Veterinary medicine - Repository of PHD, master's thesis
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Biomarker changes in suspected idiopathic normal-pressure hydrocephalus patients undergoing external lumbar drainage: a pilot study
No full textAim: To examine whether changes in biomarker concentrations in patients with idiopathic normal-pressure hydrocephalus (iNPH) during 72 h of external lumbar drainage (ELD) can differentiate between responders and non-responders.
Methods: Twenty patients with clinical and neuroradiological signs of iNPH underwent ELD over a period of 72 h. During this period, changes in cerebrospinal fluid (CSF) concentrations of biomarkers (amyloid-β, total and phosphorylated tau proteins) and intracranial pressure were monitored, and the volume of drained CSF was measured. Changes in the concentrations of selected biomarkers at three time points (0, 36, and 72 h) during ELD were tested for association with changes in clinical condition.
Results: Ten patients showed significant clinical improvement after ELD, quantified as a difference of two or more points on the Mini-Mental State Examination and/or Japanese iNPH grading scale. The concentration of all tested biomarkers increased during the first 36 h. Respondents had higher Aβ 1-42 at all time points, with a significant difference seen after 72 h. They also had a significantly higher Aβ1-42/Aβ1-40 ratio at all time points.
Conclusion: A gradual increase in Aβ 1-42 concentration during three-day ELD represents a possible positive prognostic factor for the placement of permanent CSF drainage in patients with iNPH
Diagnostic Assessment of Focal Liver Lesions Using Contrast-Enhanced Ultrasound
No full textŽarišne promjene jetre (ŽPJ) su heterogena skupina solidnih ili cističnih tvorbi koje se najčešće nađu slučajno tijekom ultrazvučnog pregleda abdomena. Uzimajući u obzir da je prevalencija benignih ŽPJ u općoj populaciji oko 15%, jednostavno i brzo razlikovanje od malignih lezija je od velike važnosti. Cilj ovog rada je pružiti pregled mogućnosti dijagnostike ŽPJ primjenom kontrastnog ultrazvuka (engl. contrast enhanced ultrasound, CEUS).
Kontrastni ultrazvuk je naziv za pregled ultrazvukom uz dodatak intravenskog ultrazvučnog kontrastnog sredstva koji je građen od mikromjehurića napunjenih plinovitim sumporovim heksafluoridom. Nakon intravenske primjene kontrasta razlikuju se tri specifične vaskularne faze (arterijska, portovenska i kasna faza) zahvaljujući dvostrukoj opskrbi jetre krvlju iz jetrene arterije i portalne vene. Najčešće benigne promjene jetre su hemangiom, fokalna nodularna hiperplazija, hepatocelularni adenom i fokalna masna infiltracija (hipersteatoza), ili zona poštede jetrenog parenhima od steatoze (hiposteatoza, engl. focal fatty sparing, FFS). Maligne ŽPJ dijele se na češće primarne (od kojih su najčešće hepatocelularni karcinom i kolangiokarcinom) te na sekundarne (metastaze), pri čemu su zadnje znatno češće u odnosu na primarne. Osim solidnih lezija jetre, razlikujemo i cistične ŽPJ. Maligne lezije su u pravilu hipervaskularne u arterijskoj fazi (u cijelosti ili djelomično) zbog obilne arterijske opskrbe, dok u portovenskoj, a pogotovo u kasnoj fazi, pokazuju fenomen ispiranja kontrasta. Benigne lezije ne pokazuju fenomen ispiranja kontrasta u portovenskoj i kasnoj fazi. Višestruka istraživanja i meta-analize potvrđuju sposobnost kontrastnog ultrazvuka da razgraniči benigne od malignih žarišnih promjena jetre sa značajno višom osjetljivošću i senzitivnošću u odnosu na klasični ultrazvuk. Također, osjetljivost i senzitivnost CEUS-a su jednake u odnosu na CT i MR. Što se tiče diferencijalne dijagnostike lezija, CEUS se pogotovo pokazao korisnim za definitivnu karakterizaciju benignih lezija jetre, dok potvrda dijagnoze malignih lezija većinom zahtijeva dodatnu dijagnostiku.
Kontrastni ultrazvuk predstavlja vrijedan dijagnostički alat kojim se može isključiti malignost i okarakterizirati benigna lezija u velikom broju slučajeva. Ovo predstavlja višestruku korist kako za pacijente, zbog brže dijagnostike i smanjenog ionizirajućeg zračenja, tako i za zdravstveni sustav zbog manje brojčane i financijske opterećenosti.Focal liver lesions (FLL) are a heterogeneous group of solid or cystic formations often discovered incidentally during abdominal ultrasound examinations. Considering the prevalence of benign FLLs in the general population is around 15%, the ability to quickly and accurately distinguish them from malignant lesions is of great importance. This paper aims to provide an overview of the diagnostic capabilities of contrast-enhanced ultrasound (CEUS) for FLLs.
Contrast-enhanced ultrasound involves the use of intravenous ultrasound contrast agents composed of microbubbles filled with gaseous sulfur hexafluoride. After intravenous administration, three specific vascular phases (arterial, portal venous, and late phases) can be distinguished due to the liver's dual blood supply from the hepatic artery and portal vein. The most common benign liver lesions include hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and focal fatty infiltration (hypersteatosis), or focal fatty sparing (hyposteatosis, FFS). Malignant FLLs are categorized into more common primary lesions (with hepatocellular carcinoma and cholangiocarcinoma being the most prevalent) and secondary lesions (metastases), with the latter being significantly more frequent than the former. In addition to solid liver lesions, cystic FLLs are also identified. Malignant lesions are typically hypervascular in the arterial phase (either completely or partially) due to abundant arterial supply, whereas in the portal venous and especially in the late phase, they exhibit a washout phenomenon. Benign lesions do not exhibit the washout phenomenon in the portal venous and late phases. Multiple studies and meta-analyses confirm the ability of contrast-enhanced ultrasound to distinguish between benign and malignant FLLs with significantly higher sensitivity and specificity compared to conventional ultrasound. Furthermore, the sensitivity and specificity of CEUS are comparable to those of CT and MRI. Regarding the differential diagnosis of lesions, CEUS has proven particularly useful for the definitive characterization of benign liver lesions, whereas the confirmation of malignant lesions often requires additional diagnostic methods.
Contrast-enhanced ultrasound represents a valuable diagnostic tool that can exclude malignancy and characterize benign lesions in a large number of cases. This offers multiple benefits for patients, including faster diagnosis and reduced exposure to ionizing radiation, as well as for the healthcare system by reducing numerical and financial burdens
Metabolic activity of CYP2C19 and CYP2D6 on antidepressant response from 13 clinical studies using genotype imputation: a meta-analysis
No full textCytochrome P450 enzymes including CYP2C19 and CYP2D6 are important for antidepressant metabolism and polymorphisms of these genes have been determined to predict metabolite levels. Nonetheless, more evidence is needed to understand the impact of genetic variations on antidepressant response. In this study, individual clinical and genetic data from 13 studies of European and East Asian ancestry populations were collected. The antidepressant response was clinically assessed as remission and percentage improvement. Imputed genotype was used to translate genetic polymorphisms to metabolic phenotypes (poor, intermediate, normal, and rapid+ultrarapid) of CYP2C19 and CYP2D6. CYP2D6 structural variants cannot be imputed from genotype data, limiting the determination of metabolic phenotypes, and precluding testing for association with response. The association of CYP2C19 metabolic phenotypes with treatment response was examined using normal metabolizers as the reference. Among 5843 depression patients, a higher remission rate was found in CYP2C19 poor metabolizers compared to normal metabolizers at nominal significance but did not survive after multiple testing correction (OR = 1.46, 95% CI [1.03, 2.06], p = 0.033, heterogeneity I2 = 0%, subgroup difference p = 0.72). No metabolic phenotype was associated with percentage improvement from baseline. After stratifying by antidepressants primarily metabolized by CYP2C19, no association was found between metabolic phenotypes and antidepressant response. Metabolic phenotypes showed differences in frequency, but not effect, between European- and East Asian-ancestry studies. In conclusion, metabolic phenotypes imputed from genetic variants using genotype were not associated with antidepressant response. CYP2C19 poor metabolizers could potentially contribute to antidepressant efficacy with more evidence needed. Sequencing and targeted pharmacogenetic testing, alongside information on side effects, antidepressant dosage, depression measures, and diverse ancestry studies, would more fully capture the influence of metabolic phenotypes
Large Anthrax Outbreak in a New Locality in Croatia, 2022
No full textBacillus anthracis is a well-known zoonotic pathogen that can cause disease in both animals and humans. Moreover, it has a high bioterrorism potential as its lethal spores are resistant to inactivation, are easy to produce in large quantities, and are easily spread over large areas. Anthrax cases occur in different parts of the world, including most European countries. Specific areas of Croatia are long known as anthrax districts, but with sporadically reported cases over the years. Here, we present a major outbreak of animal and human anthrax in the region of Lonjsko Polje in Croatia, a region not known to have anthrax cases in the past. The outbreak started in July 2022 and lasted several months, but most human and animal cases were reported in the first month. During the outbreak, there were 17 reported human cases of cutaneous anthrax and 29 laboratory-confirmed animal cases. However, due to issues in reporting in animals and the late finding of the carcasses, which made laboratory diagnostics challenging, the actual number of animal cases was probably significantly higher
Assessing Symptomatic Hypocalcemia Risk After Total Thyroidectomy: A Prospective Study
No full textIntroduction The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values.
