Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the ...development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium.
A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock.
Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy.
By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound.
At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram.
Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.
Scrotal thermography is a diagnostic method for varicocele. In short, there are five diagnostic thermographic criteria for varicocele, i.e., pattern of scrotal thermographic image indicative of ...varicocele, temperature at pampiniform plexus ≥34 C°, temperature difference between left and right pampiniform plexus ≥0.5 C°, enhancement of image during Valsalva maneuver, and temperature at pampiniform plexus ≥ temperature at ipsilateral thigh. Three or more positive signs are indicative of varicocele. The aim of this report is to present the use of digital thermography as a diagnostic method to evaluate the outcome of varicocele repair. We present a case of a student diagnosed with varicocele grade III, and assessed preoperatively and followed up postoperatively by scrotal thermography. According to thermographic indicators, our patient was positive for varicocele diagnosis before surgical treatment. Three months after varicocele repair, the patient did not show positive thermographic indicators of varicocele while physical examination and color Doppler ultrasound were equivocal. This case report suggests that infrared digital thermography of scrotum could be very valuable for monitoring patients in the period after surgery for varicocele, however, it should be confirmed in a larger number of patients.
The aim of this study was to examine the impact of education, coronavirus disease 2019 (COVID-19), and risk factors on the quality of life in patients with type 2 diabetes.
A prospective study was ...conducted in three phases: before education, after education, and in the period of pandemic coronavirus disease 2019 (COVID-19). The subjects were diabetics on oral therapy. To determine the quality of life index, a standardized Ferrans and Powers survey questionnaire was used.
A total of 205 participants took part in the study, of which 111 (54.1%) were men and 94 (46%) women. Participants were enrolled in the study between January 2019 and September 2020. Glycated hemoglobin values were significantly higher before education compared to post-education and at the time of COVID-19 (Friedman test,
= 0.002), and body mass index was significantly lower after education compared to values before education (Friedman test,
= 0.008). The quality of life was significantly lower in all domains in the COVID-19 period (Friedman test,
< 0.001).
A significant predictor of worse assessment of overall quality of life was male gender and rural place of residence. Disease duration of up to 5 years was a significant predictor of worse assessment in the psychological/spiritual domain, while being married was a predictor of better assessment of the quality of life in the family domain. The education of diabetics brought an increase in the health and quality of life while the coronavirus disease pandemic had negative consequences on the same parameters. We consider it necessary to systematically educate diabetics about the comorbidity of COVID-19.
The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups.
A two-year prospective study was ...conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Našice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education.
A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann-Whitney U test,
= 0.035). Significant differences were observed in fasted blood glucose (Friedman's test,
= 0.001), diastolic pressure (Friedman's test, P = 0.018), and glycated hemoglobin (Wilcoxon test,
< 0.001) between Phase 1 and Phase 3.
Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia.
Introduction: The aim of this study was to use cross-sectional research to determine the relationship between serum ferritin levels and arterial hypertension in women who work in shifts and women ...with regular daytime working hours.
Methods: The respondents included 67 female nurses divided into two groups: nurses working in 12-hour shifts (7 am to 7 pm/7 pm to 7 am) were the test group, while nurses regularly working for 8 hours (7 am to 3 pm) were the control group. Data collection included information on associated diseases, chronic medication, last menstruation, duration of menopause, cigarette smoking, number of years of employment in shift work and regular daytime work, laboratory and anthropometric parameters and blood pressure levels.
Results: In all respondents, there was a significant and positive relationship between ferritin and CRP levels, i.e. the higher the CRP levels, the higher the ferritin levels (Rho = 0.401; P = 0.001). Among respondents who have regular daytime working hours, there was no significant association between ferritin and other indicators, while in the group of those who work in shifts, there was a significant and positive association between ferritin and CRP (Rho = 0.468; P = 0.002). Finally, a positive correlation was found between the number of years of employment in shift work and systolic blood pressure levels, i.e. higher systolic pressure was observed in those respondents who worked longer in shifts (Rho = 0.424, P = 0.03).
Conclusion: The study demonstrated a significant correlation between the number of years of employment in shift work and systolic blood pressure. A positive correlation between serum CRP and ferritin levels was also observed in all respondents, and especially in shift workers.
Vitamin D deficiency has been associated with cardiovascular disease. The aim of this study was to determine serum concentration of 25 hydroxyvitamin D (25(OH)D) in patients with acute coronary ...syndrome (ACS) and to assess the prognostic role of serum vitamin D level in ACS patients during 3-year follow up.
The study included 60 ACS patients hospitalized at cardiology department for ACS between March 2012 and October 2012, and 60 age- and sex-matched control patients without ACS. Standard laboratory testing and vitamin D determination were performed in all study patients. In addition, ACS patients underwent coronarography and were followed-up for 36 months of ACS for major adverse cardiac events (MACE).
Patients with ACS had a statistically significantly lower mean 25(OH)D level as compared with control group (35.19 nmol/L vs. 58.08 nmol/L, p<0.001). The lowest mean level of 25(OH)D was recorded in diabetic patients with ACS (30.45 nmol/L). ACS patients were divided into three subgroups according to coronarography findings: single vessel, double vessel and triple vessel coronary artery disease (CAD) with respective serum levels of 25(OH)D of 36.44 nmol/L, 33.65 nmol/L and 31.70 nmol/L. During 36-month follow up, the event-free survival rate was 60% in the ACS group. The ACS patients having sustained MACE during follow up had low serum level of 25(OH)D in the acute phase; however, the difference from ACS patients without MACE during follow up did not reach statistical significance (32.64 nmol/L vs. 37.01 nmol/L).
