44 research outputs found
Patient assessment before using tumour necrosis factor alpha blockers in inflammatory bowel disease
Blokatori tumor-nekrotizirajuÄeg faktora alfa (TNF-Ī±) bioloÅ”ki su agensi kojima se blokira kljuÄni proupalni citokin u upalnim bolestima crijeva, stoga je bioloÅ”ka terapija postala jedna od najznaÄajnijih u lijeÄenju tih bolesti. U Hrvatskoj su registrirana dva blokatora TNF-Ī±: infliksimab (RemicadeR) i adalimumab (HumiraR). U radu su navedeni postupci koje je potrebno uÄiniti prije uporabe bioloÅ”ke terapije. Ti postupci ukljuÄuju iscrpne anamnestiÄke podatke o ranijim infektivnim bolestima i cijepljenju te detaljan kliniÄki pregled radi iskljuÄivanja infekcije. Prisustvo apscesa te pogorÅ”anje kolitisa uzrokovano Clostridium difficile toksinom ili Cytomegalovirus (CMV) infekcijom predstavljaju apsolutnu kontraindikaciju za uporabu blokatora TNF-Ī±. Njihova je uporaba takoÄer kontraindicirana u bolesnika s popuÅ”tanjem srca NYCHA III ili IV. Oprez je potreban u bolesnika s kroniÄnim bolestima jetre, neuroloÅ”kom patologijom te u bolesnika s ranijim malignim bolestima, posebno limfomima. Od laboratorijskih nalaza potrebno je uÄiniti: leukogram, diferencijalni leukogram, CD4 stanice u sluÄaju leukopenije, transaminaze, C-reaktivni protein (CRP), analizu urina, serologiju za hepatitis C virus (HCV), hepatitis B virus (HBV) i virus humane imunodeficijencije (HIV). Ovisno o anamnestiÄkim podacima potrebna je i serologija za varicella zoster virus (VZV). Broj eozinofila, pregled stolice i serologija na strongiloidijazu potrebni su u sluÄaju boravka u tropima. Nadalje je potrebno uÄiniti radiogram pluÄa, PPD i radioimunoesej za interferon gama (IGRA) (od engl. interferon gamma release assay) prema nacionalnim smjernicama, a radi iskljuÄivanja aktivne i latentne tuberkuloze. Cijepljenje živim cjepivom kontraindicirano je za vrijeme terapije blokatorima TNF-Ī±. Prije zapoÄinjanja terapije potrebno je, u seronegativnih, cijepljenje protiv hepatitisa B, dok se cijepljenje protiv humanog papiloma virusa (HPV) i VZV-a provodi samo u specifiÄnim sluÄajevima. Neživo cjepivo za sezonsku gripu potrebno je bolesnicima aplicirati jednom godiÅ”nje, a pneumokokno cjepivo jednom u pet godina.Tumour necrosis factor alpha (TNF-Ī±) blockers are biological agents that specifically target the key cytokine in the inflammatory bowel process and became almost the mainsty in the therapy of inflammatory bowel disease. Currently, there are two TNF-Ī± blockers available for clinical use in Croatia: infliximab (RemicadeR), and adalimumab (HumiraR). This paper reviews the necessary investigations before using this drugs. Before using TNF-Ī± blockers detailed interview with the history of previous infective diseases and vaccination is necessary. Clinical examination in order to exclude any infection is mandatory. In patients with abscess and with Clostridium difficile or Cytomegalovirus (CMV) superinfection, biological therapy is contraindicated. This therapy is also contraindicated in NYCHA III or IV cardiac insufficiency. It must be used with caution in patients with chronic liver disease, neurological pathology or history of malignancies, especially lymphoma. Laboratory tests include neutrophil and lymphocyte count, in the case of lymphopenia, CD4 lymphocyte count, transaminases, C-reactive protein (CRP), urine analysis, hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serology, varicella zoster virus (VZV) serology (in patients without a clear history of varicella immunisation). Eosinophil count, stool examination and strongyloidiasis serology for patients having lived in a tropical area. Furthermore, before treatment with anti TNF-Ī± all patients should be checked both for active and for latent tuberculosis infection. This check include: chest X-ray, tuberculin skin test and interferon gamma release assay (IGRA), according to country-specific guidelines. Vaccination with live vaccines is contraindicated during treatment with biological agents. Hepatitis B vaccination should be administered in naive patients. Other vaccinations (varicella, human papilloma virus) should be proposed to specific patients. Influenza vaccine should be given annually and 23-valent pneumococcal vaccine every 5 years
