Employment in Patients With Renal Replacement Therapy

Introduction: To determine the prevalence and rate of employment of patients on renal replacement therapy (RRT) for end-stage renal disease (ESRD), to study the difference in the rate of employment between patients on hemodialysis (HD) and those with functioning kidney transplant (FKT) and to compare the rate of employment with patients’ opinions about their working ability and determine the possible reasons for the presumed disproportion.. Methods: 220 RRT patients (126 on HD and 94 with FKT) at the University Hospital Centre Osijek were surveyed. We created and used a questionnaire about the level of education, occupation, employment, professional timeline during the course of RRT, personal opinion about working ability and potential reasons for unemployment. Research was conducted during April and May 2017. The data were analyzed using SPSS (version 16.0. Inc., Chicago, IL, USA). Results: At the time of our research, 13.7% of patients on RRT were employed. Employment of FKT patients prevailed, without significant difference compared with dialyzed patients of working age (15 to 65 years old). 38.3% of patients in that age group felt capable of working. Transplantation did not improve access to employment. Highly educated people were employed more frequently. The main reasons for unemployment were poor health caused by CKD, advanced age, and employers’ unwillingness to hire chronically ill persons because of the potential need to adjust working hours. Conclusion: CKD reduced working ability and employment opportunities. Only a minority of patients on RRT were employed. Kidney transplantation did not increase the rate of employment. Patients should therefore be provided with education, appropriate guidelines and support for finding employment

Spontana HBsAg serokonverzija nakon dugogodišnje infekcije virusom hepatitisa B u pacijenta na kroničnoj hemodijalizi

Aim: The aim was to present an unusual spontaneous disappearance of HBsAg after a long-lasting infection. Case report: A 26-year-old man started chronic hemodialysis (HD) in 1994 for chronic glomerulonephritis. Serological analysis was positive for hepatitis B virus (HBV) infection. During the following years he was treated with HD and his HBV markers remained unchanged (HBsAg positivity). When antiviral therapy became available the patient refused to be treated. In 2006 his HBsAg became negative for the first time in 12 years, while anti-HBs and anti-HBc became positive, which would indicate that he became immune late after a natural infection. To date, all repeated check-ups have been negative for HBsAg. In 2008 he received a kidney transplant from a deceased donor and was put on immunosuppressive (IS) therapy. During the IS treatment, which is ongoing, he has been stable and without HBV viremia (HBsAg-negative). Conclusion: It has still remained unclear how spontaneous HBsAg seroconversion did happen in our patient after long lasting infection. It has also been interesting that 11 years after seroconversion his HBV markers have still been unchanged (HBsAg negativity) and show signs of a resolved HBV infection, even though he has been immunosuppressed due to kidney transplantation for already 9 years. It is possible that his anti-HBs levels are high enough to protect him and inhibit HBV reactivation or the virus has not been dormant in his hepatic cells at all.Cilj: Cilj je prikazati neobičan spontani nestanak HBsAg nakon dugotrajne infekcije. Prikaz slučaja: Dvadesetšestogodišnji muškarac započeo je kroničnu hemodijalizu (HD) 1994. godine zbog kroničnog glomerulonefritisa. Serološka analiza bila je pozitivna na infekciju virusom hepatitisa B (VHB). Tijekom sljedećih godina liječen je HD-om i njegovi su biljezi VHB ostali nepromijenjeni (HBsAg pozitivnost). Kada je antivirusna terapija postala dostupna, pacijent je odbio liječenje. HBsAg postao je 2006. negativan po prvi put u 12 godina, dok su anti-HBs i anti-HBc postali pozitivni, što bi upućivalo na to da je nakon prirodne infekcije razvio imunost. Do sada su sve ponovljene pretrage negativne za HBsAg. 2008. godine transplantiran mu je bubreg od mrtvog darovatelja i uvedena terapija imunosupresivima (IS). Tijekom liječenja IS-om, koja je u tijeku, bio je stabilan i bez HBV viremije (HBsAg negativno). Zaključak: Još uvijek nije jasno kako se spontana HBsAg serokonverzija dogodila u našeg bolesnika nakon dugotrajne infekcije. Također je zanimljivo da su i 11 godina nakon serokonverzije njegovi biljezi VHB-a još uvijek nepromijenjeni (HBsAg negativnost) i pokazuju znakove preboljele infekcije VHB-om, unatoč devetogodišnjem IS-u zbog bubrežnog presađivanja. Moguće je da su njegove razine anti-HBs dovoljno visoke da ga zaštite i inhibiraju reaktivaciju VHB-a ili virus uopće nije prisutan u njegovim hepatocitima

