Recurrence of primary sclerosing cholangitis after liver transplantation: the Hungarian experience

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Hepatitis C-vírus-fertőzés kiújulása májátültetés után. Mi változott az elmúlt 10 évben?

Introduction: Management of hepatitis C virus recurrence is a challenge after liver transplantation. Aim: The aim of the authors was to analyse the outcome of liver transplantation performed in hepatitis C virus positive patients during the past ten years and to compare recent data with a previous report of the authors. Method: The authors retrospectively evaluated the data (donors, recipients, perioperative characteristics, patient and graft survival, serum titer of hepatitis C virus RNA, histology) of 409 patients who underwent liver transplantation between 2003 and 2012. Results: 156 patients were transplanted due to hepatitis C virus associated liver cirrhosis (38%). Worse outcome was observed in these patients in comparison to hepatitis C virus negative recipients. The cumulative patient survival rates at 1, 5, and 10 year were 80%, 61%, 51% in the hepatitis C virus positive group and 92%, 85%, 79% in the hepatitis C virus negative group, respectively (p<0.001). The cumulative graft survival rates at 1, 5 and 10 year were 79%, 59% and 50% in hepatitis C virus positive and 89%, 80% and 70% in hepatitis C virus negative patients (p<0.001). Hepatitis C virus recurrence was observed in the majority of the patients (132 patients, 85%), mainly within the first year (83%). The authors observed recurrence within 6 months in 71 patients (56%), and within 3 months in 26 patients (20%). The mean hepatitis C virus recurrence free survival was 243 days. Higher rate of de novo diabetes was detected in case of early recurrence. The cumulative patient survival rates at 1, 3, 5, 10 years were 98%, 89.5%, 81% and 65% when hepatitis C virus recurrence exceeded 3 months and 64%, 53%, 30.5% and 30.5% in patients with early recurrence (p<0.001). Conclusions: Poor outcome of liver transplantation in hepatitis C virus positive patients is still a challenge. Hepatitis C virus recurrence is observed earlier after liver transplantation in comparison with a previous report of the authors. De novo diabetes occurs more frequently in case of early recurrence. Despite an immediate start of antiviral treatment, early recurrence has a significant negative impact on the outcome of transplantation. Orv. Hetil., 2013, 154, 1058-1066

De novo diabetes és májátültetés, különös tekintettel a hepatitis C-vírus kiújulására = New-onset diabetes mellitus after liver transplantation

A de novo diabetes mellitus a májátültetés gyakori szövődménye. Célkitűzés: A de novo diabetes gyakoriságát, jelentőségét és a kockázati tényezők szerepét vizsgáltuk. Módszer: 1995 és 2009 között 310 májátültetett beteg adatait dolgoztuk fel retrospektív módszerrel. De novo diabetest állapítottunk meg, ha az éhomi vércukor a 3. posztoperatív hónapon túl ismételten >6,8 mmol/l volt, és/vagy a májátültetés után tartós, a 3. posztoperatív hónapot meghaladóan is fenntartott antidiabetikus terápia indult. Eredmények: De novo diabetes a betegek 20%-ánál (63 beteg) alakult ki. A de novo és a kontrollcsoport között az alábbiakban találtunk különbséget. Donor-testtömegindex (24±3 vs. 22,4±3,6 kg/m 2 , p = 0,003), férfi nem (58% vs. 33%, p = 0,002). Recipienséletkor (47,6±7,2 vs. 38,3±14,6 év, p<0,001), -testtömegindex (26,7±3,8 vs. 23,3±5,6 kg/m 2 , p<0,001), férfi nem (60% vs. 44%, p = 0,031). A de novo diabetesesek csoportjában a betegek 66%-át HCV talaján kialakult cirrhosis miatt transzplantálták, a kontrollcsoportban ez csak 23% volt (p<0,001). Az 1, 3, 5 és 8 éves kumulatív betegtúlélés a kontrollcsoportban 95%, 91%, 88% és 88%, a de novo csoportban a megfelelő értékek 87%, 79%, 79% és 64% (p = 0,011). Az 1, 3, 5 és 8 éves kumulatív grafttúlélés a kontrollcsoportban 92%, 87%, 86% és 79%, a de novo csoportban a megfelelő értékek 87%, 79%, 79%, 65% (p = NS). Azoknál a betegeknél, akiknél a C-vírus korai (6 hónapon belüli) kiújulását észleltük, többségben de novo diabetes is kialakult (74% vs. kontroll 26%, p = 0,03). A betegek 53%-ában észleltünk tízszeres vírustiter-emelkedést a műtét utáni 6 hónapon belül a preoperatív értékhez viszonyítva diabetes kialakulása esetén, a kontrollnál ez 20% volt (p = 0,028). A de novo csoportban magasabb volt az átlagos (Ishak-Knodell) fibrosis score az antivirális kezelés megkezdését követően 1 évvel (2,05±1,53 vs. 1,00±1,08, p = 0,039). Következtetés: Májátültetést követő de novo diabetes kockázati tényezői az időskor, elhízás, férfi nem és a C-vírus okozta cirrhosis. Víruspozitív betegek körében a korai rekurrencia, súlyosabb viraemia és az antivirális kezelés ellenére kialakuló súlyosabb fibrosis összefügg a de novo diabetes kialakulásával. | New-onset diabetes is a common complication after liver transplantation. Aim: We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome. Methods: We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation. Results: New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24±3 vs. 22.4±3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6±7.2 vs. 38.3±14.6 year, p<0.001), body mass index (26.7±3.8 vs. 23.3±5.6 kg/m 2 , p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05±1.53 vs. 1.00±1.08, p = 0.039). Conclusions: Risk factors for new-onset diabetes after transplantation are elder age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients

EVALUAREA FACTORILOR DETERMINANŢI AI NAŞTERII PREMATURE, ÎN ANUL 2013

INTRODUCTION: Premature birth complicates 5-10% of the pregnancies and is the most important cause of perinatal mortality and morbidity in the world. Delivery produced between 26 weeks (the lower limit of fetal viability) and 37 weeks of complete amenorrhoea is considered premature birth. Aim of the study: The purpose of the study was to identify determinant factors of medical behavior in premature birth. Material and METHODS: We carried out a retrospective study on premature live births at the Obstetrics and Gynecology Department of the Clinical Emergency Hospital in T&icirc;rgu Mureş during the period between 1st January &ndash; 31st December 2013. Data have been obtained from the Register of new-born babies with low birth weight and the Statistical service of the hospital. &nbsp;RESULTS: In 2013 at the Obstetrics and Gynecology Clinic of the Emergency Hospital in T&icirc;rgu Mureş 172 premature infants were born with gestational age between 25 and 37 completed weeks, representing 15.45 % of the total live births of the clinic.&nbsp; Global analysis of the pregnant women's group presenting premature delivery in 2013 shows a predominance of preterm birth in case of grand multiparas (66.22 %) and only 33.78% in primiparas. 138 of the 172 premature newborn infants came from monofetal pregnancies, 28 were from complicated twin pregnancies and 6 newborns were triplets. From all pregnant women who presented preterm delivery, 47% were admitted to the emergency unit of the hospital with spontaneous rupture of membranes for at least 1 hour; 31.25% of the women with multiple pregnancy presented early rupture of membranes (PPROM). From the total of 151 pregnant women presenting premature delivery in 116 cases was decided to end the pregnancy for maternal and fetal reasons. The gender of the live newborns was 51% male and 49% female. There have been 4 antepartum deaths. &nbsp;CONCLUSIONS: Analyzing data regarding preterm births during 2013 in the Clinical Hospital of Obstetrics and Gynecology we can conclude: Even if the number of births decreased, premature births did not record the same decreasing tendency; The profile of the pregnant women presenting premature delivery: woman between 30 and 40 years from rural area, average/poor socio-economic conditions, grand multipara who is admitted to the emergency unit with PPROM; Therapeutic behaviour requires in the majority of cases cesarean section of maternal and/or fetal causes; Prevention and treatment of premature birth is important in reducing neonatal adverse reactions and to increase the quality of life in newborns. &nbsp;Keywords: premature birth, cesarean section, pregnancy.INTRODUCERE: Naşterea prematură complică 5-10% din sarcini şi reprezintă cea mai importantă cauză de mortalitate şi morbiditate perinatală din lume. Este considerată prematură naşterea produsă &icirc;ntre 26 (v&acirc;rsta viabilităţii fetale) şi 37 de săptăm&acirc;ni complete de amenoree (SA).&nbsp; Studiul şi-a propus identificarea factorilor determinanţi ai conduitei medicale &icirc;n naşterea prematură.&nbsp;MATERIAL ŞI METODĂ: Am efectuat un studiu retrospectiv asupra naşterilor premature din Clinica Obstetrică-Ginecologie a Spitalului Clinic Judeţean de Urgenţă Tg-Mureş&nbsp; &icirc;n perioada 1 ianuarie-31 decembrie 2013. Datele au fost obţinute din Registrul de nou-născuţi cu greutate mică la naştere şi de la Serviciul Statistică a spitalului. &nbsp;REZULTATE: &Icirc;n anul 2013 &icirc;n Clinica Obstetrică &ndash;Ginecologie a Spitalului Clinic Judeţean de Urgenţă Tg-Mureş s-au născut 172 nou-născuţi prematuri cu v&acirc;rsta gestaţională &icirc;ntre&nbsp; 25 şi 37 de SA, reprezent&acirc;nd 15,45% din totalul naşterilor din clinică. Analiza