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Association between CXCL9/10 polymorphisms and acute rejection of liver allograft
Get PDFWhile increased serum concentrations of CXCL9/10 are associated with acute cellular rejection (ACR) occurrence, the association between CXCL9/10 single nucleotide polymorphisms (SNPs) and ACR after liver transplantation (LT) remains unknown. In the present case-control study, polymorphisms of CXCL9 (rs10336) and CXCL10 (rs3921) were determined by polymerase chain reaction in 215 liver transplant recipients. ACR was defined as biopsy proven within 6 months after LT. As selected SNPs were in 3'-UTR region, their possible association with protein synthesis was assessed by measuring the plasma concentration of CXCL9/10 in a cohort of 40 new transplant patients using ELISA. There was no association between CXCL9/10 genotypes and overall incidence of ACR. However, patients with CXCL9 genotype AA developed ACR earlier than patients with GG genotype (P = .003), with similar results for CXCL10 gene (CC vs GG; P = .005). There was no statistically significant difference in plasma concentrations of CXCL9/10 between the rejectors and the non-rejectors. Of note, patients with AA CXCL9 genotype had significantly higher CXCL9 plasma concentrations than patients with AG (P = .01) or GG genotype (P = .045).In conclusion, the SNPs of CXCL9 (rs10336) and CXCL10 (rs3921) are not associated with the incidence of ACR. However, patients with CXCL9 genotype AA developed ACR earlier and the same genotype was associated with greater plasma concentrations suggesting the involvement of CXCL9 mediated processes in ACR development
Analiza ishoda liječenja djece sa sindromom hipoplastičnoga lijevoga srca u Hrvatskoj [Analysis of treatment outcome in children with hypoplastic left heart syndrome in Croatia]
Get PDFHypoplastic left heart syndrome (HLHS) indicates the spectrum of developmental disorders of all left heart components. The incidence of HLHS in Croatia is 2.3% among congenital heart malformations. Diagnosis is primarily attributed to echocardiography. After initial stabilisation, the main treatment method are three palliative operations that allow lifelong function of the right ventricle as systemic (operations by Norwood, Glenn and Fontan). The aim of this study was to evaluate the outcomes of treating patients with HLHS. We included 57 patients in 12-year period operated in foreign centers, who have been treated at University hospital center Zagreb, before and in the meantime. The main methods were statistical, and the study was created according to clinical and demographic characteristics. The outcome of treatment was estimated to survive after and between surgery - from Norwood to Glenn (PCPC), Glenn to Fontan (TCPC) and after completion of surgical palliative treatment.
The majority of subjects passed in interstage, followed by a quiet period. Total long-term survival by Kaplan-Meier’s is 54% (43-69%). Almost 80% of patients have excellent quality of life, while negligible number of patients have poor or very poor quality of life (3,5%). An increasing number of patients are experiencing an adult age
Akutna okluzija koronarne arterije kao pretkazatelj ishoda bolesnika s akutnim infarktom miokarda [Acute coronary occlusion as a predictor of outcome in patients with acute myocardial infarction]
Get PDFAcute myocardial infarction remains the leading cause of death in the developed world,
despite advances in the treatment. We used the coronary angiography to reclassify subjects into
those with the angiographically occluded coronary artery and those without occlusion. Our goal
was to better define the underlying pathophysiology of acute myocardial infarction. The aim of
the study was to evaluate prognostic impact of acute occlusion of coronary artery on outcome.
We performed observational, prospective study from January 2011-January 2017 in
University Hospital Sestre milosrdnice. Follow up period lasted until 1.1.2019. The study
population was 2483 patients. Mortality rates in thirty-day follow up were higher among
patients with occlusive myocardial infarction (7,3% vs. 3,6%, p=0000). In the long term follow
up patients with the non-occlusive myocardial infarction had higher mortality rates without
statistically significance (19% vs. 21,5%, p=0,374). We identified independent risk factors for
long term mortality: age, peripheral artery disease, anemia, ventricular tachycardia at admission
or during PCI, glucosae levels at admission, left ventricular ejection fraction, mitral
regurgitation and aortic stenosis.
Patients with the occlusive myocardial infarction had higher mortality rates in thirty-day
follow up. After long term follow up had better prognosis but difference didn’t meet statistical
significance
Clustering of multiple energy balance-related behaviors in school children and its association with overweight and obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017)
Get PDFIt is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged
children. We investigated the clustering of energy balance-related behaviors and whether the
identified clusters were associated with weight status. Participants were 6- to 9-year-old children
(n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the
World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy
balance-related behaviors were parentally reported. Weight and height were objectively measured.
We performed cluster analysis separately per group of countries (North Europe, East Europe,
South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified
in each group. Healthier clusters were common across groups. The pattern of distribution of
healthy and unhealthy behaviors within each cluster was group specific. Associations between
the clustering of energy balance-related behaviors and weight status varied per group. In South
Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated
with higher risk of overweight/obesity when compared with the cluster ‘Physically active and healthy
diet’. Few or no associations were observed in North Europe and West-Central Asia, respectively.
