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Search Results: 1 - 10 of 17 matches for " Ivovi? Miomira "
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Insulin sensitivity in patients with adrenal incidentaloma
IvoviMiomira,Vujovi? Svetlana,Penezi? Zorana,?arkovi? Milo?
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,?arkovi? Milo?,Vujovi? Svetlana,IvoviMiomira
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.
Agranulocytosis and acute coronary syndrom in apathetic hyperthyreoidism
IvoviMiomira,Radojkovi? Biljana,Penezi? Zorana,Stojkovi? Mirjana
Srpski Arhiv za Celokupno Lekarstvo , 2003, DOI: 10.2298/sarh0306249i
Abstract: INTRODUCTION Tissue expose to excessive levels of circulating thyroid hormones results in thyrotoxicosis. In most cases, thyrotoxicosis is due to hyper-activity of the thyroid gland. Cardiovascular and myopathic manifestations are predominant clinical features in most hyperthyroid patients, aged 60 years and older. Some of patients have apathetic hyperthyreoidism which presents with weight loss, small goiter, severe depression and without clinical features of increased sympathetic activity [3, 6]. About 50% of patients with cardiovascular manifestations have no evidence of underlying heart disease. Cardiac problems resolve when euthyreoid state is established [3]. Three treatment modalities are available in hyperthyreodism, namely medicament therapy, surgery and radioactive iodine. Antithyroid drug therapy complications, can be mild such as rash, which is managed without cessation of therapy by antihistamines administration. On the other hand, very serious complications such as agranulocytosis, necessitate immediate discontinuation of the medication and appropriate treatment. Although extremely rear, it is life-threatening with highly variable recovery time. CASE REPORT A 62-year-old woman with recurrent hyperthyroidism was admitted after treatment of agranu locytosis due to antithyroid drugs in another institution with G-CSF. The patient presented with clinical features of apathetic hyperthyroidism with extremely elevated thyroid hormone levels (total and free T4) and suppressed TSH. Radioactive iodine (5 mCi) was administered after increased thyroid uptake was confirmed. Echocardiography on admission was normal. ECG revealed moderately inverted T waves in standard and V1, V2 precordial leads. Laboratory analysis revealed mild normocytic anemia with normal white blood cell count, hypokaliemia and normal concentration of creatine phosphokinase lactic dehidrogenase and mildly elevated aspartate transaminase in sera. Chest X-ray was consistent with pulmonary emphysema. Because the worsening of ECG changes she was transferred to Coronary unit. The diagnosis of non-Q myocardial infarction was confirmed and treatment with nitrates and beta-adrenergic antagonists was instituted. Four weeks later she became euthyroid and coronarography was performed. Subepicardial coronary arteries were normal (Figure 1). She was dismissed, and still euthyroid three months later. DISCUSSION Agranulocytosis is very rare but very serious complication of antithyroid drug therapy. It can be detected in about 0.1 -1 % patients during the first three months of treatment. Sudden appea
Adrenocorticotrophin-dependent hypercortisolism: Imaging versus laboratory diagnosis
Tan?i?-Gaji? Milina,Vujovi? Svetlana,IvoviMiomira,Stojanovi? Milo?
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1208500t
Abstract: Introduction. Cushing’s syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. Case Outline. A 38-year-old woman with a typical appearance of Cushing’s syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol after 1 mg dexamethasone suppression test. 24-hour urinaryfree cortisol level was elevated. Differential diagnostic testing indicated adrenocorticotrophin (ACTH)- dependent lesion of the pituitary origin. Pituitary abnormalities were not observed during repeated MRI scanning. Inferior petrosal sinus sampling (IPSS) was performed: 1) Baseline ratio ACTH inferior petrosal sinus/peripheral was <2; 2) Corticotropin-releasing hormone (CRH) stimulated ratio ACTH inferior petrosal sinus/peripheral was <3; 3) Baseline intersinus ratio of ACTH was <1.4; 4) Increase in inferior petrosal sinus and peripheral ACTH of more than 50 percent above basal level after CRH; 5) Baseline ratio ACTH vena jugularis interna/peripheral was >1.7. Transsphenoidal exploration and removal of the pituitary tumor was performed inducing iatrogenic hypopituitarism. Postoperative morning serum cortisol level was less than 50 nmol/l on adequate replacement therapy with hydrocortisone, levothyroxine and estro-progestagen. Conclusion. No single test provides absolute distinction, but the combined results of several tests generally provide a correct diagnosis of Cushing’s syndrome.
