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We aimed to assess the level of obesity knowledge among first-year and final-year medical students in Croatia (future medical workforce) in order to identify the potential gaps and to lay a basis for tailoring and updating medical educational programme/curriculum, as well as additional national public health and stewardship activities.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of contrast‐enhanced ultrasound (CEUS) for the diagnosis of HCC of any size and at any stage in people with chronic advanced liver disease.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the beneficial and harmful effects of pegylated interferon for patients with acute hepatitis C.

Non-alcoholic fatty liver disease (NAFLD) is an important factor in the pathogenesis of cardiovascular diseases in the general population. Recently, it has been shown that NAFLD is highly prevalent in chronic kidney disease (CKD) patients. Ninety-four hemodialysis (HD) patients were followed for a time period of 18 months or until death. Patient's survival rate was determined in relation to their nutritional and inflammatory state, and the presence of NAFLD. We also investigated the association between the presence of NAFLD and the patients' nutritional and inflammatory state. We did not find any significant association between the clinical parameters of nutritional status and the mortality rate. However, the mortality rate was statistically significantly higher in patients with low serum albumin and high high-sensitive C-reactive protein (hs-CRP) levels and in those who had NAFLD. Surprisingly, patients who had received enteral nutrition did not have a better survival rate. The severity of liver steatosis was negatively correlated with the serum albumin levels, while it was positively correlated with hs-CRP values. Furthermore, serum albumin levels showed a negative correlation with hs-CRP levels. We did not find any significant association between the presence of NAFLD and clinical parameters of nutrition. We have shown that NAFLD could be one more possible example of reverse epidemiology in patients undergoing HD. NAFLD may be the missing link that causally ties malnutrition, inflammation, and atherosclerosis syndrome to the morbidity and mortality in patients undergoing HD.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To determine and compare the diagnostic accuracy in terms of sensitivity and specificity of different serological markers for diagnosis of primary biliary cholangitis in people suspected of having the disease. To investigate variation in the diagnostic accuracy of AMA, ANA, anti‐M2, anti‐sp100, anti‐gp210, anti‐PML, anti‐sp140, and anti‐EPO antibodies according to the following potential sources of heterogeneity. 1. Studies at low risk of bias versus studies with unclear or high risk of bias (as assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool) (Table 1). 2. Full‐text publications versus abstracts (this may indicate publication bias if there is an association between the results of the study and the study reaching full publication) (Eloubeidi 2001). 3. Prospective versus retrospective studies. 4. The prevalence of people who are symptomatic versus people who are asymptomatic (the presence of symptoms may increase the pretest probability). People who are symptomatic will be defined as people with fatigue (lasting more than three months; anaemia and hypothyroidism excluded), pruritus, jaundice, and abdominal pain in the absence of biliary stones, oesophageal varices, ascites, and liver failure (Prince 2004; AASLD 2009). 5. Studies that included 30% or less of participants with other autoimmune diseases versus studies that included more than 30% of such participants. 6. Detection of index tests by different types of immunoassays. 7. Diagnostic accuracy of anti‐M2, ANA, anti‐sp100, anti‐gp210, anti‐PML, anti‐sp140, and anti‐EPO according to the prevalence of AMA‐negative participants in the included studies. 8. Diagnostic accuracy of AMA, anti‐M2, ANA, anti‐sp100, anti‐gp210, anti‐PML, anti‐sp140, and anti‐EPO in participants suspected of primary biliary cholangitis referred from a general practitioner clinicversus people referred from specialist clinic. 9. Diagnostic accuracy of AMA, anti‐M2, ANA, anti‐sp100, anti‐gp210, anti‐PML, anti‐sp140, and anti‐EPO in participants without liver cirrhosis versus participants with liver cirrhosis (as defined by individual studies).

SUMMARY Background About 170 million patients worldwide have chronic hepatitis C. Pegylated interferon plus ribavirin is currently the recommended therapy. Aim To evaluate the beneficial and harmful effects of pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C infection. Methods We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index Expanded and contacted pharmaceutical companies and authors of trials (to March 2005). Results We included 18 randomized clinical trials with 4811 patients. Eleven trials (61%) had allocation bias risks and all had assessment bias risk because of lack of blinding. Compared with interferon plus ribavirin, pegylated interferon plus ribavirin had significant beneficial effects on sustained virological response [risk ratio (RR): 0.80; 95% CI: 0.74–0.88]. Data were insufficient to determine impact on long-term outcomes. Pegylated interferon plus ribavirin significantly increased dose reductions (RR: 1.44; 95% CI: 1.14–1.82) and adverse events including neutropenia (RR: 2.25; 95% CI: 1.58–3.21), thrombocytopenia (RR: 2.28; 95% CI: 1.14–4.54), arthralgia (RR: 1.19; 95% CI: 1.05–1.35), and injection-site reaction (RR: 2.56; 95% CI: 1.06–6.22). Conclusions Pegylated interferon plus ribavirin compared with interferon plus ribavirin increased the proportion of patients with sustained virological response, but at the cost of more adverse events.

Background Endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography (IOC) are tests used in the diagnosis of common bile duct stones in people suspected of having common bile duct stones. There has been no systematic review of the diagnostic accuracy of ERCP and IOC. Objectives To determine and compare the accuracy of ERCP and IOC for the diagnosis of common bile duct stones. Search methods We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and Clinicaltrials.gov to September 2012. To identify additional studies, we searched the references of included studies and systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE)), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. Selection criteria We included studies that provided the number of true positives, false positives, false negatives, and true negatives for ERCP or IOC. We only accepted studies that confirmed the presence of common bile duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of common bile duct stones by surgical or endoscopic negative exploration of the common bile duct, or symptom-free follow-up for at least six months for a negative test as the reference standard in people suspected of having common bile duct stones. We included participants with or without prior diagnosis of cholelithiasis; with or without symptoms and complications of common bile duct stones; with or without prior treatment for common bile duct stones; and before or after cholecystectomy. At least two authors screened abstracts and selected studies for inclusion independently. Data collection and analysis Two authors independently collected data from each study. We used the bivariate model to summarise the sensitivity and specificity of the tests. Main results We identified five studies including 318 participants (180 participants with and 138 participants without common bile duct stones) that reported the diagnostic accuracy of ERCP and five studies including 654 participants (125 participants with and 529 participants without common bile duct stones) that reported the diagnostic accuracy of IOC. Most studies included people with symptoms (participants with jaundice or pancreatitis) suspected of having common bile duct stones based on blood tests, ultrasound, or both, prior to the performance of ERCP or IOC. Most studies included participants who had not previously undergone removal of the gallbladder (cholecystectomy). None of the included studies was of high methodological quality as evaluated by the QUADAS-2 tool (quality assessment tool for diagnostic accuracy studies). The sensitivities of ERCP ranged between 0.67 and 0.94 and the specificities ranged between 0.92 and 1.00. For ERCP, the summary sensitivity was 0.83 (95% confidence interval (CI) 0.72 to 0.90) and specificity was 0.99 (95% CI 0.94 to 1.00). The sensitivities of IOC ranged between 0.75 and 1.00 and the specificities ranged between 0.96 and 1.00. For IOC, the summary sensitivity was 0.99 (95% CI 0.83 to 1.00) and specificity was 0.99 (95% CI 0.95 to 1.00). For ERCP, at the median pre-test probability of common bile duct stones of 0.35 estimated from the included studies (i.e., 35% of people suspected of having common bile duct stones were confirmed to have gallstones by the reference standard), the post-test probabilities associated with positive test results was 0.97 (95% CI 0.88 to 0.99) and negative test results was 0.09 (95% CI 0.05 to 0.14). For IOC, at the median pre-test probability of common bile duct stones of 0.35, the post-test probabilities associated with positive test results was 0.98 (95% CI 0.85 to 1.00) and negative test results was 0.01 (95% CI 0.00 to 0.10). There was weak evidence of a difference in sensitivity (P value = 0.05) with IOC showing higher sensitivity than ERCP. There was no evidence of a difference in specificity (P value = 0.7) with both tests having similar specificity. Authors' conclusions Although the sensitivity of IOC appeared to be better than that of ERCP, this finding may be unreliable because none of the studies compared both tests in the same study populations and most of the studies were methodologically flawed. It appears that both tests were fairly accurate in guiding further invasive treatment as most people diagnosed with common bile duct stones by these tests had common bile duct stones. Some people may have common bile duct stones in spite of having a negative ERCP or IOC result. Such people may have to be re-tested if the clinical suspicion of common bile duct stones is very high because of their symptoms or persistently abnormal liver function tests. However, the results should be interpreted with caution given the limited quantity and quality of the evidence.

