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Tomić T, Tomić D, Vukoja M, Kraljević M, Ljevak I, Glamočlija U, Tomić V, Vukojević K, Beljan Perak R, Šoljić V. Clinical Significance and Expression Pattern of RIP5 and VGLL4 in Clear Cell Renal Cell Carcinoma Patients Treated with Sunitinib. Biomedicines 2024; 12:149. [PMID: 38255254 PMCID: PMC10813538 DOI: 10.3390/biomedicines12010149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
While clear cell renal cell carcinoma (ccRCC) is curable, advanced metastatic (mRCC) remains a clinical challenge. We analyzed clinical, pathohistological, and molecular data (Receptor Interacting Protein 5-RIP5 and Vestigial Like Family Member 4-VGLL4 expression) of 55 mRCC patients treated with first-line treatment with sunitinib. The trend of linear increase in the protein expression of RIP5 was observed with the progression of tumor grade. Overall, 80% of RIP5-positive cells were in the control kidneys and high-grade mRCC. On the contrary, RIP5 displayed low expression in grade 2 mRCC (5.63%). The trend of linear decrease in the expression of VGLL4 was observed with the progression of tumor grade. The highest protein expression of VGLL4 was observed in grade 2 (87.82%) in comparison to grade 3 and 4 and control. High expression of RIP5 mRNA was associated with longer first-line overall survival and longer progression-free survival in mRCC. In addition, a high VGLL4 mRNA expression showed better overall survival in patients with ccRCC. In conclusion, high mRNA expression of RIP5 and VGLL4 are important markers of better survival rates in mRCC patients.
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Affiliation(s)
- Tanja Tomić
- Faculty of Health Studies, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina; (T.T.); (I.L.); (V.T.); (V.Š.)
| | - Davor Tomić
- Department of Urology, University Hospital Center Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
| | - Martina Vukoja
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
| | - Marija Kraljević
- Department of Oncology, University Hospital Center Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
| | - Ivona Ljevak
- Faculty of Health Studies, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina; (T.T.); (I.L.); (V.T.); (V.Š.)
| | - Una Glamočlija
- Faculty of Pharmacy, University of Sarajevo, Zmaja od Bosne 8, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Vajdana Tomić
- Faculty of Health Studies, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina; (T.T.); (I.L.); (V.T.); (V.Š.)
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
- Department of Gynecology, University Hospital Center Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina
| | - Katarina Vukojević
- Faculty of Health Studies, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina; (T.T.); (I.L.); (V.T.); (V.Š.)
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - Renata Beljan Perak
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia;
| | - Violeta Šoljić
- Faculty of Health Studies, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina; (T.T.); (I.L.); (V.T.); (V.Š.)
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
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Miletić D, Kraljević M, Sokolović E, Soče M, Milović-Kovačević M, Bobić S, Cerić T, Pleština S, Bešlija S, Marijanović I. Differences in Outcomes Between Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Metastatic Breast Cancer Patients in Upper Middle-Income versus High-Income Countries: A Retrospective Study from 4 Oncology Centers. Med Sci Monit 2023; 29:e940356. [PMID: 37264567 DOI: 10.12659/msm.940356] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Therapeutic options for human epidermal growth factor 2 (HER2)-positive metastatic breast cancer (mBC) are developing rapidly. This study aimed to determine the differences in the survival outcomes of patients with HER2-positive mBC in relation to access to anti-HER therapy at 3 oncology centers in upper-middle-income countries (UMICs) and 1 oncology center in a high-income country (HIC). MATERIAL AND METHODS We retrospectively identified 42 patients from Croatia (HIC), 71 patients from Serbia (UMIC), and 57 from Bosnia and Herzegovina (UMIC) diagnosed with HER2-positive mBC who were treated between January 2015 and December 2020. The pathohistological features of the tumors were obtained from the pathological findings, which were made according to standard procedures for each center. Patients were treated depending on the availability of therapy, which differed for centers in different countries. We evaluated disease-free survival, progression-free survival, and overall survival (OS) based on the availability of first- and second-line anti-HER2 therapy in UMICs vs HIC. RESULTS OS in first-line therapy was better in patients treated with dual HER2 blockade than in patients treated without dual HER2 blockade, P<0.001. OS in second-line therapy was significantly better in patients treated with trastuzumab emtansine than in patients treated with other reported regimens, P=0.004. CONCLUSIONS Results of our study showed superior survival among patients who were treated with dual first-line HER2 therapy as well as second-line trastuzumab emtansine therapy than in those patients in other centers where these drugs were not available. Raising awareness about this could help improve the situation.
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Affiliation(s)
- Dragana Miletić
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Emir Sokolović
- Oncology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Majana Soče
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijana Milović-Kovačević
- Department for Radiation Oncology and Diagnostics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Simonida Bobić
- Department for Radiation Oncology and Diagnostics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Timur Cerić
- Oncology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Stjepko Pleština
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Semir Bešlija
- Oncology Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
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Kraljević M, Marijanović I, Barbarić M, Sokolović E, Bukva M, Cerić T, Buhovac T. Prognostic and predictive significance of VEGF, CD31, and Ang-1 in patients with metastatic clear cell renal cell carcinoma treated with first-line sunitinib. Biomol Biomed 2023; 23:161-169. [PMID: 35674770 PMCID: PMC9901909 DOI: 10.17305/bjbms.2022.7675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 02/08/2023]
Abstract
The most common type of renal cell carcinoma (RCC) is clear cell renal cell carcinoma (ccRCC), which has a high metastatic potential. Even though the International Metastatic RCC Database Consortium (IMDC) risk model is conventionally utilized for selection and stratification of patients with metastatic RCC (mRCC), there remains an unmet demand for novel prognostic and predictive markers. The goal of this study was to analyze the expression of Vascular endothelial growth factor (VEGF), Cluster of Differentiation 31 (CD31) to determine microvessel density, and Angiopoietin-1 (Ang-1) in primary kidney tumors, as well as their predictive and prognostic value in patients with metastatic ccRCC (mccRCC) who were treated with first-line sunitinib. The study included 35 mccRCC patients who were treated with first-line sunitinib in period between 2009 and 2019. Immunofluorescence was used to examine biomarker expression in tissue specimens of the primary tumor and surrounding normal kidney tissue. Median disease-free survival (DFS) was longer in patients with negative and low tumor VEGF score than in patients with medium tumor VEGF score (p=0.02). Those with low tumor CD31 expression had a longer median DFS than patients with high tumor CD31 expression (p=0.019). There was no correlation between Ang-1 expression and DFS. The expression of biomarkers in normal kidney tissue was significantly lower than in tumor tissue (p<0.001). In conclusion, higher VEGF scores and greater CD31 expression were associated with longer DFS, but neither of these biomarkers correlated with progression-free survival or overall survival.
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Affiliation(s)
- Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina,Correspondence to Marija Kraljević:
| | - Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Maja Barbarić
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Emir Sokolović
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Merima Bukva
- Association of Basic Medical Sciences of FBIH, Sarajevo, Bosnia and Herzegovina
| | - Timur Cerić
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Teo Buhovac
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Zlatović JJ, Omrčen T, Marijanović I, Kraljević M. Co-administration of pazopanib and enteral nutrition with omega-3 fatty acids as a safety issue in a patient treated for metastatic clear cell renal cancer: A case report. J Cancer Res Ther 2023; 19:474-476. [PMID: 37006081 DOI: 10.4103/jcrt.jcrt_533_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Pazopanib is an oral multitargeting tyrosine kinase inhibitor (TKI) of vascular endothelial growth factor receptors (VEGFRs), approved as the first-line treatment of metastatic renal cell carcinoma (mRCC) and soft tissue sarcoma (STS) at a fixed dose of 800 mg daily taken fasted. Potential drug-meal interactions and adverse events (AEs) may lack recognition and the related data in literature. We report one case of stomatitis/oral mucositis associated with pazopanib administrated with an oral nutritional supplement enriched with omega-3 fatty acids. The 50-year-old patient with mRCC started pazopanib treatment at standard doses of 800 mg daily as first-line therapy for mRCC, and after a few days, he developed stomatitis. Co-administration of pazopanib with high-fat meals could increase the solubility of highly lipophilic pazopanib, increasing its plasma pazopanib area under the curve (AUC), and maximum concentration (Cmax) above optimal therapeutic level can consequently lead to increased frequency/grade of AEs.
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Affiliation(s)
- Josipa Jović Zlatović
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | - Tomislav Omrčen
- Department of Oncology and Radiotherapy, University Hospital Split, Split, Croatia
| | - Inga Marijanović
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Balkans, Bosnia and Herzegovina
| | - Marija Kraljević
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Balkans, Bosnia and Herzegovina
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Kraljević M, Marijanović I, Barbarić M, Buhovac T. Vascular density and expression of vascular endothelial growth factor and angiopoietin-1 using immunofluorescence technique in patients with metastatic renal cell carcinoma treated with first-line sunitinib. J Cancer Res Ther 2023; 19:520-521. [PMID: 37006083 DOI: 10.4103/jcrt.jcrt_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, 88 000 Mostar, Bosnia and Herzegovina
| | - Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, 88 000 Mostar, Bosnia and Herzegovina
| | - Maja Barbarić
- Laboratory of Morphology, Department of Histology and Embryology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina, Balkans, Bosnia and Herzegovina
| | - Teo Buhovac
- Oncology Clinic, University Clinical Hospital Mostar, 88 000 Mostar, Bosnia and Herzegovina
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Tomić K, Kraljević M, Karan Križanac D, Gunarić A, Šekerija Zovko S. Concomitant Chemoradiotherapy Using Carboplatin and Etoposide-induced Cutaneous Vasculitis in a Patient with Small Cell Lung Cancer. Acta Dermatovenerol Croat 2022; 30:170-73. [PMID: 36812276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Drug-induced vasculitis occurs after drug exposure and consequent inflammation of small blood vessels which can lead to damage of affected tissue. Rare cases of drug-induced vasculitis during chemotherapy or concomitant chemoradiotherapy have been described in the literature. Our patient was diagnosed with stage IIIA (cT4N1M0) small cell lung cancer (SCLC). Four weeks after the application of the second cycle carboplatin and etoposide (CE) chemotherapy, the patient developed cutaneous vasculitis and rash on the lower extremities. CE chemotherapy was discontinued and symptomatic therapy with methylprednisolone was administered. On prescribed corticosteroid therapy, there was an improvement in local finding. After completion of chemoradiotherapy, the patient continued treatment with four cycles of consolidation chemotherapy with cisplatin (six cycles of chemotherapy in total). Clinical examination verified further regression of the cutaneous vasculitis. Elective radiotherapy of the brain was performed after completion of consolidation chemotherapy treatment. The patient was clinically monitored until disease relapse. Subsequent lines of chemotherapy for platinum-resistant disease were administered. The patient died seventeen months after diagnosis of SCLC. To our knowledge, this is the first described case of a patient who developed vasculitis of lower extremities during concomitant administration of radiotherapy and CE chemotherapy as a part of the primary treatment for SCLC.
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Affiliation(s)
| | - Marija Kraljević
- Marija Kraljević, MD, Department of Oncology University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina;
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Süsstrunk J, Kraljević M, Schneider R, Peterli R. Long-term outcome after biliopancreatic diversion type duodenal switch: A single-center experience with up to 20 years follow-up. Br J Surg 2022. [DOI: 10.1093/bjs/znac175.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Biliopancreatic diversion type duodenal switch (BPD-DS) is the most effective bariatric procedure in terms of weight loss and remission of comorbidities but carries the risk of severe long-term side effects. The aim of this study was to analyze the long-term effects of BPD-DS on weight loss, comorbidities and reoperation rate.
Methods
This is a retrospective single-center study of prospectively collected data of all patients who underwent BPD-DS from 1999 to 2011 at a single institution.
Results
116 patients (83.6% female) underwent BPD-DS with a mean initial body mass index (BMI) of 47 ± 6.5 kg/m2. 68% of the procedures were performed in open technique and 32% laparoscopically. Common channel length was routinely 1 m, mean alimentary limb length (AL) was 1.8 ± 0.6 m and mean bilio-pancreatic limb length (BPL) was 4.9 ± 1.6 m. 76.7% of patients had laparoscopic adjustable gastric banding (LAGB) prior to BPD-DS. Mean follow-up time was 14 ± 4.4 years and follow-up rate at 5, 10 and 14 years was 95.6% (n = 108), 90% (n = 98) and 75.3% (n = 70). Mean excess BMI loss (%EBMIL) at 5, 10 and 14 years was 78% ± 24.1, 76.5% ± 26.7 and 77.8% ± 33.8, respectively. The highest %EBMIL was reached two years postoperatively with 84% ± 23.6. Complete (n = 22) or partial remission (n = 4) of type 2 diabetes mellitus was observed in 92.8% of patients. Reoperation was necessary in 33 patients (28.4%) due to malnutrition or refractory diarrhea (10), excessive weight loss (1), insufficient weight loss or weight rebound (7), reflux or stenosis (7), oxalate nephropathy (2), liver cirrhosis (1) and various/combined indications (5). Mean time to reoperation was 7.7 ± 5 years. The predominant deficiencies were vitamin D (99.1%), zinc (86.9%), iron (83.5%) and calcium (71.3%). The were no procedure-related deaths in the short- or long-term.
Conclusion
BPD-DS leads to sustainable long-term weight loss with an acceptable reoperation rate. Nevertheless, regular follow-up is necessary to detect and treat malnutrition and vitamin deficiencies.
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Affiliation(s)
- J Süsstrunk
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
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Dirnberger AS, Süsstrunk J, Schneider R, Slawik M, Peterli R, Kraljević M. Outcome of revisional procedures up to 14 years after sleeve gastrectomy: A single-center experience. Br J Surg 2022. [DOI: 10.1093/bjs/znac175.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
In the long-term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss, weight regain, development of gastroesophageal reflux disease (GERD) as well as persistence or relapse of comorbidities. The study's objective was to present results regarding weight loss, evolution of comorbidities and reoperation rate of patients who underwent a revisional bariatric procedure after SG.
Methods
Retrospective single-center analysis of a prospective database on patients who had a minimal follow-up of two years after conversion from SG to either a proximal Roux-en-Y gastric bypass (PRYGB), biliopancreatic diversion type duodenal switch (BPD/DS), long bilio-pancreatic limb-Roux-en-Y gastric bypass (LRYGB) or re-sleeve gastrectomy (RSG).
