Vitamin D deficiency in adult population monitored in the Ambulance of the general practicioner

Ivana BAČOVÁ, Stanislava BACHLEDOVÁ, Martina GÁBOROVÁ, Pavol ŠVORC, Viliam DONIČ

1Ústav lekárskej fyziológie UPJŠ, Lekárska fakulta, Košice, prednosta prof. MUDr. V. Donič, CSc.
2Ambulancia praktického lekára pre dospelých – Garmedic, s.r.o., Košice, MUDr. S. Bachledová

Background: Vitamin D is well- known for anti-carcinogenic, anti-inflammatory and anti-apoptotic effects. Vitamin D deficiency in an important risk factor for many different diseases. Goal of this study was to observe the prevalence of vitamin D deficiency in adult population.
Patients and methods: 150 patients (110 women, 40 men) of outpatient department was enrolled into this observational study, ranged in age 20 – 80 years. Vitamin D deficiency was stated by electrochemiluminescence laboratory method from October to March in years 2017– 2018. The control laboratory examination was realised in patients with deficiency after 2 months of supplementation.


Results: Hypovitaminosis was registered in 67 % of all patients (women 50 %, men 17 %). In age group 50 – 80 years of age there was 87 % prevalence of hypovitaminosis in women. In men of age group 50 – 80 years the prevalence was 80.1 %. Vitamin D values decreased obviously by aging in both groups. We could also observe significant increase of serum vitamin D concentrations (p < 0.0001) after 2 months of treatment.
Conclusion: Vitamin D deficiency is widespread in our adult population of all age categories. We registered significant increase of serum vitamin D concentrations after 2 months of supplementation but almost 60 % of patients have not reached the optimal levels with our treatment. Therefore, we think it is necessary to supplement vitamin D in larger concentrations that we have already done.
Key words: vitamin D, diagnosis of vitamin D deficiency, vitamin D supplementation.
Lek obz (Med Horizon), 2020, 69 (1): 2 – 6


CHRONIC INFLAMMATORY PROCESS AND BONE TISSUE CHANGES IN PATIENTS WITH OSTEOARTHRITIS AND EXOCRINE PANCREATIC INSUFFICIENCY

Liliya S. BABINETS, Iryna M. HALABITSKA

I. Horbachevsky Ternopil National Medical University, Ukraine

SUMMARY
Introduction. Osteoporosis is characterized by decreased bone density, micro-architectonic changes of bone tissue, which leads to bone fragility and increased risk of bone fracture. This is typically and often the only symptom of this disease. Analysis of bone density speed loss shows the difference of bone density in patient without chronic disorder and person with some chronic disease. It could be making the conclusion that chronic homeostasis imbalance due to any etiology has negative influence on bone tissue state. Chronic inflammatory process plays very important role in the development of primary osteoarthritis, which accelerates the progression of this disease.
The goal of research. Make complex study of bone density in patients with primary osteoarthritis and exocrine pancreatic insufficiency and patients with primary osteoarthritis without exocrine pancreatic insufficiency, analyze possible correlations between them.
Methods. There were examined 112 patients with primary osteoarthritis without exocrine pancreatic insufficiency and combination osteoarthritis and exocrine pancreatic insufficiency.
Diagnosis of osteoarthritis was based on diagnostic X-Ray criteria – according J.H. Kellgren and J.S. Lawrence. The level of exocrine pancreatic insufficiency was based on result of Elisa test. State of mineral bone density was examined by using dual-photon densitometry.
Results. It was established the progressive, statistically significant increasing of mineral density of bone tissue in the 1st group patients with osteoarthritis. Patients in the 2nd group, with osteoarthritis in the comorbidity with exocrine pancreatic insufficiency, the densitogram rates were statistically significantly lower than in patients 1st group.
Conclusions. The changes of bone tissue can be explained by the formation of trophological insufficiency as a result of exocrine pancreatic insufficiency. One of the symptoms of trophic failure is bone and mineral changes, in particular, the decrease of bone density.
Key words: osteoarthritis; exocrine pancreatic insufficiency; trophological insufficiency; mineral density of bone tissue.
Lek Obz (Med Horizon), 2020, 69 (1): 7 – 10


Selected  shared risk factors for cardiovascular diseases and cancer

Ivan HOVANJEC, Michal BERNADIČ, Lucia ŽIDEKOVÁ, Beata MLADOSIEVIČOVÁ

1Ústav patologickej fyziológie, LF UK,  Bratislava, prednosta prof. MUDr. F. Šimko, PhD., FESC
2Klinika chirurgickej onkológie LF SZU a NOÚ, Bratislava, prednosta doc. MUDr. D. Pinďák, PhD.
3Medirex a.s., Bratislava

SUMMARY
Cardiovascular disease and cancer are leading causes of morbidity and mortality worldwide. Attention to shared risk factors between these diseases has been paid only in the last decade. Moreover, it was demonstrated that patients with heart failure  could be more susceptible to developing cancer as well as cancer patients have higher risk of cardiovascular diseases due to cardiotoxic treatment.  Additionally, cancer itself may have negative impact on cardiovascular health. This article summarizes several common risk factors and pathophysiological mechanisms  for both diseases. It also describes potential  effect of heart failure on  cancer.
Key words: cardiovascular disease, heart failure, cancer, shared risk factors.
Lek obz (Med Horizon), 2020, 69(1): 11-16


Soft Tissue Sarcomas of the Forearm and Hand

Ondřej BELEJ, Drahomír PALENČÁR

Klinika plastickej, estetickej a rekonštrukčnej chirurgie LF UK, SZU a UNB, Bratislava, prednosta MUDr. D. Palenčár, PhD.

