Current Insights Regarding Intestinal Failure-Associated Liver Disease (IFALD): A Narrative Review.

Intestinal failure-associated liver disease (IFALD) is a spectrum of liver disease including cholestasis, biliary cirrhosis, steatohepatitis, and gallbladder disease in patients with intestinal failure (IF). The prevalence of IFALD varies considerably, with ranges of 40-60% in the pediatric population, up to 85% in neonates, and between 15-40% in the adult population. IFALD has a complex and multifactorial etiology; the risk factors can be parenteral nutrition-related or patient-related. Because of this, the approach to managing IFALD is multidisciplinary and tailored to each patient based on the etiology. This review summarizes the current knowledge on the etiology and pathophysiology of IFALD and examines the latest evidence regarding preventative measures, diagnostic approaches, and treatment strategies for IFALD and its associated complications.

The Impact of Biomarkers on the Early Detection of Acute Mesenteric Ischemia.

BACKGROUND: acute mesenteric ischemia (AMI) is a life-threatening condition that is caused by inadequate blood flow through the mesenteric vessel and is related to high mortality rates due to systemic complications. This study aims to systematically review the available literature concerning the major findings of possible biomarkers for early detection of acute mesenteric ischemia in the human population. METHODS: studies that measured the performance of biomarkers during acute mesenteric ischemia were identified with the search of PubMed, Embase, Medline, and Cochrane library. RESULTS: from a total of 654 articles, 46 articles examining 14 different biomarkers were filtered, falling within our inclusion criteria. Intestinal fatty acid-binding protein (I-FABP) was the most commonly researched biomarker regarding AMI, with sensitivity ranging from 61.5% to 100% and specificity ranging from 40% to 100%. The second most commonly researched biomarker was D-dimer, with a sensitivity of 60-100% and a specificity of 18-85.71%. L-lactate had a sensitivity of 36.6-90.91% and a specificity of 64.29-96%. Several parameters within the blood count were examined as potential markers for AMI, including NLR, PLR, MPV, RDW, DNI, and IG. Citrulline, interleukin 6 (IL-6), and procalcitonin (PCT) were the least-researched biomarkers. CONCLUSION: different biomarkers showed different accuracies in detecting AMI. I-FABP and D-dimer have been the most researched and shown to be valuable in the diagnosis of AMI, whereas L-lactate could be used as an additional tool. Ischemia-modified albumin (IMA), alpha glutathione S-transferase (αGST), interleukin 6 (IL-6), and citrulline showed potential use in their respective studies. However, further research needs to be done on larger sample sizes and with controls to reduce bias. Several studies showed that neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), red-cell distribution width (RDW), delta neutrophil index (DNI), and immature granulocytes (IGs) might be useful, as well at the same time be widely distributed and affordable in combination with other markers presenting higher specificity and sensitivity.

Forms and Frequency of Sanctions against General Practitioners and Family Medicine Specialists in Macedonia.

OBJECTIVE: The goal of this study is to evaluate the reasons for sanctioning and the types of sanctions used on general medicine primary healthcare practitioners (GM-PHPs) in the Republic of Macedonia. MATERIALS AND METHOD: This is a cross-sectional study for which we used an anonymous survey. This survey was distributed in a printed and electronic form to GM-PHPs in different parts of Macedonia and 438 of them responded. We used the SPSS statistical program to process the quantitative data. RESULTS: The GM-PHPs' sex was not associated with the sanctioning in the univariable analysis, but it was in the multivariable. GM-PHPs with ≥30 years of experience have 8.7 times higher odds to be sanctioned than those with ≤5 years of experience. GM-PHPs that worked in the hospital or ≤19 km from the nearest hospital were significantly more frequently sanctioned. The most common three reasons for sanctioning were: "Financial consumption of prescriptions and referrals above the agreed amount", "Higher rate of sick leaves and/or unjustified sick leaves" and "Unrealized preventative goals or education". "Financial sanction by scale" was the most common type of sanction - 49.8% of participants. GM-PHPs who followed the guidelines, but were exposed to violence by patients or their family/companion were sanctioned significantly more frequently. CONCLUSIONS: In our sample, we can observe that in the univariable analysis age, years of experience, family medicine speciality, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. In the multivariable analysis: sex, years of experience, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. The majority of sanctions were financial sanctions (84.5%).

The Frequency and Form of Controls by HIIS over Primary Health Care Physicians in Slovenia.

OBJECTIVE: The aim of this study was to evaluate the pattern of controls and sanctions by the Health Insurance Institute (HIIS) over primary healthcare practitioners (PHCPs) in Slovenia, the reasons for sanctions and the violence against PHCPs if they followed the HIIS rules. MATERIALS AND METHODS: We performed analyses using survey data from a cross-sectional study, across public health centres and individual contractors in which 1,458 PHCPs were invited to answer a questionnaire anonymously via an online system used to collect data for the Slovenian Medical Chamber and the Association of General Practice/Family Medicine of South-East Europe. Quantitative data were presented by descriptive statistics and analysed using Pearson's chisquared test. RESULTS: Responses were obtained from 462 female and 138 male PHCPs. Of the total number of 600 participants, 430 were family medicine specialists. 263 (43.8%) responded that they have been sanctioned for various reasons. PHCPs that are more likely to be sanctioned include family medicine specialists and individual contractors. PHCPs working in areas smaller than 20 000 inhabitants were sanctioned in a bigger proportion than their counterparts. Monetary penalties levied against those working at health centres were usually covered by the health centre. Family medicine specialists, more often than other PHCPs experienced violence from patients or patients' relatives if they followed HIIS rules. CONCLUSION: Family medicine specialists are sanctioned more frequently than other PHCPs, individual contractors are sanctioned more frequently than public healthcare PHCPs and PHCPs in working area with a population less than 20.000 are more frequently sanctioned than those working in an area with a bigger population count.