Uloga polinezasićenih masnih kiselina u inflamaciji

Low-grade systemic inflammation is at the base of the most chronic non-communicable diseases, which are reaching epidemic proportions worldwide. Key players in the regulation of inflammation are n-6 and n-3 polyunsaturated fatty acids (PUFAs), in particular arachidonic acid (n-6) and eicosapentaenoic acid (n-3). They are precursors of eicosanoids - signaling molecules involved in modulating the intensity and duration of inflammatory responses. Eicosanoids derived from n-6 PUFAs have proinflammatory actions, while those derived from n-3 PUFAs act anti-inflammatory. Therefore, dietary intake of n-6 and n-3 PUFAs, as well as their ratio, could markedly affect the pathogenesis and manifestation of many chronic diseases associated with low-grade inflammation. This review will focus on the relationship between dietary PUFAs and inflammation, with reference to PUFAs status in plasma phospholipids in Serbian population.U osnovi većine hroničnih nezaraznih bolesti, koje širom sveta dostižu epidemijske razmere, leži 'tiha' inflamacija. Ključni igrač u regulaciji inflamacije su polinezasićene masne kiseline (PNMK) n-6 i n-3 familije, posebno arahidonska (n-6) i eikozapentaenska kiselina (n-3). One su prekursori eikozanoida - signalnih molekula koji su uključeni u intenzitet i trajanje inflamatornog odgovora. Eikozanoidi poreklom od n-6 PNMK deluju proinflamatorno, dok oni poreklom od n-3 PNMK imaju anti-inflamatorno dejstvo. Zbog toga dijetarni unos n-6 i n-3 PNMK, kao i njihov odnos, može značajno da utiče na patogenezu i manifestaciju mnogih hroničnih oboljenja koja su povezana sa 'tihom' inflamacijom. Ovaj pregledni rad se bavi vezom između unosa PNMK i inflamacije, sa osvrtom na status n-3 i n-6 masnih kiselina u fosfolipidima plazme u populaciji u Srbiji

Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising worldwide, paralleling the epidemic of obesity. The liver is a key organ for the metabolism of proteins, fats and carbohydrates. Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma. Therefore, nutrition can manage hepatic and cardiometabolic complications of NAFLD. Even moderately reduced caloric intake, which leads to a weight loss of 5%-10% of initial body weight, is effective in improving liver steatosis and surrogate markers of liver disease status. Among dietary patterns, the Mediterranean diet mostly prevents the onset of NAFLD. Furthermore, this diet is also the most recommended for the treatment of NAFLD patients. However, clinical trials based on the dietary interventions in NAFLD patients are sparse. Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD, such as active and fibrotic steatohepatitis, the optimal diet for patients in these stages of the disease must still be determined. In this narrative review, we aimed to critically summarize the associations between different dietary patterns, obesity and prevention/risk for NAFLD, to describe specific dietary interventions’ impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice

Assessment of mental health in patients with malignant diseases in primary health care

Uvod: Cilj ove studije je istraživanje povezanosti simptoma depresivnosti i anksioznosti kod pacijenata sa malignim bolestima u primarnoj zdravstvenoj zaštiti. Metod: Prospektivna opservaciona studija je obuhvatila odrasle korisnike primarne zdravstvene zaštite u Domu zdravlja Trstenik, Centralna Srbija, starosti 19 i više godina, oba pola, sa dijagnozom onkološke bolesti. Kao instrument istraživanja za procenu simptoma depresivnosti korišćen je upitnik PHQ-9 (The Patient Health Questionnaire), izveden iz PRIME MD-and (The Primary Care Evaluation of Mental Disorders), i Beck Anxiety Scale (BAI) za registrovanje prisustva određenih simptoma anksioznosti. Rezultati: Najveći procenat pacijenata imao je simptome blage (27,2%) ili umerene depresije (22%), dok je 18% prijavilo simptome velike depresije. Svi ispitanici su okarakterisani kao osobe sa teškom anksioznošću (skor 26-63). Nivo depresije i anksioznosti je veći kod starijih ispitanika, u prisustvu hroničnih bolesti sa većim ograničenjima i prisustvom poteškoća u obavljanju svakodnevnih aktivnosti, sa izraženijim dejstvom bola na aktivnost, prisustvo stresa. Zaključak: Briga o mentalnom zdravlju pacijenata obolelih od malignih bolesti mora zauzimati značajan deo nacionalne zdravstvene politike svake zemlje.Background: The aim of this study is to research the association of cancer with the presence of symptoms of depression and anxiety in primary health care patients. Methods: The prospective observational study which included adult users of health care at the Health Center Trstenik, Central Serbia, aged 19 and over, both sexes, with a diagnosis of oncological disease. A research instrument to assess depressive symptoms is used PHQ-9 (The Patient Health Questionnaire) questionnaire, derived from PRIME MD-and (The Primary Care Evaluation of Mental Disorders), and the Beck Anxiety Scale (BAI) to register the presence of certain anxiety symptoms. Results: The largest percentage of patients had symptoms of mild (27.2%) or moderate depression (22%), while 18% reported symptoms of major depression.All subjects were characterized as persons with severe anxiety (score 26-63). The level of depression and anxiety is higher in older subjects, in the presence of chronic diseases with greater limitations of activity and the presence of difficulties in performing daily activities, with a more pronounced effect of pain on activity, the presence of stress. Conclusion: Caring for the mental health of cancer patients must occupy a significant part of each country's national health policy

Role of Corticosteroids in Drug-Induced Liver Injury. A Systematic Review

Introduction: Apart from cessation of the implicated agent leading to drug-induced liver injury (DILI), there is no standard therapy for DILI. Corticosteroids have been used in DILI, although their efficacy is unclear. Published data showed either beneficial effects or no improvement associated with steroid therapy. The aim of the current study was to perform a systematic review of the role of corticosteroids in the treatment of DILI. Methods: A search was performed in PubMed, searching for the terms: “corticosteroids” and “drug-induced liver injury”. Observation studies were included, but case reports excluded. Results: A total of 24 papers were retrieved. Most of these were observational studies on the effects of corticosteroids in moderate/severe DILI (n = 8), reports on the corticosteroid treatment in patients with drug-induced autoimmune hepatitis (DI-AIH) (n = 5), and effects of corticosteroids in drug-induced fulminant acute liver failure (ALF, n = 2). Furthermore, treatment of corticosteroids in patients with liver injury due to check point inhibitors (CPIs) was addressed in nine studies. In moderate/severe DILI, six out of eight studies suggested steroid treatment to be beneficial, whereas two studies showed negative results. All five observational studies on the effects of corticosteroids in DI-AIH showed good therapeutic response with rapid and long lasting effects after discontinuation of corticosteroids and without evidence of relapse. Steroid therapy was not associated with improved overall survival in patients with drug-induced fulminant ALF. CPIs-induced liver injury was found to improve spontaneously in 33–50% without corticosteroids, and the rate of patients who were treated responded to steroids in 33–100% (mean 72%). Conclusions: The majority of studies analyzing the effects of corticosteroids in moderate/severe DILI have demonstrated beneficial effects. However, this was not the case in drug-induced fulminant ALF. Patients with DI-AIH had an excellent response to corticosteroids. The majority of those with CPIs-induced liver injury responded to corticosteroids; however, patients without treatment usually recovered spontaneously. The observational design and comparison with historical controls in these studies makes it very difficult to draw conclusions on the efficacy of corticosteroids in DILI. Therefore, there is a strong need for a randomized controlled trial to properly assess the role of corticosteroids in DILI