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Gombošová L, Suchanský M, Krivuš J, Hornová J, Havlíčeková Z, Fojtová A, Norek B, Valachová I, Šprláková J, Gazda J, Ondrušová M. Evaluation of the Effectiveness of Teduglutide Treatment in Patients with Short Bowel Syndrome in Slovakia-Multicenter Real-World Study. J Clin Med 2024; 13:1238. [PMID: 38592065 PMCID: PMC10931580 DOI: 10.3390/jcm13051238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: We present the first real-world-data study on teduglutide-treated SBS patients in the Slovak Republic and the first study to enable the comparison of the effects of teduglutide treatment between the adult and pediatric populations. (2) Methods: This was a non-interventional retrospective cohort study of adult and pediatric SBS patients treated with teduglutide. Primary and secondary endpoints were the results of teduglutide use at 12 weeks and 6 months after the initiation of treatment, compared to baseline. (3) Results: Teduglutide treatment led to a statistically significant reduction in the volume of intravenous hydration, HPN caloric intake, HPN and intravenous hydration applications per week and to increased urine output in adult patients. The results in the pediatric population were similar, but not statistically significant. A complete weaning off HPN was achieved in 57.14% of all patients (50.00% of children; 62.50% of adults) after a median of 0.99 years of teduglutide treatment (1.07 and 0.98 years for children and adults, respectively). (4) Conclusions: Teduglutide treatment in SBS patients leads to considerable reduction in or even weaning off PN in both pediatric and adult patients.
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Affiliation(s)
- Laura Gombošová
- 2nd Internal Clinic, University Hospital of L. Pasteur and Faculty of Medicine University of Pavol Jozef Šafárik Košice, Tr. SNP 1, 04011 Košice, Slovakia;
| | | | - Juraj Krivuš
- 1st Internal Clinic, University Hospital and Jessenius Faculty of Medicine Comenius University, Kollárova 2, 03659 Martin, Slovakia;
| | - Jarmila Hornová
- Department of Pediatrics, Faculty of Medicine Comenius University and National Institute of Children’s Diseases, Limbová 1, 83340 Bratislava, Slovakia;
| | - Zuzana Havlíčeková
- Department of Paediatrics, University Hospital Martin and Jessenius Faculty of Medicine Comenius University, Kollárova 2, 03601 Martin, Slovakia;
| | - Andrea Fojtová
- Gastroenterology Clinic, Slovak Medical University and Bratislava University Hospital, Antolská 11, 85107 Bratislava, Slovakia; (A.F.); (B.N.)
| | - Barbora Norek
- Gastroenterology Clinic, Slovak Medical University and Bratislava University Hospital, Antolská 11, 85107 Bratislava, Slovakia; (A.F.); (B.N.)
| | - Iveta Valachová
- 2nd Children Clinic, Slovak Medical University and Children's Faculty Hospital, Nám L. Svobodu 4, 97409 Banská Bystrica, Slovakia;
| | - Jana Šprláková
- Gastroenterology and Hepatology Department, Children’s Faculty Hospital, Tr. SNP 1, 04011 Košice, Slovakia;
| | - Jakub Gazda
- 2nd Internal Clinic, University Hospital of L. Pasteur and Faculty of Medicine University of Pavol Jozef Šafárik Košice, Tr. SNP 1, 04011 Košice, Slovakia;
| | - Martina Ondrušová
- PharmIn Ltd., Karadžičova 16, 82108 Bratislava, Slovakia;
- Faculty of Public Health, Slovak Medical University, 83303 Bratislava, Slovakia
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Szilasiová J, Gazda J, Mikula P, Cvengrošová A, Fedičová M, Hančinová V, Kantorová E, Karlík M, Kováčová S. Clinical and demographic characteristics of patients with NMOSD: a longitudinal retrospective analysis of a Slovak cohort of 63 patients. Neurol Sci 2024; 45:693-698. [PMID: 37698786 DOI: 10.1007/s10072-023-07050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoantibody-mediated inflammatory diseases of the central nervous system predominantly targeting optic nerves and the spinal cord. Two distinct phenotypes are recognized based on the presence of serum aquaporin-4 (AQP4-IgG) antibodies. However, contrasting clinical course patterns have been identified between AQP4-IgG-positive and AQP4-IgG-negative patients. AIMS This study aimed to present demographic and clinical characteristics of patients with NMOSD in Slovakia and to evaluate the significance of differences between AQP4-IgG-seropositive and AQP4-IgG-seronegative patients. METHODS We performed a longitudinal multi-centric retrospective study and analysed the clinical and demographic characteristics of a cohort of 63 Slovak NMOSD patients. RESULTS Eighty-six percent of patients were women, and ninety-four patients were Caucasian. The median age at diagnosis was 37 years. The most frequent initial manifestations were optic neuritis (47.6% of patients) and transverse myelitis (39.7% of patients). The median EDSS score deteriorated from the initial 3.0 to 4.0 at the last follow-up. Sixty-eight percent of patients were AQP4-IgG positive; 10% of patients were MOG-IgG positive; 27% of patients had no NMOSD-specific antibodies detected. There was a higher prevalence of autoimmune thyroiditis among AQP4-IgG-positive patients (25.6%) compared to AQP4-IgG-negative patients (0%) (p = 0.01). CONCLUSION This study provides a detailed overview of the clinical and demographic characteristics of NMOSD based on a retrospective analysis of a Slovak cohort of 63 NMOSD patients and extends information provided by similar recently published studies. The most important finding is that there is a high prevalence of autoimmune thyroiditis among AQP4-IgG-negative patients (25%).
