ALKAPTONURIA – A CASE REPORT

63-godišnja bolesnica, koja se više godina obrađuje zbog sumnje na upalnu reumatsku bolest (seronegativni reumatoidni artritis, spondiloartropatija), hospitalizirana je zbog progresije boli u kukovima, koljenima i malim zglobovima šaka. Nekoliko godina prije hospitalizacije primijetila je plavilo uški i vrška nosa te tamnjenje urina ako stoji na zraku. Navedeni simptomi uklapaju se u kliničku sliku nasljedne metaboličke bolesti alkaptonurije, koja se uz artropatiju manifestirala i ohronozom (plavičasto-crna pigmentacija ležišta nokta, bjeloočnice, hrskavice nosa, uha i zglobova). Sumnja na alkaptonuriju potvrđena je analizom urina u kojem su utvrđene povišene vrijednosti homogentizinske kiseline. Svrha je ovog članka upozoriti na rijetku bolest koja oponaša upalne reumatske bolesti te degenerativne promjene na zglobovima i kralježnici, a za koju trenutačno nema specifičnog lijeka.A 63-year-old patient, who was for a long time suspicious of inflammatory rheumatic disease (seronegative rheumatoid arthritis, spondyloarthropathies), was hospitalized due to progression of pain in the hips, knees and small joints of the hand. A few years ago she noticed that her ears and tip of the nose were flooded and urine was tarnishing in air. These symptoms fit the clinical presentation of an inherited metabolic disease alkaptonuria. Our patient manifested with arthropathy and also with the ochronosis (bluish black pigmentation of nails, scleras, cartilages, joints). The suspicion of alkaptonuria was confirmed by the analysis of urine in which elevated levels of the homogentisic acid were found. The purpose of this paper is to present a rare disease that mimics the inflammatory rheumatic diseases and degenerative changes in the joints, and for which there has not yet been discovered a specific treatment

Prikaz slučaja kronične Bellove pareze: koje su mogućnosti rehabilitacije?

Bell’s palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bell’s palsy. However, chronic cases of Bell’s palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Intensity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.Bellova pareza ili periferna idiopatska pareza facijalisa, neurološko je stanje koju karakterizira jednostrana slabost mišića lica. Smjernice za liječenje su uglavnom utemeljene na dokazima o preporukama za liječenje akutnih stadija Bellove pareze. Međutim, kronični slučajevi Bellove pareze nisu potkrijepljeni dovoljno snažnim dokazima o mogućnostima liječenja, osim slabe preporuke u smjeru primjene terapijskih vježbi. Ovaj prikaz slučaja predstavlja primjenu kombinacije modaliteta fizikalne terapije (akupunktura, laser visokog intenziteta i terapija zrcalom) unutar 10 tjedana, za liječenje bolesnika s dugotrajnim posljedicama Bellove pareze. Ova kombinacija terapija rezultirala je značajnim poboljšanjem razine oporavka mjerenog kliničkim ljestvicama. Međutim, potrebna su daljnja istraživanja kako bi se pružili snažniji dokazi o prednostima ove kombinacije terapija

Deep Eutectic Solvents for Purification of Waste Animal Fats and Crude Biodiesel

U ovom je radu istražena mogućnost primjene niskotemperaturnih eutektičkih otapala za ekstrakcijsku deacidifikaciju otpadnih životinjskih masti te uklanjanje glicerola i glicerida iz sirovog biodizela. Istraživanje je uključilo odabir povoljnog katalizatora te masenog omjera katalizatora, metanola i masti koji bi rezultirali najvećom konverzijom triglicerida u metilne estere masnih kiselina. Definirano je potrebno vrijeme pročišćavanja sirovog biodizela te optimalan maseni omjer otapala i sirovog biodizela. Ekstrakcijskom deacidifikacijom pomoću niskotemperaturnog eutektičkog otapala na bazi kalijeva karbonata uspješno je reducirana kiselost sirovine uz relativno mali utrošak otapala (maseni omjer otapala i masti: 0,25 : 1,00) i kratko vrijeme trajanja procesa (30 min). Kalijev hidroksid pokazao se kao učinkovitiji katalizator. Udio katalizatora u reakcijskoj smjesi utječe više na konverziju masti od udjela metanola. Udio glicerola i glicerida reduciran je ekstrakcijom pomoću niskotemperaturnog eutektičkog otapala na bazi kolin klorida na vrijednosti manje od standardom propisane vrijednosti (EN 14214:2019). Odabrano se otapalo pokazalo selektivnim zbog toga što nije došlo do redukcije udjela metilnih estera. Pri masenom omjeru otapala i biodizela 1 : 1 i 90 min trajanja ekstrakcije postignuti su najbolji rezultati. Pročišćeni biodizel također zadovoljava standard kvalitete s obzirom na udio estera, gustoću i viskoznost.Given the fact that biodiesel produced from oil used in the food industry is not competitive with fossil-based diesel, it is necessary to use cheaper raw materials for its production. Thereby, waste edible oil, by-products of the manufacturing process of edible oils, inedible oils, and waste animal fat are considered the economically acceptable raw materials. The goal of this work was to investigate the applicability of deep eutectic solvents for extractive deacidification of waste animal fats and removal of glycerol and glycerides from crude biodiesel. Extractive deacidification of waste animal fat was conducted using deep eutectic solvent potassium carbonate – ethylene glycol (1 : 10, mol.), and it was used in mass ratio 1 : 4 (solvent : fat), at 60 °C for 30 min. Total acid number was reduced from 26.63 to 1.1 mg KOH/g fat. After purification of the feedstock, biodiesel was synthesised with different catalysts (KOH and NaOH), and KOH exhibited better conversion; therefore it was chosen for further experiments. In order to define the optimal reaction conditions, the influence of mass ratio catalyst : methanol : fat on the conversion of triglycerides into fatty acid methyl esters was investigated. At all reaction conditions, high quality biodiesel was obtained, i.e., the ester content was above the EN 14214 limit (96.5 %). The influence of catalyst load was greater than of methanol. At the highest concentration of catalyst, neutralisation of free fatty acids occurred. Biodiesel synthesised at 1 : 40 : 100 (KOH : methanol : fat) was chosen as the best, and was used for further experiments – extraction of glycerol and glycerides from crude biodiesel. For that purpose, deep eutectic solvent choline chloride – ethylene glycol (1 : 2.5, mol.) was used. The influence of mass ratio solvent : biodiesel and extraction duration was investigated. Increase in mass ratio and extraction duration resulted in a slight increase in ester content. To confirm the removal of glycerol and unreacted glycerides, samples of biodiesel before and after extraction were analysed by gas chromatography. Three samples after extraction were chosen – one at the lowest and one at the highest mass ratio of solvent to biodiesel, and one at the highest duration of extraction. Crude biodiesel contained too high concentrations of free and total glycerol. After extraction for 90 min, a significant reduction was observed – the extraction efficiencies for free glycerol, diglycerides, triglycerides, and total glycerol were: 90.77 %, 13.19 %, 10.43 %, and 21.59 %, respectively. The content of glycerol and glycerides after extraction was well below the EN 14214 limit. Density and viscosity of biodiesel were within the range defined by the European standard EN 14214

INCIDENCE OF THYROID DISORDERS IN CHILDREN WITH SYNDROME DOWN : WITH SPECIAL REVIEW ON ACQUIRED INFLAMMATORY THYROID DISORDERS