Results
Over a time period of 14 years, 549 SGs were performed. A total of 71 patients (13.0%) underwent a conversion from SG to PRYGB (n = 28, 39.4%), BPD/DS (n = 19, 26.8%), LRYGB (n = 17, 23.9%) and RSG (n = 7, 9.9%). Indications for the revisional procedures were GERD (33.8%), insufficient weight loss/weight regain (32.4%), a combination of both (31.0%) or stenosis/kinking of the sleeve (2.8%). The mean time from SG to revision was 5.2 ± 3.1 years and the mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after revision was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and LRYGB (32.9%) compared to RSG (20.0%; p = 0.04; p = 0.01). Patients with BPD/DS had significantly higher additional %TWL (26.2%) after conversion compared to PRYGB (15.6%, p = 0.04) and RSG (10.9%, p = 0.01). In case of GERD, reoperation led to a resolution of symptoms in 81.6% after RYGB. 19.7% of patients underwent an additional revisional procedure for internal herniation, chronic diarrhea after BDP/DS, common bile duct stones and weight regain.
Conclusion
In the event of insufficient weight loss/weight regain after SG, conversion to BPD/DS provides a significant post-revisional weight loss. RYGB leads to good symptom control in patients suffering from GERD.
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Affiliation(s)
- A S Dirnberger
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - J Süsstrunk
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - M Slawik
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital , Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center , Basel, Switzerland
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Marijanović I, Bevanda Glibo D, Lasić T, Kraljević M, Buhovac T, Cerić T, Sokolović E. The Use of Complementary and Alternative Medicine among Cancer Patients Undergoing Conventional Treatment: A Single-Centre Experience. Psychiatr Danub 2021; 33:304-307. [PMID: 35150499] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The alternative medicine is increasingly accepted by modern man. People realize that healing based on natural methods is much more affordable and not more aggressive than taking potent drugs of synthetic origin. The aim of this study was to collect data on the use of complementary agents and alternative medicine in cancer patients treated at the Oncology Clinic of the University Clinical Hospital in Mostar. SUBJECTS AND METHODS We conducted a cross-sectional study that included 100 patients. Data were collected from a questionnaire compiled for this research, which comprised two groups of questions. The first group examined the sociodemographic characteristics of the respondents, and the second the modalities of using Complementary and Alternative Medicine (CAM), and health and conceptual reasons for use. RESULTS A total of 72 patients (72.0%) had used a CAM during their anticancer treatment. Only 23% of patients had used CAM before the diagnosis of cancer. Among them, 26 (36.1%) previously discussed the topic with their oncologist. CAMs ranged from herbal medicine (58.3%), cannabinoid oil (19.4%) and different vitamins and minerals (22.2%). CAMs were mainly used to improve the health (40.3%). Among patients who used CAM only 25% find it financially demanding, 90.3% of patients were satisfied with effects of CAMs, and 78.1% would recommend it to other cancer patients. CONCLUSION Our data showed that in our region, many patients used complementary and alternative methods of treatment. These results are very important because they provide information and give a clearer picture of the use of CAM among cancer patients and, accordingly, the right approach of the health practitioners to the patient, leading to optimized cancer therapy and increased safety.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Bijeli brijeg bb, 88000 Mostar, Bosnia and Herzegovina
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Marijanović I, Kraljević M, Buhovac T, Sokolović E. Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology Clinic of University Clinical Hospital Mostar, Bosnia and Herzegovina: A Cross-Sectional Study. Med Sci Monit 2021; 27:e932788. [PMID: 34772907 PMCID: PMC8596742 DOI: 10.12659/msm.932788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The pandemic of Coronavirus infectious disease 2019 (COVID-19) poses a major public health challenge, and an effective vaccine is the potential mechanism to resolve this specific situation. The present study aimed to evaluate acceptance of COVID-19 vaccination among patients attending the Oncology Clinic of University Clinical Hospital Mostar. Material/Methods This cross-sectional observational study enrolled 364 patients with cancer from the Oncology Clinic of University Clinical Hospital Mostar during February 2021. Data were collected using a questionnaire that captured general information about the participants and their attitudes toward COVID-19 vaccination. Results Of the participants, 41.8% answered “Yes” when asked if they would take the vaccine once it becomes available, 37.6% answered “Not sure”, and 20.6% answered “No”. For patients in favor of vaccination, the main reasons reported were fear of getting sick (77.6%), the desire to contribute to herd immunity (57.8%), and trusting the recommendations of health professionals (57.2%). The main reasons for the patients’ vaccination refusal/indecision were doubts about the results from clinical trials of COVID-19 vaccines (49.1%), concerns about adverse effects (24.5%), and confusion about the various vaccine options (19.8%). The majority of participants (82.4%) stated that recommendation by their oncologist could influence their decision about vaccination. Of the participants who indicated unwillingness (refusal or indecision) to be vaccinated against COVID-19, 65.3% stated that recommendation by their oncologist could influence their decision about vaccination. Conclusions The findings from the present study showed most patients had refused or were indecisive regarding immunization with COVID-19 vaccine. Increasing physician awareness of this situation may result in higher rates of vaccination.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Emir Sokolović
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Marijanović I, Kraljević M, Bevanda Glibo D, Buhovac T, Černi Obrdalj E. The Role of Family Physicians in the Prevention and Early Detection of Cancer in Herzegovina-Neretva and West-Herzegovina Canton. Psychiatr Danub 2021; 33:89-96. [PMID: 34672277] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study aimed to investigate and analyze the role of general practitioners/family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. SUBJECTS AND METHODS A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina-Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. RESULTS Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. CONCLUSIONS The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Bijeli brijeg bb, 88000 Mostar, Bosnia and Herzegovina
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12
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Kraljević M, Cordasco V, Schneider R, Peters T, Slawik M, Wölnerhanssen B, Peterli R. Long-term effects of laparoscopic sleeve gastrectomy: What are the results beyond 10 years? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Sleeve gastrectomy (SG) has become the most commonly performed bariatric procedure worldwide. Newer studies providing long-term follow-up are showing high incidence of weight regain and high incidence of de novo reflux or worsening of preexisting GERD leading to conversion to different bariatric procedure. The objective of our study was to present 5 to 15-year follow-up results in terms of weight loss, remission of comorbidities and reoperation rate.
