A RARE CASE OF A PATIENT WITH HYPERTHYROIDISM AFTER HYPOTHYROIDISM

Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in clinical practice, while one of the most commonly seen types of hyperthyroidism states is Graves' disease. In hypothyroidism, patients are thought to be lifelong treated with substitution therapy with the lacking levothyroxine hormone. Usually due to the started autoimmune process that progressively destroys the thyroid tissue, the doses of levothyroxine increase in a different period of time during the follow ups. Rarely, the doses need to be tapered down, and that is the exact moment when the physician should be suspicious of a possible conversion from a hypothyroid state to a hyperthyroid one. We describe a case of a woman who was diagnosed with hypothyroidism and treated with suitable doses of levothyroxine, and then gradually the levothyroxine doses were tapered and eventually discontinued because of the clinical and laboratory confirmed state of hyperthyroidism- requiring a treatment with thiamazole. To our knowledge, this case is one of rarest worldwide so far published cases that illustrate the shortest time interval between the diagnosis of hypothyroidism and its switch to a hyperthyroid state.

European Antibiotic Awareness Day: a five-year perspective of Europe-wide actions to promote prudent use of antibiotics

Following the European Union (EU) Council Recommendation on prudent use of antimicrobial agents in human medicine in 2001, and the success of national campaigns, i.e. Belgium and France, the European Centre for Disease Prevention and Control (ECDC) decided to establish the European Antibiotic Awareness Day (EAAD) on 18 November as platform to support national campaigns across Europe. This article provides an overview of EAAD tools, materials, and activities developed during the first five years. It shows that EAAD has been successful due to good cooperation between ECDC and national institutions, strong political and stakeholder support and evidence-based development of campaign materials. EAAD has provided a platform for pre-existing national campaigns and encouraged similar campaigns to develop where neither political support had been secured, nor financial support had been available. As a result, participating countries have continuously expressed strong support for ECDC to continue its work on EAAD. This has been endorsed by a steadily increasing number of countries participating and the growing interest of varied professional and stakeholder organisations. We conclude that EAAD should continue to act as catalyst for discussion and as mechanism to raise awareness of the public and prescribers about prudent use of antibiotics.

Serum glucocorticoids and adiponectin associate with insulin resistance in children born small for gestational age

OBJECTIVES

Altered glucocorticoid activity is one possible mechanism linking fetal growth restriction with later insulin resistance (IR) and type 2 diabetes. We aimed to investigate whether serum glucocorticoid parameters are related to IR in children born small for gestational age (SGA).

DESIGN

A total of 110 children (55 age- and gender-matched pairs born SGA or appropriate for gestational age (AGA) in a case-control setting) were studied at the mean age of 12.2 (s.d. 0.2) years.

METHODS

Serum cortisol, corticosteroid-binding globulin (CBG), free cortisol index (FCI=cortisol/CBG), and glucocorticoid bioactivity (GBA, transactivation assay) were analyzed and related to serum adiponectin and insulin-like growth factor-binding protein 1 (IGFBP1) concentrations and homeostasis model assessment for IR (HOMA-IR) and QUICKI indices.

RESULTS

In the pooled study population, GBA correlated well with cortisol and FCI (r=0.681 and 0.586 respectively; P<0.001 for both). Serum cortisol, CBG, FCI, GBA, HOMA-IR, or QUICKI did not differ between the SGA and AGA subjects, but the SGA children had lower body mass index (P=0.005) and waist circumference (WC) (P=0.001). The mean GBA in the highest GBA quartile was higher among the SGA subjects than among the AGA subjects (138.6 vs 96.4 nmol/l cortisol equivalents, P<0.001). In the SGA children, GBA correlated positively with HOMA-IR (r=0.522, P<0.001) and inversely with adiponectin (r=-0.278, P=0.042) (WC/height ratio adjustments), and in logistic regression analysis, higher GBA (odds ratio (OR) 1.3; P=0.013), lower adiponectin (OR 1.4; P=0.038), and lower IGFBP1 (OR 1.9; P=0.010) associated independently with higher HOMA-IR.

CONCLUSIONS

These findings suggest that increased glucocorticoid activity and low serum adiponectin concentrations associate with IR in SGA children.

Effect of clofibrate on the enzymes associated with oxidative stress in Wistar rat liver

BACKGROUND

A diversity of endogenous and exogenous compounds have been demonstrated to cause proliferation of peroxisomes and variety of associated effects in rodents. The aim of our study was to see the effect of clofibrate on the enzymes associated with oxidative stress.

METHODS

Male Wistar rats weighting 250-350 g were treated with clofibrate in a dose of 250 mg/1000 g/ 24 h for 12 days. Whole liver homogenates and subsequent subcellular fractions wrere proceeded for enzyme measurements by spectrophotometric methods.

RESULTS

The activity of hydrogen producing enzymes D-aminoacid oxidase, Urate oxidase and Palmitoyl CoA oxidase was statistically significantly increased in the treated group in comparison with the control one. On the contrary to the massive increase of the Palmitoyl CoA oxidase--a marker enzyme for peroxisomal proliferation, there was only a limited increase of catalase (which inactivates hydrogen peroxide) activity. On the other hand superoxide dismutase and glutathione peroxidase activities in experimental group were down regulated in the treated group.

CONCLUSION

Our results support the hypothesis that clofibrate (peroxisomal proliferators) application might produce oxidative stress in rat livers (Tab. 2, Fig. 8, Ref. 56) Full Text (Free, PDF) www.bmj.sk.

Lipoprotein (a) and apolipoprotein (a) phenotypes in healthy Macedonian children

BACKGROUND

Plasma levels of lipoprotein(a) [Lp(a)] are determined largely by genetic variation in the gene encoding apolipoprotein(a) [apo(a)], the unique protein component of Lp(a). High plasma levels of Lp(a) increase the risk of premature atherosclerosis. However, the association of apo(a) phenotypes with the development of these diseases remains largely unexplored.

OBJECTIVES

Determination of Lp(a) levels and apo(a) isoforms (phenotypes) in 100 (51 boys, 49 girls) Macedonian healthy children aged 9-18.

METHODS

We used 3-15 % gradient SDS-PAGE for separation of apo(a) isoforms. According to the different apo(a) electrophoretic mobilities, Apo(a) was classified into five single and respective double-band phenotypes.

RESULTS

Each individual expressed a single (homozygotic), double-band (heterozygotic) or no band (null phenotype). The apo(a) phenotype frequencies revealed that the frequency of single-band phenotype expression (64 %) was higher than that of double bands (32 %) and that the frequency of phenotypes representative of low molecular weight was very low (4%). The most frequent phenotype was S4 (42.65%). The distribution of plasma Lp(a) levels was skewed, with the highest frequencies at low levels. The mean Lp(a) concentration was 11.95 (SD of 5.98 and median of 9.62 mg/dL). We did not find differences in the mean and median plasma Lp(a) levels between boys and girls (p > 0.05). A strong inverse relationship was found between the apparent molecular weight of apo(a) phenotypes and plasma Lp(a) concentration (r = -0.4257).

CONCLUSIONS

Determination of Lp(a) levels and apo(a) phenotypes in children, may help in preventing and reducing the risk of atherosclerotic development (Tab. 6, Ref 32). Full Text (Free, PDF) www.bmj.sk.

Erythrocyte antioxidant enzymes in patients with alcohol dependence syndrome

BACKGROUND

The role of free radicals and hydrogen peroxides in the metabolism and toxicity of alcohol is supported by many studies, therefore, many autors have tried to use the enzymes, metabolizing highly reactive chemical compounds as biological markers of alcoholism.

METHODS

Erythrocyte antioxidant enzymes were measured in 37 male patients with alcohol dependence syndrome, without severe liver disease, aged between 18 and 59 years, with different duration (years) of alcohol abuse.

RESULTS

Superoxide dismutase (SOD) activity was statistically significantly increased in alcoholics. Glutathione peroxidase (GPX) activity has shown no significant difference in alcoholics compared to the control group. Catalase (CAT) activity was significantly decreased in alcoholics. Specific activity of CAT was positively correlated with the duration of alcohol abuse (years).

CONCLUSIONS

Catalase activity has shown statistically significant decrease in patients with alcohol dependence syndrom. (Tab. 3, Fig. 4, Ref: 31.)

Distribution of low density lipoprotein subclasses in Macedonian children

BACKGROUND

Current reports claim that small and dense LDL particles are more atherogenic than larger LDL particles. There are many studies presenting LDL subclass distribution in adults, but there is not enough data regarding children in the literature on this problem. The aim of our study was to examine LDL subclass distribution in healthy children in the Republic of Macedonia.

MATERIALS/METHODS

Plasma LDL subclasses in 100 children aged 9-18 years were analyzed using non-denaturing polyacrilamide gradient (3-31%) gel electrophoresis. Conventional plasma lipid and apoprotein parameters thought to be related to LDL size were determined as well.

RESULTS

The results obtained showed the prevalence of large LDL subclasses (phenotype A) in 89% of the children, whereas small LDL subclasses (phenotype B) were observed in 11%. The mean LDL size was 26.37 +/- 0.68 nm, and there was no difference between gender groups. No association was noted between LDL size and plasma lipid and apoprotein levels, age, or BMI.

CONCLUSIONS

LDL size and distribution is not gender- or age-dependent, or influenced by plasma lipid and apoprotein concentrations in childhood. This suggests that analysis of LDL subclass phenotype may provide better information on the risk of atherosclerosis development in adulthood.

Erythrocyte superoxide dismutase, glutathione peroxidase and catalase activities in healthy male subjects in Republic of Macedonia

OBJECTIVES

The study was aimed to establish the reference values for erythrocyte antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase (CAT) in healthy male subjects, as well as to detect their relation to age, cigarette smoking, moderate alcohol consumption, antiinflammatory drugs and supplements use and the possible correlation between individual parameters.

BACKGROUND

Superoxide dismutase, glutathione peroxidase and catalase are the three main enzymes that control the biological effects of the reactive oxygen species (free radicals).

METHODS

The authors have examined 111 healthy male blood donors aged 18-59 years. All studied enzymes were assayed in erythrocytes by manual techniques. The results were statistically evaluated by means of the ANOVA programme.

RESULTS

The group of healthy individuals had a large dispersion of interindividual activities of antioxidant enzymes. Age, cigarette smoking, antiinflammatory drugs and dietary supplements use had no significant effect on the antioxidant enzymes activity. The activity of the enzymes showed normal Gaussian distribution. We established mean reference values for SOD, GPX and CAT activity. SOD negatively correlated with CAT (r=-0.199).

CONCLUSIONS

We established the reference values for erythrocyte SOD, GPX and CAT activity in male subjects. The large dispersion of activities of the investigated enzymes in healthy individuals does not allow to make a standard use of these parameters in clinical practise without establishing "own reference values" for each laboratory. (Tab. 2, Fig. 4, Ref. 31)

Reference intervals of Apo A-1 , Apo B and Apo B/Apo A-1 ratio in sample of macedonian population

The disorders of serum concentration of Apolipoproteins A-1 and B (Apo A-1 and Apo B), as well as of Apolipoprotein B/Apoliporotein A-1 ratio (Apo B/ Apo A-1) are considered to be independent risk factors for coronary heart disease. It is recommended that each laboratory should asign its own reference intervals for Apo A-1 and Apo B, as well as for Apo B/Apo A-1 ratio, as these depend on the geographical location. For this purpose we determined the serum concentration of Apo A-1 and Apo B and we calculated the Apo B/Apo A-1 ratio in 122 healthy individuals from Macedonian population (70 women and 52 men), aged 18-60 years. We used commercial, standardized manual immunoturbidimetric assay (Randox). The obtained concentrations (x ± SD) were: Apo A-1 = 1.39 ± 0.28 g/l in the female population and 1.42 ± 0.27 g/l in the male population, Apo B = 0.95 ± 0.24 g/l in the female and 1.00 ± 0.23 g/l in the male population. The calculated Apo B/Apo A-1 ratio was 0.70 ± 0.17 in the female subgroup and 0.72 ± 0.18 in the male subgroup. Student's t-test detected no significant difference (p>0.05) in mean values for Apolipoproteins A-1 and B and for Apo B/Apo A-1 ratio between female and male subgroups, which lead to the conclusion that division according to sex is not necessary from diagnostic point of view. The Apo A-1 and Apo B concentrations estimated for the mixed group (N=122) were 1.40 ± 0.28 g/l and 0.97 ± 0.23 g/l. The Apo B/Apo A-1 ratio estimated for whole group was 0.71 ± 0.17. The type of distribution of values for Apo A-1, Apo B and Apo B/A-1 ratio was tested by calculating the values of coefficient of asymetry (Skewness), coefficient of flatness (Kurtosis) and standard deviations of these coefficients. The distribution of values was according to Gaussian curve for all three parameters. Therefore, according to the normal distribution reference intervals for Apo A-1, Apo B and Apo B/Apo A-1 ratio was estimated parametrically (mean ± 2 standard deviations). Reference intervals for Apo A-1 were 0.84 - 1.96 g/l, 0.51 - 1.43 g/l for Apo B and 0.37- 1.05 for Apo B/Apo A-1 ratio.