Hematological Indices Are Useful in Predicting Complications of Liver Cirrhosis.

BACKGROUND: Liver cirrhosis is the final stage of chronic liver disease. We aimed to evaluate non-invasive scores as predictors of complications and outcome in cirrhotic patients. METHODS: A total of 150 cirrhotic patients were included. Models for end-stage liver disease (MELD), albumin-bilirubin (ALBI) score, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MoLR), and neutrophil-lymphocyte-albumin ratio (NLA) scores were tested in relation to the development of complications and mortality using receiver operating characteristic (ROC) curves. RESULTS: The ROC curve analysis showed (area under the curve) AUC values of NLR, NLA, ALBI, and MELD of 0.711, 0.730, 0.627, and 0.684, respectively, for short-term mortality. MELD, ALBI, and NLA scores showed a statistically significant correlation with hepatic encephalopathy (p = 0.000 vs. 0.014 vs. 0.040, respectively), and the MELD cut-off value of 16 had a sensitivity of 70% and a specificity of 52% (AUC: 0.671, 95% CI (0.577-0.765)). For the assessment of the presence of ascites, the AUC values for NLA and MoLR were 0.583 and 0.658, respectively, with cut-offs of 11.38 and 0.44. CONCLUSIONS: MELD, ALBI, and NLA are reliable predictors of hepatic encephalopathy. NLA and MoLR showed a significant correlation with the presence of ascites, and MELD, ALBI, NLR, and NLA have prognostic value to predict 30-day mortality in cirrhotic patients.

The Quality of Life After Liver Transplantation-The First Experience from Serbia.

Background: Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, which dramatically effects patient's quality of life (QoL). The aim of this study was to evaluate the impact of socio-demographic and clinical factors on different QoL domains of patients who underwent orthotopic LT. Methods: A cross-sectional study included a total of 43 patients who underwent a LT from 2013 to 2018. Socio-demographic and clinical data were recorded in each patient. The QoL was estimated using two validated questionnaires: 36-Item Short Form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). Results: Male patients obtained significantly higher scores than women, in the domains of general health perception (83.2 ± 16.3 vs. 71.0 ± 18.4; t = 2.229, p = .031) and physical component summary (69.0 ± 7.2 vs. 62.0 ± 11.4; t = 2.451, p = .019). There were no significant differences in other domains of SF-36 and CLDQ. Etiology of the underlying liver disease and the presence of post-transplant complications showed no effect on score values of SF-36 and CDLQ domains (p < .05). Time from LT showed negative medium correlation with role limitations due to physical health problems (S = -0.417, p = .005), while no other significant correlations were noted in other items of SF-36 and CLDQ. Conclusions: Men had higher scores in the domain of general health perception and physical component summary following LT than women. With the increase in time from LT, patients experience a decrease in limitations due to physical health problems. The audit and improvement of QoL is an essential part of the individualized long-term health-care approach to LT patients.

Bacteremia in patients with liver cirrhosis in the era of increasing antimicrobial resistance: single-center epidemiology.

INTRODUCTION: Liver cirrhosis is commonly associated with bacterial infections, which contribute to unfavorable outcome. This study aimed to investigate the epidemiology of bacteremia and patterns of antibiotic resistance in patients with cirrhosis, factors associated with multidrug-resistant infection, and predictors of mortality. METHODOLOGY: This retrospective single-center study included patients with cirrhosis treated between January 2016 and December 2018. Data were collected from the patients' medical records. The severity of liver disease was determined using the Child-Pugh, Model for End-Stage Liver Disease-Na, Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure, and Chronic Liver Failure-Consortium Acute Decompensation scores. RESULTS: A total of 85 patients with cirrhosis and bacteremia were included (male: 82.4%, mean age 60.3 ± 9.4 years). The etiology of cirrhosis was mainly alcoholism (87.1%). After 30 days, lethal outcome occurred in 44.7% of the patients. The most commonly isolated pathogens were Enterococcus spp. (31.8%), methicillin-sensitive Staphylococcus aureus (15.3%), and Escherichia coli (14.1%), while 37.3% of all isolated microorganisms were multi-drug resistant. Multi-drug resistant infection [odds ratio (OR): 6.198, 95% confidence interval (CI): 2.326-17.540, p = 0.006] and neutrophil-to-lymphocyte ratio (OR = 1.181, 95% CI = 1.043-1.337, p = 0.009) are independent predictors of mortality. The aforementioned scores, which represent the extent of hepatic insufficiency, are significantly higher in patients with multi-drug resistant isolates, while multi-drug resistant bacteremia was more common in patients with more advanced liver disease. CONCLUSIONS: Multi-drug resistant bacteremia is more common in patients in whom liver disease is more severe and is a major independent predictor of mortality.

