Type 2 diabetes mellitus and thyroid disease: a two-sided analysis.

AIM OF THE STUDY: To assess the prevalence of thyroid diseases in patients with type 2 diabetes mellitus (T2DM) in comparison with normal population; to determine prevalence of T2DM in patients with thyroid diseases. MATERIALS AND METHODS: First group consisted of 60 patients with T2DM without previous history of thyroid disease. Second group consisted of 60 patients with thyroid disease without any previously known impairment of glucose metabolism. Control group (CG) included 100 subjects who had no previous history of thyroid disease or glucose metabolism impairment. Blood tests were performed to evaluate thyroid and glucose metabolism parameters. RESULTS: We found a significantly higher prevalence of thyroid diseases in patients with T2DM when compared to CG. Patients with T2DM showed to have higher serum levels of free triiodothyronine (fT3), thyroid­stimulating hormone (TSH) and anti-thyroid peroxidase (anti-TPO) autoantibodies. We found no statistical significance in prevalence of T2DM in patients with thyroid diseases and CG. Among parameters of glucose metabolism, there were only higher fasting glucose levels in patients with hyperthyroidism and autoimmune thyroid disease (AITD). CONCLUSIONS: Patients with T2DM showed to have higher prevalence of AITD and primary hypothyroidism. We did not find higher prevalence of T2DM in patients with thyroid diseases (Tab. 3, Ref. 29).

Type II deiodinase polymorphism: A potential risk factor of type 2 diabetes mellitus.

ype 2 diabetes mellitus (T2DM) remains one of the most challenging global epidemics of the twenty-first century. It is estimated that more than 350 million people worldwide are affected by this metabolic disorder. It has many risk factors. Several studies presume that type II iodothyronine deiodinase polymorphism Thr92Ala (DII-Thr92-Ala, rs225014) is yet another risk factor. The aim of the study was to assess the impact of this polymorphism on parameters of glycid metabolism. Our group consisted of 200 subjects (74 males and 126 females) at average age of 63.85 ± 18.98 without prediabetes, diabetes mellitus or any thyropathy. Blood tests were performed to evaluate glucose metabolism parameters as well as DII-Thr92Ala polymorphism. Our study confirmed the relationship between Ala homozygotes and glycosylated haemoglobin (HbA1c) serum levels (Tab. 2, Ref. 14). Keywords: diabetes mellitus 2, deiodinase II, polymorphism Thr92Ala.

Analysis of pheochromocytomas / paragangliomas from Eastern Slovakia.

This multi centre observational cohort study gives a view about the occurrence, clinical and laboratory presentation, localization, histological type and genetic background of pheochromocytoma (PHEO) and paraganglioma (PGL) in Eastern Slovakia. It included 28 patients (18 women + 10 men), of which 23 were diagnosed to have PHEO (82,1%) and 7 patients (25%) suffered from PGL with retroperitoneal, inguinal/pelvic and mediastinal distribution. Arterial hypertension was the major symptom present in 86 % with slight dominance of paroxysmal form (58%). In 3 cases (10,7%), the diagnosis was gained after differentiation of adrenal incidentaloma in asymptomatic patients. Five patients (17,8%) were classified to have malignant form of the disease. 9 patients (32,1%) were confirmed to have hereditary form - five of them (17,8%) with familiar medullar thyroid cancer (FMTC) and mutations in RET gene classified as multiple endocrine neoplasia 2A and 4 patients (14,3%) with germline mutations of SDHB gene, respectively. There was found a relatively high occurrence of other co-morbidities: thyroid disease in 20 patients (71,4%), impairment of glucose metabolism in 11 patients (39,3%) and apart from FMTC, 4 patients (14,3%) suffered also from other malignancy. Together with a bigger size of the primary tumor (6,6 cm), higher concentrations of metanephrines and prevalence of extra-adrenal tumors, malignant and hereditary forms, we suppose genetic and environmental factors of Eastern Slovakia may play a role in the etiopathogenesis of the tumors.

Adrenal metastases.

The adrenal gland is a frequent location for metastatic spread of a various number of malignant tumors. Among all tumors, carcinoma of lung, breast, ovary and malignant melanoma count to the most frequent ones. In nononcological and unselected populations, the prevalence of adrenal metastases is 0-21 %. The metastases are mostly discovered in patients during their follow-up carried out in consequence of their antecedent malignant disease. A malignant disease in adrenal gland may occasionally manifest as a solitary metastasis referred to as adrenal incidentaloma. If the malignant disease is disseminated at the time of adrenal mass diagnosis, no further differentiation of lesion is necessary as it does not influence the further therapeutic process. If the dissemination is not present, further differentiation of adrenal lesion is essential. CT and MRI characteristics of the adrenal mass play the key role in the differential diagnosis. The examination of adrenal overproduction is not necessary in case of known adrenal metastasis except when performing tests in order to rule out the catecholamine overproduction. In case of bilateral metastases, adrenal insufficiency should be also excluded. Surgical treatment is indicated in cases of solitary metastasis. The further management of patients with adrenal metastases belongs to the oncologist. The prognosis of the disease is usually very poor with average survival rate of three months (Fig. 2, Ref. 34).

[Short-term prognosis and treatment of patients hospitalized for acute heart failure in a regional hospital without a cardiocentre]. / Krátkodobá prognóza a lécba pacientu hospitalizovaných pro akutní srdecní selhání v regionální nemocnici bez kardiocentra.

BACKGROUND: Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre. PATIENTS AND METHODS: From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno. RESULTS: AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia. CONCLUSION: The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.

[Cost of acute heart failure related readmissions]. / Náklady na rehospitalizaci pacientu s akutním srdecním selháním.

AIM OF STUDY: To assess direct in-patient cost and length of stay in the intensive care unit (ICU) and the standard cardiology unit in acute heart failure (AHF) readmissions. RESULTS: Out of 1 759 patients hospitalized with acute heart failure, 223 patients were readmitted to Faculty Hospital Brno-Bohunice (Czech Republic) during study period (61.4% male; mean age 71.2 years) with mean total cost CZK 85 120 (Euro 3 095) per length of stay 9.2 days and interventions. Comparing to the first hospitalization of study cohort (223 pts.) the decrease was recorded in mean room rate, length of stay and need of ICU stay (from 48% to 42% pts.), nevertheless ICU stay increased (from 3.7 days to 4.1 days). The growth of mean cost was recorded in both procedures in angiology (the decrease in number of coronary angiography which is cheaper was more remarkable than PCI decrease in readmitted patients) and arrhythmology (including device: pacemaker, ICD, CRT) which made 57.5% of total readmission costs. CONCLUSION: The difference in mean in-patient cost between the first and second hospitalization was 18%. The antiarrhytmic procedures had the most significant impact on total readmission cost and its variability, butwe assume that these procedures will reduce within next readmissions and their impact will weaken as in angiology procedures.

The Association Between Three Adipocytokines (Adiponectin, Resistin and Visfatin) And Thyroid Status in Patients With Type 2 Diabetes Mellitus and Autoimmune Thyroiditis.

Autoimmune thyroiditis (AIT) and type 2 diabetes mellitus (DM2) are the most common endocrinological diseases worldwide. Relation between these diseases explains several hypotheses. One of them is influence of some adipocytokines. This study evaluated association between three adipocytokines (adiponectin, resistin and visfatin) and thyroid and glycid status in patients with DM2 and AIT compared to the control group (CG). The group consisted of four subgroups: patients with DM2 without thyreopathies, patients with AIT on substitution therapy without diabetes and prediabetes, patients with DM2 and AIT on substitution therapy and healthy subjects as the CG. We investigated parameters of thyroid and glucose metabolism and serum levels of three adipocytokines. The mean level of resistin in the group of patients with diabetes and thyroiditis was significantly higher than in patients with thyroiditis without diabetes and than in the CG. We found a weak negative correlation between visfatin and fasting glucose levels in patients with thyroiditis without diabetes. We detected a weak negative correlation between resistin and glycated haemoglobin and a weak negative correlation between visfatin and thyroid gland volume in patients with diabetes without thyroiditis. In the CG we determined a weak positive correlation between visfatin and free thyroxin. Our results are consistent with several studies, which confirmed association between AIT and adipocytokines.

[The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure]. / Prevalence anémie a vliv na hospitalizacní mortalitu pacientu prijatých pro akutní srdecní selhání.

AIM OF STUDY: To evaluate the influence of entry hemoglobin level on the hospitalization mortality of the patients admitted with AHF caused by 4 major etiologies--acute coronary syndrome with ST elevation (STEMI, n = 325) and without ST elevation (nonSTEMI, n = 210), decompensated chronic ischaemic heart disease (IHD, n = 206) and dilated cardiomyopathy (CMP, n = 88). RESULTS: We analyzed 1,253 consecutive 1st-time hospitalizations of AHF patients of whom 1,212 had their entry hemoglobin known. Out of these, 829 subjects were of STEMI (1), nonSTEMI (2), IHD (3) and CMP (4) etiology and were included in further analyses. We devided these patients into subgroups according to hemoglobin levels: I--no anemia, II--minor and III--severe anemia. The hospitalization mortality in subgroups (I-II-III) of each etiology was 16.9-24.5-35.3% (1); 12.4-9.8-35.7% (2); 9.0-9.7-18.2% (3); 1.5-21.4-33.3% (4); all etiologies together 12.4-15.0-28.8%, total rate 14.1%. Univariate analysis (chi2) showed significant differencies in hospitalization mortality depending on etiology and hemoglobin level but not type of failure (de novo/decompensation). Other parametres (comorbidities, laboratory and hemodynamic values, medication at entry) had a very variable impact on mortality throughout etiologies and hemoglobin subgroups. CONCLUSION: The presence of anemia increases hospitalization mortality of patients with acute heart failure. The relation between hemoglobin level and mortality seems to be linear, we did not observe "U shape" type of relation. It is necessary to distinguish etiologies of AHF as well as consider effects of laboratory and anamnestic variables when interpreting the results.

Serotonin receptors - from molecular biology to clinical applications.

Serotonin (5-hydroxytryptamine) is an ubiquitary monoamine acting as one of the neurotransmitters at synapses of nerve cells. Serotonin acts through several receptor types and subtypes. The profusion of 5-HT receptors should eventually allow a better understanding of the different and complex processes in which serotonin is involved. Its role is expected in the etiology of several diseases, including depression, schizophrenia, anxiety and panic disorders, migraine, hypertension, pulmonary hypertension, eating disorders, vomiting and irritable bowel syndromes. In the past 20 years, seven distinct families of 5-HT receptors have been identified and various subpopulations have been described for several of them. Increasing number of 5-HT receptors has made it difficult to unravel the role of 5-HT receptor subpopulations due to the lack of suitable selective agents. The present review describes the different populations and nomenclature of recently discovered 5-HT receptors and their pharmacological relevance.