Patients with ACS have low vitamin D level, which is lowest in diabetic patients with ACS. However, during 3-year follow up, vitamin D failed to prove useful as a prognostic biomarker in ACS patients.
The aim of the study was to determine whether serum vitamin D level is lower in female patients with glaucoma as compared with control group. The mechanism by which vitamin D reduces intraocular ...pressure is not fully clarified. Almost all tissues possess vitamin D receptor (VDR). The mice lacking VDR (VDR knockout mice) have greatly contributed to the understanding of the general vitamin D physiologic function. VDR has been found in some ganglion layer cells, external and internal nuclear layers of retina, and in retinal pigment epithelium, while VDR epitopes have also been found in the ciliary body epithelium, pointing to the role of this protein in eye physiology. The 1,25(OH)2D3 modulates expression of the genes involved in the regulation of intraocular pressure in non-human primates. Extracellular matrix can be remodeled by 1,25(OH)2D3 treatment. Actin disruption can lead to cell morphology alteration, trabecular meshwork relaxation and intraocular pressure reduction. This observational cross-sectional study included 90 female glaucoma subjects aged 45-55 and 50 glaucoma free female subjects as control group. Results of a pilot study conducted in 20 glaucoma subjects and 20 control subjects are presented below. All study subjects underwent history taking, complete ophthalmologic examination and serum vitamin D determination. The mean serum vitamin D level was 32.31 nmol/L in glaucoma patients and 64.17 nmol/L in control subjects. Serum vitamin D level was statistically significantly lower in glaucoma patients as compared with control group (p<0.05).
The development of population policy and health legislation as a result of government, the need for more young, healthy, working and military active population, resulted in the education of all ...health workers including midwives, legal regulation of their work, increasing their number and training of midwifery profession. With the development of this profession conditions of women giving birth, pregnancy and birth control were gradually improved, and thus influenced the birth rate and mortality of the population and the natural growth. On the example of the town of Brod na Savi one can see that it was time-consuming and controlled development of the midwifery profession in the region, which have affected the poor socio-economic conditions, poor climatic conditions, and the presence of the border and the consequent large-scale migration of the population. It is important to note that the foundations for population policies and the observed midwifery profession enabled the development of the same in the coming period.
Koronavirusna bolest (COVID-19) zarazna je bolest koju uzrokuje novi koronavirus odnosno virus teškoga respiratornog sindroma (engl. Severe acute respiratory syndrome coronavirus 2 – SARS-CoV-2). U ...većeg broja zaraženih bolest obilježavaju opći simptomi infekcije koji su praćeni upalnim promjenama donjih dišnih putova. U osoba starije dobi s komorbiditetima, osobito s kardiovaskularnim bolestima, koronavirusna bolest češće napreduje prema akutnomu respiratornom distresu, akutnoj ozljedi miokarda, višestrukom zatajenju organa i mogućemu smrtnom ishodu. Bolest se prvi put pojavila u prosincu 2019. u kineskom gradu Vuhanu i do danas je poprimila razmjere pandemije, s više od 70 milijuna oboljelih i 1,6 milijuna umrlih. Koronavirus SARS-CoV-2 inficira stanice domaćina preko receptora enzima koji konvertira angiotenzin tipa 2 (engl. Angiotensin converting enzyme 2 – ACE2) i važna je komponenta renin-angiotenzin-aldosteronskog sustava (engl. Renin-angiotensin-aldosterone system – RAAS). Kao membranski protein, ACE2 je prisutan u plućima, srcu, bubrezima i crijevima. Patologija koronavirusne bolesti pokazuje povezanost s raspodjelom ACE2 po tkivima. RAAS je presudan u homeostazi kardiovaskularnog sustava. Inhibitori RAAS-a (inhibitori enzima koji konvertira angiotenzin, blokatori receptora angiotenzina II tipa 1) primjenjuju se u liječenju kardiovaskularnih bolesti, hipertenzije i šećerne bolesti. Iz pretkliničkih radova poznato je da inhibitori RAAS-a mogu povećati ekspresiju ACE2. U vrijeme pandemije koronavirusne bolesti javila se zabrinutost o sigurnosti njihove primjene. Razmatra se kako povećana ekspresija ACE2 može utjecati na tijek te bolesti: povećanjem infektivnosti koronavirusa (SARS-CoV-2) ili zaštitnim, organoprotektivnim učincima koji vode do smanjene smrtnosti. Znanstvenici su postulirali potencijalno štetne učinke inhibitora RAAS-a u patogenezi koronavirusne bolesti (COVID-19), kao i njihove moguće korisne učinke, međutim, rezultate eksperimentalnih i pretkliničkih radova ne možemo potpuno primijeniti na ljudsku fiziologiju. Stručna društva preporučila su nastavak primjene inhibitora RASS-a za vrijedeće kardiovaskularne indikacije. Potrebna su klinička ispitivanja o sigurnosti i učinkovitosti rekombinantnoga humanog ACE2 i drugih inhibitora RAAS-a u koronavirusnoj bolesti. Dotad inhibitore RAAS-a treba i dalje primjenjivati u liječenju stabilnih pacijenata bez obzira na rizik ili koronavirusnu bolest.
PDF