Objective To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice.
Methods A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures.
Results Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia.
Conclusions The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited
Photodermatoses
No full textSunčeva svjetlost cjelokupni je spektar elektromagnetskog zračenja koji se sastoji od vidljivog (50 %), infracrvenog (40 %) i ultraljubičastog spektra (10 %). Upravo je ultraljubičasti spektar zračenja biološki najaktivniji. Na temelju valnih duljina, UV zračenje dijeli se na UVC (40 - 280 nm), UVB (280 - 315 nm) i UVA (315 - 400 nm). Prema odgovoru kože na sunčevo svjetlo, razlikuje se šest tipova kože (fototipova) prema Fitzpatricku (I - VI). Svi fototipovi kože reagiraju na sunčevu svjetlost jer koža sadrži molekule (kromofore) koje su sposobne upijati ultraljubičasto (UV) zračenje ili vidljivu svjetlost. Ta apsorbirana energija zatim se ponovno bezopasno emitira kao biološki neaktivno zračenje ili se preusmjerava na pokretanje fotokemijskih reakcija. Nukleinske kiseline najprisutnije su kromofore i mogu uzrokovati promjene izazvane UV zračenjem. Fotodermatoze (FD) čine veliku skupinu bolesti čije je zajedničko obilježje patološki obrazac reagiranja na izloženost sunčevu svjetlu. Prema novoj klasifikaciji, FD su podijeljene u četiri velike skupine: imunološki posredovane FD, fotoosjetljivost uzrokovana nasljednim defektima u DNA popravku, fotoosjetljivost uzrokovana kromosomskom nestabilnošću i fotoosjetljivost uzrokovana kemijskim tvarima i lijekovima. Prema učestalosti, polimorfna svjetlosna erupcija (PMLE) najčešća je imunološki posredovana FD; fotoosjetljivosti uzrokovane kromosomskom nestabilnošću ili lijekovima i kronični aktinični dermatitis, ovisno o populaciji, su nešto rjeđe, a solarna urtikarija je relativno rijetka. Svi ti oblici bolesti imaju značajan negativan učinak na kvalitetu života bolesnika. Sustavan pristup pacijentu koji uključuje anamnezu, fizikalni pregled, fototestiranje i laboratorijske testove važni su u dijagnostici bolesnika s FD. Za sve skupine FD osnova liječenja je prevencija koja uključuje zaštitu od sunca.Sunlight is the full spectrum of electromagnetic radiation, consisting of visible light (50%), infrared (40%), and ultraviolet spectrum (10%). The ultraviolet spectrum is the most biologically active. Based on wavelengths, UV radiation is divided into UVC (40-280 nm), UVB (280-315 nm), and UVA (315-400 nm). According to the skin's response to sunlight, there are six skin types (phototypes) classified based on the Fitzpatrick scale (I-VI). All skin phototypes react to sunlight because the skin contains molecules (chromophores) capable of absorbing ultraviolet (UV) radiation or visible light. This absorbed energy is then harmlessly re-emitted as biologically inactive radiation or redirected to initiate photochemical reactions. Nucleic acids are the most prevalent chromophores and can cause changes induced by UV radiation. Photodermatoses represent a large group of diseases characterized by a pathological pattern of response to sun exposure. According to the new classification, photodermatoses are divided into four major groups: immune-mediated photodermatoses, photosensitivity caused by inherited defects in DNA repair, photosensitivity caused by chromosomal instability, and photosensitivity induced by chemicals and medications. Polymorphic