Draško Pavlović

Bone mineral densitometry in patients on hemodialysis: difference between genders and what to measure

Introduction: Chronic kidney disease (CKD) and osteoporosis are important health problems. There is an interrelationship between osteoporosis and CKD. Bone densitometry is the “gold” standard in the diagnosis of osteoporosis. Unfortunately, there are some problems with the interpretation of bone densitometry in CKD patients. The goal of this study was to determine bone mineral density (BMD) in CKD patients, to assess the difference between genders and different sites of bone densitometry correlation between BMD and laboratory parameters, and to assess the most optimal measuring site. Methods: We studied 134 hemodialysis (HD) patients (62 females, 72 males). The mean age was 56.4 ± 12.4 years and the mean duration of HD was 54.4 ± 60 months. BMD of the lumbar spine (posterior–anterior projection and lateral projection), hip (femoral neck, trochanter, intertrochanter, total femur, the Wards Triangle), and forearm (ultradistal (UD), middistal (MID), distal third portion, and total forearm) was measured using dual X-ray absorptiometry (DXA) (Hologic Delphi apparatus). Values were expressed as BMD, T-score, and Z-score. Results: Females had lower values of BMD in all measurement points. There were no significant differences in T- and Z-scores of forearm between males and females. Age was in a positive correlation with lumbar spine BMD in males and females. There was a negative correlation with neck and forearm BMD in both groups. Serum parathyroid hormone (PTH) was also in negative correlation with hip and forearm BMD in both groups. The best correlation of BMD in different sites was between forearm and neck. Conclusion: BMD data in CKD patients should be interpreted with caution and appendicular skeletal sites should be included in the evaluation.

OLDER SUBJECTS WOULD MORE LIKELY USE SMARTPHONE APPLICATIONS FOR HYPERTENSION THAN MIDDLE-AGED PATIENTS. DATA FROM THE 2017 WORLD HYPERTENSION DAY IN CROATIA

Objective: Smartphone-based applications have been considered as a great opportunity to increase adherence and improve control of hypertension. However, several important items should be elucidated before applying this armature in real life. One of first tasks is to identify target population which would most likely use these applications. This was the aim of our study which was conducted in a group of individuals (aged 18 years or older) participating in the 2017 World Hypertension Day in Croatia. Design and method: This study was organized by the Croatian Society of Hypertension on 2017 World Hypertension day at 26 sites in 5 cities in Croatia (hospital open points, central squares and pharmacies). Along with BP measurement, a short questionnaire on hypertension awareness/salt intake/smartphone use was completed at the time of the interview by the physicians, trained nurses, pharmacist and medical students. Results: A total of 2175 subjects, 873 (40.1%) men, 1211 (59.9%) women were examined. Smartphones were used by 36.4% examined subjects (no gender difference), average age was 53.9 (15.6), and in the group of subjects who are using smartphone men were older (56.8(15.2) vs. 52.0(15.6); p < 0.001). We analyzed utilization of smartphone in several age categories and significant difference was found among age groups: under 35 years, 35–55 years, 55–70 years and above 70 years (87.5%, 70.4%, 33.6% and 13.3%, respectively). In the whole group 32.1% of individuals answered positive on the question of whether they would use mobile application for blood pressure control (no gender difference). Average age of those who answered positive was 55.7 (15.2) years (m vs. 58.1(15.2) vs. 54.2(15.1), p = 0.013). Significant difference in positive answer was obtained among age groups: under 35 years, 35–55 years, 55–75 years and above 70 years (58.7%, 57.7%, 32.4%, 13.3%, respectively, p < 0.001). Conclusions: In this large cohort we found that one-third of subjects having smartphone would use mobile applications for hypertension. Interestingly, all subjects older than 55 years and 58 % of subjects younger than 55 years who own a smartphone would like to use mobile applications for BP control.

Neck swelling secondary to severe hyperplasia of autotransplanted parathyroid tissue following parathyroidectomy.

Ann Saudi Med 28(6) November-December 2008 www.kfshrc.edu.sa/annals 476 Secondary hyperparathyroidism, characterized by an increase in the synthesis and secretion of parathyroid hormone (PTH) and parathyroid hyperplasia, is a very common complication of chronic kidney disease.1 Despite significant advances in medic cal therapy, in 5% to 10% of patients with chronic renal failure, parathyroidectomy (PTX) may be indicated.2,3 Unfortunately, recurrent or persistent hyperparac thyroidism can be seen in up to 10% of patients after PTX.4,5 Our case was a 44cyearcold women with recurc rent hyperparathyroidism after total PTX with autoc transplantation into the sternocleidomastoid muscle, who presented with an enlarged neck structure. She had chronic renal failure due to chronic glomerulonephritis and was on hemodialysis. Four years later, total PTX with autotransplantation in a single area into the sterc Neck swelling secondary to severe hyperplasia of autotransplanted parathyroid tissue following parathyroidectomy