Editorial

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Editorial

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Reverzibilnost lipoatrofije u HIV-om zaraženih bolesnika na antiretrovirusnoj terapiji: kohortna studija s ultrazvučnim praćenjem

The aim of this study was to characterize and compare changes in subcutaneous fat in the malar, brachial and crural region in a cohort of HIV-infected patients taking antiretroviral therapy. This prospective longitudinal study included 77 patients who were selected from the initial cohort evaluated in 2007 and 2008. We examined reversibility of lipoatrophy measured by ultrasound over at least five-year period and factors related to its reversibility. All 46 patients who used stavudine switched from stavudine to another combination. Of 58 patients on zidovudine, 16 (28%) were on a zidovudine based regimen at the second follow up. There was evidence for subcutaneous fat increase in the malar area (p<0.001) and no increase in the brachial and crural areas. Patients who were smokers and had poor adherence to the Mediterranean diet had a thinner malar area at the follow up measurement (p=0.030) and smaller increase in subcutaneous malar fat compared to others (p=0.040). Our study suggested that modest increase of subcutaneous fat in malar area coincided with stopping stavudine and fewer usage of zidovudine. Lifestyle with non-adherence to the Mediterranean diet and smoking were associated with a smaller increase in subcutaneous malar fat.Cilj ovog istraživanja bio je okarakterizirati i usporediti promjene potkožnog masnog tkiva na licu, nadlaktici i potkoljenici u skupini HIV-om zaraženih bolesnika koji uzimaju antiretrovirusne lijekove. Radi se o prospektivnoj longitudinalnoj studiji u koju je bilo uključeno 77 bolesnika koji su odabrani iz početne kohorte koja je evaluirana 2007. i 2008. godine. Istraživali smo reverzibilnost lipoatrofije mjerene ultrazvukom u razdoblju od najmanje pet godina i čimbenike povezane s tom reverzibilnošću. Kod svih 46 bolesnika koji su uzimali stavudin on je zamijenjen nekom drugom kombinacijom lijekova. Od 58 bolesnika koji su uzimali zidovudin 16 (28%) ih je uzimalo kombinacije temeljene na zidovudinu kod kontrolnog mjerenja. Dokazan je porast potkožne masti na licu (p<0,001), dok na nadlaktici i potkoljenici nije bilo porasta. Bolesnici koji su bili pušači i slabo su se pridržavali mediteranske dijete imali su tanje potkožno masno tkivo na licu kod kontrolnog mjerenja (p=0,030), kao i manji porast potkožne masti na licu u usporedbi s ostalima (p=0,040). Naše istraživanje upućuje na to da se blaži porast potkožne masti na licu podudara s prestankom uzimanja stavudina i manjim uzimanjem zidovudina. Način života uz nepridržavanje mediteranske dijete i pušenje bio je povezan s manjim porastom potkožne masti na licu

Ponovljena prezentacija Gravesove bolesti kao manifestacije sindroma imune rekonstitucije u bolesnice zaražene HIV-om koja uzima antiretrovirusne lijekove

An HIV-infected patient who experienced immune reconstitution after highly active antiretroviral therapy (HAART) (increase in CD4 T-cell count from 84/mm3 to 310/mm3) presented with severe Graves’ disease twice, after commencing and recommencing HAART. At the first episode of Graves’ disease, 21 months after the introduction of HAART, the symptoms of thyroid dysfunction vanished without any specific treatment, but were associated with termination of taking HAART. At the second episode, 5 years after recommencing HAART, the patient continued taking HAART and commenced antithyroid therapy with thiamazole. Graves’ disease developed after a long period, while the patient was in good condition and when complications resulting from HAART were not expected. No features of any autoimmune disease were diagnosed before HAART initiation.Bolesnica zaražena HIV-om u koje se razvio sindrom imune rekonstitucije nakon antiretrovirusnog liječenja (ARL) (porast broja stanica CD4 s 84/mm3 na 310/mm3) prezentirala se u dva navrata s Gravesovom bolešću, na početku liječenja ARL-om i nakon stanke u liječenju. Tijekom prve epizode 21 mjesec nakon uvođenja ARL-a simptomi tiroidne disfunkcije nestali su bez specifičnog liječenja, ali su bili povezani s prestankom uzimanja ARL-a. Tijekom druge epizode 5 godina nakon ponovnog uzimanja ARL-a bolesnica je nastavila uzimati ARL i započela s antitiroidnim lijekom tiamazolom.Gravesova bolest se ponovno javila nakon dugog razdoblja kad je bolesnica bila u dobrom općem stanju i kad se komplikacije vezane uz ARL više nisu očekivale. Prije uzimanja ARL-a bolesnica nije pokazivala nikakve znakove autoimune bolesti

Long COVID or postacute COVID-19 sequelae

Tijekom još uvijek prisutne pandemije COVID-19 uočen je problem velikog broja bolesnika s perzistirajućim simptomima nakon akutne infekcije. Postoje brojne definicije ovog sindroma, ali „dugi COVID“ (od engl. Long COVID) ili post-akutni COVID definira se kao prisutnost protrahiranih simptoma ili ponovno javljanje simptoma mjesec dana nakon početka akutne bolesti. „Dugi COVID“ dijeli se na „produljeni simptomatski COVID-19“ ako simptomi traju od 4 do 12 tjedana te „post-COVID sindrom“ ako simptomi traju dulje od 12 tjedana nakon infekcije koja klinički i epidemiološki odgovara COVID-19, a ne mogu se pripisati drugoj dijagnozi. Zahvaćen može biti svaki organski sustav, a najčešći simptomi uključuju umor, nedostatak zraka, palpitacije, vrtoglavicu, bol, neurokognitivnu disfunkciju, nesanicu, intoleranciju napora, smanjenu mogućnost obavljanja svakodnevnih aktivnosti i sveukupno smanjenu kvaliteta života. Patofiziologija je multifaktorijalna i sam mehanizam nastanka bolesti nije u potpunosti razjašnjen. Usprkos brojnim studijama, komplikacije, liječenje i prognoza postakutnih posljedica COVID-19 nisu još dovoljno istraženi. S obzirom na raznolikost kliničke prezentacije, liječenje i prevencija zahtijevaju multidisciplinarni pristup bolesti. Potrebna su daljnja istraživanja kako bi se utvrdili čimbenici rizika i patofiziološki mehanizmi i postavili pouzdaniji algoritmi dijagnostičke obrade, liječenja i praćenja bolesnika. U ovom radu prikazujemo pregled dosadašnjih svjetskih spoznaja o „dugom COVID-u“ uz prikaz najčešćih post-COVID radioloških promjena u bolesnika liječenih u Klinici za infektivne bolesti „Dr. Fran Mihaljević“.In addition to the COVID-19 pandemic itself, a new problem of the rising number of people with persisting symptoms after an acute infection emerged. There are various definitions, but long COVID or post-acute COVID is defined as the presence of prolonged symptoms or long-term complications of an acute infection longer than one month after the first symptoms. Long COVID can be divided into “prolonged symptomatic COVID-19” if symptoms last from 4 to 12 weeks and “post-COVID syndrome” if symptoms last longer than 12 weeks after infection that clinically and epidemiologically corresponds to COVID-19 and cannot be attributed to any another diagnosis. Any organ system can be affected, the most common symptoms include fatigue, dyspnea, palpitations, dizziness, pain, neurocognitive dysfunction, sleep problems, exercise intolerance, functional disability in daily activities and reduced quality of life. The pathophysiology is multifactorial and the mechanism of the disease is still not fully elucidated. Despite numerous studies, complications, treatment, and prognosis of post-acute consequences of COVID-19 are still not sufficiently investigated. Given the variety of clinical presentations, treatment and prevention require a multidisciplinary approach to the disease. Further research is needed to determine risk factors and pathophysiological mechanisms so more reliable diagnostic algorithms, treatment, and patient follow-up could be established. In this article we present an overview of the current knowledge about the long COVID syndrome and an overview of the most common post-COVID radiological presentations in patients treated at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”

Ponovljena prezentacija Gravesove bolesti kao manifestacije sindroma imune rekonstitucije u bolesnice zaražene HIV-om koja uzima antiretrovirusne lijekove

An HIV-infected patient who experienced immune reconstitution after highly active antiretroviral therapy (HAART) (increase in CD4 T-cell count from 84/mm3 to 310/mm3) presented with severe Graves’ disease twice, after commencing and recommencing HAART. At the first episode of Graves’ disease, 21 months after the introduction of HAART, the symptoms of thyroid dysfunction vanished without any specific treatment, but were associated with termination of taking HAART. At the second episode, 5 years after recommencing HAART, the patient continued taking HAART and commenced antithyroid therapy with thiamazole. Graves’ disease developed after a long period, while the patient was in good condition and when complications resulting from HAART were not expected. No features of any autoimmune disease were diagnosed before HAART initiation.Bolesnica zaražena HIV-om u koje se razvio sindrom imune rekonstitucije nakon antiretrovirusnog liječenja (ARL) (porast broja stanica CD4 s 84/mm3 na 310/mm3) prezentirala se u dva navrata s Gravesovom bolešću, na početku liječenja ARL-om i nakon stanke u liječenju. Tijekom prve epizode 21 mjesec nakon uvođenja ARL-a simptomi tiroidne disfunkcije nestali su bez specifičnog liječenja, ali su bili povezani s prestankom uzimanja ARL-a. Tijekom druge epizode 5 godina nakon ponovnog uzimanja ARL-a bolesnica je nastavila uzimati ARL i započela s antitiroidnim lijekom tiamazolom.Gravesova bolest se ponovno javila nakon dugog razdoblja kad je bolesnica bila u dobrom općem stanju i kad se komplikacije vezane uz ARL više nisu očekivale. Prije uzimanja ARL-a bolesnica nije pokazivala nikakve znakove autoimune bolesti

Severova bolest komplicirana osteomijelitisom

Sever’s disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever’s disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever’s disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient’s condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever’s disease. MRI should be done in all atypical cases of Sever’s disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najčešće u mladih sportaša, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostička obrada uključuje rendgenske snimke i ultrazvučni pregled. Bolest se liječi konzervativno, budući da prolazi sama od sebe. Prikazali smo devetogodišnjaka sa Severovom bolesti kod kojega standardna terapija nije polučila klinički učinak. Učinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo učiniti u svim atipičnim slučajevima Severove bolesti kako bi se isključila druga patološka stanja uključujući osteomijelitis