These findings support the hypothesis that unfavorable weight status is associated with a particular
combination of energy balance-related behavior patterns, but only in some groups of countries
Smjernice Hrvatskog društva za hematologiju HLZ-a i KROHEM-a za zbrinjavanje anemije uzrokovane manjkom željeza [Croatian Hematology Society and CROHEM guidelines for the treatment of iron deficiency anemia]
Get PDFIron deficiency anemia (IDA) is an important public health problem. Almost 30% of the world’s
population (> 2 billion) has iron deficiency (ID) with or without anemia. Treatment of IDA requires teamwork. It
is important to treat anemia and the underlying cause of anemia. Functional iron deficiency (FID ) is a state with
insufficient iron absorption and incorporation into erythroid precursors, whereas iron stores (ferritin) are normal
or increased. FID is associated with anemia of chronic disease (ACD), chronic kidney disease, inflammatory bowel
disease, chronic heart failure and malignant diseases. Oral and parenteral iron preparations can be used for the
treatment of IDA. Novel iron parenteral preparations allow rapid normalization of total body iron even with a
single infusion, with high effectiveness and safety
A rare case of Fitz-Hugh–Curtis syndrome caused by Chlamydia trachomatis in an HIV-positive male patient
Get PDFFitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus
called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a
sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any
morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the
perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a
33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant
pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular
thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver
computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made.
Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper
abdominal quadrant pain, especially in men who have sex with other men
Transrektalna elastografija u razlikovanju Crohnove bolesti i ulceroznoga kolitisa [Transrectal elastography in differentiation between Crohn's disease and ulcerative colitis]
Get PDFThe patterns of inflammation and collagen deposition differ between Crohn's disease (CD) and ulcerative colitis (UC). Assuming that both processes alter the mechanical properties of the bowel wall, its stiffness is a potential discriminatory feature between the two diseases.
The aim of this study was to determine whether is it possible to differentiate between active Crohn's colitis, with rectal involvement, and active ulcerative colitis, on the grounds of pseudoquantitative measurements obtained by transrectal ultrasound-guided strain elastography.
28 CD patients, 30 UC patients and 30 controls were enrolled in the study.
Regions of interest were placed over the rectal wall and the adjacent perirectal tissue. Relative strain and average Histogram values were measured in every region and Strain Ratio (SR) and Histogram Ratio (HR) were calculated.
There were no statistically significant differences in SR and HR between the three groups. The relative rectal wall strain was lower in CB group compared to UC group (P=0,035), average rectal wall Histogram value was higher in CB group compared to UC group but the difference did not reach statistical significance (P=0,067).
According to our results, SR and HR measurements do not discriminate between UC and CB, however, relative strain differences between the two groups suggest that strain elastography might have a role in inflammatory bowel disease diagnostics
Presence of ROS in inflammatory environment of peri-implantitis tissue: in vitro and in vivo human evidence
Get PDFAnalyses of composition, distribution of cellular and extracellular matrix components, and molecular analysis of mitochondria related genes of bone loss in the presence of inflammatory environment in humans was the aim of the present project. As a human model we chose peri-implantitis. Morphological analyses were performed by means classical histological, immunohistochemical, and SEM (scanning electron miscroscopy) test. Gene expression analysis was performed to evaluate epithelium maturation, collagen fiber production, and genes related to mitochondrial activity. It was found that a well-defined keratinocyte epithelium was present on the top of all specimens; a distinct basal lamina was present, as well as desmosomes and autophagic processes related to the maturation of keratinocytes. Under this epithelium, a full inflammatory cell infiltrate was present for about 60% of the represented by plasma cells. Collagen type I fibers were present mainly in the form of fragmented cord tissue without cells. A different distribution of blood vessels was also present from the apical to the most coronal portion of the specimens. High levels of genes related to oxidative stress were present, as well as the activation of genes related to the loss of ability of osteogenic commitment of Mesenchymal stem cells into osteoblasts. Our study suggests that peri-implantitis lesions exhibit a well defined biological organization not only in terms of inflammatory cells but also on vessel and extracellular matrix components even if no difference in the epithelium is evident, and that the presence of reactive oxygen species (ROS) related to the inflammatory environment influences the correct commitment of Mesenchymal stem cells
Culture of blame—an ongoing burden for doctors and patient safety
Get PDFIntroduction: Every procedure in healthcare carries a certain degree of inherent unsafety resulting from problems in practice, which might lead to a healthcare adverse event (HAE). It is very important, and even mandatory, to report HAE. The point of HAE reporting is not to blame the person, but to learn from the HAE in order to prevent future HAEs. ----- Study question: Our aim was to examine the prevalence and the impact of culture of blame on health workers' health. ----- Methods: A cross-sectional study on healthcare workers at two Croatian hospitals was conducted using the Hospital Survey on Patient Safety Culture (PSC). ----- Results: The majority of PSC dimensions in both hospitals were high. Among the dimensions, Hospital Handoffs and Transitions and Overall Perceptions of Safety had the highest values. The Nonpunitive Response to Error dimension had low values, indicating the ongoing culture of blame. The Staffing dimension had low values, indicating the ongoing shortage of doctors and nurses. -----Discussion: We found inconsistencies between a single-item measure and PSC dimensions. It was expected that Frequency of Events Reported (PSC dimension) relates to Number of Events Reported (single-item measure). However, in our study, the relations between these pairs of measures were different between hospitals. Our results indicate the ongoing culture of blame. Healthcare workers do not report HAE because they fear they will be punished by management or by law
Hypertrophic recurring lichen planus of the external auditory canal
Get PDFIntroduction: We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss. -----
Case summary: A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically. -----
Discussion: Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure