Hormonal contraceptive choice for women with polycystic ovary syndrome

Sindrom policističnih jajnika (PCOS) je najčešći endokrinološki poremećaj žena reprodukcijske dobi. Važnost PCOS nije samo u njegovoj brojnosti, nego i u čitavom nizu značajnih i različitih kliničkih posljedica. Ovaj se sindrom povezuje s povećanim rizikom nastanka brojnih reprodukcijskih (neplodnost, hiperandrogenemija, menstruacijski poremećaji), metaboličkih (pretilost, dislipidemija, smanjena tolerancija na glukozu, dijabetes tipa 2, metabolički sindrom, nepovoljni kardiovaskularni profili), psiholoških (povećana anksioznost, depresija i smanjenje kvalitete života), te onkoloških (karcinom endometrija) bolesti i poremećaja. Iako etiologija PCOS nije u potpunosti razjašnjena, postoje snažni dokazi da složene interakcije između genetskih, okolišnih i bihevioralnih (poglavito nutritivnih) čimbenika stoje u podlozi ovog sindroma. U nedostatku jasne etiologije i patogeneze ovaj se sindrom definira temeljem Rotterdamskih kriterija koji uključuju postojanje poremećaja menstruacijskih ciklusa, kliničkih i/ili biokemijski znakova povećanog stvaranja androgena i ultrazvučnog nalaze policistične morfologije jajnika. Prisutnost dva od ova tri navedena parametra dostatna je za postavljanje dijagnoze, nakon što se isključe ostale bolesti koje oponašaju PCOS. ----- U nedostatku etiološkog uzroka liječenje je usmjereno na smanjenje simptoma i prevenciju kasnijih posljedica. U prvoj liniji liječenja dermatoloških simptoma hiperandrogenemije i poremećaja menstruacijskog ciklusa te prevencije nastanka karcinoma endometrija kod žena koje trenutačno ne planiraju trudnoću stoji oralna hormonska kontracepcija. Kod odabira hormonske kontracepcije u pacijentica s PCOS zahtijeva se individualni pristup, adekvatna obrada i procjena kardiometaboličkog rizika. Niskodozirani kontraceptivi sa neutralnim ili antiandrogenim progestinima lijek su izbora za suzbijanje znakova hiperandrogenizma i regulaciju menstruacijskog ciklusa. Iako se danas vode brojne polemike i provode razna istraživanja o dobrobitima/rizicima dugotrajnog korištenja oralne hormonske kontracepcije dokazano je da iako određeni rizici postoje, korisni i pozitivni učinci OHK ih daleko nadmašuju. Stoga ovi lijekovi ostaju zlatni standard u liječenju pacijentica s PCOS koje trenutačno ne planiraju trudnoću.Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The importance of the PCOS is not only in its numerosity, but also in its substantial and diverse clinical consequences including reproductive (infertility, hyperandrogenism, menstrual dysfunction), metabolic (obesity, dyslipidemia, impaired glucose tolerance, type 2 diabetes, metabolic syndrome, adverse cardiovascular risk profiles), psychological features (increased anxiety, depression and reduced quality of life), and oncologic risk (endometrial cancer). Although etiology of PCOS is uncertain, there is strong evidence that complex interactions between genetic, environmental and behavioral factors contribute to causing this syndrome. ----- The Rotterdam classification is recommended for defining PCOS in the event of menstrual cycles abnormalities, clinical and/or biochemical signs of hyperandrogenism and ultrasound appearance of polycystic ovaries. The presence of two of these three criteria is sufficient once the other causes that mimic PCOS have been ruled out. In the absence of etiological cause the treatment is orientated to diminishing the symptoms and preventions of late sequel. The mainstay of the first-line therapy for all dermatologic symptoms of hyperandrogenism and menstrual cycle abnormalities are oral hormonal contraceptives. When choosing oral contraceptives in women with PCOS, each patient requires an individual approach, adequate treatment and assessment of cardiometabolic risks. Low dose contraceptives with neutral or antiandrogenic progestagens are in the first line of therapy for combating signs of hyperandrogenism, regulation of the menstrual cycle and prevention of endometrial carcinoma. Despite numerous published studies there is still no consensus about benefit/risk of long term usage of oral hormonal contraception. It is generally agreed that although certain risks exist, positive effects of oral hormonal contraception outweigh them by far. Therefore these drugs remain the gold standard in the treatment of patients with PCOS not immediately seeking pregnancy

