EFFECTIVENESS OF THE SEQUENTIAL THERAPY IN ERADICATION OF HELICOBACTER PYLORI INFECTION

Cilj istraživanja: Primarni cilj ovog istraživanja je bio utvrditi uspješnost sekvencijske terapije eradikacije H. pylori u populaciji Splitsko-Dalmatinske županije. Sekundarni ciljevi ovog istraživanja bili su utvrditi potencijalne nuspojave kao i suradljivost pacijenta tijekom primjene sekvencijske terapije eradikacije H. pylori infekcije. Ispitanici i metode: U ovo retrospektivno kliničko istraživanje (studijski period svibanj 2013.- svibanj 2014.) uključeno je 97 odraslih pacijenta (54 žene i 43 muškaraca) s dokazanom H. pylori infekcijom koji su liječeni sekvencijskom eradikacijskom terapijom. Rezultati: Uspješnost eradikacije H. pylori infekcije u ovom kliničkom istraživanju korištenjem sekvencijske eradikacijske terapije iznosila je 87,6%. Suradljivost (compliance) pacijenata uključenih u ovo istraživanje bila je 92,8%. Najčešće nuspojave sekvencijske terapije u ovom istraživanju bile su blagog inteziteta a uključivale su mučninu, kratkotrajni proljev i abdominalne bolove te nisu zahtjevale prekid terapijskog protokola. Zaključak: Sekvencijska terapija eradikacije H. pylori infekcije u populaciji Splitsko-Dalmatinske županije je učinkovita eradikacijska terapija uz prihvatljive nuspojave.Aims of the study: Primary aim of this study was to determine the efficiency of sequential therapy in H. pylori eradication in the population of Splitsko-Dalmatinska region. Secondary goals of this study were to determine potential side effects, as well as patient compliance during sequential therapy in eradication of H. pylori infection. Materials and methods: 97 adult patients (54 women and 43 men) with proven H. pylori infection which were treated with sequential eradication therapy were included in this retrospective clinical study (period of May 2013. - May 2014.). Results: H. pylori eradication efficacy rate using sequential therapy in this study was 87,6%. Patient compliance was 92,8%. Most common side effects of sequential therapy in this study were mild and included nausea, short term diarrhea and abdominal pains and did not require stopping the therapy. Conclusion: Sequential therapy in eradication of H. pylori infection in the population of Splitsko-Dalmattinska region is an effective eradication therapy with minimal side effects

TREATMENT OF FISTULIZING CROHN’S DISEASE

Liječenje fistulirajućeg oblika Crohnove bolesti zahtijeva tijesnu suradnju gastroenterologa i kirurga te se temelji na striktnom individualnom pristupu koji uvijek uključuje adekvatnu nutricijsku potporu. Danas još uvijek ne postoje kontrolirane randomizirane studije koje bi adekvatno evaluirale učinkovitostt medikamentne kao niti biološke terapije u liječenju neperianalne fistulirajuće Crohnove bolesti. Retroperitonealne fistule sa slijepim završetkom kao i enterovezikalne fistule apsolutna su indikacija za kiruršku intervenciju. Kirurška intervencija je neophodna i u slučaju gastrokoličnih i duodenokoličnih fistula. U većini slučajeva simptomatske enterovaginalne fistule zahtijevaju kirurški tretman. Imunosupresivna terapija (azatioprin ili merkaptopurin) uz antibiotsku terapiju (ciprofloksacin + metronidazol) u kombinaciji s drenažnim kirurškim postupcima danas je prva medikamentna linija terapije kompleksne perianalne Crohnove bolesti. Svakako treba naglasiti potrebu za dugotrajnom terapijom održavanja kliničke remisije koja u selekcioniranih bolesnika uključuje postavljanje setona uz imunosupresivnu terapiju u razdoblju od najmanje godinu dana. Sukladno dostupnim studijama, anti TNF-terapija (infliksimab ili adalimumab) danas je druga medikamentna terapijska linija u liječenju kompleksnog perianalnog oblika Crohnove bolesti.The treatment of fistulating Crohn’s disease should include a combined medical and surgical approach and should be defined on an individual basis. Asymptomatic enteroenteric fistulas usually require no treatment, but internal fistulas (gastrocolic, duodenocolic, enterovesical) that cause severe or persistent symptoms require surgical intervention. While low asymptomatic analintroital fistula may not need surgical treatment, in case of a symptomatic enterovaginal fistula surgery is usually required. There are no controlled-randomized trials to assess the effect of medical treatment for non-perianal fistulating Crohn’s disease. The incidence of perianal fistulae varies according to the location of the disease, with its occurrence varying between 21-23%. The diagnostic approach should include an examination under anesthesia, endoscopy, and either MRI or EUS before the treatment begins. Asymptomatic simple perianal fistulas require no treatment. The presence of a perianal abscess should be ascertained and if present should be drained urgently. In case of a complex perianal disease, seton placement should also be recommended. Antibiotics (metronidazole and ciprofloxacine) are useful for treating complex perianal disease, however, when discontinued, most of the fistulas relapse. The current consensus suggests that azathioprine/6-mercaptopurine is the first line medical therapy for complex perianal disease, which is always given in combination with surgical therapy (seton, fistulotomy/fistulectomy). Anti TNF-αagents (infliximab and adalimumab) should be used as a second choice medical treatment. In refractory and extensive complex perianal disease a diverting stoma or proctectomy should be performed

