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.
This cross-sectional study assessed both family and individual quality of life (QOL), and their association with self-esteem, optimism, chronic psychological stress, anxiety, and depression in ...parents of children with chronic conditions.
Parents of children with Down syndrome (DS), autistic spectrum disorder (ASD), cerebral palsy (CP), diabetes mellitus type 1 (DMT1), and parents of children without chronic diseases with typical development (TD) were included. Multivariate linear regression analysis was used to assess parental characteristics associated with the domains of individual and family QOL.
Compared to the parents of TD children, parents of children with ASD and DS were more likely to report reduced family QOL in all domains, while parents of children with DMT1 had lower parental perception. Self-esteem was positively associated with all domains of individual QOL, while optimism was associated with the overall individual QOL perception and health. Higher stress perception was negatively associated with most of the domains of individual and family QOL.
This study confirmed that parents of children with chronic conditions are more likely to have lower perception of both individual and family QOL, which were associated with self-esteem, chronic stress, anxiety, and depression. Interventions should focus not only on the child with a chronic condition but on parents too.
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.
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.
Abstract Background The standard first-line systemic treatment for patients with non-oncogene addicted advanced nonsquamous non-small cell lung cancer (NSCLC) is immunotherapy with immune checkpoint ...inhibitors (ICI) and/or chemotherapy (ChT). Therapy after failing ICI +/− ChT remains an open question, and docetaxel plus nintedanib represent a valid second line option. Patients and methods A multicenter retrospective trial of real-life treatment patterns and outcomes of patients with advanced lung adenocarcinoma treated with docetaxel plus nintedanib after the failure of ICI and/or ChT was performed. Patients from 2 Slovenian and 1 Croatian oncological center treated between June 2014 and August 2022 were enrolled. We assessed objective response (ORR), disease control rate (DCR), median progression free survival (PFS), median overall survival (OS), and safety profile of treatment. Results There were 96 patients included in the analysis, with ORR of 18.8%, DCR of 57.3%, median PFS of 3.0 months (95% CI: 3.0–5.0 months), and a median OS of 8.0 months (95% CI: 7.0–10.0 months). The majority of patients (n = 47,49%) received docetaxel plus nintedanib as third-line therapy. The ORR for this subset of patients was 19.1%, with a DCR of 57.4%. The highest response rate was observed in patients who received second-line docetaxel plus nintedanib after first-line combination of ChT-ICI therapy (n = 24), with an ORR of 29.2% and DCR of 66.7% and median PFS of 4.0 months (95% CI: 3.0–8.0 months). Fifty-three patients (55.2%) experienced adverse events (AEs), most frequently gastrointestinal; diarrhea (n = 29, 30.2%), and increased liver enzyme levels (n = 17, 17.7%). Conclusions The combination of docetaxel and nintedanib can be considered an effective therapy option with an acceptable toxicity profile for patients with advanced NSCLC after the failure of ICI +/− ChT.
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.
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Background: Inflammatory cells have important effects on tumor development. Systemicinflammation markers can be used as prognostic factors. Numerous studiesshown that high pretreatment ...neutrophil-to-lymphocyte ratio (NLR) and/or platelet-to-lymphocyte ratio (PLR) levels are potential prognostic predictors for poor progression-free survival (PFS) and overall survival (OS) in NSCLC patients receiving immunotherapy. Methods: We performed a cohort study of patients with metastatic or recurrent NSCLC treated with nivolumab monotherapy in second‐line or further‐line treatment in Clinical hospital centre Zagreb. Pre-treatment NLR and PLR were calculated by division of neutrophils and platelets by lymphocytes measured in peripheral blood. Patients were categorized in two sub-groups according to their NLR and PLR values. In previous meta-analyses it was suggested that significant cut-off value of NLR is NLR < 5 and ≥5 and PLR < 160 and ≥160. We analysed PFS and OS. Results: Overall 105 patients diagnosed with NSCLC were treated with