Učestalost trombocitoze, trombocitopenije, limfocitoze i limfocitopenije u bolesnika s infekcijom donjih dišnih putova i bolesnika s infekcijom mokraćnog sustava

There are many reasons for abnormal lymphocyte and platelet counts. In this study, we aimed to assess the prevalence of thrombocytosis, thrombocytopenia, lymphocytosis and lymphocytopenia in patients with lower respiratory tract infection (LRTI) and patients with urinary tract infection (UTI). This retrospective study included 52 LRTI patients and 60 UTI patients. Control group consisted of 70 healthy individuals admitted to the infectiology outpatient unit. No statistically significant relationship was found between the groups of subjects and platelet count. Seven (11.7%) UTI patients and four (7.7%) LRTI patients had lymphocytopenia but there was no statistically significant relationship between the groups of subjects and lymphocyte count. Study results suggested a conclusion that lymphocyte and platelet counts could be within the normal ranges in patients with UTI, as well as in those with LRTI.Mnogo je razloga koji mogu poremetiti broj limfocita i trombocita. Cilj ovoga istraživanja bio je procijeniti učestalost trombocitoze, trombocitopenije, limfocitoze i limfocitopenije u bolesnika s infekcijom donjih dišnih putova (IDDP) i bolesnika s infekcijom mokraćnog sustava (IMS). Ova retrospektivna studija uključila je 52 bolesnika s IDDP i 60 bolesnika s IMS. Kontrolnu skupinu činilo je 70 zdravih osoba primljenih u ambulantu za infektivne bolesti. Nije utvrđena statistički značajna povezanost pojedinih skupina ispitanika i broja trombocita. Limfocitopeniju je imalo sedam (11,7%) bolesnika s IMS i četiri (7,7%) bolesnika s IDDP, ali nije bilo statistički značajne povezanosti skupina ispitanika i broja limfocita. Rezultati istraživanja ukazuju na zaključak da broj limfocita i trombocita može biti unutar normalnih granica u bolesnika s IMS, kao i u onih s IDDP

Comparison of two different labial salivary gland biopsy incision techniques: a randomized clinical trial

Objectives: To compare the reliability of two different labial salivary gland biopsy (LSGB) incision techniques (vertical versus horizontal incision techniques) and to report the related complications and discomfort. Study Design: 163 patients who underwent LSGB were included in this study. Patients were randomly divided as vertical incision group (n=81) and horizontal incision group (n=82). Demographic and clinical information of each patient were recorded. A questionnaire was prepared and applied together with Visual Analog Scale (VAS) on the subjects verbally at the 7th day, postoperatively. Intraoperative, short- term and delayed complications were evaluated. Results: The mean age of patients (117 female, 46 male) was 47.3 years (range 19-79 years). Vertical incision technique was associated with less pain (p<0.001), less swelling (p<0.05), less scar formation (p<0.05) and less difficulty in eating (p<0.05) when compared with horizontal incision technique. No statistically significant differences were observed between the 2 groups in terms of hematoma, parasthesia and speech difficulty (p>0.05). Additionally, two subjects in the horizontal incision group revealed permanent paresthesia during the follow-up period of two years. Conclusions: This prospective study demonstrated that the subjects in the vertical incision group had less complication rates and discomfort after labial salivary gland procedure than those in the horizontal incision group

Četverogodišnja studija učinkovitosti i sigurnosti entekavira u bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije

Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naive HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4}41.5 IU /L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU /mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.Entekavir je analog gvanozina koji djeluje protiv virusa hepatitisa B. Cilj ove četverogodišnje studije bio je procijeniti liječenje entekavirom kod bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije. Ukupno je 49 bolesnika primalo entekavir, a devetoro ih se povuklo s terapije na kraju 96. tjedna. Početna srednja vrijednost alanin aminotransferaze bila 79,4}41,5 IU /L, dok je nakon 4 godine vrijednost alanin aminotransferaze bila u normalnim granicama kod 90% bolesnika. U 96. tjednu je <300 kopija HBV DNA zabilježeno u 91,7% bolesnika, a u 48. mjesecu je 48,90% bolesnika imalo <50 IJ/mL HBV DNA. Gubitak HBeAg zabilježen je u 7,1% bolesnika u 96. tjednu te u 12,5% bolesnika u 48. mjesecu. Stopa serokonverzije HBeAg iznosila je 4,8% u 96. tjednu i 7,5% u 48. mjesecu. Stopa serokonverzije HBsAg bila je 2,1% u 96. tjednu i 2,5% u 48. mjesecu. Sigurnost terapije bila je dobra. Bolesnici su dobro podnosili entekavir, snažan i siguran lijek koji dovodi do ustaljenog suzbijanja virusa

Četverogodišnja studija učinkovitosti i sigurnosti entekavira u bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije

Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naive HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4}41.5 IU /L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU /mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.Entekavir je analog gvanozina koji djeluje protiv virusa hepatitisa B. Cilj ove četverogodišnje studije bio je procijeniti liječenje entekavirom kod bolesnika s kroničnim hepatitisom B pozitivnih na HBeAg bez prethodne nukleoz(t)idne terapije. Ukupno je 49 bolesnika primalo entekavir, a devetoro ih se povuklo s terapije na kraju 96. tjedna. Početna srednja vrijednost alanin aminotransferaze bila 79,4}41,5 IU /L, dok je nakon 4 godine vrijednost alanin aminotransferaze bila u normalnim granicama kod 90% bolesnika. U 96. tjednu je <300 kopija HBV DNA zabilježeno u 91,7% bolesnika, a u 48. mjesecu je 48,90% bolesnika imalo <50 IJ/mL HBV DNA. Gubitak HBeAg zabilježen je u 7,1% bolesnika u 96. tjednu te u 12,5% bolesnika u 48. mjesecu. Stopa serokonverzije HBeAg iznosila je 4,8% u 96. tjednu i 7,5% u 48. mjesecu. Stopa serokonverzije HBsAg bila je 2,1% u 96. tjednu i 2,5% u 48. mjesecu. Sigurnost terapije bila je dobra. Bolesnici su dobro podnosili entekavir, snažan i siguran lijek koji dovodi do ustaljenog suzbijanja virusa

Morphometric Evaluation of Coccyx with Microcomputed Tomography (Micro CT) and Computed Tomography (CT) Technology

Aim%253A We investigated the coccyx anatomy accurately in detail by microcomputed tomography (micro CT) and computed tomography (CT) to contribute to the data related to the coccyx anatomy and the potential clinical contribution of these datas in the treatment of coccyxs pathologies. Material and Methods%253A Twenty coccyges from embalmed cadavers were examined with a micro CT device. The inferior part of the sacrum and coccyx together with the surrounding soft tissue was removed safely. The tissue was scanned with a micro CT device, and all parameters were measured with micro CT image viewer programs. CT images of 29 patients without coccyx pathology were measured with OsiriX programs. Measured morphometric parameters with micro CT and CT were evaluated using statistical methods. Results%253A Generally, the morphometric parameters as mean values were larger in males than in females. Mean values for vertical length and coccyx width were higher for CT compared with micro CT images. Coccyx was more flat in the frontal plane in females. There were statistically significant differences between the micro CT and CT images regarding mean vertical length, width, lateral deviation angle, and sacrococcygeal angle and length of the vertebrae (p lt%253B 0.05). There were no statistically significant differences in number and width of the vertebrae (p gt%253B 0.05). Conclusion%253A We suggest that examining the normal coccyx morphology will help to better understand and treat the pathologic conditions of the coccyx. We believe our findings will contribute to the data related to the coccyx anatomy

BK virus-associated hemorrhagıc cystitis in patients wıth allogeneıc hematopoıetıc cell transplantation: report of three cases

BK virus is a human polyoma virus. It is acquired in early childhood and remains life-long latent in the genitourinary system. BK virus replication is more common in receiving immunosuppressive therapy receiving patients and transplant patients. BK virus could cause hemorrhagic cystitis in patients with allogeneic stem cell transplantation. Hemorrhagic cystitis is a serious complication of hematopoietic stem cell transplantation. Hemorrhagic cystitis could cause morbidity and long stay in the hospital. Diagnosis is more frequently determined by the presence of BK virus DNA detected with quantitative or real-time PCR testing in serum or plasma and less often in urine. The reduction of immunosuppression is effective in the treatment of BK virus infection. There are also several agents with anti-BK virus activity. Cidofovir is an active agent against a variety of DNA viruses including poliomyoma viruses and it is a cytosine nucleotide analogue. Intravenous immunoglobulin IgG (IVIG) also includes antibodies against BK and JC (John Cunningham) viruses. Hereby, we report three cases of hemorrhagic cystitis. Hemorrhagic cystitis developed in all these three cases of allogeneic stem cell transplantation due to acute myeloid leukemia (AML). BK virus were detected as the cause of hemorrhagic cystitis in these patients. Irrigation of the bladder was performed. Then levofloxacin 1×750 mg intravenous and IVIG 0.5 gr/kg were started. But the hematuria did not decreased. In the first case, treatment with leflunomide was started, but patient died due to refractory AML and severe graft-versus-host disease after 4th day of leflunamide and levofloxacin treatments. Cidofovir treatment and the reduction of immunosuppressive treatment decreased the BK virus load and resulted symptomatic improvement in the second case. Initiation of cidofovir was planned in the third case. Administration of cidofovir together with the reduction of immunosuppression in the treatment of hemorrhagic cystitis associated with BK virus in allogeneic stem cell transplant recipients could be a good option

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely