PATHOPHYSIOLOGY OF ALLERGIC DRUG REACTIONS

Adverse drug reactions (ADR) may be broadly divided into types A and B. Type A comprise the majority of reactions, can affect any individual, and are predictable from the known pharmacologic properties of a drug. Type B are less common, occur in susceptible patients and cannot be predicted. Allergic/immunologic drug reactions are a group of type B ADRs. Based on the time of onset allergic drug reactions can be divided into immediate and delayed and based on their underlaying immunologic mechanism, they can be further subdivided into 4 groups: immediate and mediated by IgE (1), delayed and caused by antibody facilitated cell destruction (2), delayed and caused by drug immune complex deposition and complement activation (3) and delayed and T cell mediated (4). Physicians should always insist on obtaining a thorough patient’s history regarding drug allergy as well as on ascertaining details regarding the medication used, its route of administration, dosage and the treatment duration in order to properly assess risk of drug allergies and suggest further work-up in that regard

PATHOPHYSIOLOGY OF ALLERGIC DRUG REACTIONS

Adverse drug reactions (ADR) may be broadly divided into types A and B. Type A comprise the majority of reactions, can affect any individual, and are predictable from the known pharmacologic properties of a drug. Type B are less common, occur in susceptible patients and cannot be predicted. Allergic/immunologic drug reactions are a group of type B ADRs. Based on the time of onset allergic drug reactions can be divided into immediate and delayed and based on their underlaying immunologic mechanism, they can be further subdivided into 4 groups: immediate and mediated by IgE (1), delayed and caused by antibody facilitated cell destruction (2), delayed and caused by drug immune complex deposition and complement activation (3) and delayed and T cell mediated (4). Physicians should always insist on obtaining a thorough patient’s history regarding drug allergy as well as on ascertaining details regarding the medication used, its route of administration, dosage and the treatment duration in order to properly assess risk of drug allergies and suggest further work-up in that regard

CORRELATION OF CLINICAL AND ENDOSCOPIC INDICES IN IBD PATIENTS IN UNIVERSITY CLINICAL HOSPITAL MOSTAR

Background: To explore correlation between clinical and endoscopic indices in inflammatory bowel disease (IBD) patients. Subjects and methods: There were 112 patients with inflammatory bowel disease. All patients with diagnosed IBD was established a degree of clinical and endoscopic disease activity. CDAI (Crohn\u27s disease activity index) was used as clinical and SESCD (Simplified Endoscopic Crohn Disease Index) as endoscopic index for Crohn\u27s disease. For ulcerative colitis Truelov & Witts index was used as clinical and Baron as endoscopic activity index. Correlation of clinical and endoscopic indices were compared in Crohn disease (CD) and ulcerative colitis (UC). Patients were analyzed by clinical entities - CD and UC, according to sex, age, parameters of anemia, duration of disease and education. Results: In the total of 112 IBD patients there were 69 patients diagnosed as ulcerative colitis (61.6%) and 43 as Crohn\u27s disease (38.4%). There were 58 (51.8%) women and 54 (48.2%) men. Comparison between endoscopic and clinical indices in CD and UC demonstrated no significant differences in ilnness activity. Endoscopic and clinical disease activity was associated with a higher inflammatory parameters (CRP and leucocytes, L) and lower parameters of hemoglobin (Hb) and MCV. Conclusion: Our research has established a good correlation between clinical and endoscopic index of disease activity in the CB and UC in inflammation. Clinical indices can be used for monitoring inflammation

Psychosocial and clinical characteristics of depressive patients with the diagnosis of metabolic syndrome

There is a growing quantity of data showing that mental illnesses affect the somatic health. Depression is a complex disease, connected with the disturbances of sleep-cycle, appetite, body weight and level of physical activity, all of which may represent the risk factors for the development of metabolic disturbances. In the depressive patients, there is a number of various physiological mechanisms and psychosocial factors which may influence the development of metabolic syndrome (MS), such as sex, age, smoking, stress levels, nutrition and level of physical activity. It is considered that chronic stress causes depression and the resulting bad life habits may lead to MS and finally KVB. Aim of this study was to investigate the psychosocial and clinical features of depressive patients with the diagnosis of MS. The cross-reference study has been done at the sample of 80 patients diagnosed with MS. Among the diagnostic instruments applied, we have used the structured socio-demographic questionnaire, MINI questionnaire, Hamilton Rating Scale for Depression (HAMD-17) and Clinical Global Impression (CGI). The diagnosis of metabolic syndrome had been established following the NCEP ATP criteria. Among the depressive patients, there were 38.8% who fulfilled the criteria for establishing the diagnosis of MS. There was a greater incidence of suicide among the depressive patients with the diagnosis of MS. The diagnose was more frequently established in depressive women, while an increased intake of carbohydrates represented a significant feature of both depression and MS. Further research is needed to explain the observed gender differences and to determine if the interventions aimed to treating the depression can also contribute to accepting the healthy life habits and as a consequence, indirectly reduce the incidence of MS

TYPE OF CELL SEPARATOR, FENWAL AMICUS VS FRESENIUS COM TEC, MAY INFLUENCE THE CORPUSCULAR ELEMENTS VALUE OF THE DONOR`S BLOOD

ntroduction: During the plateletpheresis procedure the number of thrombocytes in the donor’s blood significantly decreases, and the levels of the hematocrit (HCT), hemoglobin (Hgb), and leukocyte (WBC) diminish as well. Influence of the cell separator is one of the factors that affects the levels of HCT, Hgb and WBC. In this study, the goal was to determine the value difference o f HCT, Hgb, WBC, and platelets after the platelet pheresis process between performance on Fenwal AMICUS and on Fresenius Com Tec. Donors and methods: The criteria for participation: male in the age range of 25-45. We have formed two groups: for both groups - 180 separations were performed on 60 participants were the values of hematocrits, concentration of hemoglobin and number of leukocytes were established before and after separation using the double-needle continuous flow cell separation (DN- CFCS) on two different devices, Fenwal AMICUS device and the Fresenius Com Tec. device. To confirm the statistical differences we have used Student t-test for independent or dependent samples, as well as Mann-Whitney U test as non-parametric alternative. To compare differences between the values of four parameters (P1-P2) from two groups (using two devices - Fenwal AMICUS and Fresenius Com Tec) The possibility of errors were accepted for Į<0.05, and the difference between groups as statistical relevant were accepted for p<0.05. Results Statistically significant lower values were noted for all researche d parameters after separation on both devices. The statistically significant average values for Hct, Hgb and WBC obtained between two devices, were less than 0.05 (p=0.05). For the platelets (Plt) there was no statistical significant difference (p>0.05 - Į=0.05), between average level obtained using either Fenwal AMICUS or Frazenius Com Tec. Conclusion: The type of cell separator had the influence on the decrease value of the observed parameters

ANXIETY, DEPRESSION AND PERSONALITY TYPES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: COMPARISONS WITH PEPTIC ULCER AND THE GENERAL POPULATION

Background: To explore corellation of anxiety, depression ant type of personality in inflammatory bowel disease (IBD) and compare with peptic ulcer (PU). Subjects and methods: In this study, prevalence of anxiety, depression and type of personality was investigated in 362 cases divided into three groups: 112 of IBD patients, 122 of peptic ulcer patients and 128 of control group who didn\u27t have any gastrointestinal or psychic complaints. IBD and peptic ulcer diagnosis were established by standard diagnostic procedures (anamnesis, clinical manifestations, laboratory, endoscopy and biopsy in IBD and upper endoscopy in peptic ulcer). Anxiety and depression were established by Hamilton anxiety rating scale (HAM-A) and Hamilton rating test for depression (HAM-D). Type of A/B personality was established by Bortner scale and D type of personality by Denollet scale (DS14). Results: Anxiety was found in 47 (41.9%) and depression in 44 (38.3%) of a total of 112 IBD cases. In group with peptic ulcer anxiety was found in 40 (32.8%) and depression aalso in 40 (32.8%) of total 122 cases. In control group anxiety was diagnosed in 21 (16.4%) and depression in 20 (15.6%) of total 128 cases. Anxiety and depresson were significantly higher in both groups than in control group but anxiety and depression were significantly higher in IBD group than peptic ulcer group. D type of personality was statistically significant in peptic ulcer group. Conclusion: Anxiety and depression in IBD and peptic ulcer cases have a greater prevalence compared to the normal population and surprisingly are higher in IBD than peptic ulcer group. D type of personality is associated with peptic ulcer

CORRELATION BETWEEN BIOCHEMICAL AND HISTOPATHOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN

Aim: The main goal of this study was to compare the biochemical and histopathological findings in patients with sustained virological response (SVR) before and two years after the therapy with pegylated interferon α-2a and ribavirin in chronic hepatitis C. Subjects and methods: The study was conducted at the Department of Internal Medicine and the Clinic for Infectious Diseases of the Clinical Hospital Mostar. The study included 48 patients whose treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin was finished two years prior to the achieved SVR at the end of the treatment. The main criterion for inclusion was a negative result of HCV RNA, determined by the RealTime HCV assay. After taking a history, physical examination, laboratory tests: AST, ALT, GGT, a liver biopsy were performed with the help of the ultrasound. The assessment of necroinflamatory score was determined by histologic activity index (HAI) score, and the stage of fibrosis according to Knodell\u27s numerical score. Results: The values of AST and ALT levels were statistically significantly decreased after the successful treatment (p<0.001), as well as the value of HAI score (p=0.001) and the stage of fibrosis (p=0.010), in contrast to GGT (p=0.054). For the components of HAI score like focal necrosis (0.001) and portal inflammation (0.042) the result showed that they were significantly higher before the therapy, which was not true for the piecemeal (p=0.054) and confluated necrosis (p=0.078). The improvement of HAI score after therapy was found in 36 patients (75.0%), and 27 patients (56.2%) showed an improvement in the degree of fibrosis with the most common improvement of 1 degree (85.7%). One third of patients (31.3%) had the same result in the degree of fibrosis before and after the therapy. Before the treatment, a positive correlation was observed between ALT (p=0.039) and AST (p=0.04) with HAI, AST and the stage of fibrosis (p=0.04). In contrast, after the treatment the only correlation was observed between AST and the stage of fibrosis (p=0.042). Conclusion: Virological and biochemical responses in patients with SVR may not reflect the histopathological effects of the treatment and therefore these patients should be monitored for the possible development of the liver cirrhosis and hepatocellular carcinoma

THE ROLE OF FAMILY PHYSICIANS IN THE PREVENTION AND EARLY DETECTION OF CANCER IN HERZEGOVINA-NERETVA AND WEST-HERZEGOVINA CANTON

Background: This study aimed to investigate and analyze the role of general practitioners / family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. Subjects and methods: A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina- Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. Results: Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. Conclusions: The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients

CORRELATION BETWEEN BIOCHEMICAL AND HISTOPATHOLOGICAL PARAMETERS IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN

Aim: The main goal of this study was to compare the biochemical and histopathological findings in patients with sustained virological response (SVR) before and two years after the therapy with pegylated interferon α-2a and ribavirin in chronic hepatitis C. Subjects and methods: The study was conducted at the Department of Internal Medicine and the Clinic for Infectious Diseases of the Clinical Hospital Mostar. The study included 48 patients whose treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin was finished two years prior to the achieved SVR at the end of the treatment. The main criterion for inclusion was a negative result of HCV RNA, determined by the RealTime HCV assay. After taking a history, physical examination, laboratory tests: AST, ALT, GGT, a liver biopsy were performed with the help of the ultrasound. The assessment of necroinflamatory score was determined by histologic activity index (HAI) score, and the stage of fibrosis according to Knodell\u27s numerical score. Results: The values of AST and ALT levels were statistically significantly decreased after the successful treatment (p<0.001), as well as the value of HAI score (p=0.001) and the stage of fibrosis (p=0.010), in contrast to GGT (p=0.054). For the components of HAI score like focal necrosis (0.001) and portal inflammation (0.042) the result showed that they were significantly higher before the therapy, which was not true for the piecemeal (p=0.054) and confluated necrosis (p=0.078). The improvement of HAI score after therapy was found in 36 patients (75.0%), and 27 patients (56.2%) showed an improvement in the degree of fibrosis with the most common improvement of 1 degree (85.7%). One third of patients (31.3%) had the same result in the degree of fibrosis before and after the therapy. Before the treatment, a positive correlation was observed between ALT (p=0.039) and AST (p=0.04) with HAI, AST and the stage of fibrosis (p=0.04). In contrast, after the treatment the only correlation was observed between AST and the stage of fibrosis (p=0.042). Conclusion: Virological and biochemical responses in patients with SVR may not reflect the histopathological effects of the treatment and therefore these patients should be monitored for the possible development of the liver cirrhosis and hepatocellular carcinoma

THE ROLE OF FAMILY PHYSICIANS IN THE PREVENTION AND EARLY DETECTION OF CANCER IN HERZEGOVINA-NERETVA AND WEST-HERZEGOVINA CANTON

Background: This study aimed to investigate and analyze the role of general practitioners / family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. Subjects and methods: A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina- Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. Results: Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. Conclusions: The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients