Kidney length in healthy members of Balkan endemic nephropathy families

BACKGROUND

Kidney size may differ between healthy members of Balkan endemic nephropathy (BEN) and non-BEN families. The present study was designed to elucidate this, in comparison with values for BEN patients.

METHODS

A total of 71 BEN patients (34 males, 64.4 ± 12.0 years), 74 healthy BEN family members (39 males, 49.1 ± 12.2 years), and 59 non-BEN family members (19 males, 49.2 ± 12.3 years) were involved. We measured the longest craniocaudal length and minimal parenchymal thickness on each kidney of all examined subjects using ultrasound.

RESULTS

No significant difference was found between the kidney length of healthy subjects from BEN (11.0 ± 0.8 cm) and non-BEN families (10.9 ± 0.8 cm), but kidneys were significantly longer than in BEN patients (9.9 ± 1.3 cm). Minimal parenchymal thickness was similar in all three groups. When subjects from each group were divided according to estimated glomerular filtration rate (eGFR), kidney length of the healthy groups was significantly longer than in BEN patients both in stage 1 (p =0.039) and stage 2 (p =0.044) of chronic kidney disease. The parental history of BEN was not associated with kidney dimensions, eGFR, or urinary excretion of albumin and alpha1-microglobulin.

CONCLUSION

Kidneys of BEN patients were significantly shorter than in healthy members of both BEN and non-BEN families, but no difference was found in kidney length and parenchymal thickness between healthy members of BEN and non-BEN families. No significant association was found between parental history of BEN and kidney size and function either in BEN patients or in healthy members from BEN families. Hippokratia 2015; 19 (4): 304-308.

Characterisation and preliminary lipid-lowering evaluation of Lactobacillus isolated from a traditional Serbian dairy product

We investigated the potential probiotic properties of indigenous lactic acid bacteria (LAB) isolated from Serbian homemade cheese. Seventeen LAB strains were isolated and characterised using standard protocols. One of the strains showed several probiotic properties: survival at low pH and in bile salts solution, antimicrobial activity, susceptibility to antibiotics and adhesion to hexodecane. DNA analysis identified the isolate as Lactobacillus casei, hereafter named L. casei 5s. The lipid lowering effect of L. casei 5s was evaluated in vivo using a hyperlipidemic rat model. Orally administered L. casei 5s significantly decreased the elevated total serum cholesterol and triglycerides, and attenuated macro vesicular steatosis in the liver. Moreover, L. casei 5s improved the intestinal microbial balance in favour of lactobacilli, while decreasing the number of Escherichia coli cells. The bacteria were re-isolated and identified from the surface of the intestinal mucosa and from the faecal samples of treated animals, indicating adhesiveness and colonisation ability. The results of an acute oral toxicity study in mice and the absence of translocation to other organs demonstrated the safety of the strain. In conclusion, L. casei 5s demonstrated promising probiotic potential and might be a good candidate for more detailed investigations.

A Case of Lichen Ruber Planus in a Patient with Familial Multiple Sclerosis

Multiple sclerosis and lichen ruber planus are clinically and histologically distinct complex disorders of putative autoimmune aetiology that are fairly commonly observed in isolation but rarely found in combination. Only two previous reports have described lichen skin disorders in association with multiple sclerosis. The present report describes the case of a 51-year old Caucasian woman exhibiting both familial multiple sclerosis and lichen ruber planus. This combination may have occurred by chance or it might imply that these disorders share common mechanisms in their pathogenesis.

Angiotensin-converting enzyme I/D gene polymorphism and risk of multiple sclerosis

OBJECTIVES

Angiotensin-converting enzyme (ACE) activity is increased in blood and cerebrospinal fluid of patients with multiple sclerosis (MS). In addition, in experimental autoimmune encephalomyelitis (EAE), an animal model of MS, the blockade of ACE suppresses the disease itself. To analyze the genetic association of the ACE gene with MS, we examined ACE gene insertion/deletion (I/D) polymorphism in MS patients.

MATERIALS AND METHODS

A total of 313 MS patients from Slovenia and Croatia and 376 healthy controls were genotyped by polymerase chain reaction method.

