Assessment of the reliability of the serbian version of the sickness impact profile questionnaire in patients with chronic viral hepatitis

© 2015, Serbia Medical Society. All rights reserved. SUMMARY Introduction Health-related quality of life (HRQL) of chronic patients has been researched as the ultimate goal of modern treatment of chronic diseases to improve patients’ quality of life. Objective The objective was to assess the reliability of the Serbian version of the Sickness Impact Profile (SIP) questionnaire on the sample of patients with chronic viral hepatitis. Methods The research covered 102 patients with chronic hepatitis (47 type B and 55 type C). The assessment of the reliability of the SIP questionnaire was performed by testing the internal consistency of the questions by calculating the Cronbach’s alpha coefficient. The factor analysis was used to assess whether the grouping of the questions within dimensions matches the distribution of the questions in the original English version of the questionnaire administered to U.S. patient population. Results The Cronbach’s alpha coefficient for the entire questionnaire is 0.925, 0.869 for the physical dimension, and 0.857 for the psychosocial dimension. After running a factor analysis of the psychosocial dimension, “emotional instability” was extracted as the key factor, confirming the results of previous research. Compared with the English version of the questionnaire, the Cronbach’s alpha coefficient of the Serbian version does not diverge significantly, whereas the factor analysis confirms the classification of the questionnaire into two dimensions. Conclusion Our study has shown that the Serbian version of the SIP questionnaire is a reliable tool for assessing the HRQL of patients with chronic hepatitis B and C before starting treatment

Hemolytic-uremic syndrome: Etiopathogenesis, diagnostics and basic principles of treatment

© 2015, Serbian Medical Society. All Rights Reserved. Hemolytic uremic syndrome (HUS) is a clinical syndrome that is manifested by thrombocytopenia, hemolytic anemia and acute renal failure. A typical HUS is caused by the action of verotoxin on endothelial cells of small blood vessels of the kidneys and the brain. The disorder of regulation of the alternative pathway of the complement system (mutations of genes for proteins that regulate the activity of the alternative complement system, antibodies to the complement factor H) plays the main role in the pathogenesis of atypical HUS. The disease is clinically manifested by symptoms and signs of damage to the kidneys and brain. The diagnosis of HUS is set on the basis of the reduced number of platelets, microangiopathic hemolytic anemia (negative Coombs test, decreased haptoglobin concentration, increased serum total bilirubin and lactate dehydrogenase, the number of schizonts in peripheral blood smear) and increased creatinine concentration in serum. To distinguish the typical from the atypical HUS it is necessary to perform microbiological examination chairs, measured titer anti-verotoxin antibodies and anti-lipopolysaccharide-antibodies and determine the activity of the enzyme ADAMTS13 (mutations in ADAMTS13, anti-ADAMTS13 antibody) and examine the activity of the alternative pathway of the complement system (C3 component of complement, the complement factor H. I, B, expression of MCP on mononuclear cells from peripheral blood. anti-CFH-antibodies). Patients with typical HUS infection are treated with solutions for infusion, antibiotics that do not increase the release of verotoxin dialysis and supportive therapy. In patients with atypical HUS, a therapeutic plasmapheresis is a first-line process, while in patients where there is resistance or dependence of applied plasmapheresis the blocker of the C5 component of complement (eculizumab) is used

Effects of host defense peptides B2RP, Brevinin-2GU, D-Lys-Temporin, Lys-XT-7 and D-Lys-Ascaphin-8 on peripheral blood mononuclear cells: Preliminary study

© 2017 Croatian Society of Natural Sciences. All rights reserved. Background and purpose: Host defense peptides have considerable therapeutic potential. One of the limitations for their therapeutic use is insufficient selectivity of some peptides, i.e. toxicity for eukaryotic cells. In this study, we have investigated effect of two naturally occurring and three analogs of frog skin-derived peptides on viability/proliferation of resting peripheral blood mononuclear cells and activated lymphocytes. Materials and Methods: Effect of tested peptides was assessed using MTT colorimetric assay. Concanavalin A was used as lymphocyte mitogen. Results: Brevinin-2GU induced cell death only in the highest tested concentration, whereas other peptides were not cytotoxic to resting peripheral blood mononuclear cells. Moreover, high concentrations of B2RP, DLys-Ascaphin-8 and Lys-XT-7 induced cell proliferation and this effect was more prominent in lymphocytes (p<0.05). Tested peptides had opposite effect on activated lymphocytes inhibiting proliferative response to Concanavalin A (Brevinin-2GU, B2RP and D-Lys-Temporin p<0.05). Conclusions: Tested peptides (with exception of Brevinin-2GU) didn’t show cytotoxicity toward peripheral blood mononuclear cells. Moreover, they have potential to modulate immune response by inducing proliferation of resting peripheral blood mononuclear cells and limiting proliferative response to the activation stimulus. Regarding their potent antimicrobial and low hemolytic activity this makes them good candidates for therapeutic use

Encephalopathy during H1N1 influenza a virus infection

© 2016, University of Kragujevac, Faculty of Science. All Rights Reserved. Influenza virus type A is known for its capacity to transform its antigenic structure and create new viral subtypes. The clinical picture varies from non-febrile, mild upper respiratory tract infection to severe or fatal pneumonia. Neurological complications include encephalitis, encephalopathy, Reye’s syndrome and other neurological diseases. Patients with encephalopathy exhibit a disturbed state of consciousness lasting more than 24 hours, and patients with encephalitis exhibit high temperature, focal neurological signs and pathological CSF results in addition to disturbed state of consciousness. A 54-year old, previously healthy male farmer was hospitalized at the Clinic for Infectious Diseases of the Clinical Centre Kragujevac on the fifth day of disease. In addition to general symptoms of the disease, the clinical picture was dominated by a disturbed state of consciousness (Glasgow Coma Scale score <8). The aetiological agent was an H1N1 influenza A virus, which was isolated from nasopharyngeal secretions. No other causes of infection were demonstrated from both serum and cerebrospinal fluid specimens. Interstitial pneumonia was detected by radiographic examination of the chest. There were also some changes present in the EEG. The patient was cured without consequences. Because our country is in a whirlwind of pandemic H1N1 virus activity, we should think of all the possible complications that this virus can produce regardless of the epidemiological data and the clinical picture

Therapy of chronic hcv infection – association between virological response and predictive factors

© 2014, Serbian Medical Society . All rights reserved. Objective. The treatment outcome of chronic HCV infection is influenced by numerous host and viral factors (age, sex, stage of fibrosis, immune response, viral load, genotype, etc.). The aim of this study was to estimate the association between the most important predictive factors and the response to therapy in patients with chronic HCV infection. Methods. Our study included 76 patients with chronic HCV hepatitis, who were treated at Clinic for Infectious Diseases in Kragujevac. The treatment was carried out for 24/48 weeks, depending on the genotype of the virus. Results. HCV infection is more common in men, but we did not confirm the association between the age and gender of patients and the treatment outcome. The most common risk factor in patients with a favorable response (SVR and ETR) was the intravenous use of psychoactive substances, whereas blood transfusion and dialysis were the leading risk factors for patients with unfavorable response (NR/RR). The serum aminotransferase and alkaline phosphatase were lower in the SVR and ETR group of patients. The low level of basal viremia was registered in the group of patients with sustained virological response, while the highest values were recorded in the NR/RR group of patients. The most frequent HCV genotype was genotype 1, presented in a high percentage in both groups, the patients with favorable and the ones with unfavorable responses to the therapy. The presence of genotype 2 was observed only in patients with an unfavorable response to the therapy. The highest percentage of patients with absence of fibrosis was found in the group of patients with a favorable response. Conclusion. The results of our study show that a positive response to treatment was achieved in almost 90 % of patients with chronic HCV infection. Viral load, genotype and stage of fibrosis were associated with treatment outcome in chronic HCV patients. Our study has not confirmed the association between age, sex or biochemical parameters and therapy response

Potential Hepatoprotective Role of Galectin-3 during HCV Infection in End-Stage Renal Disease Patients

© 2017 Ruzica Lukic et al. Hepatitis C virus infection (HCV), one of the greatest causes of liver disease, is a frequent complication in patients with end-stage renal disease (ESRD) on dialysis. ESRD is defined as decreased glomerular filtration and also accompanied by impaired function of the immune system. Galectin-3 is a β-galactoside-binding lectin, involved in various biological processes including pathogenesis of chronic renal disease. The aim of our study was to estimate disease severity in ESRD HCV+ patients and analyze the serum concentrations of IL-1β, IL-4, IL-23, and IL-6; anti-HCV antibodies; and galectin-3. Also, we attempted to determine potential correlation between galectin-3 level and parameters of disease severity ALT and AST. Our results showed decreased levels of ALT and AST (p=0.00), demonstrating less liver destruction in ESRD HCV+ patients in comparison to HCV+ patients. Increased levels of IL-6 (p=0.03) implicate a hepatoprotective role of IL-6 in these patients. Also, level of galectin-3 (p=0.00) in the serum of ESRD HCV+ patients was higher than that of HCV+ patients. This alteration was accompanied with negative correlation between galectin-3 and AST and ALT, respectively (p=0.029; p=0.033). The presence of increased systemic levels of IL-6 and Gal-3 in ESRD HCV+ patients may be an attempt to counteract or limit ongoing proinflammatory processes and to downregulate chronic inflammation, suggesting the new aspects of HCV infection in ESRD patients

Life-threatening plasmodium falciparum malaria in patient after visiting angola-case report

© 2017, University of Kragujevac, Faculty of Science. All rights reserved. Malaria is a potentially life-threatening disease, especially when complicated by a septic shock. It is caused by infection of erythrocytes with protozoan parasites of the genus Plasmodium that are inoculated into the humans by a feeding female anopheline mosquito. Of the four Plasmodia species, infection with Plasmodium (P.) falciparum is oftenassociated with different types of complications and significant mortality. Most imported cases of malaria are not in tourists but in immigrants and their children who have returned to the country of their family’s origin to visit friends and relatives (so-called VFR travelers) and have forgone chemoprophylaxis. We described a case of a 52 year old patient who came from Angola, an African country wiThendemic malaria before the occurrence of the first symptoms of the disease. The first symptoms were not recognized by the presence of nonspecific symptoms. Very soon the patient was gone under the hemodynamic unstability that eas followed by shock and high percentage parasitemia of 25%. A global health disorder was developedaccompanied withhemodynamic instability and cerebral dysfunction. He performs pulmonary ventilation disorder and renal failure. Only data from social epidemiological survey of travel to the African country, was sufficient to cast doubt on malaria. The diagnosis was conducted using the standard method - peripheral blood smear. After turning antimalarial drugs, improvement of health status with complete recovery within 10 days was noticed. The only consequence of the disease is persistent hypertension that is sensitive to standard antihypertensive therapy

Hepatitis C therapy-related haematological side effects are associated with treatment outcome

© 2016, University of Kragujevac, Faculty of Science. All Rights Reserved. Treatment of patients suffering from chronic hepatitis C with standard pegylated interferon alpha 2a plus ribavirin has limited efficacy. Therapy outcome is dependent on several factors of both the host and virus, including age, sex, stage of fibrosis, viral genotype, viral load, and occurrence of haematological adverse events during chronic hepatitis C treatment. The aim of this study was to determine the relationship between the viral and host factors and the haematological side effects of therapy with sustained virological response. Fifty-four patients were treated with combined pegylated interferon alpha 2a plus ribavirin therapy. Hepatitis C virus genotyping, viral load, histopathological liver changes and biochemical parameters were evaluated for each patient before beginning treatment. Each patient’s blood count was analysed during each clinical visit. Sustained virological response was achieved in 75,9% of patients. Baseline AST and ALT levels were significantly higher in patients with a poor response to therapy (p<0,05). Other clinical and laboratory parameters did not reach statistical significance. Both responders and non-responders developed anaemia. A decrease in thrombocytes, neutrophils and white blood cells was significantly associated with a sustained response to therapy (p<0,05, p<0,05 and p<0,001, respectively). Sustained virological response was associated with lower baseline AST and ALT values and thrombocytopenia, leucopenia and neutropenia at the end of the treatment. All treated patients developed anaemia