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BACKGROUND: Anemia is present in almost 5% of adults worldwide and accompanies clinical findings in many diseases. Diseases of the gastrointestinal (GI) tract and liver are a common cause of anemia, so patients with anemia are often referred to a gastroenterologist. SUMMARY: Anemia could be caused by various factors such as chronic bleeding, malabsorption, or chronic inflammation. In clinical practice, iron deficiency anemia and the combined forms of anemia due to different pathophysiological mechanisms are most common. Esophagogastroduodenoscopy, colonoscopy, and the small intestine examinations in specific situations play a crucial role in diagnosing anemia. In anemic, GI asymptomatic patients, there are recommendations for bidirectional endoscopy. Although GI malignancies are the most common cause of chronic bleeding, all conditions leading to blood loss, malabsorption, and chronic inflammation should be considered. From a gastroenterologist's perspective, the clinical spectrum of anemia is vast because many different digestive tract diseases lead to bleeding. Key Messages: The gastroenterological approach in solving anemia's problem requires an optimal strategy, consideration of the accompanying clinical signs, and the fastest possible diagnosis. Although patients with symptoms of anemia are often referred to gastroenterologists, the diagnostic approach requires further improvement in everyday clinical practice.
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Anemia Ferropriva , Anemia , Gastroenteropatias , Neoplasias Gastrointestinais , Adulto , Anemia/complicações , Anemia/etiologia , Anemia Ferropriva/complicações , Anemia Ferropriva/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Gastroenteropatias/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Neoplasias Gastrointestinais/diagnóstico , HumanosRESUMO
BACKGROUND: Diarrhea is defined as the passage of loose stools and increase in stool frequency, weight, or volume. Diarrhea is an important health issue since it accounts for 2.5 million deaths in the world each year. SUMMARY: Diarrhea can be acute, persistent, or chronic. Acute diarrhea (AD) is usually infectious, caused by viruses, less frequently by bacteria and parasites. The majority of cases of AD are self-limiting and do not require diagnostic workup. The use of diagnostic tests in AD should be limited to patients with signs of severe dehydration, bloody stools, persistent fever and those suffering from immunodeficiencies using immunosuppressive therapy or to cases of suspected nosocomial infection. These patients should be referred to gastroenterologists or infectious disease specialists. Therapy in AD consists of early oral refeeding, antidiarrheal medications, antibiotics, and probiotics. Chronic diarrhea (CD) has diverse etiology. The majority of patients have self-limiting symptoms or functional gastrointestinal disorders. Patients with blood in stool, weight loss, clinical and laboratory signs of anemia, and palpable mass in the abdomen (red flag symptoms) need urgent gastroenterology referral. Therapy in CD is possible when the underlying cause of symptoms is identified. KEY MESSAGES: The general practitioner should identify high-risk patients with AD and/or red flag symptoms for urgent gastroenterology referral.
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Gastroenterologistas , Clínicos Gerais , Antibacterianos/uso terapêutico , Diarreia/tratamento farmacológico , Diarreia/terapia , Fezes , HumanosRESUMO
BACKGROUND: Abdominal pain is a common symptom of gastroenterology examination. Chronic abdominal pain is present for >3 months. SUMMARY: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered by both gastroenterologists and general practitioners. GERD is usually a chronic disease presented with a set of symptoms including heartburn and/or regurgitation, and less commonly epigastric pain. Epigastric pain syndrome is characterized by the following symptoms: epigastric pain and/or burning. It does not necessarily occur after meal ingestion, may occur during fasting, and can be even improved by meal ingestion. Duodenal ulcers tend to cause abdominal pain that is localized in the epigastric region and commence several hours after eating, often at night. Hunger provokes pain in most of the cases and decreases after meal. Gastric ulcer pain occurs immediately after eating, and consuming food increases pain. Pain is localized in the epigastrium and can radiate to the back. Abdominal pain in irritable bowel syndrome is related to defecation. A typical symptom of chronic pancreatitis is pain that radiates to the back. In Crohn's disease, inflammation causes pain. Key Messages: Pain can occur at different locations with diverse intensity and propagation and is often associated with other symptoms. For any gastroenterologist, abdominal pain is a big challenge.
