Abstract Introduction Hemochromatosis is a disorder characterised by excessive iron absorption and accumulation in various organs leading to their damage. The most common form is hereditary hemochromatosis, occurring due to a HFE gene mutation and leading to increased intestinal iron absorption. Clinical manifestations include fatigue, weakness, joint and abdominal pain, skin hyperpigmentation, and symptoms of diabetes. Case report A 51-year-old patient was hospitalized in 2021 for bilateral COVID -19 pneumonia. During hospitalization, laboratory findings showed hyperglycemia and HbA1c levels of 7.7% consistent with diagnosis of type 2 diabetes. We also noted markedly elevated serum ferritin values (3504–2948 ng/ml), along with hepatomegaly caused by ultrasound-verified liver steatosis. Liver elastography confirmed advanced fibrosis (stage F4). Following recovery from pneumonia, the patient underwent genetic testing for hereditary hemochromatosis (HFE gene analysis), which revealed a homozygous H63D mutation in exon 2, confirming the diagnosis. A hematologist was consulted and recommended regular active monitoring. The patient has since been under regular supervision of a gastroenterologist, endocrinologist and hematologist. Given the presence of class 2 obesity (BMI 38 kg/m²) and worsening of glycoregulation, at the last check-up, SGLT2 inhibitor and GLP-1 receptor agonist were introduced. Based on findings, the patient was diagnosed with secondary diabetes due to hemochromatosis. Conclusion This case highlights the need for an individualized approach to patients with newly diagnosed diabetes, underscoring the importance of considering rare etiological factors in the differential diagnosis. Early diagnosis of hemochromatosis is essential, as it enables timely initiation of specific therapy and helps prevent development of irreversible multi-organ complications.
Introduction: Primary prevention includes health education and the promotion of healthy lifestyle habits aimed at reducing disease incidence. In the care of patients with prostate cancer, nurses play an important role in patient and family education, psychological support, and in recognizing and alleviating emotional difficulties. Quality of life represents an important outcome in the treatment of localized prostate cancer, particularly in patients undergoing radiotherapy. Aim: The aim of this study was to compare the quality of life and emotional status of patients with localized prostate cancer treated with radiotherapy in inpatient and outpatient settings. Results: The results showed certain differences, but also similarities, in the perception of quality of life between the groups. Overall, respondents rated their general health and overall quality of life positively, with variability observed in specific aspects of health status. Demographic factors, including age, marital status, and level of education, did not show a significant impact on perceived quality of life. Treatment-related side effects, sexual satisfaction, and individual differences had a greater influence on quality of life perception. No statistically significant difference in quality of life was found between patients treated in outpatient and hospital settings. Conclusion: The findings emphasize the importance of an individualized approach, continuous monitoring of radiotherapy side effects, and the provision of targeted and comprehensive patient support in order to preserve and improve quality of life. Keywords: quality of life, nurses, prevention, prostate cancer, radiotherapy
AIMS:The Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern. METHODS AND RESULTS:Between March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy. CONCLUSIONS:The CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.
Pulse pressure variation (PPV) is limited in low tidal volume mechanical ventilation. We conducted this systematic review and meta-analysis to evaluate whether passive leg raising (PLR)-induced changes in PPV can reliably predict preload/fluid responsiveness in mechanically ventilated patients with low tidal volume in the intensive care unit. PubMed, Embase, and Cochrane databases were screened for diagnostic research relevant to the predictability of PPV change after PLR in low-tidal volume mechanically ventilated patients. The QUADAS-2 scale was used to assess the risk of bias of the included studies. In-between study heterogeneity was assessed through the I2 indicator. Publication bias was assessed by the Deeks’ funnel plot asymmetry test. Summary receiving operating characteristic curve (SROC), pooled sensitivity, and specificity were calculated. Five studies with a total of 474 patients were included in this meta-analysis. The SROC of the absolute PPV change resulted in an area under the curve of 0.91 (95
Extreme precipitation and prolonged flooding are increasingly threatening ecosystems worldwide, with waterlogging emerging as a major constraint for wheat plants, disrupting metabolic processes, particularly during reoxygenation. This study investigates the physiological and molecular responses of two newly developed wheat genotypes, Nova Bosanka (B) and Julija (J), to waterlogging for up to eight days, followed by a six-day reoxygenation period. Under waterlogging conditions, genotype J showed an efficient early antioxidant response characterised by the upregulation of Cu/Zn superoxide dismutase (SOD) and catalase (CAT) genes. Although genotype B showed a stronger induction of the peroxidase (POX) gene, accompanied by an increase in hydroxycinnamic acid levels, transient oxidative stress occurred, as indicated by decreased glutathione levels and increased lipid peroxidation. However, during reoxygenation, both genotypes activated ROS-detoxifying genes (POX, Cu/ZnSOD, MnSOD and CAT), emphasising the importance of H2O2 regulation in the post-hypoxia phase. In addition, lactate dehydrogenase (LDH1) gene expression was strongly induced after reoxygenation in both genotypes, indicating its potential role in post-hypoxic metabolic recovery. On the other hand, temporal and genotype-specific differences in ethylene-responsive transcription factors (ERF) gene expression (early ERF RAP2.3 in J, ERF1 in B) were observed during waterlogging. Our study reveals a genotype-specific and complex interplay between antioxidant defence and ethylene signalling during waterlogging and subsequent reoxygenation in wheat, ultimately aiming to improve crop flooding tolerance.
