Latar belakang. Kolitis bermanifestasi sebagai diare kronik dan pada anak perlu diwaspadai karena memiliki komplikasi gangguan tumbuh kembang dan kematian. Sepuluh hingga dua puluh persen kasus diare ...infeksi akibat perawatan di rumah sakit disebabkan oleh Clostridium difficile. Metronidazol dan vankomisin oral masih menjadi terapi obat lini pertama untuk infeksi Clostridium difficile. Pada pasien diare berat, studi menunjukkan vankomisin oral menjadi pilihan utama dibandingkan metronidazole.Tujuan. Mengetahui efektifitas pemberian vankomisin oral terhadap metronidazol oral dalam menyembuhkan kolitis infektif kronik pada anak.Metode. Pencarian literatur melalui Pubmed dan Cochrane pada bulan Juli 2019 dengan kata kunci “children OR pediatric” AND “infective colitis OR Clostridium difficile” AND “oral vancomycin” AND “ oral metronidazole”.Hasil. Penelusuran artikel pada makalah ini menemukan dua artikel yang relevan terhadap pertanyaan klinis. Igarashi dkk. merupakan meta analisis terhadap lima uji klinis acak dengan total 1101 pasien dan dipublikasikan pada tahun 2018. Artikel yang kedua adalah studi pilot prospektif observatif dari Antoon dkk pada 8 subyek anak berusia 8-17 tahun pada tahun 2016.Kesimpulan. Vankomisin oral disarankan untuk digunakan dalam kolitis infektif berat. Untuk kasus kolitis infektif yang ringan atau sedang, data menunjukkan hasil yang seimbang untuk vankomisin dan metronidazol. Berdasarkan uji observasional, vankomisin oral tidak diabsorbsi dalam darah pada anak.
Ulcerozni kolitis kronična je upalna bolest za koju su karakteristične ulceracije sluznice debeloga crijeva i klinički tijek obilježen razdobljima remisije i relapsa bolesti. Klinički se ulcerozni ...kolitis najčešće očituje učestalim sluzavo-krvavim proljevima. Azatioprin je tiopurin koji imunosupresiju postiže putem svojih aktivnih metabolita. Oni potiču apoptozu T-limfocita, te, inkorporirajući se u replicirajući lanac DNA i blokirajući de novo sintezu purina, smanjuju njihovu proliferaciju. Mjerenjem aktivnosti tiopurin Smetiltransferaze i praćenjem metabolita tiopurina, uspješno se postiže optimizacija terapije. Time se poboljšava klinička djelotvornost liječenja, te sprječava neuspjeh liječenja uzrokovan štetnim nuspojavama azatioprina. Unatoč pretpostavkama da će u budućnosti, zbog razvoja učinkovitijih i sigurnijih lijekova, uloga tiopurina u liječenju bolesnika s ulceroznim kolitisom biti ograničenija, azatioprin i dalje ostaje neizostavan lijek u liječenju bolesnika s ulceroznim kolitisom.
Ulcerative colitis is a chronic inflammatory disease characterized by ulcerative lesions of the colon mucosa and clinical course characterized by periods of remissions and relapses. The most common clinical symptom of ulcerative colitis is frequent bloody diarrhea usually accompanied by mucus. Azathioprine is a thiopurine which achieves immunosuppression through its active metabolites. They induce apoptosis of T-lymphocytes and, by incorporating into the replicating DNA chain and blocking de novo purine synthesis, reduce its proliferation. The measurement of thiopurine S-methyltransferase together with thiopurine metabolites monitoring successfully lead to therapy optimization. Thus, improving clinical effectiveness of the therapy and preventing management failure from adverse effects. Despite assumptions that in future, due to the intensive development of more effective and safer medicaments, the role of thiopurines in the treatment of patients with ulcerative colitis will be more restricted, azathioprine still remains an unavoidable medicament in the treatment of patients with ulcerative colitis.
Trudnoća je vrlo osjetljivo razdoblje u životu žene, osobito kada se uz trudnoću veže dijagnoza kronične bolesti. Upalne bolesti crijeva su kronične autoimune bolesti koje nastaju kao rezultat ...interakcija između genetskih i okolišnih čimbenika. Upalne bolesti crijeva obuhvaćaju ulcerozni kolitis, Crohnovu bolest, mikroskopski kolitis i neklasificiranu upalnu bolest crijeva. Vršak incidencije upalnih bolesti crijeva javlja se između 15. i 30. godine života. Kod velikog broja žena bolest se javlja upravo u generativnoj dobi, što može značajno utjecati na odluku o ostvarivanju trudnoće. Osobe oboljele od upalnih bolesti crijeva nakon postavljanja dijagnoze i u razdoblju pogoršanja kliničke slike vrlo često isključuju pojedine namirnice ili skupine namirnica iz prehrane kako bi ublažili simptome bolesti, pa nedostatak nutrijenata nije rijetkost. Razdoblje pripreme za trudnoću, sama trudnoća i dojenje razdoblja su u životu žene koja su povezana s povećanim potrebama za energijom i određenim nutrijentima koji se smatraju ključnima za rast i razvoj djeteta te za zdravlje majke. Cilj ovog rada bio je ispitati kakvoću prehrane trudnica i žena koje planiraju trudnoću s dijagnozom upalnih bolesti crijeva u Republici Hrvatskoj, kako bi se utvrdila učestalost provođenja eliminacijskih dijeta koje mogu rezultirati narušavanjem nutritivnog statusa. Informacije o učestalosti konzumiranja različitih skupina namirnica, korištenju dodataka prehrani, provođenju eliminacijskih dijeta, te karakteristikama trudnoće prikupljene su putem anketnog upitnika. U istraživanju je sudjelovalo 15 ispitanica oboljelih od upalnih bolesti crijeva u dobi od 21 do 39 godina. Prema rezultatima, više od polovice ispitanica (53,3 %) iz svoje prehrane isključuje određene namirnice, najviše iz skupine povrća, mlijeka i mliječnih proizvoda, mesa, te voća. Također, vidljivo je kako dijagnoza rezultira značajnijim prehrambenim promjenama kod većine ispitanica (60 %). Uočen je nedovoljan unos folne kiseline, kako kod žena koje planiraju trudnoću, tako i kod trudnica tijekom prvih 12 tjedana trudnoće. Ovakvi rezultati ukazuju da važnost pravilne prehrane i unos folne kiseline prije začeća i tijekom trudnoće u Republici Hrvatskoj još uvijek nisu dovoljno prepoznati.
Pregnancy is a very sensitive period in a woman’s life, especially when it is associated with a diagnosis of a chronic disease. Inflammatory bowel diseases are chronic autoimmune disorders that result from the interplay of genetic and environmental factors, including ulcerative colitis, Crohn’s disease, microscopic colitis and unclassified inflammatory bowel disease. The peak incidence of inflammatory bowel diseases occurs between the ages of 15 and 30. Many women are diagnosed with the disease during their reproductive years, which can significantly impact their decision to become pregnant. Individuals with inflammatory bowel diseases often exclude certain foods or food groups from their diet to alleviate symptoms, particularly after diagnosis or during periods of active disease, leading to nutrient deficiencies. The period of preparing for pregnancy, pregnancy itself, and breastfeeding are phases in a woman’s life associated with increased energy and specific nutrient requirements crucial for the growth and development of the child as well as the mother’s health. Therefore, the aim of this study was to examine the dietary quality of pregnant women and women planning pregnancy with a diagnosis of inflammatory bowel diseases in the Republic of Croatia, to determine the frequency of elimination diets that may compromise nutritional status. Information on the frequency of consuming different food groups, the use of dietary supplements, implementation of elimination diets, and pregnancy characteristics were collected through a questionnaire. The study included 15 female participants with inflammatory bowel diseases aged 21 to 39 years. According to the results, more than half of the participants (53.3%) exclude certain foods from their diet, mainly from the vegetable, dairy, meat, and fruit groups. Additionally, the diagnosis leads to significant dietary changes for the majority of participants (60%). Insufficient folic acid intake was observed among women planning pregnancy as well as during the first 12 weeks of pregnancy. These results indicate that the importance of proper nutrition and folic acid intake before conception and during pregnancy in the Republic of Croatia is still not adequately recognized.
Upalne bolesti crijeva kronični su upalni poremećaji gastrointestinalnog sustava nepoznatog uzroka u koje ubrajamo Crohnovu bolest, ulcerozni kolitis i nedeterminirani kolitis. Ciljevi liječenja ...upalnih bolesti crijeva su postizanje i održavanje remisije bolesti, kao i mukozno cijeljenje. Biološka terapija predstavlja značajan napredak u liječenju s obzirom na to da može inhibirati upalnu kaskadu u podlozi kronične upalne bolesti te na taj način modificirati tijek i zaustaviti progresiju bolesti. S obzirom na to da je riječ o kompleksnim terapijama s potencijalno ozbiljnim nuspojavama, njihova primjena zahtijeva iskustvo i provodi se prvenstveno u specijaliziranim centrima, ali sve više u općim i županijskim bolnicama.
Inflammatory bowel disease is a chronic infammatory disorder of gastrointestinal system with unknown cause, which include Crohn’s disease, ulcerative colitis and undetermined colitis. The aim of treatment is to induce clinical remission of disease and to achieve mucousal healing. Biological therapy is a big progress in treatment because it can inhibite inflammatory cascade found in the base of chronic inflammatory disease, modify disease and stop its progression. That therapy is very complex with many possibly serious side effects, so its use requires experience and it is used mostly in specialised centers, but also more and more in other hospitals.
Upalne bolesti crijeva (Crohnova bolest, ulcerozni kolitis, nedeterminirani kolitis) skupina su kroničnih autoimunosnih upalnih bolesti obilježenih ponavljanim upalama različitih dijelova ...gastrointestinalnog trakta koje su važan javnozdravstveni problem današnjice. Unatoč brojnim temeljnim i kliničkim istraživanjima etiologija ovih bolesti, kao i sama patogeneza upale ostaju nedovoljno razjašnjene. Dosadašnja su istraživanja potvrdila uzročno-posljedičnu vezu između medijatora upalnog odgovora i molekula uključenih u regulaciju njihove biološke aktivnosti, osobito proteaza. Cilj ovoga preglednog rada jest sažeti prikaz dosadašnjih saznanja o različitim aspektima upalnih bolesti crijeva, s posebnim naglaskom na potencijalnu ulogu i uključenost dipeptidil-peptidaze IV, odnosno molekule CD26 (DPP IV/CD26) u mehanizme nastanka upalnih procesa u probavnom sustavu. Dan je i pregled životinjskih modela kolitisa koji su znatno pridonijeli razumijevanju i terapiji ovih bolesti, s osobitim naglaskom na mišji model ulceroznog kolitisa (DSS-kolitis) te Crohnove bolesti (TNBS-kolitis).
The present study presents long-term results of stress-related outcomes of a prospective RCT that evaluated effects of a ten-week comprehensive lifestyle-modification program (LSM) in patients with ...inactive ulcerative colitis (UC). In addition, exploratory results of a sub-study applying a laboratory stress protocol (Trier Social Stress Test; TSST) conducted within the RCT are reported.
Ninety-seven patients with inactive UC were randomized to LSM (
= 47; 50.28 ± 11.90 years; 72.3% female) or self-care (
= 50; 45.54 ± 12.49 years; 70% female). Patients' perceived stress, anxiety, flourishing and depression were assessed at week 0, 12, 24 and 48. After the respective intervention, 16 female patients (LSM:
= 8; 44.6 ± 14.3 years; Self-care:
= 8; 49.25 ± 4.30 years) additionally underwent the TSST. State anxiety, blood pressure, pulse, complete blood counts, adrenocorticotropic hormone (ACTH), cortisol, adrenalin and noradrenalin were measured at
(-15 min),
(+10 min),
(+20 min) and
(+55 min). Statistical significance was set at
< 0.05; for the exploratory sub-study using the TSST,
-values < 0.10 were considered significant.
Patients' perceived stress declined significantly after the LSM (
< 0.001) compared with control. This lasted until week 24 (
= 0.023) but did not persist until week 48 (
= 0.060). After 48 weeks, patients' flourishing was significantly increased compared with control (
= 0.006). In response to the TSST, significant group differences were evident for pulse (
= 0.015), adrenaline (
= 0.037) and anxiety (
= 0.066). After 55 min, group differences were found for ACTH (
= 0.067) and systolic blood pressure (
= 0.050).
LSM has a medium-term positive effect on perceived stress. First indications show that it is promising to investigate these effects further under laboratory conditions. It is also desirable to find out how the effects of LSM can be maintained in the long term.
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