Diagnostic of premalignant and early malignant laryngeal lesions with narrow band imaging (NBI)

Treatment and prognosis of leukoplakia significantly differ with the different pathological types and an effective examination measure is the key to make informed treatment decision. New diagnostic techniques with real-time applicability try to better detect or delineate primary squamocellular carcinoma. Narrow band imaging (NBI) is often called “optical biopsy”, because it enables the characterization of mucosal changes and making endoscopic findings more predictive without requiring tissue sampling. In detection of surface mucosal changes characteristic for neoplastic lesions - epithelial abnormalities and vascular changes can be better observed in NBI. According to the vascular pattern of NBI described by Ni, which is based on the dynamic changes of the capillary pattern on the surface of vocal cord mucosa and vocal cord leukoplakia were classified into the following types: type I-III lesions are benign, type IV lesions are precancerous, and type Va-c lesions are malignant. In University Clinical Hospital Sestre milosrdnice, we conducted a study to show the sensitivity, specificity and accuracy of NBI in predicting the pathohistological analysis in patients with vocal cord leukoplakia. During a one-year period, from 39 operated patients with leukoplakia we found 23 patients with SCC, 6 high grade dysplasia, 8 low grade dysplasia, 2 keratosis. In these cases, NBI sensitivity was 82.14%, NBI specificity 72.73%, positive predictive value 79.31% (95% CI 60.28% to 92.01%) and negative predictive value 76.19% (95% CI 52.83% to 91.78%). The accuracy of NBI in our patients was 78%. In conclusion, NBI is an advanced endoscopic imaging technique that allows early detection of small superficial mucosal lesions that are undetectable using the conventional white-light endoscopy

Diagnostic of premalignant and early malignant laryngeal lesions with narrow band imaging (NBI)

Treatment and prognosis of leukoplakia significantly differ with the different pathological types and an effective examination measure is the key to make informed treatment decision. New diagnostic techniques with real-time applicability try to better detect or delineate primary squamocellular carcinoma. Narrow band imaging (NBI) is often called “optical biopsy”, because it enables the characterization of mucosal changes and making endoscopic findings more predictive without requiring tissue sampling. In detection of surface mucosal changes characteristic for neoplastic lesions - epithelial abnormalities and vascular changes can be better observed in NBI. According to the vascular pattern of NBI described by Ni, which is based on the dynamic changes of the capillary pattern on the surface of vocal cord mucosa and vocal cord leukoplakia were classified into the following types: type I-III lesions are benign, type IV lesions are precancerous, and type Va-c lesions are malignant. In University Clinical Hospital Sestre milosrdnice, we conducted a study to show the sensitivity, specificity and accuracy of NBI in predicting the pathohistological analysis in patients with vocal cord leukoplakia. During a one-year period, from 39 operated patients with leukoplakia we found 23 patients with SCC, 6 high grade dysplasia, 8 low grade dysplasia, 2 keratosis. In these cases, NBI sensitivity was 82.14%, NBI specificity 72.73%, positive predictive value 79.31% (95% CI 60.28% to 92.01%) and negative predictive value 76.19% (95% CI 52.83% to 91.78%). The accuracy of NBI in our patients was 78%. In conclusion, NBI is an advanced endoscopic imaging technique that allows early detection of small superficial mucosal lesions that are undetectable using the conventional white-light endoscopy

Provjera povezanosti različitih aspekata ugovora i dostupnosti interneta na brodu sa zadovoljstvom poslom i životom te zdravljem pomoraca

The aim of this study was to test for associations between different aspects of contract and on-board internet access and seafarers\u27 satisfaction and health. Altogether 298 Croatian seafarers, all officers, employed on cargo ships, with a minimum work experience of two years with their current shipping company, participated in an online survey. The questionnaire included sociodemographic items, questions relating to their employment contract and internet access, and measures of job satisfaction, life satisfaction, mental health, and gastrointestinal and cardiovascular symptoms. Their job- and life- satisfaction levels were higher for shorter duration on board, favourable ratio of work to non-work days, and compliance with the employment contract regarding the changes to work and non-work days. Mental health differed likewise but only in relation to two aspects of the contract: on-board duration and compliance with the contract. The level of gastrointestinal symptoms was lower in cases of shorter on-board duration and compliance with the contract, and in seafarers who have free, unlimited internet access on board. Lower level of cardiovascular symptoms was found in seafarers with free, unlimited internet access on board. Our findings suggest that in promoting satisfaction and health in seafaring, attention should be given to reducing on-board duration, compliance with the contract, and internet accessibility on board.Cilj ovoga istraživanja bio je provjeriti povezanosti između različitih aspekata ugovora i dostupnosti interneta na brodu sa zadovoljstvom i zdravljem pomoraca. Online upitnik ispunilo je 298 hrvatskih pomoraca časničkoga ranga, zaposlenih na teretnim brodovima s radnim iskustvom u trenutačnoj radnoj organizaciji od najmanje dvije godine. Upitnik je uz pitanja o osnovnim socio-demografskim karakteristikama uključivao pitanja vezana za radni ugovor i dostupnost interneta na brodu te mjere zadovoljstva poslom, zadovoljstva životom, psihičkog zdravlja, gastrointestinalnih i kardiovaskularnih simptoma. Prosječne razine zadovoljstva poslom i životom bile su veće kod kraćih ugovornih razdoblja na brodu, povoljnijeg omjera radnih i neradnih dana te poštovanja ugovora u pogledu izmjena radnih i neradnih dana. Razina psihičkoga zdravlja razlikovala se u istom smjeru, ali samo za dva aspekta ugovora: dužinu razdoblja na brodu i poštovanje ugovora. Razina gastrointestinalnih simptoma bila je manja kod pomoraca koji su na brodu provodili kraća razdoblja i kod kojih je poštovan ugovor te kod pomoraca s neograničenim pristupom internetu na brodu, kod kojih je utvrđena i niža razina kardiovaskularnih simptoma. U promicanju zadovoljstva i zdravlja pomoraca pažnja bi se trebala usmjeriti na smanjivanje ugovornih razdoblja na brodu, poštovanje ugovora te poboljšavanje dostupnosti interneta na brodu

Descriptive study of job satisfaction and job dissatisfaction in a sample of Croatian seafarers

Background: Given the general lack of studies on well-being in Croatian seafarers, the aim of this study was to determine the level and sources of their job satisfaction and job dissatisfaction. Materials and methods: This descriptive study was conducted on a sample of Croatian seafarers (n = 530), employed in various functions on cargo ships. Using an online survey, we examined overall job satisfaction, and satisfaction with some specific aspects of work. Participants additionally responded to two open questions relating to the sources of their job satisfaction and job dissatisfaction, and these data were analysed using a qualitative approach. Results and conclusions: The results showed a moderate level of overall job satisfaction, while analysis of the 10 specific facets indicated that the participants are, on average, most satisfied with payment, and least satisfied with the achieved benefits and work organisation on board. The results of the qualitative analysis showed that among the main sources of job satisfaction are: financial stability and security, the ratio of work days to days off, and the quality of days off, and the nature and dynamics of the work. On the other hand, sources of dissatisfaction relate primarily to: separation from home and family, the status of Croatian seafarers in the Republic of Croatia, and working and living conditions on board.

Human serum albumin: Carbonylation, reactivity of Cys34 thiol group and binding of copper(II) ions

Humani serum-albumin (HSA) je najzastupljeniji protein krvne plazme (40-60% ukupnih proteina). Dominantni je antioksidant u cirkulaciji zahvaljujući slobodnoj tiolnoj grupi aminokiselinskog ostatka Cys34, kao i sposobnosti da sa visokim afinitetom veže redoks-aktivne jone. Na reaktivnost tiolne grupe Cys34 utiču brojni faktori, od kojih su promena konformacije HSA molekula usled karbonilacije i vezivanje masnih kiselina (MK), kao i vezivanje bakar(II)-jona za molekul HSA od posebnog značaja za ovu disertaciju. Relevantnost navedenih faktora u dijabetesu tipa II (DM II), kao patološkom stanju za koje je karakterističan karbonilini i oksidativni stres, povećana koncentracija MK i jona bakra u cirkulaciji, su takođe predmet ove disertacije. Konkretni ciljevi bili su da se ispita: 1) uticaj reakcije karbonilacije HSA molekula, in vitro i in vivo, na afinitet vezivanja bakar(II)-jona, odnosno da se utvrdi afinitet modifikovanog HSA za vezivanje ovih jona; 2) da li i u kom stepenu karbonilacija dovodi do otpuštanja jona bakra iz prethodno nagrađenih bakar(II)-HSA-kompleksa (in vitro); 3) efekat istovremenog vezivanja MK (zasićenih ili nezasićenih) i jona bakra(II) za HSA na reaktivnost Cys34 tiolne grupe (određivanjem konstante brzine reakcije), bez prisustva i u prisustvu reagensa za karbonilaciju i 4) promena u afinitetu HSA prema jonima bakra in vivo, kod pacijenata sa dijagnozom DM II, kao i da li potencijalno otpuštanje jona bakra iz kompleksa sa HSA (uzrokovano karbonilacijom) kod ovih pacijenata utiče na stvaranje reaktivnih kiseoničnih vrsta, odnosno na promenu u aktivnosti enzima odbrane od oksidativnog stresa. Afinitet HSA prema jonima bakra(II) smanjuje se nakon in vitro karbonilacije metilglioksalom (MG). Karbonilacija HSA-Cu(II)-kompleksa uzrokuje smanjenje sadržaja Cys34 tiolne grupe, konformacione promene HSA molekula, kao i otpuštanje vezanih bakar(II)-jona. Odnos između procenta smanjenja sadržaja slobodne tiolne grupe Cys34 i procenta smanjenja sadržaja HSA-vezanih bakar(II)-jona (R) iznosi 2,12 ± 0,28. Isti odnos (1,96 ± 0,36) dobijen je i prilikom oksidacije Cys34 tiolne grupe, pri kojoj nije došlo do promene konformacije HSA molekula...Human serum albumin (HSA) is the most abundant protein in human plasma (40-60 % of total protein content). HSA is the main plasma antioxidant due to its Cys34 free thiol group, as well as, its ability to bind redox active ions with high affinity. The reactivity of Cys34 thiol group is influenced by many factors, from which, the change in HSA conformation caused by carbonylation, binding of fatty acids (FA) and binding of copper(II) ions are the most important for this doctoral dissertation. The relevance of these factors to diabetes type II (DMT II), as a pathological state that is characterized by oxidative and carbonyl stress, increased concentration of FAs and copper(II) ions in the circulation, was also the subject of this doctoral dissertation. Therefore, the aims of this dissertation were to examine: 1. the influence of HSA carbonylation in vitro and in vivo on its affinity to bind copper(II) ions, i.e. to determine the copper(II) binding affinity of modified HSA; 2. if, and in what extent the carbonylation leads to release of copper(II) ions from already formed copper(II)-HSA-complexes (in vitro); 3. the effect of concurrent binding of FAs (saturated and unsaturated) and copper(II) ions to HSA on the reactivity of Cys34 thiol group (determination of kinetics constant of Cys34 thiol group reaction with DNTB); 4. the change in the HSA-copper(II) binding affinity in vivo, in patients with DMT II, as well as, if the potential release of copper(II) ions from copper-HSA complexes (caused by carbonylation) in these patients leads to generation of reactive oxygen species, i.e.change in the activity of antioxidative enzymes. The affinity of HSA for copper(II) ions is decreased upon in vitro carbonylation with methylglyoxal (MG). Carbonylation of HSA-Cu(II) complexes caused a decrease in the content of Cys34 thiol group, conformational changes in HSA molecule and release of HSA-bound copper(II) ions. The ratio between the percentage of decrease in the Cys34 thiol group content and percentage of decrease in the HSA-bound copper(II) content (R) is 2,12 ± 0,28. The same R (1,96 ± 0,36) was obtained upon aerobic oxidation of Cys34 thiol group, whereas no conformational changes in HSA occurred. It can be concluded that the copper(II) binding affinity (capacity) of HSA, and the release of these ions from HSA-Cu(II) complexes, depends on the redox status of Cys34 thiol group..

Hearing loss in young boy caused by cerebellar stroke- case report

Sudden sensorineural hearing loss (SSHL) and vertigo in children are relatively uncommon. The assessment of acute vertigo in childhood is often challenging. Fortunately, a central cause is rare. The incidence of ischemic strokes in children is given as six cases in 1 000 000 children per year. The aim of this report is to present a rare case of vertigo and hearing loss in young patient developed after cerebellar ischemia. A 15-yearold boy presented in emergency ENT department with symptoms of dizziness, right sided hearing loss and tinnitus. Two days prior to the visit, he participated in a wrestling training, after which he started to feel nauseous, developed dizziness without rotatory component and mild hearing loss in right ear. Few hours after that he vomited two times and noticed that his hearing worsened. History of ear inflammation or recent viral infection in upper airway was negative. Audiometry exam showed right sided sensorineural hearing loss, with thresholds from 15 to 70 dB. Upon examination he was given oral corticosteroid therapy. MRI showed three areas of restricted diffusion in right cerebellar hemisphere, consistent with ischemic lesions. He was then referred to neuropediatric department for additional diagnosis and treatment. On follow-up at 6 months, audiometric testing showed stationary findings without worsening of hearing threshold levels. The literature contains numerous models of the pathogenesis of SSHL, with childhood SSHL having certain peculiarities. In practical terms, the multifactorial nature of SSHL is important in the choice of diagnostic methods and treatment methods. Early recognition of central causes which could lead to severe health consequences is extremely important

Hearing loss in young boy caused by cerebellar stroke- case report

Sudden sensorineural hearing loss (SSHL) and vertigo in children are relatively uncommon. The assessment of acute vertigo in childhood is often challenging. Fortunately, a central cause is rare. The incidence of ischemic strokes in children is given as six cases in 1 000 000 children per year. The aim of this report is to present a rare case of vertigo and hearing loss in young patient developed after cerebellar ischemia. A 15-yearold boy presented in emergency ENT department with symptoms of dizziness, right sided hearing loss and tinnitus. Two days prior to the visit, he participated in a wrestling training, after which he started to feel nauseous, developed dizziness without rotatory component and mild hearing loss in right ear. Few hours after that he vomited two times and noticed that his hearing worsened. History of ear inflammation or recent viral infection in upper airway was negative. Audiometry exam showed right sided sensorineural hearing loss, with thresholds from 15 to 70 dB. Upon examination he was given oral corticosteroid therapy. MRI showed three areas of restricted diffusion in right cerebellar hemisphere, consistent with ischemic lesions. He was then referred to neuropediatric department for additional diagnosis and treatment. On follow-up at 6 months, audiometric testing showed stationary findings without worsening of hearing threshold levels. The literature contains numerous models of the pathogenesis of SSHL, with childhood SSHL having certain peculiarities. In practical terms, the multifactorial nature of SSHL is important in the choice of diagnostic methods and treatment methods. Early recognition of central causes which could lead to severe health consequences is extremely important

Characterisation of the binding of dihydro-alpha-lipoic acid to fibrinogen and the effects on fibrinogen oxidation and fibrin formation

