Eozinofilni kolitis

Zbog nedefiniranih kriterija dijagnostike i velikog broja sekundarnih uzroka eozinofilije kolona, ova je bolest često kasno prepoznata. Bolesnici se prezentiraju s nespecifičnim simptomima, kao što su abdominalna bol, proljev i gubitak na težini, a klinička slika ponajviše ovisi o dubini infiltracije stijenke eozinofilima. Eozinofilni kolitis ima bimodalnu dobnu distribuciju s najčešćom pojavnosti u novorođenčadi i mlađoj odrasloj populaciji. Točan uzrok ove bolesti nije poznat. Dok je u novorođenčadi to najčešće IgE posredovan odgovor na kravlje mlijeko i proteine soje, u odraslih je najčešće rezultat CD4 Th2 odgovora. Endoskopskim pregledom zamijećene promjene stijenke kolona nespecifične su, uslijed čega je potrebna biopsija za potvrdu dijagnoze i isključenje drugih mogućih bolesti. Upalne bolesti crijeva, lijekovi, paraziti, autoimune bolesti vezivnoga tkiva, te idiopatski hipereozinofilni sindrom, mogu stvoriti sličnu kliničku i histološku sliku bolesti, zbog čega je eozinofilni kolitis primarno dijagnoza isključenja. U djece je bolest nakon uvedene dijete samolimitirajuća, dok je u odraslih potrebno dugotrajno liječenje s obzirom na to da je bolest kronična tijeka s razdobljima remisije i relapsa. Najučinkovitijom se pokazala kortikosteroidna terapija, a u slučaju teških refraktornih stanja i razvoja steroidne ovisnosti, uvodi se imunosupresivna terapija

Eosinophilic colitis

Zbog nedefiniranih kriterija dijagnostike i velikog broja sekundarnih uzroka eozinofilije kolona ova je bolest često kasno prepoznata. Pacijenti se prezentiraju s nespecifičnim simptomima kao što su abdominalna bol, proljev i gubitak na težini, a klinička slika ponajviše ovisi o dubini infiltracije stijenke eozinofilima. Eozinofilni kolitis ima bimodalnu dobnu distibuciju s najčešćom pojavnosti u novorođenčadi i mladoj odrasloj populaciji. Točan uzrok ove bolesti nije poznat. Dok je u novorođenčadi to najčešće IgE posredovan odgovor na kravlje mlijeko i proteine soje, u odraslih je najčešće rezultat CD4 Th2 odgovora. Endoskopskim pregledom zamijećene promjene stijenke kolona nespecifične su, uslijed čega je potrebna biopsija za potvrdu dijagnoze i isključenje drugih mogućih bolesti. Upalne bolesti crijeva, lijekovi, paraziti, autoimune bolesti vezivnog tkiva, idiopatski hipereozinofilni sindrom mogu stvoriti sličnu kliničku i histološku sliku bolesti, zbog čega je eozinofilni kolitis primarno dijagnoza isključenja. U djece je bolest nakon uvedene dijete samolimitirajuća dok je u odraslih potrebno dugotrajno liječenje s obzirom na to da je bolest kronična tijeka s razdobljima remisije i relapsa. Najučinkovitijom se pokazala kortikosteroidna terapija, a u slučaju teških refraktornih stanja i razvoja steroidne ovisnosti uvodi se imunosupresivna terapija.Due to undefined diagnostic criteria and large number of secondary causes of eosinophilia, this disease is often late-detected. Patients are presented with unspecific symptoms such as abdominal pain, diarrhea, weight loss, and its clinical image mostly depends on the depth of eosinophilic infiltration of the intestinal wall. Eosinophilic colitis has bimodal age distribution with highest prevalence in newborns and young adult population. The exact cause of this disease remains unknown. While in infants the cause is most commonly IgE mediated response to cow's milk and soy protein, in adults it's most commonly the result of CD4 Th2 response. Endoscopically observed colon wall changes are unspecific, so biopsy is needed for conformation of the diagnosis and exclusion of other possible diseases. Inflammatory bowel diseases, medicines, parasites, autoimmune connective tissue diseases, idiopathic hypereosinophilic syndrome may create similar clinical presentation and histological findings, which is why eosinophilic colitis is primarily diagnosis of exclusion. In children, after dietary measures are introduced, the disease is self-limiting, whereas in adults long-term treatment is needed because it's a chronic relapsing disease with periods of remission. Corticosteroid therapy has proven to be the most effective, whereas in the cases of severe refractory conditions and development of steroid addiction immunosuppressive therapy is introduced

Effects of long-term multimodal psychosocial treatment on antipsychotic-induced metabolic changes in patients with first episode psychosis

Background: Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. Different approaches were used to counteract these side effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first episode psychosis on antipsychotic-induced metabolic changes. ----- Methods: We enrolled 71 patients with first episode psychosis treated at the Zagreb University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual (TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months follow-up. ----- Results: Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional level significantly increased at month 18th in both groups. ----- Conclusion: While both types of treatment were effective in reducing psychopathology and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities and antipsychotic-induced weight gain