Phytotherapy and Liver Disease

Hepatoprotective agents are medicines or dietary supplements that are used as an adjunct to the treatment of acute and chronic viral hepatitis, liver cirrhosis, hepatocellular carcinoma prevention, as well as other liver diseases. Experiments on animals and cell cultures have shown that natural compounds can alleviate and prevent pathological changes in the liver. In the past few years, considerable attention has been paid to medicinal herbs with hepatoprotective, antioxidant, and immune properties. The plants contain numerous phytochemicals, including polyphenols, phenolic acids, coumarins, styles, tannins, lignans, and lignins. These compounds include silymarin, curcumin, picroside, kutkoside, phyllanthin, hypophyllanthin, glycyrrhizin, glycyrrhizin, berberine, luteolin, quercetin, coumarin derivatives (4-methylumbelliferone), and others. Many studies have been aimed at collecting data on some types of edible plants and fruits (grapefruit, cranberries, grapes, beets, cacti, chamomile, spirulina, propolis) that have shown hepatoprotective effects

ACUTE BRUCELLA HEPATITIS – CASE REPORT

Bruceloza je vjerojatno najčešća antropozoonoza u svijetu, ali je u različitim aspektima velika enigma. Prikazan je slučaj 64-godišnjeg muškarca s akutnim hepatitisom uzrokovanim brucelom, koji zahtijeva pažnju, jer je rijedak u literaturi. Etiologija bolesti je dokazana pozitivnom hemokulturom i serološkim testom (ELISA IgM). Biljezi virusnog hepatitisa i imunološki biljezi autoimunog hepatitisa bili su negativni. Brucelozu treba uzeti u obzir u diferencijalnoj dijagnozi vrućice i hepatitisa kod osoba koje žive ili su posjetili endemska područja, posebno ako je bolesnikov posao s visokim rizikom za stjecanje bruceloze.Brucellosis is probably the most common anthropozoonosis in the world, but in various aspects remains an enigma. A case is reported of a 64-year-old man with acute brucella hepatitis, which requires attention because it is rare in the literature. The etiology of the disease was proven by positive blood cultures and serologic test (ELISA IgM). Viral hepatitis markers and immunologic markers of autoimmune hepatitis were negative. Brucellosis should be considered in the differential diagnosis of fever and hepatitis in those who live or have visited endemic areas, especially if the patient’s job is associated with a high risk of acquiring brucellosis

Acute hepatitis caused by methyldopa

Prikazan je slučaj 35-godišnje bolesnice sa slikom akutnog hepatisa, koja je zbog hipertenzije za vrijeme trudnoće i u puerperiju, liječena metildopom. Nakon prekida terapije došlo je do potpunog oporavka. Hepatotoksičnost lijekova je unatoč brojnim kliničkim i toksikološkim istraživanjima često prisutna i predstavlja diferencijalno dijagnostički problem u infektološkoj praksi.The case of a 35-year-old patient has been shown as a manifestation of acute hepatitis, which is due to hypertension during pregnancy and puerperium treated with methyldopa. After therapy interruption, there was a full recovery. Drug hepatotoxicity is still present and represents a differential diagnostic problem in infectology practice, despite of numerous clinical and toxical researches

Zoonoze u Zeničko-dobojskoj županiji i Federaciji Bosne i Hercegovine

Ciljevi istraživanja bili su: ukazati na značaj zoonoza u ljudi te istražiti koje se zoonoze u ljudi najčešće javljaju u Zeničko-dobojskoj županiji (ZDŽ) i Federaciji Bosne i Hercegovine (FBiH), tijekom desetogodišnjeg razdoblja (2010. – 2019. godine). Materijal i metode. U svrhu istraživanja korišteni su podatci o osam najučestalih zoonoza (salmoneloze, bruceloza, leptospiroza, Q-groznica, hemoragijska groznica s renalnim sindromom, borelioza, ehinokokoza, listerioza), temeljem prijava Instituta za zdravlje i sigurnost hrane Zenica i Federalnog zavoda za javno zdravstvo. Dijagnoze su postavljene klinički, mikrobiološki i/ili epidemiološki. Rezultati. Tijekom desetogodišnjeg razdoblja u ZDŽ prijavljena je 871 zoonoza. Najviše (191/871; 21,9%) prijavljenih bilo je 2019. godine. Najučestalija zoonoza bila je salmoneloza (343/871; 39,4%; 95,3/100.000 stanovnika), a zatim slijedi bruceloza (323/871; 37,1%; 87,7/100.000). Najčešća zoonoza u FBiH je salmoneloza (2.764/5.219; 53%; 125,6/100.000). Na drugom mjestu je bruceloza (1.505/5.219; 28,8%; 68,4/100.000). Leptospiroza (386/5.219; 7,4%; 17,5/100.000), Q-groznica (203/5.219; 3,9%; 9,2/100.000) i hemoragijska groznica s renalnim sindromom (164/5.219; 3,1%; 7,5/100.000) javljaju se povremeno, u vidu manjih ili većih epidemija. Ostale zoonoze javljaju se sporadično. Zaključak. Zoonoze su od posebnoga javnozdravstvenog značaja i zahtijevaju blisku interdisciplinarnu suradnju različitih profila stručnjaka (iz područja medicine, veterine, šumarstva, biologije, zoologije, ekologije), poduzimanje učinkovitih mjera u nadzoru i suzbijanju te proučavanju i znanstvenom istraživanju tih bolesti

