Higher expression of the mucin 2 (MUC2) glycoprotein and vascular endothelial growth factor (VEGF) in Barrett's mucosa may be associated with a higher risk of esophageal adenocarcinoma development. ...Thirty-six patients diagnosed with Barrett's esophagus (BE), short-segment, were included in the study due to unsuccessful treatment with proton pump inhibitors. The diagnosis was confirmed by histopathologic analysis of the tissue obtained by esophagogastric junction biopsy. Expression of MUC2 and VEGF was determined by immunohistochemistry. We found four patients in early stage of adenocarcinoma and 32 patients with BE; five of them had indication for argon plasma coagulation treatment, one for radiofrequency ablation and one for endoscopic mucosal resection; 25 patients were treated with proton pump inhibitors. Regression of BE occurred in 25 (69.44%) patients. MUC2 positivity is unique for goblet cells in patients with BE, but it is not the only marker. VEGF is an indicator of angiogenesis in the mucosa of patients with BE and adenocarcinoma.
A thorough evaluation of omeprazole and esomeprazole by FDA in 2007 concluded no association between the use of these two drugs and adverse cardiac events 6, and chest pain, as a possible side ...effect, is not part of the label of esomeprazole 1. Coronarography was indicated and showed normal epicardial coronary vessels. Because the patient had ECG changes typical of transient myocardial ischemia and without myocardial damage, we characterized the reaction as microvascular dysfunction. 4. ...the reported adverse reaction fulfills criteria of an unexpected or type B (atypical and idiosyncratic) adverse reaction.
SAŽETAK
Hereditarni (nasljedni) angioedem (HAE) je rijetka nasljedna bolest obilježena ponavljajućim napadajima bolnog oticanja potkožnog i submukoznog tkiva. Ponavljajući napadaji angioedema dovode ...do funkcionalnih oštećenja, smanjenja kvalitete života (engl. Quality of Life, QoL) i povećane smrtnosti. Na temelju koncentracije i funkcije inhibitora esteraze komponente 1 (C1) komplementa (C1-INH) HAE je podijeljen u tri tipa. Tip 1 HAE (HAE-1) obilježen je niskom koncentracijom C1-INH i obuhvaća oko 85% svih slučajeva HAE. Oko 15% bolesnika s HAE ima normalnu koncentraciju C1-INH, dok je aktivnost enzima smanjena, što je obilježje tipa 2 HAE (HAE-2). Tip 3 HAE ima normalnu koncentraciju C1-INH (HAE nC1-INH). Terapija HAE uključuju liječenje akutnih napada, kratkotrajnu profilaksu (engl. short term prophylaxis, STP) i dugotrajnu profilaksu (engl. long term prophylaxis, LTP). LTP podrazumijeva primjenu terapije za smanjenje učestalosti i ozbiljnosti napadaja te poboljšanje kvalitete života u bolesnika koji imaju učestale i ozbiljne napade. U Hrvatskoj su za LTP dostupni atenuirani androgeni koji su opterećeni štetnim učincima. No, za dugoročnu profilaksu napadaja HAE moguće je primijeniti i lanadelumab. To je potpuno ljudsko monoklonsko protutijelo i vrlo je snažan i specifičan inhibitor kalikreina u plazmi, a odobren je u više zemalja EU.
