Visnja Kokic Males

Background and Objectives: Scrotal swelling or hydrocele is a rare complication of acute pancreatitis described in the literature. We present a case of penoscrotal swelling caused by the first attack of acute interstitial edematous alcohol-induced pancreatitis in a young male patient. Case report: A 22-year-old man was admitted to the emergency unit due to diarrhea and vomiting since morning which was followed by severe abdominal pain. Urgent abdominal multislice CT scan showed steatosis, pancreatic swelling and acute peripancreatic fluid collection (interstitial edematous pancreatitis). Also, scan showed fluid between small bowel loops and along the anterior renal fascia, while there was minimal amount of fluid in the Douglas space. There was no sign of penoscrotal swelling. On the second day of admission, the patient developed left scrotal swelling and mild pain without erythema. On the fourth day, a control CT scan showed progression to moderately severe pancreatitis (CT severity index 4). Dilated scrotal veins of the pampiniform venous plexus with an increased caliber of the testicular veins were present on both sides, from the scrotum to the level of the inguinal canal. Penoscrotal swelling was significantly reduced on discharge. Conclusions: Penoscrotal swelling is a rare complication or manifestation of acute inflammation of the pancreas. It is important to identify scrotal swelling caused by pancreatitis because in severe cases it can be related to possible infertility in the future.

Varicella je visoko zarazna infektivna bolest koja može uzrokovati brojne komplikacije. Jedna od rijeđih, epididimo-orhitis, je samim time i rijetko opisana u literaturi, rijetko dijagnosticirana te neadekvatno liječena. U ovom prikazu opisat ćemo slučaj 13-godišnjeg dječaka koji je inicijalno pregledan od strane infektologa i dječjeg kirurga pod dijagnozom skrotalne bakterijske superinfekcije tokom varicella infekcije. Pogrešno liječen antibioticima, dječak je potom pregledan od strane pedijatrijskog endokrinologa, dijagnosticiran mu je epididimo-orhitis te je liječen acetaminofenom, hladnim oblozima i skrotalnom suspenzijom, s obzirom da je 24-satni ‘prozor’ za uključivanje antiviralne terapije već bio prošao. U laboratorijski testovima nisu zabilježeni znakovi upale, a ultrazvučni pregled pokazao je uvećanje desnog testisa i epididimisa uz zadebljanje tunike albuginea i paratestikularni izljev. Pacijent je potom ultrazvučno praćen pri čemu je zabilježeno postupno poboljšanje uz potpuno normalan nalaz godinu nakon infekcije. Hormonski status bio je uredan tokom praćenja. Nakon 5 godina napravljen je spermatogram uz uredan broj spermija, ali i smanjenu mobilnost, te je pacijentu dijagnosticirana astenozoospermija. Na temelju ovog slučaja moramo naglasiti ulogu varicella infekcije u mogućem razvitku dugoročnih posljedica na reproduktivno zdravlje. S obzirom na smanjenu ulogu antiviralne terapije te još uvijek upitnu mogućnost prevencije komplikacija, moramo naglasiti važnost preventivnih mjera, uključujući cijepljenje, te pogled na razvitak novih antiviralnih metoda.

Hypertriglyceridemia is a known but underestimated cause of acute pancreatitis. Although the connection between acute pancreatitis and type I, IV, and V hyperlipoproteinemia has been described, using Fredrickson’s classification, the connection between type IIb hyperlipoproteinemia and associated pancreatitis has only been reported in a few more rare cases. That is why we present a female patient with recurrent hyperlipidaemic pancreatitis with type IIb hyperlipidaemia.

