Browsing by Author "Delić, Dragan (55886413300)"

Introduction: Chronic hepatitis C virus (HCV) infection can progress to liver cirrhosis that causes bleeding from the gastrointestinal tract, liver failure and primary hepatocellular carcinoma. Use of standard therapeutic option consists of recombinant pegylated interferon alpha 2a/b with ribavirin in order to eradicate virus and prevent complications. Objective: The aim of investigation was to evaluate efficiency of combination therapy (pegylated interferon alpha 2a/b plus ribavirin) in patients with chronic HCV infection and to estimate predictive factors for successful treatment. Methods: A total of 387 patients with confirmed diagnosis of hepatitis C were evaluated (aged 18-65 years of both genders). Patients were treated with pegylated interferon alpha 2a/b and ribavirin according to a standard regimen lasting 24 or 48 weeks, dependent on virus genotype. Results: Negative HCV RNA (PCR assay) was recorded in 79.7% of patients at the end of treatment. Six months after completed therapy, negative HCV RNA, i.e. stained virologic response (SVR) was assessed in 70.5% of patients. Statistical summary of our results concerning SVR confirmed better efficiency of combination therapy for the following parameters compared to other investigated variables: age ≤40 (843% vs. 59.1%; p<0.0005), absence of cirrhosis (75.6% vs. 58.3%; p=0.003), lack of genotype 1 (86.6% vs. 61.8%; p<0.0005), and in patients who received full doses of pegylated interferon alpha 2a (78.3% vs. 633%; p=0.002). Conclusion: Combination therapy of recombinant pegylated interferon alpha 2a with ribavirin leads to SVR in the majority of treated patients (70.5%). Successful treatment depends on a variety of host and virus factors.

Results Eighty percent of patients were male of average age 29.6±8.6 years; in 61.8% patients intravenous drug abuse was determined as risk factor. Thirty patients (54.1%) had no symptoms and 38.2% were icteric. Acute hepatitis C spontaneously resolved in 33.3% patients, while in the treated group 79.6% of patients completely recovered (p=0.006). Treatment success was 92.9% in the group of patients who started with treatment before the 45th day of disease, while in the patients who started treatment later the success rated 58.3% (p=0.037).; Methods Total of 55 patients with acute hepatitis C, hospitalized at the Clinic for Infectious Diseases in Belgrade from January 2005 to December 2012 were enrolled in this study. Forty-one patients were under follow-up over six months for evaluation of the development of the disease into a chronic infection and effectiveness of treatment with INF-α.; Conclusion Acute hepatitis C is most common in young male adults infected via injection drug abuse. The use of INF-α is effective in the treatment of the disease, and success of the treatment is more probable if treatment is started before the 45th day.; Introduction Acute hepatitis C most frequently develops after parenteral infection of hepatitis C virus. The disease often develops into chronic infection, although it can resolve spontaneously. Interferon alpha (INF-α) is used in therapy, but still without precise treatment recommendations.; Objective The aim was to present characteristics of patients with acute hepatitis C and to assess effectiveness of using re-combinant INF-α in therapy. © 2014, Srpsko Lekarsko Drutsvo. All rights reserved.

Introduction Pronounced symptoms of depression and disorders of cognitive functions can be observed in patients with chronic hepatitis B. Objective The objective of the study was evaluation of the severity of symptoms and predictive factors for depression and the existence of cognitive disorders in patients with chronic hepatitis B. Methods A total of 150 respondents were included in this prospective study (50 patients with chronic hepatitis B, 50 patients with other chronic liver diseases and 50 healthy persons). The patients with chronic hepatitis B were homogeneous by age compared to healthy subjects (p=0.566) and patients with other chronic liver diseases (p=0.528). Assessment of intensity of depression was determined by the Hamilton Depression Rating Scale (HAMD). A Mini Mental State Examination (MMSE) test was used to investigate the presence of cognitive disorders. Results Significantly expressed depression was observed in patients with chronic hepatitis B compared with healthy persons as well as the occurrence of cognitive dysfunction (p=0.00), while in comparison with the patients with chronic nonviral liver diseases, depression was statistically significantly less markedly expressed (p=0.003). Depression and cognitive dysfunction were more noticeable in patients with chronic hepatitis B in the stage of liver cirrhosis in relation to the early stage of the disease. Multivariate analysis of variables related to the sociodemographic characteristics showed that the most significant positive predictor of depression was more expressed in older age (over 50 years) (B=0.276; SE=0.092; p=0.004). Conclusion Patients with chronic hepatitis B have a higher intensity of depression compared to healthy people, which is intensified with the progression of the disease. The highest expression of depression is expected in the elderly. Patients with chronic hepatitis B have a lower intensity of depression and fewer disorders of cognitive functions than patients with other chronic liver diseases. © 2015 Serbia Medical Society. All rightsreserved.

Background/Aim. In Serbia, pegylated interferon (PEG-IFN) alpha-2a has been registered since 2013 for the treatment of patients with chronic hepatitis B (CHB). Numerous advantages, new experiences during the past five years and lack of any published data in our specific population, have initiated this study, with the aim to examine efficacy and safety of PEG-IFN in patients in a Serbian referral center. Methods. This prospective study included 36 patients with CHB who were treated in the Hepatology Department of the Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia in Belgrade, during 2012–2017. Patients had a standard 48-week treatment protocol with PEG-IFN, with measurements of liver enzymes, serology and viraemia before, during, at the end of the treatment and follow-up 6 months afterwards. Treatment outcome was determined using serology (clearance of HBeAg), biochemical [normalization of alanine aminotransferase (ALT)] and virological response [hepatitis B virus (HBV) DNA < 2,000 IU/mL]. Results. Virological success in patients with HBeAg positive CHB was achieved in 50% of patients, HBeAg clearance in 62.5%, and normalization of ALT in 37.5% of patients. In patients with HBeAg negative CHB, 38% of the patients achieved virologic success, biochemical success was obtained in 47.6% of the patients and only one (4.7%) patient had HBsAg clearance. Conclusion. PEG-IFN is important for treatment of patients with CHB in well-defined situations, and in our population success rates are similar to other published studies. Although safety and tolerability are satisfactory, there is a possibility of more serious side-effects so it is necessary to monitor patients regularly during the treatment. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Toxic liver injury is becoming greater problem in today´s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: Ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient’s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient’s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: Lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions. © 2019, Serbia Medical Society. All rights reserved.

Introduction Acute liver failure is a rare and very complex clinical syndrome, a consequence of sudden and severe liver dysfunction. There are several causes of this condition (viruses, medications, toxins, metabolic, autoimmune and malignant diseases), but etiological agent often remains undiscovered. Case outline A 40-year-old male patient had suddenly taken ill with signs and symptoms of acute hepatitis, which was confirmed through biochemical analyses. The cause of acute liver failure was not determined. Despite all therapeutic measures, the clinical course of the disease was unfavorable: severe icterus, decreased synthetic function of the liver and hepatic encephalopathy developed. In the later, subacute course of the disease, ascites and episodes of hepatic encephalopathy developed, and biochemical findings indicated chronic hepatocellular failure. After three months of treatment in hepatic coma there was lethal outcome. Histopathological findings confirmed the diagnosis of decompensated liver cirrhosis of unknown origin. Conclusion The cause of acute liver failure often remains unclear; potential causes should be looked for in infections by unknown viruses or in exposures to toxins. The disease is most commonly presented as a subacute failure with the development of liver cirrhosis. Survival rate is low. © 2018, Serbia Medical Society. All rights reserved.

Background: West Nile virus neuroinvasive disease (WNND) occurs in less than 1% of infected people. Leukocytosis with lymphocytopenia, mild anaemia, thrombocytopenia, elevated liver and muscle enzymes and hyponatremia are occasionally present in patients with WNND. Cerebrospinal fluid (CSF) findings resemble other viral neuroinfections. The purpose of this study is to present some of the most important laboratory findings of our patients with WNND and to evaluate their correlation with fatal outcome. Methods: The study included 161 patients with WNND. Their blood and CSF samples were cytobiochemically analysed and the obtained variables were then tested for predictive significance of the disease outcome, or used for differentiation between two clinical syndromes (encephalitis vs meningitis). Results: West Nile encephalitis was present in 127 (78.9%) patients and West Nile meningitis was diagnosed in 34 (21.1%) cases. Leukocytosis was found in 45.9% patients. CRP level higher than 100 mg/L was registered only in those with encephalitis (p=0.020). CSF leukocyte count was 146±171 per microlitre, with slight lymphocytic predominance (mean 52%). Hypoglycorrhachia was registered in 9.3% of our patients with WNND. Twenty-eight (17.4%) patients died and all of them had encephalitis. Independent predictors of fatal outcome in WNND were serum CRP > 100 mg/L (p=0.011) and CSF proteins > 1 g/L (p=0.002). Conclusions: WNND usually affects older males. Prolonged neutrophilic predominance in CSF can occasionally be present, as well as hypoglycorrhachia. Patients with encephalitis, high serum CRP and high CSF protein level have a higher risk of fatal outcome. © 2016 Aleksandar Urošević et al.

Background: West Nile virus neuroinvasive disease (WNND) occurs in less than 1% of infected people. Leukocytosis with lymphocytopenia, mild anaemia, thrombocytopenia, elevated liver and muscle enzymes and hyponatremia are occasionally present in patients with WNND. Cerebrospinal fluid (CSF) findings resemble other viral neuroinfections. The purpose of this study is to present some of the most important laboratory findings of our patients with WNND and to evaluate their correlation with fatal outcome. Methods: The study included 161 patients with WNND. Their blood and CSF samples were cytobiochemically analysed and the obtained variables were then tested for predictive significance of the disease outcome, or used for differentiation between two clinical syndromes (encephalitis vs meningitis). Results: West Nile encephalitis was present in 127 (78.9%) patients and West Nile meningitis was diagnosed in 34 (21.1%) cases. Leukocytosis was found in 45.9% patients. CRP level higher than 100 mg/L was registered only in those with encephalitis (p=0.020). CSF leukocyte count was 146±171 per microlitre, with slight lymphocytic predominance (mean 52%). Hypoglycorrhachia was registered in 9.3% of our patients with WNND. Twenty-eight (17.4%) patients died and all of them had encephalitis. Independent predictors of fatal outcome in WNND were serum CRP > 100 mg/L (p=0.011) and CSF proteins > 1 g/L (p=0.002). Conclusions: WNND usually affects older males. Prolonged neutrophilic predominance in CSF can occasionally be present, as well as hypoglycorrhachia. Patients with encephalitis, high serum CRP and high CSF protein level have a higher risk of fatal outcome. © 2016 Aleksandar Urošević et al.

Background/Aim. The incidence of acute hepatitis B viral (HBV) infection in adults has increased in recent years in Serbia. Most icteric patients with acute hepatitis B resolve their infection and do not require treatment. Fulminant hepatitis B is a severe form of acute infection complicated by encephalopathy and liver failure. Subgroups of fulminant hepatitis B including hyperacute, acute and subacute are defined by the interval between jaundice and encephalopathy. Fulminant hepatic failure or subacute hepatitis B infection we observed in about 1% of all cases. In cases of fulminant hepatic failure or subacute form of HBV infection orthotopic liver transplantation can be life-saving operation, but in our country this procedure is difficult to achieve. Lamivudine has been established as a safe and effective antiviral agent for the treatment of chronic HBV hepatitis. Methods. In our pilot study performed at the Institute of Infectious and Tropical Diseases in Belgrade, Serbia in the period between 2002 and 2006 we treated 10 patients with clinically verified subacute HBV infection with lamivudine, 100 mg orally per day. Results. The most of the treated patients (9/10; 90%) survived subacute form of hepatitis B. After a few weeks of the treatment serum aminotransferase levels and other liver-function tests were normalized. Also, after a four-month lamivudine treatment all the patients lost HBsAg. Lamivudine was discontinued after six months in all the patients. In addition, six months after lamivudine was discontinued the patients remained well with normal results on liver-function tests. Conclusion. The obtained results suggest significant efficacy of lamivudine in patients with subacute hepatitis B. Also, we suggest that lamivudine therapy should be administered early in progression of subacute disease since it could be life-saving treatment in some patients, especially in the countries (like Serbia) where orthotopic liver transplantation is difficult to achieve.