Cytomegalovirus Infection in Kidney Transplant Recipients

Introduction: Present study examined the frequency of CMV infection during follow-up using quantitative nucleic acid amplification testing, the frequency of administration of infection prophylaxis, viremia and infection in kidney transplant recipients who underwent transplantation (TX) at the University Hospital Center Osijek. Materials and Methods: 107 kidney recipients who underwent transplantation in the period 20 October 2007 – 24 August 2016 were included. Demographic and clinical data, data about pre-transplantation CMV IgG test results of recipients and their donors, data about CMV prophylaxis, viremia, infection, and kidney transplant function were taken from medical records and analyzed. Results: 92.5% of kidney recipients and 86% of donors were CMV IgG positive before TX. 28% of recipients were CMV-DNA positive at some point after TX, none of whom received a transplant from an IgG negative donor. 89.7% of participants received CMV prophylaxis. Seven participants developed CMV disease, 2 of whom were not administered prophylaxis. Participants were tested for CMV-DNA once a year (median; min 0 max 6). CMV disease was marginally more frequent in those who did not receive valganciclovir prophylaxis (P = 0.066). Conclusion: It seems wise to enforce the administration of CMV prophylaxis and CMV-DNA testing in accordance with protocol, in order to detect viremia on time and to implement preemptive treatment, aiming at prevention of clinical manifestation of infection and preservation of graft function

Arterijskovenska fistula nakon bubrežnog presađivanja u Kliničkom bolničkom centru Osijek

Aims: To examine the proportion of patients with thrombosis or surgical ligation of arteriovenous fistula (AVF) after kidney transplantation (TX) and to explore the time passed after the TX until the loss of AVF function. Patients and methods: The study design was historical cohort study. The study included all 123 patients (57.7 % men, median age 58 years, from 34 to 79) that underwent kidney TX in the University Hospital Centre Osijek during the first 10 years of practicing that kind of surgery in the hospital. The data on AVF function, thrombosis or ligation were undertaken from medical records, along with demographics (age, gender, time after TX). The data were presented descriptively and after statistical analysis that was performed using SPSS (version 17.0). Results: FunctionalAVF immediately prior to TX was found in 78 % of the patients. The AVF was still functional in 39.84 % of all patients for 3 years (median, interquartile range, IQR 0 – 3) after TX. AVF thrombosis happened in 17.89 %, while surgical ligation was performed in 20.33 % of all patients. The most common reason for ligation was increased risk of heart failure (in 75 % of the ligations), followed by aneurysmatic dilatation and arm swelling. Median time after TX to thrombosis or ligation of AVF was 2 years, IQR 0 – 3. Thrombosis or ligations were significantly more frequent in women. The outcome of AVF after kidney TX was not related to the patient’s age. Conclusion: AVF after kidney TX often became nonfunctional, either after spontaneous thrombosis or after surgical ligation, which was required for increased heart failure risk in the majority of the cases.Cilj: Istražiti udio ispitanika u kojih je nakon bubrežnog presađivanja (transplantacije, TX) došlo do tromboze ili ligacije arterijskovenske fistule (AVF) te istražiti vrijeme nakon TX-a u kojemu je došlo do gubitka funkcije AVF-a. Ispitanici i postupci: Istraživanje je ustrojeno kao kohortno povijesno istraživanje.Uključeno je svih 123 bolesnika (57,7 % muških, medijana dobi 58 godina, od 34 do 79) kojima je bubrežni presadak trans- plantiran u Kliničkom bolničkom centru Osijek tijekom prvih 10 godina otkako se u toj bolnici vrši bubrežni TX. Iz medicinskih zapisa preuzeti su podaci o funkciji AVF-a, trombozama i ligacijama, kao i demografski podatci (dob, spol, vrijeme nakon TX-a). Podaci su prikazani deskriptivno i analitički, a statistički obrađeni pomoću SPSS-a (inačica 17.0). Rezultati: AVF neposredno prije TX-a imalo je 78 % bolesnika. Još uvijek funkcionira u 39,84 % svih ispitanika, 3 godine (medijan, interkvartilni raspon, IQR od 0 do 3) nakon TX-a. Tromboza AVF-a je nastupila u njih 17,89 %, a ligacija je izvedena u 20,33 % svih ispitanika. Najčešći razlog ligacije AVF-a u našem istraživanju bio je srčano opterećenje (u 75 % ligacija), zatim aneurizmatična dilatacija AVF-a te otok ruke. Vrijeme nakon TX-a do tromboze ili ligacije bilo je medijana 2 godine (IQR 0 – 3). Trom- boza ili ligacija bili su značajno češći u žena. Sudbina AVF-a nakon bubrežnog TX-a nije bila povezana s dobi bolesnika. Zaključak: AVF nakon bubrežnog TX-a često postaje nefunkcionalna, nakon spontane tromboze ili kirurške ligacije, a koja je najčešće indicirana zbog srčanog opterećenja

Attitudes and Behavior of Biomedical Students in Comparison With Other Students During the COVID-19 Pandemic

Aim: Since its beginning, the COVID-19 pandemic has affected many people’s usual activities and lifestyle, including Croatian students’ lives. The aim of the study was to examine whether the attitudes and behaviour of students in the biomedical (B) field differed from those in other (O) fields at the Josip Juraj Strossmayer University of Osijek (JJSUO). The hypothesis was that B students would behave more responsibly. Materials and Methods: A 10-question anonymous online survey on attitudes and behaviour related to the COVID-19 pandemic was designed and conducted. The research was carried out in November 2020 and it included a total of 348 students (46 % of B students) at the JJSUO. The data were statistically processed by the IBM ® SPSS ® Statistics 25.0 software at the statistical significance level of P < 0.05. Results: Twenty-five percent of B students and 11.17 % of O students (P = 0.001) responded that they did not go to nightclubs, in accordance with the Civil Protection Headquarters’ recommendations. Regarding their indoor socialising, 24.38 % of B students and 45.21 % of O students behaved the same as before the pandemic (P < 0.01). A total of 63.13 % of B and 39.36 % of O students (P < 0.01) responded that they would receive a vaccine against SARS-CoV-2. Conclusion: B students behaved more responsibly than O students by reducing their socialising and going to crowded places, probably because of their education and awareness of the severity of COVID-19. Accordingly, more of them were willing to get the vaccine against SARS-CoV-2.

