29 research outputs found
A Case Report of Bulimia Induced Dental Erosion in a Female Adolescent
Vrlo teÅ”ki oblici dentalne erozije rijetki su u adolescentskoj populaciji. Ovaj rad opisuje 17-godiÅ”nju pacijenticu koja se žalila na pojaÄanu osjetljivost zuba na hladan podražaj i dodir. StomatoloÅ”kim kliniÄkim pregledom ustanovljene su teÅ”ke promjene - dentalna erozija svih zuba, Å”to je tipiÄno za intrinziÄne Äimbenike dentalne erozije. Pacijentica je takoÄer ispunila upitnik kako bi se povezali erozija i moguÄi etioloÅ”ki Äimbenici. Odgovori iz upitnika, heteroanamnestiÄki podaci i dentalni status, potvrdili su preliminarnu dijagnozu bulimije nervoze koja je rezultirala, za tu dob, rijetkom dentalnom destrukcijom i to u razdoblju od samo tri godine.Very severe forms of dental erosion are uncommon finding in adolescent population. This paper describes a 17-year old female who complained of increased teeth sensitivity to cold temperature and to touch. Dental examination revealed extensive and severe pattern of dental erosion of all teeth typical for intrinsic causes of dental erosion. She also completed a questionnaire investigating any association between the presence of erosion and possible etiological factors. Questionnaire responses, heteroanamnestic data and dental status confirmed our preliminary diagnosis of bulimia nervosa that resulted in a rarely significant dental destruction for that age in only three years period
Inflammatory Bowel Diseases
Upalne bolesti crijeva (engl. infl ammatory
bowel diseases ā IBD) jesu idiopatske, infl amatorne, kroniÄne
bolesti gastrointestinalnog sustava nepredvidiva tijeka. Prema
epidemioloŔkim podacima raste im incidencija, a u patogenezi
bolesti prepoznati su genski faktori i faktori okoliŔa. Laboratorijski
podaci potvrÄuju da je bolest rezultat poremeÄenog imunosnog
odgovora u genski podložnih bolesnika, a prvi identifi cirani
gen odgovoran za nastanak Crohnove bolesti je NOD2/CARD15.
Glavna karakteristika Crohnove bolesti je transmuralnost upale
koja može zahvatiti bilo koji dio probavne cijevi za razliku od
ulceroznog kolitisa kod kojeg je upala ograniÄena samo na
sluznicu kolona, a promjene se nalaze u kontinuitetu od rektuma
prema proksimalnijim dijelovima crijeva. Ekstraintestinalne
manifestacije (koža, zglobovi, oÄi) pojavljuju se i u jednoj i drugoj
bolesti. Upalne bolesti crijeva lijeÄe se medikamentno i kirurÅ”ki.
Lijekovi koje primjenjujemo u ovih bolesnika su aminosalicilati,
kortikosteroidi, imunomodulatori, antibiotici i u novije vrijeme
bioloÅ”ki lijekovi od kojih je trenutaÄno jedini registriran i kliniÄki
dostupan infl iksimab.The chronic infl ammatory bowel diseases
(IBD) are idiopathic, infl ammatory chronic diseases of the gastrointestinal
tract, unpredictable in the course. Epidemiological
data show a rise in the incidence and suggest that both environmental
and genetic infl uences are involved in the pathogenesis
of chronic infl ammatory bowel diseases. Laboratory data suggest
that the disease is a result of aberrant mucosal immune
response in genetically susceptible individuals. NOD2/CARD15
has been identifi ed as a fi rst gene defi nitely linked to Crohnās
disease. Crohnās disease is characterised by patchy transmural
infl ammation affecting any part of the gastrointestinal tract,
whereas ulcerative colitis characteristically is limited to the
colon, producing continuous mucosal infl ammation always
involving the rectum. Extra-intestinal manifestations affecting
the skin, joints, and the eyes occur in both Crohnās disease
and ulcerative colitis. The current treatment of Crohnās disease
and ulcerative colitis comprises a combination of medical (aminosalicylates,
corticosteroids, antibiotics, immunosuppressive
agents, biologicals ā infl iximab only registered and clinically
available) and surgical therapy
Brain-gut axis dysfunction in young athlete with unfulfilled dreams - irritable bowel syndrome
Irritable bowel syndrome (IBS) is a disorder characterized by recurrent abdominal pain and bowel movement alterations in combination with psychological complaints. The exact etiology of IBS is not fully understood, however it seems that gut-brain dysfunction is the predominant cause
EpidemioloŔka studija varijanti tiopurin-metiltransferaze u skupini hrvatskih bolensika s upalnim bolestima crijeva
Thiopurine S-methyltransferase (TPMT) is an enzyme that converts thiopurine drugs into inactive metabolites. Over 20 variant TPMT-encoding alleles, which cause reduced enzymatic activity, have been discovered so far. Our aim was to investigate the frequencies of variant alleles, i.e. genotypes in inflammatory bowel disease (IBD) patients and healthy individuals and to compare these frequencies with selected world populations. The most common variant alleles
TPMT*2, TPMT*3A, TPMT*3B and TPMT*3C were analyzed with polymerase chain reactionbased assays and allele-specific polymerase chain reaction-based assays in 685 participants including
459 IBD patients and 226 healthy volunteers. Study results revealed 434/459 (94.55%) IBD patients and 213/226 (94.25%) healthy subjects to be homozygous for the wild-type allele (TPMT*1/*1).
TPMT*1/*2 and TPMT *1/*3C genotypes were found in 4/459 (0.87%) and 7/459 (1.53%) IBD patients, respectively; in healthy volunteers they were not found. TPMT*1/*3A genotype was found in 14/459 (3.05%) IBD patients and 13/226 (5.75%) healthy subjects. Variant genotypes were statistically significantly more common in Crohnās disease subgroup than in ulcerative colitis subgroup. The prevalence of variant genotypes was 23/338 (6.80%) in Crohnās disease subgroup as compared with 2/121 (1.65%) in ulcerative colitis subgroup (Ļ2=4.59; p=0.032). In conclusion, the most frequently occurring nonfunctional TPMT allele in Croatian population is TPMT*3A. The overall frequency of mutant alleles in our population is statistically nonsignificantly lower when compared with other populations of Caucasian origin. The Crohnās disease group had more mutant alleles than the ulcerative colitis group.Tiopurin S-metiltransferaza (TPMT) je enzim koji sudjeluje u konverziji tiopurinskih lijekova u inaktivne metabolite. Dosad je otkriveno viÅ”e od 20 varijanti TPMT-kodirajuÄih alela. Ovi aleli uzrokoju smanjenu enzimatsku aktivnost. NaÅ” cilj je bio istražiti frekvenciju varijantnih alela odnosno genotipova u bolesnika oboljelih od upalnih bolesti crijeva i u zdravih osoba te usporediti dobivene frekvencije s frekvencijama odabranih svjetskih populacija. NajÄeÅ”Äi varijantni aleli TPMT*2, TPMT*3A, TPMT*3B i TPMT*3C analizirani su metodama lanÄane reakcije polimeraze, odnosno alelspecifiÄnim metodama lanÄane reakcije polimeraze. U istraživanje je bilo ukljuÄeno 685 ispitanika; 459 ispitanika bili su bolesnici s upalnom bolesti crijeva, a 226 bili su zdravi dobrovoljci. Rezultati su pokazali da su 434/459 (94,55%) pacijenata s upalnom bolesti crijeva i 213/226 (94,25%) zdravih osoba homozigoti za divlji tip alela (TPMT*1/*1). Genotipovi TPMT*1/*2 i TPMT*1/*3C naÄeni su u 4/459 (0,87%) odnosno 7/459 (1,53%) bolesnika; u zdravih dobrovoljaca nisu naÄeni. Genotip TPMT*1/*3A naÄen je u 14/459 (3,05%) bolesnika i 13/226 (5,75%) zdravih dobrovoljaca. Varijantni
genotipovi bili su statistiÄki znaÄajno ÄeÅ”Äi u podskupini bolesnika s Crohnovom boleÅ”Äu, s uÄestaloÅ”Äu od 23/338 (6,80%) u odnosu na podskupinu bolesnika s ulceroznim kolitisom, gdje je uÄestalost varijantnih genotipova bila 2/121 (1,65%) (Ļ2=4,46; p=0,035). U zakljuÄku, najÄeÅ”Äi nefunkcionalni TPMT alel u Hrvatskoj populaciji je TPMT*3A. Ukupna frekvencija varijantnih alela u naÅ”oj je populaciji statistiÄki neznaÄajno niža u odnosu na druge populacije bjelaÄkog podrijetla. Bolesnici s Crohnovom boleÅ”Äu imaju viÅ”e varijantnih alela u odnosu na podskupinu bolesnika s ulceroznim kolitisom
Celiac Disease in Adults
Celijakija je Äesta kroniÄna autoimunosna bolest koja se javlja u 1% zapadne populacije, a karakterizira je doživotna nepodnoÅ”ljivost glutena u genski predisponiranih osoba. Bolest ima vrlo Å”arenu kliniÄku sliku, može se oÄitovati u bilo kojoj životnoj dobi, a mogu nastupiti teÅ”ke komplikacije ako se ne lijeÄi. Zlatni standard u postavljanju dijagnoze celijakije u odrasloj populaciji je patohistoloÅ”ka verifikacija atrofije tankog crijeva iako su seroloÅ”ki testovi (protutijelo na tkivnu transglutaminazu, antiendomizijsko protutijelo) prvi korak u identifikaciji potencijalnih bolesnika. DijagnostiÄku obradu (seroloÅ”ki testovi i biopsija sluznice) potrebno je zakljuÄiti prije iskljuÄivanja glutena iz dijete. Bolest se lijeÄi iskljuÄivo doživotnom bezglutenskom prehranom. Edukacija bolesnika kljuÄna je za uspjeÅ”no lijeÄenje. NelijeÄeni bolesnici imaju veÄe zdravstvene rizike od bolesnika koji se pravilno pridržavaju bezglutenske prehrane. Osim celijakije gluten u ljudi može izazvati joÅ” dva poremeÄaja: alergiju i osjetljivost na gluten. U podlozi ovih poremeÄaja razliÄiti su patomehanizmi i vrlo je važno razlikovati ih i pravilno dijagnosticirati.Celiac disease is a frequent chronic autoimmune disease affecting approximately 1 % of the population in the Western hemisphere. It is characterized by an abnormal response to gluten in genetically predisposed individuals. The disease has various clinical manifestations and serious complications can occur if left untreated. It can develop at any point in time during life. Intestinal biopsy with confirmation of mucosal atrophy is the gold standard in diagnosing adult celiac disease, but serologic tests (anti-endomysial antibody, anti-tissue transglutaminase antibody) provide an effective first step in identifying biopsy candidates. Serologic testing and biopsy should be done before initiating a gluten-free diet. A lifelong adherence to a gluten-free diet is the only available treatment. Patient education is crucial to successful treatment. Patients with untreated celiac disease have greater health risks than those who adhere to this treatment. Besides celiac disease, there are two forms of gluten-related diseases: wheat allergy and gluten sensitivity. Due to pathogenic differences, it is very important to properly diagnose various forms of gluten-related disorders
Dijetoterapija upalnih bolesti crijeva
Prehrana ima neupitno važnu ulogu u terapiji upalnih bolesti crijeva. U prvom redu važna je u prevenciji i lijeÄenju pothranjenosti ili malnutricije, kao i prevenciji osteoporoze, a u djece je važno istaknuti ulogu prehrane u promoviranju optimalnog rasta i razvoja. Uloga prehrane u prevenciji upalnih bolesti crijeva nije do kraja razjaÅ”njena. U aktivnoj fazi Crohnove bolesti, nutritivna terapija primjenom enteralnih pripravaka pokazala se uÄinkovitom primarnom terapijom za mnoge bolesnike. Enteralna prehrana trebala bi se danas smatrati standardnom primarnom terapijom u lijeÄenju pedijatrijskih bolesnika s Crohnovom boleÅ”Äu. Važnost enteralne prehrane osobita je u djece s loÅ”im nutritivnim statusom i usporenim rastom. Postoje brojne teorije o prehrani koje se vežu uz etiologiju upalnih bolesti crijeva, meÄutim, do danas ni jedan prehrambeni
pristup nije adekvatno znanstveno utemeljen da bi se moglo sa sigurnoÅ”Äu tvrditi kako smanjuje rizik od nastanka upalnih bolesti
crijeva. Neki nutrijenti imaju gotovo farmakoloÅ”ki terapijski potencijal u lijeÄenju i potpornoj terapiji upalnih bolesti crijeva. Posebna se pažnja pridaje protuupalnom djelovanju kratkolanÄanih masnih kiselina, prije svega butiratu, zatim ulozi probiotika i prebiotika te omega-3 masnih kiselina. TakoÄer, valja istaknuti i novije strategije terapijskog pristupa, kao Å”to je enteralna prehrana s dodatkom transformirajuÄeg Äimbenika rasta-beta (TGF-beta)
Terminal ileum resection as a trigger for strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated CrohnŹ¼s disease: a case report
The nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host. In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease. We present a case of S.āstercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn's disease.āS.āstercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy
Increased arterial stiffness ā similar findings in patients with inflammatory bowel disease without prior hypertension or diabetes and in patients with well-controlled hypertension
PURPOSE:
Chronic inflammatory diseases are related with earlier onset of atherosclerosis. We hypothesized that inflammatory bowel disease patients with chronic, systemic inflammation have an increased arterial stiffness associated with the disease duration. Also, we wanted to compare arterial stiffness markers between inflammatory bowel disease and well-controlled hypertension patients. ----- MATERIALS AND METHODS:
A total of 89 inflammatory bowel disease patients (60 patients with Crohn's disease and 29 patients with ulcerative colitis, age range 20-64 years) without history of arterial hypertension or diabetes were enrolled and age matched with a control group of patients (73 patients, age range 25-69 years, 41 (56.1%) males) with known history of well-controlled arterial hypertension. We have used a noninvasive device that simultaneously measures brachial blood pressure and estimates PWV and AIx in inflammatory bowel disease and hypertension groups of patients. ----- RESULTS:
Patients with pathological PWV values were significantly older, had significantly longer duration of inflammatory bowel disease, higher values of serum cholesterol and HDL-cholesterol, and higher AIx (17.4% vs. 9.8%) (all pā<ā.05). Higher PWV was associated with age and duration of inflammatory bowel disease in the linear regression model. PWV values were higher in hypertensive patients in the first two age quartiles while interestingly, in the last two quartiles, PWV was lower than in inflammatory bowel disease group of patients. ----- CONCLUSIONS:
Chronic subclinical inflammation is responsible for dyslipidemia and accelerated atherosclerosis which consequently alterates arterial elasticity. Inflammatory bowel disease and its duration should also be considered a risk factor for subclinical organ damage, as well as hypertension
Association of polymorphic variants in serotonin re-uptake transporter gene with Crohnās disease: a retrospective casecontrol study
Aim To analyze the distribution of SLC6A4 gene polymorphisms
in Crohnās disease (CD) patients and their association
with the disease.
Methods We evaluated the presence/absence of promoter
(5-HTTLPR, rs25531) and intron 2 (STin2 VNTR) polymorphic
variants of SLC6A4 gene in a retrospective case-control
study including 192 CD patients and 157 healthy controls
(HC). Genotyping was performed by polymerase chain reaction.
The association of polymorphisms with CD and its
clinical subtypes was analyzed using Ļ2 and Fisher exact
test, binary logistic regression, and haplotype analysis.Results CD patients and healthy controls had similar sex
(88 [45.8%] vs 84 [53.5%] women, respectively; P = 0.154)
and age (41.3 Ā± 12.8 years vs 41.7 Ā± 8.8 years, respectively,
P = 0.091) distribution. Significant differences were observed
in the STin2 genotype and allele distribution between
CD patients and healthy controls (P = 0.003 and
P = 0.002, respectively) and between the corresponding female
subgroups (P = 0.004 and P = 0.007, respectively), with
a significant negative association of biallelic ss (STin2.9 and
Stin2.10) STin2 genotype with CD (P = 0.013, age- and sexadjusted
odds ratio [OR] 0.5, 95% confidence interval [CI]
0.29-0.86; women: P = 0.006, age-adjusted OR 0.32, 95%
CI 0.14-0.72) and a significantly higher S-STin2.12 (5-HTTLPR/
rs25531: S-STin2: STin2.12) haplotype distribution in CD
patients (P = 0.004, OR 1.62, 95% CI 1.16-2.26). There was
no significant association between 5-HTTLRP and rs25531
genotype or allele frequencies and CD and between any
SLC6A4 polymorphic loci with clinical CD subtypes.
Conclusion STin2 VNTR polymorphism of SLC6A4 gene
may contribute to CD pathogenesis
Leukocitafereza u lijeÄenju teÅ”kog, o steroidima ovisnog ulceroznog kolitisa
Ulcerative colitis (UC) is a multifactorial disease of unknown precise etiology and immunopathogenesis. Peripheral blood granulocytes and monocytes/macrophages are the major sources of cytokines, which regulate inflammation. Leukocytapheresis (LCAP) is a method where blood is processed by apheresis system that removes lymphocytes and plasma before being returned to the body. We report the first case in Croatia where we used LCAP in the treatment of a patient with severe steroid-dependent UC. After 12 LCAP procedures, good clinical response was obtained and there were no significant adverse side effects noticed. The patient remained in clinical remission over two years in which he underwent regular follow ups at outpatient clinic. Over a 10-year follow-up period after LCAP, the patient had only occasional clini-cal symptoms of disease activity. The clinical course was complicated with the development of metastatic colorectal carcinoma, which points to the importance of regular disease monitoring rather than the in-creased risk of malignant disease after LCAP. Patients with UC are a demanding group of patients that warrant the search for novel treatment strategies other than conventional pharmacological therapies. Alt-hough LCAP is still not a common treatment modality in our daily practice, data from recent studies sug-gest it to be an effective and safe procedure in the management of active UC patients.Ulcerozni kolitis (UC) je kroniÄna bolest multifaktorske etiologije Äiji detaljan mehanizam imunoloÅ”kog procesa joÅ” nije sasvim razjaÅ”njen, ali kljuÄnu ulogu svakako imaju granulociti i monociti/makrofazi koji reguliraju i pojaÄavaju upalni proces luÄenjem proupalnih citokina. Leukocitofereza (LCAP) je terapijski postupak kojim se prolaskom krvi kroz sustav za aferezu odstranjuju limfociti i plazma prije nego Å”to se krv ponovno vrati u krvotok. U ovom radu je prikazan o steroidima ovisan bolesnik s teÅ”kim relapsom UC-a koji je, prvi put u Hrvatskoj, lijeÄen protokolom LCAP. Nakon 12 terapijskih protokola LCAP kod bolesnika je doÅ”lo do znaÄajnog kliniÄkog poboljÅ”anja bez razvo-ja nuspojava. Bolesnik je ostao u kliniÄkoj remisiji tijekom dvije godine ambulantnog praÄenja, a unutar 10 godina praÄenja nakon LCAP bolesnik je imao tek povremene simptome aktivnosti bolesti. KliniÄki tijek bio je kompliciran razvojem metastatskog karcinoma debelog crijeva, Å”to prvenstveno upuÄuje na važnost redovitog praÄenja bolesti, a ne na poveÄan rizik maligne bolesti nakon LCAP. Bolesnici s UC-om su zahtjevna skupina pacijenata koja zahti-jeva potragu za novim terapijskim strategijama osim onih konvencionalnih farmakoloÅ”kih. Iako LCAP nije Äest modalitet lijeÄenja u svakodnevnoj kliniÄkoj praksi, novije studije upuÄuju na to da je postupak uÄinkovit i siguran u lijeÄenju bolesnika s aktivnim UC-om