63 research outputs found
Overlap Syndrome at Rheumatology Department ā Case Report
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease, affecting mostly women of childbearing age. Dermatomyositis (DM) is a rare autoimmune inflammatory myopathy affecting both skin and muscles. Overlap syndrome is an autoimmune disease which shares features of at least two recognised connective tissue diseases. We present a case of an overlap syndrome refractory to treatment
Vrednovanje klasifikacijskih kriterija za sistemski eritemski lupus [Validation of classification criteria for systemic lupus erythematosus]
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with heterogenuous clinical presentations. Most widely used ACR classification from 1997 (ACR-97) shows high specificity and acceptable sensitivity in classifiying patients with established SLE, but its value declines in early stages and in milder cases. SLICC group has published new, revised (SLICC-12) criteria which have shown higher sensitivity, but lower specificity than the ACR-97 criteria.
The objective of this study was to validate SLICC-12 and ACR-97 classifications on a patient cohort from UHC Zagreb. It comprised 308 patients with SLE (n=146) and SLE-allied conditions (n=162). Sensitivity and specificity, as well as sensitivity and specificity according to disease duration were compared between two classifications. Merit of every criterium to diagnosing SLE was calculated using logistic regression analysis.
A clear distinction between SLICC-12 and ACR-97 criteria is observed. Sensitivity of SLICC-12 criteria is significantly higher with a tendency to rise with disase duration. ACR-97 criteria have shown higher specificity. Specificity of SLICC-12 criteria is low and declines with disease duration. Comparing the overall value of the new SLICC-12 classification to ACR-97 criteria, the new criteria show superiority in our patients.
Although SLICC-12 criteria show superiority to ACR-97, and are more successful in diagnosing early SLE, specificity in our population is too low. Our results contribute to the current initiative for developing new criteria for SLE
Rare complications of Sjƶgrenās syndrome in a female patient
Sjƶgrenās syndrome (SjS) is a systemic autoimmune disease, most common in middle-aged women, characterized by chronic inflammation
of exocrine glands. It can present by itself or alongside other autoimmune diseases. Main symptoms are dry eyes and mouth, but the disease can affect joints, lungs, kidneys, peripheral nervous system (PNS), and rarely central nervous system (CNS). SS-A antibodies in SjS can pass the fetoplacental barrier and cause congenital heart block. Patients with SjS are at higher risk of developing lymphoma
Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study
Aim To validate Systemic Lupus International Collaborating
Clinics (SLICC)-12 and American College of Rheumatology
(ACR)-97 classification criteria on a patient cohort from
the University Hospital Center Zagreb.
Methods This retrospective study, conducted from 2014
to 2016, involved 308 patients with systemic lupus erythematosus
(SLE) (n = 146) and SLE-allied conditions (n = 162).
Patientsā medical charts were evaluated by an expert rheumatologist
to confirm the clinical diagnosis, regardless of
the number of the ACR-97 criteria met. Overall sensitivity
and specificity, as well as the sensitivity and specificity according
to disease duration, were compared between ACR-
97 and SLICC-12 classifications. Predictive value for SLE for
both classifications was assessed using logistic regression
and receiver operating characteristic (ROC) curves. Results The SLICC-12 criteria had significantly higher sensitivity
in early disase, which increased with disease duration.
The ACR-97 criteria had higher specificity. The specificity
of the SLICC-12 criteria was low and decreased with
disease duration. Regression analysis demonstrated the
superiority of the SLICC-12 classification criteria over the
ACR-97 criteria, with areas under the ROC curve of 0.801
and 0.780, respectively.
Conclusion Although the SLICC-12 criteria were superior
to the ACR-97 and were more sensitive for diagnosing
early SLE, their specificity in our population was too low.
The sensitivity of the SLICC-12 classification is increased by
better defined clinical features within each criterion. Our
results contribute to the current initiative for developing
new criteria for SLE
Primopredaja i prijelaz bolesnika [Patient handover and transition]
Patient handover is considered to be one of the most delicate medical procedures as well as the most
preventable cause of medical error. It takes place at primary, secondary and tertiary healthcare, with specificities
at every level of healthcare. Improvement in the quality of patient handover is therefore essential for good medical
practice. Accurate and comprehensive communication between medical staff is required for patient safety and
continuous adequate healthcare. In this article, we describe recommendations for successful and efficient patient
handover and highlight communication errors during the process. Special attention is given to handover of rheumatological
patients and transition from pediatric to adult healthcare. Also, we emphasize the necessity of education.