Employment in Patients After Liver Transplantation

Aim: To determine the prevalence of employment of patients after liver transplantation (TX) and the history of employment, to compare employment with patients’ opinions about their ability to work and to establish possible reasons for frequent unemployment. Methods: Ninety-eight respondents participated in the study. They were the first 98 liver transplant patients who came for a check-up at Merkur University Hospital by the time of the research and agreed to participate in the study. We created and used a questionnaire about the level of education and employment prior to and after the liver TX. Results: Before the diagnosis of liver disease, 59.18 % of the patients were employed, while after liver TX, at the time of the research, the employment rate decreased to 8.2 %. During the same time span, the number of retired patients increased from 3.1 % before the diagnosis to 63.3 % after liver TX at the time of the research. The main reasons for unemployment were poor health due to liver disease and employers’ unwillingness to hire these patients because of a potential risk of adjustment of working hours. Median follow-up time after liver TX was 3 years (interquartile range 2 – 6). Conclusion: Many patients with severe liver disease are unemployed. Liver TX did not increase the rate of employment of Croatian patients. Patients should be supported by society in finding appropriate employment. (Holetić A, Đukić M, Zibar* L. Employment of Patients After Liver Transplantation. SEEMEDJ 2020; 4(1); 49-54

STANJE POST-COVID-19 U PRIMATELJA BUBREŽNOG PRESATKA: ISKUSTVO JEDNOG CENTRA

Solid organ transplant (SOT) recipients who survived acute COVID-19 can develop post-COVID-19 condition. Post-COVID-19 condition can affect multiple organ systems, and its prevalence is up to 70% in general population. Data regarding postCOVID-19 condition in SOT recipients are scarce. The aim of our study was to investigate the prevalence and characteristics of post-COVID-19 condition in SOT recipients.The study included SOT recipients who had kidney transplantation in Merkur University Hospital between 2007 and 2020, and who survived COVID-19. Between July 2020 and June 2021, 78 transplanted patients (kidney only or combined with pancreas or liver) had acute COVID-19, of which 13 patients died. The study was conducted in the form of survey and included 60 patients who all gave informed consent for participation in the study. Post-COVID-19 condition experienced 40 (67%) patients, and most common symptoms were fatigue (43%) and shortness of breath (30%), followed by hair loss (27%), insomnia (22%), sweating (22%), and decline in the quality of life (20%). There was no difference between patients with post-COVID-19 condition and those without post-COVID-19 condition regarding gender, age, transplanted organ(s), time from transplantation to COVID-19, or need of hospitalization due to COVID-19. In conclusion, post-COVID-19 condition was frequent among SOT (kidney) patients, with fatigue and shortness of breath as the most common symptoms, as in general population. Thus, unfortunately, COVID-19 contributed to their comorbidity burden at longterm as well.Bolesnici s presađenim organom koji su preboljeli COVID-19 mogu razviti sindrom post-COVID-19. Sindrom post-COVID-19 obilježen je mogućnošću zahvaćanja više organskih sustava, a javlja se u do 70 % bolesnika u općoj populaciji. Podatci o sindromu post-COVID-19 među bolesnicima s presađenim organom su oskudni te je stoga cilj ovoga istraživanja bio utvrditi učestalost i obilježja sindroma post-COVID-19 u navedenoj populaciji. Istraživanje je uključilo bolesnike koji su imali presadbu bubrega u Kliničkoj bolnici Merkur u razdoblju od 2007. do 2020. godine i koji su preživjeli COVID-19. U razdoblju od srpnja 2020. do lipnja 2021. godine 78 bolesnika (s presađenim samo bubregom ili bubregom i gušteračom ili bubregom i jetrom) preboljelo je COVID-19, od kojih je 13 umrlo. Istraživanje je provedeno u obliku ankete, a uključilo je 60 bolesnika koji su dali dobrovoljni pristanak za sudjelovanje. Sindrom post-COVID-19 razvilo je 40 (67 %) ispitanika, a najčešći simptomi bili su umor (43 %), kratkoća daha (30 %), gubitak kose (27 %), nesanica (22 %), znojenje (22 %) i smanjenje životne kakvoće (20 %). Nije nađeno razlike između bolesnika sa sindromom post-COVID-19 i onih koji nisu razvili sindrom post-COVID-19 s obzirom na spol, dob, vrstu presađenog organa, vrijeme od presadbe organa do COVID-19 ili potrebe za hospitalizacijom zbog COVID-19. Zaključno, prema rezultatima našeg istraživanja možemo reći da je sindrom post-COVID čest među bolesnicima s presađenim solidnim organom (bubregom) te da su umor i kratkoća daha najčešći simptomi, kao i u općoj populaciji. COVID-19 je tako, nažalost, i dugoročno doprinio njihovom ukupnom pobolu