Opis višekratne primjene aktivnog ugljena u liječenju predoziranja karbamazepinom popraćenog epileptičkim napadajima

Serious complications after carbamazepine poisoning, such as coma, seizures, respiratory failure, cardiac conduction abnormalities, and death are more likely with serum levels greater than 170 μmol L-1. We report a case of a single massive carbamazepine overdose in a 19-year-old male, following attempted suicide, without prior history of seizure disorder. On admission, three hours after ingestion, serum carbamazepine concentration was 179 μmol L-1 and Glasgow Coma Scale scored 6. The patient was intubated and treated with multiple doses of activated charcoal for 48 hours. Twelve hours after ingestion, two repeated generalised myoclonic seizures were noted when serum carbamazepine levels peaked at 181 μmol L-1, and were successfully treated with diazepam. Carbamazepine serum level fell within the therapeutic range 63 hours after ingestion and the patient was discharged without any long-term sequelae. As there is no antidote for carbamazepine poisoning, supportive treatment remains the only, but usually potent option.Pri razinama u serumu višim od 170 μmol L-1 veći su izgledi da će trovanje karbamazepinom dovesti do ozbiljnih komplikacija poput kome, epileptičkih napadaja, zatajenja dišnog sustava, poremećaja u srčanoj provodljivosti te smrti. U ovome je opažanju prikazan slučaj jednokratnoga snažnog predoziranja karbamazepinom prilikom pokušaja samoubojstva devetnaestogodišnjaka bez povijesti epileptičkih napadaja. Koncentracija karbamazepina u trenutku prijma, a tri sata nakon unosa, bila je 179 μmol L-1, a ocjena kome prema Glasgowskoj ljestvici (engl. Glasgow Coma Scale) bila je 6. Bolesnik je intubiran endotrahealno i liječen 48 sati višekratnim dozama aktivnog ugljena. Dvanaest sati nakon uzimanja otrova zabilježena su dva mioklonička napadaja pri vršnim koncentracijama karbamazepina od 181 μmol L-1 koji su uspješno liječeni diazepamom. Razine karbamazepina u serumu spustile su se na terapijsku razinu 63 sata nakon unosa te je bolesnik otpušten iz bolnice bez dugotrajnih posljedica. Budući da nema protuotrova za karbamazepin, potporno je liječenje i dalje jedini, ali djelotvoran izbor

Lamotrigin u liječenju rezistentne akutne boli pri radikularnom oštećenju vratnog segmenta: prikaz slučaja

Radicular pain syndromes caused by disk herniation are often accompanied by incomplete central cord syndrome. Intensive pain is difficult to control with standard analgesics. Antiepileptics of new generation have shown significant efficacy in treating pain syndromes, trigeminal neuralgia, diabetic neuropathy, migraines, etc. The treatment of radicular pain with lamotrigine, a new generation antiepileptic, turned out to be effective in lumbar disk radicular conflicts, justifying its application for resistant pain in cervical segment. In our patient, pain intensity was significantly reduced with gradual titration of lamotrigine to a dose of 200 mg/day. Pain intensity measured by the visual analog scale significantly decreased from 100 to 20 mm during eight weeks of titration. The blood concentration of the drug measured by the method of high performance liquid chromatography was 13.65 µmol/L. The patient.s quality of life improved greatly. It is necessary to further evaluate the efficacy of lamotrigine in the treatment of resistant radicular damage.Radikularni bolni sindromi uzrokovani hernijacijom diska obično su udruženi s nepotpunim sindromom kralježnične moždine. Intenzivna bol se teško kontrolira standardnim analgeticima. Antiepileptici nove generacije pokazuju značajan učinak u liječenju bolnih sindroma, neuralgije trigeminusa, dijabetične neuropatije, migrene itd. Liječenje radikularne boli lamotriginom, antiepileptikom nove generacije, pokazalo se učinkovitim u lumbarnom disk-radikularnom konfliktu pa smo ga pokušali primijeniti i u rezistentnoj boli vratnoga segmenta. Postupnom titracijom lamotrigina do doze od 200 mg/dan intenzitet boli značajno se smanjio. Intenzitet boli mjeren ljestvicom VAS smanjio se sa 100 na 20 mm kroz razdoblje od osam tjedana titracije lijeka. Razina lijeka u krvi određena pomoću metode HPLC bila je 13,65 µmol/L. Kvaliteta života naše bolesnice značajno se poboljšala. Potrebno je procijeniti učinkovitost lamotrigina u liječenju rezistentne radikularne boli

Symptomatology of Detrimental Effects of Pesticides - Literature Review

Poljoprivrednici koji su kronično izloženi niskim razinama pesticida rijetko pokazuju klinički značajne znakove i simptome. Trovanje pesticidima može biti akutno i kronično. Primarna ciljna tkiva toksičnosti su krvotvorni sustav, kardiovaskularni sustav, reprodukcijski sustav i živčani sustav. Kod izloženih osoba pesticidi mogu uzrokovati mutacije gena i poremećaje kromosoma. Blaži, prolazni simptomi trovanja su često glavobolja, mučnina, povraćanje, omaglica, proljev, bolovi u trbuhu, bolovi u mišićima, salivacija, zbunjenost, umor itd. Od bitne je važnosti pravodobno prepoznati štetno djelovanje pesticida, čime se omogućava primjena odgovarajuće terapije što je ranije moguće.Farm workers chronically exposed to low levels of pesticides seldom show signs and symptoms of clinical significance. Pesticide poisoning can be acute and chronic. The primary targets of toxicity are the hematopoietic system, the cardiovascular system, the reproductive system and the nervous system. Pesticides can cause gene mutations and chromosomal aberrations in exposed individuals. Mild temporary symptoms of poisoning including headache, nausea, vomiting, dizziness, diarrhea, abdominal pain, myalgia, salivation, mental confusion, fatigue, etc., may quite frequently occur. It is essential to recognize detrimental effects of pesticides timely, thus enabling the earliest possible administration of appropriate treatment

Vertigo in Neurological Practice

Vrtoglavica je učestali problem u neurološkoj praksi uzrokovan nizom patomorfoloških i patofizioloških supstrata. Cilj istraživanja bio je utvrditi učestalost pojedinih uzroka vrtoglavice u neurološkoj praksi. Provedeno je prospektivno istraživanje uzroka vrtoglavice u bolesnika obrađivanih u neurološkoj ambulanti. U statističkoj obradi rabili smo χ²-test, t-test, analizu varijance i post hoc LSD test. Srednja životna dob oboljelih muškaraca bila je 55,45±14,8 godina, a žena 52,9±15,1 godinu. Utvrdili smo da podjednako obolijevaju muškarci i žene (t=0,92; p=0,36). Najčešći uzrok vrtoglavice bila je vertebrobazilarna insuficijencija i tranzitorna ishemijska ataka vertebrobazilarnog sliva (36,5%), a slijedili su prema učestalosti vestibularni neuritis (23,5%) i moždani udar (14,8%) te tranzitorna ishemijska ataka uzrokovana značajnim stenozama karotidnih arterija (9,6%). Ostali znatno rjeđi uzroci vrtoglavice u neurološkoj praksi bili su benigna paroksizmalna pozicijska vrtoglavica, multipla skleroza, upalni procesi srednjeg uha, tumori mozga i akustični neurinomi. Utvrđena je statistički značajna razlika uzroka vrtoglavice s obzirom na patomorfološki supstrat prema dobi bolesnika (f=3,55; p=0,017). Oboljeli od moždanog udara i oni s tranzitornom ishemijskom atakom uzrokovanom značajnom stenozom karotidnih arterija bili su značajno starije životne dobi. Posebna pomoć u dijagnostici pojedinih uzroka vrtoglavice uz dijagnostičke metode su pridruženi simptomi te težina, trajanje i tijek vrtoglavice, o čemu treba voditi računa pri procjeni mogućih uzroka vrtoglavice.Vertigo is a common problem in neurological practice, caused by a number of pathomorphological and pathophysiological substrates. The aim of the study was to assess the incidence of particular causes of vertigo in neurological practice. This prospective study included patients treated for vertigo at neurology outpatient clinic. On statistical analysis, χ2-test, t-test, analysis of variance and post hoc LSD test were used. The mean age was 55.45±14.8 years in male patients and 52.9±15.1 years in female patients. The incidence of vertigo was comparable in the two sexes (t=0.92, p=0.36). The most common cause of vertigo was vertebrobasilar insufficiency and transient ischemic attack of the vertebrobasilar circulation (36.5%), followed by vestibular neuritis (23.5%), stroke (14.8%) and transient ischemic attacks caused by significant carotid artery stenosis (9.6%). Other, more infrequent causes of vertigo in neurology practice were benign paroxysmal positional vertigo, multiple sclerosis, inflammation processes in the middle ear, brain tumors and acoustic neuroma. There was a statistically significant difference in the causes of vertigo according to pathomorphological substrate and patient age (f=3.55; p=0.017). The patients that had suffered a stroke and those with transient ischemic attacks caused by significant carotid artery stenosis were significantly older. Besides established diagnostic methods, associated symptoms, severity, duration and course of vertigo are of great help in the diagnosis of particular causes of vertigo, which should be taken in consideration on assessing the possible causes of vertigo

