The Journal of Heart and Lung Transplantation, 2016
Purpose: Cytomegalovirus (CMV) infection has been implicated in a number of complications after h... more Purpose: Cytomegalovirus (CMV) infection has been implicated in a number of complications after heart transplant. Our study aim was to determine the effects of CMV donor-recipient status in a large cohort of patients undergoing heart transplant. Methods: All adult heart transplants from 2000 to 2012 were identified using the United Network for Organ Sharing (UNOS) database. Patients were grouped accordingly to donor and recipient CMV status: Donor+/Recipient+ (D+/R+), Donor+/Recipient-(D+/R-), Donor-/Recipient-(D-/R-) and Donor-/Recipient+ (D-/R+). We further analyzed HLA mismatch and outcomes in these four groups. Kaplan-Meir survival curves were analyzed for 10-year survival. Cox proportional hazard models were performed to determine predictors of mortality. P-values< 0.05 were considered significant. Results: A total of 20,783 patients receiving a heart transplant were analyzed, 75% were male, 72% Caucasian and 42% had ischemic cardiomyopathy. Of the total cohort, 7,963 (38%) were D+/R+, 4,839 (24%) D+/R-, 4,847 (23%) D-/R+ and 3,134 (15%) D-/R-. Ten year censored survival estimates differed significantly (p< 0.05) between all donor/recipient CMV status groups with the exception of D+/R+ vs. D+/R-(p= 0.372) and D-/ R+ vs. D-/R-(p= 0.062; figure A). When compared to D-/R-patients, the group with the greatest hazard for mortality was the D+/R+ (HR= 1.24 95%CI:1.1-1.3; p-value< 0.01) followed by the D+/R-(HR= 1.20 95%CI: 1.1-1.3; p-value< 0.01). In the D+/R+ group the presence of ≥ 5 HLA mismatches further increased mortality while it had no effect on the other groups (p-value< 0.01, figure B). Conclusion: Our analysis has demonstrated that in a large cohort of patients, CMV positive donor status is associated with worse outcomes, independent of CMV status of the recipient. In those with CMV D+/R+ status having a ≥ 5 HLA mismatches significantly increases mortality.
Background Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic ap... more Background Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. Case presentation A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. Conclusion Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.
SummaryObstructive sleep apnea is the most common sleep‐related breathing disorder worldwide and ... more SummaryObstructive sleep apnea is the most common sleep‐related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
Advanced research in gastroenterology & hepatology, Feb 6, 2017
H. pylori infection represents a limiting factor in the access to bariatric surgery irrespective ... more H. pylori infection represents a limiting factor in the access to bariatric surgery irrespective to the type of surgical procedure. Preoperative H. pylori screening and eradication is recommended to improve outcomes after bariatric surgery and to cure H. pylori related disease (gastric and extra gastric manifestations) and long term sequences of the infection. The impact of H. pylori in the pathophysiology of obesity, the role of infection in production and secretion of the orexigenic hormone ghrelin and subsequent clinical manifestations of H. pylori infection in obese population is still debated. Lower eradication rates with standard therapeutic regimens reported in obese patients than in the normal-weight population postpone bariatric surgery and related complications and is also to worse long term results. Improvement of eradication strategies and clinical approach is needed improve short and long term outcomes in bariatric surgery patients. Tailored regimen with dose adjustment to BMI might offer a proper clinical approach as presented in small retrospective clinical study.
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2009
Izhodišča Hirschsprungova bolezen (aganglionarni megakolon) je v 75 % umeščena v rektosigmoidalne... more Izhodišča Hirschsprungova bolezen (aganglionarni megakolon) je v 75 % umeščena v rektosigmoidalnem prehodu. Metode Namen vseh transanalnih kirurških tehnik, ki jih pri kirurškem zdravljenju bolezni lahko uporabljamo, je, da spojimo zdravi segment debelega črevesa z anusom. Operacije, ki jih v ta namen lahko napravimo, imenujemo enostopenjski poseg tj. »pull-through« brez laparotomije. Rezultati Operacija po De la Torre-Mondragonu daje zelo dobre klinične rezultate, omogoča zgodin zaključki nje pooperativno hranjenje, kratko hospitalizacijo in ne pušča vidnih brazgotin. Večina bolnikov, pri katerih napravimo enega od standardnih enostopenjskih »pull-through« posegov, je sposobna zavestnega zadrževanja blata (kontinenca), saj ohranimo normalno delovanje medeničnega dna. Čistost pri teh bolnikih je odvisna od intenzitete privajanja, funkcionalne kontinence, socialnega okolja in pridruženih bolezni, predvsem v smislu inteligenčnega primanjkljaja. Ključne besede Hirschsprungova bolezen; transanalna resekcija (»pull-through«); De la Torre-Mondragon
Background Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or ... more Background Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or changed composition of bacteria in the small bowel. Obese patients are at increased risk of SIBO and related complications. The purpose of this study is to evaluate the incidence of SIBO after bariatric bypass procedures, connection between SIBO, symptoms, comorbidities, and liver pathology. Methods Patients underwent a hydrogen breath test with glucose substrate (25 g/200 ml of water). The demographic, anthropometric data, comorbidities, and symptoms were analysed with a questionnaire. In 45 patients, the NAFLD Activity Score was evaluated in liver biopsies. Results Glucose breath test was positive in 24/56 (43%) of patients and was associated with higher frequency of defecation (p = 0.022), lactose intolerance (p = 0.047), scleroderma (p = 0.042), irritable bowel syndrome (p = 0.018), and diabetes (p = 0.002). Mean NAFLD Activity Score in SIBO patients (n = 18) was 3.33 and 3.00 in non-SIBO patients (n = 27). In SIBO-positive cohort of patients, a statistically important trend in difference between NAS and difference to range value anti-Xa 4 h after subtherapeutic dose application was calculated. Conclusions The incidence of SIBO after bariatric surgery bypass procedures is alarmingly high (43%). The results of our study conclude that diagnosis cannot be set based on specific symptom and SIBO is related to reduced response to the application of LMWH. Mandatory SIBO screening and appropriate treatment would affect the clinical outcome of the underlying disease, improve it significantly, and prevent the development of its complications.
Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver ... more Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non‐alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non‐alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non‐liver‐related complications.
This declaration, signed by an interdisciplinary task force of 234 experts from 83 different coun... more This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages. A ntimicrobial resistance (AMR) has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health, and food security. The substantial problem of AMR is especially relevant to antibiotic resistance (ABR), although antifungal resistance is increasing at an alarming rate. Although the phenomenon of ABR can be attributed to many factors, there is a well-established relationship between antibiotic prescribing practices and the emergence of resistant bacteria. This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by AMR and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections.
Primary hyperoxaluria type 1 (PH1) is a rare metabolic disorder caused by a defect in glyoxylate ... more Primary hyperoxaluria type 1 (PH1) is a rare metabolic disorder caused by a defect in glyoxylate metabolism attributable to low or absent activity of the liver-specific peroxisomal enzyme alanine/glyoxylate aminotransferase. This defect leads to enhanced conversion of glyoxylate to poorly soluble oxalate, which is then excreted into the urine. This process may lead to deposition of calcium oxalate crystals in many tissues as well as in the kidneys, resulting in nephrolithiasis, nephrocalcinosis, and/or renal failure. We present a 39-year-old patient with end-stage renal failure due to PH1, who was admitted with symptoms of feeling bloated, vomiting, diarrhea, and abdominal pain related to encapsulating peritoneal sclerosis (EPS). He had been treated with peritoneal dialysis for a total period of 5 years. EPS is a rare condition characterized by fibrosis and adhesions of the peritoneum to loops of the small intestine and has been described secondary to treatment with peritoneal dialy...
The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter inv... more The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.
Laparoscopic insertion of a percutaneous gastrostomy prevented malnutrition in a patient with pre... more Laparoscopic insertion of a percutaneous gastrostomy prevented malnutrition in a patient with previous Roux-enY gastric bypass
Izhodišče: Z dokazi podprte smernice za antibiotično zaščito so namenjene zmanjšanju incidence po... more Izhodišče: Z dokazi podprte smernice za antibiotično zaščito so namenjene zmanjšanju incidence pooperacijskih zapletov in hkrati zmanjšanju nepravilnega predpisovanja antibiotikov. Smernice zajemajo prikaz dejavnikov tveganja za pojav okužbe kirurške rane (OKR), koristi in dejavnike tveganja antibiotične zaščite, indikacije za antibiotično zaščito v abdominalni kirurgiji in priporočila za zdravljenje. Posodobitev priporočil za antibiotično kirurško profilakso (AKP) je namenjena pravilni uporabi antibiotične zaščite pri različnih kirurških posegih. Priporočila zajemajo najpogostejše kirurške posege v abdominalni kirurgiji. Antibiotična kirurška profilaksa je pripomoček in ne nadomestilo za dobro kirurško tehniko. Antibiotična profilaksa je pomembna komponenta učinkovitega sistema, ki je namenjen nadzoru in preprečevanju okužb, ki so povezane z zdravljenjem v zdravstvenih ustanovah.
