RESUMO
We compared the number of CD4-positive (CD4+) and CD8-positive (CD8+) cells in severe and non-severe preeclampsia (PE), and in normal pregnancy. We also evaluated the expression of matrix metalloproteinase 9 (MMP-9) in CD4+ and CD8+ cells. Immunohistochemistry for CD4+ and CD8+ was performed on the decidua basalis of 15 severe and 13 non-severe PE women and compared to decidual tissue of 19 normal pregnancies (control group). Co-expression of MMP-9 with CD8+ and CD4+ cells was determined by double immunofluorescence staining. The median number of CD8+ cells/mm2 was significantly lower for the severe PE group than for the normal pregnancy group, as was the number of CD4+ cells and MMP-9+CD8+ cells. No statistical difference was found between the non-severe PE group and the normal pregnancy group. The significant decrease of CD4+, CD8+ and MMP-9+CD8+ cells at the fetal-maternal interface only in the severe PE group suggests that immunological disorders play a role in the pathophysiology of severe PE.
Assuntos
Regulação Enzimológica da Expressão Gênica , Metaloproteinase 9 da Matriz/genética , Placenta/enzimologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/enzimologia , Adulto , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Feminino , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Metaloproteinase 9 da Matriz/metabolismo , Placenta/fisiopatologia , Gravidez , Índice de Gravidade de DoençaRESUMO
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.
Assuntos
Humanos , Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/tratamento farmacológico , Conduta do Tratamento Medicamentoso , Hipoglicemiantes , Hipoglicemiantes/farmacologiaRESUMO
Palliative care is defined as the care for patients whose disease is not responsive to curative treatment. The goals of palliative care are symptom control, life prolongation and enabling the best possible quality of life for patients and their families. For most patients with an advanced progressive incurable disease, 90% of care in their last year of life is provided at home by family physician and his team and patient family. Patients suffering from cancer have a mean of of 11.9 symptoms in the last three months of life. The most common symptoms are digestive tract symptoms and pain. The growth and spread of cancer, as well as the therapeutic procedures applied are the most important causes of symptoms. The most common symptoms in patients with cancer of digestive system are nausea, vomiting, constipation, pain, cachexia, anorexia, and psychological problems. These most common symptoms and many others will be of varying intensity and appearance depending on localization and aggressiveness of digestive system cancer, modality of treatment and patient condition. Patients with advanced cancer have longer survival and all health care professionals involved in the care of patients should have more knowledge and skills necessary to effectively treat various symptoms. Coordination, organization and implementation of palliative care in family medicine, when large part of care is provided at patient home, are one of the most complex tasks of family physician. This task requires a family practitioner with specific knowledge and skills to know how effectively control a number of symptoms and to provide adequate support to the patient and his family. Communication between doctor and patient suffering from advanced cancer of digestive system is a fundamental aspect of care. The quality of communication significantly affects the course of treatment, the benefit to patients and their families, the choice of treatment and adherence to treatment, as well as care planning. In the management of patients with advanced cancer of the digestive system, family physician should use holistic approach and respect the patient as a person and his decision.
Assuntos
Medicina de Família e Comunidade , Neoplasias Gastrointestinais/terapia , Cuidados Paliativos/métodos , Conforto do Paciente , Humanos , Equipe de Assistência ao Paciente/organização & administraçãoRESUMO
PURPOSE: The purpose of this study was to evaluate the performance of color duplex Doppler ultrasonography in the assessment of renal vascular resistance (RVR) by measuring resistive indices (RIs) and pulsatility indices (PIs) in patients with autosomal dominant polycystic kidney disease (ADPKD), and to correlate the measured values with renal function and the presence of arterial hypertension. MATERIAL AND METHODS: In 42 patients with ADPKD and 65 control subjects, RIs and PIs were measured by means of color duplex Doppler sonography and correlated with clinical and laboratory findings and with morphological abnormalities at B-mode ultrasonography. RESULTS: Mean RI in the control subjects was 0.59 +/- 0.03 (+/-SD) and in the patients 0.71 +/- 0.11, (p < 0.01). Mean PI in the controls was 1.00 +/- 0.11 and in the patients 1.69 +/- 0.21, (p < 0.01). Elevated RIs and PIs heralded a progression of ADPKD. Doppler indices correlated significantly with renal function tests and morphological changes in the affected kidneys at ultrasound. Significantly higher RIs (p < 0.01) and PIs (p < 0.04) were measured in hypertensive ADPKD patients as compared to normotensive patients. Correlation of patient age and Doppler indices did not reach statistical significance. CONCLUSION: Doppler indices do reflect the increased RVR in patients with ADPKD and they correlate with renal function disturbance, with the development of systemic arterial hypertension, and with ultrasonographic abnormality of the kidney in these subjects.
Assuntos
Rim/irrigação sanguínea , Rim Policístico Autossômico Dominante/diagnóstico por imagem , Rim Policístico Autossômico Dominante/fisiopatologia , Resistência Vascular , Adulto , Idoso , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Doença Crônica , Feminino , Humanos , Hipertensão Renal/diagnóstico por imagem , Hipertensão Renal/fisiopatologia , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Pulsátil , Ultrassonografia Doppler em Cores/instrumentação , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Doppler em Cores/estatística & dados numéricosRESUMO
BACKGROUND: The purposes of this study were: to compare conventional and duplex Doppler ultrasonography in the detection of renal changes in diabetes mellitus; to investigate whether a correlation was found with various clinical stages; and to assess whether increased renal vascular resistance in asymptomatic patients correlated with mild renal functional impairment. MATERIAL AND METHODS: In 190 diabetic patients and 85 controls, conventional ultrasonography was used to assess renal length, parenchymal thickness, and cortical echogenicity. Renal vascular resistance was estimated by duplex Doppler measurements of intrarenal arterial resistive indices. According to clinical stage, the patients were classified into 3 groups. Resistive indices were compared between controls and patient groups and correlated with age and renal function. RESULTS: In asymptomatic diabetic nephropathy, renal length and parenchymal thickness were significantly increased compared to that of controls, reflecting hyperfiltration-induced nephromegaly. Differences between controls and patients with clinically manifest nephropathy were insignificant; only in advanced renal disease were both values significantly decreased. Cortical hyperechogenicity was noted only in very advanced disease. Resistive indices correlated well with renal function, and pathologic values (i.e. > or = 0.70) were observed in 15% in the asymptomatic group and in 87% in the group with advanced nephropathy. CONCLUSION: Renal changes in diabetic patients are detectable by conventional ultrasound only in very advanced stages of the disease. Pathologic resistive indices, however, may be detected in the earlier stages. Resistive indices correlate with serum creatinine levels and creatinine clearance rates. However, it remains unclear as to whether a diagnostic or prognostic benefit can be expected as compared to standard laboratory examinations.
Assuntos
Nefropatias Diabéticas/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Ultrassonografia Doppler , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Nefropatias Diabéticas/fisiopatologia , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Resistência VascularRESUMO
Pseudothrombocytopenia is a laboratory artefact that can introduce serious problems in diagnosis and treatment in patients with low platelet count. The most common reason for this artefact is in vitro platelet clumping in blood samples collected into ethilenediaminetetraacetic acid (EDTA) anticoagulant. The clumping activity is greater at temperatures less than 37 degrees C, and the EDTA concentrations required for clumping are 20 times below anticoagulant concentrations. In this article we described the case of a female patient with diagnosed EDTA induced pseudothrombocytopenia. The cause of incorrectly low platelet counts was proved by simultaneous analysis in blood samples collected into EDTA anticoagulant and into heparin as a control sample. Absences of incorrectly low platelet count in heparin sample and rapid decrease of platelet count in EDTA sample were noticed. Decrease in platelet count was accompanied by increase in the number of leukocytes, so called pseudoleukocytosis. Careful examination of blood film is necessary to establish correct diagnosis, promptly after the blood collection and approximately two hours later. It is important to verify formation of clumps two hours after the blood collection and also progressive reduction in the platelet count in EDTA sample. By blood assessment conducted in this concern it is possible to avoid severe misinterpretation in such patients.
Assuntos
Ácido Edético/efeitos adversos , Trombocitopenia/induzido quimicamente , Adulto , Reações Falso-Positivas , Feminino , Humanos , Agregação Plaquetária/efeitos dos fármacos , Trombocitopenia/diagnósticoRESUMO
PURPOSE: To evaluate duplex Doppler sonography to assess renal vascular resistance (RVR) in diabetic patients. MATERIALS AND METHODS: Resistive indexes (RIs) and pulsatility indexes (PIs) were measured in intrarenal arteries of 144 patients with diabetes mellitus and 61 control subjects. RIs and PIs were compared for control subjects and patients with diabetic nephropathy and correlated with laboratory and clinical findings. RESULTS: In control subjects, the mean RI was 0.595 +/- 0.033 (standard deviation) and mean PI was 1.001 +/- 0.105. Elevated RIs and PIs accompanied progression of nephropathy. Statistically significant (P < .001) correlations were observed between both RI and PI and serum creatinine level, creatinine clearance rate, systolic and diastolic blood pressure measurements, and patient age. CONCLUSION: Doppler indexes reflect increased RVR in diabetic nephropathy and correlate with laboratory and clinical parameters, but RI and PI measurements offer no advantages over these parameters to predict disease progress or in patient care.
Assuntos
Nefropatias Diabéticas/diagnóstico por imagem , Circulação Renal , Resistência Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
RIs were measured in intrarenal arteries in 66 kidneys of 33 examinees without renal impairment and in 42 kidneys of 21 patients with unilateral urinary obstruction. The mean RI in normal kidneys was 0.593 +/- 0.040. Patients with unilateral obstruction had a mean RI of 0.709 +/- 0.039 in obstructed kidneys and a mean RI of 0.591 +/- 0.033 in contralateral nonobstructed kidneys. Statistically significant differences have been noticed in the groups of normal versus obstructed kidneys (P < 0.001) and of obstructed versus contralateral nonobstructed kidneys (P < 0.001). The mean dRI was 0.118 +/- 0.034 in patients with unilateral obstruction, and it was 0.014 +/- 0.012 in examinees without renal impairment (P < 0.001). A comparison of RI values between the right and left kidneys in a patient with unilateral obstruction proved more useful than using a 0.7 RI cutoff value in a Doppler sonographic diagnosis of unilateral obstruction.