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Dispepsia , Gastroenterologistas , Refluxo Gastroesofágico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dispepsia/diagnóstico , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Azia/etiologia , HumanosRESUMO
BACKGROUND: Available data suggest that the prevalence of chronic liver disease (CLD) and primary liver cancer is rising in Europe and represents a major public health problem. Predictions are showing that these trends will continue to rise in the upcoming years. SUMMARY: Alcohol-related liver disease, nonalcohol fatty liver disease, and viral hepatitis B and hepatitis C are the leading causes of liver cirrhosis and primary liver cancer in Europe. Drug-induced liver injury represents a major cause of acute hepatitis, while liver transplantation is the second most common solid organ transplantation in the world. Patients with CLD have increasing rates of hospitalization, longer hospital stays, and more adverse outcomes compared to the other chronic conditions. Direct targeting of risk factors can prevent complications of advanced liver disease and improve outcome. Patients with CLD should be referred to a hepatologist for assessment of the stage of liver disease, for specific treatment and screening for hepatocellular carcinoma. Moreover, patients with unknown etiology of abnormal liver blood tests should be referred to a hepatologist for assessment of liver disease, as well as for prevention and treatment of complications of cirrhosis and/or portal hypertension. Key Messages: CLD is amenable to prevention and treatment, while disease management strategies need to improve in order to reduce the burden of liver disease and deaths due to end-stage liver diseases.
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Carcinoma Hepatocelular , Gastroenterologistas , Neoplasias Hepáticas , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/etiologia , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologiaRESUMO
The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) underscores the need for better understanding of its complex pathogenesis. Lipid accumulation in hepatocytes is among principal mechanisms contributing to MASLD development. While routine lipid parameters are well studied, the profile of circulating fatty acids in MASLD patients remains less explored. This study aimed to assess relative proportions of individual fatty acids in plasma of MASLD patients and to explore their associations with other biochemical markers of MASLD. Ninety-one patients and 48 healthy individuals were enrolled. The relative proportions of fatty acids in plasma were determined using gas chromatography with FID detection. Proportions of total n-6 polyunsaturated fatty acids (PUFAs) and linoleic acid (LA) in plasma were lower in MASLD patients (p = 0.001 and p = 0.004, respectively), with no differences observed in n-3 PUFAs. Total plasma n-6 PUFAs correlated negatively with body mass index, hepatic steatosis indices, triglyceride concentration and coronary risk index. Decreased prevalence of n-6 PUFAs in plasma was independently associated with higher odds of MASLD (OR = 0.769; CI: 0.611-0.968; p = 0.025). Our findings indicate an altered circulatory fatty acid distribution in MASLD, characterized by a reduced amount of n-6 PUFAs, particularly LA, which may have significant implications for the prevention and treatment of MASLD.
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Ácidos Graxos Ômega-3 , Ácidos Graxos Ômega-6 , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ácidos Graxos Ômega-6/sangue , Ácidos Graxos Ômega-6/metabolismo , Ácidos Graxos Ômega-3/sangue , Fígado Gorduroso/sangue , Fígado Gorduroso/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Índice de Massa CorporalRESUMO
The mental health of healthcare workers, especially the nursing staff in intensive care units, is crucial for the optimal functioning of healthcare systems during medical emergencies. This study implements a cross-sectional design to investigate the associations between nurses' personal characteristics, workplace challenges, and job satisfaction with the increased perception of tension, stress, and pressure at the workplace (TSPW) before and during the COVID-19 pandemic. In 2021, we surveyed 4210 nurses from 19 intensive healthcare facilities in the capital of Serbia, Belgrade, and, at that time, collected data about their perceived TSPW before and during the COVID-19 pandemic. Our study identified six predictors of the increase in TSPW, as perceived by nurses: their work in COVID-19 infectious zones (OR = 1.446), exhaustion due to work under protective equipment (OR = 1.413), uncertainty and fear of infection (OR = 1.481), a high degree of superiors' appreciation and respect (OR = 1.147), a high degree of patients' attitudes (OR = 1.111), and a low degree of work autonomy (OR = 0.889). The study's findings suggest that a solution to this issue is necessary to ensure that nurses are safe and able to alleviate the physical and mental strain that comes with prolonged use of protective equipment. Nurses on the frontline of the pandemic require better health protection, better conditions, and respect for their role. Strategies to promote mental health would help reduce nurses' stress and increase job satisfaction.
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The aim of this study was to examine the prevalence and association of school-age children's participation in bullying, focusing on their health characteristics, risk factors, and leisure activities. We performed a secondary analysis of the original data of the 2017 HBSC study to examine participation in bullying once and multiple times among school-age children in Serbia. For this purpose, a nationally representative sample of 3267 children from 64 primary and high schools in the Republic of Serbia was evaluated. The outcome variable of interest in our study was participation in bullying. Further groups of individual variables such as health characteristics, risk factors, and leisure activities were assessed. Multivariate regression analysis indicated that children who felt everyday stomach pain, irritability or bad mood, and nervousness were more likely to participate in bullying at least once compared with those who rarely or never had such symptoms by 1.46, 1.58, and 1.58 times, respectively. School-age children who reported being drunk two to three times, and four or more times in life were more likely to participate in bullying than those who reported never being drunk by 1.53 and 1.74 times, respectively. Children who reported to watch TV or other media for five or more hours per day were 2.34 times more likely to be involved in bullying at least once. Multiple regression analysis showed that students with daily stomach pain, back pain, nervousness, and dizziness were more likely to be involved in multiple bullying by 1.16, 1.62, 1.82, and 1.70 times, respectively. Students who had nightly meetings or reported being drunk four or more times in the last 30 days were more likely to be involved in multiple bullying by 2.54 and 3.47, respectively. Students who reported playing games five or more times per day were 2.70 times more likely to be involved in this multiple bullying. This study highlights the importance of professional and family education programmes for early identification of specific health symptoms in the pediatric population, as well as integration with interventions aimed at reducing alcohol abuse among school-age children.
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Bullying , Vítimas de Crime , Criança , Humanos , Humor Irritável , Atividades de Lazer , Dor , Fatores de Risco , Sérvia/epidemiologiaRESUMO
Widespread coronavirus disease (COVID)-19 is causing pneumonia, respiratory and multiorgan failure in susceptible individuals. Dysregulated immune response marks severe COVID-19, but the immunological mechanisms driving COVID-19 pathogenesis are still largely unknown, which is hampering the development of efficient treatments. Here we analyzed ~140 parameters of cellular and humoral immune response in peripheral blood of 41 COVID-19 patients and 16 age/gender-matched healthy donors by flow-cytometry, quantitative PCR, western blot and ELISA, followed by integrated correlation analyses with ~30 common clinical and laboratory parameters. We found that lymphocytopenia in severe COVID-19 patients (n=20) strongly affects T, NK and NKT cells, but not B cells and antibody production. Unlike increased activation of ICOS-1+ CD4+ T cells in mild COVID-19 patients (n=21), T cells in severe patients showed impaired activation, low IFN-γ production and high functional exhaustion, which correlated with significantly down-regulated HLA-DR expression in monocytes, dendritic cells and B cells. The latter phenomenon was followed by lower interferon responsive factor (IRF)-8 and autophagy-related genes expressions, and the expansion of myeloid derived suppressor cells (MDSC). Intriguingly, PD-L1-, ILT-3-, and IDO-1-expressing monocytic MDSC were the dominant producers of IL-6 and IL-10, which correlated with the increased inflammation and accumulation of regulatory B and T cell subsets in severe COVID-19 patients. Overall, down-regulated IRF-8 and autophagy-related genes expression, and the expansion of MDSC subsets could play critical roles in dysregulating T cell response in COVID-19, which could have large implications in diagnostics and design of novel therapeutics for this disease.
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Proteínas Relacionadas à Autofagia/biossíntese , COVID-19/imunologia , Células Supressoras Mieloides/imunologia , SARS-CoV-2/imunologia , Subpopulações de Linfócitos T/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autofagia/imunologia , Proteínas Relacionadas à Autofagia/imunologia , Proteínas Relacionadas à Autofagia/metabolismo , COVID-19/metabolismo , COVID-19/patologia , COVID-19/virologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Imunidade , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Monócitos/imunologia , Células Supressoras Mieloides/patologia , Subpopulações de Linfócitos T/patologia , Linfócitos T/imunologiaRESUMO
Gastroesophageal Reflux Disease (GERD) is characterized by acid and bile reflux in the distal oesophagus, and this may cause the development of reflux esophagitis and Barrett's oesophagus (BE). The natural histological course of untreated BE is non-dysplastic or benign BE (ND), then lowgrade (LGD) and High-Grade Dysplastic (HGD) BE, with the expected increase in malignancy transfer to oesophagal adenocarcinoma (EAC). The gold standard for BE diagnostics involves high-resolution white-light endoscopy, followed by uniform endoscopy findings description (Prague classification) with biopsy performance according to Seattle protocol. The medical treatment of GERD and BE includes the use of proton pump inhibitors (PPIs) regarding symptoms control. It is noteworthy that long-term use of PPIs increases gastrin level, which can contribute to transfer from BE to EAC, as a result of its effects on the proliferation of BE epithelium. Endoscopy treatment includes a wide range of resection and ablative techniques, such as radio-frequency ablation (RFA), often concomitantly used in everyday endoscopy practice (multimodal therapy). RFA promotes mucosal necrosis of treated oesophagal region via high-frequency energy. Laparoscopic surgery, partial or total fundoplication, is reserved for PPIs and endoscopy indolent patients or in those with progressive disease. This review aims to explain distinct effects of PPIs and RFA modalities, illuminate certain aspects of molecular mechanisms involved, as well as the effects of their concomitant use regarding the treatment of BE and prevention of its transfer to EAC.