RESULTS

We found statistically significant differences in the distribution of ACE I/D allele frequencies (P < 0.01) and genotypes (P < 0.04) in male patients. ACE DD genotype was associated with MS in men at an odds ratio of 1.86 (95% CI 1.09-3.19, P = 0.02).

CONCLUSIONS

DD genotype of ACE gene might contribute to a higher risk of developing MS in men.

Insulin lispro improves postprandial glucose control in patients with diabetes mellitus

Insulin lispro was compared with regular human insulin with respect to glycaemic control in patients with diabetes mellitus on intensive insulin treatment. Sixty-two patients (55 type 1; 7 type 2) from eight study centres in the Czech Republic, Slovenia and the Slovak Republic participated in a 4-month, open-label, randomized, crossover study. Patients administered insulin lispro immediately before meals or regular human insulin 30 min before meals. A test meal (220-400 kcal), based on local and individual dietary habits and consistent for each patient throughout the study was given at baseline and at the end of each treatment. At each test meal visit HbA1c, fasting blood glucose, 1-hour and 2-hour postprandial blood glucose levels were measured. The level of HbA1c (7.6% +/- 1.5% versus 7.4% +/- 1.5%), incidence of hypoglycaemia (41-66% of patients--versus 39-63%) and daily insulin dose (0.67 +/- 0.11 U/kg versus 0.65 +/- 0.11 U/kg) did not differ between treatment groups at endpoint (insulin lispro versus regular human insulin, respectively). Mean 2-hour postprandial blood glucose excursion for the insulin lispro group (0.0 +/- 3.7 mmol/L) was significantly lower (p = 0.035) when compared with the regular human insulin group (1.3 +/- 3.7 mmol/L) at endpoint. Therapy with insulin lispro was therefore associated with a significant improvement in postprandial blood glucose excursion control when compared with regular human insulin, without an increase in rate of hypoglycaemia.

HLA class I and class II polymorphism in the population of Rijeka, Croatia

The aim of the study was to examine frequencies of HLA-A, -B, -DR antigens and haplotypes in population of Rijeka and to compare them with general Croatian and European populations. The subjects were 117 unrelated healthy blood donors. The antigens with the highest frequencies were: A2 (27.2%), A9 (16.3%), B5 (14.8%), B12 (11.8%), B18 (11.8%), DR5 (21.6%) and DR6 (13.8%). Comparison of HLA antigens frequencies has shown statistically significant difference in 1 antigen with Croatian population and in 8 antigens with European population. The HLA haplotypes with high frequencies included HLA-A2, B5 (6.84%), HLA-A2, B12 (6.84%), HLA-A2, B18 (6.84%), HLA-B12, DR2 (9.78%) and HLA-B18, DR5 (6.84%). The antigen B5 showed strongest association with DR5 (6.41%; LD = 1.30) as in general Croatian and in some European populations. The results have shown great diversity of HLA haplotypes in Rijeka population which can be the result of admixture with neighborhood immigrating populations during the history.

The effect of a compulsory curriculum on ethical attitudes of medical students

The purpose of the present study was to assess the influence of a compulsory curriculum on first-year medical students. The ethical attitude study was performed at the School of Medicine, University of Rijeka, Croatia. The samples consisted of 171 medical students (68 males and 103 females) interviewed at the beginning of the first year of studies. Some of them, namely 143 (56 males and 87 females) were interviewed again at the end of the same academic year. Data were analysed by applying factor analysis under principal component model and varimax criterion as the rotation model. The results clearly show that the current compulsory curriculum without formal ethical education has a limited influence on first-year medical students. That points to the obvious necessity to implement the medical ethics in the course of medical education.

Chromosomal anomalies in abnormal human pregnancies

OBJECTIVE

The aim of this study was to describe the cytogenetic observations on abnormal human pregnancies (anembryonic pregnancy, early fetal loss, and hydatidiform moles), and to detect the most frequent or typical chromosomal aberration for anembryonic pregnancy and early fetal loss.

STUDY DESIGN

Abnormal pregnancies were divided into three clinical and morphological groups: (a) anembryonic pregnancy; (b) early fetal loss, and (c) hydatidiform mole. Of the 119 karyotyped tissue samples, 42 (35%) were from anembryonic pregnancies, 64 (54%) from early fetal losses, and 13 (11%) were from hydatidiform moles (6 complete and 7 partial moles). Long-term cultures of chorionic villi and GTG-banding techniques were used for chromosome analysis.

RESULTS AND CONCLUSION

The overall frequency of chromosome anomalies among the 119 karyotyped spontaneous abortions was found to be 37.8%. Trisomy (double trisomy included) accounted for 35.6% of all aberrations, followed by polyploidy (33.3%), mosaicism (11.1%), structural abnormalities (4.4%), and monosomy X (2.2%). Although the difference was not statistically significant, single trisomy was the predominant chromosome abnormality found in anembryonic pregnancies (64.3 %) while in cases of early fetal loss, trisomy (double trisomy included) (38.9%) and triploidy (27.8%) were quite frequently present. The frequency of triploidy among all chromosomal abnormalities was 28.9%, and 53.8% of them were found in partial hydatidiform mole. The rest of them were almost exclusively found in early fetal losses. Complete hydatidiform moles (androgenetic in origin) were present in 13.3% of all aberrations, of which 83.3% had a 46,XX, and the rest of them had a 46,XY karyotype.

[Chronic consumption of alcohol and its damaging effects on the body]

It is widely accepted that alcohol metabolism passes through different mechanisms: alcohol dehydrogenase (ADH) activity in stomach epithelial cells, activity of ADH in the liver, microsomal-ethanol-oxydizing system (MEOS), hepatocyte catalase activity, and nonoxydizing metabolic pathway (production of fatty acid ethylesters). Alcohol causes numerous direct and indirect toxic effects on human organism. The first are directed to epithelial cells of stomach and liver cells, as well as the generation of excessive amounts of metabolites: NADH, acetaldehyde and acetate. These amounts of NADH lead to hyperlactacidaemia, hypoalbuminaemia and fat infiltration to the liver. The activity of MEOS causes drug metabolism changes in the liver and increased rate of hepatotoxic and cancerous substances. Acetaldehyde increases lipid peroxidation, immunity disorders, decrease in enzymatic activities and restoration of nucleoproteins, while acetate decreases lipolitic processes in cells.

[Non-Hodgkin's lymphoma: morphologic, immunologic and cytogenetic classification]

Malignant lymphomas (ML) encompass about 1/6 of all malignant neoplasms. They have been divided into two major categories: Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL). While the classification of Hodgkin's disease is clearly established, classification of non-Hodgkin's lymphomas is still a histopathological problem, and requires a great pathological experience. Many morphological classifications of NHL are used in different countries. In the last few years the "Working formulation for clinical usage" is widely used. Advances in immunology allowed immunological determination of different histopathological lymphoma cell types. Progress in the field of cytogenetics discovered particular cytogenetics abnormalities in patients with different types of NHL. Modern diagnostic procedures in each patient with NHL, besides clinical staging, require a detailed morphological-immunological-cytogenetical (MIC) classification. MIC classification provides the basis for the modern therapeutical management and better estimation of prognosis and evolution of the disease.

[Monitoring the nutritional status in patients on hemodialysis]

In order to monitor changes of the nutritive status of hemodialyzed patients, antropometric and laboratory parameters of the population of hemodialyzed patients in 1988 vs. 1994 have been compared. Antropometric parameters were measured by the same investigator. The results show absence of significant difference between antropometric parameters (body weight after hemodialysis, body mass index, triceps fold, circumference of upper arm and percentage of fat) in the patients hemodialyzed in 1988. The laboratory parameters (albumin and transferrin), however, show significant increase in the 1994 group. In the group of patients subjected to hemodialysis in 1988 as well, albumin was significantly elevated. Nevertheless, no differences in laboratory parameters in healthy populations of 1988 and 1994 were noted (controls). It was concluded that no significant changes in the nutritive status were present among either the population or the same patients, while elevation of laboratory parameters necessitate further investigation.

[Analysis of data on hemodialyzed patients for the development of a data base]

Needs for state-of-the-art records on haemodialyzed patients implies abandoning of conventional paper work and development of a computer data base on haemodialyzed patients. Thus, data on haemodialyzed patients were analyzed. Since haemodialysis is a specific mode of treatment and differs from out-patient and in-patient management, the records also differ from conventional files and histories. The analysis has shown that the data can be groupedinto two sets: dialysis list and history of a haemodialyzed patient. The list contains the data at the onset of dialysis, and the end of the process, and in hourly intervals. The history contains mainly relatively permanent data (personal data and basal medical parameters), annual (records and primary data) and monthly (dialysis records, history and current condition, laboratory analyses and therapy). Most of the data are systematic, i.e. periodic and necessitate tabular presentation. It has been concluded that due to the tabular presentation and predominance of systematic information, the data base will be superior to conventional records.

Activities of antioxidant enzymes and formation of the glutathione adduct of hemoglobin (Hb ASSG) in epileptic patients with long-term antiepileptic therapy

The activities of antioxidant enzymes (AOE) and amounts of glutathione adduct of Hb (Hb ASSG) in erythrocytes of chronic epileptic patients treated with mono or mixed therapy of phenobarbital (PB), carbamazepin (CBZ) and valproic acid (VPA), were evaluated and the results were compared with those for normal individuals. The activity of superoxide dismutase (SOD) was lowered for 40% to 60% in epileptic patients relative to normal controls. The lowest activity of SOD was found in patients treated with CBZ and PB. Activity of glutathione peroxidase (GSH-Px) was lowered comparing to the control from cca 15% in patients treated with PB to 50% in those treated with either CBZ alone or with CBZ in combination with PB. For the later two sub-groups of patients significantly lowered activities of catalase and glutathione reductase (cca 20% and 30-40%, respectively) were also characteristic. The highest amounts of Hb ASSG (cca 4% of the tota lHb) were found in hemolysates of patients with the lowest AOE levels i.e., in those treated with CBZ alone or with CBZ in combination with PB. In hemolysates of patients treated with PB, Hb ASSG represented 2.4% of the total Hb, while it was totally absent in those treated with VPA, although SOD and GSH-Px levels in erythrocytes of both of these sub-groups of patients were lowered to the same extent.

[Serum antithyroid antibodies in patients with pernicious anemia]

We investigated the incidence of thyroid auto-antibodies and their relationship to antigastric antibodies in 20 euthyroid patients with pernicious anaemia. To evaluate possible thyroid dysfunction we also measured total level of thyroid hormones (TT3 and TT4) and TSH in our patients. Histologic evidence of autoimmune atrophic gastritis and intestinal metaplasia was obtained in 15 patients. We found that it was surprisingly high incidence of thyroid auto-antibodies in patients with pernicious anaemia, particularly in the group with intestinal metaplasia (antithyreoglobulin antibodies 71% and antimicrosomal antibodies 100%). The incidence of antigastric antibodies in these patients was similar to that of those with significant antithyroid antibodies (16/18). Total triiodo thyronine and TSH were significantly higher in the patients with pernicious anaemia than in the control group (p less than 0.05), in the normal range. The results of our study suggest that this upset in immunological physiology is due to a more generalized defect in immune tolerance.

[Clinico-genetic expression of myotonic dystrophy in Istria]

The present genetic study has been conducted on 29 patients with myotonic dystrophy. The diagnosis of Steinert-Batten-Gibbs disease was made by anamnestic, clinical and laboratory procedures. Six families from Istria were examined in which genealogical study was carried out through five generations. Consanguinity was observed in one family. The frequency of myotonic dystrophy, correlative features and mortality was determined for each family. The incidence of myotonic dystrophy and correlative features among the first-, second-, and third-degree relatives of patients examined was determined. We conclude that the disease occurred far more frequently in families of patients with myotonic dystrophy (8 to 33%) than in the population in general (0.017%) and that it is significantly maintained among the first-, second-, and third-degree relatives.