Hepcidin Is a Reliable Marker of Iron Deficiency Anemia in Newly Diagnosed Patients with Inflammatory Bowel Disease.

RESULTS: There was a high statistically significant difference between IBD patients and controls in levels of hepcidin (P < 0.01). Namely, serum hepcidin levels were significantly higher in the control group. There was no statistically significant correlation of serum hepcidin with CRP, Mayo score, or CDAI, respectively (P > 0.05). However, we have found a statistically significant negative correlation of sTfR and TIBC with hepcidin (P < 0.01). CONCLUSION: Results of our study suggest that hepcidin is a reliable marker of IDA in patients with IBD, and it could be used in routine clinical practice when determining adequate therapy in these patients.

Pentoxifylline with metformin treatment improves biochemical parameters in patients with nonalcoholic steatohepatitis.

BACKGROUND: The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with Nash. Setting: Outpatient hepatology clinic. METHODS: A prospective trial was conducted. The first cohort included patients with biopsy-proven Nash, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in Nash group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications. RESULTS: All 33 Nash patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 mmol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA - IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase by 24.0 U/L, 9.1 U/L, 10.8 U/L respectively, was noted. CONCLUSIONS: Pentoxifylline and Metformin may provide possible treatment option in Nash. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived.

Correlation of Patient-Reported Outcome (PRO-2) with Endoscopic and Histological Features in Ulcerative Colitis and Crohn's Disease Patients.

METHODS: A cross-sectional study was conducted in consecutive newly diagnosed patients with inflammatory bowel disease in a tertiary care referral center. The initial evaluation included patient-reported outcome for stool frequency subscore and rectal bleeding. Endoscopic activity was determined using the Mayo scoring system for ulcerative colitis and the Simple Endoscopic Score for Crohn's disease. Histopathological activity was assessed using a validated numeric scoring system. RESULTS: We included 159 patients (63 Crohn's disease with colonic involvement and 96 with ulcerative colitis). We found significant correlation between the Mayo endoscopic subscoring system and histology activity in ulcerative colitis, while no correlation was found in patients with Crohn's disease. Patient-reported outcome showed inverse correlation with endoscopic and histological activity in Crohn's disease (r s = -0.67; r s = -0.72), while positive correlation was found in ulcerative colitis (r s = 0.84; r s = 0.75). Interpretation and Conclusions. Patient-reported outcome is a practical and noninvasive tool for assessment of disease activity in ulcerative colitis patients but not in Crohn's disease.

Attitudes of Nurses Toward Organ Donation in Serbia.

OBJECTIVE: Nurses represent the key persons in the process of organ donation, acting as intermediaries between the patient and the family of a potential donor. The aim of this study was to analyze the factors influencing the attitudes of nurses toward bequeathing and organ and tissue donation. METHODS: The research was designed as a cross-sectional study from November 2013 to November 2014 and included a sample of 264 nurses employed in the health system of Serbia. Data were collected using a specific questionnaire of 18 questions referring to the information on sociodemographic characteristics and the knowledge of organ donation. RESULTS: The investigation enrolled 264 participants, of which 78% were women. The majority of study subjects had secondary medical education (64.4%), lived in an urban area (82.6%), were married (56.4%), and were predominantly Orthodox (87.1%) with their work experience between 5 and 10 years (29.9%) and 10 to 20 years (29.5%). The average knowledge score concerning organ donation was 29.03 (SD, 2.33; range, 23-34). There was a statistically significant difference in the scores between 2 groups formed according the length of service (P < .001) and the level of education (P = .019), which showed the strongest influence on nurses' attitudes toward donation. CONCLUSION: This investigation showed that nurses did not express strong positive attitude toward this issue. Further education of nurses in the Serbian health care system focusing on transplantation and bequeathing of organs and tissues are warranted.

Risk factors associated with intrathyroid extension of thyroid microcarcinomas.