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Esôfago de Barrett/tratamento farmacológico , Inibidores da Bomba de Prótons/farmacologia , Bombas de Próton/metabolismo , Esôfago de Barrett/metabolismo , Humanos , Inibidores da Bomba de Prótons/química , Ablação por RadiofrequênciaRESUMO
BACKGROUND: Crohn's disease (CD) and multiple sclerosis (MS) share common pathogenic processes. Interferon (IFN) beta-1a is effective and generally well tolerated in patients with MS and has been shown to down-regulate the expression of interleukin-12, a cytokine that is thought to be involved in mucosal degeneration in CD. IFN beta-1a therefore offers promise as a treatment for CD. METHODS: In this multicentre, double-blind, placebo-controlled, phase II, dose-finding study, patients with steroid-induced clinical remissions of CD were randomized 1:1:1:1 to subcutaneous IFN beta-1a: 66 mcg three times weekly (tiw), 44 mcg tiw, 44 mcg twice weekly (biw), or matching placebo tiw with steroid tapering. The primary endpoint was the proportion of patients relapse-free at Week 26. Safety was also assessed. RESULTS: This study was terminated early following a planned interim analysis at 26 weeks. Of the planned 192 patients, 67 were randomized to treatment: placebo (n = 16), or IFN beta-1a 44 mcg biw (n = 17), 44 mcg tiw (n = 16) or 66 mcg tiw (n = 18). In total, 20/67 patients (29.9%) completed 26 weeks and 7 patients (10.4%) completed 52 weeks. The proportion of patients who remained relapse-free at Week 26 did not differ significantly between the placebo group (5/16, 31%) and the IFN beta-1a 44 mcg biw (6/17, 35%; p = 0.497), 44 mcg tiw (7/16, 44%; p = 0.280) or 66 mcg tiw (2/18, 11%; p = 0.333) groups. There was little difference between treatment groups in secondary efficacy endpoints. IFN beta-1a was generally well tolerated at all doses. Adverse events (AEs) were generally mild or moderate in IFN beta-1a-treated patients, with the most common AEs (influenza-like symptoms, headache, injection-site reactions) being similar to those reported with IFN beta-1a in MS. CONCLUSION: There was no difference in efficacy between patients with CD receiving IFN beta-1a or placebo. However, these results should be considered in the context of the low patient numbers and high dropout rate. Overall, IFN beta-1a was generally well tolerated, with a safety profile that was consistent with previous experience in MS. TRIAL REGISTRATION: ClinicalTrials.gov NCT00304252.
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Adjuvantes Imunológicos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Interferon beta/uso terapêutico , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Cefaleia/induzido quimicamente , Humanos , Influenza Humana/induzido quimicamente , Injeções Subcutâneas , Interferon beta-1a , Interferon beta/administração & dosagem , Interferon beta/efeitos adversos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Resultado do TratamentoRESUMO
The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15-24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logistic regression modeling. The study shows that 13.4% of youths experienced multi-victimization, while 10.4% were perpetrators of violence. Up to one-third of the victims were violence perpetrators. A small percentage of victims seek family and community support. Predictors of violence among youths were: male sex, households with fewer members, urban settlements, violence perpetration, self-assessed health as poor, lack of close friends and perception that it was difficult to obtain the assistance needed. Predictors of youth violence highlighted the need to improve health education, social support and community regulations, as well as strengthen the promotion of gender equality and a healthy environment.