light eruption (PMLE) is the most common immune-mediated photodermatosis. Photosensitivity caused by chromosomal instability, drug-induced photosensitivity, and chronic actinic dermatitis are also common, depending on the population, while solar urticaria is relatively rare. All these forms of the disease have a significant negative impact on the patient's quality of life. A systematic approach, including medical history, physical examination, phototesting, and laboratory tests, is important in diagnosing patients with photodermatosis. Prevention is one of the fundamental parts of treatment for all photodermatosis groups which inlcludes sun protection
HLA Polymorphisms and Clinical Manifestations in IgA Vasculitis
No full textStudies concerning the genetic background of IgA vasculitis (IgAV), a small-vessel vasculitis occurring predominantly in childhood, have confirmed that the HLA-DRB1 gene showed a strong association with disease susceptibility. The objective was to investigate human leukocyte antigen (HLA) polymorphisms among Croatian patients with IgAV and their influence on disease susceptibility and clinical heterogeneity. Thus, 130 children with IgAV and 202 unrelated healthy individuals were enrolled in the study. Genomic DNA was extracted from whole peripheral blood, and HLA-A, -B, -DRB1 and -DQB1 gene polymorphism analysis was performed. HLA-A*03 (21.4% vs. 12.38%, p = 0.0092), HLA-B*37 (2.9% vs. 0.2%, p = 0.0054) and HLA-DRB1*12 (3.1% vs. 0.7%, p = 0.0216) alleles were significantly more frequent in IgAV patients than in controls. High-resolution typing revealed significantly higher frequency of HLA-DRB1*10:01 and -DRB1*11:03 among IgAV patients with gastrointestinal manifestations of the disease in comparison to controls (p = 0.0021 and p = 0.0301, respectively), while HLA-DRB1*14:01P occurred significantly more often in the group of patients who developed nephritis during the course of the disease (17.5% vs. 4.5%, p = 0.0006). Our results demonstrated that there is an association of HLA-A*03, HLA-B*37 and HLA-DRB1*12 alleles with susceptibility to IgAV in the examined Croatian pediatric population. Studies which aim to determine the HLA profile may contribute to the elucidation of the genetic background of autoimmune diseases, including IgAV
Arterial stiffness and target organ damage in treated hypertensive patients
No full textProcjena krutosti velikih krvnih žila mjerenjem brzine pulsnoga vala (PVW) uvrštena je u međunarodne smjernice procjene ukupnog kardiovaskularnog rizika na temelju velikih opservacijskih studija, te intervencijskih kliničkih pokusa. Zadnjih nekoliko godina posebno mjesto pridodaje se novoj metodi mjerenja PWV, koja obuhvaća dinamičko, 24h određivanje brzine pulsnoga vala, čime se dobijaju podaci o cirkardijarnom ritmu, o noćnim vrijednostima, te o varijabilnosti. U istraživanje će uključeno 154 bolesnika s dijagnozom esencijalne arterijske hipertenzije, starijih od 18 godina s potpisanom informiranom pristankom.
Glavni cilj istraživanja je bio odrediti povezanost 24h mjerenja PVW sa znakovima oštećenja ciljnih organa. Dodatni ciljevi su podrazumijevali analizu karakteristika 24h PVW u našoj skupini ispitanika: varijabilnost, cirkardijarni obrazac, noćnu krutost, jutarnji skok krutosti, maskirnu krutost, te „krutost bijele kute“, te usporedbu vrijednosti PVW izmjerenoga tijekom 24 sata s vrijednostima izmjerenim u ordinaciji.
