Povezanost perifernih morfoloških promjena mrežnice i genotipskih promjena u bolesnika sa senilnom makularnom degeneracijom [The association of the peripheral morphological retinal changes and genotypic changes in the patients with age-related macular degeneration]

Age-related macular degeneration (ARMD) is a multifactorial neurodegenerative disease of macular region of the retina and is a leading cause of visual loss of elderly people in developed countries. Early signs of the disease are characterized by the presence of the visible soft drusen, areas of hyperpigmentation or depigmented areas, whereas later stages manifest as either choroidal neovascularization (CNV) or atrophy of photoreceptors and retinal pigment epithelium. In the last decade the risk assessment was based on the clinical examination of the macular region, clinically the easiest one to approach to. Recent clinical data showed that the pathologic changes could be found at the retinal periphery. Likewise, clinical studies confirmed a strong association of the CFH, ARMS2, HtrA1, C2,CFB and C3 susceptibility genes with ARMD. The reports that linked the peripheral retinal changes and nucleotide polymorphisms of the susceptibility genes have analysed peripheral retina with standard fundus camera which can analyze only 30-50 degrees at once. The aim of this study is to determine the association of the peripheral retinal changes and genotypic changes in ARMD and their implications on the course and prognosis of the disease. The inclusion criteria were the age (older than 50) and the presence or absence of the clinical signs of the disease. Depending on those criteria, they were referred either to ARMD or control group. We included 160 participants in ARMD group and 150 participants in the control group. All the participants have undergone the clinical examination, the wide angle fundus photographing, OCT of the macular region and DNA genotyping from extracted peripheral blood. 126 The results showed that there was no statistical significant difference in demographic characteristics (age, sex or habits) between those two groups. The peripheral drusen, peripheral reticular pigment and paving stone degenerations are more prevalent in ARMD group. Likewise, we found statistically significant difference in odd ratio for the association of the nucleotide polymorphisms and ARMD disease: In ARMD group, homozygotes rs10490924 have 17,83 times, rs1061170 2,01 times, rs11200638 16,02 times, rs1410996 8,33 times and heterozygotes rs10490924 2,19 times higher risk for ARMD than in control group. In the control group, we found statistically significant difference in odd ratio for the association of the nucleotide polymorphisms and control group: In the control group, heterozygotes rs4151667 2,70 times, rs641153 5,26 times, rs9332739 2,70 times and rs547154 7,69 times less risk for ARMD than in a disease group. Multivariante analysis of the magnitude of the association of peripheral retinal changes and maculopathy showed that patients with peripheral drusen have almost three times, those with RPP two times and with paving stone degenerations 4,5 times more risk for ARMD macular changes compared to the control group. In ARMD group, there was a strong association of the peripheral drusen and reticular pigment with polymorphism CFHY402H: for peripheral drusen OR=4,5for CC genotype and for RPP OR=4,49 for CC and OR=3,51 for CT genotype. When we analyze peripheral retinal changes and genotypic changes in all participants together with or without signs of maculopathy, we found that peripheral drusen and RPP are statistically significant more present in the participants with polymorphisms of CFH, ARMS2 and HTRA1 genes. We also found that paving stone degenerations are statistically significant more present in the participants with polymorphisms ARMS2 and HtrA1 genes. There was no statistically significant association between hyperpigmentations, hypopigmentations, white without pressure, lattice degenerations, holes, retinoschisis and vitreal opacities with nucleotide polymorphisms in both groups. These results have shown the significance of the peripheral drusen and RPP and potentially paving stone degenerations in the fenotypic features of ARMD and therefore, defining their potential role in the classification of the disease, early detection and follow-up of the patients with ARMD

