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Search Results: 1 - 10 of 908 matches for " ?arkovi? Milo? "
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The Role of Oxidative Stress on the Pathogenesis of Graves' Disease
Milo? ?arkovi
Journal of Thyroid Research , 2012, DOI: 10.1155/2012/302537
Abstract: Graves' disease is a most common cause of hyperthyroidism. It is an autoimmune disease, and autoimmune process induces an inflammatory reaction, and reactive oxygen species (ROSs) are among its products. When balance between oxidants and antioxidants is disturbed, in favour of the oxidants it is termed “oxidative stress” (OS). Increased OS characterizes Graves' disease. It seems that the level of OS is increased in subjects with Graves' ophthalmopathy compared to the other subjects with Graves' disease. Among the other factors, OS is involved in proliferation of orbital fibroblasts. Polymorphism of the 8-oxoG DNA N-glycosylase 1 (hOGG1) involved in repair of the oxidative damaged DNA increases in the risk for developing Grave's disease. Treatment with glucocorticoids reduces levels of OS markers. A recent large clinical trial evaluated effect of selenium on mild Graves' ophthalmopathy. Selenium treatment was associated with an improved quality of life and less eye involvement and slowed the progression of Graves' orbitopathy, compared to placebo. 1. Introduction Graves' disease is a most common cause of hyperthyroidism in iodine sufficient areas [1]. It is characterized by diffuse goitre and hyperthyroidism. Graves' orbitopathy represents orbit involvement and is clinically relevant in about half of the patients with the Graves' disease. In 3 to 5% of the patients, orbitopathy is severe [2]. Graves' disease is an autoimmune disease characterized by the presence of the serum autoantibodies. TSH receptor antibody represents the major autoantibody in Graves' disease [3]. Autoimmune process induces an inflammatory reaction and reactive oxygen species (ROSs) are among its products. ROSs are formed as normal metabolic products and are important in normal cellular functioning, but their production can be increased under pathological conditions and cause damage [4, 5]. Therefore, a large number of antioxidant systems act as protective mechanism. Among them are superoxide dismutase which catalyses dismutation of superoxide to peroxide, catalase which catalyses the decomposition of hydrogen peroxide to water and oxygen, while glutathione peroxidise which reduces lipid hidroperoxides while simultaneously oxidizing glutathione [6]. Situation in which balance between oxidants and antioxidants is disturbed in favour of the oxidants is termed “oxidative stress” (OS) [4]. 2. Oxidative Stress and the Thyroid Gland Synthesis of thyroid hormones requires formation of the hydrogen peroxide, a highly reactive oxidant. Hydrogen peroxide and oxidized iodine are immediately
Diagnosis of Thyroid Disease: Principles and Problems
Milo arkovi
Journal of Medical Biochemistry , 2010, DOI: 10.2478/v10011-010-0037-4
Abstract: Conceptually, thyroid disorders can be classified into four groups, namely: 1. disorders of thyroid morphology, 2. disorders of thyroid function, 3. presence of thyroid autoimmunity, and 4. diagnosis and follow-up of thyroid carcinoma. Of course, these groups are non-exclusive, and often there is overlap between the groups. Ultrasound exam is a standard for the diagnosis of the disorders of thyroid morphology. To diagnose disorders of thyroid function TSH and thyroid hormones should be measured. Presence of thyroid autoimmunity is confirmed by measuring antibodies against thyroid-specific antigens. Thyroid peroxidase (TPO), thyroglobulin (Tg) and TSH receptors antibodies are used in the diagnosis, follow-up and prognosis of autoimmune thyroid disorders. The measurement of serum thyroglobulin has no role in the diagnosis of thyroid cancer, but it is used in the follow-up of patients treated for differentiated thyroid carcinoma of the follicular epithelium. Medullary thyroid cancer (MTC) produces calcitonin and carcinoembryonic antigen (CEA), but calcitonin is specific for MTC. In subjects with MTC, genetic testing should be done, and in positive cases family screening is necessary.
Fifty years of subclinical primary aldosteronism: Importance of early diagnosis
?iri? Jasmina,arkoviMilo,Beleslin Biljana
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1212800c
Abstract: Clinical presentation of excessive aldosterone secretion is often not specific. The presence of resistant severe hypertension (HT) and signs of hypokalemia is useful but inconsistent characteristic. Plasma aldosterone level in primary aldosteronism (PA) could be normal, although inappropriately high for a low plasma renin activity and not suppressed by sodium. Screening of hypertensive population with no obvious signs of PA has revealed an increased prevalence of idiopathic adrenal hyperplasia as a cause of aldosterone excess. Nowadays, PA is the most common endocrine form of secondary HT, with an estimated prevalence 5-10% of hypertensive population. The diagnosis of PA can lead to surgical cure in the case of aldosterone producing adenoma and unilateral adrenal hyperplasia. The aldosterone excess is responsible for vascular inflammation and end-organ damage. Left ventricular hypertrophy, cardiac arrhythmia and cerebral insult are frequently seen in PA and preventable by mineralocorticoid receptor blockers. For this reason, screening for PA in patients with HT and hypokalemia and/or adrenal incidentaloma, resistant and severe HT, and in patients with the onset of HT at young age is advisable. The most widely accepted screening for PA is serum aldosterone to plasma rennin activity (aldosterone : PRA) ratio, with the cut-off of 30 ng/dl:ng/ml/h. Serum aldosterone level could be included as an additional screening parameter. Confirmatory tests are crucial for the diagnosis of PA in patients with an increased aldosterone : PRA ratio and subtype differentiation for the choice of treatment. [Projekat Ministarstva nauke Republike Srbije, br. br. 175036 i br. 175067]
The effects of three-week fasting diet on blood pressure, lipid profile and glucoregulation in extremely obese patients
Beleslin Biljana,?iri? Jasmina,arkoviMilo,Penezi? Zorana
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0708440b
Abstract: Introduction Obesity is often accompanied by a number of complications including diabetes mellitus and cardiovascular diseases. Elevated blood pressure and lipids, as well as deterioration of glucoregulation are attributed, as the most significant factors, to development of diabetes mellitus and cardiovascular complications in obese patients. Objective The aim of our study was to evaluate the effects of a fasting diet on blood pressure, lipid profile and glucoregulatory parameters. Method We included 110 patients (33 male and 77 female; mean age 35±1 years, body weight 131.7±2.6 kg, body mass index 45.4±0.8 kg/m2) who were hospitalized for three weeks for the treatment of extreme obesity with the fasting diet. At the beginning, during, and at the end of this period, we evaluated changes in blood pressure, lipid profile, as well as parameters of glucoregulation including glycaemia, insulinaemia, and insulin sensitivity by HOMA. Oral glucose tolerance test (OGTT) was performed in all patients at the beginning and at the end of the fasting diet. Results During the fasting diet, the body weight decreased from 131.7±2.6 kg to 117.7±2.4 kg (p<0.001), the body mass index decreased from 45.4±0.8 kg/m2 to 40.8±0.8 kg/m2 (p<0.001), and both systolic and diastolic blood pressure significantly declined (143±2 vs. 132±2 mm Hg, p<0.001; 92±2 vs. 85±2 mm Hg, p<0.001). In addition, the fasting diet produced a significant decrease in total cholesterol, LDL cholesterol, triglycerides, as well as basal glycaemia and insulinaemia (p<0.001) Before the fasting diet, OGTT was normal in 76% of patients, whereas 21% of patients showed glucose intolerance, and 4% of patients diabetes mellitus. After the fasting diet, OGTT was normal in 88% of patients, whereas 12% of patients still had signs of glucose intolerance (p<0.05). In addition, insulin resistance significantly (p<0.05) increased from 54±6% to 89±13% after the fasting diet. Conclusion The three-week fasting diet in extremely obese patients produced a significant decrease and normalization of blood pressure, decrease in lipids, and improvement in glucoregulation including the increase in insulin sensitivity.
Insulin sensitivity in patients with adrenal incidentaloma
Ivovi? Miomira,Vujovi? Svetlana,Penezi? Zorana,arkoviMilo
Srpski Arhiv za Celokupno Lekarstvo , 2006, DOI: 10.2298/sarh0608315i
Abstract: Introduction. Frequent use of modern imaging methods (such as ultrasound, CT and MRI) results in high incidence of accidentally discovered adrenal mass. Adrenal incidentalomas are accidentally discovered adrenal tumors by imaging methods without any prior suspicion of adrenal disease. Some studies have shown decreased insulin sensitivity in patients with adrenal incidentaloma. Objective. The objective of our study was to assess the insulin sensitivity in patients with adrenal incidentalom a. Method. A total of 22 patients with accidentally discovered adrenal mass confirmed by CT/MRI were evaluated in our study. Average age was 53.31±26.5 years and average BMI 25.84±3.65 kg/m2. Control group consisted of 33 healthy subjects. Insulin sensitivity was assessed by short ITT (insulin tolerance test). Blood samples were taken before, 3, 6, 9, 12, 15, 20 and 30 minutes after i.v. bolus of regular insulin (0.05 IU/kg BW). Glycemia was determined by glucose oxidase method. Statistical analysis was done by ANCOVA, using BMI as covariate. Results. Our results showed significantly lower insulin sensitivity in patients with adrenal incidentalomas comparing to the control group (4.95±0.58 vs. 6.62±0.47, p=0.015). Conclusion. Our patients with adrenal incidentalomas manifested lower insulin sensitivity what suggested further follow up and assessment of insulin sensitivity during endocrine evaluation of these patients.
The value of corticotropin-releasing hormone (CRH) test for differential diagnosis of Cushing’s syndrome
Penezi? Zorana,arkoviMilo,Vujovi? Svetlana,Ivovi? Miomira
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0702031p
Abstract: Introduction: Diagnosis and differential diagnosis of Cushing’s syndrome (CS) remain considerable challenge in endocrinology. For more than 20 years, CRH has been widely used as differential diagnostic test. Following the CRH administration, the majority of patients with ACTH secreting pituitary adenoma show a significant rise of plasma cortisol and ACTH, whereas those with ectopic ACTH secretion characteristically do not. Objective The aim of our study was to assess the value of CRF test for differential diagnosis of CS using the ROC (receiver operating characteristic) curve method. Method A total of 30 patients with CS verified by pathological examination and postoperative testing were evaluated. CRH test was performed within diagnostic procedures. ACTH secreting pituitary adenoma was found in 18, ectopic ACTH secretion in 3 and cortisol secreting adrenal adenoma in 9 of all patients with CS. Cortisol and ACTH were determined -15, 0, 15, 30, 45, 60, 90 and 120 min. after i.v. administration of 100μg of ovine CRH. Cortisol and ACTH were determined by commercial RIA. Statistical data processing was done by ROC curve analysis. Due to small number, the patients with ectopic ACTH secretion were excluded from test evaluation by ROC curve method. Results In evaluated subgroups, basal cortisol was (1147.3±464.3 vs. 1589.8±296.3 vs. 839.2±405.6 nmol/L); maximal stimulated cortisol (1680.3±735.5 vs. 1749.0±386.6 vs. 906.1±335.0 nmol/L); and maximal increase as a percent of basal cortisol (49.1±36.9 vs. 9.0±7.6 vs. 16.7±37.3 %). Consequently, basal ACTH was (100.9 ±85.0 vs. 138.0±123.7 vs. 4.8±4.3 pg/mL) and maximal stimulated ACTH (203.8 ±160.1 vs. 288.0±189.5 vs. 7.4±9.2 pg/mL). For cortisol, determination area under ROC curve was 0.815±0.083 (CI 95% 0.652-0.978). For cortisol increase cut-off level of 20%, test sensitivity was 83%, with specificity of 78%. For ACTH, determination area under ROC curve was 0.637±0.142 (CI 95% 0.359-0.916). For ACTH increase cut-off level of 30%, test sensitivity was 70%, with specificity of 57%. Conclusion Determination of cortisol and ACTH levels in CRH test remains reliable tool in differential diagnosis of Cushing’s syndrome.
Value of assessing adrenocorticotropic hormone (ACTH) levels in differential diagnosis of hypercorticism
Penezi? Zorana,arkoviMilo? P.,Vujovi? Svetlana,Beleslin Biljana
Medicinski Pregled , 2004, DOI: 10.2298/mpns0408335p
Abstract: Diagnosis and differential diagnosis of Cushing's syndrome remains a challenge in clinical endocrinology. The aim of this study was to establish the value of assessing adrenocorticotropic hormone (ACTH) levels in differential diagnosis of hypercorticism using receiver operating characteristic (ROC) curve. We have evaluated 114 patients with Cushing's syndrome testing the value of pathohistological examination and postoperative testing. The control group consisted of 53 obese healthy persons. ACTH level was determined using a commercial RIA (CIS, France). ACTH secreting pituitary adenoma was found in 56.14% examinees, ectopic secretion in 6.14%, cortisol secreting adrenal adenoma in 37.57%, and adrenal carcinoma in 6.14% of all patients with Cushing's syndrome. Basal ACTH level for pituitary adenoma was 107.29±75.69 pg/mL; for ectopic secretion 181.63±149.84 pg/mL; for adrenal adenoma 4.22±2.32 pg/mL; for adrenal carcinoma 5.50 ±7.72 pg/mL; and 34.76 ±10.07 pg/mL in control group. Testing the value of assessing ACTH the area under ROC curve was 0.9965±0.0071. Test sensitivity was 99.89% and test specificity was 97%. For ACTH cut-off level of 8 pg/mL, test sensitivity was 88.50%, with specificity of 99%. For ACTH cut-off level of 22 pg/mL, test sensitivity was 99.30%, with specificity of 98%. Our intermediate zone from 8 to 22 pg/mL confirms that assessment of ACTH level is a reliable tool in differential diagnosis of Cushing's syndrome.