Aim. The primary objective of this study was to evaluate the prevalence of increased controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as surrogate markers of liver ...steatosis and fibrosis in liver transplant recipient (LTR). Secondary objectives were to determine the predictors of increased CAP and LSM in population of LTR. Methods. In this prospective, cross-sectional study, we have evaluated 175 LTRs’ mean age as 61 (53–65) with a functioning graft for more than one year who came for regular outpatient examinations to the Department of Gastroenterology, University Hospital (UH) Merkur, Zagreb, Croatia. Results. Of 175 analyzed LTRs, 34.28% had obesity, 64.00% had hypertension, 38.28% had diabetes, and 58.85% had hyperlipidemia. The prevalence of liver steatosis was 68.57%, while the prevalence of severe liver steatosis was 46.85%. On multivariate analysis, independent factors associated with liver steatosis were male gender, total cholesterol as positive predictor, and HDL as negative predictor, and independent factors positively associated with severe liver steatosis were higher body mass index (BMI) and higher triglyceride levels. The prevalence of moderate liver fibrosis was 54.85%, while the prevalence of advanced liver fibrosis was 24%. On multivariate analysis, independent factors positively associated with moderate fibrosis were gamma-glutamyl transferase (GGT) and CAP, while the independent factor positively associated with advanced fibrosis was GGT. Conclusion. Our study showed high prevalence of increased CAP and LSM measurements as surrogate markers of liver steatosis and fibrosis. Metabolic syndrome components were highly present and were associated with CAP and LSM values as well as in the pretransplant setting. Due to high prevalence of metabolic comorbidities and nonalcoholic fatty liver disease in LTRs and the lack of the abnormal liver test in a significant number of these patients, TE with CAP may be a reasonable initial assessment for LTRs with one or more components of the metabolic syndrome.
The global social, economic and political crises related to coronavirus disease 2019 (COVID-19) presumably had more indirect than direct negative impacts on health systems. Drastic lifestyle changes, ...social isolation and distancing, and individual and global financial crises resulted in robust populations forfeiting healthy habits and seeking comfort in alcoholic beverages, drugs and unhealthy diets. The inevitable consequences are increases in the incidence of nonalcoholic fatty liver disease, viral hepatitis, acute alcoholic hepatitis, liver cirrhosis decompensation and ultimately liver-related mortality. The inaccessibility of regular clinical and sonographic monitoring systems has caused difficulties in the treatment of patients with chronic liver disease (CLD) and has prevented prompt hepatocellular carcinoma detection and treatment. A dramatic reduction in the number of liver donors and the transformation of numerous transplantation centers into COVID-19 units drastically decreased the rate of orthotopic liver transplantation. The indirect, unavoidable effects of the COVID-19 pandemic in the following years have yet to be determined. Substantial efforts in the management of patients with liver disease in order to overcome the inevitable COVID-19-related morbidity and mortality that will follow have yet to be initiated. Several questions regarding the impact of the COVID-19 pandemic on liver disease remain. The most important question for general CLD patients is: How will the modification of clinical practice during this pandemic affect the outcomes of CLD patients? This article reviews the influence of COVID-19 on patients with liver disease during the pandemic, with particular emphasis on the disease course associated with pandemic resolution.
Endothelial dysfunction (ED) is a syndrome characterized by impairment of endothelium dependent vasodilatation,altered anticoagulant, anti-inflammatory and vascular remodeling properties. The ...dysfunctionalendothelium represents an interim stage between risk factors and atherosclerosis, and is activelyinvolved in the occurrence and development of the majority of cardiovascular diseases. As ED is reversibleand has significant prognostic impacts, there is a growing body of evidence supporting the need forED assessment to become a part of the routine medical practice, however there are still no appropriatemethods available to introduce it. The purpose of this paper is to provide fundamental principles in vascularbiology for clinical cardiologists and to propose some priorities for the future research activities.
Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral ...mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in Croatia. HAE is is most often related to decreased or dysfunctional C1 inh with autoactivation of C1 and bradykinin accumulation leading to localized dilatation and increased permeability of blood vessels resulting in tissue swelling. A diagnosis of HAE can be confirmed by measuring complement and C1 inh quantitative and functional levels.Three HAE types could be differentiated: HAE type 1 (C1 inh level is low), HAE type 2 (C1 inh level is normal but dysfunctional), and HAE type 3 (normal level and function of C1 inh). All patients suspected to have HAE-1/2 should be assessed for blood levels of C4, C1 inh protein, and C1 inh function. All attacks that result in debilitation/dysfunction and/or involve the face, the neck, or the abdomen should be considered for on-demand treatment. It is recommended that attacks are treated as early as possible. HAE attacks are treated with C1 inh, ecallantide, or icatibant.If these drugs are not available, attacks should be treated with solvent detergent-treated plasma (SDP). If SDP is not available, then attacks should be treated with frozen plasma.Intubation or tracheotomy should be considered early in progressive upper airway edema. Patients with attacks could receive adjuvant therapy when indicated (pain management, intravenous fluids). All patients should have on-demand treatment for two attacks and carry their on-demand treatment at all times. The administration of short-term prophylaxis should be considered before surgeries (dental/intraoral surgery, where endotracheal intubation is required), where upper airway or pharynx is manipulated, and before bronchoscopy or endoscopy. Long-term prophylaxis should be considered in all severely symptomatic HAE-1/2 patients. C1 inh concentrate or androgens can be used. Screening children for HAE-1/2 should be deferred until the age of 12 months, and all offspring of an affected parent should be tested.
Izražajnost glikoproteina mucina 2 (MUC2) i vaskularnog endotelnog faktora rasta (VEGF) u sluznici Barrettova jednjaka (BJ) može se dovesti u vezu s višim rizikom razvoja adenokarcinoma jednjaka. ...Studija je obuhvatila 36 bolesnika s dijagnozom BJ koja je potvrđena patohistološkom analizom nakon višestrukih biopsija ezofagogastričnog spoja. Izražajnost MUC2 i VEGF-a je prikazana imunohistokemijskom analizom. Otkrivena su četiri bolesnika u ranom stadiju adenokarcinoma
(učinjena je totalna ezofagektomija) i 32 bolesnika s BJ, od kojih je petoro imalo indikaciju za argon plazma koagulaciju, jedan za endoskopsku resekciju sluznice, jedan za radiofrekventnu ablaciju, a 25 ih je liječeno inhibitorima protonske pumpe. Regresija BJ je zabilježena u 25 (69,44%) bolesnika. Pozitivan nalaz MUC2 je karakterističan za vrčaste stanice u BJ, ali nije jedini biljeg. VEGF je pokazatelj angiogeneze u sluznici bolesnika s BJ i adenokarcinomom.
Cilj ove studije bio je procijeniti učinak argon plazma koagulacije (APK) u liječenju Barrettovog jednjaka (BJ), te utvrditi izražajnost mucinoznog glikoproteina (MUC2) i vaskularnog endotelnog ...faktora rasta (VEGF) u Barrettovoj sluznici prije i / ili nakon APK. Viši stupanj izražajnosti MUC2 i VEGF u Barrettovoj sluznici može biti povezan s većim rizikom za razvoj adenokarcinoma (AK). Istraživanjem je obuhvaćeno pet bolesnika s dijagnozom BJ - kratkog segmenta. Uključni kriterij bio je neuspješno liječenje samo inhibitorima protonske pumpe (IPP). Dijagnoza je potvrđena patohistološkom (PH) analizom nakon biopsije ezogafogastričnog (EG) spoja. Izražajnost MUC2 i VEGF određena je imunohistokemijom. Nakon nekoliko APK tretmana, kompletan oporavak sluznice EG spoja nastupio je kod ispitanika s pozitivnim nalazom intestinalne metaplazija (IM). Oporavak nije postignut u bolesnika s displastičnom promjenom tkiva. Nije nađeno maligne progresije. Liječenje je nastavljeno IPP-om, te endoskopskim praćenjem po smjernicama. Na kontrolnim analizama bioptata ezofagogastričnoga spoja, prikazana je regresija nalaza BJ u gastroezofagealnu refluksnu bolest (GERB) u četiri ispitanika. Ispitanici su nas obavijestili o kliničkom poboljšanju: imali su manje ili bili potpuno bez simptoma regurgitacije, žarenja i dispepsije, koji su bili glavni simptomi zbog kojih su došli u bolnicu.
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