Dobiveni rezultati potvrdili će kliničku vrijednost 24 satnog mjerenja PWV u liječenih hipertoničara. Utvrđeno je da je 24 satno mjerenje PWV bolji pokazatelj oštećenja ciljnih organa u odnosu na ordinacijsko mjerenje PWV. Ovo je potvrđeno za PWV mjeren tijekom 24 sata pomoću Mobil-O-Graph-a a uzimajući u obzir broj korelacija s pokazateljima oštećenja ciljnih organa, te jačinu koeficijenata korelacija. Vrijednosti PWV-a mjerenoga tijekom 24 sata (pomoću Mobil-O-Graph-a) bile su statistički značajno niže u odnosu na vrijednosti PWV mjerene ordinacijski pomoću SphygmoCor-a, dok nije nađena statistički značajna razlika u usporedbi s PWV mjerenim tijekom 24 sata pomoću Arteriograph-a. Vrijednosti PWV-a mjerene tijekom 24 sata pomoću Arteriograph-a bile su statistički značajno više u odnosu na 24 satne vrijednosti mjerene pomoću Mobil-O-Graph-a. Prosječne dnevne vrijednosti PWV bile su veće u odnosu na prosječne noćne vrijednosti PWV, na nivou statističke značajnosti mjerene pomoću obje oscilometrijske metode (Mobil-O-Graph i Arteriograph). Dnevno-noćni obrazac PWV-a pratio je dnevno-noćni obrazac AT-a. Analizirajući fenomene arterijske krutosti kao što je jutarnji skok krutosti verificirana je snažna povezanost s jutarnjim skokom AT (bez utjecaja drugih metaboličkih čimbenika, dobi, spola, termina poroda i porođajne mase u univarijatnome korelacijskom modelu analize), te je također verificirana statistički značajna korelacija između „efekta bijele kute“ za krutost mjerenu PWV-om i efekta „maskirne krutosti“ za PWV odnosu na iste fenomene AT-a tijekom 24 satnog mjerenja, čime je odgovoreno na zadane ciljeve istraživanja.Estimation of arterial stiffness by measuring pulse wave velocity (PVW) has been included in international guidelines for assessment of general cardiovascular risk based on large observational studies and interventional clinical trials. In the last few years, a special attention has been given to a new method of measuring PVW, i.e. dynamic, 24-hour measurement of
the pulse wave velocity, which provides data on circadian rhythm, night values, and variability. It was included 154 patients with primary arterial hypertension, older than 18 years with signed informed consent.
The main goal of the study was to determine the association of 24 hours PVW measurements with target organ damages. Additional goals include analysis of 24 hours PVW characteristics in our group of subjects: variability, circadian pattern, night stiffness, increased morning stiffness, masked stiffness, and "white coat stiffness", and comparison of PVW values
measured during 24 hours with values measured in the office.
The obtained results confirmed the clinical value of 24 hours PVW measurements in treated hypertensive patients. It was found that 24 hours PWV measurement is a better indicator of target organ damages compared to office PWV measurement. This was confirmed for PWV measured over 24 hours using the Mobil-O-Graph, taking into account the number of correlations with indicators of target organ damage, and the strength of the correlation coefficients. Pulse wave velocity values measured during 24 hours (using Mobil-O-Graph) were statistically significantly lower compared to PWV values measured in the office using SphygmoCor, while no statistically significant difference was found compared to PWV
measured during 24 hours using Arteriograph. PWV values measured over 24 hours using the Arteriograph were statistically significantly higher compared to 24 hour values measured using the Mobil-O-Graph. An average daytime PWV values were higher compared to an average nighttime PWV values, at the level of statistical significance measured using both oscillometric methods (Mobil-O-Graph and Arteriograph). The day-night pattern of PWV followed the day-night pattern of arterial pressure. Analyzing the phenomena of arterial stiffness such as the morning surge in stiffness, a strong association with the morning surge in arterial pressure was verified (without the influence of other metabolic factors, age, sex, date of birth and birth weight in the univariate correlation model of the analysis), and a statistically significant correlation was also verified between "white coat effect" for stiffness measured by PWV and the effect of "masked stiffness" for PWV in relation to the same phenomena in arterial pressure during 24 hours measurement, what answered the main goals of the research
Impact of COVID – 19 pandemic on the quality of life of medical students
No full textUvod: U dostupnoj literaturi populacija studenata izdvaja se iz opće populacije kao zasebna s uočenom
nižom razinom kvalitete života u odnosu na opću populaciju. Studije prije pandemije pokazuju da studenti,
a poglavito studenti medicine, prijavljuju nižu kvalitetu života tijekom pandemije. Pandemija COVID-19
utjecala je na sve aspekte života, uključujući i kvalitetu života. Cilj ovoga istraživanja bio je procijeniti
kvalitetu života studenata Medicinskog fakulteta Sveučilišta u Zagrebu tijekom pandemije COVID-19.
Ispitanici i metode: Uzorak ispitanika u ovom istraživanju činilo je 404 studenata medicine (34,4%
mladića i 65,6% djevojaka) sa Sveučilišta u Zagrebu, akademske godine 2019./2020. Studenti su ispunili
demografski upitnik, upitnik Svjetske zdravstvene organizacije o kvaliteti života-kratka verzija
(WHOQOL-BREF) i dodatni upitnik o COVID-19.
Rezultati: Studenti medicine, u procjeni kvalitete života, najviše vrijednosti iskazali su u okolišnoj
domeni (75,97 ± 15,10),tjelesnoj (69,18 ± 17,79), društvenoj (66,46 ± 21,15),te u psihološkoj domeni
(63,11 ± 20,06). Multivarijatna regresijska analiza izdvojila je ženski spol (β= -2,213, p<0,001) i osjećaj
zabrinutosti nakon porasta pandemije COVID-19 (β= -2,306, p=0,022) kao prediktore lošijeg tjelesnog
funkcioniranja. Nasuprot tome, prediktori boljeg tjelesnog funkcioniranja bili su viša godina studija
(β=0,162, p<0,001) i bolja akademska postignuća (β=0,384, p<0,001).
Zaključak: Rezultati pokazuju da su studenti medicine procijenili svoju kvalitetu života na početku
pandemije COVID-19 dobrom u sve četiri domene. Utjecaj ženskoga spola i više godine studija na tjelesnu
i psihološku domenu kvalitete života, upućuju na potrebu razvoja intervencije u specifičnim dijelovima
studentske populacije.Introduction: Considering the quality of life, it has been found that students stand out from the general population as a separate population, with an observed lower level of quality of life compared to the general population, especially medical students. The COVID-19 pandemic affected all aspects of life, including the quality of life. The aim of this study was to estimate the quality of life of medical students of the University of Zagreb during the COVID-19 pandemic.
Method and materials: The sample of respondents in this study consists of 404 medical students (34.4% males) from the University of Zagreb, in the academic year 2019/2020. The students filled out a demographic questionnaire, the World Health Organization Quality of Life Questionnaire-Short Version (WHOQOL-BREF), and an additional questionnaire about COVID-19.
Results: Medical students, in assessing the quality of life, achieved the highest values in the environmental domain (75.97 ± 15.10), followed by the physical domain (69.18 ± 17.79), the social domain (66.46 ± 21.15) and the psychological domain (63.11 ± 20.06). Multivariate regression analysis singled out women (β= -2.213, P<0.001), and the feeling of concern after the escalation of the COVID-19 pandemic (β= -2.306, P=0.022) as predictors of poorer physical functioning. In contrast, predictors of better physical functioning were higher years of study (β=0.162, p<0.001) and better academic achievements (β=0.384, P<0.001).
Conclusion: The results showed that medical students at the beginning of the COVID-19 pandemic reported their quality of life as good in all four domains. The influence of the female gender and higher study years on the physical and psychological domains of quality of life point to the need for the development of interventions in specific parts of the student population
Severe Early-Onset Intrahepatic Cholestasis of Pregnancy Following Ovarian Hyperstimulation Syndrome with Pulmonary Presentation after In Vitro Fertilization: Case Report and Systematic Review of Case Reports
No full textBackground: Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease, usually presented in the third trimester with pruritus, elevated transaminase, and serum total bile acids. Evidence shows that it can be developed in the first trimester, more commonly after in vitro fertilization (IVF) procedures, with the presence of ovarian hyperstimulation syndrome (OHSS).
Methods: A literature search was conducted in the PubMed/MEDLINE database of case reports/studies reporting early-onset ICP in spontaneous and IVF pregnancies published until July 2023.
Results: Thirty articles on early-onset ICP were included in the review analysis, with 19 patients who developed ICP in spontaneous pregnancy and 15 patients who developed ICP in IVF pregnancies with or without OHSS. Cases of 1st and 2nd trimester ICP in terms of “early-onset” ICP were pooled to gather additional findings.
Conclusions: Proper monitoring should be applied even before expected pregnancy and during IVF procedures in patients with known risk factors for OHSS and ICP development (patient and family history), with proper progesterone supplementation dosage and genetic testing in case of ICP recurrence