THE INFLUENCE OF VITAMIN D ON THE PREVENTION AND TREATMENT OF MALIGNANT DISEASES

Vitamin D has long been recognized for its essential role in maintaining healthy bones and teeth. In recent years, there has been increasing research into the potential influence of vitamin D on malignant diseases. It is estimated that more than 10 million people die from cancer each year, making it one of the leading causes of death globally. While many factors contribute to cancer development, including genetic and environmental factors, research has suggested that vitamin D may play a role in reducing the risk of certain types of cancer. Vitamin D has numerous physiological functions, such as anti-inflammatory, immunomodulatory, proapoptotic, and antiangiogenic effects. Preclinical studies have shown that it could inhibit carcinogenesis, slowing tumor progression by stimulating cell differentiation and inhibiting cancer cell proliferation. Several types of cancer have been studied concerning vitamin D. While more research is needed, some evidence suggests that vitamin D may play a role in reducing the risk of certain types of cancer. Maintaining adequate vitamin D levels through sunlight exposure, diet, or supplementation may be essential in promoting overall health and reducing the risk of malignant diseases

Effects of Hyperglycemia and Metformin on Expression of Adhesion Molecules on Human Aortic Endothelial Cells

Expression of adhesion molecules on the endothelial cell surface as a response to elevated glucose concentration is considered as a main event in the development of atherosclerosis. The influence of high glucose concentration and metformin, a wide used anti-diabetic drug, on the expression of E-selectin, vascular adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) on human aortic endothelial cells (HAECs) was investigated. HAECs were cultured 4 h in a medium with 5.5, 8.0, 12.0, and 16.5 mmol dm-3 glucose with or without metformin addition. The expression of cell adhesion molecules (CAM) was measured by flow-cytometry. Compared to CAM expression in the medium with 5.5 mmol dm-3 glucose, glucose concentration of 12.0 mmol dm-3 increased expression of E-selectin (62 %), VCAM-1 (four fold) and ICAM-1 (81 %). Metformin administration in the medium with 12.0 mmol dm-3 glucose additionally enhanced E-selectin and VCAM-1 expression compared to effects of corresponding glucose concentration. ICAM-1 expression was only significantly increased in the medium with metformin and 8.0 mmol dm-3 glucose. In conclusion, metformin in condition with elevated glucose concentration additionally increased expression of CAM on HAECs which could contribute to development of macrovascular complications in diabetic patients

Od erektilne disfunkcije do subependimoma mozga: prikaz slučaja

Endocrinopathies are relatively rare causes of erectile dysfunction. Cases of hyperprolactinemia and pituitary adenomas have been previously reported. We present a clinical case of a 27-year-old male with suspected infertility and recent symptoms of erectile dysfunction. Additional radiological and endocrinologic workup revealed underlying subependymoma, which was expanding in the sellar and suprasellar regions, causing pressure against the pituitary gland. The resulting endocrine disorder caused problems that were subjectively at first manifested mainly as erectile dysfunction. The case is an educative example pointing to the need of taking possible intracranial lesions in consideration when starting workup in a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists but also for practitioners in various fields.Endokrinopatije su relativno rijetki uzroci erektilne disfunkcije. Prethodno su opisani slučajevi hiperprolaktinemije i adenoma hipofize. Mi prikazujemo klinički slučaj 27-godišnjeg muškarca sa sumnjom na neplodnost i nedavnim simptomima erektilne disfunkcije. Dodatna radiološka i endokrinološka obrada otkrila je u podlozi subependimom s ekspanzijom u selarnoj i supraselarnoj regiji, s kompresijom na hipofizu. Posljedični endokrini poremećaj uzrokovao je probleme koji su se prvobitno subjektivno manifestirali pretežno kao erektilna disfunkcija. Slučaj je edukativni primjer koji upućuje na to da je kod bolesnika koji se prezentira s erektilnom disfunkcijom pri započinjanju obrade potrebno uzeti u obzir moguće intrakranijske lezije. Slučaj bi mogao biti klinički zanimljiv ne samo za endokrinologe, nego i za praktičare iz drugih stručnih područja

IMPORTANCE OF NUTRITION AND ADJUSTING INSULIN DOSES BEFORE AND DU-RING PREGNANCY IN WOMEN WITH TYPE 1 DIABETES: CASE REPORT

U žena s tipom 1 šećerne bolesti važno je postići uredne vrijednosti glikemije prije trudnoće i primijeniti lijekove koji su dopušteni u trudnoći. Prikazana je 35 g. žena kojoj je tip 1 šećerne bolesti dijagnostici-ran u djetinjstvu. Pacijentica je na intenziviranoj inzulinskoj terapiji koja se sastoji od kratkodjelujućeg inzulin-asparta uz tri glavna obroka (15g ugljikohidrata: 1,5j. uz doručak, 1j. uz ručak i 1j. uz večeru) i dugodjelujućeg inzulin-degludeka u 22h. Primljena je na Endokrinološki odjel s oscilirajućim vrijed-nostima glikemije, uz hipoglikemije poslijepodne i noću (HbA1c 8,7%), radi regulacije glikemije u sklopu planiranja trudnoće. Provedena je dodatna edukacija o redovitoj i uravnoteženoj prehrani, korigirana je doza aspart-inzulina ovisno o glikemiji i ugljikohidratnim jedinicama u obroku (15g ugljikohidrata: 1j. uz doručak, 0.75j. uz ručak i 0.75j. uz večeru), te je uvedeno kontinuirano mjerenje glukoze. Nakon 4 mjeseca kontrolni HbA1c bio je 6,9%. Radi planiranja trudnoće degludec-inzulin zamijenjen je detemir-inzulinom u dvije dnevne doze. U trudnoći je imala mučnine, jela je više voća i ugljikohidrata i, sukladno tome, povišena je doza aspart-inzulina uz obroke (do 2:2:2 j. uz glavne dnevne obroke). U 28. tjednu trudnoće glikemija je bila 5,0-5,7 mmol/l, glukoza i ketoni u urinu uredni, HbA1c 6,2% te nije imala simptome hipoglikemije. Prije i za vrijeme trudnoće važno je postići uredne vrijednosti glikemije. Provodi se dodatna edukacija o redovitoj uravnoteženoj prehrani, samokontroli i kontinuiranom mjerenju glikemije, prilagođavanju doze kratkodjelujećeg inzulina vrijednostima glikemije i ugljikohidratnim jedinicama u obroku te o korigiranju doze bazalnog inzulina, kao i o važnosti tjelesne aktivnosti.In women with type 1 diabetes, it is important to achieve proper glycemic values before pregnancy and to use medications that are allowed in pregnancy. Case covers 35 year old woman who was diagnosed with type 1 diabetes in childhood. The patient is on intensive insulin therapy which consists of short-acting insulin-aspart with three main meals (15 g carbohydrates: 1.5 U at breakfast, 1 U at lunch and 1 U at dinner) and long-acting insulin degludek at 10 pm. She was admitted to the Endocrinology De-partment with fluctuating glycemic values, with hypoglycemia in the afternoon and at night (HbA1c 8.7%), to regulate blood glucose as part of pregnancy planning. Further education on a regular bal-anced diet was conducted, the dose of aspart-insulin corrected depending on blood glucose and carbo-hydrate units in the meal (15 g carbohydrates: 1U at breakfast, 0.75U at lunch and 0.75U at dinner), and continuous glucose measurements is introduced. After 4 months, control HbA1c was 6.9%. Be-cause of pregnancy planning, degludec-insulin was replaced with detemir-insulin, at two daily doses. She had nausea during her pregnancy, ate more fruits and carbohydrates and, accordingly, increased dose of aspart-insulin was applied with meals (now up to 2: 2: 2 U with main daily meals). At week 28 of pregnancy, blood glucose was 5.0-5.7 mmol / l, glucose and ketones in the urine were normal, HbA1c 6.2% and had no symptoms of hypoglycemia. It is very important to achieve proper glycemic values prior and during pregnancy. Additional education is being conducted on a regular balanced diet, self-control or continuous measurement of blood glucose, adjusting the dose of short-acting insulin to glycemic values and carbohydrate units in the meal and correcting the basal insulin dose, as well as the importance of physical activity

Comorbidity of Somatic Illnesses on People With Treated Mental Disorders – A New Challenge in Medicine

Aim. Comorbidities pose a major challenge for 21st century medicine. The mutual pathophysiological effect of one disease on another can significantly affect their course and prognosis. The aims of this study were to examine the frequency of comorbidities and the most common psychiatric and somatic comorbidities and to determine the difference in the incidence of certain diseases by gender and age. Methods. Data were recorded in several groups: demographic characteristics, psychiatric and somatic diagnoses classified according to gender, age, and the legally determined ability to work, and correlations of somatic and psychiatric diagnoses. Results. The most common psychiatric diagnoses in men were post-traumatic stress disorder (PTSD) (25%) and alcoholism (23%), while in women these were recurrent depressive disorder (19%) and psychosis (10%). A statistically significant difference was found in the incidence of alcoholism and PTSD, which are more common in men than in women. The most common somatic diseases in both sexes were arterial hypertension (M = 33%, F = 46%) and diabetes mellitus (M = 18%, F = 32%). Statistically significant differences were found in the frequency of hypertension (p = 0.03) and epilepsy (p = 0.002), which are more common in men. The ratio alcoholism-hypertension (p = 0.03), alcoholism-diabetes (p < 0.0001), alcoholism-COPD (p < 0.001) was statistically significant. Conclusion. It is extremely important to improve the multidisciplinary approach and cooperation in treatment in order to reduce the number of hospitalizations, emergency interventions and suicides and to improve the patients’ quality of life and life expectancy

Pheochromocytoma in pregnancy – a rare but dangerous diagnosis

Pheochromocytoma is a rare cause of hypertension in pregnancy. Unrecognized, it carries a great risk for both mother and the foetus. The main reason for missing the diagnosis is the misconception that any hypertension occurring in pregnancy is gestational hypertension or pre (eclampsia). As many as 90% of patients report one or more pheochromocytoma-related symptoms antenatally, but the diagnosis is made in 75% of patients, meaning that 3 out of 10 patients are diagnosed after childbirth or post-mortem. The symptoms are similar to other more common causes of hypertension in pregnancy, which presents a major diagnostic challenge. The diagnosis is based on determination of metanephrines in plasma or 24-hour urine. Magnetic resonance imaging (MRI) and ultrasound (US) are used to localize the tumour. If the diagnosis is made before the 24th week of pregnancy, laparoscopic removal of the tumour in the second trimester is recommended. If diagnosed later, the tumour could be removed during or after delivery. Preoperative preparation with alpha blockers is required to stabilize blood pressure. The decision on the mode of delivery depends on several factors, so an experienced multidisciplinary team is needed to minimize maternal and foetal mortality

Lipid profile of postmenopausal women

Objectives: The main objectives of the research are to examine the incidence of hyperlipoproteinemia in postmenopausal women and to determine the differences in lipid profile considering age, duration of menopause and body mass index in postmenopausal women. Respondents and methods: The research is structured as cross-sectional with historical data. The research used data collected during regular check-ups in primary health care clinics in Osijek Health Center from November 2021 to March 2022. Collected data: demographic data, information on the duration of menopause, body mass, body height, body mass index, values of total, LDL, HDL cholesterol and triglycerides, and data on associated diseases. Results: 98 postmenopausal women were included in the research, of which over 50% had elevated total and LDL cholesterol values, and 39.8% had elevated triglyceride values. Subjects aged 45 to 65 years and subjects with a duration of menopause of 10 or more years had significantly higher values of total and LDL cholesterol while no difference was observed in the lipid profile with regard to the body mass index. Using the SCORE2 table, it was estimated that 65% of the subjects had a very high cardiovascular risk, and only 6% of the subjects achieved the target values of LDL cholesterol in accordance with the cardiovascular risk. Conclusion: There is a very high incidence of hyperlipoproteinemia in postmenopausal women, and the age and duration of menopause have an impact on the poorer achievement of the target values of the lipid profile, while the body mass index showed no impact. Given the high prevalence of subjects with a very high cardiovascular risk (SCORE 2 tables), intensive interventions are needed at all levels of health care, especially at the primary level of health care, which include non-pharmacological and pharmacological methods of treating hyperlipoproteinemia