Methods
This is a retrospective analysis of prospectively collected data. The minimal follow-up time was 5 years. Patients who underwent SG between August 2004 and December 2014 were included. In case of reoperation patients were converted to Roux-en-Y gastric bypass or biliopancreatic diversion type duodenal-switch with or without hiatal hernia repair.
Results
A total of 307 patients underwent SG either as primary bariatric procedure (n = 262) or as redo operation after failed laparoscopic gastric banding (n = 45). Mean body mass index at time of primary SG was 46.4 ± 8.0 kg/m2. Mean age at operation was 43.7 ± 12.4 years with 68% females. Follow-up was 84% and 70% at 5 and 10 years respectively. The mean EBMIL for primary SG was 62.8 ± 23.1% after 5 years, 53.6 ± 24.6% after 10 years and 51.2 ± 20.3% after 13 years. Reoperation after SG was necessary in almost every fifth SG patient: 24 patients (7.8%) were reoperated due to insufficient weight loss, 12 patients (3.9 %) due to reflux, while 23 patients (7.5%) needed conversion due to both, insufficient weight loss and reflux. Comorbidities improved considerably while the incidence of new onset reflux was 29.7%.
Conclusion
SG provides a long-term EBMIL from 51 to 54% beyond 10 years and a significant improvement of comorbidities. On the other hand, a high incidence of both weight loss failure and de novo reflux was observed leading to conversion.
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Affiliation(s)
- M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - V Cordasco
- Department of Research, St. Clara Hospital, Basel, Switzerland
| | - R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - T Peters
- Department of Medecine, St. Clara Hospital, Basel, Switzerland
| | - M Slawik
- Department of Medecine, St. Clara Hospital, Basel, Switzerland
| | - B Wölnerhanssen
- Department of Research, St. Clara Hospital, Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
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14
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Schneider R, Schulenburg M, Kraljević M, Klasen JM, Peters T, Wölnerhanssen B, Peterli R. Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.038] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB.
Methods
Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, 493 without jejunal mesenteric defect closure, 292 with closure by non-absorbable suture with a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel, as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored.
Results
By primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5% to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery could reduce the rate of IH from 5.3% to 2.4%. Higher weight loss seemed to increase the risk of developing an IH.
Conclusion
The closure of the jejunal mesenteric defect by non-absorbable suture can reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, especially in patients with excellent weight loss. Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.
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Affiliation(s)
- R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - M Schulenburg
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - J M Klasen
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - T Peters
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital, Basel, Switzerland
| | - B Wölnerhanssen
- St. Clara Research Ltd, St. Clara Hospital, Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
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15
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Schneider R, Kraljević M, Peterson CJ, Lazaridis I, Rohm TV, Bosch AJT, Low AJY, Vonaesch P, Peterli R, Delko T, Cavelti-Weder C. Roux-en-Y gastric bypass with a long compared to a short biliopancreatic limb leads to better weight loss and glycemic control in obese mice. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Roux-en-Y gastric bypass (RYGB) shows durable long-term weight loss and control of comorbidities in randomized controlled trials. However, the impact of the proportions of the biliopancreatic limb (BPL) and the total alimentary limb (TALL) on weight loss or glucose metabolism is still unclear.
Methods
Six weeks old C57BL/6J mice were fed high fat diet (HFD) to induce obesity and glucose intolerance. Mice underwent RYGB surgery with a very-long BPL (35% of total bowel length [TBL]), long BPL (25% of TBL), short BPL (15 % of TBL), or sham surgery. The alimentary limb (AL) was adjusted in dependency on the BPL to achieve a fixed CC length. Glycemia was assessment by intraperitoneal glucose tolerance tests.