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Vítimas de Crime/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Adulto , Agressão , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Sérvia , Adulto JovemRESUMO
INTRODUCTION: Chronic liver diseases (CLD) are an important cause of morbidity and mortality in general population. The aim of this study was to analyze potential differences between patients with CLD and healthy control group, and to estimate the severity of CLD by using simple questionnaires: general health questionnaire (GHQ-12) and chronic liver disease questionnaire (CLDQ). METHODS: A cross-sectional pilot study was performed in Zemun Clinical Hospital during years 2014 and 2015. Sixty participants were divided into 4 groups (15 per group): chronic alcoholic hepatitis, other chronic hepatitis, liver cirrhosis, and healthy control group. Entire study population chose one of four offered answers of structured questionnaires GHQ-12 and CLDQ, based on which mean model of end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were calculated. RESULTS: Mean GHQ12 and CLDQ scores were 10.5 and 5.21 ± 1.11 respectively. Regarding certain CLDQ domain scores, a significant difference between alcoholic and non-alcoholic hepatitis groups in the worry domain was observed. Mean MELD score was 7.42 ± 2.89 and did not differ between chronic hepatitis groups, while mean CTP score was 5.73 ± 0.88. A statistically significant correlation was observed between GHQ12 and CLDQ scores (ρ = -0.404, p < 0.01), but not between subjective and objective scores. CONCLUSIONS: Mean GHQ12 and CLDQ scores pointed out to general psychological no-distress condition of the studied participants, as well as scarcely expressed CLD-specific complaints. Mean MELD and CTP scores indicated stable chronic liver diseases, with low three-month mortality rates in the cases of chronic hepatitis, as well as determination to Child A group in the case of liver cirrhosis.
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Hepatopatias/psicologia , Pacientes Ambulatoriais , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Colorectal cancer (CRC) is an important oncological and public health problem worldwide, including Serbia. Unfortunately, half of the patients are recognized in an advanced stage of the disease, therefore, early detection through specific tumor biomarkers, such as carcinoembryonic (CEA) and carbohydrate antigen 19-9 (CA 19-9), is the only way to cope with CRC expansion. METHODS: Our cross-sectional study evaluated the influence of some clinical, endoscopic and histological characteristics of CRC on CEA and CA 19-9 serum levels, to determine whether these biomarkers could be related to CRC detection. The study included 372 participants: 181 suffered from CRC and 191 participants were controls. Endoscopic and histological examinations were used for CRC diagnosis, while additional ultrasound and abdominal computerised tomography imaging were used for staging the disease. Measurement of CEA and CA 19-9 was performed after CRC confirmation. RESULTS: Age, gender, tumor localization, macro-morphological and histological characteristics did not influence biomarkers serum levels. Both were significantly higher (p<0.01) in patients with Dukes D stage of CRC compared with controls. Sensitivity (76.8%) and specificity (76.6%) of CEA alone were higher than for CA 19-9, but with no statistical significance. Furthermore, sensitivity of CEA alone in the Dukes A/B group was similar to the entire CRC patient group. CONCLUSIONS: Although not recommended as a screening method for the general population, elevated values of each biomarker indicate further diagnostic procedures and their simultaneous testing can improve the diagnostic sensitivity in early detection of CRC, as shown by the united analysis (AUC 0.842).
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The aim of this study was to investigate the effect of levothyroxine (LT4) replacement therapy during three months on some parameters of metabolic syndrome and atherosclerosis in patients with increased thyroid-stimulating hormone (TSH) level. This study included a group of 30 female patients with TSH level >4 mIU/L and 15 matched healthy controls. Intima media complex thickness (IMCT) and peak systolic flow velocity (PSFV) of superficial femoral artery were determined by Color Doppler scan. In hypothyroid subjects, BMI, SBP, DBP, and TSH were significantly increased versus controls and decreased after LT4 administration. FT4 was significantly lower in hypothyroid subjects compared with controls and significantly higher by treatment. TC, Tg, HDL-C, and LDL-C were similar to controls at baseline but TC and LDL-C were significantly decreased by LH4 treatment. IMCT was significantly increased versus controls at baseline and significantly reduced by treatment. PSFV was similar to controls at baseline and significantly decreased on treatment. In this study, we have demonstrated the effects of LT4 replacement therapy during three months of treatment on correction of risk factors of metabolic syndrome and atherosclerosis.