Hepatitis D: report of two patients

Infekcija virusom hepatitisa D (HDV) javlja se samo u HBsAg pozitivnih osoba. Oko 350 milijuna ljudi u svijetu zaraženo je virusom hepatitisa B (HBV), a oko 5% njih ima i HDV infekciju. Prikazana su prva dva prijavljena slučaja hepatitisa D u Bosni i Hercegovini. Bolesnici su liječeni u Službi za zarazne bolesti Kantonalne bolnice Zenica, tijekom 2013. i 2014. godine. Serološki testovi na HDV rađeni su u Klinici za mikrobiologiju Kliničkog centra Sarajevo. Kod prvog, 67-godišnjeg muškarca radilo se o akutnoj HBV-HDV koinfekciji, s teškim, produženim kliničkim tijekom i povoljnim ishodom bolesti: negativnim HBsAg, HDVAg i anti-HDV. Kod drugog, 34-godišnjeg muškarca radilo se o superinfekciji hepatitis D virusom, na terenu kroničnog hepatitisa B. Potrebno je podići svijest zdravstvenih djelatnika o opasnosti od udružene HBV i HDV infekcije i osigurati bolju dostupnost HDV dijagnostici.Hepatitis D virus (HDV) infection occurs only in HbsAg positive persons. About 350 million persons are infected with hepatitis B virus (HBV) worldwide and about 5% of them are infected with HDV. We present the first two reported cases of hepatitis D in Bosnia and Herzegovina. Patients were treated at the Department of Infectious Diseases, Cantonal Hospital Zenica during 2013 and 2014. Serological tests for HDV were performed at the Clinical Microbiology Department, Clinical Center Sarajevo. The first patient was a 67-year-old male with acute HBV-HDVcoinfection with severe, prolonged clinical course and favorable disease outcome: negative HBsAg, HDVAg and anti-HDV. The second patient was a 34-year-old male with chronic hepatitis B and HDV superinfection. It is necessary to raise awareness among health workers about the threats of combined HBV and HDV infection and provide better availability of HDV diagnostics

ACCIDENTAL POISONING WITH A PLANT COLCHICUM AUTUMNALE: REPORT OF TWO CASES

Otrovanja kolhicinom teška su i veoma opasna stanja koja nastaju kao posljedica otrovanja hranom s biljkama koje sadržavaju ovaj alkaloid ili predoziranja lijekom koji sadržava kolhicin. Lišće jestivoga medvjeđeg luka (srijemuša) zbog svoje se sličnosti često zamijeni s vrlo otrovnim listovima mrazovca (lat. Colchicum autumnale) koji uzrokuju otrovanja. Opisana su dva slučaja otrovanja hranom s mrazovcem, koji su imali slične simptome u početnoj fazi, ali različit klinički tijek i ishod. Znakovi otrovanja zahtijevaju rano prepoznavanje i intenzivnu potpornu terapiju, što povećava izglede za preživljavanje.Colchicine poisonings are serious and highly fatal conditions that occur as a result of food poisoning from plants that contain this alkaloid or overdose with drug containing colchicine. The leaves of edible wild garlic because of their similarity are often replaced with highly poisonous leaves of autumn crocus, causing poisoning. Described are two cases of food poisoning with Colchicum autumnale, who had similar symptoms in the initial stage, but different clinical course and outcome. Signs of poisoning require early identification and intensive supportive therapy, which increases the chances of survival

HBsAg SEROCONVERSION IN THE TREATMENT OF CHRONIC HEPATITIS B WITH PEGYLATED INTERFERON

Idealni cilj antivirusne terapije ili izlječenje kroničnog hepatitisa B jesu gubitak HBsAg i HBsAg-serokonverzija. Prema suvremenim smjernicama svih udruga za bolesti jetre, pegilirani interferon alfa-2a i nukleoz(t)idni analozi (entekavir, tenofovir) prvi su izbor u liječenju kroničnog hepatitisa B. Cilj je rada bio ocijeniti uspjeh terapije bolesnika s kroničnim hepatitisom B, koji su primali pegilirani interferon. Na kraju desetogodišnjeg perioda HBV DNK < 50 IU/mL i HBsAg-serokonverziju postigla su 4 (4/55; 7,00%) bolesnika. Svi su bili HBeAg-negativni. Dodatno je prikazan slučaj bolesnika koji je nakon terapije imao najkraći period izlječenja. Bolesnik je muškarac, u dobi od 47 godina, s novootkrivenim HBeAg-negativnim kroničnim hepatitisom B i izraženom aktivnošću serumskih aminotransferaza. Liječen je pegiliranim interferonom alfa-2a, 180 μg jednput na tjedan, tijekom 48 tjedana. Nakon antivirusne terapije bolesnik je HBV DNK negativan, HBsAg-negativan i urednih aminotransferaza, a 12 mjeseci nakon završetka antivirusne terapije dolazi do HBsAg-serokonverzije. Stupanj izlječenja kroničnog hepatitisa B, nažalost, ni do danas ne zadovoljava potpuno, s izuzetkom rijetkih, pojedinačnih slučajevaThe ideal goal of antiviral therapy or cure of chronic hepatitis B is HBsAg clearance and HBsAg seroconversion. According to modern guidelines of all Associations for liver diseases pegylated interferon alfa-2a and nucleos(t)ide analogues (entecavir, tenofovir) are fi rst choice in the treatment of chronic hepatitis B. The aim of the study was to evaluate the success of the treatment of patients with chronic hepatitis B who received pegylated interferon. At the end of ten year period, HBV DNA <50 IU/ml and HBsAg seroconversion achieved 4 (4/55, 7.00%) patients. All were HBeAg negative. Additionally, is presented the case of patients, who, after the treatment, had the shortest period of healing. Patient is a man, aged 47 years, with the newly discovered HBeAg negative chronic hepatitis B and pronounced activity of serum aminotransferases. He was treated with pegylated interferon alfa-2a, 180 μg once a week, for 48 weeks. After antiviral therapy, the patient is HBV DNA negative, HBsAg negative and neat aminotransferases, and 12 months after completion of antiviral therapy comes to HBsAg seroconversion. The degree of cure of chronic hepatitis B, unfortunately, has not been entirely satisfactory, with the exception of the few individual case

Rare routes of transmission of hepatitis C

Prospektivno su u oboljelih od hepatitisa C (HC) s nepoznatim putevima prijenosa (n = 119) i njihovih obiteljskih kontakata (n = 297) istražene mogućnosti i načini obiteljske transmisije. Područje istraživanja je Zeničko-dobojski kanton, 2008. – 2009. godine. U 31,07% (119/383; P 0,05). Najznačajniji rizični faktori za nastanak bolesti (P 0,05). The major risk factors for the occurrence of disease (P < 0,00) were: a combination of two or more risk factors (OR 13,67; 95% CI 6,10–30,64); a family member with HC (OR 7,28 and 95% CI 0,89–59,22); members of the household who use drugs (OR 5,88; 95% CI 1,68–20,60); the presence of a chronic illness in the household (OR 5,80; 95% CI 2,74–12,77); sharing a razor (OR 4,45; 95% CI 2,36–8,37); exposure to blood in the household (OR 3,57; 95% CI 1,91–6,26). The frequency of HCV genotypes was significant (P < 0,00) for 1a (χ2 = 12,33) in the group with unknown routes, and for 1b (χ2 = 11,50) in the group of patients with known routes of disease transmission. Cumulative incidence of newly discovered HC within examined familial contacts is 1,35% (4/297). The total probability of the exposure in newly discovered familial contacts (OR 1,38; 95% CI 0,15–12,48) is greater than in unexposed individuals. Anti-HCV point prevalence in examined familial contacts is 4,13%, and among the general population 2,42%. The results of this research suggest that the presence of a family member with HC is a significant risk factor. Therefore, for the purpose of disease prevention there is a need for a routine serological testing and continuous monitoring of all intrafamilial contacts of anti-HCV positive individuals

Rare routes of transmission of hepatitis C

Prospektivno su u oboljelih od hepatitisa C (HC) s nepoznatim putevima prijenosa (n = 119) i njihovih obiteljskih kontakata (n = 297) istražene mogućnosti i načini obiteljske transmisije. Područje istraživanja je Zeničko-dobojski kanton, 2008. – 2009. godine. U 31,07% (119/383; P 0,05). Najznačajniji rizični faktori za nastanak bolesti (P 0,05). The major risk factors for the occurrence of disease (P < 0,00) were: a combination of two or more risk factors (OR 13,67; 95% CI 6,10–30,64); a family member with HC (OR 7,28 and 95% CI 0,89–59,22); members of the household who use drugs (OR 5,88; 95% CI 1,68–20,60); the presence of a chronic illness in the household (OR 5,80; 95% CI 2,74–12,77); sharing a razor (OR 4,45; 95% CI 2,36–8,37); exposure to blood in the household (OR 3,57; 95% CI 1,91–6,26). The frequency of HCV genotypes was significant (P < 0,00) for 1a (χ2 = 12,33) in the group with unknown routes, and for 1b (χ2 = 11,50) in the group of patients with known routes of disease transmission. Cumulative incidence of newly discovered HC within examined familial contacts is 1,35% (4/297). The total probability of the exposure in newly discovered familial contacts (OR 1,38; 95% CI 0,15–12,48) is greater than in unexposed individuals. Anti-HCV point prevalence in examined familial contacts is 4,13%, and among the general population 2,42%. The results of this research suggest that the presence of a family member with HC is a significant risk factor. Therefore, for the purpose of disease prevention there is a need for a routine serological testing and continuous monitoring of all intrafamilial contacts of anti-HCV positive individuals