Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (p_adjusted = 0.0124 and p_adjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (p_adjusted = 0.027 and p_adjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Mediterranean diet and hip fracture incidence among older adults: the CHANCES project

The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk.

INTRODUCTION

Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults.

METHODS

A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis.

RESULTS

A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p_{heterogeneity} = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence.

CONCLUSIONS

In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

Croatian Recommendations for Dialysis of HIV-Positive Patients

Human immunodeficiency virus (HIV) infection may be associated with renal impairment since about 0.4% of all HIV-positive patients develop end-stage renal disease. The share of patients with HIV infection in hemodialysis centers throughout the world ranges from 0.3% to as high as 38%. In Croatia, renal replacement therapy was needed by 1% of all the HIV-positive patients from 1985 until the end of 2014. Healthcare professionals (HP) should be aware of the risks of occupational exposure to blood-borne infections in their daily work. Performing dialysis in HIV-positive patients increases the risk of exposure to HIV during the extracorporeal circulation of the infected blood. However, post-exposure prophylaxis (PEP) with effective antiretroviral drugs significantly reduces the risk of infection after occupational exposure. On behalf of the Croatian Society of Nephrology, Dialysis and Transplantation, the authors of this paper have proposed recommendations for the management of HIVpositive patients on dialysis, which aim to prevent the transmission of HIV among patients and HPs. The important recommendations include the following: 1. when the need arises, it is necessary to provide HIV-positive patients with dialysis in the vicinity of their place of residence. 2. HIV-positive patients should be dialyzed with a separate hemodialysis machine in an isolated area. Alternatively, they can be dialyzed in an area for the hemodialysis of HCV-positive and/or HBVpositive patients. 3. Specialized and trained personnel should be provided during the hemodialysis procedure, together with strict compliance with the standard precautions for the prevention of blood-borne infections. 4. There should be a good and prompt cooperation with the National Referral Center for HIV infection.

Angiogenic and lymphangiogenic profiles in histological variants of papillary thyroid carcinoma

INTRODUCTION

Papillary thyroid carcinoma (PTC) is a well‑differentiated tumor that occurs in several histological variants whose biological behaviors remain unclear. Angiogenesis and lymphangiogenesis are critical processes that enable tumor progression.

OBJECTIVES

The aim of this study was to evaluate the angiogenic and lymphangiogenic phenotypes of PTC, considering the differences between histological variants.

PATIENTS AND METHODS

Angiogenic and lymphangiogenic profiles were analyzed by determining microvascular density (MVD) and lymphatic vessel density (LVD) in 73 cases of PTC, using immunohistochemistry. To assess the biological markers involved in blood and lymph vessel formation, the expression of vascular endothelial growth factor (VEGF), cyclooxygenase 2 (COX‑2), and p27kip1 (p27) was determined.

RESULTS

MVD was significantly higher in patients with high‑risk PTC and in those with local extrathyroidal and vascular invasion. Positive VEGF expression was strongly associated with high MVD and age‑related tumor enlargement. The presence of lymph vessel invasion was associated with the expression of either VEGF or COX‑2. The analysis of angiogenesis and lymphangiogenesis in different histological variants of PTC revealed elevated LVD rather than MVD in the follicular variant of PTC (FV‑PTC).Lower MVD was observed in FV‑PTC relative to the classic variant of PTC (CV‑PTC). The frequency of VEGF‑positive tumors was higher in CV‑PTC than in FV‑PTC. A significant association between COX‑2 and p27 expression was observed in FV‑PTC but not in CV‑PTC.

CONCLUSIONS

These results suggest that VEGF, COX‑2, and p27 may be important biological markers that determine the angiogenic and lymphangiogenic potentials of PTC, particularly between the follicular and classic variants.

Correlation of Residual Diuresis with MIS Score and Nutritional Status in Peritoneal Dialysis Patients: A Croatian Nationwide Study

Introduction. Residual diuresis (RD) is an important predictor of mortality and cardiovascular (CV) deaths in peritoneal dialysis (PD) patients, and contributes more to overall survival compared to PD clearance. In this study we investigated the correlation between RD and CV outcomes in PD patients.

Methods. A total of 190 PD patients from 13 dialysis centers, a national representation, were included in this analysis. Biomarkers of anemia, nutritional status [malnutrition inflammation score (MIS), subjective global assessment (SGA), serum albumin, anthropometric measurements including body mass index (BMI)], dialysis dose (Kt/V) and laboratory measurements were determined. RD was estimated using the volume of daily urine.

Results. There were 78(41.05 %) females and 112 (58.95 %) males; aged 57.35±14.41 years, on PD for 24.96±24.43 months. Fifty-six patients had diabetes type II (44 as primary kidney disease). The mean RD was 1170±673.6 ml (range 0-3000 mL). Statistically significant correlations between RD and BMI, hip circumference, time on PD, Kt/V, MIS, SGA, erythrocytes (E), Hemoglobin (Hb), PTH, and serum albumin were observed.

Conclusions. We demonstrated a significant correlation between RD and MIS score, SGA, anthropometry and albumin. Every effort should be invested to maintain RD for as long as possible to achieve optimal treatment results and to decrease CV mortality in PD population.

Circulating and tissue galectin-1 and galectin-3 in colorectal carcinoma: association with clinicopathological parameters, serum CEA, IL-17 and IL23

PURPOSE

Galectins are modulators of many processes critical for tumor progression and metastasis but their clinical significance is still unclear. The objective of this study was to analyze the clinical significance of Galectin-1 and Galectin-3 in the tissue and sera of patients with colorectal carcinoma (CRC). Examined were also their association with serum CEA, IL-17 and IL-23 in CRC patients.

METHODS

One hundred and twenty patients with CRC were included in this study. The expression of Galectin-1 and Galectin-3 in biopsy samples of CRC was determined using immunohistochemistry (N=120). The concentrations of Galectin-1, Galectin-3, IL-17 and IL-23 in the sera of CRC patients (N=38) were determined by Enzyme Linked Immunosorbent Assay (ELISA).

RESULTS

Serum Galectin-1 concentrations positively correlated with parameters of malignancy including perineural invasion (p=0.016), lymph node involvement and distant metastases (p=0.029). Higher expression of peritumoral Galectin-1 was associated with both presence of perineural invasion and poor differentiation of CRC. Serum CEA levels positively correlated with circulating Galectin-1, but inversely correlated with peritumoral Galectin-1 expression. There was no correlation between Galectin-3 and clinicopathological parameters of CRC, but it was found that Galectin-3 expression in the tumor tissue positively correlated with serum IL-17 and IL-23. Circulating Galectin-3 levels significantly correlated with IL-17 (p=0.042), but not with IL-23 in the sera of CRC patients.

CONCLUSIONS

This study suggests that Galectin-1 and Galectin-3 exhibit protumorigenic activity in CRC by affecting different aspects of tumor progression. Galectin-1 facilitates tumor invasion and metastasis while Galectin-3 preferentially modulates tumor-associated inflammatory processes.

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans

BACKGROUND

Serbia, as the largest market of the Western Balkans, has entered socioeconomic transition with substantial delay compared to most of Eastern Europe. Its health system reform efforts were bold during the past 15 years, but their results were inconsistent in various areas. The two waves of global recession that hit Balkan economies ultimately reflected to the financial situation of healthcare. Serious difficulties in providing accessible medical care to the citizens became a reality. A large part of the unbearable expenses actually belongs to the overt prescription of pharmaceuticals and various laboratory and imaging diagnostic procedures requested by physicians. Therefore, a broad national survey was conducted at all levels of the healthcare system hierarchy to distinguish the ability of cost containment strategies to reshape clinician's mindsets and decision-making in practice.

AIMS

Assessment of healthcare professionals' judgment on economic consequences of prescribed medical interventions and evaluation of responsiveness of healthcare professionals to policy measures targeted at increasing cost-consciousness.

STUDY DESIGN

Cross-sectional study.

METHODS

A nationwide cross-sectional survey was conducted through a hierarchy of medical facilities across diverse geographical regions before and after policy action, from January 2010 to April 2013. In the middle of the observed period, the National Health Insurance Fund (RFZO) adopted severe cost-containment measures. Independently, pharmacoeconomic guidelines targeted at prescribers were disseminated. Administration in large hospitals and community pharmacies was forced to restrict access to high budget-impact medical care. Economic Awareness of Healthcare Professionals Questionnaire-29 (EAHPQ-29), developed in Serbian language, was used in face-to-face interviews. The questionnaire documented clinician's attitudes on: Clinical-Decision-Making-between-Alternative-Interventions (CDMAI), Quality-of-Health-Care (QHC), and Cost-Containment-Policy (CCP). The authors randomly and anonymously recruited 2000 healthcare experts, with a total of 1487 responding; after eliminating incomplete surveys, 649 participants were considered before and 651 after policy intervention.

RESULTS

Dentists (1.195±0.560) had a higher mean CDMAI score compared to physicians (1.017±0.453). The surgical group compared to the internist group had a higher total EAHPQ-29 score, CCP score and CDMAI score. Policy intervention had a statistically significant negative impact on the QHC score (F=4.958; df=1; p=0.027). There was no substantial impact of policy interventions on professional behavior and judgment with regard to the CDMAI, CCP, and total EAHPQ-29 scores.

