GASTROINTESTINAL CAUSES OF IRON DEFICIENCY ANEMIA

Najčešći uzroci sideropenične anemije jesu manifestna ili kronična okultna krvarenja iz probavnog sustava. U radu je analizirano 596 bolesnika (323 muškarca i 273 žene), prosječne dobi 61±10,67 godina, liječenih tijekom 2002. godine sa sideropeničnom anemijom uzrokovanom okultnim ili manifestnim gubitkom krvi iz probavnog sustava. Prosječna vrijednost hemoglobina bila je 88±9,8 g /l, a prosječna vrijednost željeza 6,3±14,3 μmol/l te UIBC-a 61±12,4 μmol/l. Uzroci sideropenične anemije bili su: ulkusna bolest u 28,9% bolesnika, varikoziteti jednjaka u 15,1% bolesnika, upalna bolest crijeva u 14,1% bolesnika, karcinom debelog crijeva u 8,5% bolesnika, karcinom želuca u 5,6 % bolesnika, karcinom jednjaka u 1% bolesnika, erozivni gastritis u 6,2% bolesnika, hijatalna hernija u 4,7% bolesnika, polipi u 7,3% bolesnika, a divertikuloza u 5,3% bolesnika te hemeroidi u 0,5% bolesnika i ostali uzroci u 2,8 % bolesnika. Sideropenična anemija je u gastroenterologiji posljedica patoloških promjena duž probavnog sustava koja su praćena akutnim ili kroničnim gubitkom krviThe manifest or chronic bleeding are the most common causes of iron deficiency anemia. We studied 596 patients (323 men and 273 women), with a mean age 61±10.67 godina who were admitted to our hospital in 2002 beceause of iron deficinecy anemia caused by manifest or chronic bleeding. A mean hemoglobin was 88±9.8 g /L, a mean serum iron was 6.3±14.3 μmol/L and UIBC 61±12.4 μmol/L. The causes of iron deficiency anemia were: peptic ulcerations in 28.9% patients, varices in 15.1% patients, inflammatory bowel diseases in 14.1% bolesnika, colonic cancers in 8.5% patients, gastric cancer in 5.6 % patients, esophageal cancer in 1% patients, erosive gastritis in 6.2% patients, hiatal hernia in 4.7% patients, polyps in 7.3% patients, diverticulosis in 5.3% patients, hemorrhoids in 0.5% patients and other causes in 2.8 % patients. In the gastroenterology iron deficiency anemia is result of manifest or chronic bleeding from the gastrointestinal lesions

GASTROINTESTINAL CAUSES OF IRON DEFICIENCY ANEMIA

Najčešći uzroci sideropenične anemije jesu manifestna ili kronična okultna krvarenja iz probavnog sustava. U radu je analizirano 596 bolesnika (323 muškarca i 273 žene), prosječne dobi 61±10,67 godina, liječenih tijekom 2002. godine sa sideropeničnom anemijom uzrokovanom okultnim ili manifestnim gubitkom krvi iz probavnog sustava. Prosječna vrijednost hemoglobina bila je 88±9,8 g /l, a prosječna vrijednost željeza 6,3±14,3 μmol/l te UIBC-a 61±12,4 μmol/l. Uzroci sideropenične anemije bili su: ulkusna bolest u 28,9% bolesnika, varikoziteti jednjaka u 15,1% bolesnika, upalna bolest crijeva u 14,1% bolesnika, karcinom debelog crijeva u 8,5% bolesnika, karcinom želuca u 5,6 % bolesnika, karcinom jednjaka u 1% bolesnika, erozivni gastritis u 6,2% bolesnika, hijatalna hernija u 4,7% bolesnika, polipi u 7,3% bolesnika, a divertikuloza u 5,3% bolesnika te hemeroidi u 0,5% bolesnika i ostali uzroci u 2,8 % bolesnika. Sideropenična anemija je u gastroenterologiji posljedica patoloških promjena duž probavnog sustava koja su praćena akutnim ili kroničnim gubitkom krviThe manifest or chronic bleeding are the most common causes of iron deficiency anemia. We studied 596 patients (323 men and 273 women), with a mean age 61±10.67 godina who were admitted to our hospital in 2002 beceause of iron deficinecy anemia caused by manifest or chronic bleeding. A mean hemoglobin was 88±9.8 g /L, a mean serum iron was 6.3±14.3 μmol/L and UIBC 61±12.4 μmol/L. The causes of iron deficiency anemia were: peptic ulcerations in 28.9% patients, varices in 15.1% patients, inflammatory bowel diseases in 14.1% bolesnika, colonic cancers in 8.5% patients, gastric cancer in 5.6 % patients, esophageal cancer in 1% patients, erosive gastritis in 6.2% patients, hiatal hernia in 4.7% patients, polyps in 7.3% patients, diverticulosis in 5.3% patients, hemorrhoids in 0.5% patients and other causes in 2.8 % patients. In the gastroenterology iron deficiency anemia is result of manifest or chronic bleeding from the gastrointestinal lesions

Splanchnic vein thrombosis as a rare cause of acute abdominal pain: case report

Cilj: Prikazati slučaj pacijenta s akutnim abdominalnim bolom kojemu je dijagnosticirana tromboza splanhničkog venskog sustava, a uzrok je naknadno dokazana mijeloproliferativna bolest uz JAK2 V617F varijantu sekvence. Prikaz slučaja: 44-godišnji pacijent primljen je u hitnu medicinsku službu zbog akutizacije paraumbilikalnog bola koji je trajao 10-ak dana. U laboratorijskim nalazima bile su povišene vrijednosti alfa amilaze i upalnih parametara, zbog čega je pacijent hospitaliziran. Nativna snimka abdomena i ultrazvuk abdomena pokazivali su meteorizam tankog i debelog crijeva. Zbog nejasne dijagnoze učinjena je i kompjutorizirana tomografija (CT) abdomena koja je pokazala samo zamućeno mezenterijalno masno tkivo u korijenu mezenterija. Trećeg dana hospitalizacije zbog intenzivnijih bolova, koji nisu popustili ni na opiodne analgetike, učinjen je kontrolni CT abdomena koji je pokazivao trombozu v. portae, v. mesentericae superior i v. lienalis. Navedene promjene bile su praćene zadebljanjem stijenke tankog crijeva u smislu kongestije i raslojavanja stijenke, ali bez znakova jasne ishemije, te parcijalnim poremećajima perfuzije jetre uz prisutnost ascitesa. U terapiju je uveden niskomolekularni heparin u punoj dozi uz acetilsalicilnu kiselinu, a zbog dodatnog pogoršanja stanja sa znakovima paralitičkog ileusa i progresijom ishemijskih promjena tankog crijeva učinjena je hitna laparotomija. Za vrijeme hospitalizacije, hematološkom obradom dokazana je JAK2 V617F varijanta sekvence i mijeloproliferativna bolest koja je etiološki čimbenik tromboze portalnog sustava i ishemije crijeva. Zaključak: Uzrok akutnog bola u trbuhu može rijetko biti i tromboza splahničkog sustava, koja u kratkom vremenskom periodu može dovesti do životno ugrožavajućeg stanja. Akutno nastalu trombozu splanhničkog venskog sustava nužno je liječiti antikoagulantnom terapijom, a ako taj način liječenja ne pokaže zadovoljavajuće rezultate, nužan je kirurški zahvat. Dokazana mijeloproliferativna bolest uz JAK2 V617F varijantu sekvence mogući je etiološki čimbenik splanhničke venske tromboze kod mlađih pacijenata.Aim: To present a patient with acute abdominal pain diagnosed with acute thrombosis of the splannchnic vein system and subsequently diagnosed myeloproliferative disease and JAK2 V617F sequence variant. Case report: A 44-year-old patient was admitted to an emergency medical tract due to the acutization of paraumbilical abdominal pain that was present for 10 days, with mild intensity. In the laboratory findings, elevated values of alpha amylase and inflammatory parameters were elevated, wherefor patient was hospitalized. Native abdominal radiograph and abdominal ultrasound showed meteorism of the small intestine and colone. Due to unclear diagnosis, computerized tomography (CT) of the abdomen was performed, which showed blurred mesenterial fatty tissue at the mesenteric root. On the third day of hospitalization due to intense persistent pain that did not decrease with opioid analgetic threatment, a control CT scan was performed and showed thrombosis of v.Portae, v.Mesentericae superior and v.Lienalis. These changes were followed by thickening of the small intestine wall in terms of congestion and wall layering, but without signs of clear ischemia, and partial liver perfusion disorders in the presence of ascites. Low-molecular heparin was given in the full dose with acetylsalicylic acid, and due to an additional worsening of the condition with signs of paralytic ileus and the progression of ischemic changes in the bowel gland, emergency laparotomy was ordered. During hospitalization, a sequence variant of JAK2 V617F and myeloproliferative disease was confirmed, which is the etiological factor of thrombosis and ischemia of the portal system. Conclusion: The cause of acute abdominal pain may be, rarely, thrombosis of the splanchnic system that can lead to life-threatening condition in a short period of time. An acute splanchnic vein thrombosis is required to be treated with anticoagulant therapy without delay, and if this treatment does not show satisfactory results, an emergency surgical procedure is required. The proven myeloproliferative disease with JAK2 V617F sequence variant is a possible etiological factor of splanchnic vein thrombosis in younger patients

HEPATITIS C - CLINICAL MANIFESTATIONS AND COMPLICATIONS

SAŽETAK Infekcija hepatitis C virusom uobičajeno se prikazuje kao akutna infekcija, kronična infekcija, ili se očituje kao bolest izvan jetre. U kliničkoj praksi akutna se infekcija rijetko prepoznaje, budući da su u većine bolesnika simptomi asimptomatski, ili se razvijaju simptomi koji ne pobuđuju kliničku pozornost, poput mučnine, anoreksije, nelagode ili bolnosti u gornjem desnom kvadrantu trbuha, mialgije i atralgije. Stoga se u većine bolesnika kronični hepatitis dijagnosticira nakon više godina, kada se tijekom rutinske laboratorijske obrade ustanove povišene vrijednosti aminotransferaza. To je u skladu s činjenicom da se u 80% bolesnika inficiranih hepatitis C virusom, razvije kronični hepatitis. Niz je bolesti izravno ili neizravno povezano s kroničnim hepatitisom C. Dok se za pojedine pokazatelje bolesti izvan jetre zna da su združeni s kroničnim hepatitisom C, za druge postoji tek sumnja. Kronični hepatitis C podmukla je bolest koja je tijekom dugotrajna razdoblja bez simptoma, ili simptomi nisu karakteristični, stoga često postaje uočljivom tek kada se razviju komplikacije kronične jetrene bolesti. Smatra se da će 20% bolesnika s kroničnim hepatitisom C u razdoblju od 10 do 30 godina razviti cirozu jetre, uz mogući razvoj hepatocelularnoga karcinoma u 1% – 5% slučajeva tijekom godine dana. Dekompenzacija jetre i hepatocelularni karcinom u bolesnika s kroničnim hepatitisom C, danas su vodeći pokazatelji za transplantaciju jetre.SUMMARY HCV infection usually presents as an acute infection, chronic infection or as an extrahepatic manifestation. Acute infection is rarely recognized in clinical practice because the large majority of the patients are asymptomatic or develop symptoms which don’t attract clinical attention such as sickness, anorexy, anxiety and pain in the upper right quadrant of stomach, mialgy and artralgy. Therefore, chronic hepatitis is diagnosed in a large majority of the patients after many years in case of large values of aminotransferasis during a routine laboratory check. A vast number of diseases are directly or indirectly connected with chronic hepatitis C. It is known for some of the extrahepatic manifestations to be firmly connected with hepatitis C while there is a doubt for others. Chronic hepatitis C is disease with no symptoms manifested for a long time or the symptoms are uncharacteristic, so it often becomes visible after development end-stage liver disease. It is considered that around 20% of the patients with the chronic type of the disease will develop cirrhosis within a period of 10 – 30 years with the possibility of developing hepatocellular carcinoma in 1% – 5% of the cases per year. Furthemore, decompensation of liver cirrhosis and hepatocellular carcinoma are the leading indications for liver transplantation in patients with chronic hepatitis C

UNIVERSITY TEACHING THROUGH THE EFFECTS OF CELLULAR WORK APPLICATION AND ADDITIONAL EXERCISE WITH MUSIC AS THE METHODICAL AND ORGANIZATIONAL FORM OF WORK

These articles are a result of the bilateral cooperation project ”Assumptions and possibilities of developing innovative models of teaching for accomplishing transparency of university education and for raising competitiveness in national and international knowledge markets”, carried out and financied by the University of Kragujevac, Faculty of Education, Jagodina (Republic of Serbia) and the University of Primorska, Faculty of Education, Koper (Republic of Slovenia), in the period 2017–2019.The holistic development of students at schools largely depends on properly directed learning process, for which the students, future teachers, are getting prepared during their university education, thus being able to acquire teaching competence and develop their pedagogical skills as well. Nowadays, students are faced with a series of demands arising from the development of technology and scientific advances, but in order to successfully meet their requirements, the application of innovative teaching models is essential. The aim of this paper is to show the effects of methodological and organizational forms of work in teaching with the integration of different methodological content. The sample was made up of primary school students (n = 120), aged 12 to 13 from the Jagodina region, divided into two sub-samples where the first group consisted of 60 subjects, who were included in the experimental program of the cell forms of methodical work and the additional exercises accompanied with the selected music compositions (Experimental group) and the second group consisting of 60 subjects, who were engaged in the regular program of physical education (Control group). Through the application of test subjects, the following motor skills were monitored: coordination, explosive force, repetitive force, sprint and segment speed, as well as the following functional capacities: vital lung capacity, anaerobic power and pulse frequency after the load. For the purpose of determining the differences between the motor and the functional capacities of the children, in addition to the basic statistical parameters to define the global quantitative differences in the motor and functional area, multivariate and univariate analysis of variance and co-variance as well as factor analysis are applied. The results show that statistically significant differences do exist in the motor and the functional space of children as well as the existence of latent dimensions of the defined space.Publishe

Croatian Society of Medical Biochemistry and Laboratory Medicine: National recommendations for blood collection, processing, performance and reporting of results for coagulation screening assays prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer

A modern diagnostic laboratory offers wide spectrum of coagulation assays utilized in the diagnosis and management of patients with haemostatic disorders, preoperative screening and anticoagulation therapy monitoring. The recent survey conducted among Croatian medical biochemistry and transfusion laboratories showed the existence of different practice policies in particular phases of laboratory process during coagulation testing and highlighted areas that need improvement. Lack of assay standardization together with non-harmonized test results between different measurement methods, can potentially lead to incorrect decisions in patient’s treatment. Consequently, patient safety could be compromised. Therefore, recommended procedures related to preanalytical, analytical and postanalytical phases of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer testing are provided in this review, aiming to help laboratories to generate accurate and reliable test results

Random errors in research and the importance of sample size

Slučajne pogreške sastavni su dio svakog eksperimenta, odnosno kliničkog istraživanja i posljedica su varijabilnosti uzorkovanja. Rezultati istraživanja trebaju biti primjenjivi na čitavu populaciju zbog čega su reprezentativnost i adekvatna veličina ispitivanog uzorka izuzetno bitne. Provođenjem određenog mjerenja na uzorku populacije, nastojimo utvrditi s kojom vjerojatnošću je opažena razlika između mjerenih varijabli posljedica slučajnosti, odnosno postojanja stvarne razlike u populaciji. Navedena vjerojatnost izražava se P-vrijednošću. Slučajnost se očituje u istraživanjima kao pogreška tipa I i pogreška tipa II. Rizik slučajne pogreške u istraživanjima umanjuje se povećanjem broja mjerenja, odnosno veličine istraživanog uzorka. Zbog toga je u fazi planiranja istraživanja nužno izračunati i definirati potreban broj ispitanika na temelju prethodno definiranog primarnog ishoda istraživanja. Time se omogućuje provođenje vjerodostojnih i metodološki čvrstih istraživanja koja rezultiraju solidnim dokazima.Random errors are essential parts of every experiment and clinical research resulting from sampling variability. Research results should be applicable to the entire population, which is why the representativeness and adequate sample size are of crucial importance. By conducting a specific measurement on a population sample, we try to determine the probability of the observed difference between measured variables being the result of chance or acutal difference in the population. This probability is known as the P-value. Chance in research manifest itself as error type I and error type II. The risk of random error diminishes by increasing the number of measurements or enlarging the sample size. Therefore, it is necessary to calculate and define the required sample size based on a priorly defined primary outcome. This enables the implementation of credible and methodologically strong research resulting in solid evidence

Approach to the patient with suspected liver disease

Kliničke manifestacije jetrene bolesti širokog su spektra, počevši od asimptomatskog povišenja jetrenih enzima do mogućeg dramatičnog zatajenja jetre. Bolesnici su dugo vremena bez simptoma, a otkrivaju se u kasnijim fazama bolesti. Loša prognoza i visoki troškovi liječenja uznapredovale jetrene bolesti zahti jevaju rano dijagnosti ciranje bolesti i pravovremeno liječenje. U pristupu bolesniku s povišenim jetrenim enzimima nužna je iscrpna anamneza i detaljan fi zikalni pregled. Pravovremena rana dijagnoza jetrene bolesti može spriječiti razvoj ireverzibilnog oštećenja jetre.Clinical manifestati ons of liver disease are of wide spectra, from asymptomatic elevation of liver enzymes to possible dramatic and progressive liver failure. The liver disease develops subclinically for a long time and the disease is being diagnosed in its later stages. Bad prognosis and high costs of treatment demand early diagnosis and adequate treatment. In the approach to the patient with elevated liver enzymes the most important are detailed medical history and physical exam. Early diagnosis of the liver disease can prevent the development of irreversible liver damage

Clinical Utility of Red Cell Distribution Width in Alcoholic and Non-alcoholic Liver Cirrhosis

Red blood cell distribution width (RDW) is a measure of the variation of red blood cell width that is reported as a part of standard complete blood count. Red blood cell distribution width results are often used together with mean corpuscular volume (MCV) results to figure out mixed anemia. The aim of our study was to compare the values of RDW in alcoholic and non-alcoholic liver cirrhosis and to determine if RDW follows the severity of disease according to Child-Pugh score. We retrospectively analyzed 241 patients (176 men and 65 women) with liver cirrhosis and anemia, defined as a hemoglobin value <130 g/L in men and <120 g/L in women, which were hospitalized in our Division in a period between 2006 and 2008. Patients were divided in two groups; in first were patients with alcoholic liver cirrhosis, and in second with non-alcoholic cirrhosis. Severity of disease was determined according to Child-Pugh score. Red blood cells distribution width Normal reference range is 11–15%. Alcoholic liver cirrhosis had 204 patients (85%) while non-alcoholic cirrhosis had 37 patients (15%). In group of alcoholic cirrhosis the average RDW was 16.8%. In relation to severity of disease the average RDW for Child-Pugh A was 16.80%, for Child-Pugh B was 16.92%, for Child-Pugh C was 17.10%. In the group of non-alcoholic cirrhosis the average RDW was 16.73% and in relation to severity of disease for Child-Pugh A was 16.25%, for Child-Pugh B 17.01% and for Child-Pugh C was 16.87%. We didn’t find statistically significant difference of RDW between alcoholic and non alcoholic cirrhosis (p>0.05) and we didn’t proved any statistically significant increase of RDW in relation to severity of disease in group of alcoholic cirrhosis (p=0.915) nor in group of patients with non-alcoholic cirrhosis (p=0.697). Our study showed that RDW had not any clinical value in differentiation of anemia neither in alcoholic and non-alcoholic liver cirrhosis nor in severity of liver disease

Gender Related Differences in Quality of Life and Affective Status in Patients with Inflammatory Bowel Disease

According to the literature, quality of life has been shown to be reduced in females compared with males with Inflamatory Bowel Disease (IBD). Psychosocial factors are also playing an important role in IBD, especially emotional lability. The aims of study was to investigate the sex differences in general and specific health-related quality of life (HRQoL), anxiety and depression in IBD patients. Hundred and twelve outpatients of the Gastroenterology Division, Clinical Hospital Centre Rijeka, were enrolled in our study and divided in two groups: 50 females (31 with ulcerative colitis,UC and 19 with Crohn disease, CD) and 62 males (30 with UC and 32 with CD), age range 19 to 74 (M=41.46; SD=13.06). Most patients have been in long clinical remission or with mild disease acording to Clinical Disease Activity Index (CDAI) score for CD and Clinical Activity Index (CAI) score for UC. There were significant differences in physical (F=13.96, p<.0001) and mental (F=9.44, p<.001) component of the general HRQoL, emotional domain ((F=9.26, p<.001) and bowel symptoms (F=7.04, p<.001) of the Inflamatory Bowel Disease Quality of life (IBDQoL), as well as, in anxiety (F=7.03, p<.001) and depression (F=12.09, p<.0001) between men and women with IBD. Women have expressed significantly lower level of the general HRQoL and more emotional disturbances connected with their disease as well as more frequent bowel symptoms compared with men. Effect sizes of those differences were large. Results of this study confirm that women with IBD are more prone to the negative impact of the disease on their HRQoL than men. Women with higher level of depression and anxiety experienced more emotional disturbances, bowel and systemic symptoms and lower general HRQoL. These results should deserve more considerations in the clinical treatment of IBD patients