Diabetes is a chronic, progressive metabolic disease that has now reached pandemic proportions. It’s estimated that 10.5% of the world’s population has diabetes, making it a global challenge that requires attention and innovative strategies from healthcare systems worldwide. While macrovascular complications remain the leading cause of death in diabetes patients, this study provides a detailed description of dermatological changes in these individuals, with a particular emphasis on the severity of diabetic foot conditions. Within the realm of dermatological manifestations, specific changes such as acanthosis nigricans, diabetic dermopathy, and xerosis are thoroughly described, and they are all specific for individuals with type 2 diabetes. Other manifestations, such as diabetic blisters and vitiligo, which are more common in individuals with type 1 diabetes, are also analysed. The study places a special focus on the crucial role of nurses in recognizing skin changes in diabetes patients. It highlights the importance of continuous education about precise insulin application and emphasises the need for regular systematic skin examinations, particularly in areas that are not easily visible to the patient, such as the feet or back. Nurse educators, like physicians, also share the responsibility for demonstrating self-examination skills or conducting joint examinations of these areas during consultations. Ultimately, this study advocates for an active partnership between healthcare professionals and individuals with diabetes to collectively address the challenges presented by diabetes, particularly in terms of dermatological changes.

Background: Thrombosis is a detrimental sequala of COVID-19 infection; thus, prophylactic anti-coagulant therapy has been deemed mandatory in treatment unless serious contraindications are present. Susceptibility to thromboembolic events in COVID-19, or following COVID-19 vaccination, is likely attributable to an interplay of factors, including a patient’s baseline clinical status and comorbidities, alongside genetic risk factors. In Europe, 8–20% of the population are homozygous for the MTHFR (methylene tetrahydrofolate reductase) variant, which compromises folate metabolism and elevates homocysteine levels. While heightened homocysteine levels are considered a risk factor for thromboembolic events, the precise clinical significance remains a contentious issue. However, recent research suggests elevated homocysteine levels may predict the course and severity of COVID-19 infection. Given the lack of reliable biomarkers predictive of COVID-19 thrombotic risk existing in practice, and the accessibility of MTHFR screening, we established two main outcomes for this study: (1) to determine the association between hereditary MTHFR mutations and COVID-19 severity and thromboembolic events and (2) to determine the link between MTHFR variants and adverse thrombotic events following COVID-19 vaccination. Methods: The review was conducted in accordance with PRISMA guidelines. Medline, Scopus, and Web of Science databases were searched from pandemic inception (11 March 2020) to 30 October 2023. Eligibility criteria were applied, and data extraction performed. Results: From 63 citations identified, a total of 14 articles met the full inclusion criteria (8 of which were cross-sectional or observational studies, and 6 were case studies or reports). Among the eight observational and cross-sectional studies evaluating the relationship between MTHFR variants (C667T; A1298C) and thromboembolic events in COVID-19 infection, four studies established a connection (n = 2200), while the remaining four studies failed to demonstrate any significant association (n = 38). Conclusions: This systematic review demonstrated a possible association between the MTHFR gene variants and COVID-19 severity, thromboembolic events, and adverse events following vaccination. However, the paucity of robust data precluded any firm conclusions being drawn. Further prospective trials are required to determine the connection between the MTHFR gene variant and COVID-19 infection and vaccination outcomes.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a group of drugs that are a staple in diabetes treatment. Its representatives dapagliflozin and empagliflozin are oftentimes used in combination with other antidiabetic drugs such as metformin. In this manuscript, we examine the interactions of dapagliflozin and empagliflozin in mixtures of metformin and water, varying the concentration of metformin to better reflect the drug ratios prescribed in therapy. We found that both SGLT2 inhibitors have a tendency to hydrogen bond with water rather than metformin, with more bonds formed simultaneously that have a lifetime in the picosecond range. These findings were corroborated with structural information, thus providing a backbone for future understanding of transport processes of SGLT2 inhibitors and metformin in highly complex environments.

SIADH ili Sindrom neodgovarajućeg izlučivanja antidiuretskog hormona je endokrinološki poremećaj koji nastaje kad postoji kontinuirano lučenje ADH u odsutnosti odgovarajuće osmotske stimulacije. Sekundarna adrenalna insuficijencija je uzrokovana nedovoljnom produkcijom adrenokortikotropnog hormona te imitira SIADH. Oba stanja vode euvolumnoj hiponatremiji te mogu biti krivo dijagnosticirana što rezultira krivim liječenjem, a može imati i fatalni ishod. Naš prikaz slučaja je o pedesetsedmogodišnjem muškom pacijentu koji je liječen kemoradioterapijom zbog hematološkog maligniteta orofarinksa, a koji se prezentirao teškom hiponatremijom nekoliko puta koja je skoro završila fatalno. Uzimajući u obzir onkološku bolest, pacijentu je dijagnosticiran SIADH kao uzrok hiponatremije, no nakon što mu je dijagnosticirana COVID-19 infekcija započeta je terapija glukokortikoidima te je vrijednost natrija normalizirana, a kao razlog hiponatremije utvrđena je sekundarna adrenalna insuficijencija. Često se misli da je uzrok hiponatremije SIADH. No, SIADH je dijagnoza isključivanja. Prvo treba kao uzrok isključiti poremećaj štitnjače i adrenalnu insuficijenciju. Adrenalna insuficijencija imitira SIADH i rezultira hiponatremijom, ali liječenje i ishod ova dva stanja su drugačiji. Kod pacijenta s COVID-19 infekcijom, naročito liječenog onkološkog pacijenta (kemoradioterapija, inhibitori kontrolnih točaka) glukokortikoidna terapija treba biti pažljivo deskalirana zbog rizika od neprepoznate sekundarne adrenalne insuficijencije. Glukokortiokoidi koji se daju pacijentima s malignim bolestima i COVID-19 pneumonijom ne bi trebali biti naglo ukidani.

Objectives: To investigate possible associations between 25-hydroxyvitamin D₃(25(OH)D₃), oestradiol (E₂) and IFN-gamma (IFNγ) in female patients with inactive systemic lupus erythematosus (SLE).Methods: Female patients with inactive SLE and age-matched healthy controls were recruited into this cross-sectional study. Serum concentrations of 25(OH)D_3,E₂and IFNγ were measured by radioimmunoassay with gamma-counters and enzyme-linked immunosorbent assay.Results: 36 patients and 37 controls were enrolled. In patients with SLE, the concentration of 25(OH)D₃was lower and E₂was higher compared with controls. In vitamin D deficient (i.e., 25(OH)D₃≤20 ng/ml) patients, IFNγ was 150% higher compared with patients with 25(OH)D₃>20 ng/ml and controls. The concentration of E₂was higher in all patients compared with controls independently of the vitamin D level. A difference was found between patients and controls in the correlation of 25(OH)D₃with E₂and a positive correlation was found between E₂and IFNγ in all participants.Conclusions: Our results suggest that E₂may have a strong modulating effect on vitamin D function which is significant only at low concentration of E₂.

Aims/Introduction: Prediabetes (PD) represents a transitional state where the glucose levels are higher than normal, but not enough for diabetes mellitus diagnosis. As there is a growing number of the population with PD, its early detection and treatment could prevent the development of diabetes mellitus and its complications. We aimed to assess the overall knowledge of PD among medical professionals of different varieties.Materials and Methods: A questionnaire‐based study addressing PD and type 2 diabetes mellitus knowledge among Southeastern European general practitioners, postgraduates, physicians and superior specialists was carried out.Results: A total of 397 physicians completed the questionnaire. The total rate of correct answers from diabetologists, non‐diabetologist internists, residents and general practitioners was 69, 56.1, 54 and 53%, respectively. Questions related to the PD definition achieved a total of 46.6% correct answers. Correct responses considering the numerical definition of impaired fasting glucose and impaired glucose tolerance were 46.3 and 46.8%, respectively. Younger physicians had better knowledge of numerical values regarding PD and type 2 diabetes mellitus criteria (P < 0.001).Conclusions: The present results show that overall knowledge of PD is poor among Southeastern European physicians, which necessitates adequate educational programs on PD in this region.