Background. The aim of our study was to establish whether one-week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with low dose (2 × 20 mg/day) or high dose omeprazole (2 × 40 mg/day) is more effective in curing H. pylori infection in patients with active duodenal ulcer disease. Methods. One hundred and twenty patients with duodenal ulcer and H. pylori infection were treated with amoxicillin 2 × 1000 mg/day for the first 7 days plus azithromycin 500 mg/day for the first 6 days. Patients were randomly assigned to receive either omeprazole 2 × 20 mg/day for the first 7 days (group A; n = 60) or omeprazole 2 × 40 mg/day for the first 7 days (group B; n = 60). After 7 days all patients in both groups continued treatment with omeprazole (40 mg/day (days 8–14) and 20 mg/day (days 15–28)). H. pylori status was determined by urease test and histology before the treatment and 4 weeks after cessation of any medication. Results. One hundred and thirteen patients completed the study. H. pylori infection was eradicated in 73.2%[41/56] of patients in group A (intention-to-treat [ITT] analysis: 68.3%; 95% CI: 58.6–80.4%) vs. 82.5%[47/57] of patients in group B (ITT analysis: 78.3%; 95% CI: 67.8–87.9%; NS). All ulcers had healed after 4 weeks of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and in 14% (group B) of patients (NS), but therapy was discontinued for only one patient in group B (NS). Conclusion. There was no statistically significant difference between one-week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with high dose omeprazole (2 × 40 mg/day) and regimen with low dose omeprazole (2 × 20 mg/day) in curing H. pylori infection in patients with active duodenal ulcer disease.

Background Azithromycin is a new generation, acid stable, macrolide antibiotic that achieves remarkably high concentrations in gastric tissue (above the minimal inhibitory concentration for Helicobacter pylori) after oral administration. Aim To establish whether azithromycin plus omeprazole in association with either amoxycillin or metronidazole are useful in curing H. pylori infection in patients with a duodenal ulcer. Methods One hundred patients with active duodenal ulcers and H. pylori infection were treated with omeprazole (days 1–10, 40 mg b.d.; days 11–24, 40 mg o.m.; days 25–42, 20 mg o.m.) plus azithromycin 500 mg o.m. for the first 6 days. Patients were randomly assigned to receive either amoxycillin 1 g b.d. (OAzA group; n = 50) or metronidazole 400 mg t.d.s. (OAzM group; n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before the treatment and 6 weeks after completion of therapy. Results Ninety-seven patients completed the study. H. pylori infection was eradicated in 85% (41/48) of patients in the OAzA group (intention-to-treat analysis 82%) vs. 74% (36/49) of patients in the OAzM group (intention-to-treat analysis: 72%) (N.S.). All ulcers had healed after 6 weeks of omeprazole treatment. Side-effects, usually minor, were recorded in 13% (OAzA group) and 47% (OAzM group) of patients (P

The study provide the prevalence of the C282Y, H63D and S65C. mutations in two Slavic populations (Croatian and Slovenian) in SE Europe which further support the well documented European NW-too-SE gradient of the C282Y mutation distribution. Our results have an important clinical implication for the detection and management of hemocromatosis in both observed populations.