Cilj istraživanja: Utvrditi pojavnost bolesti štitnjače u djece sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Klinici za dječje bolesti, Kliničkog Bolničkog Centra Split u razdoblju od siječnja 2000. do prosinca 2012. Od posebnog interesa su entiteti koji spadaju u stečene upalne bolesti štitnjače. Materijali i metode: U istraživanje su uključena djeca sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Kliničkom odjelu za hematologiju, onkologiju, imunologiju i genetiku, djeca koja se kontroliraju u Ambulanti za bolesti štitnjače dječje i adolescentne dobi, te Ambulanti za sindrom Down, KBC-a Split u razdoblju od siječnja 2000. do prosinca 2012. godine. Ukupno se radi o 135 bolesnika. Za svakoga je detaljno pregledana povijest bolesti i ostala medicinska dokumentacija odakle su prikupljeni potrebni podaci. Od bolesti štitnjače analizirane su: kongenitalna hipotireoza, tranzitorna hipotireoza, te stečene upalne bolesti štitnjače (latentna hipotireoza, Hashimoto tireoiditis, hipertireoza). Rezultati: Od ukupno 135 bolesnika sa SD u ovom istraživanju za njih 41 postoje podaci iz medicinske dokumentacije o utvrđenim bolestima štitnjače. Dakle, prevalencija bolesti štitnjače u djece sa SD u ovom uzorku je 30.3%. Bolesti štitnjače u djece sa SD u ovom istraživanju su: kongenitalna hipotireoza u četiri bolesnika (9.76%), tranzitorna hipotireoza u 17 bolesnika (41.46%), latentna hipotireoza u 14 bolesnika (34.15%), Hashimoto tireoiditis u šest bolesnika (14.63%). Dakle, najčešće bolesti štitnjače u djece sa SD u ovom istraživanju su stečene upalne bolesti štitnjače (48.78%). Ostalih 94 bolesnika nema dokazanu bolest štitnjače. Bolesti štitnjače u djece sa SD su najčešće asimptomatske (80.49% u ovom istraživanju). Od ukupno 41 bolesnika koji imaju utvrđenu bolest štitnjače njih 32 (78.05%) uzima terapiju L-tiroksinom. Zaključci: Bolesti štitnjače u djece sa SD potrebno je na vrijeme prepoznati i liječiti. To je važno zbog visoke prevalencije, važnosti hormona štitnjače za rast i razvoj, međusobnog preklapanja simptoma osnovne bolesti i hipotireoze, te vrlo često asimptomatskog tijeka samih bolesti štitnjače. U tome nam djelomično može pomoći novorođenački probir na kongenitalnu hipotireozu. S ciljem pravovremenog otkrivanja stečenih upalnih bolesti štitnjače mišljenja smo kako je važno preventivno godišnje praćenje funkcije štitnjače u sve djece sa SD, a u dobi veće učestalosti stečenih upalnih bolesti štitnjače još intenzivnije kontroliranje. Smatramo da je posebno važno prepoznati autoimunosne bolesti štitnjače u djece sa SD koja inače imaju povećanu pojavnost autoimunosnih bolesti.Objective: To determine the prevalence of thyroid disorders in children with syndrome Down aged 0-18 years known at the Department of Pediatrics, University Hospital Center Split in the period from January 2000 to December 2012 with special review on acquired inflammatory thyroid disorders. We found 135 patients with SD. For each patient medical history and other medical records were inspected and the neccessary data were collected. Thyroid disorders of our interest were: congenital hypothyroidism, transient hypothyroidism and acquired inflammatory thyroid disorders (subclinical hypothyroidism, Hashimoto thyroiditis, hyperthyroidism). Results: From total of 135 patients with SD, forty one had thyroid disorder. Prevalence of thyroid disorders in this study is 30.3%. Thyroid disorders in children with SD in this study were: congenital hypothyroidism in four patients (9.76%), transient hypothyroidism in 17 patients (41.46%), subclinical hypothyroidism in 14 patients (34.15%) and Hashimoto thyroiditis in six patients (14.63%). The most common thyroid disorder is acquired inflammatory thyroid disorder in 20 patients (48.78%). The rest of 94 patient had no thyroid disorder. Thyroid disorders in children with SD have been asymptomatic in 80.49%. Out of 41 patients with thyroid disorders, 32 (78.05%) were on L-thyroxine therapy. Conclusion: Thyroid disorders in children with SD should be recognised and treated immediately. It is important timely to recognize and treat thyroid disorder in children considering high prevalence of these disorders in children with SD, the role of thyroid hormones for growth and development, overlapping of symptoms of SD and hypothyroidism, and asymptomatic clinical presentation of thyroid disorders in children with SD. Neonatal screening for congenital hypothyroidism is very useful in detecting thyroid disorders. In order to detect acqired inflammatory thyroid disorders, we suggest preventive annular screening of thyroid function in all children with SD is expected. When higher incidence of thyroid disorders is expected, thyroid gland screening should be more often. We consider especially important detecting autoimmune thyroid disorders in children with SD as they have higher incidence of autoimmune diseases

INCIDENCE OF THYROID DISORDERS IN CHILDREN WITH SYNDROME DOWN : WITH SPECIAL REVIEW ON ACQUIRED INFLAMMATORY THYROID DISORDERS

Cilj istraživanja: Utvrditi pojavnost bolesti štitnjače u djece sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Klinici za dječje bolesti, Kliničkog Bolničkog Centra Split u razdoblju od siječnja 2000. do prosinca 2012. Od posebnog interesa su entiteti koji spadaju u stečene upalne bolesti štitnjače. Materijali i metode: U istraživanje su uključena djeca sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Kliničkom odjelu za hematologiju, onkologiju, imunologiju i genetiku, djeca koja se kontroliraju u Ambulanti za bolesti štitnjače dječje i adolescentne dobi, te Ambulanti za sindrom Down, KBC-a Split u razdoblju od siječnja 2000. do prosinca 2012. godine. Ukupno se radi o 135 bolesnika. Za svakoga je detaljno pregledana povijest bolesti i ostala medicinska dokumentacija odakle su prikupljeni potrebni podaci. Od bolesti štitnjače analizirane su: kongenitalna hipotireoza, tranzitorna hipotireoza, te stečene upalne bolesti štitnjače (latentna hipotireoza, Hashimoto tireoiditis, hipertireoza). Rezultati: Od ukupno 135 bolesnika sa SD u ovom istraživanju za njih 41 postoje podaci iz medicinske dokumentacije o utvrđenim bolestima štitnjače. Dakle, prevalencija bolesti štitnjače u djece sa SD u ovom uzorku je 30.3%. Bolesti štitnjače u djece sa SD u ovom istraživanju su: kongenitalna hipotireoza u četiri bolesnika (9.76%), tranzitorna hipotireoza u 17 bolesnika (41.46%), latentna hipotireoza u 14 bolesnika (34.15%), Hashimoto tireoiditis u šest bolesnika (14.63%). Dakle, najčešće bolesti štitnjače u djece sa SD u ovom istraživanju su stečene upalne bolesti štitnjače (48.78%). Ostalih 94 bolesnika nema dokazanu bolest štitnjače. Bolesti štitnjače u djece sa SD su najčešće asimptomatske (80.49% u ovom istraživanju). Od ukupno 41 bolesnika koji imaju utvrđenu bolest štitnjače njih 32 (78.05%) uzima terapiju L-tiroksinom. Zaključci: Bolesti štitnjače u djece sa SD potrebno je na vrijeme prepoznati i liječiti. To je važno zbog visoke prevalencije, važnosti hormona štitnjače za rast i razvoj, međusobnog preklapanja simptoma osnovne bolesti i hipotireoze, te vrlo često asimptomatskog tijeka samih bolesti štitnjače. U tome nam djelomično može pomoći novorođenački probir na kongenitalnu hipotireozu. S ciljem pravovremenog otkrivanja stečenih upalnih bolesti štitnjače mišljenja smo kako je važno preventivno godišnje praćenje funkcije štitnjače u sve djece sa SD, a u dobi veće učestalosti stečenih upalnih bolesti štitnjače još intenzivnije kontroliranje. Smatramo da je posebno važno prepoznati autoimunosne bolesti štitnjače u djece sa SD koja inače imaju povećanu pojavnost autoimunosnih bolesti.Objective: To determine the prevalence of thyroid disorders in children with syndrome Down aged 0-18 years known at the Department of Pediatrics, University Hospital Center Split in the period from January 2000 to December 2012 with special review on acquired inflammatory thyroid disorders. We found 135 patients with SD. For each patient medical history and other medical records were inspected and the neccessary data were collected. Thyroid disorders of our interest were: congenital hypothyroidism, transient hypothyroidism and acquired inflammatory thyroid disorders (subclinical hypothyroidism, Hashimoto thyroiditis, hyperthyroidism). Results: From total of 135 patients with SD, forty one had thyroid disorder. Prevalence of thyroid disorders in this study is 30.3%. Thyroid disorders in children with SD in this study were: congenital hypothyroidism in four patients (9.76%), transient hypothyroidism in 17 patients (41.46%), subclinical hypothyroidism in 14 patients (34.15%) and Hashimoto thyroiditis in six patients (14.63%). The most common thyroid disorder is acquired inflammatory thyroid disorder in 20 patients (48.78%). The rest of 94 patient had no thyroid disorder. Thyroid disorders in children with SD have been asymptomatic in 80.49%. Out of 41 patients with thyroid disorders, 32 (78.05%) were on L-thyroxine therapy. Conclusion: Thyroid disorders in children with SD should be recognised and treated immediately. It is important timely to recognize and treat thyroid disorder in children considering high prevalence of these disorders in children with SD, the role of thyroid hormones for growth and development, overlapping of symptoms of SD and hypothyroidism, and asymptomatic clinical presentation of thyroid disorders in children with SD. Neonatal screening for congenital hypothyroidism is very useful in detecting thyroid disorders. In order to detect acqired inflammatory thyroid disorders, we suggest preventive annular screening of thyroid function in all children with SD is expected. When higher incidence of thyroid disorders is expected, thyroid gland screening should be more often. We consider especially important detecting autoimmune thyroid disorders in children with SD as they have higher incidence of autoimmune diseases

INCIDENCE OF THYROID DISORDERS IN CHILDREN WITH SYNDROME DOWN : WITH SPECIAL REVIEW ON ACQUIRED INFLAMMATORY THYROID DISORDERS

Cilj istraživanja: Utvrditi pojavnost bolesti štitnjače u djece sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Klinici za dječje bolesti, Kliničkog Bolničkog Centra Split u razdoblju od siječnja 2000. do prosinca 2012. Od posebnog interesa su entiteti koji spadaju u stečene upalne bolesti štitnjače. Materijali i metode: U istraživanje su uključena djeca sa SD u dobi od 0 do 18 godina koja su bila hospitalizirana na Kliničkom odjelu za hematologiju, onkologiju, imunologiju i genetiku, djeca koja se kontroliraju u Ambulanti za bolesti štitnjače dječje i adolescentne dobi, te Ambulanti za sindrom Down, KBC-a Split u razdoblju od siječnja 2000. do prosinca 2012. godine. Ukupno se radi o 135 bolesnika. Za svakoga je detaljno pregledana povijest bolesti i ostala medicinska dokumentacija odakle su prikupljeni potrebni podaci. Od bolesti štitnjače analizirane su: kongenitalna hipotireoza, tranzitorna hipotireoza, te stečene upalne bolesti štitnjače (latentna hipotireoza, Hashimoto tireoiditis, hipertireoza). Rezultati: Od ukupno 135 bolesnika sa SD u ovom istraživanju za njih 41 postoje podaci iz medicinske dokumentacije o utvrđenim bolestima štitnjače. Dakle, prevalencija bolesti štitnjače u djece sa SD u ovom uzorku je 30.3%. Bolesti štitnjače u djece sa SD u ovom istraživanju su: kongenitalna hipotireoza u četiri bolesnika (9.76%), tranzitorna hipotireoza u 17 bolesnika (41.46%), latentna hipotireoza u 14 bolesnika (34.15%), Hashimoto tireoiditis u šest bolesnika (14.63%). Dakle, najčešće bolesti štitnjače u djece sa SD u ovom istraživanju su stečene upalne bolesti štitnjače (48.78%). Ostalih 94 bolesnika nema dokazanu bolest štitnjače. Bolesti štitnjače u djece sa SD su najčešće asimptomatske (80.49% u ovom istraživanju). Od ukupno 41 bolesnika koji imaju utvrđenu bolest štitnjače njih 32 (78.05%) uzima terapiju L-tiroksinom. Zaključci: Bolesti štitnjače u djece sa SD potrebno je na vrijeme prepoznati i liječiti. To je važno zbog visoke prevalencije, važnosti hormona štitnjače za rast i razvoj, međusobnog preklapanja simptoma osnovne bolesti i hipotireoze, te vrlo često asimptomatskog tijeka samih bolesti štitnjače. U tome nam djelomično može pomoći novorođenački probir na kongenitalnu hipotireozu. S ciljem pravovremenog otkrivanja stečenih upalnih bolesti štitnjače mišljenja smo kako je važno preventivno godišnje praćenje funkcije štitnjače u sve djece sa SD, a u dobi veće učestalosti stečenih upalnih bolesti štitnjače još intenzivnije kontroliranje. Smatramo da je posebno važno prepoznati autoimunosne bolesti štitnjače u djece sa SD koja inače imaju povećanu pojavnost autoimunosnih bolesti.Objective: To determine the prevalence of thyroid disorders in children with syndrome Down aged 0-18 years known at the Department of Pediatrics, University Hospital Center Split in the period from January 2000 to December 2012 with special review on acquired inflammatory thyroid disorders. We found 135 patients with SD. For each patient medical history and other medical records were inspected and the neccessary data were collected. Thyroid disorders of our interest were: congenital hypothyroidism, transient hypothyroidism and acquired inflammatory thyroid disorders (subclinical hypothyroidism, Hashimoto