HEPATITIS B: WHO SHOULD BE TREATED?

U ovom trenutku dostupna terapija za liječenje hepatitisa B rijetko može eradicirati infekciju (normalizacija ALT, negativizacija HBV DNK, serokonverzija HBsAg u anti-HBs). U posljednje 4 godine postignuti su manji pomaci u pogledu uspješnosti liječenja. Promjene u odnosu na ranije hrvatske konsenzus konferencije iz 2005. i 2009. g. su temeljene na stajalištima osuvremenjene Konsenzus konferencije Američkog društva za istraživanje jetre iz 2009., Konsenzus konferencije Europske udruge za istraživanje jetre (EASL) iz 2012.g. te Smjernicama Azijsko-Pacifičke udruge za istraživanje jetre (APASL) iz 2012. g. U ovom radu ćemo navesti samo razlike u odnosu na ranije spomenute Hrvatske smjernice iz 2005. i 2009. godine. Novosti se odnose na primjenu neinvazivnih metoda za prosudbu fibroze, kvantifikaciju HBsAg u cilju predviđanja ishoda liječenja, registraciju novih lijekova i neke nove preporuke u cilju učinkovitijeg i racionalnijeg liječenja. Novosti su i preporuke za liječenje bolesnika u posebnim okolnostima što uključuje liječenje trudnica, bolesnika s rezistencijom na lijekove, bolesnika s koinfekcijama, jetrenom dekompenzacijom, bolesnika na imuno i kemoterapiji i bolesnika nakon transplantacije jetre te bolesnike s HCC.Currently, therapy for hepatitis B has a limited effect and can rarely eradicate infection (ALT normalization, undetectable HBV DNA, HBsAg/anti-HBs seroconversion). Minimal progress in terms of treatment success has been achieved in the past four years. Changes from the previous Croatian Consensus Conferences in 2005 and 2009 are based on standings of the Consensus Conference of the American Association for the Study of Liver Disease (AASLD) 2009, Consensus Conference of the European Association for the Study of Liver (EASL) 2012, and Asia-Pacific Association Guidelines for the Study of Liver (APASL) 2012. In this paper, we will mention only differences in relation to the before mentioned Croatian guidelines from 2005 and 2009. New developments relating to the application of noninvasive methods for assessing fibrosis, quantification of HBsAg to predict treatment outcome, registration of new drugs, and some new recommendations for more efficient and rational treatment will be reviewed. New findings as well as recommendations for the treatment of patients in special circumstances including treatment of pregnant women, patients with drug resistance, patients with co-infection, hepatic decompensation, patients on immune and chemotherapy, patients after liver transplantation, and patients with HCC will also be included

Prikaz slučaja kronične Bellove pareze: koje su mogućnosti rehabilitacije?

Bell’s palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bell’s palsy. However, chronic cases of Bell’s palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Intensity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.Bellova pareza ili periferna idiopatska pareza facijalisa, neurološko je stanje koju karakterizira jednostrana slabost mišića lica. Smjernice za liječenje su uglavnom utemeljene na dokazima o preporukama za liječenje akutnih stadija Bellove pareze. Međutim, kronični slučajevi Bellove pareze nisu potkrijepljeni dovoljno snažnim dokazima o mogućnostima liječenja, osim slabe preporuke u smjeru primjene terapijskih vježbi. Ovaj prikaz slučaja predstavlja primjenu kombinacije modaliteta fizikalne terapije (akupunktura, laser visokog intenziteta i terapija zrcalom) unutar 10 tjedana, za liječenje bolesnika s dugotrajnim posljedicama Bellove pareze. Ova kombinacija terapija rezultirala je značajnim poboljšanjem razine oporavka mjerenog kliničkim ljestvicama. Međutim, potrebna su daljnja istraživanja kako bi se pružili snažniji dokazi o prednostima ove kombinacije terapija

<it>Campylobacter fetus</it> infection presenting with bacteremia and cellulitis in a 72-year-old man with an implanted pacemaker: a case report

Abstract Introduction Campylobacter is an important causative agent of intestinal infections in humans. Bacteremia is detected in less than 1% of patients, mainly in immunocompromised patients and in extreme age groups. Cellulitis is a relatively common manifestation of Campylobacter infection, but concomitant bacteremia is a rare event. Infections of the pacemaker area are caused primarily by staphylococci, followed by fungi, streptococci and Gram-negative rods. To the best of our knowledge, this is the first case report of pacemaker pocket infection and bacteremia caused by Campylobacter fetus. Case presentation A 72-year-old Croatian Caucasian man with myelodysplasia, impaired fasting glucose levels and a recently implanted permanent pacemaker was admitted to hospital after six days of fever, development of red swelling of the pacemaker pocket area and worsening of his general condition. No antibiotic therapy was introduced in the outpatient setting. He denied any recent gastrointestinal disturbances. With the exception of an elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein and blood glucose levels, other laboratory findings were normal. Treatment with vancomycin plus netilmicin was introduced, and a surgical incision with drainage of the pacemaker pocket was performed. The entire pacemaker system was removed and a new one re-implanted after 14 days of antibiotic therapy. Transesophageal echocardiography showed no pathological findings. Three subsequent blood cultures obtained on admission as well as swab culture of the incised pacemaker area revealed Campylobacter fetus; stool and pacemaker lead cultures were negative. According to the microbiological results, antibiotic therapy was changed to ciprofloxacin plus netilmicin. A clinical examination and the results of a laboratory analysis performed after two weeks of therapy were within normal limits. Conclusion Myelodysplasia, impaired fasting glucose levels and older age could be contributing factors for the development of bacteremic Campylobacter fetus cellulitis. Emergent surgical and antibiotic treatment are mandatory and provide the optimal outcome for such types of pacemaker pocket infection.</p