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Affiliation(s)
- Jarmila Szilasiová
- Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, L. Pasteur University Hospital, Trieda SNP 1, Košice, 04011, Slovak Republic.
| | - Pavol Mikula
- Department of Social and Behavioral Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Anna Cvengrošová
- Department of Neurology, J. A. Reiman Faculty Hospital, Prešov, Slovak Republic
| | - Miriam Fedičová
- Department of Neurology, L. Pasteur University Hospital, Košice, Slovak Republic
| | - Viera Hančinová
- Department of Neurology, University Hospital, Bratislava Ružinov, Slovak Republic
| | - Ema Kantorová
- Department of Neurology, University Hospital, Martin, Slovak Republic
| | - Martin Karlík
- Department of Neurology, L. Dérer University Hospital Bratislava, Bratislava, Slovak Republic
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Di Cola S, Lapenna L, Gazda J, Fonte S, Cusi G, Esposito S, Mattana M, Merli M. Role of Transjugular Intrahepatic Portosystemic Shunt in the Liver Transplant Setting. J Clin Med 2024; 13:600. [PMID: 38276106 PMCID: PMC10816519 DOI: 10.3390/jcm13020600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Liver transplantation is currently the only curative therapy for patients with liver cirrhosis. Not all patients in the natural course of the disease will undergo transplantation, but the majority of them will experience portal hypertension and its complications. In addition to medical and endoscopic therapy, a key role in managing these complications is played by the placement of a transjugular intrahepatic portosystemic shunt (TIPS). Some indications for TIPS placement are well-established, and they are expanding and broadening over time. This review aims to describe the role of TIPS in managing patients with liver cirrhosis, in light of liver transplantation. As far as it is known, TIPS placement seems not to affect the surgical aspects of liver transplantation, in terms of intraoperative bleeding rates, postoperative complications, or length of stay in the Intensive Care Unit. However, the placement of a TIPS "towards transplant" can offer advantages in terms of ameliorating a patient's clinical condition at the time of transplantation and improving patient survival. Additionally, the TIPS procedure can help preserve the technical feasibility of the transplant itself. In this context, indications for TIPS placement at an earlier stage are drawing particular attention. However, TIPS insertion in decompensated patients can also lead to serious adverse events. For these reasons, further studies are needed to make reliable recommendations for TIPS in the pre-transplant setting.
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Affiliation(s)
- Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Jakub Gazda
- 2nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital in Kosice, 040 11 Kosice, Slovakia;
| | - Stefano Fonte
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Giulia Cusi
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Samuele Esposito
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Marco Mattana
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.D.C.); (L.L.); (S.F.); (G.C.); (S.E.); (M.M.)
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Jarcuskova D, Kozarova M, Bali-Hudak M, Lackova A, Gazda J. Characteristics of delirium among COVID-19 patients. BRATISL MED J 2024; 125:50-54. [PMID: 38041846 DOI: 10.4149/bll_2024_009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
OBJECTIVE This study estimated delirium incidence in Slovak COVID-19 patients, explored treatment associations and examined the impact on hospitalization and mortality. BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected global health. Delirium, a severe form of acute brain dysfunction, is common in hospitalized patients, including those with COVID-19. METHODS A retrospective study analyzed data from 474 hospitalized patients with confirmed SARS-CoV-2 infection in Kosice, Slovakia. Delirium was diagnosed using standardized ICD-10 criteria. Statistical analyses examined associations between delirium, psychiatric symptoms, treatment modalities, hospitalization duration, and mortality. RESULTS 29.54 % (140 patients) had delirium. Insomnia, anxiety, and delirium were prevalent psychiatric symptoms. Delirium patients had higher insomnia, anxiety, somnolence, agitation, and aggression rates. Treatments like high-flow nasal oxygen, glucocorticoids, antibiotics, and anakinra were associated with higher delirium incidence. Delirium was more common with antipsychotic use (tiapride, quetiapine, haloperidol), while citalopram seemed protective. No significant associations were found with mortality. Patients using benzodiazepines, hypnotics, or tiapride had longer hospital stays. CONCLUSION This study provides insights into delirium incidence in Slovak COVID-19 patients, treatment associations, and the importance of managing psychiatric symptoms and treatment choices for optimal outcomes (Tab. 6, Ref. 33).
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HockickovA I, HatalovA E, Gazda J, LenArtovA PD, JaniCko M, JarCuSka P, DraZilovA S, Logoida M, HalAnova M, SchrEter I, Kristian P. Distribution and relevance of hepatitis B genotypes in the general population of Slovakia. BRATISL MED J 2024; 125:17-23. [PMID: 38041841 DOI: 10.4149/bll_2024_004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIMS The aim of the presented study was to determine the distribution of HBV genotypes and their influence on selected parameters in patients in eastern Slovakia. METHODS The study includes 202 patients with confirmed chronic HBV infection or hepatitis. For each patient, basic demographic data, and serum samples were collected. The degree of liver fibrosis was determined by transient elastography. The obtained data were evaluated statistically. RESULTS Out of a total of 202 patients, 96.0 % of the patients were from the EU region and 27 patients (13.4 %) self-identified as Roma ethnic group. The most common genotype among our patients was genotype A (n = 104; 51.5 %), followed by genotype D (n = 76; 37.6 %) and A/D (n = 13; 6.4 %). In patients from the EU region, genotypes A and D predominated statistically significantly (p < 0.0001). Due to a low number of patients with other genotypes, in the subsequent analysis, we only compared patients with HBV genotypes A or D. Patients with genotypes D and A/D significantly more often mention tattoos as a possible risk factor for disease transmission compared to patients with genotype A (p = 0.043). Subsequently, we divided patients into two groups - treated and untreated. The level of qHBsAg was significantly higher in untreated patients with genotypes A (p < 0.0001). The influence of HBV genotypes on other laboratory parameters was not confirmed in our study. CONCLUSION This is the first HBV genotypes study from Slovakia. We suggest that HBV genotypes may play a role in the virus-host relationship Keywords: chronic hepatitis B, genotypes, hepatitis B virus, prognostic factors, distribution.
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Gazda J, Drazilova S, Gazda M, Janicko M, Koky T, Macej M, Carbone M, Jarcuska P. Treatment response to ursodeoxycholic acid in primary biliary cholangitis: A systematic review and meta-analysis. Dig Liver Dis 2023; 55:1318-1327. [PMID: 36593158 DOI: 10.1016/j.dld.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Several ursodeoxycholic acid (UDCA) treatment response definitions have been introduced in primary biliary cholangitis (PBC). However, the lack of a gold standard results in heterogeneity in second-line treatment research and clinical practice. AIMS This study aimed to explore which UDCA treatment response endpoint serves as the most accurate predictive model of long-term outcome. METHODS A systematic review and meta-analysis of UDCA treatment response endpoints (and corresponding validations) were performed. RESULTS Sixteen individual UDCA treatment response endpoints and 96 external validations were found. Barcelona, Paris-1, Paris-2, Rotterdam, Toronto and GLOBE and UK-PBC Risk Scores are currently most robustly validated in external populations. The results show that the continuous models (GLOBE and UK-PBC Risk Scores) serve as the most accurate predictive models. Besides standard UDCA treatment response endpoints, the alkaline phosphatase and total bilirubin normalization has been suggested as a new therapeutic target. CONCLUSIONS The GLOBE and UK-PBC Risk Scores are the most suitable for the real-world allocation of second-line therapies (obeticholic acid and fibrates). However, in the wake of the recent findings, alkaline phosphatase and total bilirubin normalization should be the primary outcome in trial research in PBC.
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Affiliation(s)
- Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia
| | - Sylvia Drazilova
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia.
| | - Matej Gazda
- Intelligent Information Systems Laboratory, Technical University of Kosice, Bozeny Nemcovej 32, 04201 Kosice, Slovakia
| | - Martin Janicko
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia
| | - Tomas Koky
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia
| | - Marian Macej
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia
| | - Marco Carbone
- Division of Gastroenterology and Centre for Autoimmune Liver Disease, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Peter Jarcuska
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, 040 12, Kosice, Slovakia
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Lapenna L, Di Cola S, Gazda J, De Felice I, Gioia S, Merli M. New Indications for TIPSs: What Do We Know So Far? J Clin Exp Hepatol 2023; 13:794-803. [PMID: 37693277 PMCID: PMC10483008 DOI: 10.1016/j.jceh.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/29/2023] [Indexed: 09/12/2023] Open
Abstract
Since 1988, transjugular intrahepatic portosystemic shunt (TIPS) has been an effective therapy for portal hypertension in many settings. Thanks to continuous technical improvements and a wiser selection of patients, excellent results have been achieved with this therapeutic strategy. The historical indications for TIPS placement, in the context of liver cirrhosis, such as refractory ascites and variceal bleeding are now well established and known. However, in recent years, new indications are emerging. These have been investigated and approved in some studies but are not yet included in guidelines and clinical practice. This review aims to highlight what is new for the role of TIPS in portal vein thrombosis (especially in patients awaiting liver transplantation), in recurrent ascites and not only refractory ascites, as a neoadjuvant therapy before abdominal surgery and, finally, in the setting of noncirrhotic portal hypertension. All these new aspects are addressed in this review with a critical approach based on the literature revision and clinical practice. Future research is needed to explore and validate the new role of TIPS in these scenarios.
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Affiliation(s)
- Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Jakub Gazda
- 2nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital in Kosice, Slovakia
| | - Ilaria De Felice
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Stefania Gioia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
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Sedlák M, Wazir A, Dima A, Gazda J, Morochovič R. Cutaneous Impact Location Predicts Intracranial Injury Among the Elderly Population with Traumatic Brain Injury. Open Access Emerg Med 2023; 15:265-275. [PMID: 37520843 PMCID: PMC10386855 DOI: 10.2147/oaem.s422785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
Background Traumatic brain injury (TBI) is one of the most common trauma-related diagnoses among the elderly population treated in emergency departments (ED). Identification of patients with increased or decreased risk of intracranial bleeding is of clinical importance. The objective of this study was to evaluate the implication of cutaneous impact location (CIL) on the prevalence of intracranial injury after suspected or confirmed TBI irrespective of its severity. Methods This was a retrospective, single-center, descriptive observational study of geriatric patients aged 65 years and older treated for suspected or confirmed TBI in a trauma surgery ED. The primary outcome of the study was the assessment of a CIL of the injury and its association with the prevalence of intracranial lesions found on a head computed tomography scan. Results Among 381 patients included in the analysis, the CIL of interest (temporo-parietal and occipital impacts) was present among 178 (46.7%) cases. Thirty-six (9.5%) patients were diagnosed with intracranial bleeding. The prevalence of intracranial bleeding was higher in the CIL of interest group compared with other locations outside (12.9% vs 6.4%; p = 0.030). CIL of interest was a predictor of intracranial bleeding (p = 0.033; OR: 2.17; 95% CI: 1.06 to 4.42). Conclusion The CIL of head injury is a predictor of intracranial lesions among geriatric patients with traumatic brain injury. Physicians should be aware of this association when assessing elderly patients with head injuries. More studies are needed to develop a clinical management tool incorporating CIL to guide the diagnosis of TBI in this population.
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Affiliation(s)
- Marián Sedlák
- Trauma Surgery Department, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Kosice, Slovakia
- Zachranna Sluzba Kosice, Kosice, Slovakia
| | | | | | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Kosice, Slovakia
| | - Radoslav Morochovič
- Trauma Surgery Department, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Kosice, Slovakia
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Di Cola S, Cusi G, Lapenna L, Gazda J, Fonte S, Mattana M, Mennini G, Pasqualetti P, Merli M. Diabetes and Metabolic Disorders: Their Impact on Cardiovascular Events in Liver Transplant Patients. Can J Gastroenterol Hepatol 2023; 2023:2199193. [PMID: 37396501 PMCID: PMC10313467 DOI: 10.1155/2023/2199193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
Cardiovascular diseases are currently one of the most important causes of morbidity and mortality in liver transplant patients over the long term. Therefore, evaluating prognostic factors for cardiovascular events (CVEs) in this population is essential for taking preventive measures. The aim of this study was to identify the impact of diabetes and other metabolic disorders on CVEs in liver transplant patients. Three hundred fifty-six liver transplant recipients who survived at least 6 months after surgery were enrolled. Patients were followed for a median time of 118 months (12-250 months). All cardiovascular events were carefully recorded and detailed in the patients' charts. Demographic data, diabetes, hypertension, dyslipidemia, weight changes, and a diagnosis of metabolic syndrome both before and after transplantation were noted to assess their possible relationship with CVE. The presence of a diagnosis of metabolic-associated fatty liver disease (MAFLD) was also evaluated. Immunosuppressive therapy was included in the analysis. Diabetes mellitus (DM), especially when present before transplantation, was strongly associated with CVEs (hazard risk HR 3.10; 95% confidence interval CI: 1.60-6.03). Metabolic syndrome was found to be associated with CVEs in univariate analysis (HR 3.24; 95% CI: 1.36-7.8), while pretransplantation and de novo MAFLD were not. Immunosuppressive therapy had no influence on predisposing transplanted patients to CVEs during follow-up. Further prospective studies may be useful in investigating the risk factors for CVEs after liver transplantation and improving the long-term survival of transplant patients.
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Affiliation(s)
- Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
| | - Giulia Cusi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Trieda SNP 1, Kosice 040 11, Slovakia
| | - Stefano Fonte
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
| | - Marco Mattana
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
| | - Gianluca Mennini
- Department of Hepato-Biliopancreatic and Transplant Surgery, Sapienza University of Rome, Viale Del Policlinico 155, Rome 00161, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Dell'Università 37, Rome 00185, Italy
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Di Cola S, Gazda J, Lapenna L, Ceccarelli G, Merli M. Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis. JHEP Rep 2023; 5:100703. [PMID: 36844944 PMCID: PMC9938945 DOI: 10.1016/j.jhepr.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background & Aims Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis. Methods The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient's exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard. Results We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 vs. 8.9%, p <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26-0.73, p = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states. Conclusions The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes. Impact and implications Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections.
