Uspješno liječenje embolije bubrežne arterije čak 48 sati nakon ispada

Renal artery embolism is a disease that is easily missed due to its infrequent and nonspecific presentations. Although early diagnosis and optimal thrombolytic treatment can sometimes restore renal function, therapeutic guidelines have not yet been established. However, early anticoagulant therapy is beneficial and selective infusion of lytic agents into renal artery has been reported with increasing frequency and efficacy if used in the early stage. We report that intra-arterial thrombolytic therapy with low dose of 35 mg recombinant tissue plasminogen activator (t-PA) may be an effective and safe strategy for the treatment of renal artery embolism, despite the period of ischemia being longer than 48 hours.Embolija bubrežne arterije je bolest koja se lako previdi zbog rijetke pojavnosti i nespecifične prezentacije. Iako rana dijagnoza i optimalno trombolitičko liječenje ponekad može vratiti bubrežnu funkciju, terapijske smjernice još nisu uspostavljene. Međutim, rana primjena antikoagulantne terapije je korisna, a o selektivnoj infuziji litičkih sredstava u bubrežne arterije, ako se primijeni u ranom stadiju, sve se češće izvješćuje u smislu povećanja njene učinkovitosti. Mi smo opisali kako intraarterijska trombolitička terapija s niskim dozama od 35 mg rekombinantnog tkivnog aktivatora plazminogena (t-PA) može biti učinkovita i sigurna strategija za liječenje embolije bubrežne arterije unatoč tomu što je razdoblje ishemije bilo duže od 48 sati

Uspješno liječenje embolije bubrežne arterije čak 48 sati nakon ispada

Renal artery embolism is a disease that is easily missed due to its infrequent and nonspecific presentations. Although early diagnosis and optimal thrombolytic treatment can sometimes restore renal function, therapeutic guidelines have not yet been established. However, early anticoagulant therapy is beneficial and selective infusion of lytic agents into renal artery has been reported with increasing frequency and efficacy if used in the early stage. We report that intra-arterial thrombolytic therapy with low dose of 35 mg recombinant tissue plasminogen activator (t-PA) may be an effective and safe strategy for the treatment of renal artery embolism, despite the period of ischemia being longer than 48 hours.Embolija bubrežne arterije je bolest koja se lako previdi zbog rijetke pojavnosti i nespecifične prezentacije. Iako rana dijagnoza i optimalno trombolitičko liječenje ponekad može vratiti bubrežnu funkciju, terapijske smjernice još nisu uspostavljene. Međutim, rana primjena antikoagulantne terapije je korisna, a o selektivnoj infuziji litičkih sredstava u bubrežne arterije, ako se primijeni u ranom stadiju, sve se češće izvješćuje u smislu povećanja njene učinkovitosti. Mi smo opisali kako intraarterijska trombolitička terapija s niskim dozama od 35 mg rekombinantnog tkivnog aktivatora plazminogena (t-PA) može biti učinkovita i sigurna strategija za liječenje embolije bubrežne arterije unatoč tomu što je razdoblje ishemije bilo duže od 48 sati

Characteristics of COVID-19 Infection among -Nursing Home Residents – A Cross Sectional Study from Croatia

Given high risk of infection-related mortality due to impaired immunity, elderly patients are at increased risk with COVID-19. In its diagnostic procedure clinical laboratory medicine has a pivotal role. The aim of this study was to investigate clinical and laboratory specificities in Croatian population of nursing home residents affected by coronavirus. One hundred and six residents of nursing homes that were hospitalized due to COVID-19 infection, were included in this retrospective study. Clinical and laboratory findings at three time points were extracted from medical records. There were 86 females and 20 males, with median of age 84 (min-max: 47–97) years. Patients were divided into three groups: Survivors (S), patients who are still alive (N=65), In-Hospital Non-Survivors (IHNS), patients who died from coronavirus during hospitalization (N=31) and Out-of-Hospital Non-Survivors (OHNS), patients who recovered from infection but died during the period of three months of the follow-up (N=10). We have established differences between these three groups in laboratory findings (p<0.05). At the admission, survivors had lower values of lactate dehydrogenase, aspartate transaminase, sedimentation ratio, ferritin and C-reactive protein, OHNS were in the middle, and IHNS had the highest values. Leukocytes and absolute lymphocyte count were greater in OHNS group, and same between survivors and IHNS. After 7 days, we noticed increase in leukocyte and neutrophils count among IHNS. Assessing of complete blood count, differential blood count, reactants of acute infection and combination of their ratios might predict worse outcome in nursing home residents due to coronavirus infection

