Bleeding Ulcers: Effect of low dose Aspirin - Our experience

Aspirin is among the most commonly used pharmaceutical products used for the management of fever, to relieve mild to moderate pain, to reduce swelling in inflammatory conditions such as arthritis, while a low dose aspirin is used to prevent blood clots. The latter effect reduces the risk of stroke and heart attack. However, its use is associated with gastrointestinal and other complications. The aim of this study was to evaluate the influence of aspirin in bleeding ulcers. 122 patients were included in this prospective comparative study that were divided in two groups: the first group consisting of 60 patients that were treated with low dose Aspirin, and the second group consisting of 62 patients that were treated with low dose aspirin and pantoprazole (a proton pump inhibitor). All the patients had positive history for previous ulcer disease in whom bleeding ulcers were evaluated with endoscopic examinations during 12 months of treatment. The mean age of the patients with bleeding ulcers in the study was 60.4±14.3 years, of whom 68.8% were males and 31.2 % were females. In the aspirin only treated group, after 12 months of administration, bleeding ulcers were present in 11 patients (18.3 %) while in the group that were co-prescribed aspirin and pantoprazole were present only in 3 (4.8 %) patients. Findings from this study show that the prevalence of bleeding ulcers is significantly higher in the group treated with aspirin as monotherapy compared to the group that were co-prescribed aspirin and pantoprazole. Gastroprotection with proton pump inhibitors is essential in patients with positive history of gastrointestinal ulcers in the past that need long-term use of prophylactic low-dose aspirin

Proton Pump Inhibitors Diminish Barrett's Esophagus Length: Our Experience

AIM: Our main objectives were to evaluate the influence of two-year proton pump inhibitors (PPI) therapy in patients with Barrett's oesophagus on its length, in both types, short and long segment.METHODS: In this single-centre, prospective interventional controlled study were analysed data collected prospectively over two years from patients with Barrett's oesophagus diagnosed by endoscopy. Patients who received continuous proton pump inhibitors (PPI) for 2 years. At each patient visit symptoms were recorded, and at each endoscopy, the length of Barrett's oesophagus (BE) was measured. Biopsies were taken along the length of the oesophagus at intervals of 1 cm. In total, 50 patients with Barrett's oesophagus were included in the study: 10 of whom had long-segment Barrett's oesophagus, and 40 patients had short-segment Barrett's oesophagus. The mean number of endoscopies performed was 3 per patient.RESULTS: The length of Barrett's esophagus (BE) was influenced by PPI therapy: Circumferential extension in BE patients short-segment Barrett's esophagus (SSBE) (before treatment was 1.5 cm and after treatment was 0.8 cm Maximum proximal extension in SSBE group before treatment was 2.3 cm (SD ± 1.1 cm), and 1.1 cm (SD ± 0.9 cm), respectively. Squamous islands were detected in 25% of patients examined after 2 years on PPIs.CONCLUSIONS: PPIs achieve a reduction to the length of Barrett's oesophagus, in both types, and the development of squamous islands is commonly associated with their use

Antibiotic Utilization in Pediatric Hospitalized Patients – A Single Center Study

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in paediatrics. In most cases, antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards.AIM: The main objective of this study was to analyse the consumption of antibiotics in hospitalised paediatric patients.MATERIAL AND METHODS: This retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical/DDD index) in Pulmonology, Gastroenterology and Nephrology Departments at Pediatric Clinic of the tertiary hospital. The data on the consumption of antimicrobials were collected for five years by using properly designed form. The consumption was related to days of hospital care.RESULTS: The most utilised antibiotics group in all three departments Pulmonology, Gastroenterology and Nephrology Departments were penicillins. Cephalosporins were mostly used in Pulmonology department. Metronidazole and Chloramphenicol were used in minimal quantities in all three departments.CONCLUSION: This study demonstrates that surveillance programs on antibiotic resistance should be established and accompanied by analyses of drug utilisation data which can aid in the creation of valid cross-national studies on antibiotic usage and resistance, to motivate improvements in prescribing and guideline-directed antibiotic prescribing

Endoscopic Removal of a Giant Complicated Hyperplastic Gastric Polyp

The patient, a 40-year-old male, was referred to our clinic with intermittent nausea, vomiting and symptomatic anemia for 4 months. Notable hematological indices were low hemoglobin levels of 9.6 g/dl and hematocrit levels of 35.8%, while after receiving two units of concentrated red blood cells, at discharge; they achieved levels of 15.2 g/dl and 42.3%, respectively. Esophagogastroduodenoscopy revealed a 3 cm antral pedunculated polyp, prolapsing into pylorus thus causing intermittent pyloric obstruction and anemia. Histological examination revealed a hyperplastic polyp without evidences of malignancy. No atrophy, metaplasia, dysplastic changes or Helicobacter pylori infection were detected in samples taken from the antrum and the corpus; however, the examination provided evidence for gastritis. Follow-up endoscopy was provided after 12 weeks to see polypectomy site after a course of Pantoprazole administration, and to define symptom-free time after polypectomy. Endoscopic removal of complicated gastric polyps should be considered at the time of initial diagnostic endoscopy. Endoscopic resection of polyps enables to determine the exact histopathologic type as well as to effectively treat symptomatic gastric outlet obstruction and anemia

REUMATOIDNI ARTRITIS KASNOG NASTUPA: OPSERVACIJSKA STUDIJA

Reumatoidni artritis (RA) može imati početak u starijoj životnoj dobi. Nastup bolesti sa 60 i više godina naziva se RA kasnog početka (engl. Late-Onset Rheumatoid Arthritis – LORA). Cilj ove studije bio je analizirati klinička, laboratorijska, radiološka obilježja i obilježja liječenja u bolesnika s LORA-om u usporedbi s RA ranijeg početka (engl. Early-Onset Rheumatoid Arthritis – EaORA) s tim da su pacijenti u obje grupe bili približno jednakog trajanja bolesti. Radi se o opservacijskoj studiji provedenoj u jednome reumatološkom centru, koja je uključila 120 bolesnika s utvrđenom dijagnozom RA podijeljenih u dvije grupe: 60 bolesnika s LORA-om (istraživana grupa) i 60 bolesnika s EaORA-om (kontrolna skupina). Aktivnost bolesti, mjerena Disease Activity Score 28 (DAS28SE) bila je značajno viša u grupi LORA u odnosu prema grupi EaORA (p < 0,05). Značajno više bolesnika u grupi LORA imalo je zahvaćena ramena (LORA vs. EaORA, 30% vs. 15%; p < 0,05) i koljena (LORA vs. EaORA, 46,7% vs. 16,7%; p < 0,05). Radiološke erozivne promjene bile su značajno češće vidljive u grupi LORA u usporedbi s grupom EaORA (p 0,05), dok je broj pacijenata s pozitivnim nalazom anticitrulinirajućih protutijela (ACPA) bio značajno veći u grupi EaORA (p < 0,05). Vrijednosti C-reaktivnog proteina (CRP) i brzina sedimentacije eritrocita (SE) bile su značajno više/brže u grupi LORA u odnosu prema grupi EaORA. Hemoglobin je bio niži u grupi LORA (11,96 ± 1,64 g/dl) nego u grupi EaORA (12,18 ± 1,56 g/dl). Najčešće primijenjeni lijekovi koji mijenjaju tijek upalnih reumatskih bolesti bili su metotreksat i sulfasalazin, dok biološki lijekovi nisu bili upotrijebljeni. U zaključku, na temelju rezultata iz našeg istraživanja, bolesnici s LORA-om imaju neka obilježja koja se razlikuju od onih u bolesnika s EaORA-om, kao što su viša aktivnost bolesti, češća zahvaćenost velikih zglobova i veće strukturne promjene. Ovo se mora uzeti u obzir u kliničkom radu, napose u odabiru terapije.Rheumatoid arthritis (RA) may have an onset at older age. Th e onset of the disease at the age of 60 and over is called late-onset rheumatoid arthritis (LORA). Th e aim of this study was to analyze the clinical, laboratory, radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA), provided that all the patients had an approximately equal duration of the disease. Th is is an observational single-center study, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patients EaORA. Th e disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was signifi cantly higher in the LORA group compared to the EaORA group (p<0.05). Signifi cantly more patients with LORA had involvement of the shoulders (LORA vs. EaORA, 30% vs. 15%; p <0.05) and knees (LORA vs. EaORA, 46.7% vs. 16.7%; p <0.05). Radiological erosive changes were signifi cantly more frequent in the LORA group in comparison with EaORA (p <0.05). Th ere was no diff erence between the groups regarding rheumatoid factor (RF) positivity (p>0.05), while the number of patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group (p<0.05). Th e values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were signifi cantly higher in the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than in the EaORA group (12.18±1.56 g/dL). Th e most used disease-modifying antirheumatic drugs (DMARDs) were methotrexate and sulfasalazine, while biological drugs were not used. In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such as higher disease activity, more frequent involvement of large joints, and more pronounced structural damage. Th is should be taken in account in clinical practice, especially regarding treatment choices

