Tireotropin i hormoni štitnjače u eutireoidnom Hashimotovu tireoiditisu

Little is known about thyrotropin (TSH) and thyroid hormones in euthyroid Hashimoto’s thyroiditis (HT), thus the aim was to investigate TSH and thyroid hormone economy in euthyroid HT and its relation to thyroid function. Ninety-five patients with euthyroid HT with normal TSH and thyroid hormones on the last follow up between 2009 and 2011 were investigated. Previous observation period ranged from 1.5 to 4.8 (mean 2.8) years, and they had never been treated with levothyroxine. The results of TSH and thyroid hormones were compared with 210 healthy subjects and expressed as median (25%-75%). According to TSH value, the subjects were divided into quartiles: TSH 0.4-0.99 (1q), 1.0-1.99 (2q), 2.0-2.99 (3q) and 3.0-4.0 mIU /L (4q). Euthyroid HT patients had higher TSH (2.53 [1.79-3.14] vs.1.95 [1.24-2.72], p<0.001). T4 and T3 were not different. The distribution of TSH in HT patients was significantly shifted to the right; 71% of patients were in the 3q and 4q groups. When HT patients with higher TSH (3q and 4q) were compared with those with lower TSH (1q and 2q), significant differences emerged in TSH (3.01 [2.48-3.48] vs.1.45 [1.07-1.71] mIU /L), T4 (99.0 [88.2-112.0] vs.112.0 [105.0-122.0] nmol/L) and T3 (1.78 [1.48-2.05] vs. 2.10 [1.85-2.21] nmol/L; p<0.01). TPO values were similar in both groups. A gradually increasing proportion of euthyroid HT patients with at least one supranormal TSH during the observation period were found: 0% in 1q, 10% in 2q, 15% in 3q and 44% in 4q TSH group. Euthyroid HT patients maintain euthyroidism only under strenuous TSH stimulation. The patients with high normal TSH are identified as those with a major risk of hypothyroidism in the near future.Malo je poznato o vrijednostima tireoptropina (TSH) i hormona štitnjače u eutireoidnom Hashimotovu tireoiditisu (HT) te je cilj bio istražiti razinu TSH i hormona štitnjače u HT i njihov odnos prema funkciji štitnjače. Ispitano je 95 bolesnika s eutireoidnim HT s normalnim TSH i hormonima štitnjače na posljednjoj kontroli između 2009. i 2011. godine. Prethodno razdoblje promatranja variralo je od 1,5 do 4,8 (u prosjeku 2,8) godina, bolesnici nisu nikada liječeni levotiroksinom. Rezultati TSH i hormona štitnjače uspoređeni su s onima u 210 zdravih osoba i prikazani kao medijan (25%-75%). Prema vrijednosti TSH ispitanici su podijeljeni u kvartile: TSH 0,4-0,99 (1q), 1,0-1,99 (2q), 2,0-2,99 (3q) i 3,0-4,0 mIU /L (4q). Eutireoidni bolesnici s HT imali su viši TSH (2,53 [1,79-3,14] prema 1,95 [1,24-2,72], p<0,001). T4 i T3 se nisu razlikovali. Raspodjela TSH u HT izrazito je pomaknuta udesno. Ukupno je 71% bolesnika bilo u skupini 3q i 4q. Kada se usporede HT bolesnici s višim (3q i 4q) i nižim TSH (1q i 2q) nalaze se značajne razlike u TSH (3,01 [2,48-3,48] prema 1,45 [1,07-1,71] mIU /L), T4 (99,0 [88,2-112,0] prema 112,0 [105,0-122,0] nmol/L) i T3 (1,78 [1,48- 2,05] prema 2,10 [1,85-2,21] nmol/L; p<0,01). Vrijednosti TPO bile su slične u obje skupine HT bolesnika. Opažen je postupni porast postotka eutireoidnih HT bolesnika s najmanje jednom povišenom vrijednošću TSH tijekom razdoblja promatranja: 0% u skupini 1q, 10% u 2q, 15% in 3q i 44% u skupini 4q. Eutireoidni bolesnici s HT održavaju eutireozu jedino uz povećanu stimulaciju pomoću TSH. Bolesnici s visoko normalnim TSH imaju najveći rizik nastupa hipotireoze u bliskoj budućnosti

Studies on the Life Cycle and Transmission of \u3ci\u3eCougourdella\u3c/i\u3e Sp., A Microsporidian Parasite of \u3ci\u3eGlossosoma Nigrior\u3c/i\u3e (Trichoptera: Glossosomatidae)

The trichopteran Glossosoma nigrior, the dominant benthic invertebrate grazer in Michigan trout streams, hosts a microsporidian (Protozoa) pathogen, Cougourdella sp., which strongly regulates the population density of larvae in the stream. In order to better understand the interactions between these two species, two possible modes of pathogen transmission, oral and transovum, were investigated. While both sexes of adult G. nigrior were found to be infected with mature environmental spores, spores were not found associated with reproductive tissue. This suggests that transovum transmission does not occur in this system. Glossosoma nigrior, when ex- posed to viable spores taken from infected larvae, did not produce Cougourdella sp. infections, which suggests that oral transmission also does not occur. It is possible that an intermediate host is required

Opće preporuke za liječenje aneurizmatskog subarahnoidnog krvarenja

Subarachnoid hemorrhage is a neurologic emergency and a detrimental cerebrovascular event with a high rate of death and complications. Recommendations have been developed and based on literature search, evaluation of the results of large international clinical trials, collective experience of the authors, and endorsed by the Croatian Society of Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. The aim of these guidelines is to provide current and comprehensive recommendations and to assist physicians in making appropriate decisions in the management of subarachnoid hemorrhage. Evidence based information on the epidemiology, risk factors and prognosis, as well as recommendations on diagnostic work up, monitoring and management are provided, with regard to treatment possibilities in Croatia.Subarahnoidno krvarenje je hitno neurološko stanje s visokom stopom smrtnosti i komplikacija. Preporuke su temeljene na dostupnoj literaturi, rezultatima velikih međunarodnih kliničkih ispitivanja i kolektivnom iskustvu autora, a prihvaćene od strane Hrvatskoga društva za neurovaskularne poremećaje, Hrvatskoga društva za neurologiju uključivo i Sekciju za intenzivnu neurologiju, Hrvatskoga društva za neurokirurgiju, Hrvatskoga društva za zbrinjavanje otežanog dišnog puta i Hrvatskoga liječničkog zbora. Cilj ovih preporuka je pomoć liječnicima u donošenju odgovarajućih odluka u dijagnostici i liječenju bolesnika sa subarahnoidnim krvarenjem

Tumor mozga kao prototip teškog moždanog oštećenja u bolesnika sa “sindromom niskog t3”

The purpose of our study was to contribute to better understanding of cerebrospinal fluid (CSF) as a valuable biological material in the research of brain tumors within the “low T3 syndrome”, and to discuss the role of thyroid hormones in the central nervous system in subjects with severe cerebral lesions. We studied the levels of total triiodothyronine (tT3), total thyroxine (tT4), free triiodothyronine (fT3), free thyroxine (fT4), reverse triiodothyronine (rT3) and thyrotropin (TSH) in serum, and fT3, fT4, rT3 and TSH levels in CSF of patients with brain tumor, and compared the results with control group. Study results indicated a statistically significantly higher level of rT3 in serum and CSF of brain tumor patients vs. control group (p<0.05). The rT3/fT3 ratio was highest in CSF and serum of brain tumor patients, yielding a statistically significant difference (p<0.05). These results could suggest higher permeability of the blood brain barrier in brain tumor patients. We also assume that rT3, in the framework of “cerebral low T3 syndrome”, is also generated through local intracerebral conversion. Disruption of this process in severe cerebral lesion can lead to increased rT3 concentrations, i.e. development of the “low T3 syndrome”.Cilj studije bio je doprinijeti boljem poznavanju cerebrospinalne tekućine kao vrijednog biološkog materijala u istraživanju moždanih tumora i “sindroma niskog T3”, te razmotriti ulogu hormona štitnjače unutar središnjega živčanog sustava kod bolesnika s ozbiljnim moždanim oštećenjem. Analizirali smo razinu ukupnog trijodtironina (tT3), ukupnog tiroksina (tT4), slobodnog trijodtironina (fT3), slobodnog tiroksina (fT4), reverznog trijodtironina (rT3) i tireotropina (TSH) u serumu i razinu fT3, fT4, rT3 i TSH u cerebrospinalnoj tekućini u bolesnika s tumorom mozga te dobivene rezultate usporedili s kontrolnom skupinom ispitanika. Rezultati su ukazali na statistički značajno veću razinu rT3 u serumu i cerebrospinalnoj tekućini u bolesnika s tumorom mozga u usporedbi s kontrolnom skupinom (p<0,05). Odnos rT3/fT3 bio je također statistički značajno veći kod bolesnika s tumorom mozga (p<0,05). Naše istraživanje moglo bi ukazivati na veću propustljivost krvno-moždane barijere u bolesnika s tumorom mozga. Također pretpostavljamo da se u bolesnika s tumorom mozga rT3 pojačano stvara kroz aktivniju intracerebralnu pretvorbu. Svakako, naši rezultati trebaju biti potvrđeni i daljnjim podrobnijim istraživanjima

Management of Hypertension in Student Patients in a University Student Clinic

Purpose: To evaluate provider adherence to a clinical guideline for management of hypertension, and to assess improvement in quality of management of student patients with hypertension in a university student clinic. Methods: A retrospective chart review was conducted to identify student patients with hypertension. Data collected included the demographics of the sample patients, blood pressures, LDL results, weights, and evidence of provider compliance with guidelines. Results: Of the 13 patient charts audited, providers recommended exercise to 46.15% of patients, weight loss or maintenance to 53.85% of patients, no-added salt diets to 53.85% of patients, low fat to 23.08% of patients, fruits and vegetables to 23.08% of patients, and alcohol moderation to 15.38% of patients. There were no smokers in the sample. Measured outcomes were: LDLs ≤ 130 in 15.38% of patients, achievement of a 5% weight loss if BMI ≥ 25 in 7.69% of patients, weight maintenance if BMI \u3c 25 in 15.38% of patients. A systolic BP of Conclusion: Outcomes were mixed. Blood pressures improved in more than half of the patients, 7.69% met weight goals. LDLs were recommended for 61.54% of patients but were done in only 23.08% of patients. 61.54% of patients were treated with a preferred ACE1, 7.69% with ACE1/thiazide, 23.08% with a thiazide alone, 7.69% with no antihypertensive. Improvements were made in quality of hypertension management, but further improvement is needed

A New Microsporidium in Alfalfa Weevil Populations: Distribution and Characterization

A microsporidium species, not previously reported, was found infecting field populations of the alfalfa weevil, Hypera postica, in Illinois. The pathogen is widely distributed thoughout the state. Percent infection ranged from 1 % to 50% at different collection locations. Characteristics of the microsporidium and possible modes of transmission are presented