Results
Mice undergoing RYGB with a very-long BPL showed excessive weight loss and mortality and were therefore excluded for further analyses. Total weight loss (TWL%) was significantly higher in the long BPL- compared to short BPL-group. Mice with a long BPL showed significantly improved glucose tolerance 14 days postoperatively, while 35 days postoperatively, the improvement in glucose tolerance with a long BPL was much less distinctive.
Conclusion
RYGB with a longer BPL leads to improved results including weight loss and glucose tolerance. However, the metabolic improvements seem to decrease over time. These findings could potentially be translated to humans by adjusting the BPL according to body weight and comorbidities. To avoid possible negative effects of a longer BPL total bowel length measurement is mandatory.
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Affiliation(s)
- R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C J Peterson
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - I Lazaridis
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - T V Rohm
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - A J T Bosch
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - A J Y Low
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - P Vonaesch
- Swiss Tropical Health Institiute, Swiss Tropical Health and Public Health Institute, Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - T Delko
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Cavelti-Weder
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
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Marijanović I, Kraljević M, Buhovac T, Cerić T, Mekić Abazović A, Alidžanović J, Gojković Z, Sokolović E. Use of the Depression, Anxiety and Stress Scale (DASS-21) Questionnaire to Assess Levels of Depression, Anxiety, and Stress in Healthcare and Administrative Staff in 5 Oncology Institutions in Bosnia and Herzegovina During the 2020 COVID-19 Pandemic. Med Sci Monit 2021; 27:e930812. [PMID: 33867520 PMCID: PMC8063632 DOI: 10.12659/msm.930812] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Providing oncology services during a pandemic can contribute to mental health challenges among healthcare workers. The present study aimed to evaluate the levels of depression, anxiety, and stress in healthcare and administrative staff in 5 oncology institutions in Bosnia and Herzegovina (BiH) in 2020 during the coronavirus disease 2019 (COVID-19) pandemic using the Depression, Anxiety and Stress Scale (DASS-21) questionnaire. Material/Methods A cross-sectional observational study enrolled 175 healthcare and administrative workers from 5 oncology institutions in BiH during December 2020. Data were collected using a questionnaire that captured general information about the participants and a DASS-21 questionnaire. Results Statistical analysis revealed a statistically significant difference in the levels of depression, anxiety, and stress (P=0.003, P=0.011, and P=0.022, respectively) among participants with comorbidities connected with increased risk of severe illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with participants without comorbidities. There was also a statistically significant difference in the levels of stress among participants from different cities (P=0.031). Supplement intake and educational level were significantly related (P=0.012). High levels of stress and anxiety were accompanied by high levels of depression among participants (P<0.01). Conclusions The findings from the present study showed that the COVID-19 pandemic has had an effect on depression, anxiety, and stress levels in oncology staff in BiH. Monitoring these levels and providing interventions and support to oncology staff are increasingly important for their wellbeing and retention at a time of global crisis in healthcare.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Timur Cerić
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alma Mekić Abazović
- Department of Oncology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Jasmina Alidžanović
- Department of Oncology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zdenka Gojković
- Oncology Clinic, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Emir Sokolović
- Health Care Center of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina
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Kozomara D, Marijanović I, Šutalo N, Kraljević M, Buhovac T. Metastatic Malignant Melanoma Causing Small Bowel Intussusception: A Case Report with 4-year Follow-up. Acta Dermatovenerol Croat 2021; 291:35-38. [PMID: 34477061] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Primary mucosal malignant melanoma of the small bowel is extremely rare. The small bowel is mostly affected by metastases of the primary malignant melanoma of the skin. Bowel obstruction is a rare complication of metastatic melanoma. We present a case of small bowel obstruction in a 49-year-old man with history of skin malignant melanoma. A segmental resection of the ileum with termino-terminal anastomosis was performed. Pathohistological examination showed metastatic melanoma. After 4 years of follow-up, the patient is still free of the disease.
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Affiliation(s)
| | | | | | - Marija Kraljević
- Marija Kraljević, MD, , Department of Oncology University Clinical Hospital Mostar, , Kralja Tvrtka bb, 88000 Mostar, Bosnia and Herzegovina ;
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Marijanović I, Kraljević M, Jović Zlatović J, Buhovac T, Pavleković G. Tumour Size Distribution of Invasive Breast Cancer in a One-Year Period: Case Study Herzegovina. Psychiatr Danub 2020; 32:520-527. [PMID: 33212458] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND To analyse the early stage breast cancer tumour size distribution as an important prognostic factor among the female patients within our local geographic region of Herzegovina. SUBJECTS AND METHODS This cross-sectional retrospective study included 379 patients who were treated in 2017 at the Oncology Clinic, University Clinical Hospital Mostar. The patients were divided into two groups based on their primary tumour size: early (≤2 cm) and late (>2 cm) stage groups. RESULTS The number of patients tested for advanced stage tumours surpassing 2 cm was statistically higher (χ2=106,325; p<0.001). 39.32% (N=149) of the patients presented with tumours ≤2 cm (T1) and 52.24% (N=198) of the total number of the patients presented with tumours >2 cm but ≤5 cm in greatest dimension (T2). The patients' knowledge about breast cancer, availability and adherence of mammography did not show any statistically significant difference with regard to tumour size, while the number of patients with smaller tumours who indicated that they underwent regular mammography was statistically significantly higher (χ2=13,629; p<0.003). CONCLUSIONS Our data shows that in our region, more women with a diagnosis of breast cancer presented with a larger tumor size. Although there was no statistically significant difference with regard to prior knowledge about breast cancer and availability to mammography, this may be due to a small sample size. Our region does not have a screening mammogram program and this data suggests that the implementation of such a program may improve adherence to existing mammography guidelines which might capture tumors at a smaller size and hence an earlier stage.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Kralja Tvrtka bb, 88000 Mostar, Bosnia and Herzegovina,
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Marijanović I, Kraljević M, Buhovac T, Karan Križanac D. Rare Human Epidermal Growth Factor Receptor 2 (HER-2)-Positive Neuroendocrine Carcinoma of the Breast: A Case Report with 9-Year Follow-up. Am J Case Rep 2020; 21:e925895. [PMID: 33067411 PMCID: PMC7579747 DOI: 10.12659/ajcr.925895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neuroendocrine carcinoma of the breast (NECB) is very rare, accounting for 0.1% of all breast tumors and less than 1% of all neuroendocrine tumors. Most NECBs are hormone receptor-positive and human epidermal growth factor receptor 2 (HER-2)-negative and more than 50% are the luminal B subtype. Because prospective studies of NECB are lacking, treatment is the same as for other breast tumors. CASE REPORT A 70-year-old woman was diagnosed with NECB in February 2011. She underwent radical right mastectomy and right axillary node dissection. Final histopathological examination revealed NECB with positive axillary nodes (N1). The tumor cells were 100% positive for estrogen receptors and 10% positive for progesterone receptors. The HER-2 status was 3+. According to the Tumor, Node, Metastasis (TNM) Classification of Malignant Tumors, the pathologic stage was IIB - pT2pN1cM0. The histologic grade was 2 and the Ki-67 proliferation index was 5.7%. The patient received adjuvant chemotherapy, radiation therapy, IV trastuzumab, and endocrine therapy. After 9 years of follow-up, she remains disease-free. CONCLUSIONS As far as we know, this is only the second report describing treatment of HER-2-positive NECB with trastuzumab. A literature review shows that it is the first report of treatment of HER-2-positive primary NECB with adjuvant trastuzumab. In similar cases, long-term follow-up is recommended because of the potential for multiple metastases of NECB even years after completion of adjuvant therapy.
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Affiliation(s)
- Inga Marijanović
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Dragana Karan Križanac
- Department of Pathology, Cytology and Forensic Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Kozomara D, Babić D, Marijanović I, Kraljević M, Buhovac T. Workplace Stress in the University Clinical Settings: Comparison between the Cardiac Unit snd Emergency Center Medical Staff. Psychiatr Danub 2019; 31:796-804. [PMID: 32160175] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stress at work is a specific type of stress arising from the work environment. Stress of the medical staff has been investigated in recent years by the medical institutions of different countries. The aim of this study was to examine the stress levels in medical staff of Department of Cardiac Surgery and Center of emergency medicine (CEM) in the Clinical settings, and to compare them. SUBJECTS AND METHODS We conducted a cross-sectional study which included 55 patients between 21 and 50 years of age. The study group consisted of 30 employees from the Department of Cardiac Surgery of Mostar University Clinical Hospital, while the control group comprised 25 employees from the CEM. Research instruments were the Occupational Stress Questionnaire for Hospital Health Care Workers (OSQ-HHCW), General Health Questionnaire (GHQ 28) and a Stress MGMT-TEST A. RESULTS The subjects from the control group had significantly higher stress experience in "bombing" with new information (p=0.028), unavailability of literature (p=0.039), poor communication with superiors (p<0.001), conflicts with patients (p=0.042) and inappropriate public criticism (p=0.007). The highest stress level showed F1 group of stressors, concerning the organization of work and funding. CEM employees had statistically significantly higher level of stress on public criticism and lawsuits compared to the study group (p=0.013), as well as higher score on the anxiety/insomnia subscale (p<0.001), social dysfunction scale (p=0.002) and on the depression subscale (p<0.001). CONCLUSIONS Stressors from the group of organizational factors have proven to be the most common stressors in both groups. However, in some areas within the impact of workplace stress, CEM employees had significantly greater vulnerability compared to employees of the Department of cardiac surgery. Further studies are needed to establish the frequency and intensity of stress among health professionals, and to clearly determine the risk factors for its development.