REUMATOIDNI ARTRITIS KASNOG NASTUPA: OPSERVACIJSKA STUDIJA

Reumatoidni artritis (RA) može imati početak u starijoj životnoj dobi. Nastup bolesti sa 60 i više godina naziva se RA kasnog početka (engl. Late-Onset Rheumatoid Arthritis – LORA). Cilj ove studije bio je analizirati klinička, laboratorijska, radiološka obilježja i obilježja liječenja u bolesnika s LORA-om u usporedbi s RA ranijeg početka (engl. Early-Onset Rheumatoid Arthritis – EaORA) s tim da su pacijenti u obje grupe bili približno jednakog trajanja bolesti. Radi se o opservacijskoj studiji provedenoj u jednome reumatološkom centru, koja je uključila 120 bolesnika s utvrđenom dijagnozom RA podijeljenih u dvije grupe: 60 bolesnika s LORA-om (istraživana grupa) i 60 bolesnika s EaORA-om (kontrolna skupina). Aktivnost bolesti, mjerena Disease Activity Score 28 (DAS28SE) bila je značajno viša u grupi LORA u odnosu prema grupi EaORA (p < 0,05). Značajno više bolesnika u grupi LORA imalo je zahvaćena ramena (LORA vs. EaORA, 30% vs. 15%; p < 0,05) i koljena (LORA vs. EaORA, 46,7% vs. 16,7%; p < 0,05). Radiološke erozivne promjene bile su značajno češće vidljive u grupi LORA u usporedbi s grupom EaORA (p 0,05), dok je broj pacijenata s pozitivnim nalazom anticitrulinirajućih protutijela (ACPA) bio značajno veći u grupi EaORA (p < 0,05). Vrijednosti C-reaktivnog proteina (CRP) i brzina sedimentacije eritrocita (SE) bile su značajno više/brže u grupi LORA u odnosu prema grupi EaORA. Hemoglobin je bio niži u grupi LORA (11,96 ± 1,64 g/dl) nego u grupi EaORA (12,18 ± 1,56 g/dl). Najčešće primijenjeni lijekovi koji mijenjaju tijek upalnih reumatskih bolesti bili su metotreksat i sulfasalazin, dok biološki lijekovi nisu bili upotrijebljeni. U zaključku, na temelju rezultata iz našeg istraživanja, bolesnici s LORA-om imaju neka obilježja koja se razlikuju od onih u bolesnika s EaORA-om, kao što su viša aktivnost bolesti, češća zahvaćenost velikih zglobova i veće strukturne promjene. Ovo se mora uzeti u obzir u kliničkom radu, napose u odabiru terapije.Rheumatoid arthritis (RA) may have an onset at older age. Th e onset of the disease at the age of 60 and over is called late-onset rheumatoid arthritis (LORA). Th e aim of this study was to analyze the clinical, laboratory, radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA), provided that all the patients had an approximately equal duration of the disease. Th is is an observational single-center study, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patients EaORA. Th e disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was signifi cantly higher in the LORA group compared to the EaORA group (p<0.05). Signifi cantly more patients with LORA had involvement of the shoulders (LORA vs. EaORA, 30% vs. 15%; p <0.05) and knees (LORA vs. EaORA, 46.7% vs. 16.7%; p <0.05). Radiological erosive changes were signifi cantly more frequent in the LORA group in comparison with EaORA (p <0.05). Th ere was no diff erence between the groups regarding rheumatoid factor (RF) positivity (p>0.05), while the number of patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group (p<0.05). Th e values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were signifi cantly higher in the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than in the EaORA group (12.18±1.56 g/dL). Th e most used disease-modifying antirheumatic drugs (DMARDs) were methotrexate and sulfasalazine, while biological drugs were not used. In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such as higher disease activity, more frequent involvement of large joints, and more pronounced structural damage. Th is should be taken in account in clinical practice, especially regarding treatment choices

Prevalence of Coxitis and its Correlation with Inflammatory Activity in Rheumatoid Arthritis

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterised by intra-articular and extra-articular manifestations but very rarely with coxitis.AIM: This study aimed to investigate the prevalence of coxitis, clinical changes, and its correlation with the parameters of inflammatory activity.METHODS: A cohort of 951 patients diagnosed with ACR/EULAR (American College of Rheumatology/European League against Rheumatism) 2010 criteria was enrolled in this prospective, observational and analytic research study. The CBC (Complete Blood Count), ESR (Erythrocyte sedimentation rate), CRP(C - reactive protein), Anti CCP (Antibodies to cyclic citrullinated peptides), X-ray examination of palms and pelvis, and the activity of the disease as measured by DAS - 28 (28 - joint disease activity score) were carried out in all subjects. Independent samples t-test was used to compare the group's characteristics, whereas Pearson correlation test was used to analyse the correlation between study variables.RESULTS: Of the total number of the subjects, 730 (76.8 %) were females, whereas 221 (23.2%) were males. The average age was 51.3, y/o while the most of them were between 40 - 49 y/o (32.6%). The prevalence of coxitis was 14.2%, mostly found in males (19.46%). The echosonografic prevalence of changes was 21.45%, while the radiological changes were 16.3%; in both cases, the changes were more expressed in males. The analysis showed that inflammatory parameters were significantly higher in patients with coxitis.CONCLUSION: Coxitis has high economic cost because it ends up with a mandatory need for a total hip joint prosthesis. Thus the results of this study can serve to plan and initiate early preventive measures

Prevalence of Asymptomatic Arterial Hypertension and Its Correlation with Inflammatory Activity in Early Rheumatoid Arthritis

BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that worsens during the course of the disease and can cause disability. Early RA refers to the onset of symptoms within the past 3 months. In RA, increased levels of mediators of inflammation may cause arterial stiffness consequently leading to arterial hypertension.AIM: The aim of this cross-sectional study was to assess the prevalence of asymptomatic arterial hypertension in early RA patients as well as the correlation with parameters of inflammation.METHODS: One hundred and seventy-nine early RA patients diagnosed in agreement with ACR/EULAR (American College of Rheumatology/ European League against Rheumatism) 2010 criteria were consecutively included in the study. CRP (C-reactive protein) and anti CCP (Antibodies to cyclic citrullinated peptides) serum levels, WBC (white blood cells) count and ESR (Erythrocyte sedimentation rate), likewise DAS-28 (28-joint disease activity score) was determined in all included patients. Parametric tests were used to compare the characteristics of the groups and to test the correlation of the variables.RESULTS: Statistical data analysis revealed that a majority of the patients were females (n = 141; 78.7%); the mean age at RA onset was 49.13 ± 12.13 years. Overall prevalence of hypertension was 44.13 % (n = 79). In comparison with the normotensive patients, the hypertensive patients were older and had significantly higher values of CRP, ESR, anti-CCP and DAS-28. A highly significant positive correlation between all the study parameters and systolic and diastolic blood pressure was observed.CONCLUSION: Presence of significantly higher values of CRP, ESR, anti-CCP and DAS-28 in hypertensive patients indicate that inflammation is associated with an increased risk of hypertension. In this context, early screening for arterial hypertension and adequate therapeutic measures should be considered in early RA patients

Prevalence of Antibiotic Prescription in Primary Healthcare Settings in the Municipality of Prishtina, Kosovo

Background: Antibiotics remain among the most prescribed drugs in primary healthcare, contributing to increased antibiotic resistance in the community and prevailing as an emerging global health concern. We aimed to quantify the prevalence and quality of antibiotic prescription in primary healthcare settings in the Municipality of Prishtina to identify targets for quality improvement. Methods and Results: This study represents a population-based, retrospective cohort, including data from eight randomly selected family medical centers in the Municipality of Prishtina. Each 150th patient on medical records was assessed for demographic data, diagnosis (ICD-10), antibiotic prescription, antibiotic class, and antibiotic form. In total, the study included 1614 cases reviewed. The antibiotic prescription rate was 16%. The health condition for which most of the cases received antibiotics was J18 - Pneumonia, unspecified organism (67%), followed by J03 - Acute tonsillitis (54%), J42 - Unspecified chronic bronchitis (46%), and N39 - Other disorders of the urinary system (43%) Broad-spectrum antibiotics, such as co-amoxiclav (17.7%), amoxicillin (16.5%), and ceftriaxone (12.6%), featured among the most routinely prescribed antibiotics. The antibiotic prescription rate was the highest for cases in the 3-5 age group, of whom 27% received an antibiotic prescription. In 73% of cases, oral antibiotics were prescribed, 69% of which belong to the WHO AWaRe (Access, Watch, Reserve) essential medicines list. Only 18% of antibiotics were prescribed with their generic names. Conclusion: The prevalence of antibiotic prescription in primary healthcare settings in Prishtina is moderately low. These data cannot be extrapolated to other municipalities in Kosovo or other countries due to different organizational levels. High antibiotic prescription rates for young age groups, prescription of broad-spectrum antibiotics, and high rates of parenteral antibiotics were identified as targets for quality improvement

Proton Pump Inhibitors Intake and Iron and Vitamin B12 Status: A Prospective Comparative Study with a Follow up of 12 Months

BACKGROUND: Proton pump inhibitors (PPIs) represent the most widely prescribed antisecretory agents, but their prolonged use, may influence iron and vitamin B12 status, which could have important implications for clinical practice.AIM: We undertook this study aiming to investigate the association between PPIs use for 12 months and potential changes in iron and vitamin B12 status, as well as whether this potential association varies among four specific PPI drugs used in the study.METHODS: A total of 250 adult subjects were recruited into this study, of which 200 subjects were PPIs users while 50 subjects belonged to the control group. Serum iron, ferritin, vitamin B12, and homocysteine (Hcy) levels were measured before the start of the study and after 12 months. Mann - Whitney U test and Kruskal - Wallis test was used to compare the baseline characteristics of the study groups, while Wilcoxon test was used to analyse post - pre differences.RESULTS: Statistical analysis showed significant changes within PPIs group and specific PPIs subgroups between the two-time points in serum ferritin and vitamin B12 levels, respectively, while no significant changes in serum iron and homocysteine levels were shown. However, subsequent diagnosis of hypoferremia and hypovitaminosis B12 in the whole study sample at 12 months was established in only 3.8% and 2.9% of the subjects, respectively.CONCLUSION: PPIs use for 12 months did not result in clinically significant iron and/or vitamin B12 deficiency; thus, these findings argue routine screening under normal circumstances, although monitoring in elderly and malnourished may be of precious value