AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. ...METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one ’perfect score’ and we suggest that these two tests be used concomitantly.
Severe alcoholic hepatitis (AH) is a distinct entity in the spectrum of alcohol-related liver disease, with limited treatment options and high mortality. Supportive medical care with corticosteroids ...in selected patients is the only currently available treatment option, often with poor outcomes. Based on the insights into the pathogenetic mechanisms of AH, which are mostly obtained from animal studies, several new treatment options are being explored. Studies have implicated impaired and deranged liver regeneration processes as one of the culprit mechanisms and a potential therapeutic target. Acknowledging evidence for the beneficial effects of granulocyte colony-stimulating factor (G-CSF) on liver regeneration and immunomodulation in animal models, several human studies investigated its role in the treatment of advanced alcohol-related liver disease and AH. Contrary to the previously published studies suggesting benefits of G-CSF in the outcomes of patients with severe AH, these effects were not confirmed by a recently published multicenter randomized trial, suggesting that other options should rather be pursued. Stem cell transplantation represents another option for improving liver regeneration, but evidence for its efficacy in patients with severe AH and advanced alcohol-related liver disease is still very scarce and unconvincing, with established lack of efficacy in patients with compensated cirrhosis. In this review, we summarize the current knowledge on the pathogenesis and experimental therapies targeting liver regeneration. The lack of high-quality studies and evidence is a major obstacle in further treatment development. New insights into the pathogenesis of not only liver injury, but also liver regeneration processes are mandatory for the development of new treatment options. A reliable experimental model of the pathogenesis of AH and processes involved in liver recovery is still missing, and data obtained from animal studies are essential for future research.
Astma je najčešća plućna bolest, iako s manjim utjecajem na zbroj izgubljenih godina života zbog preuranjene smrtnosti i godina proživljenih s invaliditetom nego neke druge plućne bolesti, kao što je ...kronična opstruktivna plućna bolest. Budući da se radi o bolesti s velikim javnozdravstvenim utjecajem na radnu sposobnost i kvalitetu života oboljelih, kao i s potrošnjom značajnih zdravstvenih i financijskih resursa, potrebno je primijeniti
kvalitetno i standardizirano liječenje. Osnova liječenja astme – primjena temeljnoga protuupalnog lijeka s najmanjom dozom koja može održati dobru kontrolu – nije se značajno promijenila u odnosu na posljednje hrvatske smjernice za dijagnostiku i liječenje astme u odraslih, objavljene prije petnaestak godina. Međutim, u međuvremenu su se u globalnoj strategiji za upravljanje i prevenciju astme dogodile značajne promjene u stavu
prema kratkodjelujućem bronhodilatatoru salbutamolu, gdje se on više ne primjenjuje samostalno u akutnom bronhospazmu ili pri pojavi tegoba, bez inhalacijskog glukokortikoida. Također, značajan je napredak postignut u biološkoj terapiji teške astme, prepoznat je značaj izrade osobnog plana liječenja astme, kao i pojava novih mogućnosti liječenja (fiksna trojna terapija), što je uključeno u nove hrvatske smjernice za liječenje astme.
Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on ...increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.
The COVID-19 pandemic has posed a major challenge to modern medicine. Despite significant efforts by the medical and scientific community, at the time of writing, there is still no targeted ...etiological treatment for acutely ill COVID-19 patients as well as patients with post-COVID syndrome. Hyperbaric oxygen therapy (HBOT) is a medically and scientifically recognized therapeutic procedure in the treatment of a number of acute and chronic conditions in which oxygen deficiency is pathophysiologically primary disorder. Given the several published series of cases that have shown a significant beneficial effect of HBOT in the treatment of patients with COVID-19 infection, and based on decades of experience in the use of HBOT in other fields, the need to conduct quality and well-structured studies arose with the aim to clearly examine the impact of HBOT use in the treatment of COVID-19 patients. According to available sources, nine such studies are being conducted worldwide.The mechanisms of the effect of HBOT in the treatment of COVID-19 patients are based on the correction of hypoxia, attenuation of the inflammatory response and “repayment of oxygen debt” in a short period of time, thus providing a window to aerobic metabolism in deeply hypoxic tissues and important organs.
Pandemija COVID-19 postavila je velik izazov suvremenoj medicini. Unatoč značajnim naporima medicinske i znanstvene zajednice, do trenutka pisanja ovog članka i dalje ne postoji ciljano etiološko ...liječenje bolesnika akutno oboljelih od COVID-19, kao i bolesnika s post-COVID sindromom. Hiperbarična oksigenoterapija (HBOT) jest medicinski i znanstveno priznat terapijski postupak u liječenju brojnih akutnih i kroničnih stanja u kojima je nedostatak kisika osnovni patofiziološki poremećaj. S obzirom na nekoliko publiciranih serija slučajeva koji su pokazali značajan povoljni učinak primjene HBOT-a u liječenju pacijenata oboljelih od infekcije COVID-19 te na osnovi višedesetljetnog iskustva u primjeni HBOT-a u drugim poljima, rodila se potreba za provođenjem kvalitetnih i dobro strukturiranih studija kojima je cilj jasno ispitati utjecaj primjene HBOT-a u liječenju oboljelih od COVID-19. Prema dostupnim izvorima trenutno se u svijetu provodi 9 takvih istraživanja. Mehanizmi učinka primjene HBOT-a u liječenju oboljelih od COVID-19 zasnivaju se na korekciji hipoksije, atenuaciji upalnog odgovora te „otplate duga kisika“ u kratkom vremenskom razdoblju, na taj način osiguravajući prozor aerobnom metabolizmu u duboko hipoksičnim tkivima i važnim organima.
Many chronic medical conditions such as glaucoma, senile macular degeneration and diabetic retinopathy are further complicated by emotional and psychological disorders. Religiousness represents a ...part of a social culture and has a significant role in the prevention of mental difficulties of the patients, especially those belonging to older population. The aim of this study was to investigate the connection between religiousness, anxiety, and depression in patients with glaucoma, age-related macular degeneration and diabetic retinopathy and to test their connection related to different diagnosis.
This cross-sectional study included 163 patients divided into three groups (glaucoma group, senile macular degeneration group and diabetic retinopathy group). Respondents voluntarily agreed to participate in the study and with assistance they fully completed the Scale of Religiousness, Hospital Anxiety and Depression Scale, General Health Questionnaire and demographic information (age, gender, education, employment and marital status).
The results showed noticeable religiosity of the respondents (M=18.31, SD=5.28), but also the presence of anxiety (M=7.55, SD=3.73), especially in patients with glaucoma, as well as impaired mental health in AMD patients (M=19.56, SD=4.14). No differences were found in the severity of anxiety, depression, general health and religiosity between groups, but the presence of depression in subjects with age-related macular degeneration significantly affects the level of religiosity (p=0.032).
These results unequivocally point to the need for further research and raising awareness of all health professionals about the importance of a holistic approach to the patient regardless of his diagnosis in order to identify the possible effective ways to deal with chronic disease considering all levels of patient's needs.
Abstract
BACKGROUND AND AIMS
The kidney disease secondary to obesity is obesity-related glomerulopathy characterized by the following: glomerulomegalia, progressive glomerulosclerosis, proteinuria ...and progression of renal failure. The aims of the present study were to evaluate the clinical features and 2 years outcome in obese and non-obese patients with glomerular diseases.
METHOD
This study included 125 patients with renal biopsy-proven glomerular diseases: minimal change disease, FSGS, IgA nephropathy, membranous glomerulonephritis, membranoproliferative glomerulonephritis (mean age 46.93 ± 15.10 years). There were 63 obese (BMI ≥ 27 kg/m2) and 62 non-obese (BMI <27 kg/m2) patients. The serum concentration of protein, albumin, cholesterol, trygliceride, creatinine and daily proteinuria were measured at the time of kidney biopsy, 6, 12 and 24 months after the biopsy. The estimated glomerular filtration rate (eGFR) was calculated according to the equations: Cockcroft–Gault#(Cockcroft–Gault–BMI < 27 kg/m2 Cockcroft–GaultLBW-BMI ≥27kg/m2) and Chronic Kidney Disease Epidemiology Collaboration Equation (CKD–EPI).
RESULTS
At the time of kidney biopsy, the obese had significantly lower eGFR calculated by formulas: Cockcroft–Gault# (62.29 ± 27.53 versus 96.30 ± 38.80 mL/min) and CKD–EPI (71.52 ± 31.15 versus 86.36 ± 27.63 mL/min/1.73 m2), significantly higher daily proteinuria (6.11 ± 4.94 versus 4.47 ± 4.95 g/day), creatinine (122.14 ± 87.56 versus 93.66 ± 41.40 μmol/L), trygliceride (2.76 ± 1.39 versus 2.20 ± 1.30 mmol/L) in comparison with non-obese. There was statistically significant difference in eGFR calculated by Cockcroft-Gault# 6 months (t = 5.353, P < .01), 12 (t = 5.234, P < .01) and 24 months (t = 2.329, P < .05) after the kidney biopsy between obese and non-obese. The reduction in eGFR Cockcroft–Gault# after 24 months compared with baseline in obese was 14.7%, in non-obese 13.7% (P > 0.05). After 12 months follow-up significantly higher percentage of non-obese patients reached complete remission (59.4% versus 35.3%) compared with obese (χ2 = 4.548), but after 24 months there were no significant difference.
CONCLUSION
Obese patients at the time of kidney biopsy, 6, 12 and 24 months later had the significant lower eGFR compared to non-obese. After 24 months follow-up there was no significant difference in percentage of patients with complete remission between two groups, although after 12 months follow-up a significantly smaller number of obese were in complete remission.
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