[POMPE DISEASE - GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF ADULT PATIENTS]

These guidelines provide a short summary of recommendations on Pompe disease, how to diagnose this disease, management of adult patients with this disease, follow-up of the patients and recommendations on therapy and genetic testing. Early diagnosis and management of patients with Pompe disease requires a multidisciplinary approach of several different experts. These guidelines were produced by the Division of Metabolic Diseases, Department of Internal Medicine, University Hospital Center Zagreb which is a Referral expert center for rare and metabolic diseases of the Ministry of Health of the Republic of Croatia. They were endorsed by the Croatian Society for Rare Diseases, Croatian Medical Association.These are the first guidelines published in Croatia on diagnosis, treatment and follow-up of Pompe disease.

Mitochondrial myopathy associated with a novel 5522G>A mutation in the mitochondrial tRNA(Trp) gene

We report a novel pathogenic mutation of the mitochondrial transfer RNA (tRNA) gene for tryptophan in a patient with isolated myopathy and persistently elevated creatine kinase. Muscle studies revealed ragged red fibres and decreased activity of respiratory chain complex I and cytochrome c oxidase (COX). Sequencing of the 22 mitochondrial tRNA genes revealed a mutation m.5522G>A, which alters a conserved base pairing in the D-stem of the tRNA for tryptophan. The mutation was heteroplasmic with a mutational load between 88 and 99% in COX-negative fibres. This case contributes to the genetic heterogeneity of mitochondrial diseases caused by mutations in mitochondrial tRNA genes.

Diabetic dyslipidemia or 'diabetes lipidus'?

Diabetes mellitus is one of the most important risk factors for cardiovascular diseases. The results of several studies have shown that achieving satisfactory glucoregulation results in a significant reduction in the incidence of microvascular and macrovascular complications, and cardiovascular mortality. However, the risk of the development of cardiovascular diseases is markedly increased in the presence of dyslipoproteinemia. Research has shown that hyperglycemia not only causes apoptosis of β-cells in the islets of Langerhans (glucotoxicity) but also determines the degree of accumulation of oxidized LDLs. On the other hand, dyslipoproteinemia itself has a toxic effect on β-cells, but only in the presence of increased blood glucose levels, thus increasing the risk of the development of cardiovascular diseases exponentially. As diabetes and the lipid metabolism disorder can be neither scrutinized nor treated separately, the authors query whether 'diabetes lipidus' would be a more appropriate term.