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BACKGROUND/AIM: Endoscopic mucosal resection (EMR) or mucosectomy is a removing method of flat or sessile lesions, laterally spreading tumors and carcinoma of the colon or the rectum limited to mucosa or the surface part of the submucosa. The aim of the study was to estimate the efficacy and safety of EMR in removing flat and sessile colorectal adenomas. METHODS: This prospective study involved 140 patients during the period of 8 years. A total of 187 colorectal adenomas were removed using the EMR method "inject and cut with snare". RESULTS: The approximate size of mucosectomised adenomas was 13.6 mm (from 8 mm to 60 mm). There was a total of 48 (25.7%) flat adenomas and 139 (74.3%) sessile adenomas, P < 0.01). Using "en bloc" and "piecemeal" resection, 173 (92.5%) and 14 (7.5%) of colorectal adenomas were removed, respectively. In all the cases, a complete removal of colorectal adenomas was achieved. Two (1.4%) patients had adenoma removal with intramucosal carcinoma each. In the average follow-up period of 21.2 +/- 17.8 months, 2 (1.4%) patients had adenoma relapse after EMR. Considering complications, there was bleeding in 1 (0.7%) patient with a big rectum adenoma removed with EMR. Furthermore, one (0.7%) patient had a postcoagulation syndrome after cecal adenoma was removed by EMR. CONCLUSION: EMR is an efficient, safe and minimally invasive technique of removing flat and sessile adenomas in the colon and the rectum, with a very low percentage of adenoma recurrence over a long period of monitoring.
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Adenoma/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Mucosa Intestinal/cirurgia , Adenoma/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Prospectivos , Sérvia/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND/AIM: Balloon dilatation is a standard approach to the initial achalasia treatment. Modified dilatation is also applied to rise efficacy and to lower complications. METHODS: A total of 57 patients were analysed within a median follow-up of 8.2 years. No premedication was used, dilatation was performed up to the pain treshold, while introduction and positioning of a dilatator was done in combination of endoscopic and radiological control. Dilatation effect was estimated by both Kim Symptom Scoring and objective parameters: body weight rise and radiological scintigraphic findings. RESULTS: Excellent and good results were obtained in 50 (88%) of the patients, while in 7 (12%) of the patients surgery was performed. There was no difference in dilatation efficacy regarding sex of the patients, but the results were better in the patients above 40 years. Duration of symptoms, body weight loss, esophageal lumen width do not indicate the definitive dilatation outcome. Esophageal scintigraphy and body weight increase were in a direct correlation with the effect of dilatation measured with the Kim Symptom Scoring. After the one to two repeated dilatations the efficacy increased from 74% to 88% justifying the repetition of dilatation. In 2 (3.57%) of the patients, that is in 2.65% of the totally dilated patients, perforation was recorded. There was no lethal outcome of dilatation, and the other complications were not clinically significant. CONCLUSION: Modified balloon dilatation can be recommended for initial method in achalasia treatment due to high efficacy, easy performance in daily hospital while complications are in standard range.
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Dilatação , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/terapia , Dilatação/efeitos adversos , Dilatação/métodos , Acalasia Esofágica/fisiopatologia , Perfuração Esofágica/etiologia , Esofagoscopia/métodos , Esôfago/diagnóstico por imagem , Esôfago/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Radiografia , Cintilografia/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune chronic disease. In comparison with the overall population, mortality and morbidity of RA patients are increased due to cardiovascular diseases. There is increasing evidence that autoimmunity mechanisms are included in pathogenesis of cardiovascular diseases. Isolated disorder of diastolic function can, even with normal heart contractility, lead to heart failure. The aim of this study was to assess diastolic function in RA patients and determine factors causing diastolic dysfunction. MATERIAL AND METHODS: The study included 88 patients with RA treated at Rheumatology Department, Clinical Hospital Centre, Zemun. All the patients were thoroughly examined (clinical findings, laboratory and echocardiographic examination). All parameters of diastolic function (mitral and pulmonary flow) were measured. RESULTS: In RA patients 98.9% had diastolic function disorder. This parameter had been changed prior to clinical signs of heart failure and decrease of ejection fraction. Indicators of diastolic function, velocities E, A and their ratio V(E)/V(A), as well as velocities S, D and their ratio V(S)/V(D) were lower in patients with positive rheumatoid factor. The patients' age (p < 0.01), duration of the disease (p < 0.05), high level of cholesterol (p < 0.05), triglycerides (p < 0.05) and arterial hypertension (p < 0.05) were significant factors considerably affecting diastolic function. CONCLUSION: These findings suggest subclinical myocardial disorder in a great number of RA patients. Apart from early and aggressive treatment of the chronic inflammatory process, it is also necessary to prevent further heart complications by timely recognition and treatment of "standard" risk factors fbr cardiovascular diseases.
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Artrite Reumatoide/fisiopatologia , Ecocardiografia Doppler , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Disfunção Ventricular Esquerda/complicaçõesRESUMO
INTRODUCTION: In the last three decades numerous epidemiologic studies have shown the correlation between risk factors and cardiovascular diseases. Clinical research has proven that rheumatoid arthritis patients (RA) have higher prevalence of classical risk factors in relation to general population, and over the last few years there has been an emphasis on some new risk factors which can contribute to cardiovascular diseases (CVD). MATERIAL AND METHODS: This study examined risk factor values for CVD in 88 patients with RA treated at Rheumatology Department, Clinical Hospital Centre, Zemun. All patients have been thoroughly examined (clinical findings, laboratory and echocardiographic examination). Apart from classical factors, "new" risk factors have been examined in all patients: C-reactive proteine (CRP), high-sensitive C-reactive proteine (hs-CRP) and homocystein. RESULTS: It has been determined that RA patients have more frequent higher new risk factors in comparison to classical ones. 84.1% of patients had higher CRP values, 97.1% had hsCRP and 39.5% had homocystein. The mean CRP values, especially hsCRP have been higher in patients with positive rheumatoid factor finding. DISCUSSION: Rheumatoid arthritis patients may have worse "background atherosclerosis" than even subjects matched for classical cardiovascular risk factors. Continuous exposure to high grade systemic inflammation may be linked to accelerated atherosclerosis. CONCLUSIONS: Timely identification of patients with risk factors, particularly with new risk factors, enables adequate approach in prevention of and treatment for CVD in rheumatoid arthritis patients.
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Artrite Reumatoide/sangue , Doenças Cardiovasculares/etiologia , Adulto , Idoso , Artrite Reumatoide/complicações , Proteína C-Reativa/análise , Feminino , Homocisteína/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Systemic lupus erythematosus is a multisystemic inflammatory disease with diverse clinical manifestations. Hepatic lesion is a rarely seen complication of systemic lupus erythematosus. We report a case of complication of lupus presented as cholestatic syndrome in a 41-year old woman with lupus in her medical history for the past seven years. A general examination showed jaundice and hepatomegaly, with elevated bilirubin and aminotransferase levels in the liver function tests. The liver biopsy was performed and the microscopic examination revealed cholestasis with bile plugs without any signs of inflammation and liver tissue necrosis. After the three months steroid therapy the clinical symptoms resolved and the laboratory values normalized. The various factors are considered to be involved in the ethiopathogenesis of liver damage. Previous treatment with potentially hepatotoxic drugs (imuran in this case) or viral hepatitis have usually been implicated as the main cause of liver disease in lupus patients. On the other hand, even after careful exclusion of these ethiologies, the problem remains whether to classify the patient as having a primary liver disease with associated autoimmune and laboratory features resembling lupus, or as having a liver disease as a manifaestaion of lupus.
Assuntos
Colestase Intra-Hepática/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Adulto , Biópsia por Agulha , Colestase Intra-Hepática/complicações , Colestase Intra-Hepática/patologia , Diagnóstico Diferencial , Feminino , Humanos , Fígado/patologiaRESUMO
BACKGROUND: Although relatively rare, gastric vascular anomalies can be recognized as a source of both chronic and acute blood loss, most often presenting as long term iron deficiency anemia, rarely as severe acute gastrointestinal bleeding. CASE REPORT: We present five patients with various gastric vascular anomalies, diagnosed during the year of 2003. in the Clinical Hospital Center Zemun. The diagnosis was based on endoscopic appearances, clinical history and characteristic histological findings. Gastric vascular anomalies presented in our review were: portal hypertensive gastropathy, gastric antral vascular ectasia, angiodysplasia, hereditary hemorrhagic telangiectasia and Dieulafoy lesion. The used treatment modalities included surgery and various endoscopic techniques (schlerotherapy, argon plasma coagulation). CONCLUSION: Patients presented with chronic iron deficiency anemia or acute and recurrent gastrointestinal hemorrhage should be considered as having one of gastric vascular anomalies.