Dermatophytes and other fungi isolated from the soil in Serbia

Der Erdboden Serbiens ist reich an Dermatophyten. In mehr als der Hälfte der isolier-ten Stämme handelte es sich um Mikrosporum gypseum (57,38 %). Es folgten Chryso-sporium keratinophilum (8,25 %, Mikrosporum fulvum (6,25 %), Keratinomyces Ajelloi (3,97 %), Arthroderma quadrifidum (2,27 %) und Trichophyton (Chrysosporium) evolcea-nui(1,73%).
In 200 aus verschiedenen Gebieten stammenden Erdproben wurden insgesamt 176 Pilze verschiedener Art festgestellt. Einige Stämme waren mehr in höheren Lagen, andere mehr am Fuße von Bergen zu finden. Die Erklärung hierfür ist hauptsächlich in der verschiedenen Zusammensetzung des Bodens zu suchen, insbesondere der Humusgehalt ist von Bedeutung für die Entwicklung ganz bestimmter Arten von keratinophilen Pilzen. Schwe-felhaltiger Boden begünstigt nur wenige Pilzarten. An den als Köder verwendeten auto-klavierten und dekolorierten menschlichen Haaren entwickelten sich Cleistothecien.     

Primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (MALT): single institution experience in a large cohort of patients

Extranodal marginal zone B-cell lymphoma is the most common orbital tumour. We conducted a retrospective analysis to examine: (i) the impact of initial presentation and staging on outcome and (ii) response to various treatment modalities and the effect of the latter on recurrence. Ninety patients with primary ocular adnexal marginal zone lymphoma (POAML) diagnosed at our institution between 1984 and 2009 were studied. POAML was associated with monoclonal gammopathy (13%) at presentation. Most POAML patients (86%) presented with Ann-Arbor stage I disease. Radiotherapy led to excellent local control, but relapses occurred in 18% of Ann-Arbor stage I patients during a median follow-up of 5 years. Local relapses, including secondary central nervous system (CNS) involvement, were observed in patients receiving radiation doses <30·6 Gy. No differences in relapse rate and survival were observed between patients who did or did not undergo staging bone marrow biopsy. Ann-Arbor stage II-IV disease and high lactate dehydrogenase levels were associated with shorter freedom from progression. In conclusion, POAML is an indolent lymphoma with continuous risk for relapse. Radiation doses of at least 30·6 Gy should be given in Ann-Arbor stage I disease, since lower doses may be more frequently associated with relapses, including CNS relapses.     

Hemodialysis treatment in patients with Balkan endemic nephropathy: an epidemiological study

AIM: To analyze hemodialysis (HD) treatment of patients with Balkan endemic nephropathy (BEN) from five endemic villages in the South Morava Region of Serbia. Analyses of patterns of incidence may generate hypotheses about the underlying causes of BEN, and prevalence data provide information on the current and likely future burden on health services for managing BEN. METHODS: A total of 143 end-stage kidney disease patients (ESKD) with BEN were admitted to the renal replacement program from 1974 to 2004: 121 to HD, 15 peritoneal dialysis, and 7 kidney transplantation. As a control group, 117 patients with other kidney disease (chronic pyelonephritis, glomerulonephritis, and ischemic nephropathy) admitted to HD at the time of BEN patients and matched by age and gender were studied. RESULTS: Most of the BEN patients (93.4%) treated by HD were born from 1917 to 1941. The majority of patients (79.3%) started HD from 1977 to 1991 (period of 15 years). The mean age of BEN patients starting HD treatment was 49.1 years in the period from 1974 to 1978, and increased steadily in the following years, being 72.5 years in the last period of study (2004-2006) The mean survival time of BEN males was 4.70 (95% CI 3.66-5.75) and for females was 5.02 (95% CI 1.47-4.53). Difference between males and females was not statistically significant (log rank 0.14, p = 0.7, P > 0.5). Mean survival times of 4.84 (95% CI 3.97-5.70) in BEN patients and 3.1 (95% CI 2.78-3.84) in other kidney disease patients were found. Difference between BEN patients and controls was statistically significant (log rank 8.38, p = 0.0038, P < 0.01). CONCLUSION: The population of endemic villages around the South Morava River admitted to HD treatment after 1974 was exposed to environmental toxicant(s) from 1917 to 1941. The most intense effect of environmental exposure was in that period, with ESKD in patients in their forties. The exposure to environmental toxicants has diminished, so ESKD of BEN has become less frequent and manifested in the older age, mean 72.5 in the period from 2004 to 2006. Different type of exposure was registered in some other endemic regions in Serbia and abroad.     

Influence of co-morbidity on health-related quality of life in patients treated with hemodialysis

Studies on the outcome of hemodialysis (HD) patients over time have mainly focused on morbidity and mortality, but currently, the importance of measuring the patient's health-related quality of life (HRQoL) is being increasingly recognized. On the other hand, comorbidity is the single most important determinant of outcome in patients on HD. The aims of this study were to evaluate HRQoL in patients at the initiation of HD therapy (incident cohort), and in patients on long-term HD treatment (prevalent cohort), and to establish the relationship between the presence of comorbidity and patient's HRQoL. The study enrolled 229 patients on HD, divided into two groups: prevalent cohort comprised 192 patients on chronic HD more than 3 months, and incident cohort with 37 patients who started their dialysis during the study. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), including two sub-indexes: Index of Disease Severity (IDS), a medical record review of 16 medical conditions, and Index of Physical Impairment (IPI), an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Patient's self-assessment of HRQoL was measured by the 36-item Short Form Health Survey Questionnaire (SF-36), encompassing 8 summary scales and 2 summary dimensions. Based on the ICED index level, in both groups of patients (prevalent and incident group), a high presence of associated diseases was observed, i.e. 56.8 % and 67.6 % respectively. Indicators of comorbidities have negative and statistically significant correlation, so that any increase of IDS and IPI indexes produces significant decrease of HRQoL parameters. HRQoL summary scales in both groups of patients were similar, but generally with lower values in incident subjects and with statistical significance only in social functioning (SF) scale (40.5 +/- 24.9 vs 51.0 +/- 27.2). In the incident group of patients, one year of HD treatment was associated with a slight improvement in all HRQoL parameters, but statistical significance (p < 0.05) was observed only in the role-physical limitation (RP) scale and SF scale. CONCLUSIONS: In the patients on HD treatment, comorbid conditions have negative and statistically significant correlation with parameters of HRQoL, and could explain poor HRQoL to a remarkable extent. One year after starting HD, patients reported better scores in some domains, especially in the RP and SF scale. From a clinical perspective, parameters of HRQoL and comorbidities should be considered in the follow up of patients treated with HD.     

Modulatory role of cyclooxygenase-2 in cerebrovascular coupling

To investigate the role of cyclooxygenase-2 (COX-2) in the cerebrovascular coupling, hemodynamic and neuronal responses to forepaw stimulation were measured in alpha-chloralose-anesthetized rats (N = 18) before and after intravenous administration of Meloxicam (MEL), a preferential COX-2 inhibitor, and following a bolus of prostaglandin E(2) (PGE(2)), a prominent vasodilatatory product of COX-2 catalyzed metabolism of arachidonic acid. The cerebral blood flow (CBF) and blood-oxygenation-level-dependent (BOLD) response was quantified using continuous arterial spin labeling magnetic resonance imaging. Neuronal activity was measured by recording somatosensory-evoked potentials (SEPs) via intracranial electrodes. Both MEL and PGE(2) had a significant effect on the activation-elicited CBF (P < 10(-6)) and BOLD (P < 10(-6)) responses, without affecting the baseline perfusion. Meloxicam decreased brain COX enzymatic activity by 57 +/- 14% and decreased the stimulation-induced CBF response to 32 +/- 2% and BOLD to 46 +/- 1% of their respective pre-drug amplitudes. In turn, PGE(2) bolus resulted in a partial recovery of functional hyperemia, with the CBF response recovering to 52 +/- 3% and the BOLD response to 56 +/- 2% of their values prior to MEL administration. There was no concomitant decrease in either amplitudes or latencies of SEP components. These findings suggest a modulatory role of COX-2 products in the cerebrovascular coupling and provide evidence for existence of a functional metabolic buffer.     

Two intrauterine rescue transfusions in treatment of severe fetomaternal hemorrhage in the early third trimester

When massive fetomaternal hemorrhage is diagnosed in the early third trimester of pregnancy, serial fetal intravascular transfusion may be an alternative to immediate delivery.     

Nephroprotective effects of pentoxifylline in experimental myoglobinuric acute renal failure

The nephroprotective effects of pentoxifylline, a methylxantine, were studied in glycerol-induced acute renal failure. Glycerol treated rats exhibited collecting duct and medullary ascending limb dilation and casts, with focal tubular damage, confined mainly to the superficial cortex. In the interstitium focal mononuclear infiltration was observed. In some glomeruli there was swelling of mesangial spaces and mesangial cells. Pentoxifylline injected to glycerol pretreated rats exerted a protective effect. Only few groups of proximal tubules in the subcapsulary region of renal cortex showed necrosis and tubulorhexis. There were not leukocyte infiltrations or vascular congestion. Morphometric analysis showed increased surface area fraction of tubular lumen in rats treated with glycerol (p < 0.01) compared to those in controls. Intratubular cast formations in rats treated with glycerol alone were significantly higher than in rats given pentoxifylline in addition to glycerol. Kidney cortex ectopeptidases (APA, APN and DPP IV) were not significantly changed after glycerol administration. Serum creatinine and blood urea were markedly increased in glycerol treated rats, however, pentoxifylline reduced significantly their levels. This study in glycerol-induced acute renal failure showed a marked renal morphologic and functional protection by pentoxifylline.     

Total bilirubin in young men and women: Association with risk markers for cardiovascular diseases

Objective

The aim of this study was to investigate whether high bilirubin concentration is a protective factor in cardiovascular disease (CAD) and how it correlates with parameters of oxidative stress in young males and females.

Methods

The study comprised 628 healthy subjects of both genders, 18–22 years of age. In fasting sera the concentration of total bilirubin (Tbil), parameters of cardiovascular risk and oxidative stress were determined. The results were analyzed by appropriate statistical methods.

Results

We found no gender differences in body mass index (BMI), blood pressure and lipid profile between subjects with low and high Tbil level. Men with high Tbil had higher concentrations of albumin and uric acid (p < 0.001) and lower of oxLDL (< 0.05), while women had higher albumin (p < 0.05) and lower TBARS (p < 0.05). Significant positive correlation in men was found between Tbil, uric acid and albumin, while for glucose and TBARS this association was negative. In female significant positive correlation was between Tbil, HDL-C, fibrinogen, albumin and uric acid and negative between Tbil and TBARS. The high concentration of Tbil in men was independently associated with uric acid (p < 0.05) and oxLDL (p < 0.001), while in women it was independently associated with TBARS (p < 0.05). After adjustment for traditional lipid parameters the predictive power of high bilirubin in men remained for uric acid (p < 0.001) and TBARS in women (p < 0.05).

Conclusion

These findings jointly support the concept that bilirubin via its antioxidant potential has a protective effect against cardiovascular disease in young male and female.     

A hazardous link between malnutrition, inflammation and oxidative stress in renal patients

BackgroundAtherosclerosis is the main cause of mortality in end stage renal disease (ESRD) patients.Design and methodsMalnutrition, inflammation and diminished paraoxonase activity were used to calculate the sum of risk factors for atherosclerosis development in a cohort of 141 chronic renal disease patients. Kaplan–Meier survival analysis was implemented to assess risk of death.ResultsKaplan–Meier analysis (Log rank = 12.06, P = 0.0072) showed higher risk of death with increasing number of risk factors in haemodialysis patients.ConclusionsMalnutrition in combination with inflammation and oxidative stress is associated with higher mortality in patients on long-term haemodialysis.