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BACKGROUND: Crohn’s disease(CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD), whose incidence is constantly increasing. The diseases are unpredictable and cyclical, because of that they have impact on the ability of patients to remain employed, and on their education. Our aim was to determine the relationship between education, employment, and marriage status with incidence and prevalence of inflammatory bowel disease. Results in this study are part of results of the doctoral dissertation by M. Žulj, MATERIALS AND METHODS: This study is based on medical documentation of patients affected by IBD treated in hospitals in area of Osijek-Baranja Country in period of 2000-2014. This research is part of the large project mentored by prof.dr.sc. A. Včev named "Povezanost polimorfizama jednog nukleotida u NOD 2 i MDR 1 genima s nastankom upalnih bolesti crijeva”. RESULTS: Patiens with elementary school education have a greater incidence to have UC, while patients with with higher education are more likely to have CD (χ2 test, P = 0, 02), also CD is significantly higher with employees (Fisher’s exact test, P = 0, 01), compared to retires or unemployed who have more UC. The prevalence of the UC is higher in patients with elementary school education, while in patients with higher education is much common CD (χ2 test, P < 0, 001). Speaking of employment, prevalence of CD is higher with employees (Fisher’s exact test, P < 0, 001), compared to retires or unemployed where is it more common UC. According to marital status 762 (66, 4%) of the respondents were married. CONCLUSION: It seems that risk factors in the observed group are higher education and being employed for the CD, while the risk factors for the UC are completed elementary school and being unemployed and retired.

The increasing incidence of the last decades of Crohn's disease and ulcerative colitis in the world has sparked a different way of thinking about their cause and susceptibility.Laboratory data confirm that the disease is a result of a disturbed immune response in a genetic subject, and the first identified gene responsible for the development of Crohn's disease is NOD2/CARD15.The aim of this study was to put Crohn's disease and ulcerative colitis in relation to the occurrence of relapse, duration of remission, number of hospitalizations and number of surgical procedures.This research is part of the large project mentored by prof.dr.sc. A. Včev named "Prevalence of NOD2 and MDR1 polymorphisms among patients with inflammatory bowel disease in KBC Osijek and OB Našice in the period 2000-2014", which seeks out more attention to molecular biology in the medical compatibility model and genetics in their role as a modifier of clinical diseases.The results obtained through research within the project used in this publication are the results of the doctoral dissertation of the chief investigator M. Žulj, MD. MATERIALS AND METHODS: The research was based on medical documentation and conducting a survey of patients affected by inflammatory bowel disease, treated at the Department of gastroenerology at Clinical hospital Osijek and County hospital Našice. In total, 81 patients were involved, of which 52 of them were diagnosed with ulcerative colitis and 29 with Crohn's disease. RESULTS: Relapse occurred in 60 patients, alike in Crohn's disease and ulcerative colitis. Operative procedure was performed in 20 (24.7%) patients, significantly more frequent in Crohn's disease (Fisher's exact test, P

BACKGROUND: One of the significant health issues in modern era are ulcerative colitis (UC) and Crohn's disease (CD). Beneath clinical manifestation of those inflammatory bowel diseases (IBDs) lays chronic inflammation of gastrointestinal wall, mediated by the release of interleukins, cytokines and TNF. Drugs used in treatment are antibiotics, corticosteroids, immunomodulators and biological agents. Aim of this study was to compare usage of immunomodualting drugs vs. antibiotics and corticosteroids in treatment of IBDs during the time. Results in this study are part of results of the doctoral dissertation by M. Žulj, MD. MATERIAL AND METHODS:This study is based on medical documentation of IBD patients treated at KBC Osijek and OB Našice in the period of 2000-2014. In total of 78 patients, 51 was diagnosed with UC and 27 with CD. This study is a part of the university project "Povezanost polimorfizama jednog nukleotida u NOD 2 i MDR 1 genima s nastankom upalnih bolesti crijeva" VIF 2016-MEFOS 16 conducted at the University J.J.Strossmayer led by prof.dr.sc. A.Včev. RESULTS: At the beginning of treatment there was a statistical significant difference in usage of antibiotics between groups with UC and CD (32 UC, 10 CD, p=0, 03 χ2test), immunosupressants (11 UC, 15 CD, p=0, 001 χ2test) and biological agents (7 UC, 9 CD, p=0, 04 χ2test) while there was no statistical significant difference in usage of corticosteroids (36 UC, 21 CD, p=0, 59, χ2test). During this study drugs used in treatment of those patients were modified. Statistical significant differences were found in usage of biological agents (7 UC, 17 CD, p0, 99, χ2test), corticosteroids (13 UC, 3 CD, p=0, 13, χ2test) and immunosupressants (6 UC, 4 CD, p=0, 72, χ2test). CONCLUSION: Although drug groups used in treatment of UC and CD are similar, biological agents are mostly used in CD while corticosteroids are used in UC and CD equally, regardless of time of the treatment. Immunosupressants are mostly used in patients with CD while antibiotics in patients with UC at the beginning of treatment.