globală a lotului de gravide care au născut prematur &icirc;n anul 2013 ne arată o preponderenţă a naşterii &icirc;nainte de termen&nbsp; la marile multipare (66,22%) şi doar&nbsp; 33,78%&nbsp; la primipare. Cei 172 de nou&ndash;născuţi prematuri au provenit &icirc;n număr de 138 din sarcina monofetală, 28 din sarcină gemelară complicată şi 6&nbsp; nou-născuţi au fost tripleţi. Din totalul gravidelor care au născut prematur, 47% femei &icirc;nsărcinate s-au prezentat &icirc;n urgenţă cu ruptura spontană a membranelor amniocoriale de cel puţin 1 oră; 31,25% din gravidele cu sarcină multiplă au avut ruptura prematură precoce de membrane amniocoriele (PPROM). Finalizarea sarcinii din motive materne şi fetale s-a decis la 116 gravide din totalul celor&nbsp; 151 femei&nbsp; care au născut prematur. Sexul nou-născuţilor vii a fost de 51% masculin şi 49% feminin. S-au &icirc;nregistrat 4 decese antepartum. &nbsp;CONCLUZII: Din analiza naşterilor premature &icirc;n anul 2013 la Clinica Obstetrică-Ginecologie am constatat următoarele: chiar dacă natalitatea a scăzut naşterile premature nu au &icirc;nregistrat acelaşi trend descendent; profilul gravidei care a născut prematur: femeie &icirc;ntre 30-40 ani din mediul rural, de condiţie socio-economică medie/precară, mare multipară care se internează de urgenţă &icirc;n clinică cu PPROM, conduita terapeutică de finalizarea sarcinii din cauze materne şi/sau fetale presupune &icirc;n majoritatea cazurilor&nbsp; intervenţia cezariană; prevenirea şi tratamentul naşterii premature este importantă &icirc;n reducerea reacţiilor adverse neonatale şi pentru creşterea calităţii vieţii nou-născutului.&nbsp;Cuvinte cheie: naştere prematură, operaţie cezariană, sarcin

IDENTIFICAREA TIMPURIE A DEPOZITELOR MOLECULARE ÎN RETINĂ SPECIFICE PENTRU DEMENȚĂ ȘI BOLI NEURODEGENERATIVE ASOCIATE

Ageing population in the western world brings socio-economic implications and provides new challenges for the healthcare system. Dementia and related neurodegenerative disorders affecting the elderly deprive cognition, memory, self-sustenance and cause death in late stages. Even if patients consult the doctors as early as first symptoms appear, that usually occurs after several years of disease progression with already irreversible organ damage. New research targets to overcome the problem of late diagnosis and to give efficient and cost-effective solutions in health management of the ageing population. This paper summarises, in a literature review, the latest advancements in the field of non-invasive imaging of hallmark deposits in the retina for dementia and related neurodegenerative disorders.   Keywords: retina imaging, dementia, neurodegenerative disorders, fluorochrome, hallmark deposits&Icirc;mbătr&acirc;nirea populației din lumea occidentală are implicații socio-economice și aduce provocări noi sistemului de sănătate. Demența și bolile neurodegenerative asociate afect&acirc;ndu-i pe bătr&acirc;ni, ii privează de discernăm&acirc;nt, memorie și subzistență, provoc&acirc;nd deces &icirc;n stadii avansate. Chiar dacă pacienții sunt consultați de medici la apariția primelor simptome, acest stadiu presupune mai mulți ani de evoluție a bolii cu manifestări organice ireversibile. Cercetările recente țintesc depășirea acestei probleme de diagnostic &icirc;nt&acirc;rziat și oferă soluții eficiente inclusiv din punct de vedere financiar a managementului &icirc;n sănătate a populației &icirc;mbătr&acirc;nite. Acest articol rezumă, printr-o revizuire a literaturii de specialitate, ultimele progrese &icirc;n domeniul imagisticii neinvazive a depozitelor moleculare retiniene pentru demență și boli neurodegenerative asociate. &nbsp; Cuvinte cheie: imagistică retiniană, demență, boli neurodegenerative, florocrom, depozite specifice&nbsp

