Extrahepatic Manifestations of Hepatitis C Virus Infection

Chronic hepatitis C virus (HCV) infection causes progressive liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Additional to liver damage, HCV infection causes a variety of systemic disorders, some of which sometimes bear more severe morbidity than the liver disease itself. These extrahepatic manifestations represent a wide spectrum of disorders, ranging from the presence of a variety of clinically insignificant autoantibodies to diseases affecting a variety of organ systems. Mixed cryoglobulinemia is a common manifestation, and associated vasculitis can affect many organs (kidney, skin, and joints). The skin can also be affected by porphyria cutanea tarda and lichen planus. Other common extrahepatic manifestations include autoimmune disorders, lymphoproliferative disorders, and a number of neurological and neuropsychiatric disorders such as fatigue, depression, or cognitive impairment. Insulin resistance, diabetes mellitus, accelerated atherosclerosis, and increased cardiovascular disease morbidity and mortality have also been associated with chronic HCV infection. The existence and severity of extrahepatic manifestations do not correlate with the severity of liver disease, and the mainstay of treatment is HCV eradication. Patients with systemic manifestations of HCV infection should be prioritized for treatment, especially in the era of new interferon-free therapies with fewer side effects

Endoscopic treatment of mediastinal pancreatic pseudocyst using lumen apposing metal stents - Case report

Mediastinal pancreatic pseudocyst (PP) is a rare complication of acute alcoholic pancreatitis. Endoscopic drainage has become widely used in the management of PPs and novel lumen apposing metal stents (LAMS) could provide more effective treatmen

ETIOLOGY OF ERYTHEMA NODOSUM IN RHEUMATOLOGY OUTPATIENT CLINIC

Nodozni eritem (erythema nodosum, EN) kožna je promjena uzrokovana reaktivnim imunosnim procesom koja se prezentira akutnom pojavom crvenih čvorastih eflorescencija. EN spontano regredira u periodu od 3 do 6 tjedana, ali nerijetko recidivira. Ovaj je rad uključio 98 bolesnika s područja Republike Hrvatske koji su ambulantno liječeni kod istog specijalista internista-reumatologa. Analizirana je prezentacija i definirane razlike između sekundarnog i idiopatskog oblika EN u spomenutoj populaciji. Rezultati pokazuju da je udio EN-a povezanog sa sekundarnom etiologijom bio 47/98. Većinu EN-a sekundarne etiologije činile su infektivne bolesti (23/98), sarkoidoza (18/98) i upalna bolest crijeva (4/98). Usporedbom brojnih kliničkih i laboratorijskih parametara utvrđen je manji broj statistički značajnih razlika (grlobolja, nedavne respiratorne infekcije, promjena titra ASO-a, uzimanje antibiotika). Na temelju rezultata zaključak je da je u pristupu bolesniku s EN-om potrebno uzeti dobru anamnezu s naglaskom na nedavne upale gornjeg dijela respiratornog sustava i pojavu dijareje. Treba učiniti fizikalni pregled, odrediti osnovne hematološke i biokemijske nalaze, odrediti upalne biljege (SE, CRP), napraviti rendgenogram srca i pluća i PPD-test te na taj način odrediti komu je potrebna daljnja obrada. Također, potrebno je napraviti i obrisak ždrijela i/ili odrediti titar ASO-a u dva navrata u razmaku od 2 do 4 tjedna i nastaviti pratiti bolesnika. S obzirom na regionalne razlike u etiologiji EN-a koje su dokazane u literaturi, potrebno je za svaku populaciju utvrditi prevalenciju pojedinih uzroka EN-a i tomu prilagoditi standardiziranu obradu.Erythema nodosum (EN) is a skin lesion presenting with the acute appearance of red nodular eflorescences caused by a reactive immunological process. In most cases EN regresses spontaneously within 3 to 6 weeks and often recurs. This paper is based on a sample of 98 patients from Croatia which were treated in a rheumatologic outpatient clinic by the same internal medicine and rheumatology specialist. Presentation and differences between secondary and idiopathic forms of EN in the Croatian population were analyzed. The results show the final proportion of EN associated with secondary etiology as 47/98. Secondary etiology of EN included mostly infectious diseases (23/98), sarcoidosis (18/98) and IBD (4/98). Comparison of various clinical and laboratory parameters of both idiopathic and secondary EN resulted in a small number of statistically significant differences found (sore throat, recent respiratory infections, ASO titer changes, antibiotics use). The conclusion is that the approach to patients with EN starts by a careful taking of patient history, with an emphasis on recent upper respiratory tract infections and occurrence of diarrhea. A thorough physical examination, basic hematological and biochemical tests, basic inflammatory markers (ESR, CRP), chest X-ray and PPD test are required to determine which patients need further evaluation. A throat swab and/or determination of the titer of ASO on two occasions at intervals of 2–4 weeks should be done. It is important to perform regular patient follow-up. Considering literature substantiated regional differences in the etiology of EN it is recommended that for each population the prevalence of individual causes of EN is determined and the clinical approach accordingly standardized

Krvarenje iz peptičkog vrijeda – iskustva tercijarnog centra: epidemiologija, liječenje i prognoza

The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.Cilj ove studije bio je prikazati epidemiološke, kliničke i endoskopske karakteristike akutnog krvarenja iz gornjeg pro-bavnog sustava s naglaskom na krvarenje iz peptičkog vrijeda. U studiju je bilo uključeno 2198 bolesnika koji su pregledani u hitnoj službi naše ustanove zbog akutnog krvarenja iz gornjeg probavnog sustava u razdoblju od siječnja 2009. do prosin-ca 2012. godine. Svim bolesnicima je učinjena hitna gastroskopija unutar 24 sata od prijma, a u 842 bolesnika kod kojih je dokazana peptička ulkusna bolest nastavljeno je kliničko praćenje. Kumulativna incidencija krvarenja je bila 126/100.000 u razdoblju od 5 godina. Dva od pet bolesnika su imali krvareći peptički vrijed; ukupno 440 (52,3%) bolesnika je imalo krva-reći želučani vrijed, 356 (42,3%) duodenalni vrijed, 17 (2%) želučani i duodenalni vrijed, a 29 (3,5%) krvareći vrijed na ­gastroenteralnoj anastomozi. Srednja dob bolesnika je bila 65,9 godina. Većina bolesnika je uzimala lijekove koji suprimi-raju citoprotektivne funkcije želučane i duodenalne sluznice (57%). Recidiv krvarenja zabilježen je u 77 (9,7%) bolesnika, a 47 (5,9%) je zahtijevalo kiruršku intervenciju. Smrtnost kroz 30 dana je bila 5,2%, a 10% bolesnika je umrlo zbog krvarenja i pratećih komorbiditeta. Krvarenje iz peptičkog vrijeda je najčešći uzrok krvarenja iz gornjeg probavnog sustava, a obilje-ženo je značajnom stopom recidiva krvarenja i smrtnosti

Stable gastric pentadecapeptide BPC 157 in the treatment of colitis and ischemia and reperfusion in rats: new insights

AIM: To provide new insights in treatment of colitis and ischemia and reperfusion in rats using stable gastric pentadecapeptide BPC 157. ----- METHODS: Medication [BPC 157, L-NAME, L-arginine (alone/combined), saline] was bath at the blood deprived colon segment. During reperfusion, medication was BPC 157 or saline. We recorded (USB microscope camera) vessel presentation through next 15 min of ischemic colitis (IC-rats) or reperfusion (removed ligations) (IC + RL-rats); oxidative stress as MDA (increased (IC- and IC + RL-rats)) and NO levels (decreased (IC-rats); increased (IC + RL-rats)) in colon tissue. IC + OB-rats [IC-rats had additional colon obstruction (OB)] for 3 d (IC + OB-rats), then received BPC 157 bath. ----- RESULTS: Commonly, in colon segment (25 mm, 2 ligations on left colic artery and vein, 3 arcade vessels within ligated segment), in IC-, IC + RL-, IC + OB-rats, BPC 157 (10 μg/kg) bath (1 mL/rat) increased vessel presentation, inside/outside arcade interconnections quickly reappeared, mucosal folds were preserved and the pale areas were small and markedly reduced. BPC 157 counteracted worsening effects induced by L-NAME (5 mg) and L-arginine (100 mg). MDA- and NO-levels were normal in BPC 157 treated IC-rats and IC + RL-rats. In addition, on day 10, BPC 157-treated IC + OB-rats presented almost completely spared mucosa with very small pale areas and no gross mucosal defects; the treated colon segment was of normal diameter, and only small adhesions were present. ----- CONCLUSION: BPC 157 is a fundamental treatment that quickly restores blood supply to the ischemically injured area and rapidly activates collaterals. This effect involves the NO system

Mobile reception of orders and program support for field sales people

Kroz rad biti će analiziran i opisan pojam terenskih komercijalista, njihov način i metode rada koje su usko povezane internetskom vezom i bazama podataka te njihov velik značaj za samo poslovanje kroz nekoliko sustava

Mobile reception of orders and program support for field sales people

Kroz rad biti će analiziran i opisan pojam terenskih komercijalista, njihov način i metode rada koje su usko povezane internetskom vezom i bazama podataka te njihov velik značaj za samo poslovanje kroz nekoliko sustava

Data mining for fault diagnostics

In manufacturing processes the automated identification of faulty operating conditions that might lead to insufficient product quality and reduced availability of the equipment is an important and challenging task. This paper proposes a data mining approach to the identification of complex faults, i.e. unplanned machine stops in plastic injection molding. Several data mining methods are considered, with a focus on the abilities to reveal patterns of faulty operating conditions and on the interpretation of the induced models with the objective to find the data mining method that best corresponds to the nature of the plastic-injection-molding process and the related data. Well-known data mining methods, i.e. J48, random forests, JRip rules, naïve Bayes, and k-nearest neighbors are applied to real industrial data. The results show that tested data mining methods can be effectively used to reveal patterns related to faulty operating conditions. The interpretation capacity of the tested methods, their ability to describe the operating conditions, and to reveal patterns related to faulty operating conditions, are demonstrated and discussed

Interpretative identification of the faulty conditions in a cyclic manufacturing process

The intensive development of information and communication technologies in recent years has led to an increase in data size and complexity. Conventional approaches, with associated methods of analysis based on descriptive and inductive statistics, may no longer be suitable for extracting the valuable information that is hidden in the available data. Computer-controlled manufacturing systems are becoming rich sources of data. Plastic injection moulding and die casting systems are typical examples of such manufacturing systems where the parts are produced by repeating the same sequence of steps that make up a manufacturing cycle. For each cycle, similarly structured data is generated. In this work a method for systematic data analysis for cyclic manufacturing processes is presented. The proposed data-analysis method integrates well-known heuristic algorithms, i.e., decision trees and clustering, with the purpose of identifying types of faulty operating conditions. The result of the analysis is an interpretable model for decision support that can be used for fault identification, to search for root causes, and to develop prognostic systems. A holistic approach of applying the proposed data-analysis method, along with suggestions and guidelines for implementation, is presented. A case study is presented in which the proposed method is applied to real industrial data from a plastic injection-moulding process