Serum levels of nitric oxide as a predictor of survival in acute respiratory distress syndrome caused by H1N1 pneumonia?

A large number of studies show elevated levels of nitric oxide (NO) in infective syndromes, but there is an insufficient number of studies which have investigated serum levels of NO in patients with acute respiratory distress syndrome (ARDS), especially in relation to survival. Hence, we created a study with the aim of determining the NO levels in relation to ARDS survival. Serum levels of NO were measured by Griess reaction in 29 patients [16 men (55%), mean age years 52.72±18]. All data were statistically analyzed using one way ANOVA. Our results show significantly higher serum NO levels in ARDS survivors compared to ARDS non-survivors, (p < 0.05). We conclude that higher serum levels of NO are strongly associated with better clinical outcomes, including increased survival

Klinički značajne interakcije opioidnih i neopioidnih analgetika

Patients often seek advise from doctors and pharmacists about pain treatment. Opioid and non-opioid analgesics are the most commonly used drugs in the treatment of pain, but they have potential for pharmacodynamic and pharmacokinetic drug-drug interactions. The risk of central nervous system depression and respiratory depression is increased if opioid analgesics are used with anxiolytics, first-generation antihistamines, and antidepressants. Serotonin syndrome can occur if tramadol and fentanyl are used with selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline inhibitors, monoamino oxidase inhibitors, etc. Decreased elimination of opioid analgesics as a consequence of CYP2D6 and CYP3A4 isoenzyme inhibition can result in their increased efficacy but sedation and respiratory depression have also been reported. Caution is needed when non-steroidal anti-inflammatory drugs (NSAIDs) are used concomitantly with other drugs that cause bleeding such as anticoagulants and SSRIs or drugs that decrease the elimination of NSAIDs by inhibition of CYP2C9. NSAIDs can antagonize the effect of antihypertensives, and interaction with angiotensin-converting enzyme inhibitors may result in renal failure. In comparison with opioid analgesics and NSAIDs, paracetamol has the lowest potential for clinically significant interactions. The prophylactic administration of paracetamol after vaccination should be avoided and patients should be advised not to use alcohol during therapy.Pacijenti se često obraćaju lekarima i farmaceutima za pomoć u terapiji bola. Opioidni i neopioidni analgetici su najčešće lekovi izbora u terapiji bola ali imaju veliki potencijal za stupanje u farmakodinamske i farmakokinetičke interakcije sa drugim lekovima. Kod opioidnih analgetika povećan je rizik od pojave depresije centralnog nervnog sistema i respiratorne depresije ukoliko se ovi lekovi primenjuju sa anksioliticima, antihistaminicima prve generacije i antidepresivima. Serotoninski sindrom se može javiti ukoliko se tramadol i fentanil primenjuju sa selektivnim inhibitorima preuzimanja serotonina (SSRI), inhibitorima preuzimanja serotonina i noradrenalina, inhibitorima monoamino-oksidaze i dr. Usporena eliminacija opioidnih analgetika, kao posledica inhibicije izoenzima CYP2D6 i CYP3A4 može rezultirati njihovom povećanom efikasnošću ali i pojavom sedacije i respiratorne depresije. Oprez je potreban kada se nesteroidni antiinflamatorni lekovi (NSAIL) primenjuju istovremeno sa drugim lekovima koji mogu dovesti do krvarenja poput antikoagulanasa i SSRI ili lekovima koji usporavaju eliminaciju NSAIL inhibicijom izoenzima CYP2C9. NSAIL mogu antagonizovati dejstvo antihipertenziva, a interakcija sa inhibitorima angiotenzin-konvertujućeg enzima može rezultirati bubrežnom insuficijencijom. U poređenju sa opioidnim analgeticima i NSAIL, paracetamol ima najmanji potencijal za stupanje u klinički značajne interakcije. Potrebno je izbegavati profilaktičku primenu paracetamola nakon vakcinacije i skrenuti pacijentima pažnju da ne primenjuju alkohol u toku terapije

Izazovi i stavovi o doziranju radioaktivnog joda u terapiji benignih oboljenja štitaste žlijezde

Radioactive iodine represents the significant therapeutic option in the treatment of benign thyroid disease. Despite a decades-long experience and a large number of treated patients, many issues related to the therapy with radioactive iodine are still under discussion, including the method of therapeutic dose determination and the factors that affect the therapy outcome. Clinical practice, as well as recommendations of the relevant guidelines in terms of the dosing of radioactive iodine, vary widely in the world: from the fixed dose application to the complex dosimetric protocols. A greater presence of dosimetric approach would facilitate the establishment of dose-effect correlation and the study of influence of various factors on the therapy outcome. Development of the new dosing protocols, as well as new insights into factors that affect therapeutic outcome, enable further improvement of both efficacy and safety of the radioactive iodine therapy for an individual patient.Radioaktivni jod predstavlja značajnu terapijsku opciju u liječenju benignih oboljenja štitaste žlijezde. Uprkos višedecenijskom iskustvu i velikom broju liječenih pacijenata, mnoga pitanja vezana za terapiju radioaktivnim jodom još su uvijek predmet diskusija, uključujući način određivanja terapijske doze, kao i faktore koji utiču na ishod terapije. Klinička praksa, kao i preporuke odgovarajućih vodiča u pogledu doziranja radioaktivnog joda široko variraju u svijetu, od primjene fiksnih doza do kompleksnih dozimetrijskih protokola. Veća zastupljenost dozimetrijskog pristupa olakšala bi uspostavljanje korelacije doza-efekat i proučavanje uticaja raznih faktora na ishod terapije. Razvoj novih protokola za izračunavanje terapijske doze aktivnosti, kao i nova saznanja o faktorima koji utiču na ishod terapije omogućavaju dalje unaprijeđenje kako efikasnosti, tako i bezbjednosti terapije radioaktivnim jodom za individualnog pacijenta

COST Action CA19114, Network for Optimized Astatine labelled Radiopharmaceuticals

Cancer is a major health concerns for European citizens. Thus, the main research aim of this Network for Optimized Astatine labeled Radiopharmaceuticals (NOAR) COST Action is to successfully demonstrate that one of the most promising radionuclides for Targeted Alpha Therapy (TAT), namely astatine-211, can become the European standard for treatment of certain cancerous pathologies. To this end, an efficient networking is essential among all European stakeholders interested in promoting astatine-211 for medical applications. NOAR COST Action brings together European and international excellence labs, astatine-211 production centers, hospitals, industry and patient associations from more than 20 countries, thus covering the whole value chain of innovation: production, chemistry, radiochemistry, biology, preclinical and clinical research and delivery of radiopharmaceuticals to patients. A European web portal will be created containing information for patients, practitioners, researchers, Industry and as a contact point for National and European patient associations. The idea is to gather forces at the European level in order to implement actions to leverage hurdles to the development of this powerful radionuclide and to identify pathologies in which it will be particularly relevant. A special emphasis will be given to train a new generation of young researchers and PhD students, promoting interdisciplinary competencies through international and inter-sectoral mobility. The long-term goal of this project is to make Astatine-211 technology available to all European citizen

Newborn screening for congenital hypothyroidism in Republika Srpska / Prevencija kongenitalnog hipotireoidizma u Republici Srpskoj

Congenital hypothyroidism (CH) is a syndrome hipometabolizma with insufficient production or inadequate action of thyroid hormones. Most infants with normal CH looks and show no signs of hypothyroidism. Unrecognized and not treated in time CH has serious consequences in the psycho-physical development of the newborn are included in the form of mental and physical retardation of varying degrees. CH is not common, the incidence of her 1 / 3000-4000 newborns, but it is important to detect it in time and prevent its consequences. In terms of prevention and early detection in many countries introduced newborn screening at the CH. Screening involves a systematic search of the entire population of newborns specific regions or entire countries, for the diseases that are accessible treatment, which can not be clinically recognized early enough. In Republika Srpska neonatal screening for congenital hipotireize (NSCH) was introduced for all newborns since 2007. In the world, in order to implement different protocols NSCH concentration measurements Tireo stimulating hormone (TSH) and thyroxine (T4) in blood. Measurement of TSH is more specific in the diagnosis of KH, while the more sensitive measurement of T4, but more expensive and less specific in frequent false-positive findings in premature infants and infants with low birth weight. In the Republika Srpska in order to NSCH determines the concentration of TSH in the blood of newborn structural differences of 3-5. days after birth. A retrospective study of data NS CH in Republika Srpska for the period 2007-2012. year showed that in 24 out of 58 680 infants found elevated TSH, which is a further clinical trial demonstrated the existence of CH. The incidence of CH in Republika Srpska 1/2445, but the ratio is 2: 1 in favor of males, with an unequal representation in municipalities. By introducing timely saplementne therapy (thyroxine) in neonates with CH provided them a normal psychological and physical development, which confirms the importance of NS in diagnosing congenital hypothyroidism

Detection of pulmonary calcification in haemodialised patients by whole-body scintigraphy and the impact of the calcification to parameters of spirometry