Purpose: Current discoveries imply a connection between periodontitis and metabolic associated fa... more Purpose: Current discoveries imply a connection between periodontitis and metabolic associated fatty liver disease (MAFLD). This study aimed to determine the prevalence of periodontitis and MAFLD in obese patients with BMI >40, employing the most reliable diagnostic methods, namely liver biopsy, and detailed periodontal examination. Materials and methods: Liver biopsy and periodontal examination were performed in 30 obese patients with BMI BMI >40 undergoing bariatric surgery. Kleiner's classification was used to determine non-alcoholic steatohepatitis (NAS) activity score, non-alcoholic steatohepatitis (NASH) and liver fibrosis. The periodontal condition was classified following the recent AAP/EFP classification. Patients were divided into periodontitis (PG) and non-periodontitis groups (NPG). Data on systemic health parameters were collected from patients' medical records. Descriptive statistics and simple statistical tests were used to determine the differences between the two groups. Results: The prevalence of NASH in the sample was 43% (13/30), borderline NASH 37% (11/30), while fibrosis stage 1 was most common (72%, [22/30]). Periodontitis prevalence was 67% (20/30), while all non-periodontitis patients (33%; 10/30) exhibited gingivitis. PG and NPG did not differ in NAS or NASH prevalence (p > 0.05). However, the periodontitis group showed higher C-reactive protein levels, while NPG showed higher gamma-glutamyl transpeptidase levels (p < 0.05). Conclusion: The study results suggest the considerable prevalence of MAFLD, periodontitis and gingivitis in obese patients with BMI >40 undergoing bariatric surgery. Patients with periodontitis had higher CRP levels, while those with gingivitis presented higher gamma-glutamyl transpeptidase levels.
Background: Laparoscopic sleeve gastrectomy (LSG) is an innovative and relatively safe surgical a... more Background: Laparoscopic sleeve gastrectomy (LSG) is an innovative and relatively safe surgical approach for weight reduction in morbidly obese people. Splanchnic vein thrombosis (SVT) is an extremely rare complication of LSG and, if not recognized, carries a high mortality rate. This paper highlights a potentially lethal condition of SVT after LSG. Case Report: A 37-year-old morbidly obese woman was referred to our institution for LSG. Three weeks after the intervention, she was readmitted with abdominal pain, vomiting, nausea, diarrhea, and fever with positive family anamnesis to viral disease. Abdominal X-ray as well as utrasonography were both normal, and no X-ray contrast medium leakage was observed. One week later, she was readmitted with septic condition. An abdominal computed tomography scan diagnosed lienal vein thrombosis along its whole length and partial thrombosis of the superior mesenteric vein. Conclusion: SVT presents very heterogeneously, which makes it extremely challenging to diagnose and to make an appropriate treatment decision. With regard to the high prevalence of obesity and the increasing frequency of LSG, prompt diagnosis and management are crucial.