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Affiliation(s)
- Davorin Kozomara
- Department of Plastic and Reconstructive Surgery, Surgery Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Matijević V, Barbarić B, Kraljević M, Milas I, Kolak J. GENDER DIFFERENCES IN NEURODEVELOPMENTAL OUTCOMES AMONG FULL-TERM INFANTS WITH INTRAVENTRICULAR HEMORRHAGE. Acta Clin Croat 2019; 58:107-112. [PMID: 31363332 PMCID: PMC6629191 DOI: 10.20471/acc.2019.58.01.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/29/2022] Open
Abstract
Intraventricular hemorrhage (IVH) is usually associated with premature infants; however, it has been estimated to occur in up to 5% of infants born at term and may be associated with different prenatal, perinatal and postnatal risk factors. The present retrospective study included toddlers aged 13-24 months, born at term (≥36 weeks), referred to the Department of Rheumatology, Physical Medicine and Rehabilitation in Zagreb, Croatia, because they had at least two risk factors for neurodevelopmental delay. A total of 63 patients without hemorrhage were control subjects, while 103 case patients were children with IVH. The ordinal logistic regression revealed that neurodevelopmental outcome in term infants was associated with IVH grade (p<0.05). Although more boys than girls suffered from severe IVH (grades III and IV), there were no statistically significant gender differences in the distribution of IVH or in neurodevelopmental outcomes (p>0.05).
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Affiliation(s)
| | - Bernarda Barbarić
- 1Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Croatian Institute of Public Health, Vinkovci, Croatia
| | - Marija Kraljević
- 1Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Croatian Institute of Public Health, Vinkovci, Croatia
| | - Ivan Milas
- 1Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Croatian Institute of Public Health, Vinkovci, Croatia
| | - Juraj Kolak
- 1Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Croatian Institute of Public Health, Vinkovci, Croatia
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Zeljko Penavić J, Šimić D, Petrušić I, Kraljević M, Sulić AM. The Usage of Hypoallergenic Cosmetics in Patients with Atopic Dermatitis. Acta Dermatovenerol Croat 2018; 26:105-108. [PMID: 29989865] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of this study was to investigate how many patients with atopic dermatitis applied hypoallergenic cosmetics compared with topical corticosteroids. The study included 41 patients with atopic dermatitis (AD) who were treated from June 1 to July 1, 2017 at the Department of Dermatology and Venerology, Clinical Hospital Mostar. According to the data analyzed, 46.34% of patients used hypoallergenic cosmetics while 24.39% used them periodically. 32.7% patients used topical corticosteroids and 17.07 % used them periodically. 19.51 % of the patients with atopic dermatitis used alternative products, while 17.07% used them periodically. Out of the total number of patients, most of the patients used neutral products. 78.05% used neutral cosmetic products, and 19.51 % used them periodically. 65.85 % patients used sunscreens and 24.40 % used them periodically. The majority of patients used neutral cosmetic products and sunscreens. There was no statistically significant difference in the frequency of the use hypoallergenic cosmetics compared with topical corticosteroids (χ2 = 1.802; df = 2; P=0.405). Women used sunscreens more often (χ2 = 16,02; df = 1; p = <0,05).
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Affiliation(s)
- Jasna Zeljko Penavić
- Assist. Prof. Jasna Zeljko Penavić, MD, PhD, Department of Dermatology and Venerology, University Clinical Hospital Mostar, Kralja Tvrtka bb, 88 000 Mostar, Bosnia and Herzegovina;
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Morović ML, Matijević V, Divljaković K, Kraljević M, Dimić Z. DRAWING SKILLS IN CHILDREN WITH NEURODEVELOPMENTAL DELAY AGED 2-5 YEARS. Acta Clin Croat 2015; 54:119-126. [PMID: 26415307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
In typically developing children, drawing development occurs in stages from uncontrolled strokes to complex drawing. In this study, we examined drawing development in children with neurodevelopmental delay (NDD). In order to do so, we observed the influence of age, intraventricular hemorrhage (IVH) and gender on the development of drawing skills. The sample consisted of 52 children with NDD, aged 2 years and 6 months to 5 years. All children were hospitalized for multidisciplinary team monitoring and developmental support. The evaluation of drawing development was administered by giving each child a blank A4 paper and the instruction to draw anything they wanted. All of the drawings were scored satisfactory or unsatisfactory. Descriptive statistics was employed on all relevant data to show results in frequencies and percentages. In order to determine differences between groups, the χ2-test was administered. The results showed greatest difference in drawing in children aged from 3 years to 3 years and 11 months. Children with lower IVH had better drawing scores than children with higher IVH levels. According to gender dissimilarities, a difference was found showing girls to have better drawing skills than boys. All study results pointed to the importance of early rehabilitation and continuous structured work with children with NDD.
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