STANJE POST-COVID-19 U PRIMATELJA BUBREŽNOG PRESATKA: ISKUSTVO JEDNOG CENTRA

Solid organ transplant (SOT) recipients who survived acute COVID-19 can develop post-COVID-19 condition. Post-COVID-19 condition can affect multiple organ systems, and its prevalence is up to 70% in general population. Data regarding postCOVID-19 condition in SOT recipients are scarce. The aim of our study was to investigate the prevalence and characteristics of post-COVID-19 condition in SOT recipients.The study included SOT recipients who had kidney transplantation in Merkur University Hospital between 2007 and 2020, and who survived COVID-19. Between July 2020 and June 2021, 78 transplanted patients (kidney only or combined with pancreas or liver) had acute COVID-19, of which 13 patients died. The study was conducted in the form of survey and included 60 patients who all gave informed consent for participation in the study. Post-COVID-19 condition experienced 40 (67%) patients, and most common symptoms were fatigue (43%) and shortness of breath (30%), followed by hair loss (27%), insomnia (22%), sweating (22%), and decline in the quality of life (20%). There was no difference between patients with post-COVID-19 condition and those without post-COVID-19 condition regarding gender, age, transplanted organ(s), time from transplantation to COVID-19, or need of hospitalization due to COVID-19. In conclusion, post-COVID-19 condition was frequent among SOT (kidney) patients, with fatigue and shortness of breath as the most common symptoms, as in general population. Thus, unfortunately, COVID-19 contributed to their comorbidity burden at longterm as well.Bolesnici s presađenim organom koji su preboljeli COVID-19 mogu razviti sindrom post-COVID-19. Sindrom post-COVID-19 obilježen je mogućnošću zahvaćanja više organskih sustava, a javlja se u do 70 % bolesnika u općoj populaciji. Podatci o sindromu post-COVID-19 među bolesnicima s presađenim organom su oskudni te je stoga cilj ovoga istraživanja bio utvrditi učestalost i obilježja sindroma post-COVID-19 u navedenoj populaciji. Istraživanje je uključilo bolesnike koji su imali presadbu bubrega u Kliničkoj bolnici Merkur u razdoblju od 2007. do 2020. godine i koji su preživjeli COVID-19. U razdoblju od srpnja 2020. do lipnja 2021. godine 78 bolesnika (s presađenim samo bubregom ili bubregom i gušteračom ili bubregom i jetrom) preboljelo je COVID-19, od kojih je 13 umrlo. Istraživanje je provedeno u obliku ankete, a uključilo je 60 bolesnika koji su dali dobrovoljni pristanak za sudjelovanje. Sindrom post-COVID-19 razvilo je 40 (67 %) ispitanika, a najčešći simptomi bili su umor (43 %), kratkoća daha (30 %), gubitak kose (27 %), nesanica (22 %), znojenje (22 %) i smanjenje životne kakvoće (20 %). Nije nađeno razlike između bolesnika sa sindromom post-COVID-19 i onih koji nisu razvili sindrom post-COVID-19 s obzirom na spol, dob, vrstu presađenog organa, vrijeme od presadbe organa do COVID-19 ili potrebe za hospitalizacijom zbog COVID-19. Zaključno, prema rezultatima našeg istraživanja možemo reći da je sindrom post-COVID čest među bolesnicima s presađenim solidnim organom (bubregom) te da su umor i kratkoća daha najčešći simptomi, kao i u općoj populaciji. COVID-19 je tako, nažalost, i dugoročno doprinio njihovom ukupnom pobolu