Kristina Kralik

DETECTION OF THALLIUM AND URANIUM IN WELL WATER AND BIOLOGICAL SPECIMENS OF AN EASTERN CROATIAN POPULATION

Abstract Using inductively-coupled plasma mass spectrometry (ICP-MS), we measured the concentrations of thallium and uranium in local water resources from three villages (Ćelije, Draž, and Potnjani) in eastern Croatia, with the aim to determine if they were associated with the levels of these same elements in the serum, urine, and hair collected from the residents of this area. The exposure of the local population to thallium and uranium through drinking water was generally low. ICP-MS was capable of measuring the levels of both of the elements in almost all of the analysed samples. Although there were differences in the concentrations of both elements in water samples and biological specimens taken from the residents, they did not reach the maximum contaminant level in any of the four sample types studied. Although hair was previously reported as an excellent indicator of occupational and environmental exposure to various elements, our study did not confirm it as a reliable biological material for tracing thallium and uranium levels, mainly due to the very low concentrations of these elements, often well below the detection limit. However, our results have shown that the concentration of thallium and uranium in drinking water can be effectively traced in urine samples. Sažetak ODREĐIVANJE RAZINA TALIJA I URANA U BUNARSKOJ VODI I BIOLOŠKIM UZORCIMA STANOVNIŠTVA TRIJU ISTOČNOHRVATSKIH SELA Koristeći masenu spektrometriju induktivno spregnute plazme (ICP-MS), izmjerili smo koncentracije talija i urana u lokalnim izvorima vode triju istočnohrvatskih sela (Ćelije, Draž i Potnjani) radi određivanja jesu li povezane s razinama obaju elemenata u serumu, urinu i kosi stanovnika tih triju sela. Izloženost lokalnog stanovništva taliju i uranu preko pitke vode općenito je bila niska. ICP-MS uspješno je izmjerio razine obaju elemenata u gotovo svim analiziranim uzorcima. Iako je bilo razlika u razinama obaju elemenata u uzorcima vode i biološkim uzorcima stanovnika, nijedan nije prešao maksimalnu dopuštenu granicu. Kosa je prethodno opisana kao izvrstan pokazatelj profesionalne ili okolišne izloženosti različitim elementima, no rezultati našeg ispitivanja nisu potvrdili njenu pouzdanost pri mjerenju talija i urana uslijed vrlo niskih koncentracija obaju elemenata, koje su često bile i ispod razine detekcije. Međutim, pokazali su kako uzorci urina mogu poslužiti kao vrlo dobri indikatori prisutnosti talija i urana u pitkoj vodi.

Postoperative immunosuppression markers and the occurrence of sepsis in patients with benign and malignant disease

SummaryAimTo investigate associations between the postoperative immune response and the levels of extracellular circulating DNA (cDNA), C-reactive protein (CRP), neutrophil/lymphocyte (N/L) ratio, and regulatory T (Treg) cells in the peripheral blood and their role as potential predictors of postoperative septic complications.MethodsThis was a prospective observational study involving 115 adult patients who underwent elective surgery. Patients were divided into three groups: with benign disease, with malignant disease, and with malignant disease and administration of dexamethasone. Serum CRP levels, N/L ratio, monocyte human leukocyte antigen-DR (HLA-DR) expression, proportion of Treg cells, and cDNA levels were measured at different time points before and after surgery.ResultsAll patients had increased CRP levels after surgery. Septic patients had higher serum CRP levels at baseline. Compared with the other groups, the dexamethasone group had significantly higher CRP levels before and after surgery, a significantly higher N/L ratio before surgery, a significantly lower rise in the N/L ratio after surgery, and a significantly lower HLA-DR expression at baseline, which remained stable after surgery. In the malignant-disease group, we observed a significant postoperative decrease in the HLA-DR expression.ConclusionsOur results suggest that the immunosuppressive effect of surgery and the presence of a malignant disease may contribute to a higher risk of postoperative sepsis. Preoperative CRP levels may be a reliable predictor of sepsis in oncological patients.ZusammenfassungZielder Studie war es, Zusammenhänge zwischen der postoperativen Immunantwort und den Konzentrationen der zirkulierenden extrazellulären DNA (cDNA), des CRPs, des Quotienten Neutrophile/Lymphozyten (N/L) und der regulatorischen T (Treg) Zellen im peripheren Blut sowie deren Rolle als mögliche Vorhersager von postoperativen septischen Komplikationen zu untersuchen.MethodenIn diese prospektive Beobachtungsstudie haben wir 115 erwachsene Patienten, die einer elektiven Operation unterzogen wurden, eingeschlossen. Die Patienten wurden in 3 Gruppen eingeteilt: eine mit benigner Erkrankung, eine mit maligner Erkrankung und eine mit maligner Erkrankung und Gabe von Dexamethason. Die Serum-Konzentrationen des CRPs, der N/L Quotienten, der HLA-DR Expression der Monozyten, des Anteils der Treg Zellen und die Konzentrationen der cDNA wurden zu verschiedenen Zeitpunkten vor und nach der Operation gemessen.ErgebnisseAlle Patienten hatten nach der Operation erhöhte CRP Konzentrationen. Bei den Patienten mit postoperativer Sepsis waren die CRP Ausgangswerte höher. Im Vergleich mit den anderen Gruppen hatte die Gruppe der Patienten mit Dexamethason signifikant höhere CRP Werte vor und nach der Operation. Außerdem waren die N/L Quotienten präoperativ vergleichsweise signifikant erhöht, während postoperativ bei dieser Gruppe ein signifikant niedrigerer Anstieg der N/L Quotienten beobachtet wurde. Die Ausgangswerte der HLA-DR Expression waren bei diesen Patienten signifikant erniedrigt und blieben postoperativ stabil. Bei der Gruppe der Patienten mit maligner Erkrankung beobachteten wir postoperativ einen signifikanten Abfall der HLA-DR Expression.SchlussfolgerungenUnsere Ergebnisse lassen vermuten, dass der immunsuppressive Effekt einer Operation und das Vorliegen einer malignen Erkrankung zu einem erhöhten Risiko für das Auftreten einer postoperativen Sepsis beitragen können. Präoperative CRP Werte scheinen einen verlässlichen Vorhersagewert bezüglich Sepsis bei onkologischen Patienten zu haben.

Primary Care Provider Counseling Practices about Adverse Drug Reactions and Interactions in Croatia

Background: Prescribing medications is one of the most common medical decisions that is made by primary care providers (PCPs). In the Republic of Croatia, PCPs hold a key position in prescribing and evaluating the medications that are provided for patients. Accordingly, providing advice for patients regarding the potential adverse drug reactions (ADRs) and drug-drug interactions (DDIs) is frequently the responsibility of the PCPs. The aim of the current study was to assess the knowledge, attitudes, and counseling practices of PCPs regarding drug interactions and adverse effects. Methods: After enrolling 195 PCPs that were selected at random, a survey was conducted while using an anonymous questionnaire that was created based on previously published studies, adjusted in a way that includes the most commonly prescribed medications in Croatia. Results: Of the 10 questions on knowledge about DDIs and ADRs, the median number of correct responses by PCPs was 5 (interquartile range 4 to 7). More than half of respondents (56%) agreed with the claim that knowledge of drug side effects facilitated their work in family medicine. Almost all of the respondents (92.8%) explained side effects and drug interactions to special groups of patients (pregnant women, elderly patients etc.). Conclusion: The results show a need for additional education in the field of drug prescribing. However, PCPs were aware of the importance of counseling practices about adverse drug reactions and interactions and counseling practices among special patients populations are satisfactory.

Association of Wnt Inhibitors, Bone Mineral Density and Lifestyle Parameters in Women with Breast Cancer Treated with Anastrozole Therapy

Aim: To determine the levels of Wnt inhibitors in patients treated with aromatase inhibitors (AIs) prior to therapy and to investigate their association with bone mineral density (BMD) and lifestyle parameters. Methods: 137 breast cancer patients were divided into a group treated with 1 mg of anastrozole and a group w/o anastrozole therapy. Serum concentrations of sclerostin and dickkopf1 (DKK1) were measured by ELISA. BMD was measured by dual-energy X-ray absorptiometry (DXA). Lifestyle factors were investigated by a self-reported questionnaire. Results: Sclerostin was significantly higher in the AI-treated group (31.8 pmol/L vs. 24.1 pmol/L; p < 0.001), whereas DKK1 was significantly lower in the AI-treated group (24.3 pmol/L vs. 26.02 pmol/L; p < 0.001). Total hip and femoral neck BMD were significantly lower in the AI-treated group. Conclusion: AI treatment was associated with increased levels of sclerostin and decreased levels of DKK1.

Psoriasis Severity—A Risk Factor of Insulin Resistance Independent of Metabolic Syndrome

Background: It is still debatable whether psoriasis increases cardiovascular risk indirectly since it is associated with metabolic syndrome or is an independent cardiovascular risk factor. The aim of this study was to evaluate psoriasis severity as an independent predictor of insulin resistance (IR) irrespective of the presence of metabolic syndrome (MetS). Methods: This was a case control study including 128 patients stratified into two groups: patients with psoriasis and metabolic syndrome vs. patients with psoriasis and no metabolic syndrome. MetS was diagnosed according to ATP III criteria with homeostatic model assessment of insulin resistance (HOMA-IR), as well as a homeostatic model assessment of beta cell function (HOMA-β) were calculated. Results: Compared to subjects without metabolic syndrome, patients with metabolic syndrome had a significantly higher Psoriasis Area Severity Index (PASI) values (p < 0.001). The strongest correlation was established for HOMA-IR and the PASI index (p < 0.001), even after adjustment for body mass index (BMI) in regression analysis model. In patients without MetS and severe forms of disease, the HOMA-IR and HOMA-β values were significantly higher compared to mild forms of disease (p < 0.001 for all) while in subjects with MetS no difference was established for HOMA-IR or HOMA-β based on disease severity. Conclusions: Psoriasis severity is an independent risk factor of HOMA-IR, the strongest association being present in the non-MetS group, who still had preserved beta cell function suggesting direct promotion of atherosclerosis via insulin resistance depending on the disease severity, but irrespective of the presence of metabolic syndrome.

Depression, Personality and Life Stress Among Women with Breast Cancer in Eastern Croatian Region

Breast cancer is the most common among women and representsthe overall leading cancer in mortality rates. There is more than million newlydiagnosed breast cancer in the world every year. Incidence of breast cancer inCroatia is 100/100 000 or 2300 women per year. Every year, in Croatia, 900women die due to this carcinoma. Breast carcinoma is mostly found in women ages45-60. As the depression rates grow higher every year it isimportant to address the fact that among women with breast cancer the depressivesymptomes or depressive disorder is three times higher. These symptomes areoften correlated with stress (various life events), personality traits, sociodemographics and course of the primary disease (breast cancer). We have conducted a research among eighty (N=80)premenopausal women (40-60 years) withdiagnosed breast cancer shortly (3-7 days) after surgical treatment. Exclusion criteria was any kind of earliermental illness or psychiatric treatment/therapy . This research was conductedon Clinic for Surgery, Department of Thoracic surgery in the Clinical HospitalCentre Osijek (Croatia) and following questionnaires were applied: Hamiltondepression rating scale; Temperament and Character Inventory and Life Change Index Scale – The Stress Test. The obtained results were showed new perspective in dealingwith this disease, especially in this eastern Croatian region, and need forinterdisciplinary approach since significantly high ratio of women showeddepressive simptomes due to negative results correlated with stress and poorsocial/family support and also with specific personality features.

EPA-1139 – Influence of personality traits on depression severity in adolescents

Introduction Recognizing the link between depression and personality traits in adolescents can alleviate identification of individual triggers for developing and diagnosing depression, treatment approach and plan as well as at-risk individuals for suicide ideation. Current studies suggest that depression is linked to several personality traits according to psychobiological model such as: harm avodiance, novelty seeking and self-directedness. Also, personality traits appear to contribute to the onest and course/severity ofdepression. Often, this is more pronounced if there are adverse social factors affectingthe overall family functioning of particular adolescent. Material and Methods Our study was conducted on the Clinical Department for Children and Adolescents during 6-month period. We included both female and male adolescentes (15 years and older) entering the psychatric treatment and diagnosed as depressive disorder according to criteria of ICD-10. Personality traits (temperament and character)were assesed with, Temperament and Character Inventory-revised’ (TCI, Cloninger) and depressive symptoms with, Beck Depression Inventory’ (BDI). The social factors were identified through the region-specific questionnaire. Conclusion Our study has shown that severity of depression correlates with specific temperament and character traits according to psychobiological model but also how adverse social factors have significant impact on presentation of depressive symptoms. It might be possible that such negative social enviroment could impact the development of specific personality traits which predispose individual for development of depression

EPA-0277 – Post-stroke depression and suicidality correlated with personality features among elderly patients

Introduction Depression may occur as a result of cerebrovascular disease in a significant subpopulation of elderly persons. Recent studies indicate a high frequency of depression in older patients with cardiovascular and cerebrovascular diseases, and the possibility of a bidirectional relationship between depression and vascular disease. Materials and methods Our research included 62 post-stroke patients above age 60 undergoing post-stroke treatment in department of Neurology and 30 elderly patients who had suffered stroke one year ago and underwent psychiatric treatment. Each patient were given scales for assessment of depressive symptomes (Hamilton depression rating scale HAM-D), suicidality (Columbia suicide severity rating scale CSSR-S) and the list for assessment of borderline personality symptoms (Borderline Symptom List BSL) with examination of mental state (MMSE). These scales were given prior to antidepressant treatment and two weeks following the treatment. Results The obtained results shown positive correlation of depressive symptoms, suidical ideation and cognitive impairment in the group of post-stroke patients in psychiatric (with higher positive correlation in women). While in the group of elderly patients in psychiatric treatment (> than 1 year) the depressive symptoms were highly correlated with positive bordeline personality features and these specific personality features were highly correlated with suicidal ideation. Conclusion Our research showed how depressive symptoms are variable and highly correlated with personality features along with cognitive functioning. However, suicidal ideation was more correlated with specific personality features than depression itself. We have also concluded that concept of suicidality in the elderly seems unjustifiable neglected and should be more vigorously identified.