Hormonal contraceptive choice for women with polycystic ovary syndrome

Sindrom policističnih jajnika (PCOS) je najčešći endokrinološki poremećaj žena reprodukcijske dobi. Važnost PCOS nije samo u njegovoj brojnosti, nego i u čitavom nizu značajnih i različitih kliničkih posljedica. Ovaj se sindrom povezuje s povećanim rizikom nastanka brojnih reprodukcijskih (neplodnost, hiperandrogenemija, menstruacijski poremećaji), metaboličkih (pretilost, dislipidemija, smanjena tolerancija na glukozu, dijabetes tipa 2, metabolički sindrom, nepovoljni kardiovaskularni profili), psiholoških (povećana anksioznost, depresija i smanjenje kvalitete života), te onkoloških (karcinom endometrija) bolesti i poremećaja. Iako etiologija PCOS nije u potpunosti razjašnjena, postoje snažni dokazi da složene interakcije između genetskih, okolišnih i bihevioralnih (poglavito nutritivnih) čimbenika stoje u podlozi ovog sindroma. U nedostatku jasne etiologije i patogeneze ovaj se sindrom definira temeljem Rotterdamskih kriterija koji uključuju postojanje poremećaja menstruacijskih ciklusa, kliničkih i/ili biokemijski znakova povećanog stvaranja androgena i ultrazvučnog nalaze policistične morfologije jajnika. Prisutnost dva od ova tri navedena parametra dostatna je za postavljanje dijagnoze, nakon što se isključe ostale bolesti koje oponašaju PCOS. ----- U nedostatku etiološkog uzroka liječenje je usmjereno na smanjenje simptoma i prevenciju kasnijih posljedica. U prvoj liniji liječenja dermatoloških simptoma hiperandrogenemije i poremećaja menstruacijskog ciklusa te prevencije nastanka karcinoma endometrija kod žena koje trenutačno ne planiraju trudnoću stoji oralna hormonska kontracepcija. Kod odabira hormonske kontracepcije u pacijentica s PCOS zahtijeva se individualni pristup, adekvatna obrada i procjena kardiometaboličkog rizika. Niskodozirani kontraceptivi sa neutralnim ili antiandrogenim progestinima lijek su izbora za suzbijanje znakova hiperandrogenizma i regulaciju menstruacijskog ciklusa. Iako se danas vode brojne polemike i provode razna istraživanja o dobrobitima/rizicima dugotrajnog korištenja oralne hormonske kontracepcije dokazano je da iako određeni rizici postoje, korisni i pozitivni učinci OHK ih daleko nadmašuju. Stoga ovi lijekovi ostaju zlatni standard u liječenju pacijentica s PCOS koje trenutačno ne planiraju trudnoću.Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The importance of the PCOS is not only in its numerosity, but also in its substantial and diverse clinical consequences including reproductive (infertility, hyperandrogenism, menstrual dysfunction), metabolic (obesity, dyslipidemia, impaired glucose tolerance, type 2 diabetes, metabolic syndrome, adverse cardiovascular risk profiles), psychological features (increased anxiety, depression and reduced quality of life), and oncologic risk (endometrial cancer). Although etiology of PCOS is uncertain, there is strong evidence that complex interactions between genetic, environmental and behavioral factors contribute to causing this syndrome. ----- The Rotterdam classification is recommended for defining PCOS in the event of menstrual cycles abnormalities, clinical and/or biochemical signs of hyperandrogenism and ultrasound appearance of polycystic ovaries. The presence of two of these three criteria is sufficient once the other causes that mimic PCOS have been ruled out. In the absence of etiological cause the treatment is orientated to diminishing the symptoms and preventions of late sequel. The mainstay of the first-line therapy for all dermatologic symptoms of hyperandrogenism and menstrual cycle abnormalities are oral hormonal contraceptives. When choosing oral contraceptives in women with PCOS, each patient requires an individual approach, adequate treatment and assessment of cardiometabolic risks. Low dose contraceptives with neutral or antiandrogenic progestagens are in the first line of therapy for combating signs of hyperandrogenism, regulation of the menstrual cycle and prevention of endometrial carcinoma. Despite numerous published studies there is still no consensus about benefit/risk of long term usage of oral hormonal contraception. It is generally agreed that although certain risks exist, positive effects of oral hormonal contraception outweigh them by far. Therefore these drugs remain the gold standard in the treatment of patients with PCOS not immediately seeking pregnancy

Effect of Iron Deficiency Anemia and Other Clinical Conditions on Hemoglobin A1c Levels

Iron deficiency anemia is the most common type of anemia in the world, the most common form of malnutrition deficit with a prevalence of 50% affecting the developed countries as well as developing countries with a strong influence on social and economic development. According to current guidelines of the American Diabetes Association (2019.) glycated hemoglobin (HbA1c) is a reflection of the patient\u27s glycemic status in the last three months and is used for monitoring of therapeutic effect as well as for diagnostic purposes. Previous studies have proven that not only iron deficiency anemia but also a range of other clinical conditions can affect the level of HbA1c independent of glycemic status. The exact mechanism of the effect of iron deficiency on glycated hemoglobin levels remains unknown and is still at the hypothesis level. Studies have proven that treatment of iron deficiency anemia leads to better control of HbA1c level, regardless of whether the patient is diabetic or not. A small number of studies have noted a correlation between iron deficiency and levels of glycated hemoglobin, thus further research on larger number of patients is certainly necessary in order to improve the therapeutic possibilities for patients with diabetes, more accurately diagnose and understand the pathophysiology of formation and influence on glycated hemoglobin levels. (Vučić D, Veselski K, Bosnić Z. Effect Of Iron Deficiency Anemia And Other Clinical Conditions On Hemoglobin A1c Levels. SEEMEDJ 2019; 3(2); 76-81

Allergic Rhinitis and Adenoidal Hypertrophy

Background: Allergic rhinits is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air. The underlying mechanism involves IgE antibodies that attach to an allergen, and subsequently result in the release of inflammatory chemicals such as histamine from mast cells. It is triggered by environmental allergens such as pollen, pet, hair, dust or mold. Inherited genetics and environmental exposures contribute to the development of allergies. Signs and symptoms of allergic rhinitis are runny or stuffy nose and it can affect sleep and normal daily functions. Adenoidal hypertrphy is the unusual growth of the adenoid (pharyngeal tonsil) that causes an obstruction of the nasal airways. Adenoids start to get sizable during the first year of life and reach maximal volume in the age group of 5-6 years. Just how big the adenoids become is quite variable among individual children. Objective: To determine the relationship between adenoid hypertrophy and allergic rhinits in children. Methods: Retrospective study of clinical studies for adenoid hypertrophy in children with allergic rhinitis. Results: Some authors found that patients with allergic rhinitis have larger adenoidal tissue, but most of them found a reverse clinical picture with possible interpretation that severe anterior nasal obstruction, mainly caused by allergy, affects the passage of allergens able to stimulate adenoid tissue to enlarge. Infections may also play a more important role in the absence of allergy. Conclusion: In children with allergic rhinitis, we should not only look for adenoidal hypertrophi. ENT doctor must pay attention to the anterior nasal obstruction by inferior turbinate hypertrophy

Assessment of Nutritional Status of Elderly People in a Practice of Family Medicine in Relation to MNA Test, Comorbidity and Chronic Therapy

Introduction: Nutrition assessment is one of the biggest challenges in family medicine practice because of the increasing number of older people with more comorbidities and chronic therapy. The MNA(Mini Nutritional Assessment) test has proven to be the most sensitive and exact tool for this type of research. The aim of this study was to assess whether there is a difference in the nutritional status of elderly people, over 65 years of age, with respect to sociodemographic characteristics, number and type of chronic diseases, and number of medications used in chronic therapy. Materials and methods: Research subjects were 207 patients at the age of 65 treated at the Medical Centre Slavonski Brod during a period of 3 months. During the visit, the nutritional status was examined by using the MNA test. The information on chronic diseases and number of medications the patients were using has been collected from the Medicus computer program. Results: According to the MNA test results, 62 subjects (30%) showed risk of malnutrition, average age of the subjects was 72 years and the median of MNA test results was 25.50. Also, multimorbidity is present in 64.73% of the subjects and 42% of them take more than three medications in chronic therapy. No statistically significant difference was found in the results of the MNA test regarding the number of chronic diseases (p =0.89) and number of medications (p = 0.87). Conclusion: It is important to regularly monitor the nutritional status in order to prevent progression of chronic diseases and reduce additional cost of treatment. (Bosnić Z, Miškić M, Veselski K, Vučić D, Trtica Majnarić Lj. Assessment of Nutritional Status of Elderly People in a Family Medicine Practice in Relation to MNA Test, Comorbidity and Chronic Therapy. SEEMEDJ 2019; 3(2); 1-10

Primarni sinonazalni karcinom s gubitkom SMARCB1 (INI-1) - prikaz slučaja

Maligni sinonazalni karcinomi rijedak su entitet s godišnjom incidencijom od 0,5 na 100.000 osoba. Histološki su vrlo raznoliki, što predstavlja veliki izazov u njihovoj dijagnostici. Prema klasifikaciji SZO dijele se na epitelne, neuroektodermalne i mezenhimalne tumore. Na osnovi novih imunohistokemijskih markera i genetike opisani su novi dijagnostički entiteti koji su uključeni u novu klasifikaciju SZO, a među njima je i SMARCB1(INI-1) deficijentni sinonazalni karcinom koji je varijanta sinonazalnog nediferenciranog karcinoma (SNUC). Radi se o slabo diferenciraniranom karcinomu, karakteriziranom potpunim gubitkom imunoekspresije SMARCB1(INI-1) kao posljedica inaktivacije gena SMARCB1, poznatog tumorskog supresora. Imaju dosta agresivan tijek, prikazuju se kao progresivno rastuće, lokalno infiltrativne i destruktivne sinonazalne mase. Do danas je u literaturi zabilježeno manje od stotinu slučajeva ovoga karcinoma s prvim opisanim slučajem 2014. godine. U ovom radu predstavljamo slučaj primarnog sinonazalnog karcinoma s gubitkom SMARCB1(INI-1) kod 39-godišnje bolesnice obrađivane radi glavobolje i dvoslika. Učinjenom radiološkom obradom (CT i NMR) prikazuje se proces sfenoida koji infiltrira veliko krilo sfenoida s lijeve strane, klivus i selarnu regiju. Biopsijom je postavljena dijagnoza slabo diferenciranog karcinoma, s gubitkom ekspresije SMARCB1 (INI- 1). Obzirom na lokaciju tumora i zahvaćenost struktura, kod bolesnice je učinjena endoskopska redukcija tumora, te postoperativna kemoradioterapija. S obzirom na to da se većina bolesnika javlja u uznapredovaloj fazi bolesti, prognoza im je loša

The Correlation between Iron Deficiency and Recurrent Aphthous Stomatitis: A Literature Review

Aphthous lesions of the oral mucosa are a very common symptom and can be seen in both family medicine practice, dental medicine practice, and dermatology or otorhinolaryngology clinics. Some patients develop a chronic recurrent condition, which is clinically known as recurrent aphthous stomatitis (RAS). These ulcers are round, clearly defined, and can be visible on the movable part of the oral mucosa, with variations in size. A prodromal symptom like the burning or stinging sensation can precede the appearance of lesions. The main reason why patients seek medical help is oropharyngeal pain with lack of appetite. The exact etiopathogenesis of RAS remains unknown. Immune disorders, nutritional deficiencies, allergies, mechanical injuries, and even psychological disorders are being studied as potential causes of this condition. Some authors claim that iron deficiency may be a possible causative factor of RAS due to its role in DNA synthesis, mitochondrial function, and enzymatic activity. In iron deficiency, epithelial cells turn over more rapidly and produce an immature or atrophic mucosa. Such mucosa is vulnerable and can be a fertile soil for chronic inflammation and development of aphthae. Finally, our goals were to describe the clinical aspects and etiology of RAS, as well as to determine whether RAS may be related to iron deficiency, in order to identify potential patients with iron deficiency in everyday work

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health