Uloga metalotionina u karcinomu dojke

Metallothioneins (MTs) are a family of small cysteine-rich proteins involved in many physiological and pathological processes. Genes that encode the four isoforms of metallothioneins (MT1-M4) are located on chromosome 16q13. Strucutures of these four isoforms allow metallothioneins their various biological functions. Many studies have shown that MT plays an important role in carcinogenesis, tumour growth, its progression from local to metastatic disease and may contribute to resistence to chemotherapy and radiotherapy. Due to the fact that breast cancer is one of the leading causes of death in women worldwide it is important to better understand the biology of breast cancer. So, findings of MT could evenutally help as a prognostic tool and could lead to a possible new specific anti-cancer treatment.Metalotioneini su skupina proteina bogatih cisteinima koji su uključeni u mnoge fiziološke i patološke procese. Geni koji kodiraju četiri izoforme metalotioneina locirani su na lokusu 16q13. Strukture ovih četiriju izoformi omogućuju metalotioneinima njihove razne biološke funkcije. Mnoge su studije pokazale da metalnotionein ima važnu ulogu u karcinogenezi, rastu tumora, njegovoj progresiji od lokalne prema metastatskoj bolesti te je povezan sa razvojem rezistencije na kemoterapiju i radioterapiju. Rak dojke jedan je od vodećih uzroka smrti u svijetu i važno je bolje razumijeti ulogu metalotioneina u različitim podtipovima karcinoma dojke. Ovakvi podaci mogli bi pomoći kao prognostički alat i voditi pronalasku novog specifičnog liječenja karcinoma

Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurškog zahvata

Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žarišta u oči, što u najvećem broju slučajeva rezultira sljepilom. Bolest je rijetka, a najčešće se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. Budući da se radi o bolesniku bez prethodno opisanih predisponirajućih čimbenika za razvoj ove teške bolesti, smatramo ovaj prikaz klinički važnim za rano prepoznavanje i što ranije agresivno liječenje ove teške bolesti

Verhältnis zwischen Streßbekämpfungsstrategien und Gemütsverfassungen in Streßsituationen