The Influence of Oxidative Stress-Related Factors on Pregnancy and Neonatal Outcomes

Background: Pregnancy is a physiological process associated with an excessive oxidative stress for both the mother and the neonate. Oxidative stress was extensively studied and is still in focus as a factor of maternal pathologies during pregnancy, with consequences on the outcome of the neonate

STUDIUL DINAMICII UNOR PARAMETRI BIOCHIMICI LA PACIENȚII DIABETICI, ÎN FUNCȚIE DE STILUL DE VIAȚĂ ȘI OBICEIURILE ALIMENTARE

We evaluated in dynamics, during 2002 – 2016, the diet and lifestyle habits of patients suffering from type 1 and 2 diabetes, using a complex questionnaire. We also compared the values of the main important laboratory results regarding carbohydrate metabolic balance and lipidic status (glycated hemoglobin and glycemic profile, serum total cholesterol, HDL-cholesterol and triglycerides). Several unhealthy habits can be observed in the majority of the patients, like sedentarism, which showed increasing percentage in type 2 diabetic patients,  and can represent a factor that contributed to the high number of overweight and obese individuals in this group. The level of stress exposure shows increasing tendency during the trial. We observed a decrease in the number of diabetic patients consuming dietary supplements. Monitoring the carbohydrate metabolic balance by measuring the glycated hemoglobin value has been improved during the study.    Keywords: diabetes mellitus, life style, diet, clinical managementS-au evaluat &icirc;n dinamică, &icirc;n perioada 2002 &ndash; 2016, cu ajutorul unui chestionar complex, obiceiurile alimentare și stilul de viață la pacienții cu diabet zaharat de tip 1 și 2. De asemenea, s-au comparat valorile obținute la parametrii principali de laborator, prin care s-au evaluat echilibrul metabolic glucidic și statusul lipidic (hemoglobină glicozilată și profil glicemic, colesterol total, HDL-colesterol, trigliceride din ser). Se pot constata o serie de obiceiuri nesănătoase la majoritatea pacienților, cum ar fi sedentarismul cu procentaj crescător la cei cu diabet de tip 2, ceea ce poate fi un factor care a determinat numărul mare de indivizi supraponderali și obezi &icirc;n acest lot. Nivelul de stres la care sunt expuși bolnavii este &icirc;n creștere pe parcursul studiului. S-a putut observa scăderea numărului pacienților diabetici care consumă suplimente alimentare. Frecvența monitorizării echilibrului metabolic glucidic bazat pe determinarea hemoglobinei glicozilate s-a &icirc;mbunătățit pe parcursul perioadei de studiu. Cuvinte cheie: diabet zaharat, stil de viață, dietă, management clinic

Management of Microvascular Complications in Secondary Diabetes Associated with Autoimmune Diseases — Case Report

The association of multiple autoimmune diseases may represent the main focus of physicians treating patients with such pathology presenting no comorbidities of different etiology. However, autoimmune diseases and side effects of drugs may lead to development of silent health-threatening diseases that should be identified promptly. We present the case of an elderly, obese, Caucasian female patient suffering of autoimmune thyroiditis, rheumatoid arthritis, and psoriasis, who developed arterial hypertension and insulin-treated secondary diabetes mellitus (due to long-term oral corticotherapy) with microvascular end-organ changes. Retinal imaging for capillary anomalies identified mild non-proliferative diabetic retinopathy with apparent diabetic macular edema and hypertensive retinopathy. Laboratory investigations looking for further vascular risk factors revealed zinc deficiency, elevated serum homocysteine levels, and constantly high C-reactive protein concentration. Attention should be payed to the proper investigation of patients with autoimmune diseases, targeting the early diagnosis of microvasculopathies due to autoimmune diseases or possible medication side effects, in order to prevent end-organ damage