Editorial

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Editorial

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HEPATITIS B: WHO SHOULD BE TREATED?

U ovom trenutku dostupna terapija za liječenje hepatitisa B rijetko može eradicirati infekciju (normalizacija ALT, negativizacija HBV DNK, serokonverzija HBsAg u anti-HBs). U posljednje 4 godine postignuti su manji pomaci u pogledu uspješnosti liječenja. Promjene u odnosu na ranije hrvatske konsenzus konferencije iz 2005. i 2009. g. su temeljene na stajalištima osuvremenjene Konsenzus konferencije Američkog društva za istraživanje jetre iz 2009., Konsenzus konferencije Europske udruge za istraživanje jetre (EASL) iz 2012.g. te Smjernicama Azijsko-Pacifičke udruge za istraživanje jetre (APASL) iz 2012. g. U ovom radu ćemo navesti samo razlike u odnosu na ranije spomenute Hrvatske smjernice iz 2005. i 2009. godine. Novosti se odnose na primjenu neinvazivnih metoda za prosudbu fibroze, kvantifikaciju HBsAg u cilju predviđanja ishoda liječenja, registraciju novih lijekova i neke nove preporuke u cilju učinkovitijeg i racionalnijeg liječenja. Novosti su i preporuke za liječenje bolesnika u posebnim okolnostima što uključuje liječenje trudnica, bolesnika s rezistencijom na lijekove, bolesnika s koinfekcijama, jetrenom dekompenzacijom, bolesnika na imuno i kemoterapiji i bolesnika nakon transplantacije jetre te bolesnike s HCC.Currently, therapy for hepatitis B has a limited effect and can rarely eradicate infection (ALT normalization, undetectable HBV DNA, HBsAg/anti-HBs seroconversion). Minimal progress in terms of treatment success has been achieved in the past four years. Changes from the previous Croatian Consensus Conferences in 2005 and 2009 are based on standings of the Consensus Conference of the American Association for the Study of Liver Disease (AASLD) 2009, Consensus Conference of the European Association for the Study of Liver (EASL) 2012, and Asia-Pacific Association Guidelines for the Study of Liver (APASL) 2012. In this paper, we will mention only differences in relation to the before mentioned Croatian guidelines from 2005 and 2009. New developments relating to the application of noninvasive methods for assessing fibrosis, quantification of HBsAg to predict treatment outcome, registration of new drugs, and some new recommendations for more efficient and rational treatment will be reviewed. New findings as well as recommendations for the treatment of patients in special circumstances including treatment of pregnant women, patients with drug resistance, patients with co-infection, hepatic decompensation, patients on immune and chemotherapy, patients after liver transplantation, and patients with HCC will also be included

Venomous Snakebites in Southern Croatia

This retrospective study is based on the analysis of 542 snakebite envenomation cases in southern Croatia, which were treated in the University Hospital Split over the period of 21 years. The aim of this study was to determine the incidence of venomous snakebite in southern Croatia, epidemiological and clinical features of snakebite and treatment in the region. The mean annual snakebite incidence in southern Croatia was 5.2 per 100,000 inhabitants. The nose- horned viper (Vipera ammodytes) was responsible for most bites, only a small proportion being inflicted by the adder (Vipera berus). People of all ages were affected (1 – 82 year old), but the bites were more frequent in individuals older than 50 (46% of the cases) and in children and adolescents 19 year old and younger (27% of the cases). Most snakebite accidents happened in warm spring and summer months, the highest number occurring in May (22%). A majority of the victims were rural people engaged in agricultural activities. Bites on the upper limbs were more frequent (57%) than bites on the lower limbs (42%). With regard to envenomation severity, there were 15.1% minor, 40.5% mild, 26% moderate and 18% severe cases. Two victims died (0.4%). The antivenom produced by the Institute of Immunology in Zagreb was given to virtually all patients, and complications following its administration were rare. The antivenom was used more often than it was suggested by the symptoms present

Alimentary Infections during War Conditions: Mostar and Tomislavgrad, Bosnia and Herzegovina, 1992–1995

The aim of this study was to assess the outcome of sanitary and epidemiologic measures undertaken in relation to alimentary infections in the military corps of the Croatian Defense Council (Hrvatsko vije}e obrane) and civilian population in Mostar and Tomislavgrad regions during the 1992–1995 War in Bosnia and Herzegovina. A total of 25 (4.8%) of soldiers and 7 (7.1%) of non-military personnel were not being granted medical clearance to be employed in the food provision services. We recorded a total of 68 alimentary infections cases in military personnel (with an incidence of 536,2 per 100,000 persons), and 436 in civilian population (573,9 per 100,000 person), without significant difference between them (p=0.647).We did not record any alimentary infection outbreak in the military personnel, while two smaller epidemics of the abdominal typhus were recorded among civilian populations, but without lethal outcomes. The results of this study suggest that even the most basic adherence to the principle of standard sanitary and epidemiologic preventive measures may substantially reduce the probability of alimentary infections outbreaks, even in the highly disruptive, warfare environment

Cystic Echinococcosis of Lung and Heart Coupled with Repeated Echinococcosis of Brain – A Case Report

Echinococcosis is rarely encountered as a cystic brain dissease. In this article we are presenting a case of a young woman repeatedly operated due to echinococcosis of lung, heart and brain. Recurrent brain ecchinococcosis developed despite preoperative and postoperative albendazol therapy after first and combined therapy with albendazol and praziquantel after the second brain surgery. The mechanism of recurrence remains unclear (primary infestation, dissemination after spontaneous or intraoperative cyst rupture or new infestation)

Hepatitis B

Infekcija čovjeka virusom hepatitisa B može se manifestirati kao asimptomatska infekcija ili kao akutna bolest s različitim kliničkim oblicima, od blagog do fulminantnog hepatitisa. Ishod bolesti također može biti različit, od izlječenja s normalizacijom svih laboratorijskih nalaza i eliminacijom virusa, preko inaktivnog nosilaštva HBsAg bez znakova kliničke bolesti do perzistentne infekcije sa znakovima kronične bolesti jetre. Posljedice perzistentne infekcije mogu biti pogubne, kao što su ciroza i hepatocelularni karcinom jetre. Danas postoje mogućnosti brze dijagnostike svih navedenih oblika bolesti, efi kasne i sigurne zaštite svih rizičnih populacija i liječenja teških oblika bolesti kao što su akutni fulminantni hepatitis i kronični hepatitis. Cilj ovog rada je prikazati najnovije spoznaje o patogenezi, dijagnostici, profi laksi i terapiji B hepatitisa, koje će nam pomoći da bolje razumijemo bolest, da upoznamo svoje bolesnike sa zaštitom od ove bolesti, o mogućim posljedicama infekcije i današnjim mogućnostima liječenja akutnih i kroničnih oblika bolesti.Infection with hepatitis B virus can be manifested either as asymptomatic infection or as acute disease with various clinical manifestations, from mild to fulminant hepatitis. The outcome of the infection is also complex, from normalization of all laboratory tests, elimination of the virus, inactive carrier state of HBsAg without signs of clinical disease, to persistent infection with signs of chronic liver disease. The sequelae of persistent infection may be serious such as liver cirrhosis or hepatocellular carcinoma. At present time, the accurate diagnosis of all forms of the disease, effi cient protection of risk population and antiviral treatment for severe forms of the disease, such as acute fulminant hepatitis and chronic hepatitis, are available. The aim of this paper is to present new knowledge about the pathogenesis, diagnostic procedures, prophylaxis and treatment of hepatitis B in order to better understand the disease, inform our patients about protection from this disease, analyze possible consequences of the infection, and review present status of available therapies of acute and chronic forms of the disease

Snakebites in Mostar Region, Bosnia and Herzegovina

The aim of this study was to provide an overview of the snakebites in patients hospitalized at the Mostar Clinical Hospital, admitted between 1983 and 2006. A total of 341 patients were recorded, with moderate men predominance (52.8%). Majority of patients were bitten for the first time (99.1%). In 98.8% of patients snakebite occurred to the bare skin, most commonly during June to September period (64.2%). Snakebites were the commonest in agricultural workers (48.1%). Until 2003 all admitted patients were treated according to Russel’s scheme (3-anti). As of 2003 new treatment scheme was applied, resulting in the reduction of antidote and supportive treatment use, causing a reduction in the number of clinically apparent allergic reactions. Serum sickness was recorded in only 2 patients, while lethal outcome was recorded in one (0.3%). Overall results indicate that lethality of snakebite is low, and that patients were often administered treatment without medical indication. High number of tourists as well as the presence of the peace keeping troops and other visiting personnel in this region make the snakebites and awareness on snakes not only a local issue, but also more general concern

HEPATITIS C: WHO SHOULD BE TREATED?

Liječenje je nužno u bolesnika s akutnom infekcijom, bolesnika s povišenim vrijednostima ALT-a, bolesnika s normalnim vrijednostima ALT-a i prisutnom fibrozom od najmanje F2 po METAVIR sustavu ili fibrozom dokazanom nekom neinvazivnom metodom utvrđivanja fibroze, nonrespondera i relapsera genotipa 1 na ranije primijenjenu antivirusnu terapiju (trojna terapija - pegilirani interferon, ribavirin, bocaprevir ili telaprevir), bolesnika s kompenziranom cirozom jetre te bolesnika na hemodijalizi. Liječenje dolazi u obzir u bolesnika s kod koinfekcijom HBV i HIV-om, u bolesnika s teškim ekstrahepatičnim manifestacijama HCV infekcije, u bolesnika ovisnih o teškim drogama i alkoholu nakon najmanje 6 mjeseci apstinencije, moguće i uz suportivnu terapiju metadonom i buprenorfinom, te bolesnika s transplantiranom jetrom. Terapija se ne preporučuje bolesnicima s fulminantnim hepatitisom, bolesnicima s normalnim ALT-om bez prisutne fibroze te bolesnicima s transplantiranim bubregom i trudnicama.Therapy is strongly recommended in patients with acute infection, patients with elevated ALT levels, patients with normal ALT level and F ≥2 METAVIR score, in genotype 1 nonresponders and relapsers to antiviral therapy with triple therapy (pegylated interferon, ribavirin, bocaprevir or telaprevir), in patients with compensated cirrhosis and patients on hemodialysis. It is possible to treat patients with HBV and HIV co-infection, patients with severe HCV extrahepatic manifestations and patients with transplanted liver. Drug users and alcoholics can be treated after 6-month abstinence, but also with supportive therapy. This therapy is not recommended in patients with fulminant hepatitis, patients with persistent normal ALT levels and without fibrosis, in kidney transplant recipients and in pregnant women

Cystic Echinococcosis of Lung and Heart Coupled with Repeated Echinococcosis of Brain – A Case Report

Echinococcosis is rarely encountered as a cystic brain dissease. In this article we are presenting a case of a young woman repeatedly operated due to echinococcosis of lung, heart and brain. Recurrent brain ecchinococcosis developed despite preoperative and postoperative albendazol therapy after first and combined therapy with albendazol and praziquantel after the second brain surgery. The mechanism of recurrence remains unclear (primary infestation, dissemination after spontaneous or intraoperative cyst rupture or new infestation)