Adropin - potencijalni čimbenik kardiovaskularne sigurnosti u muškaraca oboljelih od šećerne bolesti tip 2 liječenih liraglutidom

The aim of this study was to determine plasma adropin concentration and parameters of insulin resistance in obese male type 2 diabetes mellitus (T2DM) patients before and after 3-month liraglutide treatment. In this interventional study, we enrolled 15 obese male T2DM patients with body mass index (BMI) >35 kg/m2, uncontrolled disease and HbA1c >7.5%, having previously taken taking two oral antidiabetic drugs. We modified their therapy to metformin and liraglutide for the next three months. After three months of liraglutide treatment, we observed significant decrease in body weight (from 111.5±18.7 kg to 109.2±17.5 kg, p=0.016) and BMI (from 40.9±7.3 to 40.1±7.0 kg/m2, p=0.021). Plasma adropin concentration increased significantly (p=0.003) compared with baseline. Fasting plasma insulin level decreased from 17.79±6.53 to 13.38±3.51 mU/L (p=0.002), fasting plasma glucose level decreased from 8.66±3.07 to 7.41±2.21 mmol/L (p=0.004) and HbA1c decreased from 7.98±0.70% to 7.26±0.36% (p=0.003). Insulin resistance presented as HOMA-IR decreased significantly from 7.30±5.19 to 4.52±2.61 (p=0.002). Systolic blood pressure, lipid status, liver and kidney function improved, but not reaching statistical significance. Treating obese male T2DM patients with liraglutide resulted in a significantly higher plasma adropin concentration, significant weight loss and improved parameters of insulin resistance, i.e. decreased fasting plasma insulin, plasma glucose levels and HOMA-IR.Cilj je bio usporediti plazmatske vrijednosti adropina i parametre inzulinske rezistencije kod pretilih muškaraca koji boluju od šećerne bolesti tip 2 (ŠBT2) prije i nakon 3 mjeseca primjene liraglutida. U ovoj intervencijskoj studiji sudjelovalo je 15 pretilih muškaraca koji boluju od ŠBT2 s indeksom tjelesne mase (ITM) >35 kg/m2, loše reguliranom bolešću i HbA1c >7,5%. Ispitanici su prethodno u terapiji imali dva peroralna antidijabetična lijeka. Nakon uključenja u studiju terapija im je modificirana na metformin i liraglutid tijekom tri mjeseca. Nakon primjene liraglutida kod ispitanika je zamijećeno smanjenje tjelesne mase (sa 111,5±18,7 na 109,2±17,5 kg, p=0,016) i ITM (s 40,9±7,3 na 40,1±7,0 kg/m2, p=0,021), dok su plazmatske vrijednosti adropina bile značajno povišene (p=0,003). Zamijećeno je sniženje vrijednosti inzulina natašte (sa 17,79±6,53 na 13,38±3,51 mU/L, p=0,002), glukoze natašte (s 8,66±3,07 na 7,41±2,21 mmol/L, p=0,004) te HbA1c (sa 7,98±0,70% na 7,26±0,36%, p=0,003). HOMA-IR se značajno smanjio (sa 7,30±5,19 na 4,52±2,61, p=0,002). Također su zabilježene niže vrijednosti sistoličkog arterijskog tlaka, bolji lipidni profil te poboljšanje jetrene i bubrežne funkcije, iako ne statistički značajno. Primjena liraglutida u pretilih muškaraca koji boluju od ŠBT2 rezultira statistički značajno višim razinama plazmatskog adropina, značajnim smanjenjem tjelesne težine i poboljšanjem svih parametara inzulinske rezistencije, tj. sniženjem plazmatskog inzulina i glukoze natašte te nižim HOMA-IR

NEW INSIGHTS IN STEROID DIABETES

Glukokortikoidi su učinkoviti u liječenju širokog spektra kroničnih autoimunih i upalnih bolesti. Liječenje glukokortikoidima povezano je sa značajnim metaboličkim nuspojavama uključujući inzulinsku rezistenciju i šećernu bolest. Predisponirajući čimbenici za pojavu steroidnog dijabetesa su starija dob, povećana tjelesna masa, obiteljska anamneza šećerne bolesti i gestacijski dijabetes. Nekoliko mehanizama pridonose pojavi steroidnog dijabetesa, uključujući smanjenje periferne inzulinske osjetljivosti, povećanje proizvodnje glukoze u jetri i ometanje proizvodnje i lučenja inzulina iz gušterače. Liječnici koji liječe bolesnike glukokortikoidima trebali bi biti upućeni u metaboličke poremećaje koje oni uzrokuju. U liječenju steroidnog dijabetesa mogu se koristiti sve skupine antidijabetika, ali inzulinska terapija bio bi najbolji izbor u liječenju većine bolesnika sa steroidnim dijabetesom.Glucocorticoids (GC) are the cornerstone in the treatment of numerous chronic autoimmune and inflammatory diseases. GC treatment is accompanied by significant metabolic adverse effects, including insulin resistance, glucose intolerance and diabetes, visceral adiposity, dyslipidemia and skeletal muscle atrophy. GCs are the most common cause of drug-induced diabetes mellitus. However, not everyone treated with glucocorticoids develops diabetes. Predictors of development of diabetes are age, weight, family history of diabetes mellitus, or personal history of gestational diabetes. There is evidence that patients with decreased insulin secretory reserve are much more likely to develop diabetes. Diabetes from topical steroid use is uncommon, but high-dose steroids have been associated with significant hyperglycemia, including development of hyperglycemic hyperosmolar syndrome and even diabetic ketoacidosis in patients with type 1 diabetes mellitus. Several mechanisms contribute to the development of hyperglycemia and steroid-induced diabetes, including decreased peripheral insulin sensitivity, increased hepatic glucose production, and inhibition of pancreatic insulin production and secretion. Physicians treating patients with GCs should be aware of the induction of metabolic disturbances and should not solely rely on fasting measurements. In addition, our review indicates that insulin therapy could be considered when treating patients on GC therapy

The evaluation of risk for obstructive sleep apnea in patients with type 2 diabetes

Cilj istraživanja je procijeniti rizik za opstrukcijsku apneju tijekom spavanja (engl. Obstructive sleep apnea, OSA) u bolesnika sa šećernom bolešću tipa 2, s pomoću STOP upitnika (engl. Snoring, Tiredness, Observed, Pressure; STOP). S pomoću Epworthove ljestvice pospanosti (ESS) procijenjena je prekomjerna dnevna pospanost i ispitana povezanost pospanosti i rizika za OSA-u u bolesnika sa šećernom bolešću tipa 2. Dosadašnja istraživanja pokazala su da oštećena tolerancije glukoze i šećerna bolest tipa 2 predstavljaju čimbenik rizika za OSA-u, ali i da OSA predstavlja čimbenik rizika za šećernu bolest tipa 2. U našem istraživanju sudjelovala su 252 ispitanika sa šećernom bolešću tipa 2, koji su bili anketirani za vrijeme redovitih pregleda u Kliničkom bolničkom centru Split. Rezultati našeg istraživanja pokazali su da je 156 ispitanika (61,9%) imalo povećan rizik za OSA-u prema rezultatima STOP upitnika. Nadalje, ispitanici koji su imali povećani rizik u odnosu na ispitanike koji nisu imali rizik za OSA-u bili su stariji (65 vs. 61 godina, p < 0,05), imali viši indeks tjelesne mase (28,6 ± 5,1 vs. 26,5 ± 4,1, p < 0,001), veći opseg vrata (41,5 ± 4,7 vs. 39,6 ± 6,2, p < 0,009) i bili pospaniji prema rezultatima ESS (5,3 ± 3,1 vs. 3,9 ± 2,5, p < 0,001). Uz šećernu bolest, većina ispitanika imala je i pridružene bolesti: arterijska hipertenzija (46%), gastroezofagealna refluksna bolest (28%), depresija (10%) i astma (8%). OSA je dio širokoga spektra poremećaja disanja tijekom spavanja koja se dovodi u vezu s metaboličkim poremećajima poput šećerne bolesti tipa 2, a epidemiološki podaci o zastupljenosti OSA u Hrvatskoj su nedostatni. Ovo istraživanje ukazuje na potrebu provođenja probira za OSA u bolesnika sa šećernom bolešću tipa 2, koristeći STOP upitnik.The aim of this study was to evaluate the risk for obstructive sleep apnea (OSA) in patients with type 2 diabetes using the STOP questionnaire (Snoring, Tiredness, Observed, Pressure; STOP). Excessive daytime sleepiness was evaluated with the Epworth sleepiness scale (ESS). Previous studies support the idea that glucose intolerance and type 2 diabetes might represent risk factors for OSA, as well as the idea of OSA being the risk factor for type 2 diabetes. A total of 252 patients with type 2 diabetes were surveyed during the regular follow-up in the Regional Centre for Diabetes, Endocrinology and Metabolic Diseases of Split University Hospital. The results of our study indicate that 156 patients (61.9%) had increased risk for OSA according to STOP questionnaire score. In addition, those at high risk for OSA were older (65 vs. 61 years of age, p < 0.05), had higher body mass index (BMI, 28.6 ± 5.1 vs. 26.5 ± 4.1, p < 0.001), higher neck circumference (41.5 ± 4.7 vs. 39.6 ± 6.2, p < 0.009), and had excessive daytime sleepiness according to the ESS score (5.3 ± 3.1 vs. 3.9 ± 2.5, p < 0.001). Individuals with type 2 diabetes reported to have comorbidities, mainly hypertension (46%), gastroesophageal reflux disease (28%), depression (10%), and asthma (8%). Based on current evidence from literature, OSA could be related to clinical conditions such as diabetes and essential hypertension. More epidemiological data are needed to establish the prevalence of OSA in Croatian patients with type 2 diabetes. Our findings indicate the relevance of STOP questionnaire use as a screening tool for obstructive sleep apnea in patients with type 2 diabetes in Croatia

Recommendations of the Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association for people with diabetes and healthcare professionals in the Republic of Croatia during COVID-19 pandemic

Radna skupina Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora pripremila je smjernice za postupanje u pandemiji COVID-19 za osobe sa šećernom bolešću i za zdravstvene djelatnike. U preporukama su naglašeni razmjeri pandemije i moguće posljedice za oboljele od šećerne bolesti. Opisana je klinička slika i ponovljene smjernice Nacionalnog stožera civilne zaštite kako se osobe od šećerne bolesti mogu zaštititi i što trebaju činiti za dobru regulaciju glikemije. Predložene su mjere koje trebaju provoditi zdravstvene ustanove koje skrbe o bolesnicima sa šećernom bolešću i načela zbrinjavanja glikemije u hitnom prijemu i tijekom hospitalizacije.The Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association has prepared recommendations for people with diabetes and healthcare professionals in the age of COVID-19 pandemic. The recommendations emphasized the scale of the pandemic and the possible consequences for those suffering from diabetes. Enclosed are clinical presentation and directions of the National civil protection headquarters on the methods that enable people with diabetes to protect themselves, and maintain their blood glucose in target range as well. Measures have been proposed to be implemented by healthcare facilities that deliver care for patients with diabetes, and the principles of glycemic control in emergency department and during hospitalization

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes