7 research outputs found
IMUNOMODULATORNA REUMATOLOÅ KA TERAPIJA I NESTEROIDNI ANTIREUMATICI PRIJE ZAÄEÄA, U TRUDNOÄI I DOJENJU ā PREGLED SMJERNICA
The course and outcome of pregnancy can be affected by the activity of the inflammatory rheumatic disease itself and by the drugs we use. Evidence on the safe use of drugs during pregnancy is largely lacking due to the observational nature of the studies conducted and the difficulty of conducting clinical trials in pregnancy. The current guidelines of the professional and scientific societies of rheumatology ā the European Alliance of Associations for Rheumatology (EULAR), the American College of Rheumatology (ACR) and the British Society for Rheumatology (BSR) are analysed and consolidated in this review paper. Drugs like methotrexate, leflunomide, mycophenolate mofetil, cyclophosphamide and Janus kinase inhibitors (JAK inhibitors) are contraindicated in pregnancy and should be avoided during pregnancy planning and replaced by drugs that are compatible with pregnancy. Immunomodulators that are considered compatible with pregnancy are prednisone, hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, colchicine, dapsone and most biologic drugs. When it comes to biologics, tumour necrosis factor inhibitors (TNF-inhibitors) are the most studied drugs and all of them are safe to use in the first and second trimesters of pregnancy. Certolizumab is considered to be the safest due to almost no placental transfer. There is still insufficient evidence for other biologic drugs, and it is recommended to discontinue them before pregnancy/when pregnancy is confirmed. The use of all biologic drugs can be continued throughout the pregnancy if they are necessary to establish control over the activity of the motherās severe/life-threatening disease. Effective drug treatment of an active inflammatory rheumatic disease is possible with reasonable safety for the mother and the foetus/child during pregnancy and lactation nowadays.Upalne reumatske bolesti na razliÄite naÄine mogu utjecati na tijek i ishod trudnoÄe, kako zbog aktivnosti same bolesti, tako i zbog lijekova koje primjenjujemo. Dokazi o sigurnoj upotrebi lijekova tijekom trudnoÄe uglavnom su manjkavi zbog opservacijske prirode studija i poteÅ”koÄa u provoÄenju kliniÄkih ispitivanja u trudnoÄi. U ovom preglednom radu analizirane su i objedinjene aktualne smjernice reumatoloÅ”kih struÄnih druÅ”tava ā European Alliance of
Associations for Rheumatology (EULAR), American College of Rheumatology (ACR) i British Society for Rheumatology (BSR). Metotreksat, leflunomid, mofetilmikofenolat, ciklofosfamid i inhibitori janus kinaze (JAK-inhibitori) kontraindicirani su u trudnoÄi te ih treba kod planiranja trudnoÄe iskljuÄiti i zamijeniti kompatibilnim lijekom. Imunomodulatorni lijekovi koji se smatraju kompatibilnima s trudnoÄom jesu prednizon, hidroksiklorokin, sulfasalazin, azatioprin, ciklosporin, takrolimus, kolhicin, dapson te veÄina bioloÅ”kih lijekova. Inhibitori faktora tumorske nekroze (TNF inhibitori) najbolje su prouÄeni i svi se smatraju sigurnima u prvom i drugom tromjeseÄju trudnoÄe, a certolizumab se smatra najsigurnijim i gotovo bez placentalnog prijenosa kroz sva tri tromjeseÄja. Za ostale bioloÅ”ke lijekove joÅ” uvijek nema dovoljno dokaza i preporuÄuje ih se prekinuti prije/kod potvrÄene trudnoÄe. Svi bioloÅ”ki lijekovi mogu se nastaviti uzimati kroz Äitavu trudnoÄu ako su potrebni za kontrolu aktivnosti teÅ”ke/životno ugrožavajuÄe
bolesti majke. Aktivnu upalnu reumatsku bolest danas je uglavnom moguÄe uÄinkovito lijeÄiti uz razumnu sigurnost za majku i za plod/dijete tijekom trudnoÄe i dojenja
Difference in anaemia expression in men and women with renal failure treated with peritonial dyalisis
Anemija je poznata i Äesta komplikacija kroniÄnoga zatajenja bubrega (KZB) sa znaÄajnim utjecajem na morbiditet i mortalitet, smanjenje kvalitete života i troÅ”kove zdravstvene zaÅ”tite. Smjernice za lijeÄenje anemije KZB ne odreÄuju spolno specifiÄne ciljne vrijednosti hemoglobina (Hb). Iako meÄu spolovima postoje sliÄnosti u temeljnoj fiziologiji anemije KZB, sve je viÅ”e dokaza dokaza o razliÄitom odgovoru na anemiju. IzvrÅ”ili smo retrospektivnu analizu anemije bolesnika tijekom prvih Å”est mjeseci lijeÄenja peritonejskom dijalizom (PD). Spolne razlike razine Hb koje postoje kod zdrave populacije održane su i kod terminalne faze KZB na poÄetku lijeÄenja PD-om, kao i nakon Å”est mjeseci lijeÄenja. VeÄi udio žena (15-30%) zahtijeva uvoÄenje lijekova za stimulaciju eritropoeze (LSE), za razliku od muÅ”karaca. ProsjeÄna mjeseÄna doza eritropoetina bila je 70% veÄa kod žena. UnatoÄ nižim apsolutnim razinama Hb, žene pokazuju viÅ”e razine Hb u odnosu na referentne vrijednosti specifiÄne za spol, nego muÅ”karci.Anemia is recognized as a common complication of chronic kidney disease (CKD) with a significant impact on morbidity and mortality and a decline in quality of life and health care costs. Guidelines for the treatment of CKD anemia do not specify sex-specific Hb targets. There are similarities among genders in the basic physiology of anemic CKD, but there is growing evidence with respect to differential responses to anemia between genders.
We performed a retrospective analysis of patients during the first six months of peritoneal dialysis (PD) treatment. Gender differences in Hb level seen in the healthy populations are maintained in subjects with end stage renal disease at PD inception and after six months of treatment. A greater proportion (15-30%) of females require erythropoiesis stimulating agents (ESA) than males. The average monthly EPO dose was 70% higher in females. Despite lower absolute levels of Hb, women manifest higher Hb levels relative to gender-specific normative values than men