Suplementacija s antioksidansima u terapiji Graves-ove bolesti: učinak na ekstracelularne antioksidativne parametre

In this study, the effect of supplementation with a fixed combination of antioxidants (vitamins C and E, beta-carotene and selenium) on concentrations of antioxidative parameters in serum was monitored. Measurements were performed prior to the commencement of therapy and after 30 and 60 days in patients with Graves\u27 disease treated with methimazole. Patients who received extra supplementation with antioxidants (group A, n = 29) attained euthyroidism faster than the patients treated only with methimazole (group B, n = 28). Statistically significant differences were achieved after supplementation with antioxidants for all investigated parameters (uric acid, transferrin, ferritin), except TAS and glucose. Nevertheless, due to the fact that all measured parameters remained within the range of referent values, they may not be proposed as reliable indicators of the level of oxidative stress in Graves\u27 disease.U ovom istraživanju promatran jw učinak suplementacije fiksnom kombinacijom antioksidansa (vitamini C i E, β-karoten i selen) na koncentracije pokazatelja antioksidacijske obrane u serume. Mjerenja su obavljena u bolesnika s Graves-ovom bolešću liječenih metilmazolom (tiamazolom) prije početka terapije, te nakon 30 i 60 dana. Bolesnici, koji su uz metimazol imali i dodatnu terapiju s antioksidansima (skupina A, n=29), postizali su eutireozu brže od bolesnika koji su bili samo na terapiji metimazolom (skupina B, n=28). Koncencentracije svim mjernih parametara (urata, feritina i transferina), (osim koncentracije TAS-a i glukoze), značajno su se razlikovale među skupinama. Unatoč tomu, rezultati ove studije ukazuju na to kako se određivani parametri ne mogu smatrati dovoljno pouzdanim pokazateljima razine oksidacijskog stresa u Graves-ovoj bolesti, radi činjenice da su njihove koncentracije tijekom ispitivanja ostale unutar granica referentnih vrijednosti

Clinical chemistry and laboratory medicine in Croatia: regulation of the profession

Heterogeneity exists across Europe in the definition of the profession of clinical chemistry and laboratory medicine and also in academic background of specialists in this discipline. This article pro-vides an overview of the standards of education and training of laboratory professionals and quality regulations in Croatia. Clinical chemistry in Croatia is almost exclusively practiced by medical bioc-hemists. Although term Medical biochemist often relates to medical doctors in other European coun-tries, in Croatia medical biochemists are not medical doctors, but university degree professionals who are qualified scientifically. Practicing the medical biochemistry is regulated by The Health Care Law, The Law of the Medical Biochemistry Profession and The Law of the State and Private Health Insu-rance. According to the law, only medical biochemists are entitled to run and work in the medical biochemistry laboratory. University degree is earned after the 5 years of the studies. Register for me-dical biochemists is kept by the Croatian Chamber of Medical Biochemists. Licensing is mandatory, valid for 6 years and regulated by the government (Law on the Health Care, 1993). Vocational training for medical biochemists lasts 44 months and is regulated by the national regulatory document issued by the Ministry of Health. Accreditation is not mandatory and is provided by an independent, non-commercial national accreditation body. The profession has interdisciplinary character and a level of required competence and skills comparable to other European countries

Concentration of C-reactive protein, magnesium and calcium in children with acute bronchoconstriction before and after therapy with salbutamol

Introduction: In childhood, bronchoobstruction is mostly caused by respiratory viral infections. The aim of this study was to find out possible changes in serum concentration of magnesium and calcium (participants in bronchoconstriction), and concentration of C-reactive protein (marker of inammation) in children with moderate and severe bronchoconstriction, caused by viral respiratory infections. Materials and methods: The study included 32 children with acute bronchoconstriction caused by a viral respiratory infection. Inhalation of salbutamol was administered according to the severity of bronchoconstriction. Blood sampling was done on admission and the third day of salbutamol administration. Results: Therapy with salbutamol led to a relief of dyspnea within 36 hours, and symptoms of viral infection have relieved. During follow-up period, magnesium concentration was higher in children with moderate (but not in severe) bronchoconstriction than in healthy children, with consequently higher magnesium to calcium ratio. Concentration of C-reactive protein decreased spontaneously by gradual disappearance of signs and symptoms of viral infection. Conclusion: Determination of serum magnesium and calcium concentrations and determination of their ratio are not sufficient enough to follow-up on effects of therapy. Additional studies of ionized forms of magnesium and calcium, their intracellular content, as well as concentration in exhaled breath condensate are needed