ENTERAL FEEDING IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Uloga enteralne prehrane u lijeÄenju kroniÄne upalne bolesti crijeva joÅ” uvijek nije jasno definirana. U radu su prikazane posljedice malnutricije kao jednog od osnovnih simptoma kroniÄne upalne bolesti crijeva te, sukladno tome, njihovo lijeÄenje. Iz prikazanog jasna je potreba suportivne terapije adekvatnim enteralnim pripravcima. To se posebice odnosi na djeÄju populaciju oboljelih buduÄi da poremeÄaj rasta i razvoja ima dalekosežne posljedice. Važnost potpune enteralne prehrane kao inicijalne terapije joÅ” nema adekvatnog odgovora i zahtijeva daljnje prospektivne analize. Prikazane su i neke nove mogu}nosti prehrane u lijeÄenju kroniÄne upalne bolesti crijeva, koje predstavljaju moguÄu budÄ}nost u terapiji tih bolestiThe purpose of enteral feeding in the inflammatory bowel diseases (IBD) has not been well defined yet. This article presents the consequences of malnutrition, as one of the basic symptoms of IBD and its therapy, respectively. As it is shown here, a supportive therapy with adequate enteral feeding is of great value, especially in pediatric patients due to long-term consequences of the growth failure and the failure to thrive. A complete enteral feeding as a primary and the only therapy in IBD has not been established completely yet and needs further analyses. We have shown some new ways of the enteral treatment of IBD that could be a future therapy of these illnesse
SCREENING FOR OPPORTUNISTIC INFECTIONS AND VACCINATION BEFORE INTRODUCTION OF BIOLOGIC THERAPY
Bolesnici koji primaju anti-TNF-Ī± lijekove imaju poviÅ”eni rizik za oportunistiÄke infekcije. Prije uvoÄenja terapije potreban je probir na: viruse hepatitisa, HIV, EBV, HPV, tuberkulozu, bakterijske i gljiviÄne infekcije te parazite. Probir se sastoji od anamnestiÄkih podataka za ranije infektivne bolesti, ranija cijepljenja i putovanja u krajeve s endemskim bolestima. KlasiÄni kliniÄki pregled je potrebno nadopuniti stomatoloÅ”kim i ginekoloÅ”kim pregledom. Laboratorijski nalazi ukljuÄuju leukogram, aminotransferaze, Creaktivni protein, analizu urina i urinokulturu, serologiju na hepatitis B i C, HIV te EBV. Serologija za varicella zoster virus (VZV) ovisi o anamnestiÄkim podacima. U sluÄaju boravka u tropima potrebna je analiza stolice i serologija na strongiloidijazu. Od ostalih pregleda obvezan je radiogram pluÄa, PPD i seroloÅ”ka dijagnoza tuberkuloze testom IGRA (od engl. Interferon Gamma Release test). Kod sumnje na intraabdominalni apsces preporuÄuje se magnetska rezonancija abdomena. Prisustvo apscesa te pogorÅ”anje kolitisa uzrokovano toksinom Clostridium difficile ili CMV infekcijom su apsolutna kontraindikacija za uporabu anti-TNF-Ī±. Cijepljenje živim cjepivom je kontraindicirano u bolesnika na terapiji anti-TNF-lijekovima. Sve seronegativne bolesnike treba cijepiti cjepivom hepatitisa B. Cjepivo protiv sezonske gripe preporuÄa se aplicirati jednom godiÅ”nje, a 23-valentno pneumokokno cjepivo jednom u pet godina. Ovisno o anamenzi i serologiji bolesnike cijepimo VZV cjepivom uz poseban oprez, dok se cijepljenje protiv humanog papiloma virusa (HPV) provodi u žena do 23. godine života i nakon uzimanja cervikalnog brisa.Patients on anti-TNFmedications carry a higher risk for developing opportunistic infections. In order to introduce anti-TNFĪ± therapy, screening for hepatitis viruses B and C, HIV, EBV, HPV, TBC, bacterial, fungal and parasitic infections should be performed. Screening involves patientās history of earlier infectious diseases, vaccinations and traveling to parts of the world with endemic diseases. Clinical examination should be supplemented with stomatologic and gynecologic exams. Laboratory results include leukogram, transaminases, C-reactive protein, urine analysis, hepatitis B, C, HIV and EBV serology. Varicella zoster virus serology depends on past medical history. If the patient has traveled to tropical areas, both stool analysis and strongiloidiasis serology should be performed. Other mandatory examinations include chest radiography, PPD and TBC serology using interferon gamma