The Histopathological Findings of Operated Tumors of the Parathyroid Glands and Patient Data: A Single Centre Experience

Introduction: Parathyroid proliferative disorders include adenoma, hyperplasia and carcinoma. Adenoma and hyperplasia are more commonly found in women, while carcinoma, which is very rare, is equally common in both sexes. The aim of this study was to analyze parathyroid tumors location and histopathology and to compare differences between the sexes. Tumors were surgically removed at the University Hospital Centre Osijek between 2016 and 2019. Patients and Methods: Patients of both sexes who underwent parathyroidectomy for parathyroid tumor at the University Hospital Centre Osijek between 2016 and 2019 were included in the study. Parathyroid tumor samples were histologically analyzed, and their size and histopathology were noted. Existing documentation on patients with parathyroid tumor was used. Analyses were done on archived histologic material stained with hematoxylin and eosin. Results: Overall, 19 samples of parathyroid tumor were included in this study. Tumors of the parathyroid glands were most commonly localized on the lower left parathyroid (8 cases, 42%), and least commonly on the upper right parathyroid (2 cases, 11%). The most common disorder was adenoma (11 cases, 58%), followed by hyperplasia, while no cases of cancer were diagnosed. Women underwent tumor operations more frequently than men (17 versus 2 cases). There was no correlation between histopathology of parathyroid tumor and sex (Fisher’s exact test, p = 1) or between tumor location and sex (Fisher’s exact test, p = 1). Conclusion: The most common locations of tumors of the parathyroid glands were the inferior glands; the most common location was the left inferior parathyroid gland and the most common disorder was adenoma. Women were operated on more frequently than men. (Feldi I, Jurić A, Marjanović K, Mihalj H, Bačun T. The Histopathological Findings of Operated Tumors of the Parathyroid Glands and Patient Data: A Single Centre Experience. SEEMEDJ 2020; 4(2); 113-120

Depression, Anxiety and Cognitive Dysfunction in Patients with Type 2 Diabetes Mellitus – A Study of Adult Patients with Type 2 Diabetes Mellitus in Osijek, Croatia

im of the study was to determine the rate of depression and anxiety in the patients with diagnosed Type 2 Diabetes mellitus (DM), and also to determine the state of the congnitive functions in patients with Type 2 Diabetes mellitus compared with the control group. Study was designed as a epidemiological cross sectional study, sample consisted of 108 patients, 66 of the patients were diagnosed with Type 2 Diabetes mellitus, and 42 were control group. All of them were interviwed by psychiatrist and tested through clinical interview with Hamilton depression rating scale, Hamilton Anxiety rating scale, Mini mental state examination and questionnaire about sociodemografic data. Results show that group of patients with DM were statistically significat more depressed than the control group of the patients (p=0.035). Pathological anxiety measured by Hamilton Anxiety Rating Scale (HAM-A) appeared in 34 DM patients and 7 of the patients in control group, which is also statistically significant difference (p=0.002). Evaluation of the congnitive status done with Mini Mental State Examination (MMSE showed us tha patients with DM presented more cognitive dysfunctions compared with the control group. We can conclude that the high prevalence of psychiatric disorders in diabetic patients points to the need for greater investment in appropriate diagnostic evaluation of patients that consider mental issues