association has prepared recommendations for people with diabetes and healthcare professionals in the age of COVID-19 pandemic. The recommendations emphasized the scale of the pandemic and the possible consequences for those suffering from diabetes. Enclosed are clinical presentation and directions of the National civil protection headquarters on the methods that enable people with diabetes to protect themselves, and maintain their blood glucose in target range as well. Measures have been proposed to be implemented by healthcare facilities that deliver care for patients with diabetes, and the principles of glycemic control in emergency department and during hospitalization

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

Ružička days : International conference 16th Ružička Days “Today Science – Tomorrow Industry” : Proceedings

Proceedings contains articles presented at Conference divided into sections: open lecture (1), chemical analysis and synthesis (3), chemical and biochemical engineering (8), food technology and biotechnology (8), medical chemistry and pharmacy (3), environmental protection (11) and meeting of young chemists (2)

Obstruction of left ventricular outflow tract by a calcified mass at mitral valve

A case of an unusual left ventricular outflow tract obstruction by mitral valve pathology in a 35-year old female with diabetes and end-stage renal disease is presented in the study. The patient sufferedfrom fever of an unknown origin after lower-leg amputation. Although the wound healed well, fever persisted for three weeks despite a triple antibiotic treatment until the infection was resolved with vancomycin.Three months later echocardiography displayed a floating mass attached to mitral valve, producing a newly developed systolicmurmur and a mild haemodynamic obstruction of the left ventricular outflow tract. The calcified vegetation was probably formed during an unrecognized subacute infective endocarditis