CONCLUSION

Although cost savings were forcibly imposed in practice, the effects on clinical decision-making were modest. Clinicians' perceptions of quality of medical care were explained in a less effective manner due to the severely constrained resources allocated to the providers. This pioneering effort in the Balkans exposes the inefficiency of current policies to expand clinicians' cost consciousness.

Obstruction of left ventricular outflow tract by a calcified mass at mitral valve

A case of an unusual left ventricular outflow tract obstruction by mitral valve pathology in a 35-year old female with diabetes and end-stage renal disease is presented in the study. The patient suffered from fever of an unknown origin after lower-leg amputation. Although the wound healed well, fever persisted for three weeks despite a triple antibiotic treatment until the infection was resolved with vancomycin. Three months later echocardiography displayed a floating mass attached to mitral valve, producing a newly developed systolic murmur and a mild haemodynamic obstruction of the left ventricular outflow tract. The calcified vegetation was probably formed during an unrecognized subacute infective endocarditis.

[Fear of vaccination against hepatitis B--one of the reasons of low vaccination rate among health-care workers]

We examined 120 health care workers from two Zagreb hospitals with regard to hepatitis B vaccination, and the reasons for not accepting the vaccination. The majority of the examinees (83, 88%) were often exposed to HBV infection and many experienced needlestick exposure to blood (63, 67%). Despite all this, only 55 (67%) examinees routinely use some protective devices at work, but 26 (33%) do not. 57 (60%) examinees believe they can be infected with hepatitis B through vaccination and 57 (72%) believe other "dangerous" complications are also possible. Only 33 (35%) examinees received complete vaccination while others received only one (30, 37%) or two doses of vaccine (30, 35%). 33 (66%) examinees did not accept the vaccination. Only 8.3 (10%) examinees know the procedure after the needlestick exposure to blood. A total of 38 (60%) examinees attended educative lectures on HBV infection before the vaccination. Therefore, poor knowledge about vaccination against hepatitis B among our health care workers demands continuous education and permanent vaccination to avoid occupational hepatitis B.

Hepatitis C and hepatitis B virus infection in hemodialysis patients and staff: a two year follow-up

To estimate the prevalence of antibodies to the hepatitis C virus ((HCV) and hepatitis virus (HBV) and the presence of infection, 101 patients receiving renal replacement therapy and 75 staff members caring for them were tested. Evaluation included detailed history, screening for anti-HCV antibody, HBV markers and liver enzymes 38% of patients were anti-HCV positives and 15 (40%) of these had antibodies to the hepatitis B core antigen indicating previous hepatitis B infection. Positive markers indicating HBV infection only, accounted for another 18% of patients. All staff members were anti-HCV negative, although 34 (45%) were anti-HBc positive. Age, sex and history of blood transfusions did not influence the prevalence of anti-HCV and anti-HBC in patients. There was, however, a significant difference in the prevalence of anti-HCV and anti-HBc positivity between polytransfused and occasionally transfused patients (p < 0.05). During a 24-months follow-up a decline was observed in HBs antigen carriers from 20% to 10% and in HBc antibody carriers from 47% to 33%. At the same time, regardless of accurate preventive measures, an increase in incidence of anti-HCV seropositivity from 30% to 38% was detected.

The Role of Sympathetic Dysfunction in Blood Pressure Regulation in Uremic Patients Treated by Continuous Ambulatory Peritoneal Dialysis

The role of autonomic nervous system dysfunction In the regulation of arterial blood pressure In 4 male and 10 female uremic patients, age 35–65 years (57±9 years), treated by continuous ambulatory peritoneal dialysis (CAPO) for 6–40 months (20±12 months), was studied. The integrity of the entire autonomic reflex arc was checked using Valsalva's test and the orthostasis challenge test in parallel, efferent sympathetic function was tested with the handgrip test.

A significantly decreased Valsalva ratio was found In 7 patients (50%), and it was normal in only 2 patients (14%). The handgrip test was subnormal in 5 patients (36%) and abnormal In 7 patients (50%). On the contrary, the orthostatic challenge test showed normal compensatory reaction in 10 patients (72%). The evaluation of three autonomic tests showed combined (afferent + efferent) lesion In 6 patients (43%), predominant afferent lesion In 3 patients (21 %), and In 3 patients predominant efferent lesion. In 2 patients (14%) there was no end-organ response.

Despite significant autonomic nervous system dysfunction In uremics on CAPO, as demonstrated by these results, blood pressure regulation In the supine and up right position was adequate In most patients (72%), indicating a relatively greater role of other blood pressure-regulating factors.