Journal of International Medical Research, Apr 24, 2018
High-quality data indicating the advantages of preoperative Helicobacter pylori screening and era... more High-quality data indicating the advantages of preoperative Helicobacter pylori screening and eradication as well the clinical outcomes of patients with and without H. pylori after bariatric surgery are lacking. Methods: In total, 96 morbidly obese patients with H. pylori preparing for bariatric surgery were retrospectively reviewed. Results: Of 96 biopsy specimens, 73 (76%) were positive for H. pylori on initial Giemsa staining. These patients were treated with the standard 7-day antibiotic treatment protocol corrected by the individual patient's creatinine clearance rate and body mass index and received a 30% higher dose because of their H. pylori positivity. A linear correlation was found between the effective antibiotic dose and the BMI with a recurrence rate of only 2.1% (2/96 patients). The preoperative percent estimated weight loss before surgery (17%) and in the first year of follow-up (68%-88%) was statistically equal between H. pylori-positive and-negative patients. Two early postoperative infectious complications and two postoperative surgical complications occurred in the preoperatively H. pyloripositive patients. Conclusions: A patient-tailored H. pylori eradication protocol prior to bariatric surgery is mandatory to improve the eradication rate and reduce the incidence of postoperative complications in mostly asymptomatic H. pylori-positive bariatric candidates.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Rationale: Several studies indicated that self-efficacy can be used as a predictor of weight chan... more Rationale: Several studies indicated that self-efficacy can be used as a predictor of weight change. We hypothesized that participants with higher self efficacy can lose more weight. Methods: This study was conducted among 30 premenopausal women, aged 20e50 years old and had body mass index (BMI) 30 kg/m 2. Each participant received a balanced meal plan according to their requirements through reduced energy intake. Weight, height and body composition were measured at baseline and every 2 weeks during the 8 weeks. To find out the self efficacy status of the participants Weight Efficacy Lifestyle Questionnaire (WEL test) was applied at baseline and at the end of 8 weeks. Lower WEL scores indicates better self efficacy. Participants were divided into groups according to their weight loss success (<5%, "lost less weight-LLW" or 5%, "lost more weight-LMW" of initial weight). Statistical analysis were performed using the IBM SPSS software version 23. Results: At baseline,women were 35,7±8,7 years with a mean of BMI 35,9±5,2 kg/m 2. Participants lost 5,6 kg ±2,2 kg or 6,5±3,1% and decreased from initial mean in weight 89,7±16,1 kg to 84,1±16,6 kg at the end of 8 weeks (p<0,001). This corresponded to a reduction in BMI (p<0,001). It was observed that the WEL scores of the participants decreased from 52,9±17,7 to 36,9±9,2 (p<0,001) in comparison with the initial and the last values. Furthermore when participants were divided into groups based on weight loss success LMW group demonstrated lower WEL scores meaning that better self efficacy (p<0,05). Conclusions: Our study showed that self efficacy plays an important role in the success of weight loss. Identifying the possible effects of self efficacy will be useful in the treatment of obesity. Furthermore there is a possibility that psychological support can positively affect weight loss in relationship with self efficacy. Disclosure of interest: None declared.
The Journal of Heart and Lung Transplantation, 2016
Purpose: Cytomegalovirus (CMV) infection has been implicated in a number of complications after h... more Purpose: Cytomegalovirus (CMV) infection has been implicated in a number of complications after heart transplant. Our study aim was to determine the effects of CMV donor-recipient status in a large cohort of patients undergoing heart transplant. Methods: All adult heart transplants from 2000 to 2012 were identified using the United Network for Organ Sharing (UNOS) database. Patients were grouped accordingly to donor and recipient CMV status: Donor+/Recipient+ (D+/R+), Donor+/Recipient-(D+/R-), Donor-/Recipient-(D-/R-) and Donor-/Recipient+ (D-/R+). We further analyzed HLA mismatch and outcomes in these four groups. Kaplan-Meir survival curves were analyzed for 10-year survival. Cox proportional hazard models were performed to determine predictors of mortality. P-values< 0.05 were considered significant. Results: A total of 20,783 patients receiving a heart transplant were analyzed, 75% were male, 72% Caucasian and 42% had ischemic cardiomyopathy. Of the total cohort, 7,963 (38%) were D+/R+, 4,839 (24%) D+/R-, 4,847 (23%) D-/R+ and 3,134 (15%) D-/R-. Ten year censored survival estimates differed significantly (p< 0.05) between all donor/recipient CMV status groups with the exception of D+/R+ vs. D+/R-(p= 0.372) and D-/ R+ vs. D-/R-(p= 0.062; figure A). When compared to D-/R-patients, the group with the greatest hazard for mortality was the D+/R+ (HR= 1.24 95%CI:1.1-1.3; p-value< 0.01) followed by the D+/R-(HR= 1.20 95%CI: 1.1-1.3; p-value< 0.01). In the D+/R+ group the presence of ≥ 5 HLA mismatches further increased mortality while it had no effect on the other groups (p-value< 0.01, figure B). Conclusion: Our analysis has demonstrated that in a large cohort of patients, CMV positive donor status is associated with worse outcomes, independent of CMV status of the recipient. In those with CMV D+/R+ status having a ≥ 5 HLA mismatches significantly increases mortality.
Background Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic ap... more Background Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. Case presentation A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. Conclusion Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.
SummaryObstructive sleep apnea is the most common sleep‐related breathing disorder worldwide and ... more SummaryObstructive sleep apnea is the most common sleep‐related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
Advanced research in gastroenterology & hepatology, Feb 6, 2017
H. pylori infection represents a limiting factor in the access to bariatric surgery irrespective ... more H. pylori infection represents a limiting factor in the access to bariatric surgery irrespective to the type of surgical procedure. Preoperative H. pylori screening and eradication is recommended to improve outcomes after bariatric surgery and to cure H. pylori related disease (gastric and extra gastric manifestations) and long term sequences of the infection. The impact of H. pylori in the pathophysiology of obesity, the role of infection in production and secretion of the orexigenic hormone ghrelin and subsequent clinical manifestations of H. pylori infection in obese population is still debated. Lower eradication rates with standard therapeutic regimens reported in obese patients than in the normal-weight population postpone bariatric surgery and related complications and is also to worse long term results. Improvement of eradication strategies and clinical approach is needed improve short and long term outcomes in bariatric surgery patients. Tailored regimen with dose adjustment to BMI might offer a proper clinical approach as presented in small retrospective clinical study.
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2009
Izhodišča Hirschsprungova bolezen (aganglionarni megakolon) je v 75 % umeščena v rektosigmoidalne... more Izhodišča Hirschsprungova bolezen (aganglionarni megakolon) je v 75 % umeščena v rektosigmoidalnem prehodu. Metode Namen vseh transanalnih kirurških tehnik, ki jih pri kirurškem zdravljenju bolezni lahko uporabljamo, je, da spojimo zdravi segment debelega črevesa z anusom. Operacije, ki jih v ta namen lahko napravimo, imenujemo enostopenjski poseg tj. »pull-through« brez laparotomije. Rezultati Operacija po De la Torre-Mondragonu daje zelo dobre klinične rezultate, omogoča zgodin zaključki nje pooperativno hranjenje, kratko hospitalizacijo in ne pušča vidnih brazgotin. Večina bolnikov, pri katerih napravimo enega od standardnih enostopenjskih »pull-through« posegov, je sposobna zavestnega zadrževanja blata (kontinenca), saj ohranimo normalno delovanje medeničnega dna. Čistost pri teh bolnikih je odvisna od intenzitete privajanja, funkcionalne kontinence, socialnega okolja in pridruženih bolezni, predvsem v smislu inteligenčnega primanjkljaja. Ključne besede Hirschsprungova bolezen; transanalna resekcija (»pull-through«); De la Torre-Mondragon
Background Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or ... more Background Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or changed composition of bacteria in the small bowel. Obese patients are at increased risk of SIBO and related complications. The purpose of this study is to evaluate the incidence of SIBO after bariatric bypass procedures, connection between SIBO, symptoms, comorbidities, and liver pathology. Methods Patients underwent a hydrogen breath test with glucose substrate (25 g/200 ml of water). The demographic, anthropometric data, comorbidities, and symptoms were analysed with a questionnaire. In 45 patients, the NAFLD Activity Score was evaluated in liver biopsies. Results Glucose breath test was positive in 24/56 (43%) of patients and was associated with higher frequency of defecation (p = 0.022), lactose intolerance (p = 0.047), scleroderma (p = 0.042), irritable bowel syndrome (p = 0.018), and diabetes (p = 0.002). Mean NAFLD Activity Score in SIBO patients (n = 18) was 3.33 and 3.00 in non-SIBO patients (n = 27). In SIBO-positive cohort of patients, a statistically important trend in difference between NAS and difference to range value anti-Xa 4 h after subtherapeutic dose application was calculated. Conclusions The incidence of SIBO after bariatric surgery bypass procedures is alarmingly high (43%). The results of our study conclude that diagnosis cannot be set based on specific symptom and SIBO is related to reduced response to the application of LMWH. Mandatory SIBO screening and appropriate treatment would affect the clinical outcome of the underlying disease, improve it significantly, and prevent the development of its complications.
Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver ... more Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non‐alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non‐alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non‐liver‐related complications.
This declaration, signed by an interdisciplinary task force of 234 experts from 83 different coun... more This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages. A ntimicrobial resistance (AMR) has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health, and food security. The substantial problem of AMR is especially relevant to antibiotic resistance (ABR), although antifungal resistance is increasing at an alarming rate. Although the phenomenon of ABR can be attributed to many factors, there is a well-established relationship between antibiotic prescribing practices and the emergence of resistant bacteria. This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by AMR and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections.
Primary hyperoxaluria type 1 (PH1) is a rare metabolic disorder caused by a defect in glyoxylate ... more Primary hyperoxaluria type 1 (PH1) is a rare metabolic disorder caused by a defect in glyoxylate metabolism attributable to low or absent activity of the liver-specific peroxisomal enzyme alanine/glyoxylate aminotransferase. This defect leads to enhanced conversion of glyoxylate to poorly soluble oxalate, which is then excreted into the urine. This process may lead to deposition of calcium oxalate crystals in many tissues as well as in the kidneys, resulting in nephrolithiasis, nephrocalcinosis, and/or renal failure. We present a 39-year-old patient with end-stage renal failure due to PH1, who was admitted with symptoms of feeling bloated, vomiting, diarrhea, and abdominal pain related to encapsulating peritoneal sclerosis (EPS). He had been treated with peritoneal dialysis for a total period of 5 years. EPS is a rare condition characterized by fibrosis and adhesions of the peritoneum to loops of the small intestine and has been described secondary to treatment with peritoneal dialy...
The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter inv... more The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.
Laparoscopic insertion of a percutaneous gastrostomy prevented malnutrition in a patient with pre... more Laparoscopic insertion of a percutaneous gastrostomy prevented malnutrition in a patient with previous Roux-enY gastric bypass
Izhodišče: Z dokazi podprte smernice za antibiotično zaščito so namenjene zmanjšanju incidence po... more Izhodišče: Z dokazi podprte smernice za antibiotično zaščito so namenjene zmanjšanju incidence pooperacijskih zapletov in hkrati zmanjšanju nepravilnega predpisovanja antibiotikov. Smernice zajemajo prikaz dejavnikov tveganja za pojav okužbe kirurške rane (OKR), koristi in dejavnike tveganja antibiotične zaščite, indikacije za antibiotično zaščito v abdominalni kirurgiji in priporočila za zdravljenje. Posodobitev priporočil za antibiotično kirurško profilakso (AKP) je namenjena pravilni uporabi antibiotične zaščite pri različnih kirurških posegih. Priporočila zajemajo najpogostejše kirurške posege v abdominalni kirurgiji. Antibiotična kirurška profilaksa je pripomoček in ne nadomestilo za dobro kirurško tehniko. Antibiotična profilaksa je pomembna komponenta učinkovitega sistema, ki je namenjen nadzoru in preprečevanju okužb, ki so povezane z zdravljenjem v zdravstvenih ustanovah.
Purpose: Current discoveries imply a connection between periodontitis and metabolic associated fa... more Purpose: Current discoveries imply a connection between periodontitis and metabolic associated fatty liver disease (MAFLD). This study aimed to determine the prevalence of periodontitis and MAFLD in obese patients with BMI >40, employing the most reliable diagnostic methods, namely liver biopsy, and detailed periodontal examination. Materials and methods: Liver biopsy and periodontal examination were performed in 30 obese patients with BMI BMI >40 undergoing bariatric surgery. Kleiner's classification was used to determine non-alcoholic steatohepatitis (NAS) activity score, non-alcoholic steatohepatitis (NASH) and liver fibrosis. The periodontal condition was classified following the recent AAP/EFP classification. Patients were divided into periodontitis (PG) and non-periodontitis groups (NPG). Data on systemic health parameters were collected from patients' medical records. Descriptive statistics and simple statistical tests were used to determine the differences between the two groups. Results: The prevalence of NASH in the sample was 43% (13/30), borderline NASH 37% (11/30), while fibrosis stage 1 was most common (72%, [22/30]). Periodontitis prevalence was 67% (20/30), while all non-periodontitis patients (33%; 10/30) exhibited gingivitis. PG and NPG did not differ in NAS or NASH prevalence (p > 0.05). However, the periodontitis group showed higher C-reactive protein levels, while NPG showed higher gamma-glutamyl transpeptidase levels (p < 0.05). Conclusion: The study results suggest the considerable prevalence of MAFLD, periodontitis and gingivitis in obese patients with BMI >40 undergoing bariatric surgery. Patients with periodontitis had higher CRP levels, while those with gingivitis presented higher gamma-glutamyl transpeptidase levels.
Background: Laparoscopic sleeve gastrectomy (LSG) is an innovative and relatively safe surgical a... more Background: Laparoscopic sleeve gastrectomy (LSG) is an innovative and relatively safe surgical approach for weight reduction in morbidly obese people. Splanchnic vein thrombosis (SVT) is an extremely rare complication of LSG and, if not recognized, carries a high mortality rate. This paper highlights a potentially lethal condition of SVT after LSG. Case Report: A 37-year-old morbidly obese woman was referred to our institution for LSG. Three weeks after the intervention, she was readmitted with abdominal pain, vomiting, nausea, diarrhea, and fever with positive family anamnesis to viral disease. Abdominal X-ray as well as utrasonography were both normal, and no X-ray contrast medium leakage was observed. One week later, she was readmitted with septic condition. An abdominal computed tomography scan diagnosed lienal vein thrombosis along its whole length and partial thrombosis of the superior mesenteric vein. Conclusion: SVT presents very heterogeneously, which makes it extremely challenging to diagnose and to make an appropriate treatment decision. With regard to the high prevalence of obesity and the increasing frequency of LSG, prompt diagnosis and management are crucial.
Journal of International Medical Research, Apr 24, 2018
High-quality data indicating the advantages of preoperative Helicobacter pylori screening and era... more High-quality data indicating the advantages of preoperative Helicobacter pylori screening and eradication as well the clinical outcomes of patients with and without H. pylori after bariatric surgery are lacking. Methods: In total, 96 morbidly obese patients with H. pylori preparing for bariatric surgery were retrospectively reviewed. Results: Of 96 biopsy specimens, 73 (76%) were positive for H. pylori on initial Giemsa staining. These patients were treated with the standard 7-day antibiotic treatment protocol corrected by the individual patient's creatinine clearance rate and body mass index and received a 30% higher dose because of their H. pylori positivity. A linear correlation was found between the effective antibiotic dose and the BMI with a recurrence rate of only 2.1% (2/96 patients). The preoperative percent estimated weight loss before surgery (17%) and in the first year of follow-up (68%-88%) was statistically equal between H. pylori-positive and-negative patients. Two early postoperative infectious complications and two postoperative surgical complications occurred in the preoperatively H. pyloripositive patients. Conclusions: A patient-tailored H. pylori eradication protocol prior to bariatric surgery is mandatory to improve the eradication rate and reduce the incidence of postoperative complications in mostly asymptomatic H. pylori-positive bariatric candidates.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Rationale: Several studies indicated that self-efficacy can be used as a predictor of weight chan... more Rationale: Several studies indicated that self-efficacy can be used as a predictor of weight change. We hypothesized that participants with higher self efficacy can lose more weight. Methods: This study was conducted among 30 premenopausal women, aged 20e50 years old and had body mass index (BMI) 30 kg/m 2. Each participant received a balanced meal plan according to their requirements through reduced energy intake. Weight, height and body composition were measured at baseline and every 2 weeks during the 8 weeks. To find out the self efficacy status of the participants Weight Efficacy Lifestyle Questionnaire (WEL test) was applied at baseline and at the end of 8 weeks. Lower WEL scores indicates better self efficacy. Participants were divided into groups according to their weight loss success (<5%, "lost less weight-LLW" or 5%, "lost more weight-LMW" of initial weight). Statistical analysis were performed using the IBM SPSS software version 23. Results: At baseline,women were 35,7±8,7 years with a mean of BMI 35,9±5,2 kg/m 2. Participants lost 5,6 kg ±2,2 kg or 6,5±3,1% and decreased from initial mean in weight 89,7±16,1 kg to 84,1±16,6 kg at the end of 8 weeks (p<0,001). This corresponded to a reduction in BMI (p<0,001). It was observed that the WEL scores of the participants decreased from 52,9±17,7 to 36,9±9,2 (p<0,001) in comparison with the initial and the last values. Furthermore when participants were divided into groups based on weight loss success LMW group demonstrated lower WEL scores meaning that better self efficacy (p<0,05). Conclusions: Our study showed that self efficacy plays an important role in the success of weight loss. Identifying the possible effects of self efficacy will be useful in the treatment of obesity. Furthermore there is a possibility that psychological support can positively affect weight loss in relationship with self efficacy. Disclosure of interest: None declared.
Uploads
Papers by Tadeja Pintar