SUMMARY
This review article should elucidate to reader how to diagnose, manage and treat patients with hand and forearm sarcomas. Etiology, incidence, signs and symptoms, diagnostics, surgical and combined treatment as well as the postoperative observation will be discussed.
Patients with this disease are treated in specialized departments which can provide multidisciplinary discussed complex and proper treatment options. The combination of wide excision and adjuvant therapy in certain types of tumors decrease the risk of recurrence and development of metastatic spreading. In general wide excision was determined into 2 centimetres safe margins. In certain patients radical excision can vary according to histological type, grading, staging of the tumor, metastatic spreading risk, general condition of the patient, the risk and benefit consideration and to disease prognosis. The presence of soft tissue sarcoma in the limb is no longer an absolute indication for amputation.
Key words: hand and forearm sarcoma, needle biopsy, core- cut biopsy, imaging techniques, combined therapy, surgical therapy, radiochemotherapy, wide excision, regional lymph node metastasis, hand spare surgery and reconstruction.
Lek Obz (Med Horizon), 2020, 69 (1): 17 – 20


Primary biliary cholangitis – recommendations for clinical practise

Sylvia DRAŽILOVÁ, Ľubomír GÜRTLER, Ľubomír SKLADANÝ, Marián OLTMAN, Peter JARČUŠKA

1Oddelenie vnútorného lekárstva s JIS metabolickou, Nemocnica Poprad, a.s., a Lekárska fakulta UPJŠ Košice, vedúca pracoviska MUDr. S. Dražilová, PhD.
2Oddelenie klinickej imunológie, Univerzitná nemocnica Bratislava, Nemocnica sv. Cyrila a Metoda, vedúci pracoviska
MUDr. Ľ. Gürtler, PhD.
3II. interná klinika SZU a Hepatologické, gastroenterologické a transplantačné oddelenie, Slovenská zdravotnícka univerzita a Fakultná nemocnica s poliklinikou F.D. Roosevelta Banská Bystrica, vedúci pracoviska MUDr. Ľ. Skladaný, PhD.
4Gastroenterologické a hepatologické centrum Thalion, Bratislava, vedúci pracoviska MUDr. M. Oltman, PhD.
5II. interná klinika, LF UPJŠ Košice a UN L. Pasteura Košice, vedúci pracoviska prof. MUDr. P. Jarčuška, PhD.

SUMMARY
Primary biliary cholangitis (PBC) is a rare autoimune disease predominantly affecting women. It is primary cholestatic liver disease in the final phase resulting to the liver cirrhosis with its complications. Ursodeoxycholic acid (UDCA) is a first line therapy, which improves long-term survival, but it is not effective in all patients. Identification of patients with an inadequate response to the UDCA therapy is a key for the indication of second-line therapy.
Key words: primary biliary cholangitis, cholestasis, antimitochondrial antibodies, ursodeoxycholic acid.
Lek obz (Med Horizon), 2020, 69 (1): 21 – 28


Treatment of patients in dental practice treated with NOAC anticoagulants

Peter PLACHÝ, Roman PECHÁŇ

Klinika stomatológie a maxilofaciálnej chirurgie LF UK a OÚSA, Bratislava, prednosta prof. MUDr. P. Stanko, PhD.

SUMMARY
In recent yeares they have been includet in treatment for suppressing haemocoagulation new oral anticoagulants – NOAC. New oral anticoagulants are direct inhibitors of free thrombin so-called gatrans and direct inhibitors of activated factor Xa, the so-called xabans (6), they are also called direct anticoagulants. The indications for their use mainly non-valvular fibrilation and increased risk of venous thromboembolism. The advantage of these anticoagulants is a fast anticoagulant effect but also their resonance. Depending on the type of medicament, the anticoagulant effect lasts 24 hours, e.g. for epixaban and rivaroxaban and 36 to 48 hours, e.g. dabigatran. For dentist,this means that it is possible to extract the tooth 24 hours or 48 hours after taking NOAK. Again,the patient start to use the NOAC 24 hours after extraction. Accurate management for surgical procedurs in NOAC treated patients has been published by the relevant medical companies (www.arytmie.sk).
Key words: NOAC, gatrans, xabans.

Lek obz (Med Horizon), 2020, 69 (1): 29 – 31


Application of Biologic Matrix in the Reconstruction of Abdominal Wall

Nina ŠARKŐZYOVÁ, Ján KOLLER

Klinika popálenín a rekonštrukčnej chirurgie LF UK a UNB, prednosta prof. MUDr. J. Koller, PhD.

SUMMARY
The case report describes the successful application of biological dermal matrix in the reconstruction of the abdominal wall. We point out its availability also in our conditions and we emphasize the particular positive properties of these biological matrices, in which the native dermal structure is preserved. These characteristics are often absent in the commercially available products due to the application of aggressive decelullarisation methods. Based on our positive experience with this biomaterial, an acellular dermal allograft was applied in the reconstruction of secondary healing, infected abdominal wall wounds after repeated relaparotomias in a 40 years old woman. During the reconstruction operation in our workplace, the infected synthetic meshes were removed, the acellular dermal allografts - biological matrices were implanted, and the abdominal wall was reconstructed along anatomical layers. Within 19 days, the wounds healed per primam, and in 5 years postoperatively, a satisfactory condition without hernia with solid, well-adapted scars that did not limit the patient‘s daily life persisted.
Key words: acelullar dermal substitute, biological matrix, reconstruction of abdominal wall.
Lek Obz (Med Horizon), 2020, 69(1): 32-35.