Na uzorku od 147 ispitanika ispitane su promjene u strategijama suočavanja i pozitivnom i negativnom raspoloženju tijekom specifične stresne situacije razredbenog postupka te bidirektivni i prospektivni odnosi između strategija suočavanja i pozitivnog i negativnog raspoloženja. Strategije suočavanja i raspoloženja mjerena su tri puta tijekom stresne situacije, pri čemu su se procjene ispitanika odnosile na razdoblje do dolaska na razredbeni postupak, zatim razdoblje tijekom pisanog dijela razredbenog postupka i razdoblje od završetka pisanog dijela razredbenog postupka do trenutka neposredno prije nego što će im biti priopćeni rezultati pisanog dijela. Dobiveni rezultati pokazuju da tijekom stresne transakcije dolazi do značajnih promjena u uporabi problemu usmjerene strategije suočavanja i suočavanja izbjegavanjem, dok se emocijama usmjereno suočavanje ne mijenja tijekom stresne transakcije. Problemu usmjereno suočavanje najviše je tijekom trajanja pisanog dijela ispita, a u toj fazi je suočavanje izbjegavanjem najniže. Raspoloženje ispitanika također se značajno mijenja, pri čemu općenito tijekom stresne transakcije dolazi do smanjenja pozitivnog i povećanja negativnog raspoloženja. Problemu usmjereno suočavanje konkurentno je pozitivno povezano s pozitivnim raspoloženjem, a pokazuje i odloženu pozitivnu povezanost s pozitivnim i odloženu negativnu povezanost s negativnim raspoloženjem. Osim toga, pozitivno raspoloženje je odloženo pozitivno povezano s problemu usmjerenim suočavanjem. Emocijama usmjereno suočavanje konkurentno je i odloženo pozitivno povezano s negativnim raspoloženjem, a negativno raspoloženje je također odloženo pozitivno povezano s ovom strategijom suočavanja. Suočavanje izbjegavanjem najmanje je povezano s raspoloženjima, pri čemu ono pokazuje odloženu pozitivnu povezanost i s pozitivnim i s negativnim raspoloženjem, ovisno o fazi stresne transakcije.On a sample of 147 examinees, the changes in coping strategies and positive and negative moods during the specific stressful situation of the final high-school graduation exam were analysed, as well as the bidirectional and prospective relations between coping strategies and positive and negative moods. Coping strategies and moods were measured three times during the stressful situation: the period prior to taking the exam, during the written graduation exam and the period following the exam up to the moment the results of the written exam were announced. The results obtained indicate that significant changes occurred during this time in using the problem-aimed coping strategy and avoidance strategy, while emotionally-aimed coping did not change during the stressful transaction. Problem-aimed coping is highest in the period during the written exam, while in this phase, coping through avoidance is the lowest. Examinees’ moods also changed siginificantly, and, generally speaking, during the stressful transaction positive mood dropped and negative mood rose. Problemaimed coping is concurrently positively correlated with the positive mood, and also demonstrates a lagged positive correlation with positive and lagged negative correlation with negative mood. Furthermore, positive mood has a lagged positive correlation with problem-aimed coping. Emotionallyaimed coping is concurrently and lagged positively correlated with negative mood, and negative mood is also lagged positively correlated with this coping strategy. Coping through avoidance is the least connected with moods, demonstrating a lagged positive correlation with both positive and negative mood, depending on the phase of the stressful transaction.Eine unter 147 Testpersonen durchgeführte Untersuchung sollte zeigen, wie sich Streßbekämpfungsstrategien und Gemütsverfassungen im Laufe einer spezifischen Streßsituation (Aufnahmeprüfung von Studienbewerbern) ändern, ferner wollte man das bidirektive und prospektive Verhältnis zwischen Streßbekämpfungsstrategien einerseits und positiver sowie negativer Gemütsverfassung andererseits aufzeigen. Streßbekämpfungsstrategien und Gemütsverfassungen wurden dreimal im Laufe der Streßsituation geprüft, wobei sich die Aussagen der Testpersonen auf folgende drei Zeitabschnitte bezogen: die Zeit bis zum Beginn der Aufnahmeprüfung, die Dauer des schriftlichen Prüfungsteils und die Zeit vom Abschluß des Schriftlichen bis unmittelbar vor der Bekanntgabe der schriftlichen Prüfungsergebnisse. Die ermittelten Resultate zeigen, daß es im Laufe der Streßsituation zu bedeutenden Veränderungen in der problemorientierten Streßbekämpfungsstrategie und der Strategie des Ausweichens kommt, während die gefühlsorientierte Konfrontierungsart unverändert bleibt. Die Problemorientierung erwies sich während des schriftlichen Prüfungsteils am ausgeprägtesten, das Phänomen des Ausweichens war am wenigsten gegenwärtig. Auch kam es in dieser Phase zu starken Stimmungsschwankungen: positive Gemütsverfassung verringerte sich im Verlauf der Streßsituation, während negative Stimmung zunahm. Problemorientiertes Streßverhalten verläuft parallel und im positiven Bezug zu positiver Gemütsverfassung, auch stellt es einen zeitlich verzögerten positiven Bezug zur positiven sowie einen zeitlich verzögerten negativen Bezug zur negativen Gemütsverfassung her. Andersherum bringt auch positive Gemütsverfassung mit bestimmter zeitlicher Verzögerung ein problemorientiertes Verhalten hervor. Gefühlsorientiertes Streßverhalten verläuft parallel und im positiven Bezug zu negativer Gemütsverfassung, während andersherum eine negative Gemütsverfassung nach einer gewissen Zeit in ebensolcher Streßbekämpfungsstrategie resultiert. Die Strategie des Ausweichens vor Problemen steht am allerwenigsten mit der Gemütsverfassung in Zusammenhang, wobei sie – je nach der Phase der Streßsituation – einen verzögerten positiven Bezug zu positiver wie auch negativer Gemütsverfassung offenbart

Kliničke karakteristike i liječenje lupusnog nefritisa - preliminarna analiza opservacijskih podataka Nacionalnog referentnog centra

