Acta clinica Croatica最新文献

Health-related quality of life (HRQoL) is significantly reduced in patients with chronic nonspecific low back pain. In these patients, the relationship between physical and mental health with quality of life has not been adequately studied, nor has the relationship between functional disability and pain intensity. The aim of this study was to evaluate the relationship between the physical and mental components of HRQoL and their association with pain intensity and functional disability in patients with better and worse physical and mental health. In addition to sociodemographic and baseline data, disease-specific measures were obtained using standard questionnaires, i.e., the visual analog scale for pain, the Roland-Morris Disability Questionnaire for functional capacity in patients with chronic low back pain, and the Brief Health-Related Quality of Life Questionnaire (SF-36). Statistical significance was determined at p<0.05. The study involved 129 consecutive patients (33 men and 96 women) with chronic low back pain. A significant positive association was found between overall HRQoL, height, and body weight in relation to physical and mental health, but not with body weight in relation to physical health. A negative association was found with age, intensity of movement pain, and functional disability in relation to physical and mental health. An improvement in mental health was found compared to an increase in physical health. Better physical and mental health scores were associated with lower levels of functional disability. In conclusion, the results of this real-life study demonstrated the importance of improving the physical components of HRQoL as it affects assessment of the mental component in patients with chronic low back pain. Moreover, patients with better quality of life rated functional disability lower.

The MTHFR mutations C677T and A1298C combined with folate and vitamin B12 deficiency lead to hypercoagulability. We evaluated thrombotic risk due to MTHFR mutations, individually and in combination, in patients with venous thromboembolism (VTE). The case-control study included groups of 262 VTE patients and 101 healthy controls. Allelic distribution of MTHFR C677T/A1298C mutations was determined by real-time polymerase chain reaction and results were statistically analyzed using χ²-test and comparison of proportions with 95% confidence intervals (95% CI) and p=0.05. There was no statistically significant difference in the frequencies of C677T MTHFR genotypes between the patient group and controls (p=0.676; odds ratio (OR)=1.297; 95% CI 0.649-2.592), or for A1298C mutation (p=0.872; OR=0.894; 95% CI 0.564-1.419). The allele distribution of both MTHFR mutations did not show any significant differences (C677T p=0.808; OR=1.043; 95% CI 0.741-1.468 and A1298C p=0.738; OR=0.943; 95% CI 0.667-1.332). MTHFR genotype distributions did not show any significant difference between genders when analyzed with χ²-test. When evaluating a combination of mutations, the greatest difference between the cases and controls was found in the frequencies of MTHFR TT/AA carriers (2.6%), which, however, did not reach significance (p=0.520). In conclusion, MTHFR C677T and A1298C mutations do not represent risk factors for VTE development in the group of Croatian patients.

Evaluation of hepatitis C virus (HCV) infection in cell culture is important for development of new antiviral agents and for understanding the viral life cycle, as well as the correlation among the genotypes spreading worldwide. Development of HCV cell culture systems offers great advantage by enabling growth of the virus in cell culture, allowing for discovery of potential therapeutics and vaccines. The aim of this study was to introduce the steps of HCV infection in the cell culture system as a determinant for the competence of more potent antiviral compounds. Two plasmids, JFH1 (genotype 2a) full length and 4a (ED43/C-NS2/NS5A) were subjected to in vitro transcription for HCV RNA synthesis followed by transfection of Huh7.5 with the resulting RNA from each genotype processed to generate the virus. Later, Huh7.5 cells infected with the replicated virus resulted in the generated HCV infected cells. Immunostaining of the infected cells showed fluorescence of green color, indicating positive infection of both genotypes 2a and 4a. In addition, real-time polymerase chain reaction was performed to measure viral load from extracted cells previously infected with the RNAs of genotypes 2 and 4, which resulted in 32,500 and 107,375 copies/mL, respectively. In conclusion, introduction of HCV cell culture system is a convenient method to evaluate active antiviral drugs against HCV genotypes 2a and 4a using both qualitative and quantitative techniques in distinguishing the effectiveness of antiviral agents.

Phosphorus plays an important role in many physiological functions. Numerous studies have linked phosphorus concentration to cardiovascular (CV) disease and mortality rates. In this study, we investigated the association between high-normal serum phosphorus levels and CV morbidity in patients with type 2 diabetes. Two groups of patients with type 2 diabetes were studied, comprising both males and females aged 18 years and older. One group (140 subjects) had no CV events, while the other group (140 subjects) had one or more CV events. In both groups, we collected fasting laboratory values, medical history, and examination findings. Serum phosphorus levels were statistically significant- ly higher in patients with CV events and had statistically significant but relatively modest discriminatory properties (AUC 0.591; 95% confidence interval (CI) 0.531-0.649; p=0.008). A univariate logistic re- gression model of serum phosphorus as a continuous variable revealed a statistically significant associ- ation with the presence of a cardiovascular event (odds ratio (OR) 7.1849, 95% CI 1.7728 - 29.1190; p=0.0057). For each 1 mmol/L increase in serum phosphorus, the probability of a CV event increased 7.4-fold. After a multivariable logistic regression model, serum phosphorus was associated with a CV event (p=0.0016, OR 16.6), regardless of age, sex, total cholesterol, and systolic blood pressure.

