Putting Functional Gastrointestinal Disorders within the Spectrum of Inflammatory Disorders Can Improve Classification and Diagnostics of These Disorders.

The spectrum, intensity, and overlap of symptoms between functional gastrointestinal disorders (FGIDs) and other gastrointestinal disorders characterize patients with FGIDs, who are incredibly different in their backgrounds. An additional challenge with regard to the diagnosis of FGID and the applicability of a given treatment is the ongoing expansion of the risk factors believed to be connected to these disorders. Many cytokines and inflammatory cells have been found to cause the continuous existence of a low level of inflammation, which is thought to be a basic pathophysiological process. The idea of the gut-brain axis has been created to offer a basic framework for the complex interactions that occur between the nervous system and the intestinal functions, including the involvement of gut bacteria. In this review paper, we intend to promote the hypothesis that FGIDs should be seen through the perspective of the network of the neuroendocrine, immunological, metabolic, and microbiome pathways. This hypothesis arises from an increased understanding of chronic inflammation as a systemic disorder, that is omnipresent in chronic health conditions. A better understanding of inflammation's role in the pathogenesis of FGIDs can be achieved by clustering markers of inflammation with data indicating symptoms, comorbidities, and psycho-social factors. Finding subclasses among related entities of FGIDs may reduce patient heterogeneity and help clarify the pathophysiology of this disease to allow for better treatment.

Patterns of the physical, cognitive, and mental health status of older individuals in a real-life primary care setting and differences in coping styles.

Background: Physical frailty and cognitive decline are two major consequences of aging and are often in older individuals, especially in those with multimorbidity. These two disorders are known to usually coexist with each other, increasing the risk of each disorder for poor health outcomes. Mental health disorders, anxiety and depression, are common in older people with multimorbidity, in particular those with functional or sensory deficits, and frailty. Purpose: The aim of this study was to show how physical frailty, cognitive impairments and mental disorders, cluster in the real life setting of older primary care (PC) patients, and how these clusters relate to age, comorbidities, stressful events, and coping strategies. Knowing that, could improve risk stratification of older individuals and guide the action plans. Methods: Participants were older individuals (≥60, N = 263), attenders of PC, independent of care of others, and not suffering from dementia. For screening participants on physical frailty, cognitive impairment, and mental disorders, we used Fried's phenotype model, the Mini-Mental State Examination (MMSE), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS). For testing participants on coping styles, we used the 14-scale Brief-Coping with Problems Experienced (Brief-COPE) questionnaire. To identify clusters, we used the algorithm fuzzy k-means. To further describe the clusters, we examined differences in age, gender, number of chronic diseases and medications prescribed, some diagnoses of chronic diseases, the number of life events, body mass index, renal function, expressed as the glomerular filtration rate, and coping styles. Results: The most appropriate cluster solution was the one with three clusters, that were termed as: functional (FUN; N = 139), with predominant frailty or dysfunctional (DFUN; N = 81), and with predominant cognitive impairments or cognitively impaired (COG-IMP; N = 43). Participants in two pathologic clusters, DFUN and COG-IMP, were in average older and had more somatic diseases, compared to participants in cluster FUN. Significant differences between the clusters were found in diagnoses of osteoporosis, osteoarthritis, anxiety/depression, cerebrovascular disease, and periphery artery disease. Participants in cluster FUN expressed mostly positive reframing coping style. Participants in two pathological clusters were represented with negative coping strategies. Religion and self-blame were coping mechanisms specific only for cluster DFUN; self-distraction only for cluster COG-IMP; and these two latter clusters shared the mechanisms of behavioral disengagement and denial. Conclusion: The research approach presented in this study may help PC providers in risk stratification of older individuals and in getting insights into behavioral and coping strategies of patients with similar comorbidity patterns and functional disorders, which may guide them in preparing prevention and care plans. By providing some insights into the common mechanisms and pathways of clustering frailty, cognitive impairments and mental disorders, this research approach is useful for creating new hypotheses and in accelerating geriatric research.

Alopecia in preexisting autoimmune thyroid disease in family medicine practice: can hyperprolactinemia induce hair loss? A case report.

Management of hair loss in women presents several challenges for general practitioners, who are the first in identifying its cause and consequences in everyday clinical practice. It is usually associated with multiple secondary factors, including endocrine disorders, drug side effects, and physical or emotional stress. We report a possible pathophysiological link between hyperprolactinemia and alopecia in a patient with preexisting autoimmune thyroid disease, which has not been documented in a significant number in the literature. A 27-year-old female patient with a previous history of an autoimmune thyroid disease on hormone substitution therapy presented to a family doctor with signs of frontal alopecia that had started several months previously. On examination, frontal alopecia was confirmed. Laboratory results and thyroid ultrasound confirmed autoimmune thyroid disease, with reduced parathyroid hormone and elevated prolactin. Her female sex hormones were in the normal range. Due to elevated prolactin levels, computed tomography of the pituitary gland was performed, which excluded any brain pathology. Based on available data, there is no published systematic analysis on hyperprolactinemia-induced alopecia in previous autoimmune diseases (large cohort studies). This report indicates that, due to moderately elevated prolactin values, consideration of alternative causes and further diagnostics are necessary to exclude a prolactin-producing tumor of the pituitary gland.

Neutrophil-to-Lymphocyte Ratio as a Cardiovascular Risk Marker May Be Less Efficient in Women Than in Men.

Cardiovascular disease (CVD) is the leading cause of death in women, although traditionally, it has been considered as a male dominated disease. Chronic inflammation plays a crucial role in the development of insulin resistance, diabetes type 2 and CVD. Since studies on women were scarce, in order to improve diagnosis and treatment of CVD, there is a need to improve understanding of the role of inflammation in the development of CVD in women. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and widely available marker of inflammation, and has been studied in cardio-metabolic disorders. There is a paucity of data on sex specific differences in the lifetime course of NLR. Men and women differ to each other in sex hormones and characteristics of immune reaction and the expression of CVD. These factors can determine NLR values and their variations along the life course. In particular, menopause in women is a period associated with profound physiological and hormonal changes, and is coincidental with aging. An emergence of CV risk factors with aging, and age-related changes in the immune system, are factors that are associated with an increase in prevalence of CVD in both sexes. The aim of this review is to comprehend the available evidence on this issue, and to discuss sex specific differences in the lifetime course of NLR in the light of immune and inflammation mechanisms.

The Effect of Hypertension Duration and the Age of Onset on CV Risk Factors Expression in Perimenopausal Women.

BACKGROUND: The impact of hypertension duration and the time of onset on the expression of metabolic syndrome (MS) and other CV risk factors, in perimenopausal women, have not been studied so far. Methods. A total of 202 women, old 47-59 years, and diagnosed with hypertension, were recruited from primary care practices in eastern Croatia. The categories of hypertension duration were defined as <5, 5-10, and >10 years. Data were analyzed by standard statistical procedures. RESULTS: The proportion of women with MS increases in parallel with hypertension duration (p = 0.025). Among the examined CV risk factors, significant increase in parallel with hypertension duration was found for body mass index (p = 0.007) and triglycerides (p = 0.07). The highest proportion of women with diabetes duration of less than 5 years, indicating recent diabetes onset, was found in the category of hypertension duration of less than 5 years, corresponding with the onset of hypertension in the time around menopause (p = 0.003). The strongest linear correlations with BMI and waist circumference were found for total serum cholesterol (r = 0.355 and 0.499, respectively). CONCLUSION: Hypertension onset at the time around menopause appears together with abdominal obesity and may be a driving force for CV risk factor accumulation in postmenopausal women.

Clustering of Mental and Physical Comorbidity and the Risk of Frailty in Patients Aged 60 Years or More in Primary Care.

BACKGROUND This study aimed to identify the clustering of comorbidities, cognitive, and mental factors associated with increased risk of pre-frailty and frailty in patients ≥60 years in a primary healthcare setting in eastern Croatia. MATERIAL AND METHODS There were 159 patients included in the cluster analysis who were ≥60 years and who underwent four-month follow-up. The first cluster contained 50 patients, the second cluster contained 74 patients, and the third cluster contained 35 patients. Clinical parameters were identified from electronic health records and patient questionnaires. Laboratory tests, anthropometric measurements, the number of chronic diseases, the number of prescribed medications were recorded. Frailty was determined using the five criteria of Fried's phenotype -model. Levels of anxiety and depression were recorded using the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS), and the Mini-Mental State Examination (MMSE) score assessed cognitive impairment. Logistic regression models were used to identify predictors of frailty and pre-frailty. RESULTS Three overlapping clusters of phenotypes predicted frailty, and included obesity (n=50), multimorbidity with mental impairment (n=74), and decline in renal function with cognitive impairment (n=35). The predictors of outcome included increasing age, number of chronic diseases, inflammation, anemia, anxiety, and cognitive impairment, and reduced muscle mass. CONCLUSIONS In patients ≥60 years in a primary healthcare setting, multimorbidity predictors of pre-frailty and frailty included a decline in cognitive function and renal function.

Seasonality of the Cardiac Biomarker Troponin in the Eastern Croatian Population.

BACKGROUND: The seasonality of acute myocardial infarction and progressive heart failure has been well established so far. Cardiac troponins (cTns) are organ-specific, not disease-specific, biomarkers. The seasonality of cTns has not been reported before. METHODS: Data were collected from the emergency admission unit of a community hospital in eastern Croatia for each month of the year 2014 covering the number of patients whose doctors requested high-sensitivity cTn I (hs-cTn I) testing, the number of positive test results and hospital admissions. RESULTS: The proportion of patients with positive test results was 15.75% (350 patients out of 2221 patients referred to testing), with the males being outnumbered by the females (F: 57.15%, M: 42.85%) (p = 0.069). The month with the highest number of patients with positive test results was December, whereas the month with the lowest number of those patients was January (p < 0.001). The highest numbers of patients referred to testing (30.9%) and of those with positive test results (50.8%) were found in the oldest age group (76+). CONCLUSION: Tracking the results of cTns testing during patient admissions to emergency departments would be a more effective approach from a public health perspective than tracking the number of patients diagnosed with a particular cardiovascular (CV) disease and could be used as a research approach to guide a search for precipitating factors for CV disease specific to a local community.

Colorectal cancer early detection program integrated in practice of family physicians.

AIM: To present preliminary results of the colorectal cancer early detection program, a part of the project called "A Model of Early Cancer Detection Integrated in a Practice of a Family Physician", carried out by the Department of Family Medicine of the Osijek University School of Medicine and the Health Centre of Osijek, Croatia. METHODS: The strategy of the project, based on the central role of a family physician in the implementation of the early cancer detection programs, was described and preliminary results of the colorectal cancer early detection program are presented and compared with the same issues of the National Program, centrally conducted and supplied by public services. RESULTS: From the beginning of April unil the end of May 2009, a total number of 516 testing cards on occult faecal blood were delivered to patients from two target groups (aged 45-50 and 75-79). A high responding rate of 69.76% (360) was recorded. This is an advantage in comparison with the low responding rates of about 20% (43 862), obtained by the National Program. In the project, there were in average 2.5% (9) positive tests, with the higher percent in the older than in the younger age group, 3.5% (12) and 1% (4) respectively). CONCLUSION: Data obtained by the Project, and by the National Program--indicate that there could be a need for a more precise definition of risk groups who have to be invited for screening.

Prediction of influenza vaccination outcome by neural networks and logistic regression.

The major challenge in influenza vaccination is to predict vaccine efficacy. The purpose of this study was to design a model to enable successful prediction of the outcome of influenza vaccination based on real historical medical data. A non-linear neural network approach was used, and its performance compared to logistic regression. The three neural network algorithms were tested: multilayer perceptron, radial basis and probabilistic in conjunction with parameter optimization and regularization techniques in order to create an influenza vaccination model that could be used for prediction purposes in the medical practice of primary health care physicians, where the vaccine is usually dispensed. The selection of input variables was based on a model of the vaccine strain which has frequently been changed and on which a poor influenza vaccine response is expected. The performance of models was measured by the average hit rate of negative and positive vaccine outcome. In order to test the generalization ability of the models, a 10-fold cross-validation procedure revealed that the model obtained by multilayer perceptron produced the highest average hit rate among neural network algorithms, and also outperformed the logistic regression model with regard to sensitivity and specificity. Sensitivity analysis was performed on the best model and the importance of input variables was discussed. Further research should focus on improving the performance of the model by combining neural networks with other intelligent methods in this field.