Anti-IgE terapija astme i alergijskog rinitisa omalizumabom

The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE from attaching to effector cells, and thereby blunts IgE-mediated inflammatory responses. After subcutaneous administration its absorption is slow, reaching peak concentration in serum after an average of 7-8 days. At recommended doses, serum free IgE levels decrease within 1 hour following the first dose and maintained between doses. Dose and dosing frequency are adjusted according to body mass and serum total IgE concentration before the start of treatment. Omalizumab administered subcutaneously is an effective treatment for add-on therapy in patients with poorly controlled, moderate-to-severe allergic asthma and allergic rhinitis (adults and adolescents >12 years). It reduces the requirement for inhaled corticosteroids while protecting against disease exacerbation. Omalizumab is well tolerated, but the safety profile requires long-term assessment in adults as well as in children.Opisani su farmakologija, djelotvornost, doziranje, nuspojave i ekonomičnost primjene anti IgE antitijela – omalizumab. Omalizumab je generičko ime za ljudsko / mišje kimerično (rekombinantno humanizirano) monoklonalno IgG antitijelo. Anti-IgE sprječava vezanje IgE na efektorske stanice i sprječava upalni odgovor posredovan s IgE. Nakon subkutane primjene sporo se apsorbira te dostiže vršnu koncentraciju u serumu nakon 7 do 8 dana. Uz preporučene doze koncentracija slobodnog IgE u serumu smanjuje se unutar jednog sata. Doziranje se podešava prema tjelesnoj masi i koncentraciji IgE-a u serumu. Omalizumab je djelotvoran kao dopunska terapija u pacijenata (starijih od 12 godina) sa slabo kontroliranom umjerenom do teškom alergijskom astmom odnosno s alergijskim rinitisom. Smanjuje potrebu za inhalacijskim kortikosteroidima te pogoršanje astme. Dobro se podnosi, ali sigurnost primjene, kako u odraslih tako i u djece, treba još ispitati

Gamma-Glutamyltransferase and C-Reactive Protein in Stable Chronic Obstructive Pulmonary Disease

Systemic inflammation and oxidative stress are the most important features of chronic obstructive pulmonary disease (COPD). The presence of oxidative stress in the airways of smokers, the largest population of COPD patients, is a consequence of direct inhalation of cigarette smoke and increased inflammation-related production of reactive oxygen species. On the other hand, oxidative stress appears to be the key component of many processes associated with chronic inflammation. We intend to examine whether serum C-reactive protein (CRP) concentration and gamma-glutamyltransferase (GGT) activity might be used as auxiliary markers in monitoring level of oxidative stress and inflammation in clinically stable COPD. We also investigated influence of cigarette smoking on these two systemic parameters. Catalytic activity of GGT and concentration of CRP were determined in sera of COPD patients (N=109) and in healthy controls (N=51) by using standard spectrophotometric method and immunoturbidimetric method, respectively. Concentration of CRP and activity of GGT were increased in COPD patients, as compared to healthy controls (p<0.05). We found a significant positive correlation between those two parameters in COPD patients (r=0.202, p=0.0371). Our results showed no difference in GGT activity (p=0.606) or CRP concentration (p=0.573) between groups of patients when subdivided according to the severity of the disease. Smoking did not have a significant impact on CRP and GGT values in COPD patients and healthy controls. We showed an increase of serum CRP and GGT values in COPD patients, and we suggest that serum GGT activity might also represent an inflammation/oxidative stress marker. It seems that COPD patients present higher serum CRP and GGT values than healthy subjects independently from their smoking habits

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Anti-IgE therapy with omalizumab in asthma and allergic rhinitis

Opisani su farmakologija, djelotvornost, doziranje, nuspojave i ekonomičnost primjene anti IgE antitijela – omalizumab. Omalizumab je generičko ime za ljudsko / mišje kimerično (rekombinantno humanizirano) monoklonalno IgG antitijelo. Anti-IgE sprječava vezanje IgE na efektorske stanice i sprječava upalni odgovor posredovan s IgE. Nakon subkutane primjene sporo se apsorbira te dostiže vršnu koncentraciju u serumu nakon 7 do 8 dana. Uz preporučene doze koncentracija slobodnog IgE u serumu smanjuje se unutar jednog sata. Doziranje se podešava prema tjelesnoj masi i koncentraciji IgE-a u serumu. Omalizumab je djelotvoran kao dopunska terapija u pacijenata (starijih od 12 godina) sa slabo kontroliranom umjerenom do teškom alergijskom astmom odnosno s alergijskim rinitisom. Smanjuje potrebu za inhalacijskim kortikosteroidima te pogoršanje astme. Dobro se podnosi, ali sigurnost primjene, kako u odraslih tako i u djece, treba još ispitati.The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE from attaching to effector cells, and thereby blunts IgE-mediated inflammatory responses. After subcutaneous administration its absorption is slow, reaching peak concentration in serum after an average of 7-8 days. At recommended doses, serum free IgE levels decrease within 1 hour following the first dose and maintained between doses. Dose and dosing frequency are adjusted according to body mass and serum total IgE concentration before the start of treatment. Omalizumab administered subcutaneously is an effective treatment for add-on therapy in patients with poorly controlled, moderate-to-severe allergic asthma and allergic rhinitis (adults and adolescents >12 years). It reduces the requirement for inhaled corticosteroids while protecting against disease exacerbation. Omalizumab is well tolerated, but the safety profile requires long-term assessment in adults as well as in children

Urates in exhaled breath condensate of children with obstructive sleep apnea

Background: Urate levels may be a marker of oxidative stress. The aim of the present study was to find out are there any differences in urate concentrations in exhaled breath condensate (EBC) between children with obstructive sleep apnea (OSA) and healthy children. Materials and methods: EBC was collected in children with obstructive sleep apnea (OSA) and clinically healthy children. Urate measurements in EBC and serum were performed by enzymatic co-lor test. Results: The higher concentration of urates in EBC of children with OSA than clinically healthy chil-dren indicate the oxidative stress in their airways. Since there was no significant difference in serum concentration of urates between children with OSA and healthy children, it could be considered that urates are sintetized in the airways of children with OSA. Conclusions: The present study indicated that urates in EBC (but not in serum) may be used as a marker of local synthesis of antioxidant compounds, but definitive conclusion must be supported by investigations involving larger number of participants