Compressive thorax injury is mostly observed in road traffic accidents which lead to multiple traumas. Eye findings after thoracic injury can be Purtscher's retinopathy, Valsalva retinopathy, and even blindness. We report a rare case of unilateral optic neuropathy associated with compressive chest injury. In our case, a 31-year-old construction worker developed irreversible optic nerve damage after ground collapsed on him and buried him up to his neck. There was no evidence of head trauma and blood loss, but multislice computed tomography showed diffuse brain edema caused by prolonged hypoxia due to compression of the thorax.

We present a case of endonasal leishmaniasis diagnosed on a frozen section biopsy specimen obtained from a 47-year-old woman treated with corticosteroids and anti-TNF^α for rheumatoid arthritis. Similar cases of isolated mucosal leishmaniasis have not yet been reported in Croatia. Microscopic analysis of the biopsy specimen sent for frozen sections revealed Leishmania amastigotes in macrophages infiltrating nasal mucosa. Subsequent communication with the referring clinician revealed that the patient had been diagnosed with visceral leishmaniasis 13 years prior to current biopsy. Thus, the present nasal lesion was interpreted as a solitary lesion related to reactivation of the previous infection. She received liposomal amphotericin B which led to prompt amelioration of the lesion. As shown in the present case, clinical presentation of leishmaniasis is unspecific and can mimic many other conditions, especially in the setting of concomitant immunosuppressive and anti-inflammatory treatment. It is important to be aware of this entity in order to treat such patients properly.

Urethral stricture is a complex disease with an etiology that remains insufficiently studied. The frequency of etiological factors associated with urethral stricture has undergone significant changes in recent decades, considering geographical factors, socioeconomic characteristics of the population, and the different etiological factors present in developed and developing countries. We retrospectively collected data from 146 patients who underwent urethroplasty for urethral stricture between 2009 and 2019 at the University Clinical Center of Serbia (Belgrade, Serbia). The patients with urethral stricture were divided into several groups based on their age and the localization of the stricture. Eleven causes of urethral stricture were identified. Urethral catheterization was the leading cause of strictures, regardless of age, accounting for 48.6% of all patients (p<0.001). The most common localization was the penile urethra, accounting for 41.8% of patients (p<0.001), whereas posterior strictures were observed in only 5 patients (3.4%). Considering etiology, iatrogenic (catheterization) and idiopathic urethral stenosis are the predominant factors. Careful urethral manipulation during catheterization is crucial, as it contributes to the prevention of the most common etiological factor of urethral stricture.

There is a paucity of data concerning morphological differences in the resected distal femur and proximal tibia between osteoarthritis (OA) and normal knees. The objective of this study was to determine if morphometric differences existed in the resected distal femur and proximal tibia surface between OA and normal knees in the Chinese population. Ninety-eight OA knees and 96 normal ones taken from the Chinese population were measured by computed tomography for femoral mediolateral (fML), medial anteroposterior (fMAP), lateral anteroposterior (fLAP), medial condylar width (fMCW), lateral condylar width (fLCW) and tibial mediolateral (tML), middle anteroposterior (tAP), medial anteroposterior (tMAP), and lateral anteroposterior (tLAP) dimensions to determine morphological differences between OA and normal knees. The mean tMAP and fMCW dimensions were 50.2±3.3 mm and 28.7±2.3 mm for OA, and 48.8±3.8 mm and 27.1±2.2 mm for normal knees, respectively. There were significant differences between OA and normal knees concerning tMAP and fMCW dimensions (p<0.05). The study revealed morphological differences in tMAP and fMCW between the OA and normal knee groups, which may provide guidelines for designing better knee implants that are more size-matching for OA knees.

Chronic inflammation and protein energy malnutrition in patients on hemodialysis lead to decrease in muscle mass and impaired functional ability. Our goal was to evaluate the effect of a combination of electrical stimulation (ES) with intradialytic therapeutic exercises on dialysis efficacy, ar- terial blood pressure, and functional ability of lower extremities. The study involved 35 patients who were on chronic hemodialysis. The study consisted of two phases. During the first month, no intervention was performed. It was followed by a therapeutic program combining intradialytic resistance exercises with ES on quadriceps muscle, which was performed 3 times a week for 3 months. Functional tests for lower extremity and body composition analysis were obtained at baseline and at the end of the study. Arterial pressure, dialysis efficacy and laboratory parameters were monitored. Functional tests showed significant improvement after the intervention. A significant positive correlation was found in patients who had shown improvement in functional tests, with less intradialytic episodes of hypotension and improvement in dialysis efficacy. This study found a positive effect of combining resistance exercises and ES on dialysis efficacy and functional ability of lower extremities in patients on chronic hemodialysis.

Orthodontic tooth movement relies on the application of force that drives bone resorption and formation. As saliva reflects these processes and harbors proteins of diagnostic and prognostic value, we studied these changes in patients with malocclusion. This study sampled the proteomes and evaluated the intensity of experienced pain related to the apparatus placement in ten male patients with malocclusion on day 0, 30 and 60 of orthodontic therapy. A prospective shotgun proteomic pilot study identified 947 proteins, and demonstrated a shift in the salivary proteome during orthodontic therapy. Gene enrichment analysis revealed hemostasis, but also platelet activation, signaling, aggregation and degranulation as prominent processes occurring 30 days post appliance placement, while proteins related to antimicrobial resistance were detected throughout the observed tooth movement period. Our research indicated an increased expression of proteins related to the immune and protective response to foreign bodies and pathogens, cellular and tissue injury, and biomechanical stimuli associated to bone remodeling. While a direct linkage between the alteration of the proteomic profile and the direction of painful perception was not identified, all results suggest a well-coordinated yet complex occurrence involving a multitude of biologically active signaling pathways and molecules.