release test (IGRA). If suspecting intra-abdominal abscess, magnetic resonance of the abdomen is recommended. In case of abscess, CMV or Clostridium difficile colitis anti-TNF-therapy is contraindicated. Live vaccine application is contraindicated in patients receiving anti-TNFtherapy. All seronegative patients should be vaccinated against hepatitis B virus. Seasonal flu vaccination is recommended to be applicated yearly and pneumococcal polysaccharide vaccine once in every five years. Based on the past medical history and serologic results, patients are vaccinated against VZV with extra precaution. Human papilloma virus vaccination is performed in a group of women under 23 years of age, after gathering cervical smear sample analysis
ENTERAL FEEDING IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Uloga enteralne prehrane u lijeÄenju kroniÄne upalne bolesti crijeva joÅ” uvijek nije jasno definirana. U radu su prikazane posljedice malnutricije kao jednog od osnovnih simptoma kroniÄne upalne bolesti crijeva te, sukladno tome, njihovo lijeÄenje. Iz prikazanog jasna je potreba suportivne terapije adekvatnim enteralnim pripravcima. To se posebice odnosi na djeÄju populaciju oboljelih buduÄi da poremeÄaj rasta i razvoja ima dalekosežne posljedice. Važnost potpune enteralne prehrane kao inicijalne terapije joÅ” nema adekvatnog odgovora i zahtijeva daljnje prospektivne analize. Prikazane su i neke nove mogu}nosti prehrane u lijeÄenju kroniÄne upalne bolesti crijeva, koje predstavljaju moguÄu budÄ}nost u terapiji tih bolestiThe purpose of enteral feeding in the inflammatory bowel diseases (IBD) has not been well defined yet. This article presents the consequences of malnutrition, as one of the basic symptoms of IBD and its therapy, respectively. As it is shown here, a supportive therapy with adequate enteral feeding is of great value, especially in pediatric patients due to long-term consequences of the growth failure and the failure to thrive. A complete enteral feeding as a primary and the only therapy in IBD has not been established completely yet and needs further analyses. We have shown some new ways of the enteral treatment of IBD that could be a future therapy of these illnesse
Gluten-related disorders
Gluten je bjelanÄevina koja se nalazi u pÅ”enici, dok se u raži, jeÄmu i zobi nalaze sliÄne bjelanÄevine. ZajedniÄkim imenom one se nazivaju gluten i mogu uzrokovati viÅ”e razliÄitih poremeÄaja koji se dijele na autoimune, alergijske i neautoimune ā nealergijske. Samo se celijakija pojavljuje u genetski predisponiranih osoba te se manifestira crijevnim, ali i brojnim izvancrijevnim manifestacijama. Važno je toÄno dijagnosticirati poremeÄaje povezane s glutenom jer je njihovo lijeÄenje razliÄito. Velik broj ljudi samoinicijativno se odluÄuje za bezglutensku dijetu pod utjecajem popularne literature. No, na taj se naÄin otežava postavljanje toÄne dijagnoze i odgovarajuÄe terapije.Gluten is a protein found in wheat, while similar proteins are present in rye, barley and oats. These proteins can cause many different disorders, classified as autoimmune, allergic, and non-autoimmune non-allergic. Only celiac disease can occur in genetically predisposed people, and it presents with a variety of both intestinal and extraintestinal manifestations. Early recognition of symptoms and diagnosis of gluten-related disorders is important for the adequate treatment. A large number of people decide to go on a gluten-free diet under the influence of popular literature. However, it makes much more difficult establish the accurate diagnosis and appropriate therapy
ASSESSMENT OF NUTRITIONAL RISKS IN HOSPITALISED PATIENTS