A reduced form of the alpha-lipoic acid, dihydro-alpha-lipoic acid (DHLA) is a potent, naturally occurring antioxidant which can be consumed as food constituent or as supplement at doses up to 600 mg/day. DHLA has inhibitory effect on coagulation as it can reduce concentrations of some coagulation factors. In this study, a direct interaction between DHLA and fibrinogen, the main protein in coagulation, is described. Binding constant for DHLA/fibrinogen complex is of moderate strength (104) and interaction probably occurs in D regions of fibrinogen, as shown by docking simulations. Fibrinogen stability remains the same with only marginal structural changes in its secondary structure favouring more ordered molecular organisation upon DHLA binding. Fibrinogen with bound DHLA forms fibrin with thicker fibers, as measured by coagulation assay and is protected from oxidation to certain extent. Obtained results support beneficial effects of DHLA on fibrinogen and consequently on coagulation process, suggesting that DHLA supplementation may be indicated for persons with an increased risk of developing thrombotic complications, particularly those whose fibrin is characterised by increased oxidative modification and formation of thinner and less porous fibers. Also, DHLA in complex with fibrinogen can be located at site of injury where it may exert antioxidant effects.This is the peer-reviewed version of the article: International Journal of Biological Macromolecules, 2020, 147, 319-325, doi: [https://dx.doi.org/10.1016/j.ijbiomac.2020.01.098]The published version: [http://cer.ihtm.bg.ac.rs/handle/123456789/3378

Subglottic laryngitis - changes in therapy approach over the past 20 years

OBJECTIVE: To show changes in the management of subglottic laryngitis over the last twenty years in Croatia. ----- METHODS: We sent questionnaires to paediatricians and otolaryngologists (ENT) in 9 Croatian hospitals in 1993, 2003 and 2013. In the questionnaire we presented a case of a child with moderately difficult subglottic laryngitis, after which they had to answer questions about the management of this kind of a patient and common therapy practice in their hospitals. All data were categorical, described in absolute frequencies and with relative percentages. The Cochran-Armitage test for trend was used in the analysis of different treatments over the years among ENT and paediatricians. Associations were statistically significant if p<0.05. ----- RESULTS: During a twenty-year period main novelties included the introduction of racemic epinephrine use (ENT from 3.3% in 1993 to 92.3% in 2013; paediatricians from 17.2% in 1993 to 100.0% in 2013) and downfall of humidification (ENT from 60.0% to 23.3%; paediatricians from 60.0% to 12.0%), antibiotic (ENT from 53.0% to 2.3%; paediatricians from 21.0% to 0.0%) and antihistaminic use (ENT from 67.7% to 0%; paediatricians from 43.2% to 2%), while corticosteroids (both parenteral and nebulized form) remained the cornerstone in treatment of moderately severe subglottic laryngitis. ----- CONCLUSION: Main novelties included the use of racemic epinephrine and downfall of antibiotic, antihistaminic and humidification therapy use, while corticosteroids remained the cornerstone in the treatment of moderately severe subglottic laryngitis. Differences between approaches among specialities are minimized during 20-year period

Non-Hodgkin\u27s lymphoma of the frontal sinus. Case report and literature review

Primary frontal sinus Non-Hodgkin\u27s lymphoma (NHL) is an extremely rare condition with 20 cases published in the existing literature to date. We describe a 64-year-old patient who presented with right orbital pain, severe headache and diplopia. He was initially diagnosed with acute exacerbation of chronic rhinosinusitis and responded well to antibiotic treatment, but his symptoms returned. The diagnosis of frontal sinus NHL was made only after functional endoscopic frontal sinus surgery was performed in general anaesthesia. A tumor mass, which was filling the entire right frontal sinus, was completely removed and sent to histopathological examination. The patient was finally diagnosed with diffuse large B-cell lymphoma of the frontal sinus and referred to the haematology department for tumor staging and chemotherapy. This case emphasizes the importance of early clinical suspicion and diagnosis, which leads to early treatment and better prognosis