Premature ovarian failure
Vujovi? Svetlana,IvoviMiomira,Tan?i?-Gaji? Milina,Marina Ljiljana
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1212806v
Abstract: Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhea in women under the age of forty years. It is idiopathic in 74-90% patients. Known cases can be divided into primary and secondary POF. In primary POF genetic aberrations can involve the X chromosome (monosomy, trisomy, translocations, deletions) or autosomes. Genetic mechanisms include reduced gene dosage and non-specific chromosome effects impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. Autoimmune ovarian damage is caused by alteration of T-cell subsets and T-cell mediated injury, increase of autoantibody producing B-cells, a low number of effector/cytotoxic lymphocyte, which decreases the number and activity of natural killer cells. Bilateral oophorectomy, chemotherapy, radiotherapy and infections cause the secondary POF. Symptoms of POF include irritability, nervousness, loss of libido, depression, lack of concentration, hot flushes, weight gaining, dry skin, vaginal dryness, frequent infections etc. The diagnosis is confirmed by the level of FSH of over 40 IU/L and estradiol below 50 pmol/L in women aged below 40 years. Biochemical and other hormonal analysis (free thyroxin, TSH, prolactin, testosterone), karyotype (<30 years of age), ultrasound of the breasts and pelvis are advisable. Optimal therapy is combined estrogen progestagen therapy given in a sequential rhythm, after excluding absolute contraindications. Testosterone can be added to adnexectomized women and those with a low libido. Sequential estrogen progestagen replacement therapy is the first line therapy for ovulation induction in those looking for pregnancy and after that oocyte donation will be advised. Appropriate estro-progestagen therapy improves the quality of life and prevents complications such as cardiovascular diseases, osteoporosis, stroke etc.
Gaining weight and components of metabolic syndrome in the period of menopause
Simoncig-Netjasov Aleksandra,Vujovi? Svetlana,IvoviMiomira,Tan?i?-Gaji? Milina
Srpski Arhiv za Celokupno Lekarstvo , 2008, DOI: 10.2298/sarh0810505s
Abstract: INTRODUCTION Menopause induces redistribution of fat mass and development of abdominal obesity, increasing risk for metabolic syndrome (MS) by 60%. Related cardiovascular diseases become a leading cause of morbidity and mortality in women after fifty years of age. OBJECTIVE The aim of this study was to investigate the influence of gaining weight on components of MS in the menopause. METHOD The study included 50 obese women, BMI=31.92± 5.83 kg/m2, age 54.40±3.64, time since menopause 5.90±5.46 years, and 37 normal weight women, BMI=23.50±2.13 kg/m2, age 53.92±3.95, time since menopause 5.96±4.92 years. Both groups were divided according to the presence of MS into two subgroups. Anthropometric characteristics and blood pressure were measured. Blood was taken at 8 am for the following: fasting glucose, triglycerides, cholesterol, HDL, LDL, apolipoprotein A (ApoA), apolipoprotein B (ApoB), lipoprotein(a) (Lp(a)), C-reactive protein (CRP), fibrinogen, FSH, LH, prolactin, oestrogen, progesterone, testosterone and sex hormonebinding globulin (SHBG). RESULTS 66% of obese women had MS compared with 22% normal weight women. Significant differences between groups were found for the following: weight, BMI, waist, hip circumference, waist/hip ratio, diastolic blood pressure, Lp(a), FSH, LH, prolactin (all p<0.01) and fasting glucose (p<0.05). Obese women with and without MS were significantly diverse for the following: waist/hip ratio, systolic blood pressure and fasting glucose (all p<0.01); age, BMI, waist circumference, triglycerides, HDL, Lp(a) and SHBG (all p<0.05). Normal weight women with and without MS had significantly different values of waist/hip ratio, systolic, diastolic blood pressure, triglycerides (all p<0.01); HDL and testosterone (p<0.05). Significant differences were found between obese and normal weight women with MS in anthropometric characteristics, ApoA, Lp(a), fibrinogen (all p<0.01) and FSH (p<0.05). CONCLUSION Abdominal obesity significantly increases incidence of MS as a cluster of cardiovascular risk factors in the menopause.