thyroiditis, hyperthyroidism). Results: From total of 135 patients with SD, forty one had thyroid disorder. Prevalence of thyroid disorders in this study is 30.3%. Thyroid disorders in children with SD in this study were: congenital hypothyroidism in four patients (9.76%), transient hypothyroidism in 17 patients (41.46%), subclinical hypothyroidism in 14 patients (34.15%) and Hashimoto thyroiditis in six patients (14.63%). The most common thyroid disorder is acquired inflammatory thyroid disorder in 20 patients (48.78%). The rest of 94 patient had no thyroid disorder. Thyroid disorders in children with SD have been asymptomatic in 80.49%. Out of 41 patients with thyroid disorders, 32 (78.05%) were on L-thyroxine therapy. Conclusion: Thyroid disorders in children with SD should be recognised and treated immediately. It is important timely to recognize and treat thyroid disorder in children considering high prevalence of these disorders in children with SD, the role of thyroid hormones for growth and development, overlapping of symptoms of SD and hypothyroidism, and asymptomatic clinical presentation of thyroid disorders in children with SD. Neonatal screening for congenital hypothyroidism is very useful in detecting thyroid disorders. In order to detect acqired inflammatory thyroid disorders, we suggest preventive annular screening of thyroid function in all children with SD is expected. When higher incidence of thyroid disorders is expected, thyroid gland screening should be more often. We consider especially important detecting autoimmune thyroid disorders in children with SD as they have higher incidence of autoimmune diseases

From Coffee to Biodiesel—Deep Eutectic Solvents for Feedstock and Biodiesel Purification

Over three billion cups of coffee are consumed daily, making waste coffee grounds readily available throughout the world. Containing approximately 10–15 wt% of oil, they have great potential for biodiesel production. The goal of this work was to produce high quality biodiesel from waste coffee grounds. One fresh and four different types of waste coffee grounds were collected. Oil was extracted by the Soxhlet method with n-hexane and then purified via extractive deacidification with a potassium carbonate-based deep eutectic solvent. Biodiesels were synthesized by means of alkali catalyzed transesterification at different catalyst:methanol:oil mass ratios and reaction times. Impurities present in crude biodiesels were extracted with a choline chloride-based deep eutectic solvent. All batch extraction experiments were performed at room conditions in a small scale extractor. Optimal conditions for synthesis and purification were defined in order to assure high quality of the produced biodiesel. Additionally, continuous column extraction with the choline chloride-based solvent was tested as a purification method for crude biodiesel. Stabilization time and optimal biodiesel to solvent mass ratio were determined. The potassium carbonate-based solvent efficiently reduced the total acid number of the feedstock (deacidification efficiency ranged from 86.18 to 94.15%), while the one based on choline chloride removed free glycerol and glycerides from crude biodiesels. After continuous purification, the purified biodiesel was of excellent quality with glycerol and glyceride contents below the EN 14214 limit