Coincidence of colorectal cancer and diverticular disease of the colon

Uvod: Divertikuloza (DK) debeloga crijeva i karcinom debeloga crijeva (KDC) imaju neke zajedničke karakteristike (npr. češći su u zapadnom dijelu svijeta i kod starijih osoba, slične prehrambene značajke uključene su u obje bolesti) a povremena povezanost između njih je ispitivana. Naš cilj je bio procijeniti koincidenciju KDC-a i DK u kontinentalnoj i primorskoj Hrvatskoj, kao i prehrambenu varijabilnost u našoj populaciji - prehrana s manjim udjelom vlakana u kontinetalnoj Hrvatskoj i mediteranska prehrana u primorskoj Hrvatskoj stvara povoljnu situaciju za istraživanje bolesti sa sumnjom na prehrambenu etiologiju. Metode: Analizirane su medicinske povijesti 710 bolesnika iz kontinentalne regije i 406 bolesnika iz primorske regije s dijagnozom KDC od 2011. do 2016. godine s obzirom na prevalenciju DK. Skupine su nadalje podijeljene prema različitim dobnim i spolnim skupinama, a prevalencija DK u svakoj skupini izračunata je i uspoređena. Analizirane su i distribucije DK i KDC-a za skupine KDC u usporedbi s DK. Rezultati: Prevalencija DK u skupini KDC u obalnom području iznosila je 32,3%, a u kontinentalnoj regiji 11,5%. Prevalencija DK u primorskom području bila je znatno veća u ukupnom broju u usporedbi s kontinentalnom regijom, kao i u ukupnom broju muškaraca i žena, te u dobno stratificiranoj skupini > 65. Lijevi kolon je češće zahvaćen s DK i KDC u obje skupine. Zaključci: Naši podaci upućuju da bolesnici s KDC i DK mogu proizaći iz različitih ispitivanih skupina, a učinak prehrane tek treba ustanoviti.Background: Diverticular disease (DD) of the colon and colorectal cancer (CRC) have common characteristics (e.g. more common in the westernized world and in the elderly, similar dietary features implicated for both diseases) and a casual relationship between them has been suggested. Our aim was to evaluate the coincidence of CRC and DD in continental and coastal Croatia as a dietary variability observed in our population – low fiber diet in the continent and Mediterranean diet on the coast creates a favourable situation for the investigation of diseases with suspected nutritional aetiology. Methods: Medical histories of 710 patients from the continental region and 406 from the coastal region diagnosed with CRC from 2011 to 2016 were analyzed with regard to the prevalence of DD. The groups were furthermore divided in different age and sex groups and the prevalence of DD in each group was calculated and compared. Distribution of DD and CRC in the colon for the groups of CRC in concomitance with DD were also analyzed. Results: The prevalence of DD among the CRC group in the coastal region was 32.3% and in the continental region 11.5%. The prevalence of DD in the coastal region was significantly higher in the overall number compared to the continental region as well as in the overall number of men and women, and in the age-stratified group > 65. The left colon was affected more often with DD and CRC in both groups. Conclusions: Our findings suggest that patients with CRC and DD could derive from distinct groups and the effect of the diet has yet to be established

Posttraumatic hepatic artery pseudoaneurysm presenting as gastrointestinal bleeding

Posttraumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition which should be considered in patients with a history of blunt abdominal trauma who present with abdominal pain or gastrointestinal bleeding. We report a case of a patient with such a pseudoaneurysm discovered five months after a bicycle accident resulting in hepatic rupture that was treated conservatively. The patient presented with fatigue, dizziness, inability to tolerate major exertion and gastrointestinal bleeding. After extensive diagnostic procedures, a right hepatic artery pseudoaneurysm was found. The condition was treated successfully with transcatheter coil embolization

CROATIAN GUIDELINES FOR DIAGNOSTICS AND TREATMENTS OF HELICOBACTER PYLORI INFECTION

Dosadašnjim 30-godišnjim istraživanjima potvrđena je temeljna uloga bakterije Helicobacter pylori pri razvoju kroničnoga gastritisa, želučanog i duodenalnog ulkusa, a potom i njegova etiološka uloga u patogenezi želučanog karcinoma i MALT limfoma. Godine 1996. održan je prvi sastanak Europske grupe za istraživanje infekcije Helicobacterom pylori i publicirane prve smjernice za dijagnostiku i terapiju te infekcije, revidirane 2000., 2007. i 2010. godine. Već 1998. godine održan je i prvi sastanak hrvatskih liječnika s istim ciljem – stvaranja hrvatskih preporuka za dijagnostiku i terapiju infekcije Helicobacterom pylori u našoj zemlji. Posljednjih se godina nametnula potreba za revizijom starih smjernica. Godine 2012. osnovana je ekspertna grupa gastroenterologa koja je u prosincu 2012. godine održala u Zagrebu Konsenzusnu konferenciju za donošenje novog postupnika za dijagnostiku, liječenje i praćenje bolesnika s infekcijom Helicobacterom pylori u Hrvatskoj. Obrađene su ove teme iz problematike infekcije Helicobacterom pylori: 1. indikacije i kontraindikacije za dijagnostiku i liječenje, 2. dijagnostičke metode i 3. terapija primjerena za našu zemlju.In the past 30-year period of investigations, the crucial role of Helicobacter pylori in chronic gastritis, gastric and duodenal ulcer development, and subsequently in gastric cancer and MALT lymphoma pathogenesis, has been recognized. During the first meeting of European Helicobacter Study Group in 1996 in Maastricht, the first recommendations for diagnostics and treatments of Helicobacter pylori infection were published, later reviewed in 2000, 2007 and 2010. The first meeting of Croatian doctors focusing on the same topics, but suitable to specific national circumstances, was held as early as 1998. The need for updating the old guidelines has emerged during the last years. The working expert group of gastroenterologists was formed and gathered on Consesus Conference in December 2012 in Zagreb, to arrive to current guidelines for the clinical management of Helicobacter pylori infection in Croatia. The following topics relating to Helicobacter pyloriinfection were examined: 1. indications and contraindications for diagnostics and treatments; 2. diagnostic methods and 3. treatments applicable in our country

Helicobacter pylori Diagnostic Tests Used in Europe : Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management

Funding Information: This study was funded by Richen; however, clinical data were not accessible and the company was not involved in any stage of the Hp-EuReg study (design, data collection, statistical analysis, or manuscript writing). We want to thank Richen for their support. This project was promoted and funded by the European Helicobacter and Microbiota Study Group (EHMSG), the Spanish Association of Gastroenterology (AEG) and the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). The Hp-EuReg was co-funded by the European Union programme HORIZON (grant agreement number 101095359) and supported by the UK Research and Innovation (grant agreement number 10058099). The Hp-EuReg was co-funded by the European Union programme EU4Health (grant agreement number 101101252). Acknowledgments We want to especially thank Sylva-Astrik Torossian for her assistance in language editing. Natalia García Morales is the first author who is acting as the submission’s guarantor. All authors approved the final version of the manuscript.Peer reviewedPublisher PD