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Humans carry up to 200 bacterial species in the gastrointestinal tract. Important contribution of these genes is in carbohydrate degradation. The main task of the gut microbiota is digestion of food. The dominant gut bacteria are degradates of complex polysaccharides and releasing SCFA which are the sources for energy, cholesterol synthesis and gluconeogenesis. The mutual interaction of gut microbiota and host immune system is necessary for maintaining their symbiotic relationship. Microbial compositions differ in different metabolic conditions. Firmicutes are dominant in obese subjects while Akkermansia muciniphila which protect against adiposity, low grade inflammation in adipose tissue and insulin resistance is reduced in this population. Intestinal dysbiosis is associated with insulin resistance and diabetes type 2. Betaproteobacteria was highly enriched in diabetic population. The ratio of Bacteriodetes to Firmicutes and the Bacteroides-Prevotella group to the C.coccoides-E.rectale group are reduced. Gastrointestinal rearrangements after RYGB promote substantial changes on the gut microbiota. Gut microbota manipulation in favor of Akkermansia spp. may contribute in antidiabetic effect of metformin and could be potential treatment for T2D. Changes in gut bacteria after RYGB (Roux-en-Y gastric bypass) alter the body weight independent of other effects of bariatric/metabolic surgery. Mechanism for diabetes remission after bariatric surgery is still not clear. Besides change in incretin secretion and bile acid recirculation, potential mechanism is change of gut microbiota content. Possible improvement of glucose regulation following bariatric surgery may be related to butyrate and propionate production by some bacteria species, which influence glucose metabolism independently of bile acids recirculation.

Introduction: pseudohypoparathyroidism (PHP) is hormone resistance syndrome described for the first time in 1942 by Albright et al. All this patients had high levels of the PTH and specific skeletal deformities which were later termed as Albright hereditary osteodystrophy (AHO). The PTH requires the alpha subunit of G protein for its action. GNAS1 gene encodes the alpha subunit of the G protein and molecular defects in this gene lead to the occurrence of at least four different forms of this syndrome. Pseudopseudohypoparathyroidism (PPHP) is a form of PHP which is characterized by physical features of AHO without any evidence of PTH resistance. Albright hereditary osteodystrophy like syndrome (AHO like syndrome) has some common characteristics with AHO but is not connected with the molecular defect in the GNAS 1 gene. Case outline: we reported the case of the female patient with the phenotypic characteristics of AHO (brachydactyly, short stature, mild degree of intelectual deficit and genu varum) but without any evidence of PTH resistance. PPHP occurs mainly in families with PHP 1a and it is inherited from the father which is not the case with our patient. There is a theoretical possibility that the mutation of the GNAS 1 gene occurred de novo but without genetic testing the 2q37 deletion and AHO like syndrome can not be excluded. Conclusion: in same cases of PPHP the diagnosis of AHO like syndrome should be considered but the only way to make the precise diagnosis is the genetic testing as it was in our case.

Introduction. Losartan, the angiotensin type 1 receptor blocker (ARB) exercises its main antihypertensive effect by vasodilatation of peripheral arteries. Objective. The aim of this study was to evaluate the antihypertensive effect and safety of losartan in patients with mild and moderate arterial hypertension (AH). Methods. This was an open post-marketing study with losartan as monotherapy in previously treated or untreated patients with AH. Primary efficacy parameter was the percentage of patients that achieved target blood pressure after 8-week treatment with a single daily dose of losartan of 50-100 mg. Safety parameters were assessed according to the percentage of adverse events and metabolic effects of therapy. Results. The study included 550 patients with AH (59% female and 41% male), mean age 56.8±11.4 years, BMI=27±4 kg/m2. Losartan was applied in 31% of untreated and 69% of previously treatment-resistant patients After 8 weeks target blood pressure was achieved in 67.8% (SBP) and in 81.1% (DBP) of patients, respectively. The mean decrease was 21.8% for SBP and 21.1% for DBP (p

Background/aim: Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. Methods. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated - HbA1c, mean blood glucose value in daily profiles - MBG, daily requirement for insulin - IJ/kg BM), lipid levels, blood pressure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. Results. There was a significant improvement in HbA1c (8.94±1.62 vs. 6.90±1.22 %, p < 0.05), MBG (9.23±2.22 vs. 6.41±1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66±0.22 vs. 0.55±0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbA1c (r = -0.60, p < 0.05), triglyceride levels (r = −0.63, p < 0.01), and the number of pregnancies (r = −0.62, p < 0.01), as well as between APGAR score and MBG (r = −0.52, p < 0.05) and cholesterol levels (r = −0.65, p < 0,01) before a portable insulin pump was applicated. Conclusions. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.

Polycystic ovary syndrome (PCOS) is considered a metabolic disorder closely related to obesity, insulin resistance (IR), hyperinsulinemia and unfavorable lipid profile, all increasing the risk for the occurrence of cardiovascular diseases. The aim of this study was to assess age and body mass index (BMI) related changes of cardiovascular risk factors in 90 women with PCOS. The cut-off age point was 30 years and for BMI 27.8 kg/m2. In all patients systolic and diastolic blood pressure (BP), metabolic parameters comprising values of glucose and insulin during oral glucose tolerance test (OGTT), and basal lipid values were determined. Significant increase in blood pressure (BP) indices, basal insulin values and insulin resistance (IR) assessed by HOMA model were observed with aging and the increase of BMI, while the parameters of glucose metabolism, total cholesterol and triglycerides were significantly elevated only with aging. However, the correlation between the indices of arterial blood pressure, and lipid and glucose metabolism parameters occurred only in patients over 30 years of age, pointing to the causative relation and the consequent deterioration of IR and lipid profile with aging, influencing cardiovascular function in women with PCOS.

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim. Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. Methods. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated -- HbA1c, mean blood glucose value in daily profiles - MBG, daily requirement for insulin -- IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. Results. There was a significant improvement in HbA1c (8.94±1.62 vs. 6.90±1.22%, p < 0.05), MBG (9.23±2.22 vs. 6.41±1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66±0.22 vs. 0.55±0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbA1c (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated. Conclusions. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome. [ABSTRACT FROM AUTHOR]

Prethodilo je pokazano daje kod pacijenata sa primarnim hiperparatireoidizmom (PHPT) prisutna insulinska rezistencija i da se ovi pacijenti često klinički prezentuju sa znacima metaboličkog sindroma (gojaznost, dislipidemija, dijabetes i hipertenzija). Cilj naše studije je bio da procemmo učestalost metaboličkog sindroma i njegovih parametara kod novootkrivenih pacijenata sa PHPT i efekat operativnog lečenja PHPT na iste. MATERIJAL I METODE: Kod 41 pacijenta sa PHPT (starosti: 56.73=10.59 godine, ITM 26.34=4.24 kg/m2), glikemija, insuhnemija i lipidni status su određivani pre 14 meseca nakon operativnog lečenja PHPT. Insulinska senzitivnost je procenjivana puteni HOMA indeksa. REZULTATI: Pre operacije metabolički sindrom je dijagnostikovan kod 11 pacijenata (26.82%; korišćena je IDF klasifikacija), pri čemu je kod 7 (17.07%) pacijenata dijagnostikovan tip 2 dijabetesa (kod 4 pacijenta dijabetes je bio prethodno dijagnostikovan). Hipertenzija je bila prisutna kod 19 pacijenata (46.24%), dok je dishpidemija verifikovana kod 17 pacijenata (41.46%). Hirurško lečenje je sprovedeno kod 28 pacijenata (kod svih sa metaboličkim sindromom). Kod pacijenata sa metaboličkim sindromom nije bilo promene u ITM (28.33±2.46 vs. 28.45±2.92 kg/ m², p>0.05), HDL (1.01±0.05 vs 0.96±0.07, p>0.05), TG (2.26±0.21 vs. 2.53±0.39 mmol/l, p>0.05) i HOMA indeksu (4.43±3.03 vs. 4.97±2.27, p>0.05) 4 meseca nakon operacije. U zaključku, u našoj grupi pacijenata sa PHPT verifikovana je povećana prevalenca metaboličkog sindroma. Nakon operacije nije došlo do poboljšanja metaboličkog profila, moguće zbog kratkog vremena do retestiranja nakon operativnog lečenja. [ABSTRACT FROM AUTHOR]

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Losartan, the angiotensin type 1 receptor blocker (ARB) exercises its main antihypertensive effect by vasodilatation of peripheral arteries., Objective: The aim of this study was to evaluate the antihypertensive effect and safety of losartan in patients with mild and moderate arterial hypertension (AH)., Methods: This was an open post-marketing study with losartan as monotherapy in previously treated or untreated patients with AH. Primary efficacy parameter was the percentage of patients that achieved target blood pressure after 8-week treatment with a single daily dose of losartan of 50-100 mg. Safety parameters were assessed according to the percentage of adverse events and metabolic effects of therapy., Results: The study included 550 patients with AH (59% female and 41% male), mean age 56.8 +/-11.4 years, BMI = 27 +/- 4 kg/m2. Losartan was applied in 31% of untreated and 69% of previously treatment-resistant patients After 8 weeks target blood pressure was achieved in 67.8% (SBP) and in 81.1% (DBP) of patients, respectively. The mean decrease was 21.8% for SBP and 21.1% for DBP (p < 0.001). Out of all, 65% of patients achieved both target SBP and DBP values. Hydrochlorothiazide was added to the therapy in 11.6% of patients. There were no significant differences in drug efficacy between the entire group and subgroups of patients with diabetes mellitus and impaired renal function (p = ns). Adverse events were rare and metabolic effect was favorable., Conclusion: Monotherapy with losartan in a dosage of 50-100 mg applied during 8 weeks resulted in achieving target values of blood pressure in 65% of patient with mild and moderate hypertension, also including the patients with diabetes mellitus and impaired renal function. Losartan is a safe and metabolically neutral medication.