THE IMPORTANCE OF ANTHROPOMETRIC PAREMETERS IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM

Introduction: The concept of subclinical thyroid disease appeared in the 1980s when sensitive procedures for the measurement of the thyroid-stimulating hormone in the serum were introduced. Subclinical hypothyroidism is defined by the finding of elevated serum TSH concentrations with normal thyroid hormone levels. The incidence of subclinical hypothyroidism with increased cardiovascular risk has not yet been fully clarified. The aim of the study was to identify anthropometric parameters that may indicate an increased cardiometabolic risk in patients with subclinical hypothyroidism. Method: The study will include 140 patients aged 18-65, with 105 patients with subclinical hypothyroidism and a control group of 35 healthy, normally nourished subjects without subclinical hypothyroidism. A program of research will be carried out in all patients and it will include: detailed anamnesis and physical examination, anthropometric measurements (weight measurements, body height, waist circumference, hip circumference, body weight mass measurement by the bioelectrical impedance analysis method (%BFP), calculation of: body mass index (BMI), waist-to-hip circumference ratio (WC/HC), waist-to-height ratio (WC/Ht) and laboratory testing (FT3, FT4, TSH). Results: Examinees with subclinical hypothyroidism had statistically significantly elevated mean TSH values (6.87+1.34 mIU/ml) compared to TSH euthyroid examinees (1.9+.88 mIU/ml). The mean age of subjects with subclinical hypothyroidism was 44.15±11.23 years (MA = 43 years), and in subjects without subclinical hypothyroidism, 33.80±10.60 years (MA = 33 years). In relation to the control group (euthyroid patients), patients with subclinical form of hypothyroidism had higher average mean values and statistically significantly higher incidence of elevated values: BMI (T test=7.465, p<0.0001; c2=35.977, p<0.0001), %BFP (T test=8.594, p<0.0001; c2=44.956, p<0.0001), WC (T test=6.262, p<0.0001; c2=48.865,p<0.0001), and WC/Ht ratio (T test=7.372, p<0.0001; c2=39.175, p<0.0001). The WC/HC ratio in the group with subclinical hypothyroidism was higher than in the group without subclinical hypothyroidism, but not statistically significant (T test=-0.946, p= ns; c2=0.622, p=0). Conclusion: In the subclinical form of hypothyroidism, changes in the degree of nutrition and body weight can already be recorded, which, among other things, contributes to the development of increased cardiometabolic risk

CALCIURIA IN CHILDREN WITH PRIMARY MONO-SYMPTOMATIC NOCTURNAL ENURESIS

Introduction: The prevalence of idiopathic hypercalciuria (IH) in healthy pediatric population ranges from 3.0% to 7.0%. There is insufficient data about IH in children with mono-symptomatic enuresis. The aim of this study was to examine calcium excretion in urine (UCa) in patients with primary mono-symptomatic nocturnal enuresis (PMNE). Methods: In patients with PMNE, aged 5 to 17 years, IH was determined in 24-h urine and from second morning spot urine. The completeness of the 24-h urine collections was estimated via measuring 24h-urine creatinine excretion (UCr) of 0.1–0.2 mmol/kg/24h. Results: Sixty patients with PMNE, 32 males and 28 girls, median age of 9 years were enrolled in the study. Only 41.7% patients successfully completed 24 h urine collection. IH, defined as 24-h UCa >0.1 mmol/kg body weight, was diagnosed in 12% of the patients, while when defined as UCa/UCr >0.8 mmol/mmol in children 5-7 years and >0.6 mmol/mmol in those>7 years, IH was 8.3% and 6.7% from 24h- urine and spot urine, respectively. Conclusion: Children and adolescents with PMNE are in risk of hypercalciuria. Therefore, it is useful to examine 24 hours of urine calcium excretion in these patients

TYPES OF TREMOR IN PATIENTS WITH CEREBROVASCULAR DISEASES AND CARDIOVASCULAR EVENTS

Abstract: Introduction: Tremor can occur as a part of the clinical picture of cerebrovascular diseases. Many patients with cerebral stroke have cardiovascular diseases as a comorbidity or complication of stroke; sometimes cardiovascular events can lead to embolic stroke. Aim: To present types of tremor in patients with cerebrovascular diseases and cardiovascular events and diabetes mellitus type 2, clinical characteristics of tremor and investigations used. Material and methods: In our study we included 36 patients, 24 men and 12 women, that were examined and followed for 3 years, from 2012-2015. All patients were subjected to the following investigations: neurological examination, laboratory analysis, computerized tomography of brain, magnetic resonance imaging and electroencephalography. In cardiovascular patients we also performed Doppler sonography of carotid arteries, electrocardiography, cardiac ultrasound. The patients were examined and treated by cardiologists. Results: Of all patients 22% had cerebral infarction, 41% atherosclerosis, 36% multiple lacunar infarctions and 28% diabetes mellitus type 2. Three patients with cerebral infarction had chorea, hemiballismus, dystonia and dystonic tremor, three had postural tremor and two cerebellar intention tremor. Atherosclerotic patients had atherosclerotic action tremor, while diabetic patients predominantly had with action-type tremor. Electroencephalography showed irritative basic brain activity with slow waves, while carotid arteries stenosis was diagnosed by Doppler sonography. Computerized tomography of the brain and magnetic resonance imaging revealed cerebrovascular diseases in certain areas. Patients with cardiomyopathy, rhythm disorders, high blood pressure, hyperlipidemia was investigated and medically treated by a cardiologist. Conclusion: In cerebrovascular diseases different types of tremor can occur as a result of damage of the extrapyramidal system

BENEFICIAL EFFECTS OF LEVOTHYROXINE IN THE TREATMENT OF SUBCLINICAL HYPOTHYROIDISM

Introduction:Increased cardiovascular risk in thyroid dysfunction is associated with disorders of lipid and lipoproteins, endothelial dysfunction, metabolic, hormonal, hemodynamic changes and coagulation disorders. Subclinical hypothyroidism is characterized by a suprarnormal level of TSH with normal levels of thyroid hormones. The correlation between subclinical hypothyroidism of the lipid profile and cardiovascular outcomes remains unclear. Several intervention studies assessed the effect of levothyroxine therapy on the lipid profile of patients with subclinical hypothyroidism and obtained conflicting results. The aim of the research is to determine whether subclinical hypothyroidism is associated with the atherogenic lipid profile and whether these changes are reversible after the introduction of the L-thyroxine replacement therapy. Method: The study included 51 patients over 50 years of age with subclinical hypothyroidism. All the participants were subjected to an examination programme which included a detailed anamnesis and physical examination, laboratory tests (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, T3, T4, TSH). After eight weeks of levothyroxine therapy, the same laboratory parameters were determined in the patients. Results: Subjects with subclinical hypothyroidism had high average values: TSH (12.77 + 2.78 mIU / ml), total cholesterol (7.55 ± 0.79 mmol / l), LDL cholesterol (5.03 ± 0.61 mmol / l), triglycerides (2.48 ± 1.01 mmol / l); and the average value of HDL cholesterol was within reference values (1.12 ± 0.21 mmol / l). After eight weeks of levothyroxine replacement therapy, there was a statistically significant reduction of average values (p <0.0001): TSH (3.83 ± 1.33 mIU / ml), total cholesterol (6.28 ± 0.96 mmol / l), LDL cholesterol ( 4.03 ± 0.70 mmol / mmol / l l), triglycerides (1.98 ± 0.87 mmol / l); and the average value of HDL cholesterol increased significantly (p <0.0001) (1.32 ± 0.22 mmol / l). Conclusion: Subjects with subclinical hypothyroidism have the atherogenic lipid profile which is corrected after the levothyroxine treatment. Subclinical hypothyroidism can be considered a disorder that leads to increased cardiovascular risk

EPILEPTIC SEZURES AS THE FIRST MANIFESTATION OF THE FRONTOPARIETAL ARTERIOVENOUS MALFORMATION OF THE BRAIN

Introduction: Arteriovenous malformations of the brain include a group of congenital disorders in the early development of arterial-venous blood vessels of the brain. Their clinical presentation is most common in the form of a brain hemorrhage, epileptic seizures, and headaches. Case report: We showed a man who at the age of 28 early in the morning after breakfast had the first generalized tonic-clonic seizure. After the second unprovoked epileptic seizure, antiepileptic therapy was introduced. The brain scanner showed the existence of arteriovenous malformations in the right frontoparietal region. As the size of the malformation was less than 30mm, it was decided that the patient should be treated with Gamma knife radiosurgery. After the successful radiosurgery together with the antiepileptic drugs treatment, the patient is in a stable 1.5 year- long remission of epileptic seizures without neurological failures. Conclusion: Epileptic seizures can be the initial clinical manifestations of arteriovenous malformations of the brain. With an early diagnosis, adequate antiepileptic drugs therapy and neurosurgery, radiosurgery (Gamma Knife), which is often necessary, many symptomatic epilepsies enter a stable remission of epileptic seizures

OCCIPITAL LOBE EPILEPSY OR MIGRAINE HEADACHE

Introduction: Occipital lobe epilepsies are rarely met in clinical practice, but when they occur, they can be misdiagnosed as migraine-like headache. Their prevalence ranges from 5%to 10% of all epilepsies. Seizures can occur at any age; etiologically speaking they can be symptomatic, cryptogenic and idiopathic (most often onsetis in childhood). Clinical symptomatology is manifested by partial epileptic seizures in the sense of visual elementary and/or complex manifestations, palinopsia, amaurosis, tonic head deviation, bulbus, nistagmus and headache. Propagation discharge to neighbour areas (temporal, parietal and frontal) is a frequent occurrence appearing with complex partial seizures frequently finishing with secondary generalized tonic-clonic (GTC) seizures. Case report: We are presenting a17-year-old male patient who has suffered from attacks of visual problemswith headache since 10 years of age. All the time it is treated as a migraine headache. During the last attack of headache the patient also had a loss of consciousness, EEG that was performed for the first time evidenced epileptic discharges of the occipital area. The therapy also included treatment with antiepileptic drug pregabalin resulting in seizure withdrawal. Conclusion: The appearance of visual symptoms followed by headache is most frequently qualified as migraine triggered headache. However, when antimigraine therapy does not give favorable results epileptic headache should be suspected, with obligatory performance of EEG recording. Occipital lobe epilepsy often presents diagnostic dilemmas due to clinical manifestations that are similar to that of non-migraine headache

TYPES OF TREMOR IN PATIENTS WITH CEREBROVASCULAR DISEASES AND CARDIOVASCULAR EVENTS

Introduction: Tremor can occur as a part of the clinical feature of cerebrovascular diseases. Many patients with cerebral stroke have cardiovascular diseases as a comorbidity or complication of stroke; sometimes cardiovascular events can lead to embolic stroke. Aim: To present types of tremor in patients with cerebrovascular diseases and cardiovascular events and diabetes mellitus type 2, clinical characteristics of tremor and investigations used. Material and methods: In our study we included 36 patients, 24 men and 12 women, that were examined and followed for 3 years, from 2012-2015. All patients were subjected to the following investigations: neurological examination, laboratory analysis, computerized tomography of brain, magnetic resonance imaging and electroencephalography. In cardiovascular patients we also performed Doppler sonography of carotid arteries, electrocardiography, cardiac ultrasound. The patients were examined and treated by cardiologists. Results: Of all patients 22% had cerebral infarction, 41% atherosclerosis, 36% multiple lacunar infarctions and 28% diabetes mellitus type 2. Three patients with cerebral infarction had chorea, hemiballismus, dystonia and dystonic tremor, three had postural tremor and two cerebellar intention tremor. Atherosclerotic patients had atherosclerotic action tremor, while diabetic patients predominantly presented with action-type tremor. Electroencephalography showed irritative basic brain activity with slow waves, while carotid arteries stenosis was diagnosed by Doppler sonography. Computerized tomography of the brain and magnetic resonance imaging revealed cerebrovascular diseases in certain areas. Patients with cardiomyopathy, rhythm disorders, high blood pressure, hyperlipidemia was investigated and medically treated by a cardiologist. Conclusion: In cerebrovascular diseases different types of tremor can occur as the result of the damage of the extrapyramidal system

PRIMARY SPONTANEOUS PARTIAL PNEUMOTHORAX IN A PATIENT WITH COVID-19 PNEUMONIA. HAVE WE UNDERESTIMATED THIS COMPLICATION? A CASE REPORT

Introduction and case report: We described a case of primary spontaneous partial pneumothorax in a middle-aged man with COVID-19 pneumonia who presented with fever, loss of appetite, and malaise. Laboratory results revealed higher levels of inflammatory markers, as well as sterile urine and blood cultures. On admission, a chest X-ray revealed bilateral patchy consolidations in the lung parenchyma, as well as a left-sided partial pneumothorax. Throughout his hospitalization, the patient was closely examined by a thoracic surgeon, and a chest X-ray was taken on multiple occasions. There was spontaneous resorption of air from the pleural space. Conclusion: Pneumothorax is a rare but serious complication of the COVID-19 infection that has recently been documented in patients with no comorbidities, requiring various types of ventilatory support. The precise mechanism of primary spontaneous pneumothorax in COVID-19 infection is unknown, but it will undoubtedly pose a challenge to future researchers

PULMONARY THROMBOEMBOLISM AND ROLE OF FACTOR V LEIDENIN ITS DEVELOPMENT-REVIEW OF LITERATURE

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are associated with considerable morbidity and mortality, and for as much as twenty-five percent of PE patients the primary clinical appearance is unexpected death. Diagnosis of PE is based on clinical suspicious at first, but sometimes its diagnostics can be extremely difficult. Newly increased interest in an inherited thrombophilic states has been provoked by the discovery of several common inherited abnormalities, i.e. the prothrombin (PT) gene G20210A, Factor V Leiden (FVL) mutation (Arg506Gln), hyperhomocystenemia and homocysteiuria, Wein-Penzing defect, Sticky Platelet Syndrome (SPS), Quebec platelet disorder (QPD) and Sickle Cell Disease (SCD). PE incidence rates increase in recent years. The only explanation at this moment is increased awareness of PE, especially after any kind of surgery, immobile state or unexplained shorthness of breath