A RARE CASE OF A PATIENT WITH HYPERTHYROIDISM AFTER HYPOTHYROIDISM.

Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in clinical practice, while one of the most commonly seen types of hyperthyroidism states is Graves' disease. In hypothyroidism, patients are thought to be lifelong treated with substitution therapy with the lacking levothyroxine hormone. Usually due to the started autoimmune process that progressively destroys the thyroid tissue, the doses of levothyroxine increase in a different period of time during the follow ups. Rarely, the doses need to be tapered down, and that is the exact moment when the physician should be suspicious of a possible conversion from a hypothyroid state to a hyperthyroid one. We describe a case of a woman who was diagnosed with hypothyroidism and treated with suitable doses of levothyroxine, and then gradually the levothyroxine doses were tapered and eventually discontinued because of the clinical and laboratory confirmed state of hyperthyroidism- requiring a treatment with thiamazole. To our knowledge, this case is one of rarest worldwide so far published cases that illustrate the shortest time interval between the diagnosis of hypothyroidism and its switch to a hyperthyroid state.

European Antibiotic Awareness Day: a five-year perspective of Europe-wide actions to promote prudent use of antibiotics.

Following the European Union (EU) Council Recommendation on prudent use of antimicrobial agents in human medicine in 2001, and the success of national campaigns, i.e. Belgium and France, the European Centre for Disease Prevention and Control (ECDC) decided to establish the European Antibiotic Awareness Day (EAAD) on 18 November as platform to support national campaigns across Europe. This article provides an overview of EAAD tools, materials, and activities developed during the first five years. It shows that EAAD has been successful due to good cooperation between ECDC and national institutions, strong political and stakeholder support and evidence-based development of campaign materials. EAAD has provided a platform for pre-existing national campaigns and encouraged similar campaigns to develop where neither political support had been secured, nor financial support had been available. As a result, participating countries have continuously expressed strong support for ECDC to continue its work on EAAD. This has been endorsed by a steadily increasing number of countries participating and the growing interest of varied professional and stakeholder organisations. We conclude that EAAD should continue to act as catalyst for discussion and as mechanism to raise awareness of the public and prescribers about prudent use of antibiotics.

Serum glucocorticoids and adiponectin associate with insulin resistance in children born small for gestational age.

OBJECTIVES: Altered glucocorticoid activity is one possible mechanism linking fetal growth restriction with later insulin resistance (IR) and type 2 diabetes. We aimed to investigate whether serum glucocorticoid parameters are related to IR in children born small for gestational age (SGA). DESIGN: A total of 110 children (55 age- and gender-matched pairs born SGA or appropriate for gestational age (AGA) in a case-control setting) were studied at the mean age of 12.2 (s.d. 0.2) years. METHODS: Serum cortisol, corticosteroid-binding globulin (CBG), free cortisol index (FCI=cortisol/CBG), and glucocorticoid bioactivity (GBA, transactivation assay) were analyzed and related to serum adiponectin and insulin-like growth factor-binding protein 1 (IGFBP1) concentrations and homeostasis model assessment for IR (HOMA-IR) and QUICKI indices. RESULTS: In the pooled study population, GBA correlated well with cortisol and FCI (r=0.681 and 0.586 respectively; P<0.001 for both). Serum cortisol, CBG, FCI, GBA, HOMA-IR, or QUICKI did not differ between the SGA and AGA subjects, but the SGA children had lower body mass index (P=0.005) and waist circumference (WC) (P=0.001). The mean GBA in the highest GBA quartile was higher among the SGA subjects than among the AGA subjects (138.6 vs 96.4 nmol/l cortisol equivalents, P<0.001). In the SGA children, GBA correlated positively with HOMA-IR (r=0.522, P<0.001) and inversely with adiponectin (r=-0.278, P=0.042) (WC/height ratio adjustments), and in logistic regression analysis, higher GBA (odds ratio (OR) 1.3; P=0.013), lower adiponectin (OR 1.4; P=0.038), and lower IGFBP1 (OR 1.9; P=0.010) associated independently with higher HOMA-IR. CONCLUSIONS: These findings suggest that increased glucocorticoid activity and low serum adiponectin concentrations associate with IR in SGA children.

Low density lipoprotein subclass distribution in children with diabetes mellitus.

BACKGROUND: The role of small dense low-density lipoprotein (sLDL) subclasses in atherosclerosis has been demonstrated in many studies. Among other metabolic changes, the alteration in LDL lipoprotein subclass distribution and size has been proved in diabetic adults. Because there is not enough literature data presenting LDL subclass distribution in childhood, the aim of this study was to examine LDL subclass profile in diabetic children compared with healthy control. MATERIAL AND METHODS: Plasma LDL subclasses in 30 children with type I diabetes mellitus and 100 healthy children aged 9-18 years were analyzed using non-denaturing polyacrilamide gradient (3-31%) gel electrophoresis. Conventional plasma lipid and apoprotein parameters which are thought to affect LDL size were determined as well. RESULTS: Analysis of LDL phenotype has shown that a great percentage of healthy children (89%) yield bigger LDL1 with LDL2 subclasses being dominant (phenotype A), whereas 11 % of the children belong to phenotype B characterized by the presence of small, atherogenic LDL3 and LDL4 subclasses. In diabetic children despite no significant differences in their plasma lipid profile when compared with healthy control, the frequency of LDL phenotype B was increased (86.7 %), and the mean LDL diameter was smaller (p < 0.0001). LDL size was inversely correlated with plasma levels of triglycerides, and positively correlated with plasma HDL cholesterol and BMI. CONCLUSION: Although plasma levels for lipid and apoprotein were within the normal range, the increased frequency of LDL phenotype B confirms a grater risk of atherosclerosis development in children with diabetes mellitus. LDL size measurement may potentially help to assess cardiovascular risk and adapt the treatment goals thereafter (Tab. 3, Ref. 38). Full Text (Free, PDF) www.bmj.sk.

Lipoprotein (a) and apolipoprotein (a) phenotypes in healthy Macedonian children.

BACKGROUND: Plasma levels of lipoprotein(a) [Lp(a)] are determined largely by genetic variation in the gene encoding apolipoprotein(a) [apo(a)], the unique protein component of Lp(a). High plasma levels of Lp(a) increase the risk of premature atherosclerosis. However, the association of apo(a) phenotypes with the development of these diseases remains largely unexplored. OBJECTIVES: Determination of Lp(a) levels and apo(a) isoforms (phenotypes) in 100 (51 boys, 49 girls) Macedonian healthy children aged 9-18. METHODS: We used 3-15 % gradient SDS-PAGE for separation of apo(a) isoforms. According to the different apo(a) electrophoretic mobilities, Apo(a) was classified into five single and respective double-band phenotypes. RESULTS: Each individual expressed a single (homozygotic), double-band (heterozygotic) or no band (null phenotype). The apo(a) phenotype frequencies revealed that the frequency of single-band phenotype expression (64 %) was higher than that of double bands (32 %) and that the frequency of phenotypes representative of low molecular weight was very low (4%). The most frequent phenotype was S4 (42.65%). The distribution of plasma Lp(a) levels was skewed, with the highest frequencies at low levels. The mean Lp(a) concentration was 11.95 (SD of 5.98 and median of 9.62 mg/dL). We did not find differences in the mean and median plasma Lp(a) levels between boys and girls (p > 0.05). A strong inverse relationship was found between the apparent molecular weight of apo(a) phenotypes and plasma Lp(a) concentration (r = -0.4257). CONCLUSIONS: Determination of Lp(a) levels and apo(a) phenotypes in children, may help in preventing and reducing the risk of atherosclerotic development (Tab. 6, Ref 32). Full Text (Free, PDF) www.bmj.sk.

Effect of clofibrate on the enzymes associated with oxidative stress in Wistar rat liver.

BACKGROUND: A diversity of endogenous and exogenous compounds have been demonstrated to cause proliferation of peroxisomes and variety of associated effects in rodents. The aim of our study was to see the effect of clofibrate on the enzymes associated with oxidative stress. METHODS: Male Wistar rats weighting 250-350 g were treated with clofibrate in a dose of 250 mg/1000 g/ 24 h for 12 days. Whole liver homogenates and subsequent subcellular fractions wrere proceeded for enzyme measurements by spectrophotometric methods. RESULTS: The activity of hydrogen producing enzymes D-aminoacid oxidase, Urate oxidase and Palmitoyl CoA oxidase was statistically significantly increased in the treated group in comparison with the control one. On the contrary to the massive increase of the Palmitoyl CoA oxidase--a marker enzyme for peroxisomal proliferation, there was only a limited increase of catalase (which inactivates hydrogen peroxide) activity. On the other hand superoxide dismutase and glutathione peroxidase activities in experimental group were down regulated in the treated group. CONCLUSION: Our results support the hypothesis that clofibrate (peroxisomal proliferators) application might produce oxidative stress in rat livers (Tab. 2, Fig. 8, Ref. 56) Full Text (Free, PDF) www.bmj.sk.

Erythrocyte antioxidant enzymes in patients with alcohol dependence syndrome.

BACKGROUND: The role of free radicals and hydrogen peroxides in the metabolism and toxicity of alcohol is supported by many studies, therefore, many autors have tried to use the enzymes, metabolizing highly reactive chemical compounds as biological markers of alcoholism. METHODS: Erythrocyte antioxidant enzymes were measured in 37 male patients with alcohol dependence syndrome, without severe liver disease, aged between 18 and 59 years, with different duration (years) of alcohol abuse. RESULTS: Superoxide dismutase (SOD) activity was statistically significantly increased in alcoholics. Glutathione peroxidase (GPX) activity has shown no significant difference in alcoholics compared to the control group. Catalase (CAT) activity was significantly decreased in alcoholics. Specific activity of CAT was positively correlated with the duration of alcohol abuse (years). CONCLUSIONS: Catalase activity has shown statistically significant decrease in patients with alcohol dependence syndrom. (Tab. 3, Fig. 4, Ref: 31.)

The G-250A substitution in the promoter region of the hepatic lipase gene is associated with the conversion from impaired glucose tolerance to type 2 diabetes: the STOP-NIDDM trial.

OBJECTIVES: Dyslipidaemia that includes high levels of triglycerides and low high-density lipoprotein cholesterol is a risk factor for type 2 diabetes. Hepatic lipase gene encoding a lipolytic enzyme participating in remodelling of plasma lipoproteins and formation of serum lipid profile is a promising candidate gene for type 2 diabetes. The purpose of the study was to investigate whether the G-250A promoter polymorphism of the LIPC gene predicts the conversion from impaired glucose tolerance (IGT) to type 2 diabetes. SUBJECTS AND DESIGN: Study population comprised of subjects who participated in the STOP-NIDDM trial aiming to investigate the effect of acarbose compared with placebo on the prevention of type 2 diabetes in subjects with IGT. RESULTS: Compared with subjects carrying the G-250G genotype, subjects with the A-250A genotype of the LIPC gene had a 2.35-fold [95% confidence interval (CI) 1.27-4.33, P = 0.006] higher risk of developing type 2 diabetes. Subjects in the placebo group and all women carrying the A-250A genotype had an especially high risk for the conversion to type 2 diabetes [odds ratio (OR) 2.74, 95% CI 1.14-6.61, P = 0.024 and OR 3.70, 95% CI 1.35-10.1, P = 0.011 respectively]. CONCLUSION: The G-250A promoter polymorphism of the LIPC gene is associated with an increased risk of development of type 2 diabetes in high-risk subjects with IGT. Therefore, genes regulating atherogenic dyslipidaemia are promising candidate genes for type 2 diabetes.

Erythrocyte superoxide dismutase, glutathione peroxidase and catalase activities in healthy male subjects in Republic of Macedonia.

OBJECTIVES: The study was aimed to establish the reference values for erythrocyte antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase (CAT) in healthy male subjects, as well as to detect their relation to age, cigarette smoking, moderate alcohol consumption, antiinflammatory drugs and supplements use and the possible correlation between individual parameters. BACKGROUND: Superoxide dismutase, glutathione peroxidase and catalase are the three main enzymes that control the biological effects of the reactive oxygen species (free radicals). METHODS: The authors have examined 111 healthy male blood donors aged 18-59 years. All studied enzymes were assayed in erythrocytes by manual techniques. The results were statistically evaluated by means of the ANOVA programme. RESULTS: The group of healthy individuals had a large dispersion of interindividual activities of antioxidant enzymes. Age, cigarette smoking, antiinflammatory drugs and dietary supplements use had no significant effect on the antioxidant enzymes activity. The activity of the enzymes showed normal Gaussian distribution. We established mean reference values for SOD, GPX and CAT activity. SOD negatively correlated with CAT (r=-0.199). CONCLUSIONS: We established the reference values for erythrocyte SOD, GPX and CAT activity in male subjects. The large dispersion of activities of the investigated enzymes in healthy individuals does not allow to make a standard use of these parameters in clinical practise without establishing "own reference values" for each laboratory. (Tab. 2, Fig. 4, Ref. 31)

Comparative evaluation of two commonly accepted tests for adjustment of fixed prosthetic constructions.

Regardless of the great advance in prosthetic dentistry related to the development of new more elaborate materials and methods, the dentist must often correct some defects of the newly fabricated prosthetic constructions. In dentistry practice worldwide two tests for adjustment of fixed prosthetic constructions are applied most often - the silicone test and the suspension of Fe2O3 (rouge) and chloroform. The capabilities of the suspension of chloroform and rouge to assess the preliminary contacts between the prosthetic construction and the dental tissues haven't been reviewed in the dentistry literature in Bulgaria. The test is not familiar to the practicing dentists and this is an obstacle for its wide application in everyday practice. The purpose of the current study was to compare the advantages and disadvantages of the silicone test and the modified suspension of halothane and rouge recommended in the recent years. The assessment of the capabilities of the two tests for adjustment is based on the results of their application in the adjustment of crowns and bridges on the working model and on the prosthetic field. The results demonstrate that the two tests have different capabilities in different clinical situations and their concomitant use will allow more precise prosthetic treatment.

Correlation between overcontouring of fixed prosthetic constructions and accumulation of dental plaque.

INTRODUCTION: In prosthetic treatment with fixed prosthetic constructions the reproduction of the dimension and form of natural teeth crowns is important for the preservation of normal articulation-occlusal relationship as well as for periodontal health. THE AIM of the study was to evaluate to what degree there is an attempt to preserve and reproduce the natural dental contour in everyday dental practice and its impact on plaque accumulation. MATERIALS AND METHODS: The study was performed in patients with different types of fixed prosthetic constructions - metal, metal-ceramic and the combination of metal/plastic with intact symmetrical homonymous teeth. We used the index of J. Silness and H. Loe (1964) for evaluating the amount of accumulated plaque on the prosthetic construction in the area between the equator of the tooth and gingival margin. RESULTS: Our study reveals that the practicing dentists and dental technicians underestimate the preservation of natural dimension and form of dental crowns. Most often they are significantly enlarged for solving the esthetic requests of the patients. The basis for this is the incorrect preparation of the teeth and the ignorance of the negative effect of overcontouring of fixed prosthetic constructions on the periodontium by the practicing dentists. The overcontouring leads to a greater accumulation of dental plaque in the area between the equator and the margin of the gingiva.