Lupus nephritis (LN) is one of the most severe features of systemic lupus erythematosus (SLE). Data on LN is scarce in the Croatian population. We analysed the characteristics of LN patients diagnosed at our tertiary referral centre. In this retrospective study, we analysed the following features of patients with biopsy-proven LN diagnosed between 2011 and 2020: demographics, renal laboratory parameters, renal histopathology, and treatment. A total of 38 patients were included (30 females; mean age 39±15 years). The most common indication for kidney biopsy was proteinuria (89%). The proportion of LN classes was: class I (2.6%), II (5.3%), III (18.4%), IV (42.1%), V (13.2%), III+V (10.5%), IV+V (5.3%). The median time from SLE diagnosis to histologic confirmation of LN was 1.0 year. All patients were treated with methylprednisolone (MP), 68% received MP pulses. Induction treatment included intravenous (IV) cyclophosphamide (CYC) (71%) (15 patients treated per Euro-Lupus and 9 per the National Institutes of Health regimen), oral CYC (3%), or mycophenolate mofetil (11%). 79% of patients received antimalarials. While there is heterogeneity between different populations, our patient profile was similar to that from other European studies. Further follow-up of this group is necessary to assess outcomes in our population.Lupusni nefritis (LN) je česta i vrlo ozbiljna manifestacija sustavnog eritemskog lupusa (SLE). Još uvijek nema dovoljno podataka o karakteristikama bolesnika s LN u Hrvatskoj. Analizirali smo karakteristike bolesnika s LN koji su liječeni u referentnom centru naše tercijarne ustanove. U ovu retrospektivnu studiju uključili smo bolesnike s biopsijom potvrđenim LN u periodu od 2011. do 2020. godine, analizirali smo demografske podatke, parametre bubrežne funkcije, patohistološki nalaz bioptata bubrega i liječenje. U studiju je uključeno 38 bolesnika (30 žena, prosječna dob 39±15godina). Najčešća indikacija za biopsiju bubrega bila je proteinurija (89%). Raspodjela klasa LN bila je sljedeća: klasa I(2,6 %), II(5,3 %), III(18,4 %), IV(42,1 %), V(13,2 %), III+V(10,5 %), IV+V(5,3 %). Prosječno vrijeme od dijagnoze SLE do histološke potvrde LN bilo je 1,0 godina. Svi bolesnici su liječeni kortikosteroidima, 68 % liječeno je bolusima metilprednizolona. Indukcijska terapija uključivala je parenteralnu primjenu ciklofosfamida (CYC) (71 %) (15 bolesnika liječeno je prema Euro-lupus protokolu, 9 bolesnika prema protokolu Nacionalnog instituta za zdravlje (NIH)), peroralni CYC (3 %) ili mikofenolat mofetil (11 %). Antimalarike je primilo 79 % bolesnika. Unatoč heterogenosti između različitih populacija s LN, profil bolesnika uključen u ovu studiju sličan je ostalim europskim studijama. Daljnje praćenje potrebno je da bi se istražili ishodi u ovoj populaciji

Imunski odgovor pilića na kokcidijalnu infekciju

It is important to study the immunological response of chicken to infections caused by Eimeria spp. because control of this disease is a specific problem in conditions of intensive poultry production. The details of the protective mechanisms which are activated in the course of a coccidial infection have still not been satisfactorily explained, but it is known that cellmediated immunity plays a dominant role in defending the host from this agent. Intraepithelial lymphocytes (IEL) play a very important role in the local defense of intestinal mucosa from coccidial invasion. A certain number of IEL in chicken CD3 are positive and can be detected at the earliest on day 6 after hatching. Poultry IEL are mostly T-lymphocytes, most of which on their surface carry receptors for CD8 antigen, and since they are cytotoxic lymphocytes, they have an important role in resistance to secondary infection.Izučavanje imunskog odgovora pilića na infekciju prouzrokovanu Eimeria spp značajno je zbog toga, što suzbijanje ovog oboljenja predstavlja specifičan problem u uslovima intenzivne živinarske proizvodnje. Dosadašnji rezultati u razvoju imunoprofilakse, kao i sumnja u dostupnost novih antikokcidijala utiču na intenziviranje istraživanja u oblasti suzbijanja kokcidioze imunološkim metodama. Njihovo potpunije poznavanje može da doprinese uspešnijem iskorenjivanju bolesti, koja prati ekonomski značajnu intenzivnu proizvodnju mesa i jaja živine. Detalji zaštitnih mehanizama, koji su se aktivirali u toku kokcidijalne infekcije, još uvek nisu u potpunosti objašnjeni, ali se zna da imunitet ćelijski posredovan ima dominantnu ulogu u odbrani domaćina od ovog uzročnika

Učestalost pseudoeksfolijativnog sindroma i pseudoeksfolijativnog glaukoma u populaciji sjeverozapadne hrvatske u dobi od 40 godina i više

The purpose of this study was to assess the prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma and to evaluate its association with open-angle glaucoma in patients attending the Department of Ophthalmology, Dr Tomislav Bardek General Hospital in Koprivnica, northwestern Croatia. This prospective study was conducted at Dr Tomislav Bardek General Hospital between December 2012 and October 2013. A total of 5349 subjects aged 40 or above presenting for general ophthalmic examination were screened for pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Each patient underwent complete ophthalmologic examination including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, optic disc evaluation, visual field analysis, and gonioscopy if glaucoma was suspected. Exclusion criteria were pseudophakic and/or aphakic patients of any age, patients with concomitant congenital eye disease, and patients with very dense ocular media opacities. Out of 5349 patients examined, there were 1994 (38.38%) males and 3201 (61.61%) females. The prevalence of pseudoexfoliation syndrome was 3.6% and primary open angle glaucoma 9.4%, out of which 23.6% with pseudoexfoliation glaucoma. The findings of this study improve our knowledge of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Croatia, particularly in the northwest region.Svrha ovoga istraživanja bila je procijeniti učestalost pseudoeksfolijativnog sindroma i pseudoeksfolijativnog glaukoma te njihovu povezanost s glaukomom otvorenog kuta kod bolesnika Očne poliklinike Opće bolnice “Dr. Tomislav Bardek” u Koprivnici, sjeverozapadna Hrvatska. Ovo prospektivno istraživanje provedeno je od prosinca 2012. do listopada 2013. godine. Ukupno je pregledano 5349 ispitanika u dobi od 40 godina i više. Kod svakog je učinjen kompletan oftalmološki pregled uključujući anamnezu, ispitivanje vidne oštrine, pregled na biomikroskopu, aplanacijsku tonometriju, pregled očnoga živca i pozadine oka te vidno polje i gonioskopiju kod onih sa sumnjom na glaukom. Kriteriji za isključenje bili su bolesnici s pseudofakijom/afakijom, bolesnici s prirođenim očnim bolestima te oni s vrlo gustim zamućenjem očnih medija. Od 5349 bolesnika bilo je 1994 (38,38%) muškaraca i 3201 (61,61%) žena. Učestalost pseudoeksfolijativnog sindroma bila je 3,6%, a primarnog glaukoma otvorenog kuta 9,4%, od čega 23,6% spada u skupinu pseudoeksfolijativnog glaukoma. Rezultati ove studije proširuju naše spoznaje o pseudoeksfolijativnom sindromu i pseudoeksfolijativnom glaukomu u Hrvatskoj, osobito u sjeverozapadnoj regiji

Angiotensin-Converting Enzyme Gene Insertion/Deletion Polymorphism in Patients with Chronic Pancreatitis and Pancreatic Cancer

The purpose of this study was to determine the frequency of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and to investigate its role as a potential risk factor in patients with chronic pancreatitis and pancreatic cancer. Deletion polymorphism of the 287-bp fragment of intron 16 of the ACE gene results in higher levels of circulating enzyme and therefore may represent a risk factor for disease development. The study included 55 patients with chronic pancreatitis, 45 patients with pancreatic cancer and 128 healthy subjects. The presence of I and D variants in the ACE gene was analyzed by a polymerase chain reaction (PCR) method. Distribution of ACE ID genotypes was analyzed by means of logistic regression. When chronic pancreatitis and pancreatic cancer groups were compared in the univariate analysis, the following factors were identified as statistically significant predictors of pancreatic disease: age, gender, smoking, fat intake, ACE II genotype and ACE DD genotype. However, in the multivariate analysis, only age, gender and smoking were singled out as predictors for the occurrence of pancreatic disease. Our findings indicate that the ACE I/D polymorphism could play a role in the development of chronic pancreatitis and pancreatic cancer through interaction with other genetic and environmental factors