Antikoagulacija: pregled farmakoloških sredstava i terapijskih implikacija u reumatologiji

The use of anticoagulant therapy is a part of the daily work of clinicians and a reason for fear, primarily due to the risk of bleeding. The use of anticoagulant drugs in rheumatology remains a challenge. First, a large number of clinicians consider rheumatic conditions as a hypercoagulable state, which often leads to wrong decisions. Second, the use of drugs in the treatment of rheumatic diseases may be associated with an increased risk of venous thromboembolism (VTE ), and they can have effect on dose of anticoagulant agent. The aim of this paper is to present the properties of anticoagulant therapy through the prism of rheumatological pathology.Primjena antikoagulantne terapije dio je svakodnevnog rada kliničara i postupak koji izaziva strah, prvenstveno zbog opasnosti od krvarenja. Primjena antikoagulantnih lijekova u reumatologiji i dalje je izazovan postupak. Kao prvo, velik broj kliničara smatra reumatska stanja hiperkoagulabilnim stanjima, što često dovodi do donošenja pogrešnih odluka. Kao drugo, primjena lijekova u liječenju reumatskih bolesti može biti povezana s povećanim rizikom od venske tromboembolije (VTE ) te lijekovi mogu utjecati na dozu antikoagulansa. Cilj je ovog rada prikazati svojstva antikoagulantne terapije kroz prizmu patologije reumatskih bolesti

Toksična epidermalna nekroliza inducirana ibuprofenom - prikaz bolesnika

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, life-threatening mucocutaneous hypersensitivity reactions. The inflammatory response is mediated by cytotoxic T lymphocytes and NK (natural killer) cells with cytotoxic proteins and cytokines as mediators in the onset of cell apoptosis. Drugs are responsible for about 95% of cases of toxic epidermal necrolysis. Although non-steroidal anti-inflammatory drugs (NSAID) are classified as drugs that can potentially lead to this hypersensitivity reaction, a small number of cases have been described in the literature regarding the occurrence of this reaction to the use of ibuprofen. We present the case of a 58-year-old man who developed symptoms of TEN seven days after using ibuprofen. The treatment of toxic epidermal necrolysis is still a matter of debate. Given that there is no uniform protocol for treatment, and the lethal outcome in such conditions occurs in about 40% of cases, each presented case is significant in terms of considering the effectiveness and improvement of the therapeutic approach.Stevens-Johnsonov sindrom (SJS) i toksična epidermalna nekroliza (TEN) teške su, po život opasne, mukokutane reakcije preosjetljivosti. Inflamatorni odgovor je posredovanom citotoksičnim T-limfocitima i NK (engl. natural killer) stanicama uz citotksične proteine i citokine kao posrednike u nastanku stanične apoptoze. Lijekovi su odgovorni za oko 95% slučajeva toksične epidermalne nekrolize. Iako se nesteroidni protuupalni lijekovi (NSAIL) svrstavaju u lijekove koji potencijalno mogu dovesti do ove reakcije preosjetljivosti, u literaturi je opisan mali broj slučajeva u vezi s nastankom ove reakcije na primjenu ibuprofena. Prezentiramo slučaj 58-godišnjeg muškarca kojemu su se simptomi TEN-a pojavili sedam dana nakon početka primjene ibuprofena. Tretman toksične epidermalne nekrolize i dalje je predmetom rasprava. Budući da ne postoji jedinstven stav i protokol za liječenje, a letalni ishod u ovakvim se stanjima događa u do 40% slučajeva, svaki je prezentirani slučaj značajan u pogledu razmatranja učinkovitosti i poboljšanja terapijskog pristupa

Epidemiology of hospitalized patients with peripheral arterial disease in Bosnia and Herzegovina

Aim To investigate a profile of patients with peripheral artery disease (PAD) in Bosnia and Herzegovina. Methods This observational study included 1022 patients hospitalized at the Clinical Centre University of Sarajevo in a 5-year period, 2015 to 2019. Results Disease prevalence rises sharply after the age of 50. Most patients, 797 (78%) had proximal PAD; 658 (64.4%) were males. The death occurred in 73 (7.1%) patients, more often in females (66- 10%), and in patients with chronic kidney disease (10- 23.8%). Amputation occurred in 153 (15%) patients, where 102 (66.7%) patients had diabetes. Other surgical procedures were more common in males and smokers. Necrosis and phlegmon on lower extremities were found in 563 (55.1%) and 43 (4.2%) patients, respectively. History of tobacco use was noted in 620 (60.2%) patients, and 414 (40.8%) patients were current smokers. More than a half of patients had hypertension and diabetes, 596 (58.3%) and 513 (50.2%), respectively. One in 10 patients had a history of myocardial infarction or stroke. Most patients had high fibrinogen and blood glucose and low high-density lipoprotein (HDL). Conclusion Patients with PAD have multiple comorbidities and risk for various complications. Primary and secondary prevention of risk factors is the mainstay of treatment

Impact of physical therapy on muscle strength in patients with degenerative hip changes

Introduction: An increasing number of people suffer from degenerative diseases of the hip joints. Many studies report the long-term outcomes of invasive therapy in the treatment of coxarthrosis. However, results of prolonged conservative treatment are scarce. The purpose of this study was to evaluate the effects of prolonged conservative physical therapy on functional recovery of degenerative hip changes. Methods: We retrospectively analyzed 47 patients diagnosed with coxarthrosis according to the American College of Rheumatology criteria. Data on sex and age, duration of physical therapy, the type of physical therapy, the values of manual muscle test (MMT) at admission and discharge, were taken from the medical records of the patients. Results: There were 76.6% female and 23.4% male patients. Half of the patients were 70 or more years old. Majority of patients were treated by kinesiotherapy (74.5%) and had significantly different (p < 0.05) values of MMT at admission and discharge. Duration of treatment was 10-20 days for 23.4% of patients, while 29.8% received treatment for 31-40 days. Conclusion: According to our results, MMT significantly improved at the end of the treatment. Thus, physical therapy had a positive effect on the recovery of muscle strength in patients with coxarthrosis

The serum triglyceride to high-density lipoprotein (HDL) ratio in patients with acute coronary syndrome with and without renal dysfunction

Aim To assess triglyceride – to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS – RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDL-C ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction

Effects of early diagnosis of the wrist over-use syndrome on the treatment

Aim To demonstrate the effects of early diagnosis of overuse syndrome in the wrist on healing, pain intensity and quick recovery to daily work and sport activities. Methods This clinical retrospective study included 60 patients of both sexes aged from 22 to 44 years, with pain in the wrist and clinical signs of creeping tenosynovitis. Patients were divided into two groups: the first group - persons doing sports activity, and the second group - patients who did not deal with sports activities. Results Females in 31 (51.7%) cases compared to males with 29 (48.3%) were slightly more represented in the total sample. Patients with injuries due to sports activities had previously reported to the physician and the diagnosis was set at an average of 3.1±0.9 days after the first symptoms (the range of 2-5 days), compared to the patients of the second group whose diagnosis was set at an average of 4.7±1.1 days after the first symptoms (p <0.05). Conclusion Patients involved in sports activities were more motivated for faster recovery, they had earlier doctor’s examination with rapid reduction of subjective symptoms during intensive physical therapy