The early diagnosis of metastatic pulmonary calcification is beneficial, as some patients may develop restrictive changes in respiratory function or in some cases lethal acute respiratory distress. The aim of the study was to evaluate whether scanning with “mTc DPD might be useful in early diagnosis of pulmonary calcification in setting of chronic renal failure and hemodialysis and if presence of pulmonary calcification is associated with an abnormality in respiratory parameters. Forty-two patients with end-stage renal disease, who were treated by regular haemodialysis, were investigated. Twenty five (59.5%) out of forty two patients had increased lung uptake of 99mTc DPD at whole body scintigraphy-grade 2 group. These patients were on dialysis 149±26 months compared with 57±16 months in 17 patients with a normal lung uptake of 99mTc DPD at whole body scintigraphygrade 1 group (p0.05). These observations confirm previous findings that scintigraphy with 99mTc DPD may be efficious in early diagnosis of pulmonary calcification in hemodialised patients as well as the fact that spirometry is useful in patients with confirmed pulmonary calcifications

Detection of pulmonary calcification in haemodialised patients by whole-body scintigraphy and the impact of the calcification to parameters of spirometry

The early diagnosis of metastatic pulmonary calcification is beneficial, as some patients may develop restrictive changes in respiratory function or in some cases lethal acute respiratory distress. The aim of the study was to evaluate whether scanning with “mTc DPD might be useful in early diagnosis of pulmonary calcification in setting of chronic renal failure and hemodialysis and if presence of pulmonary calcification is associated with an abnormality in respiratory parameters. Forty-two patients with end-stage renal disease, who were treated by regular haemodialysis, were investigated. Twenty five (59.5%) out of forty two patients had increased lung uptake of 99mTc DPD at whole body scintigraphy-grade 2 group. These patients were on dialysis 149±26 months compared with 57±16 months in 17 patients with a normal lung uptake of 99mTc DPD at whole body scintigraphygrade 1 group (p0.05). These observations confirm previous findings that scintigraphy with 99mTc DPD may be efficious in early diagnosis of pulmonary calcification in hemodialised patients as well as the fact that spirometry is useful in patients with confirmed pulmonary calcifications

99mtc-Sestamibi Scintimammography in Detection of Recurrent Breast Cancer

The aim of this study was to asses the accuracy of 99mTc-sestamibi scintimammography in patients with suspected recurrent breast cancer in the breast or loco regional tissues. After routine analyses in twenty-eight women (clinical examination, ultrasound, X-ray mammography, and fine needle aspiration biopsy) they were examined by scintimammography. All patients with suspected recurrent cancer in the breast or loco regional tissues (19) undergone surgery and the final diagnosis was determined by histopathological examination. Another 9 patients were followed 6-24 months. The scintigraphic studies were correlated with radiological findings and/ or with histopathology. There were 19 patients with recurrent tumours (15 with loco-regional recurrent and 4 in another breast). X-ray mammography identified 13 of these cancers. 99mTc-sestamibi scintimammography identified seventeen of recurrent breast cancers. In the seven out of nine patients without cancer, scintimammography were reported as having no changes consistent with cancer. X-ray mammography showed suspected cancer lesions in four out of nine patients without cancer. There were two false-positive scintimammograms and one false negative. Axillary lymph node recurrence occurred in four patients. All of them were positive on scinti-mammography. 99mTc-sestamibi scintimammography showed higher sensitivity, specificity and accuracy per patient than did X-ray mammography (90,9% vs. 63,6%, 71,4% vs. 57,1% and 83,3% vs. 61,1%, respectively). To identifying recurrent breast cancer disease is better to use scintimammo-raphy than X-ray mammograph

Ventilator Function Improvement in Patients Undergoing Regular Hemodialysis: Relation to Sex Differences

Uremic lung is different entity then oedema present in cardiovascular diseases or in adult respiratory distress syndrome as well. This state is one of the possible complications in patients with chronic renal failure (CRF) receiving regular hemodialysis (HD). There are several studies suggesting that in these patients in 30-40% cases pulmonary hypertension was developed. It is known that patients with primary pulmonary hypertension have peripheral airway obstruction The data also showed that primary as well secondary pulmonary hypertension are more often developed in females; even real reason is still unknown. The aim of the study was to estimate the ventilator functionimprovement in patients with CRF receiving regular HD related to sex differences. The study population consisted in 39 patients with CRF, with no cardiac and pulmonary diseases. These patients were treated by regular hemodialysis using bicarbonate or acetate mode, respectively. They were divided into two groups according to the sex. Spirometry parameters before and after onset of hemodialysis were recorded. The results were analyzed using Student t-test and presented as mean +/-SD. All p values <0,05 were considered significant. The result showed that ventilatory function in male patients is significantly improved, especially VC and FEV1, whereas in female patientsimprovement had not statistical significance. It can be concluded that one of the possible reasons for slight improvement of ventilatorfunction in female patients is pulmonary hypertension