nivolumab. The patients were enrolled from March 2017 until October 2017 and were observed them for disease progression and death until June 1st 2020. Most of the patients were male (71; 67.6%) with median age 60.3 years (36-77). Our patients were selected on the basis of good performance status, so most of them had ECOG PS 0 and 1 (103; 98.1%). Therapy was applied mostly in the second and third line (67; 64%), but even up to seventh line (2; 1.9%). Median duration of therapy was 34.5 weeks (2-149), while median number of doses was 17 (1-69).The median PFS was 7.2 months (95% CI 4.53-9.86). Regardless of previous treatment the mOS was 16.1 months (95% CI 11.26-20.93).We observed median value of NLR 4.08 (IQR 2.44-5.84) and PLR 200 (IQR 127.49-284.72). Patients with low PLR had better overall survival compared to patients with low PLR (mOS 20.5 months vs 11.9 months; 95%CI 14.07-26.92 vs 7.35-16.44; p = 0.039). The same was not as clear in mPFS, tendency of better mPFS was toward low PLR, but it did not reach statistical difference (low PLR mPFS 9.1 months vs high PLR mPFS 6.1 months; p = 0.49).Patients with low NLR had significantly better overall survival compared to patients with high NLR (mOS low NLR 18.2 vs high NLR 10.1 months; 95%CI 13.07-23.32 vs 6.04-14.15; p = 0.014). Again, the statistical significance was not reached for progression-free survival (mPFS low NLR 8.3 months vs high NLR 5.8 months; 95%CI 4.81-11.78 vs 2.91-8.68; p = 0.214). Conclusions: Here, we demonstrated that the presence of indicators of systemic inflammation suchas high NLR and high PLR are associated with poor overall survival, but not withprogression-free survival in pre‐treated NSCLC patients who received nivolumabtreatment. The limitation of our study is the lack of a randomizedcontrol and small sample size. The main strength of our study is that it is real-worldeveryday clinical setting.
Abstract
Background and Aims
The aim of the study was to evaluate glomerular morphometry in obese and non-obese patients with glomerular diseases: FSGS, IgA nephropathy, membranous glomerulonephritis ...(MGN) and membranoproliferative glomerulonephritis (MPGN).
Method
The study included 125 patients with glomerular diseases (77 males, mean age 46± 15.2 years): obese (BMI> 27kg/m2- 63 patients) and non-obese (BMI< 27kg/m2-62 patients). The serum concentration of creatinine, proteins, albumin, cholesterol, trygliceride, daily proteinuria were measured at the time of kidney biopsy. Formula Cockcroft-Gault#(Cockcroft-Gault: non-obese) and Cockcroft-GaultLBW: obese) was calculated. Glomerular radius (GR), glomerular volume (GV) and glomerular density (GD) were compared morphometrically between two groups.
Results
At the time of kidney biopsy the obese had significantly lower eGFR, significantly higher creatinine, trygliceride, daily proteinuria compared to non-obese. Obese FSGS patients had significantly higher GR (109.44±6.03 μm vs 98.53±14.38 μm) and GV (3.13±0.49 x106 μm?vs 2.26±0.83 x106 μm?, only midly lower GD (1.91±0.39/mm2 vs 1.95±0.61/mm2) compared to non-obese. Obese IgA nephropathy patients had higher GR (110.69± 15.24 μm vs 107.77±14.53 μm), significantly higher GV(3.34±1.78 x106 μm?vs 2.31± 1.51 x106 μm? and significantly lower GD (1.21±0.29/mm2 vs 2.14±0.54/mm2) in comparation with non-obese. Significant positive association between GV and BMI (r=0.439; p<0.01) in FSGS patients was found. Significant positive correlation between GV and BMI (r=0.683; p< 0.01), but significant negative correlation between GD and BMI (r=-0.710; p< 0.01) in IgA nephropathy patients were found. Obese MGN patients had lower GR (112.82± 13.65 μm vs 118.39± 14.52 μm), GV (3.57± 1.19 x106 μm?vs 4.07± 1.28 x106 μm? and GD (1.89± 0.17/ mm2 vs 1.91± 0.92/mm2) but without significance compared to non-obese. Obese MPGN patients had higher GR(105.89± 12.24 μm vs 92.73± 30.01 μm), GV (2.94± 0.91 x106 μm?vs 2.31± 1.27 x106 μm? and GD (2.32± 0.63/ mm2 vs 2.03± 0.73/ mm2) but without significance in comparation with non-obese. Significant negative association between GD and daily proteinuria (r=-0.417; p<0.01) in MGN patients was found.
Conclusion
Obese FSGS patients had significantly higher GV, lower GD compared to non-obese. Obese IgA nephropathy patients had significantly higher GV and significantly lower GD. Obese MGN patients had lower and obese MPGN patients had higher morphometric parameters of glomeruli compared to non-obese. Significant positive correlation between GV and BMI in FSGS and IgA nephropathy patients were found.
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