Medical staff should be competent in sharing and exchanging relevant information when the patient transfers
to another medical care provider. Teaching communication skills has been part of undergraduate and postgraduate
curriculum in medical schools. At the University of Zagreb School of Medicine we have introduced a
longitudinal six-year course Fundamentals of Medical Skills where special attention is given to communication
skills. Nevertheless, medical specialty training still lacks educational contents specialized in patient handover and
safe patient discharge
Patient handover and transition
Primopredaja bolesnika smatra se jednim od najdelikatnijih postupaka u medicini i najvažnijim sprjeÄivim uzrokom medicinske pogreÅ”ke. Ovaj se proces zbiva na svim razinama zdravstvene zaÅ”tite: primarnoj,
sekundarnoj i tercijarnoj, od kojih svaka ima svoje specifiÄnosti. UnaprjeÄenje kvalitete primopredaje na svakoj razini izrazito je važno. Prikladan i precizan prijenos informacija izmeÄu medicinskog osoblja nuždan je za sigurnost bolesnika i kontinuiranu zdravstvenu zaÅ”titu. U ovom su Älanku opisane preporuke za uspjeÅ”nu i kvalitetnu primopredaju bolesnika te su istaknute pogreÅ”ke pri komunikaciji i postupku prijelaza u skrb drugom lijeÄniku. Poseban je osvrt dan na primopredaju reumatoloÅ”kog bolesnika i na prijelaz iz pedijatrijske skrbi u adultnu reumatoloÅ”ku skrb. Osobito je naglaÅ”ena potreba pouÄavanja pri komunikaciji i prenoÅ”enju podataka tijekom prijelaza bolesnika od jednog lijeÄnika drugomu, iz ustanove u ustanovu. PouÄavanje komunikacijskih vjeÅ”tina danas se provodi na medicinskim fakultetima na diplomskoj i poslijediplomskoj razini. Na Medicinskom fakultetu SveuÄiliÅ”ta u Zagrebu uveli smo longitudinalni 6-godiÅ”nji predmet Temelji lijeÄniÄkog umijeÄa u kojem studente pouÄavamo komunikaciji. Ipak, istiÄemo nedovoljan broj nastavnih sadržaja specijalistiÄkog usavrÅ”avanja koji obuhvaÄaju izobrazbu o primopredaji bolesnika i vjeÅ”tinama otpusta bolesnika.Patient handover is considered to be one of the most delicate medical procedures as well as the most preventable cause of medical error. It takes place at primary, secondary and tertiary healthcare, with specificities at every level of healthcare. Improvement in the quality of patient handover is therefore essential for good medical practice. Accurate and comprehensive communication between medical staff is required for patient safety and continuous adequate healthcare. In this article, we describe recommendations for successful and efficient patient handover and highlight communication errors during the process. Special attention is given to handover of rheumatological
patients and transition from pediatric to adult healthcare. Also, we emphasize the necessity of education. Medical staff should be competent in sharing and exchanging relevant information when the patient transfers to another medical care provider. Teaching communication skills has been part of undergraduate and postgraduate curriculum in medical schools. At the Universitiy of Zagreb School of Medicine we have introduced a longitudinal six-year course Fundamentals of Medical Skills where special attention is given to communication skills. Nevertheless, medical specialty training still lacks educational contents specialized in patient handover and safe patient discharge
Povezanost bioloŔke terapije i malignih bolesti u upalnim reumatskim bolestima
Inflammatory rheumatic diseases are chronic, progressive autoimmune diseases which affect the musculoskeletal system and other organ systems. Nowadays, a large number of patients is treated with biological therapy. Although biological drugs selectively affect specific molecules of the immune system, they weaken the overall immune system of the body. Therefore, the patients are more susceptible to infections and other diseases such as lymphomas, breast and skin cancers and melanomas. Chronic inflammation which occurs due to autoimmune disease is also a risk factor for malignant development. So far, studies have not proven direct correlation between biological therapy and solid or haematologic tumours. On the other hand, the increased risk for developing skin cancer in patients on tumour necrosis factor alpha inhibitors has been described. In this review paper we analysed the available medical literature on the risks for malignant disease development in patients with rheumatic diseases who are on biological disease ā modifying anti-rheumatic drugs.Sistemske upalne reumatske bolesti jesu kroniÄne, progresivne autoimunosne bolesti koje zahvaÄaju lokomotorni sustav i druge organske sustave. Danas je sve viÅ”e bolesnika lijeÄeno bioloÅ”kom terapijom. Iako bioloÅ”ki lijekovi selektivno djeluju na specifiÄne molekule imunosnog sustava, oni smanjuju opÄu obrambenu funkciju organizma, zbog Äega su bolesnici podložniji infekcijama, ali i nekim malignim bolestima poput limfoma, karcinoma kože, dojke ili melanoma. TakoÄer, sama kroniÄna upala u sklopu autoimunosne bolesti jest riziÄni Äimbenik za razvoj tumorske bolesti. Prema do sada objavljenim studijama, nije dokazana jednoznaÄna povezanost primjene bioloÅ”kih lijekova s razvojem solidnih i hematoloÅ”kih tumora. Suprotno tomu, istraživanja su pokazala povezanost primjene inhibitora tumorske nekroze alfa i razvoja tumora kože. U ovom preglednom radu analizirana je dostupna medicinska literatura o rizicima za razvoj malignih bolesti u bolesnika s reumatoloÅ”kim bolestima koji su lijeÄeni bioloÅ”kim antireumatskim lijekovima koji mijenjaju tijek bolesti
Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study
AIM:
To validate Systemic Lupus International Collaborating Clinics (SLICC)-12 and American College of Rheumatology (ACR)-97 classification criteria on a patient cohort from the University Hospital Center Zagreb. ----- METHODS:
This retrospective study, conducted from 2014 to 2016, involved 308 patients with systemic lupus erythematosus (SLE) (n=146) and SLE-allied conditions (n=162). Patients' medical charts were evaluated by an expert rheumatologist to confirm the clinical diagnosis, regardless of the number of the ACR-97 criteria met. Overall sensitivity and specificity, as well as the sensitivity and specificity according to disease duration, were compared between ACR-97 and SLICC-12 classifications. Predictive value for SLE for both classifications was assessed using logistic regression and receiver operating characteristic (ROC) curves. ----- RESULTS:
The SLICC-12 criteria had significantly higher sensitivity in early disease, which increased with disease duration. The ACR-97 criteria had higher specificity. The specificity of the SLICC-12 criteria was low and decreased with disease duration. Regression analysis demonstrated the superiority of the SLICC-12 classification criteria over the ACR-97 criteria, with areas under the ROC curve of 0.801 and 0.780, respectively. ----- CONCLUSION:
Although the SLICC-12 criteria were superior to the ACR-97 and were more sensitive for diagnosing early SLE, their specificity in our population was too low. The sensitivity of the SLICC-12 classification is increased by better defined clinical features within each criterion. Our results contribute to the current initiative for developing new criteria for SLE
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