Adrenal cortex function impairment in chronic fatigue syndrome
arkoviMilo? P.,Pavlovi? Milorad,Pokrajac-Simeunovi? Ana,?iri? Jasmina D.
Srpski Arhiv za Celokupno Lekarstvo , 2003, DOI: 10.2298/sarh0310370z
Abstract: Chronic fatigue syndrome (CFS) is defined as constellation of the prolonged fatigue and several somatic symptoms, in the absence of organic or severe psychiatric disease. However, this is an operational definition and conclusive biomedical explanation remains elusive. Similarities between the signs and symptoms of CFS and adrenal insufficiency prompted the research of the hypothalamo-pituitary-adrenal axis (HPA) derangement in the pathogenesis of the CFS. Early studies showed mild glucocorticoid deficiency, probably of central origin that was compensated by enhanced adrenal sensitivity to ACTH. Further studies showed reduced ACTH response to vasopressin infusion. The response to CRH was either blunted or unchanged. Cortisol response to insulin induced hypoglycaemia was same as in the control subjects while ACTH response was reported to be same or enhanced. However, results of direct stimulation of the adrenal cortex using ACTH were conflicting. Cortisol and DHEA responses were found to be the same or reduced compared to control subjects. Scott et all found that maximal cortisol increment from baseline is significantly lower in CFS subjects. The same group also found small adrenal glands in some CFS subjects. These varied and inconsistent results could be explained by the heterogeneous study population due to multifactorial causes of the disease and by methodological differences. The aim of our study was to assess cortisol response to low dose (1 μg) ACTH using previously validated methodology. We compared cortisol response in the CFS subjects with the response in control and in subjects with suppressed HPA axis due to prolonged corticosteroid use. Cortisol responses were analyzed in three subject groups: control (C) secondary adrenal insufficiency (AI), and in CFS. The C group consisted of 39 subjects, AI group of 22, and CFS group of nine subjects. Subject data are presented in table 1. Low dose ACTH test was started at 0800 h with the iv injection of 1 μg ACTH (Galenika, Belgrade, Serbia). Blood samples for cortisol determination were taken from the iv cannula at 0,15, 30, and 60 min. Data are presented as mean standard error (SE). Statistical analysis was done using ANOVA with the Games-Howell post-hoc test to determine group differences. ACTH dose per kg or per square meter of body surface was not different between the groups. Baseline cortisol was not different between the groups. However, cortisol concentrations after 15 and 30 minutes were significantly higher in the C group than in the AI group. Cortisol concentration in the CFS group was not sig
Orbital decompression in Graves` orbitopathy
Kne?evi? Miroslav,Stankovi? Branislav,Ra?i? Dejan M.,arkoviMilo
Medicinski Pregled , 2012, DOI: 10.2298/mpns1206206k
Abstract: Introduction. This paper was aimed at presenting our experience and results in the surgical management for proptosis in patients with Graves` orbitopathy. Material and Methods. This is a retrospective, interventional, non-comparative case series review. Seventeen eyes of ten patients underwent orbital decompression between 2008 and 2009. Depending on case, the surgery involved one to 3 orbital walls with or without fat removal, being approached through combined transcaruncular and lower fornix incision. Results. All the operated patients were females, their mean age being 48, with proptosis ranging from 21 to 28 mm, and 18 to 22 mm three months after surgery. A mean reduction in proptosis of 4.59 ± 1.58 mm was attained. Intra-operative course was uneventful and post-operatively transient infraorbital hypoesthesia was seen in twelve patients (70.57%). Conclusion. Orbital decompression proved to be a safe, reliable and effective way to reduce proptosis provided that the procedure is carefully planned and properly performed.
Rents in property rights creation and implementation
arkovi? Jelena
Economic Annals , 2006, DOI: 10.2298/eka0669089z
Abstract: The institution of property rights is increasingly being recognized as an essential building block of an economically prosperous society. The question that remains unanswered however, is how do we develop effective property rights institutions? The literature dealing with the development of property rights tends to be, in general, overly optimistic since there is a tendency to view the design of property rights institutions as optimizing decisions to economize on transaction costs and to facilitate new economic activities. On the other hand, since property rights define the distribution of wealth and political power in a society changes in property rights structures are likely to be influenced by more than pure efficiency considerations. Therefore, in order to achieve a balanced analysis of the evolution of property rights institutions our article introduces the state in the whole process. Following the propositions of the interest group theory of government we show an important relationship between rent seeking and state involvement in property rights creation. The state with a coercive power to establish and enforce property rights can also use that power, through the process of economic regulation, to redistribute property rights to politically influential interest groups. Herein lies the state failure in property rights creation.
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