Crohnova bolest i ulcerozni kolitis su kronične upalne bolesti crijeva nepoznate etiologije na čiji razvoj utječu genetski, okolišni i imunološki čimbenici. Namjera nam je istražiti epidemiološke pokazatelje upalnih bolesti crijeva u istočnoj Hrvatskoj te utvrditi čimbenike rizika koji su povezani s nastankom upalnih bolesti crijeva.

Introduction: Postgraduate Doctoral Study of Biomedicine and Health is the highest level of education at the Faculty of Medicine Osijek. It is constantly evaluated in order to maintain suitable standards for an educational institution. The aim of this study was to assess students' satisfaction with current PhD program at the Faculty of Medicine Osijek. Matherials and methods: 60 PhD students enrolled at the program have filled an anonymous questionnaire covering several aspects of the PhD program, including prevalence of different fields of biomedicine in the curricula, quality of teaching, opportunities for advanced language course, teachers’ commitment to PhD courses and overall quality of communication between students and Faculty. They were asked to rank their satisfaction with the quality of different domains of the program with grades from 1 (insufficient) to 5 (excellent). Results: Most of the students completely (36.7%) or partially disagreed (61.7 %) that all field of biomedicine are equally represented at MEFOS PhD program. Two- thirds of students agreed partially or completely that quality of teaching at MEFOS PhD program is satisfactory. Significantly more clinician scientist agreed that advanced language courses during PhD program are important for personal development of researches, comparing to teacher or research scientist (Fischer’s Exact Test, p=0.04). Another claim that clinician scientist agreed with significantly more is that guest professors can increase the quality of a PhD program (Fischer’s Exact Test, p=0.013). Clinician scientist were also significantly more satisfied with the quality of personal communication between PhD students and Faculty (Fischer’s Exact Test, p=0.001). We have found some significant differences between male and female PhD students – male students attended formal lectures and practices less regularly than female (Fischer’s Exact Test, p=0.011), and they were more satisfied with the teachers’ dedication to MEFOS PhD program than female students (Fischer’s Exact Test, p=0, 01). Conclusion: Results of our study suggest that there is a need for introducing new courses from all fields of biomedicine. Inviting guest professors and introduction of advanced language courses would further increase the quality of the programme.

U svrhu praćenja fenotipske osobitosti, stupnja aktivnosti bolesti, relapsa, remisije i uspješnosti terapije uzorkovat će se venska krv za hematološke i biokemijske pretrage. Kako je anemija jedna od najvažnijih komplikacija upalnih bolesti crijeva, osobitu pozornost u našem istraživanju posvećujemo laboratorijskom određivanju i praćenju pokazatelja anemije iz uzoraka venske krvi ispitanika, kako standardnih tako i najnovijih laboratorijskih parametara anemije.

PhD students enrolling postdoctoral program of Biomedicine and health at Faculty of Medicine University of Osijek (Croatia) are of different background, including basic medical sciences (13.2%), clinical medical sciences (60.4%), public health (20.8%), dental medicine (3.8%) and pharmacy (1.9%). Their everyday workload and time dedicated to research activities differ significantly which could also have significant impact on their international visibility and collaboration. Therefore, the aim of this study was to assess the number of published papers, attended international conferences, active participations in research projects, granted scholarships and collaborations with foreign or domestic institutions.

Endothelium plays a complex role in vascular biology: regulates blood vessel tone, haemostasis, neutrophil recruitment, hormone trafficking, and fluid filtration.Endothelial adherence and migration of leukocytes into tissue is mediated by different sets of adhesion molecules expressed on activated endothelial cells and their complementary ligands on leukocytes, such as ICAM-1:LFA1 pair, or VCAM-1:VLA4 pair.The expression of these molecules might not only preselect the types of leukocytes that enter the inflammatory sites, but also activate these leukocytes, induce adherence to epithelial cells, and cause the release of cytokines, leading to inflammatory response and endothelial damage, such as in atherosclerosis, lung diseases and diabetes mellitus. Our recent studies demonstrated significantly increased expression of certain subsets of endothelial cell adhesion molecules (eCAMs) accompanied with decrease in their ligands expression on circulating leukocytes in patients with untreated hypertension. Antihypertensive therapy, regardless of class of drugs used decreased blood pressure (BP) and modified the eCAMs expression, which positively correlate with BP while their ligands on circulating leukocytes inversely correlated with BP. In conclusion, increased BP is linked to endothelial activation and increased adherence of leukocytes to endothelium, which together with increased vascular oxidative stress contributes to endothelial damage and development of atherosclerotic lesions.

The aim of this study was to investigate the effects of AT1 blockade on the oxidative stress marker 8-iso-prostaglendin F2-alpha (8iPGF2α), vascular function and inflammation in patients with essential hypertension. An additional aim was to test whether supplementation of antioxidants can further decrease blood pressure (BP) by reducing the level of oxidative stress. 57 newly discovered hypertensive patients were randomly divided into two groups receiving AT1 antagonist olmesartan (10-20mg/day, N=27) or Ca-channel blocker amlodipine (5-10mg/day, N=30). Patients on amlodipine were used as a control group to specifically test the effect of AT1 blockade and to differentiate these effects from the mere blood pressure reduction. After 8 weeks of therapy patients from both groups were further subdivided according to addition of vitamin C or placebo. Serum levels of 8iPGF2α, sICAM-1, sVCAM-1, sE-selectin were measured by ELISA at the time of inclusion in the study and after 8 and 16 weeks of treatment. Vascular function was assessed by flow mediated dilatation (FMD). In both groups BP reached target values

OBJECTIVE: The aim of this study was to assess the effects of AT1-receptor antagonisms on the markers of oxidative stress and endothelial activation in relation to vascular function and arterial blood pressure (ABP) changes in hypertensive patients. DESIGN AND METHODS:30 newly discovered hypertensive subjects of both sexes received AT1 antagonist (olmesartan, 10-20mg/day) during 8 weeks. At the beginning and 8 weeks after therapy flow-mediated dilation (FMD) of brachial artery (BA) was measured by ultrasound (Acuson Siemens X300 ; ultrasound probe VF10-5 ; 105 MHz). The BA diameter, relative change in the diameter (delta r) and percentage of diameter change (FMD%) were calculated for pre-occlusion, and after occlusion duration for 1, 2 and 3min. Serum levels of 8-iso- prostaglendin F2-alpha (8iPGF2α), endoglin and sICAM-1, sVCAM-1 and E-selectin were assessed by commercial ELISA kits. Paired t-test, or t-test were used as appropriate, with Pearson’s correlation calculated ; p