Relationships between obesity, lipids and fasting glucose in the menopause
Simoncig-Netjasov Aleksandra,Vujovi? Svetlana,IvoviMiomira,Tan?i?-Gaji? Milina
Srpski Arhiv za Celokupno Lekarstvo , 2013, DOI: 10.2298/sarh1302041s
Abstract: Introduction. Menopause leads to the development of central adiposity, a more atherogenic lipid profile and increased incidence of metabolic syndrome independent of age and other factors. Objective. The aim of the study was to investigate the relationships between anthropometric characteristics, sex hormones, lipids and fasting glucose in menopausal women. Methods. The study included 87 menopausal women, who where divided into groups according to two criteria: BMI≥26.7 kg/m2 and BMI≥25 kg/m2. Anthropometric characteristics and blood pressure were measured. Blood was taken at 08.00 h for fasting glucose, triglycerides, cholesterol, HDL, LDL, apolipoprotein A, apolipoprotein B, lipoprotein(a) (Lp(a)), C-reactive protein, fibrinogen, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG). Results. Significant differences between groups were found for weight, BMI, waist, hips circumference, waist/hip ratio (WHR), systolic and diastolic blood pressure, Lp(a), FSH, LH, PRL (for systolic blood pressure p<0.05, for the rest p<0.01) and fasting glucose (p<0.05). In obese and overweight women with BMI≥26.7kg/m2 significant negative correlations were found for FSH and glucose, SHBG and LDL, SHBG and total cholesterol, SHBG and glucose, BMI and HDL, WC and HDL. In obese and overweight women with BMI≥25kg/m2 significant negative correlations were found for BMI and HDL, waist circumference (WC) and HDL, WHR and HDL, FSH and glucose, SHBG and glucose; significant positive correlations were between BMI and glucose, WC and glucose and WHR with triglycerides. Conclusion. Gaining weight and decreased SHBG are related to dyslipidemia and increased fasting glucose confirming increased incidence of metabolic abnormalities in the menopause.
Influence of duration of menopause, anthropometric and hormonal parameters on metabolic syndrome
Simoncig-Netjasov Aleksandra,Vujovi? Svetlana,IvoviMiomira,Tan?i?-Gaji? Milina
Medicinski Pregled , 2010, DOI: 10.2298/mpns1002033s
Abstract: Introduction. Hypoestrogenic status in the menopausal women shows a shift to a central android fat distribution and metabolic syndrome (MS). Related metabolic changes and hypertension increase the risk for cardiovascular (CV) diseases. The aim of this study was to investigate the influence of duration of menopause, anthropometric and hormonal parameters on metabolic syndrome. Material and methods. 50 obese women were examined with BMI=31.92±5.83 kg/m2, age 54.40±3.64, time since menopause 5.90±5.46 years. Control group consisted of 37 normal weight women with BMI=23.50±2.13 kg/m2, age 53.92±3.95, time since menopause 5.96±4.92 years. Anthropometric characteristics and blood pressure were measured. Blood was taken at 8 am for: fasting glucose, triglycerides, cholesterol, HDL, LDL, apolipoprotein A (ApoA), apolipoprotein B (ApoB), lipoprotein(a) (Lp(a)), C-reactive protein (CRP), fibrinogen, FSH, LH, prolactin, estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG). Results. In obese women significant negative correlations were found for: BMI and HDL (p<0,05), waist and HDL (p<0,05), FSH and systolic blood pressure (p<0.01), FSH and fasting glucose (p<0,05), LH and waist (p<0.05), SHBG and fasting glucose (p<0.05). A positive correlation was found for lime since meno-pause and waist/hip ratio (p<0.05). In controls positive correlations were found for: waist/hip ratio and systolic and diastolic blood pressure (p<0,05), LH and HDL (p<0.05), estradiol and diastolic blood pressure (p<0,05). Negative correlations were detected for estradiol and waist (p<0,05), time since menopause and HDL (p<0,05). Conclusion. Gaining weight together with menopausal endocrine changes cause metabolic and hemodynamic imbalances, which contribute to risk for cardiovascular diseases.
Setting standards of restorative justice
Kosti? Miomira
Temida , 2007, DOI: 10.2298/tem0701005k
Abstract: In the article the author deals with the basic theoretical statements and discussions about the practical use of restorative justice. She discusses the questions of introducing and application of restorative justice in order to reach the balance of interests between a victim, society and a delinquent. There is no unique statement about the restorative justice concept, so the authors make this concept by listing certain activities with rispect of standards and principles. Also she emphasizes the values of restorative justice process. A part of the article is dedicated to the standards for restorative justice that are harmonized with the international documents of human rights. .
Workshops with refugees: Special experiences from the work with elderly people
Kosti? Miomira P.,?or?evi? Radmila
Temida , 2005, DOI: 10.2298/tem0501043k
Abstract: The authors explain the phenomenon of refuge as a form of experience which differentiate refugees from indigenous population. They explore changes in number and geographical distribution of refugees in Serbia and Montenegro. Also, the method of work and goals of the humanitarian organization "Hi Neighbor" are elaborated. The paper is focused on the workshops with elderly people. One of the workshop activities is drawing on the topic "My personal space". In the pictures drawn by refugees the readiness for establishment of "life line", interrupted "somewhere", by the war and refuge, is pronounced.
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