Otkrivanje pothranjenosti u bolesnika važan je zadatak jer pothranjenost utjeÄe na morbiditet, mortalitet, dužinu hospitalizacije i troÅ”kove lijeÄenja. Cilj rada bio je jednostavnim i brzim testom otkriti koliko se hospitaliziranih bolesnika nalazi u nutritivnom riziku. Ispitana su 843 bolesnika hospitalizirana na Klinici za internu medicinu lokaliteta Rijeke od 1. studenoga 2001. do 1. listopada 2003. Za procjenu nutritivnog rizika koristili smo Nottingham Screening Tool (NST) koji boduje indeks tjelesne mase (engl. body mass index ā BMI), gubitak težine u zadnja tri mjeseca, uzimanje hrane mjesec dana prije hospitalizacije i težinu osnovne bolesti. Od ukupnog broja ispitanika, 48% se nije nalazilo u nutritivnom riziku, 27% je zahtijevalo praÄenje i reevaluaciju, a 25% nutritivnu potporu. U skupini bolesnika s malignom boleÅ”Äu, Äak se 75% bolesnika nalazilo u nutritivnom riziku, Å”to je statistiÄki znaÄajno ÄeÅ”Äe (p<0, 001) u odnosu prema skupini nemalignih bolesnika. Dobiveni rezultati nalažu evaluaciju nutritivnog statusa pri prijemu u bolnicu jer adekvatnim tretmanom pothranjenosti možemo utjecati na tok i troÅ”kove lijeÄenja.Revealing nutrition status in patients is an important task because malnutrition influences morbidity, mortality, the length of hospital stay and costs. The aim of the study was to find out how many hospitalised patients are at a nutritional risk, with a fast and simple test. We examined patients hospitalised at the Internal Clinic of the Clinical Hospital Centre Rijeka in the period from November 1st 2001 till October 1st 2003. To assess the nutritional risk we used the Nottingham Screening Tool (NST) which scores body mass index (BMI), recent body weight loss, food intake before the hospitalisation and the severity of illness. We examined 843 patients. Only 48% were not at nutritional risk, 27% demanded monitoring and re-evaluation, and 25% were referred to dietetic advice. Of those 23% with malignancies, 75% were at nutritional risk. In comparison with non-malignant patients, the result was statistically significant (p<0,001). There is a significant malnutrition risk in hospitalised patients, especially in malignant ones. NST is a fast and efficient test for assessing the malnutrition risk. Malnutrition has to be evaluated and treated with nutrition support measure
ASSESSMENT OF NUTRITIONAL RISKS IN HOSPITALISED PATIENTS
Otkrivanje pothranjenosti u bolesnika važan je zadatak jer pothranjenost utjeÄe na morbiditet, mortalitet, dužinu hospitalizacije i troÅ”kove lijeÄenja. Cilj rada bio je jednostavnim i brzim testom otkriti koliko se hospitaliziranih bolesnika nalazi u nutritivnom riziku. Ispitana su 843 bolesnika hospitalizirana na Klinici za internu medicinu lokaliteta Rijeke od 1. studenoga 2001. do 1. listopada 2003. Za procjenu nutritivnog rizika koristili smo Nottingham Screening Tool (NST) koji boduje indeks tjelesne mase (engl. body mass index ā BMI), gubitak težine u zadnja tri mjeseca, uzimanje hrane mjesec dana prije hospitalizacije i težinu osnovne bolesti. Od ukupnog broja ispitanika, 48% se nije nalazilo u nutritivnom riziku, 27% je zahtijevalo praÄenje i reevaluaciju, a 25% nutritivnu potporu. U skupini bolesnika s malignom boleÅ”Äu, Äak se 75% bolesnika nalazilo u nutritivnom riziku, Å”to je statistiÄki znaÄajno ÄeÅ”Äe (p<0, 001) u odnosu prema skupini nemalignih bolesnika. Dobiveni rezultati nalažu evaluaciju nutritivnog statusa pri prijemu u bolnicu jer adekvatnim tretmanom pothranjenosti možemo utjecati na tok i troÅ”kove lijeÄenja.Revealing nutrition status in patients is an important task because malnutrition influences morbidity, mortality, the length of hospital stay and costs. The aim of the study was to find out how many hospitalised patients are at a nutritional risk, with a fast and simple test. We examined patients hospitalised at the Internal Clinic of the Clinical Hospital Centre Rijeka in the period from November 1st 2001 till October 1st 2003. To assess the nutritional risk we used the Nottingham Screening Tool (NST) which scores body mass index (BMI), recent body weight loss, food intake before the hospitalisation and the severity of illness. We examined 843 patients. Only 48% were not at nutritional risk, 27% demanded monitoring and re-evaluation, and 25% were referred to dietetic advice. Of those 23% with malignancies, 75% were at nutritional risk. In comparison with non-malignant patients, the result was statistically significant (p<0,001). There is a significant malnutrition risk in hospitalised patients, especially in malignant ones. NST is a fast and efficient test for assessing the malnutrition risk. Malnutrition has to be evaluated and treated with nutrition support measure