Objective: To determine the effect of arterial blood pressure (BP) reduction on soluble cell adhesion molecules' (sCAM) and endocan plasma concentration and the expression of their ligands on circulatory leukocyte subpopulations. Design and Methods: 20 newly discovered hypertensive subjects of both sexes (age: 53±8 yrs) were treated with Ca-channel blocker, amlodipin (5-10mg/day for 8 weeks ; dose to reach BP≤139/89 mmHg). The serum sCAMs and endocan concentrations were determined by commercially available ELISA kits. Level of sCAMs ligands on lymphocytes, monocytes and granulocytes was assessed by flow cytometry. Paired t-test, or t-test were used as appropriate, with Pearson’s correlation calculated ; results are presented as mean±SD (SigmaPlot v.11). Results: Serum levels of sICAM-1 and sVCAM-1 were significantly decreased (p≤0.001 and p=0.002, respectively), while E-selectin levels were significantly increased after the amlodipin treatment (P=0.014). Endocan levels tended to decrease with BP reduction (p=0.063). Expression of CD11a/LFA-1 (ICAM-1 and endocan ligand) was significantly increased in all three cell types with BP decrease (Ly p=0.009, Mo p≤0.001, Gr p=0.005). CD15 (E-selectin ligand) showed weak reactivity on lymphocytes and monocytes, but it was abundant on granulocytes. CD15 and CD49d/VLA-4 (VCAM-1 ligand) did not change significantly after the treatment. All three ligands showed significantly different pattern of expression on various cell types (p≤0.001). There was significant positive correlation of systolic and diastolic BP with ICAM-1 and VCAM-1, and negative correlation of systolic BP with their respective leukocyte ligands, reaching significance for granulocyte and monocyte CD11a/LFA-1. Endocan significantly positively correlated with ICAM-1. Conclusions: The increased expression of sCAMs’ ligands on circulatory leukocytes, together with significant decrease of endothelial CAMs and endocan after amlodipin treatment suggests the de-activation of the endothelium with successful reduction in blood pressure. This potentially decreases the adherence of circulatory leukocytes to endothelium possibly via endocan regulated pathway and subsequently decreases the risk for development of atherosclerotic lesions.

Cilj istraživanja: Hipertenzija, DM i pretilost su stanja obilježena endotelnom disfunkcijom i povećanim oksidativnim stresom s razvojem vaskularnih komplikacija. Važna posljedica endotelne disfunkcije su strukturne i funkcionalne promjene krvnih žila i povećani rizik za razvoj ateroskleroze. Cilj istraživanja bio je utvrditi kako povećani oksidativni stres i/ili hipertenzija utječe na aktivaciju endotela i cirkulirajućih leukocita te koja je uloga AT1 receptora za angiotenzin II u nastanku oksidativnog stresa. Dodatni cilj je bio utvrditi ulogu potencijalnih novih biljega aktivacije endotela, endokana i endoglina u endotelnoj funkciji. Nacrt studije: Provedena je prospektivna, randomizirana, usporedna („case-control“) klinička studija. Ispitanici i metode: Nakon inicijalnog pregleda i mjerenja krvnog tlaka i prvog uzorkovanja venske krvi te provođenja funkcionalnog mjerenja promjera brahijalne arterije (FMD), ispitanici su randomizirani u dvije terapijske skupine. Prva grupa dobivala je olmesartan 1x50 mg dnevno. Druga grupa ispitanika liječena je amlodipinom 1x5mg/dnevno, obje u trajanju od 8 tjedana. U drugoj fazi ispitivanja, liječeni su dodatno vitaminom C i E u trajanju od 8 tjedana. Nakon 8, tj. 16 tjedana učinjene su biokemijske pretrage, mjerenje plazmatske koncentracije solubilnih staničnih adhezivnih molekula (sCAMs) te FMD. Rezultati: Antihipertenzivna terapija dovodi do značajnog sniženja krvnog tlaka koji nije daljnje promijenjen uvođenjem antioksidativne terapije. Došlo je do značajnih promjena u izražaju staničnih adhezivnih molekula i njihovih liganada. Nije bio značajne promjene koncentracije endokana i endogina u plazmi, ali je postojala značajna pozitivna povezanost endokana s sICAM-1 u obje grupe ispitanika. Postoje značajne funkcijske promjene, u smislu poboljšanja endotelne funkcije mjerene FMD koje su rezultat sniženja krvnog tlaka i specifičnog utjecaja antihipertenzivne terapije. Zaključak: Postoji povezanost aktivacije endotela i njegove interakcije s cirkulirajućim leukocitima u hipertenziji. Rezultati sugeriraju novi biljeg endotelne aktivacije - endokan, koji bi mogao imati zaštitnu ulogu, natječuči se za ligand LFA-1 izražen na leukocitima, smanjujući rizik od prijanjanja aktiviranih leukocita i njihovog proaterogeničnog djelovanja. Povećana izražajnost sCAM liganada na cirkulirajućim leukocitima, zajedno sa značajnim smanjenjem sCAMs-a nakon tretmana amlodipinom te djelomično olmesartanom sugerira de-aktivaciju endotela s uspješnim smanjenjem krvnog tlaka. Također, rezultati djelomično potvrđuju još nejasnu patofiziološku ulogu endoglina u sistemskoj hipertenziji, koji je povezan s aktivacijom AT1 receptora.

Endotel je važan organ koji oblaže čitav krvožilni sustav, a njegove su najznačajnije funkcije: kontrola vaskularnoga tonusa, inhibicija agregacije trombocita, modulacija migracije leukocita, regulacija proliferacije glatkih mišićnih stanica i moduliranje propusnosti vaskularne stijenke. Endotelna disfunkcija termin je koji opisuje stanje oštećenoga endotela i njegove poremećene funkcije koju karakterizira proupalni, protrombotski i vazokonstrikcijski fenotip. Patofiziološki faktori koji dovode do nastanka endotelne disfunkcije su važni rizični čimbenici za nastanak, razvoj i progresiju kardiovaskularnih bolesti. Kako je jedna od temeljnih značajki endotelne disfunkcije reverzibilnost, procjenu endotelne funkcije treba uzeti kao univerzalnu metodu za procjenu kardiovaskularnoga rizika te primarnu i sekundarnu prevenciju kardiovaskularnih incidenata., Endothelium is a dynamic organ which lines the entire vascular system. Endothelial cells control vascular function by responding to various hormones, neurotransmitters and vasoactive factors which affect vasomotion, thrombosis, platelet aggregation and inflammation. These functions are compromised in endothelial dysfunction, a systemic disorder that is characterized by a proinflammatory, proliferative, procoagulatory and vasoconstrictive milieu that favors all stages of atherogenesis. The pathophysiological factors leading to endothelial dysfunction are key risk factors for development and progression of cardiovascular diseases. Endothelium dysfunction is reversible so it seems attractive to consider integrating endothelial function testing as a universal tool for cardiovascular risk stratification in primary and secondary prevention.

The aim of this study was to present our experiences in diagnosing spondyloarthritides (SpA), and to list the most common clinical features of HLA-B27 positive patients. The study included 65 HLA-B27 positive patients with confirmed diagnosis of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) who were analyzed between 2009 and 2010 in Clinic of Internal Medicine in Osijek. The diagnosis of seronegative spondyloarthritides was based on the ASAS (Assessment in AS Working Group) classification criteria for axial and then supplemented with ASAS criteria for peripheral SpA and was confirmed by radiological techniques. For diagnosing the ankylosing spondylitis (AS), there have been applied the modified New York criteria. Radiological criteria for definite sacroiliitis according to the modified New York criteria is bilateral sacroiliitis, grade 2-4 (> or = 2) or unilateral sacroiliitis, grade 3-4. For diagnosing the psoriatic arthritis (PsA), there were used CASPAR diagnostic criteria. Other features of SpA are defined within the existing classification criteria. HLA-B27 antigen was determined by direct immune-fluorescence technique using flow cytometer. The average age of patients was 50.34 years, of whom 27 female (41.53%), 38 male (58.46%). Duration of illness was 15.79 years on average. With 75.38% of patients, there had been determined the diagnosis of AS ; 24.62% of patients had the diagnosis of PsA. The most common clinical characteristics that patients had were: inflammatory back pain (pain Inflammation along the lumbosacral spine), peripheral arthritis, intermittent pain in the gluteus, sacroiliitis, enthesitis, uveitis, dactilitis.

Oxidative stress occurs in inflammation of gastric mucosa. The role of zinc in modulating oxidative stress has recently been recognized. Zn deficiency results in an increased sensitivity to oxidative stress and have a higher risk of musoca damage in inflammation. The aim of this study was to determine wheather chronic inflammation affects on the concentration of Zn2+ ions in gastric mucosa of patients with chronic gastritis. Forthy-three patients with chronic gastitis were enrolled. Patients were endoscoped. Histology and scoring of gastritis was performed following the guidelines of the updated Sydney system. Endoscopic finding of mucosa were scored according to a Lanza scoring system. The diagnosis of Helicobacter pylori (H. pylori) infection, histopathologic changes, intensity of inflammation and zinc concentration were determined from biopsies of gastric mucosa. The atomic absorption spectrophotometer was used to determine tissue concentrations of zinc. Twenty of 43 patients with chronic gastritis were uninfected by H. pylori. There was no statistically significant difference in tissue concentrations of zinc between H. pylori-positive and H. pylori-negative patients. From those infected patients 53.3% had chronic active gastritis. There was no statistically significant difference in tissue concentrations of zinc between patients with chronic active gastritis and patients with chronic inactive gastritis (p = 0.966). Zn in antrum showed positive correlation with density of H. pylori in antrum (Spearman' rho = 0.481, p = 0.020), negative correlation with density of H. pylori in corpus (Spearman' rho = -0.492, p = 0.017) and with zinc in corpus (Spearman' rho = 0.631, p =0.001). Tissue concentration of zinc was not affected by chronic inflammation of gastric mucosa in patients with chronic gastritis.

The purpose of this investigation was to determine the atherosclerotic changes in patients with vascular parkinsonism and in patients with idiopathic Parkinson’s disease, in order to evaluate the possible influence of the extracranial pathology of carotid arteries in developing lacunar cerebral infarcts. Degree of stenosis and plaque morphology of the extracranial part of carotids in both group of patients were evaluated by color Doppler flow imaging ultrasound investigation and the results were compared. We selected two matched groups of patients with parkinsonism: 22 patients with vascular parkinsonism, and 28 with idiopathic Parkinson’s disease.The atherosclerotic changes found in patients with Parkinson’s disease showed mild carotid lesions with mostly stable calcified plaques and lesser risk for embolic cerebral intravascular events contrary to the higher degree of carotid stenosis found in patients with vascular parkinsonism with mostly mixed plaques prone to embolization. Therefore, we suggest performing ultrasonographic examination of the extracranial part of carotid arteries in all patients with parkinsonism to assess risk of vascular accidents originating from carotid lesions. That would enable adequate treatment of parkinsonism and prevent further occurrence of intracranial vascular changes.

Hipersplenizam je sindrom koji uključuje splenomegaliju, smanjen broj jedne ili više krvnih stanica u perifernoj krvi, što dovodi do anemije, trombocitopenije i leukopenije, te normalnu staničnost ili kompenzacijsku hiperplaziju svih krvnih elemenata u koštanoj srži čiji je broj snižen u perifernoj krvi. Pored poremećaja čimbenika koagulacije, česta komplikacija jetrenih bolesti, posebice ciroze, kvalitativne su i kvantitativne promjene trombocita. Smatra se da je upravo trombocitopenija najčešća manifestacija hipersplenizma i igra značajnu ulogu u krvarenju kod portalne hipertenzije. Blaga do umjerena splenomegalija uglavnom je asimptomatska. Osjećaj pritiska u lijevom gornjem kvadrantu trbuha može izazvati uvećana slezena. Krvarenje kao jedan od znakova jetrene bolesti može biti blagog, umjerenog, do teškog stupnja. Liječenje hipersplenizma usmjereno je na liječenje osnovne bolesti. Liječenje poremećaja koagulacije u jetrenih bolesnika indicirano je samo u dva slučaja: ukoliko se radi o manifestnom krvarenju ili prevenciji krvarenja tijekom invazivnog dijagnostičkog ili terapijskog postupka.