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Key Words
- ALD, alcoholic liver disease
- Antibiotic resistance
- Antimicrobial stewardship
- BB, beta-blockers
- Bacterial infections
- C19MC, COVID-19 measures cohort
- CA, community acquired
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- EATF, empiric antibiotic treatment failure
- Empiric antibiotic failure
- HAI, hospital-acquired infection
- HCA, healthcare-associated
- IPCC, infection prevention and control cohort
- IPCP, infection prevention and control programme
- Liver cirrhosis
- MAP, mean arterial pressure
- MDR, multidrug-resistant
- MELD, model for end-stage liver disease
- Multidrug-resistant bacteria
- NASH, non-alcoholic steatohepatitis
- Nosocomial infections
- OR, odds ratio
- PDR, pandrug-resistant
- PPI, proton pump inhibitor
- SARS-CoV-2
- SBP, spontaneous bacterial peritonitis
- SMC, standard measures cohort
- UTI, urinary tract infection
- WBC, white blood cell
- XDR, extensively drug-resistant
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Affiliation(s)
- Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovakia
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Internal Medicine, Endocrinology and Metabolic Science and Infectious Diseases, University Hospital Policlinico Umberto I, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Corresponding author. Address: Department of Translational and Precision Medicine, ‘Sapienza’ University of Rome, Viale dell’Universita’ 37, 00185 Rome, Italy. Tel.: +39-064-997-2001..
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Gazda J, Di Cola S, Lapenna L, Khan S, Merli M. The Impact of Transjugular Intrahepatic Portosystemic Shunt on Nutrition in Liver Cirrhosis Patients: A Systematic Review. Nutrients 2023; 15:nu15071617. [PMID: 37049459 PMCID: PMC10096634 DOI: 10.3390/nu15071617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/14/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background and Aims: Liver cirrhosis leads to clinically significant portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) has been shown to effectively reduce the degree of portal hypertension and treat its complications. However, poor nutritional status has been shown to be associated with hepatic encephalopathy, acute on chronic liver failure, and mortality following TIPS placement. The purpose of this systematic review is to create another perspective and evaluate the effect of TIPS placement on the nutritional status of patients with liver cirrhosis. Methods: A comprehensive search of four major electronic databases was conducted to identify studies that assessed the nutritional status of cirrhotic patients before and after TIPS placement. The risk of bias was evaluated using ROBINS-I guidelines. Results: Fifteen studies were analyzed in this review. The results indicate that among the 11 studies that evaluated changes in ascites-free weight and body mass index or body cell mass, 10 reported an improvement in one or more measures. Furthermore, all seven studies that evaluated changes in muscle mass demonstrated an increase in muscle mass. Among the four studies that evaluated subcutaneous fat tissue, three showed a significant expansion, while two out of three studies evaluating visceral fat tissue reported a significant reduction. Conclusions: The results of this systematic review suggest that TIPS placement is associated with improvement in the nutritional status of cirrhotic patients, indicated by an increase in ascites-free weight, body mass index, and muscle mass. Additionally, TIPS placement leads to a shift in the distribution of fat mass, with a preference for subcutaneous over visceral adipose tissue. Notably, sarcopenic patients seem to benefit the most from TIPS placement in terms of nutritional status.
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Affiliation(s)
- Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, 040 12 Kosice, Slovakia
| | - Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Saniya Khan
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-49972001
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Šafčák D, Dražilová S, Gazda J, Andrašina I, Adamcová-Selčanová S, Barila R, Mego M, Rác M, Skladaný Ľ, Žigrai M, Janičko M, Jarčuška P. Alcoholic Liver Disease-Related Hepatocellular Carcinoma: Characteristics and Comparison to General Slovak Hepatocellular Cancer Population. Curr Oncol 2023; 30:3557-3570. [PMID: 36975484 PMCID: PMC10047624 DOI: 10.3390/curroncol30030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Hepatocellular carcinoma (HCC) has multiple molecular classes that are associated with distinct etiologies and, besides particular molecular characteristics, that also differ in clinical aspects. We aim to characterize the clinical aspects of alcoholic liver disease-related HCC by a retrospective observational study that included all consequent patients diagnosed with MRI or histologically verified HCC in participating centers from 2010 to 2016. A total of 429 patients were included in the analysis, of which 412 patients (96%) had cirrhosis at the time of diagnosis. The most common etiologies were alcoholic liver disease (ALD) (48.3%), chronic hepatitis C (14.9%), NAFLD (12.6%), and chronic hepatitis B (10%). Patients with ALD-related HCC were more commonly males, more commonly had cirrhosis that was in more advanced stages, and had poorer performance status. Despite these results, no differences were observed in the overall (median 8.1 vs. 8.5 months) and progression-free survival (median 4.9 vs. 5.7 months). ALD-HCC patients within BCLC stage 0-A less frequently received potentially curative treatment as compared to the control HCC patients (62.2% vs. 87.5%, p = 0.017); and in patients with ALD-HCC liver function (MELD score) seemed to have a stronger influence on the prognosis compared to the control group HCC. Systemic inflammatory indexes were strongly associated with survival in the whole cohort. In conclusion, alcoholic liver disease is the most common cause of hepatocellular carcinoma in Slovakia, accounting for almost 50% of cases; and patients with ALD-related HCC more commonly had cirrhosis that was in more advanced stages and had poorer performance status, although no difference in survival between ALD-related and other etiology-related HCC was observed.
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Affiliation(s)
- Dominik Šafčák
- Department of Radiotherapy and Oncology, East Slovakia Institute of Oncology, 04191 Košice, Slovakia
- 2nd Department of Internal Medicine, Louis Pasteur University Hospital, 04011 Košice, Slovakia
| | - Sylvia Dražilová
- 2nd Department of Internal Medicine, Louis Pasteur University Hospital, 04011 Košice, Slovakia
- Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Louis Pasteur University Hospital, 04011 Košice, Slovakia
- Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia
| | - Igor Andrašina
- Department of Radiotherapy and Oncology, East Slovakia Institute of Oncology, 04191 Košice, Slovakia
| | | | - Radovan Barila
- Oncological Cluster, Saint Michael Hospital Michalovce, 07101 Michalovce, Slovakia
| | - Michal Mego
- Department of Clinical Oncology, National Oncology Institute of Slovakia, 83310 Bratislava, Slovakia
| | - Marek Rác
- Department of Internal Medicine, University Hospital Nitra, 94901 Nitra, Slovakia
| | - Ľubomír Skladaný
- Department of Internal Medicine, F.D. Roosevelt University Hospital, 97517 Banská Bystrica, Slovakia
| | - Miroslav Žigrai
- Department of Internal Medicine, University Hospital in Bratislava, 83101 Bratislava, Slovakia
| | - Martin Janičko
- 2nd Department of Internal Medicine, Louis Pasteur University Hospital, 04011 Košice, Slovakia
- Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia
| | - Peter Jarčuška
- 2nd Department of Internal Medicine, Louis Pasteur University Hospital, 04011 Košice, Slovakia
- Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04011 Košice, Slovakia
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Safcak D, Drazilova S, Gazda J, Andrasina I, Adamcova-Selcanova S, Barila R, Mego M, Rac M, Skladany L, Zigrai M, Janicko M, Jarcuska P. Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival-A Retrospective Analysis of a Slovak Cohort. J Clin Med 2021; 10:3186. [PMID: 34300352 PMCID: PMC8306860 DOI: 10.3390/jcm10143186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system. METHODS We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the period from 2010 through 2016. RESULTS 12.59% of patients had NAFLD-related HCC, and 21.91% had either NAFLD or cryptogenic etiology. NAFLD-related HCC patients were younger (p = 0.0007), with a higher proportion of women (p < 0.001) compared to other etiology-related HCC patients. The NAFLD group had a significantly lower proportion of patients with liver cirrhosis at the time of HCC diagnosis (p < 0.0001), and they were more frequently diagnosed with both diabetes and metabolic syndrome when compared to other etiology-related HCC (p < 0.0001). We did not find any difference in the overall survival or in the progression-free survival between NAFLD-related and other etiology-related HCC patients staged as BCLC B and BCLC C. NAFLD-related HCC patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions (p = 0.0097), while patients with baseline CRP values of ≥5 mg/L or with PLR ≥ 150 had worse overall survival (p = 0.012 and p = 0.0028, respectively). ALBI Grade 3 predicted worse overall survival compared to ALBI Grade 1 or 2 (p = 0.00021). In NAFLD-related HCC patients, PLR and ALBI remained significant predictors of overall survival even after adjusting for BCLC. CONCLUSION NAFLD-related HCC patients have a similar prognosis when compared to other etiology-related HCC. In NAFLD-related HCC patients, ALBI and PLR are significant predictors of the overall survival independent of the BCLC staging system.
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Affiliation(s)
- Dominik Safcak
- Department of Radiotherapy and Oncology, East Slovakia Institute of Oncology, Rastislavova 43, 041 91 Kosice, Slovakia; (D.S.); (I.A.)
| | - Sylvia Drazilova
- Internal Medicine Department, Hospital Poprad a.s., Banicka 803, 058 01 Poprad, Slovakia
- 2nd Department of Internal Medicine, P. J. Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11 Kosice, Slovakia; (J.G.); (M.J.); (P.J.)
| | - Jakub Gazda
- 2nd Department of Internal Medicine, P. J. Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11 Kosice, Slovakia; (J.G.); (M.J.); (P.J.)
| | - Igor Andrasina
- Department of Radiotherapy and Oncology, East Slovakia Institute of Oncology, Rastislavova 43, 041 91 Kosice, Slovakia; (D.S.); (I.A.)
| | - Svetlana Adamcova-Selcanova
- 2nd Department of Internal Medicine, HEGITO, F. D. Roosevelt University Hospital, Namestie L Svobodu 1, 975 17 Banska Bystrica, Slovakia; (S.A.-S.); (L.S.)
| | - Radovan Barila
- Oncological Cluster, Stefan Kukura Hospital in Michalovce, Spitalska Ulica 2, 071 01 Michalovce, Slovakia;
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Oncology Institute of Slovakia, Klenova 1, 833 10 Bratislava, Slovakia;
| | - Marek Rac
- Department of Internal Medicine, Teaching Hospital Nitra, Spitalska 6, 949 01 Nitra, Slovakia;
| | - Lubomir Skladany
- 2nd Department of Internal Medicine, HEGITO, F. D. Roosevelt University Hospital, Namestie L Svobodu 1, 975 17 Banska Bystrica, Slovakia; (S.A.-S.); (L.S.)
| | - Miroslav Zigrai
- 1st Department of Internal Medicine, Ladislav Derer University Hospital in Bratislava, Limbova 5, 833 05 Bratislava-Kramare, Slovakia;
| | - Martin Janicko
- 2nd Department of Internal Medicine, P. J. Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11 Kosice, Slovakia; (J.G.); (M.J.); (P.J.)
| | - Peter Jarcuska
- 2nd Department of Internal Medicine, P. J. Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11 Kosice, Slovakia; (J.G.); (M.J.); (P.J.)
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Szilasiová J, Gazda J, Cimprichová A, Cvengrošová A, Donáth V, Fedičová M, Gurčík L, Hančinová V, Jurčaga F, Kahancová E, Kantorová E, Karlík M, Klímová E, Kováčová S, Krastev G, Megová A, Michalík J, Mikula P, Snopeková Ľ, Števková Z. Incidence and prevalence of neuromyelitis optica spectrum disorders in Slovakia. Neurol Res 2021; 44:38-46. [PMID: 34261427 DOI: 10.1080/01616412.2021.1952741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE : Neuromyelitis optica spectrum disorders (NMOSDs) are a group of rare, inflammatory, demyelinating diseases that affect the central nervous system. Neither the incidence nor the prevalence of NMOSD has been determined in Slovakia thus far. The aim of this study was to determine both the incidence and the prevalence of NMOSD in Slovakia using the 2015 International Panel of NMOSD diagnosis (IPND) criteria. METHODS : We performed a population-based study in Slovakia to estimate both the incidence and the prevalence of NMOSD during the period from 1 January 2006 through 31 December 2019. NMOSD cases were reported from multiple sources and the diagnosis was subsequently verified using the IPND criteria by a joint commitee of three neurologists. The prevalence is reported as number of cases per 100,000 inhabitans and the incidence as number of new cases per 1,000,000 person-years. Age-adjusted rates to the WHO standard population 2005-2025 were also calculated. RESULTS : We identified 63 NMOSD cases. The crude point-prevalence rate was 1.37 (95% CI 1.03-1.71) per 100,000 inhabitants. The crude indidence rate was 0.88 (95% CI 0.65-1.12) per 1,000,000 person-years. The age-adjusted point-prevalence rate was 1.42 (95% CI 1.07-1.84) per 100,000 persons and the age-adjusted incidence rate was 0.96 (95% CI 0.72-1.25) per 1,000,000 person-years. CONCLUSION : The NMOSD epidemiological situation in Slovakia is comparable to those reported from other Caucasian populations.
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Affiliation(s)
- Jarmila Szilasiová
- Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Jakub Gazda
- II Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | | | - Anna Cvengrošová
- Department of Neurology, J. A. Reiman Faculty Hospital, Prešov, Slovak Republic
| | - Vladimír Donáth
- Department of Neurology, F. D. Roosevelt Faculty Hospital, Banská Bystrica, Slovak Republic
| | - Miriam Fedičová
- Department of Neurology, L. Pasteur University Hospital, Košice, Slovak Republic
| | - Ladislav Gurčík
- Department of Neurology, AGEL Hospital, Levoča, Slovak Republic
| | - Viera Hančinová
- Department of Neurology, University Hospital, Bratislava Ružinov, Slovak Republic
| | - František Jurčaga
- Department of Neurology, St. Michal University Hospital, Bratislava, Slovak Republic
| | - Edita Kahancová
- Department of Neurology, L. Pasteur University Hospital, Košice, Slovak Republic
| | - Ema Kantorová
- Department of Neurology, University Hospital, Martin, Slovak Republic
| | - Martin Karlík
- Department of Neurology, L. Dérer University Hospital Bratislava, Slovak Republic
| | - Eleonóra Klímová
- Department of Neurology, J. A. Reiman Faculty Hospital, Prešov, Slovak Republic
| | | | - Georgi Krastev
- Department of Neurology, Faculty Hospital, Trnava, Slovak Republic
| | - Andrea Megová
- Department of Neurology, University Hospital, Bratislava, Slovak Republic
| | - Jozef Michalík
- Department of Neurology, University Hospital, Martin, Slovak Republic
| | - Pavol Mikula
- Department of Social and Behavioral Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Ľubica Snopeková
- Department of Neurology, Hospital Poprad, Poprad, Slovak Republic
| | - Zuzana Števková
- Department of Neurology, Faculty Hospital, Trnava, Slovak Republic
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Drazilova S, Babinska I, Gazda J, Halanova M, Janicko M, Kucinsky B, Safcak D, Martinkova D, Tarbajova L, Cekanova A, Jarcuska P. Epidemiology and clinical course of primary biliary cholangitis in Eastern Slovakia. Int J Public Health 2020; 65:683-691. [PMID: 32500239 DOI: 10.1007/s00038-020-01391-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine both the incidence and the prevalence of primary biliary cholangitis (PBC) in Eastern Slovakia and to describe its clinical course and the response to ursodeoxycholic acid (UDCA). METHODS We recorded data of patients with PBC, who were followed up in gastroenterology and hepatology centers in Eastern Slovakia during the period from June 30, 1999, through June 30, 2019. RESULTS The annual incidence of PBC varied from 0.7 to 1.5 cases per 100,000 inhabitants between 2014 and 2018. PBC prevalence steadily increased from initial 10.2 cases per 100,000 inhabitants in 2014 to 14.9 cases per 100,000 inhabitants in June 2019. The mean age at the time of diagnosis was 56.3 ± 10.9 years. 95.7% of patients were females, and female/male gender ratio was 22.3:1. In June 2019, prevalence in the female population was 28 cases per 100,000 women. At the time of diagnosis, three-quarters of patients were symptomatic and 10% of patients had liver cirrhosis. The mean follow-up was 7.3 ± 5.2 years. Response to UDCA was observed in 72.1% of patients. Patients with higher baseline alkaline phosphatase (ALP) levels, liver cirrhosis at entry or at the end of follow-up and women younger than 45 years responded worse to UDCA. One-quarter of patients had liver cirrhosis at the end of follow-up. During follow-up, 1.6% of patients underwent liver transplantation and 5.5% of patients died. Five-year and 10-year liver-related mortalities were 2.7% and 4.3%, respectively. CONCLUSION PBC prevalence in Eastern Slovakia is increasing, and most of the patients respond to therapy with UDCA.
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Affiliation(s)
- Sylvia Drazilova
- Department of Internal Medicine, Hospital Poprad, Poprad, Slovakia
| | - Ingrid Babinska
- Department of Epidemiology, PJ Safarik University, Faculty of Medicine, Kosice, Slovakia.
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
| | - Monika Halanova
- Department of Epidemiology, PJ Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - Martin Janicko
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
| | - Branislav Kucinsky
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
| | - Dominik Safcak
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
- Department of Radiotherapy and Oncology, Faculty of Medicine and Eastern Slovakia Institute of Oncology Kosice, PJ Safarik University, Kosice, Slovakia
| | | | - Lucia Tarbajova
- Department of Internal Medicine, Hospital Poprad, Poprad, Slovakia
| | - Anna Cekanova
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
| | - Peter Jarcuska
- 2nd Department of Internal Medicine, Faculty of Medicine and L Pasteur University Hospital, PJ Safarik University, Kosice, Slovakia
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Drotár P, Gazda J, Smékal Z. An experimental comparison of feature selection methods on two-class biomedical datasets. Comput Biol Med 2015; 66:1-10. [PMID: 26327447 DOI: 10.1016/j.compbiomed.2015.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022]
Abstract
Feature selection is a significant part of many machine learning applications dealing with small-sample and high-dimensional data. Choosing the most important features is an essential step for knowledge discovery in many areas of biomedical informatics. The increased popularity of feature selection methods and their frequent utilisation raise challenging new questions about the interpretability and stability of feature selection techniques. In this study, we compared the behaviour of ten state-of-the-art filter methods for feature selection in terms of their stability, similarity, and influence on prediction performance. All of the experiments were conducted on eight two-class datasets from biomedical areas. While entropy-based feature selection appears to be the most stable, the feature selection techniques yielding the highest prediction performance are minimum redundance maximum relevance method and feature selection based on Bhattacharyya distance. In general, univariate feature selection techniques perform similarly to or even better than more complex multivariate feature selection techniques with high-dimensional datasets. However, with more complex and smaller datasets multivariate methods slightly outperform univariate techniques.
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Affiliation(s)
- P Drotár
- Department of Telecommunications, Brno University of Technology, Technická 12, 61200 Brno, Czech Republic.
| | - J Gazda
- Department of Computers and Informatics, Technical University of Kosice, Letna 9, 0401 Kosice, Slovakia
| | - Z Smékal
- Department of Telecommunications, Brno University of Technology, Technická 12, 61200 Brno, Czech Republic
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