The Jubilees of the Discovery of Insulin & Glycemic Index: Where Conventional meets Complementary Medicine in the Management of Diabetes Mellitus

This year we marked two important jubilees in the management of diabetes mellitus: one is the discovery of insulin 90 years ago and the other one is the introduction of the Glycemic Index, 60 years later, both originated at the University of Toronto, Canada. Both discoveries can help to improve diabetes tremendously and thus have contributed to the advancement of management of this troubling disease the incidence of which continues to climb at a staggering rate

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods

The Jubilees of the Discovery of Insulin & Glycemic Index: Where Conventional meets Complementary Medicine in the Management of Diabetes Mellitus

This year we marked two important jubilees in the management of diabetes mellitus: one is the discovery of insulin 90 years ago and the other one is the introduction of the Glycemic Index, 60 years later, both originated at the University of Toronto, Canada. Both discoveries can help to improve diabetes tremendously and thus have contributed to the advancement of management of this troubling disease the incidence of which continues to climb at a staggering rate

INTEGRATED PROTECTION OF WHEAT AGAINST Fusarium graminearum

Fuzarijska palež klasova (FHB) pšenice ekonomski je značajna bolest koja može imati nepovoljne posljedice na prinos i kvalitetu pšenice. Do danas ne postoji mjera zaštite koja osigurava potpunu zaštitu usjeva pšenice, ali kombinacija više mjera može dati dobre rezultate. Učinkovitost svake pojedine mjere pod utjecajem je okolišnih uvjeta koji prevladavaju tijekom vegetacijske sezone, a učinkovitost će ovisiti i o osjetljivosti pojedine sorte na FHB. Sve veći broj istraživanja potvrđuje kako je integrirana zaštita bilja (IZB) ključ za što uspješniju borbu protiv FHB-a. Kako bi primijenjene mjere zaštite bile što uspješnije, od iznimne je važnosti dobro poznavati uzročnika bolesti, njegov životni ciklus i ekologiju. Budući da je F. graminearum dominantni uzročnik FHB-a na području Republike Hrvatske, osobiti naglasak je stavljen na sve dostupne mjere zaštite u njegovu suzbijanju.Fusarium head blight (FHB) is an economically devastating disease that may exert an adverse impact on the wheat yield and quality. To date, no measure ensures a complete protection of wheat crops, but the combination of multiple protection measures may produce the promising results. The effectiveness of each measure is influenced by environmental conditions during the growing season and cultivar susceptibility to the FHB. The Integrated Pest Management (IPM) is the most effective approach to the management of FHB. For a successful control, it is essential to acquire a good knowledge of the pathogen, its life cycle, and its ecology. Since the F. graminearum is a predominant species causing the FHB on the wheat in Croatia, this paper aims to describe all available measures for its control

Computer-Aided Evaluation of Radiologist’s Reproducibility and Subjectivity in Mammographic Density Assessment

Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists’ repro- ducibility and subjectivity in breast density estimation and in order to decrease the radiologists’ subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73–1, p<0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651–0.777, p<0.001). Detected dif- ferences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p<0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p<0.001). It can be concluded that the estimation of glandular tissue percent- age in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determina- tion of type of breast (ARCI-IV) depends on the radiologist’s experience. This study showed that software aided determi- nation of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists

Computer-Aided Evaluation of Radiologist’s Reproducibility and Subjectivity in Mammographic Density Assessment

Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists’ repro- ducibility and subjectivity in breast density estimation and in order to decrease the radiologists’ subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73–1, p<0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651–0.777, p<0.001). Detected dif- ferences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p<0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p<0.001). It can be concluded that the estimation of glandular tissue percent- age in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determina- tion of type of breast (ARCI-IV) depends on the radiologist’s experience. This study showed that software aided determi- nation of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists

Tromboliza okludiranog femoropoplitealnog grafta lokalno primenjenim humanim plazminom

Introduction Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin.Uvod Ishemija donjih ekstremiteta je posledica tromboze ili embolizacije obolele nativne arterije ili implantiranog grafta. Postoji nekoliko načina lečenja ishemije: tromboliza kateterom, mehanička trombektomija i hirurško lečenje. Osnovni razlozi za primenu perkutanih intervencija jeste izbegavanje klasičnog hirurškog lečenja kod bolesnika s visokim rizikom, kao i izbegavanje preparisanja krvnog suda u ožiljku. Prikaz bolesnika Muškarac star 67 godina primljen je u bolnicu zbog kritične ishemije donjih ekstremiteta. Po učinjenoj angiografiji dijagnostikovana je tromboza femoropoplitealnog grafta. Okluzija je rešena primenom plazmina uz upotrebu intraarterijskog katetera. Stenoze koje su otkrivene posle trombolize lečene su angioplastikom. Zaključak Trombolizom uz primenu plazmina i intraarterijskog katetera uspešno je izlečena okluzija femoropoplitealnog grafta

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