Cancer Patients During the COVID-19 Pandemic

Bolesnici s malignim bolestima izloženi virusu SARS-CoV-2 mogu biti pod povišenim rizikom od razvoja teže kliničke slike COVID-19. To se prvenstveno odnosi na bolesnike koji su u aktivnom onkološkom liječenju i primaju kemoterapiju, radioterapiju ili druge oblike specifičnog liječenja. Prema dosadašnjim spoznajama, i sama dijagnoza maligne bolesti dovedena je u vezu s povećanim rizikom od razvoja težeg oblika i smrti od COVID-19. Nadalje, onkološki bolesnici mogu imati atipičnu prezentaciju bolesti, a s druge strane komplikacije liječenja mogu oponašati COVID-19, primjerice pneumonitis i febrilno stanje s neutropenijom. Štoviše, limfopenija koja je česta kod zaraze, može već biti prisutna kao posljedica kemoterapije. S obzirom na navedeno, kliničke aktivnosti prilagođene su uvjetima pandemije. Preporuke za liječnike i bolesnike uključuju smanjenje izloženosti bolesnika i medicinskog osoblja, korištenje telemedicine, odgodu ambulantnih pregleda koji nisu hitni te prilagodba intenziteta i načina aplikacije terapije kada je to dozvoljeno.Patients with malignancies exposed to the SARS-CoV-2 virus may be at increased risk of developing a more severe clinical picture of COVID-19. This primarily refers to patients who are in active oncological treatment and are receiving chemotherapy, radiotherapy or other forms of specific treatment. To date, the diagnosis of the malignancy has been associated with an increased risk of developing a more severe form or even death from COVID-19. Furthermore, cancer patients may have an atypical presentation of the disease, while treatment complications may mimic COVID-19, such as pneumonitis and neutropenic fever. Moreover, lymphopenia, which is common in infections, may already be present as a result of chemotherapy. Given the above, clinical activities have been adapted to the circumstances surrounding the pandemic. Recommendations for physicians and patients include reducing patient and medical staff exposure, use of telemedicine, postponing outpatient non-urgent examinations, and adjusting the intensity and modality of administration of therapy when possible

Spolne razlike u osteotropnim elementima u ljudskoj kosi i krvi [Gender dependent differences in osteotrophic elements in human hair and blood]

Metabolic changes related to age and gender are becoming a public health and clinical problem. Reliable bioindicators for individual assessment of bioelement metabolic status are needed. Blood and hair are two easily accessible tissues suitable for metabolic status assesment. The study included 192 subjects (83 men, 109 women). The samples were analyzed with the ICP-MS highlighting the osteotrophic elements (B, Ba, Ca, Mg, P, Si, Sr, and Zn) as the primary research objectives. The accumulation of bioelements (Ca>Zn>P>Mg>Si>Sr>B>Ba) appeared significantly higher in the hair than the blood. This fact makes hair a more suitable biological matrix for chemical analysis of the studied elements than whole blood. For the first time the normal concentration ranges of bioelements were defined by analyzing the frequency distribution properties in the hair and whole blood. At the same time, the concentration limits for bioelement deficiency and excess were defined. Especially significant is the finding of higher concentrations of elements belonging to the 2A group of the Periodic table of elements (Ca>Mg>Sr>Ba) in women's hair compared to men's. The ratio of osteotrophic bioelements within the same gender remained unchanged. Evidently, the metabolic control of mineralization of the organic biological matrix differs substantially between the genders. No such differences were observed in the whole blood

Cancer Patients During the COVID-19 Pandemic

Bolesnici s malignim bolestima izloženi virusu SARS-CoV-2 mogu biti pod povišenim rizikom od razvoja teže kliničke slike COVID-19. To se prvenstveno odnosi na bolesnike koji su u aktivnom onkološkom liječenju i primaju kemoterapiju, radioterapiju ili druge oblike specifičnog liječenja. Prema dosadašnjim spoznajama, i sama dijagnoza maligne bolesti dovedena je u vezu s povećanim rizikom od razvoja težeg oblika i smrti od COVID-19. Nadalje, onkološki bolesnici mogu imati atipičnu prezentaciju bolesti, a s druge strane komplikacije liječenja mogu oponašati COVID-19, primjerice pneumonitis i febrilno stanje s neutropenijom. Štoviše, limfopenija koja je česta kod zaraze, može već biti prisutna kao posljedica kemoterapije. S obzirom na navedeno, kliničke aktivnosti prilagođene su uvjetima pandemije. Preporuke za liječnike i bolesnike uključuju smanjenje izloženosti bolesnika i medicinskog osoblja, korištenje telemedicine, odgodu ambulantnih pregleda koji nisu hitni te prilagodba intenziteta i načina aplikacije terapije kada je to dozvoljeno.Patients with malignancies exposed to the SARS-CoV-2 virus may be at increased risk of developing a more severe clinical picture of COVID-19. This primarily refers to patients who are in active oncological treatment and are receiving chemotherapy, radiotherapy or other forms of specific treatment. To date, the diagnosis of the malignancy has been associated with an increased risk of developing a more severe form or even death from COVID-19. Furthermore, cancer patients may have an atypical presentation of the disease, while treatment complications may mimic COVID-19, such as pneumonitis and neutropenic fever. Moreover, lymphopenia, which is common in infections, may already be present as a result of chemotherapy. Given the above, clinical activities have been adapted to the circumstances surrounding the pandemic. Recommendations for physicians and patients include reducing patient and medical staff exposure, use of telemedicine, postponing outpatient non-urgent examinations, and adjusting the intensity and modality of administration of therapy when possible

The Stochastic Determinism of Aging and Death

We have studied human life expectancy in Croatia with the median derivative power function model; the median age of death was 76 and 81 years for men and women respectively. Cummulative mortality increases at a constant rate after the age 60 y and 65 y for men and women, respectively (r2 = 0.99 and 0.98). Individual life span is a stochastic (random) event within the deterministic frame of cumulative mortality

Successful resection of hepatocellular cancer not amenable to Milan criteria and durable complete remission induced by systemic polichemotherapy after development of metastases – should we think about revising the current treatment guidelines in selected patients?

OBJECTIVES: To refresh clinical diagnostic and therapeutic dilemmas in patients presenting with hepatocellular cancer (HCC) and to report a rare success of systemic polichemotherapy in metastatic HCC. METHODS: Case report of a patient with successfully resected HCC although initially deemed inoperable according to current guidelines, and who was successfully treated by systemic polichemotherapy after development of metastatic disease, resulting in a sustained complete remission. RESULTS: We describe a 71-year-old female with HCC initially treated by atypical liver resection, although not amenable to initial surgery according to current treatment guidelines, which resulted in 6 months disease-free interval. After development of pulmonary metastases, the patient was treated by systemic polichemotherapy, due to local unavailability of novel biologic agents. After 3 months of chemotherapy biochemical remission was confirmed, and after 10 months of active treatment complete radiological remission was verified according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, now exceeding 9 months in duration. CONCLUSION: There is an increasing body of evidence that criteria for surgical interventions in HCC should be revised and expanded, and our case is an example of such an approach. Although novel biologic therapies are not widely available in all regions of the world due to their cost, currently there are no hard recommendations for use of chemotherapy in such areas. Since this is a large problem in clinical practice, we conclude that chemotherapy should be offered to selected patients of good performance status if novel agents are unavailable

Unutarstanični signalni putevi u karcinogenezi kolorektalnog tumora

Karcinom kolorektalnog tumora jedna je od najčešćih i najsmrtonosnijih malignih bolesti, s oko 500 000 novootkrivenih sluča jeva diljem svijeta godišnje. Zlatni standard sekundarne prevencije je kolonoskopija s polipekto mijom, koja smanjuje učestalost raka crijeva za 30-40% u rizičnoj populaciji. Prvotni pokušaji primarne prevencije karcinoma crijeva selektivnim nesteroidnim protuupal nim lijekovima pokolebani su njihovom neočekivanom toksičnošću. Boljim upoznavanjem unutarstaničnih signalnih puteva karcinogeneze, čiji pregled donosimo u ovom članku, spoznaju se nove mogućnosti njihovog selektivnog isključivanja, a samim time i sprečavanja nastanka karcinoma

High hair selenium mother to fetus transfer after the Brazil nuts consumption

Lactating mother and her two month old healthy daughter (APGAR 10) gave their scalp hair for a multielement profile analysis; 25 elements were analyzed with the ICP MS. Mother's hair was divided into 5cm long segment proximal to the scull (Young), and the distal segment further up to the hair tip (Old). One centimeter of hair records one month of the metabolic activity of the bioelements in the body. Mother's Young hair and daughters hair have 2.70 and 9.74μgg(-1)Se, a distinctly higher Se concentrations than the Old hair of 0.87μgg(-1). The adequate hair Se concentrations in Croatia women population vary from 0.08 to 0.63μgg(-1); values below or above that range indicate deficiency or excess, respectively. Dietary recall revealed that during the last trimester of pregnancy and over a period of a week, the mother has consumed 135g of Brazil nuts (Bertholletia excelsa) (BN); BN is an exceptionally rich Se dietary source. The amount of Se in BN varies and one week consumption of 135g of BN may result in Se daily intake of 367 to 492μgg(-1)day(-1) over a period of seven consecutive days, and what is about or exceeds the Upper Limit of daily selenium intake of 400μg(-1)g(-1). The excessively high infant hair Se mirrored a natural high mother to fetus transplacental transfer of bio elements in the last trimester of pregnancy. The potential toxicological risks of such a high Se transfer remains to be elucidated

Praćenje onkoloških bolesnika – kliničke preporuke Hrvatskog društva za internističku onkologiju HLZ-a III. dio: neuroendokrine neoplazme, hepatocelularni karcinom, rak gušterače, rak žučnih vodova [Cancer patients follow-up – Croatian society of medical oncology clinical guidelines Part III: neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer, cancer of the bile ducts]

The treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not based on prospective studies, but on the experts opinion of individual oncological centers or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures algorithm in the follow-up of oncological patients after primary treatment, in patients with neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer and cancer of the bile ducts

CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY OF MEDICAL ONCOLOGY CLINICAL GUIDELINES Part III: neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer, cancer of the bile ducts

Liječenje onkoloških bolesnika mora se temeljiti na multidisciplinarnom pristupu, a provodi se u specijaliziranim onkološkim centrima. Nakon završetka specifičnog onkološkog liječenja daljnje praćenje uglavnom provode onkolozi, ali je uloga liječnika primarne zdravstvene zaštite (PZZ) sve važnija i potrebno ju je jasno definirati. Trenutačno se većina preporuka za praćenje ne temelji na prospektivnim studijama, već se zasniva na stručnim mišljenjima pojedinih onkoloških centara ili specijalista. Hrvatsko društvo za internističku onkologiju (HDIO) ovim preporukama želi standardizirati i racionalizirati dijagnostičke postupke u praćenju onkoloških bolesnika, nakon završetka primarnog liječenja, u bolesnika s neuroendokrinim neoplazmama, hepatocelularnim karcinomom, rakom gušterače i rakom žučnih vodova.The treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not based on prospective studies, but on the experts opinion of individual oncological centers or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures algorithm in the follow-up of oncological patients after primary treatment, in patients with neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer and cancer of the bile ducts

CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY OF MEDICAL ONCOLOGY CLINICAL GUIDELINES Part III: neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer, cancer of the bile ducts

Liječenje onkoloških bolesnika mora se temeljiti na multidisciplinarnom pristupu, a provodi se u specijaliziranim onkološkim centrima. Nakon završetka specifičnog onkološkog liječenja daljnje praćenje uglavnom provode onkolozi, ali je uloga liječnika primarne zdravstvene zaštite (PZZ) sve važnija i potrebno ju je jasno definirati. Trenutačno se većina preporuka za praćenje ne temelji na prospektivnim studijama, već se zasniva na stručnim mišljenjima pojedinih onkoloških centara ili specijalista. Hrvatsko društvo za internističku onkologiju (HDIO) ovim preporukama želi standardizirati i racionalizirati dijagnostičke postupke u praćenju onkoloških bolesnika, nakon završetka primarnog liječenja, u bolesnika s neuroendokrinim neoplazmama, hepatocelularnim karcinomom, rakom gušterače i rakom žučnih vodova.The treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not based on prospective studies, but on the experts opinion of individual oncological centers or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures algorithm in the follow-up of oncological patients after primary treatment, in patients with neuroendocrine neoplasms, hepatocellular carcinoma, pancreatic cancer and cancer of the bile ducts