PURPOSE: The aims of this study were to investigate the rate of intrathyroid extension of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid disease and to identify independent risk factors associated with it. METHODS: A retrospective study of 301 patients operated for benign thyroid diseases (hyperthyroid diseases, multinodular goitre, Hashimoto thyroiditis and benign thyroid tumours) was performed at a high-volume endocrine surgery unit of a tertiary referral academic hospital, in a 5-year period. These patients had a PTMC incidentally discovered on definite histopathological findings following total or near-total thyroidectomy. Since distinguishing between intrathyroid extension of PTMC as the result of intrathyroid dissemination or as the result of multicentricity is challenging, we observed them together as multifocality. In statistical analysis, we used standard descriptive statistics and univariate and multivariate logistic regression analysis to determine independent risk factors associated with multifocality. RESULTS: In our study, there were 85.4% females and 14.6% males with a median age of 54 years. A multinodular goitre (32.5%) was the most common indication for an operation. Most patients (68.4%) had a PTMC that was 5 mm or smaller. The most frequent histological variants of PTMC were the follicular variant (52.8%), followed by the papillary variant (22.6%) and the mixed follicular-papillary variant (18.6%). A multifocal PTMC was present in 26.6% of cases. An independent protective factor for multifocality of PTMC was a thyroid gland that weighed more than 38 g (OR 0.55, 95% CI 0.31-0.97, p = 0.039). Size of PTMC greater than 5 mm was an independent risk factor for a multifocal PTMC (OR 3.26, 95% CI 1.85-5.75, p = 0.000). Finally, the mixed follicular-papillary variant of PTMC represents an independent risk factor for a multifocal PTMC (OR 2.42, 95% CI 1.09-5.36, p = 0.030). CONCLUSIONS: Intrathyroid extension is present in more than a quarter of PTMCs found in patients operated for benign thyroid disease. Independent risk factors for intrathyroid extension are size of PTMC greater than 5 mm and the mixed follicular-papillary variant of PTMC, while a large thyroid gland is an independent protective factor.

Influence of IL-6, TNF-α and Hs-CRP on Insulin Sensitivity in Patients after Laparoscopic Cholecystectomy or Open Hernia Repair.

BACKGROUND: The aim of this study was to investigate the influence of IL-6, TNF-α and hs-CRP on insulin sensitivity during postoperative follow-up in patients with laparoscopic cholecystectomy (LC) or open hernia repair (OHR). METHODS: 65 patients were studied: after laparoscopic cholecystectomy (LC; n=40) or open hernia repair (OHR; n=25). Glucose, insulin, hs-CRP, IL-6 and TNF-a were determined at day 0 (before the operation) and at days 1, 3 and 7 (after the operation). RESULTS: There were no difference between LC and OHR groups concerning age, BMI, glucose, insulin, hs-CRP, IL-6 and TNF-α at day 0. hs-CRP increased at day 1, 3 and 7 vs. day 0 (p<0.0005), without difference between groups (p=0.561). IL-6 increased at day 1 and day 3 vs. day 0 (p<0.005). IL-6 was higher at day 1 in OHR group in comparison with LC group (p=0.044). There were no differences in TNF-a levels between LC and OHR groups (p=0.056). There was increase of HOMA-IR at day 1, 3 and 7 vs. day 0 (p<0.0005) in both groups. Significantly higher increase of HOMA-IR was in OHR group compared with LC group at day 1 (p=0.045). There was a positive correlation between hs-CRP and HOMA-IR (r=0.46; p=0.025) and between IL-6 and HOMA-IR at day 1 in OHR group (r=0.44; p=0.030). CONCLUSIONS: Significantly higher HOMA-IR was found in OHR group compared with LC. Positive correlation between hs-CRP and IL-6 with HOMA-IR in OHR group at day 1, indicate possible influence of this mediators on impairment of insulin sensitivity.

Cadmium Exposure as a Putative Risk Factor for the Development of Pancreatic Cancer: Three Different Lines of Evidence.

Although profoundly studied, etiology of pancreatic cancer (PC) is still rather scant. Exposure to cadmium (Cd), a ubiquitous metal associated with well-established toxic and carcinogenic properties, has been hypothesized to one putative cause of PC. Hence, we analyzed recently published observational studies, meta-analyses, and experimental animal and in vitro studies with the aim of summarizing the evidence of Cd involvement in PC development and describing the possible mechanisms. Consolidation of epidemiological data on PC and exposure to Cd indicated a significant association with an elevated risk of PC among general population exposed to Cd. Cadmium exposure of laboratory animals was showed to cause PC supporting the findings suggested by human studies. The concordance with human and animal studies is buttressed by in vitro studies, although in vitro data interpretation is problematic. In most instances, only significant effects are reported, and the concentrations of Cd are excessive, which would skew interpretation. Previous reports suggest that oxidative stress, apoptotic changes, and DNA cross-linking and hypermethylation are involved in Cd-mediated carcinogenesis. Undoubtedly, a significant amount of work is still needed to achieve a better understanding of the Cd involvement in pancreatic cancer which could facilitate prevention, diagnosis, and therapy of this fatal disease.