Non-alcoholic fatty liver disease: a multidisciplinary clinical practice approach—the institutional adaptation to existing Clinical Practice Guidelines

Non-alcoholic fatty liver disease (NAFLD) is among the most frequently encountered chronic liver diseases in everyday clinical practice. It is considered the hepatic manifestation of metabolic syndrome. Today, liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD's possible progression to non-alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Because of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures, it is of great interest to recruit the patients for liver biopsy. However, as the presence of liver fibrosis determines the further clinical course, liver biopsy is expectedly reserved for those with increased fibrosis risk. The quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners, gastroenterologists, and endocrinologists. As a result, the quality of liver biopsy recruitment and patients monitoring could be significantly improved. Here, we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients

DYNAMIC BEHAVIOR OF TWO ELASTICALLY CONNECTED NANOBEAMS UNDER A WHITE NOISE PROCESS

This paper investigates the almost-sure and moment stability of a double nanobeam system under stochastic compressive axial loading. By means of the Lyapunov exponent and the moment Lyapunov exponent method the stochastic stability of the nano system is analyzed for different system parameters under an axial load modeled as a wideband white noise process. The method of regular perturbation is used to determine the explicit asymptotic expressions for these exponents in the presence of small intensity noises

Use of complementary and alternative medicine in patients with inborn errors of metabolism: A single-center study

Background and Objectives: There is a paucity of information on the use of complementary and alternative medicine (CAM) in patients with inborn errors of metabolism (IEM). This study\u27s objective was to evaluate the self-reported use and perceived effectiveness of CAM in adults and children with IEM. Methods: Patients aged 0-70 years and caregivers seen at the London Health Sciences Centre Metabolic Clinic (London, Ontario, Canada) between July 2017 and August 2017 were recruited to complete a questionnaire regarding CAM use to help their IEM diagnosis and perceived effectiveness of these therapies. Survey responses were analyzed using descriptive statistics; age, sex, and education level associations among CAM users were tested using the Pearson χ2 test. Results: Of 50 potential participants, 44 (88%) completed the questionnaire, including 21 adults (6 by caregivers) and 23 children (22 by caregivers). The most common IEM category was Aminoacidopathies and Small Molecule Disorders (50%). Twenty-seven (61%) participants reported CAM use to help their IEM diagnosis. The most common CAM therapies used were chiropractic manipulation, omega-3 fatty acids, probiotics, and aromatherapy/essential oils. Most CAM users and caregivers (74%) perceived their CAM therapies as effective overall. Among CAM users, 40% had not discussed CAM use with a health care professional (HCP). CAM use was similar when comparing age, sex and education level. Conclusions: CAM is commonly used among patients with IEM. The safety and efficacy of CAM therapies for IEM should be further investigated. HCPs and patients should openly discuss CAM use in order to evaluate safety

A quality of life assessment and the correlation between generic and disease-specific questionnaires scores in outpatients with chronic liver disease-pilot study

Introduction. Chronic liver diseases (CLD) are an important cause of morbidity and mortality in general population. The aim of this study was to analyze potential differences between patients with CLD and healthy control group, and to estimate the severity of CLD by using simple questionnaires: general health questionnaire (GHQ-12) and chronic liver disease questionnaire (CLDQ). Methods. A cross-sectional pilot study was performed in Zemun Clinical Hospital during years 2014 and 2015. Sixty participants were divided into 4 groups (15 per group): chronic alcoholic hepatitis, other chronic hepatitis, liver cirrhosis, and healthy control group. Entire study population chose one of four offered answers of structured questionnaires GHQ-12 and CLDQ, based on which mean model of end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were calculated. Results. Mean GHQ12 and CLDQ scores were 10.5 and 5.21 +/- 1.11 respectively. Regarding certain CLDQ domain scores, a significant difference between alcoholic and non-alcoholic hepatitis groups in the worry domain was observed. Mean MELD score was 7.42 +/- 2.89 and did not differ between chronic hepatitis groups, while mean CTP score was 5.73 +/- 0.88. A statistically significant correlation was observed between GHQ12 and CLDQ scores (rho = -0.404, p LT 0.01), but not between subjective and objective scores. Conclusions. Mean GHQ12 and CLDQ scores pointed out to general psychological no-distress condition of the studied participants, as well as scarcely expressed CLD-specific complaints. Mean MELD and CTP scores indicated stable chronic liver diseases, with low three-month mortality rates in the cases of chronic hepatitis, as well as determination to Child A group in the case of liver cirrhosis

Examining the impact of Ground Control point quantity on the geometric accuracy of UAV photogrammetric products formed using Structure-from-Motion approach

The positional and vertical accuracy of UAV aerial photogrammetry products generated using the Structure from Motion (SfM) approach depends on various factors, such as flight plan parameters, camera quality, camera calibration, the SfM algorithm used, and the georeferencing process. The influence of the quantity of Ground Control Points (GCPs) on the geometric quality of generated models and the stability of camera calibration parameters assessed through self-calibration in the block-aerotriangulation process was investigated in this study. Three software systems were used to process the collected UAV photogrammetry images: Pix4D Mapper, Agisoft Metashape, and Trimble Inpho UASMaster. Standard statistical quality assessments were employed to assess the accuracy of the block-aerotriangulation. The research findings indicate that augmenting the quantity of GCPs enhances model reliability and decreases the RMSE values of vertical deviation on the control points. The RMSE values of vertical deviation on the check points for all three used software systems converged to approximately twice the value of the average spatial resolution. Additionally, the RMSE values of positional deviation on check points converged to the value of the average spatial resolution

FOUR CASES OF APPENDICEAL NEUROMA MIMICKING ACUTE APPENDICITIS

Herein we report four cases of appendiceal neuroma found during a short (one month) monitoring period in patients with severe pain in the lower right abdominal quadrant that underwent appendectomies. Tissue samples were routinely processed to obtain histological sections that were stained with hematoxylin and eosin (H&E) and further with anti-S100 protein antibody. Characteristics of appendiceal neuroma were noted in these cases and they included the absence of mucosal and lymphoid tissue of the appendices, stroma with spindle-shaped cells that were positively stained with anti-S100 protein antibody. This clinical entity is important due to a possible misdiagnosis with acute appendicitis or exacerbation of inflammatory bowel disease and great attention should be paid during the clinical evaluation of similar symptoms.Key words: appendiceal neuroma, misdiagnosis, lumen obliteration, immunohistochemistry, S100 protei

Effects of Levothyroxine Replacement Therapy on Parameters of Metabolic Syndrome and Atherosclerosis in Hypothyroid Patients: A Prospective Pilot Study

The aim of this study was to investigate the effect of levothyroxine (LT4) replacement therapy during three months on some parameters of metabolic syndrome and atherosclerosis in patients with increased thyroid-stimulating hormone (TSH) level. This study included a group of 30 female patients with TSH level GT 4mIU/L and 15 matched healthy controls. Intima media complex thickness (IMCT) and peak systolic flow velocity (PSFV) of superficial femoral artery were determined by Color Doppler scan. In hypothyroid subjects, BMI, SBP, DBP, and TSH were significantly increased versus controls and decreased after LT4 administration. FT4 was significantly lower in hypothyroid subjects compared with controls and significantly higher by treatment. TC, Tg, HDLC, and LDL-C were similar to controls at baseline but TC and LDL-C were significantly decreased by LH4 treatment. IMCT was significantly increased versus controls at baseline and significantly reduced by treatment. PSFV was similar to controls at baseline and significantly decreased on treatment. In this study, we have demonstrated the effects of LT4 replacement therapy during three months of treatment on correction of risk factors of metabolic syndrome and atherosclerosis

Uhvaćen je stari lisac - stafilokokni toksični šok sindrom kod odraslog muškarca - prikaz slučaja

Staphylococcal toxic shock syndrome (STSS) is typically detected in newborns and children but can be seen in adults occasionally. In such a case, it points out usually on some immune system dysfunction. We present a case of a critically-ill adult male with STSS and symptoms and signs of serious systemic infection (hemodynamic instability, acute renal failure, mental confusion). After the completion of applied treatment (antistaphylococcal antimicrobials, hemodialysis, vasopressor, supportive, and symptomatic therapy), complete restoration of presented patients' derangements was achieved. Timely diagnosis and appropriate treatment is the mainstay in the management of STSS in adults.Stafilokokni toksični šok sindrom (STŠS) se obično javlja kod novorođenčadi i dece, ali se povremeno može javiti i kod odraslih. U tom slučaju, obično ukazuje na disfunkciju imunog sistema. Prikazan je slučaj kritično-obolelog odraslog muškarca sa STŠS i simptomima i znacima životno-ugrožavajuće sistemske infekcije (hemodinamska nestabilnost, akutna insuficijencija bubrega, konfuzija). Nakon završenog lečenja (anti-stafilokoni antibiotici, hemodijaliza, vazopresori, suportivna i simptomatska terapija), postignuta je potpuna remisija kod obolelog. Pravovremena dijagnostika i adekvatan tretman je glavno uporište u lečenju STŠS kod odraslih