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Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. Pregnancies with GDM have worse outcomes compared to pregnancies with normal glucose tolerance. The objectives of the study were to determine the prevalence of GDM and perinatal outcomes according to the old WHO criteria and IADPSG criteria. Subjects and methods: A retrospective study included 2, 405 pregnant women who delivered between January 2009 and December 2010. According to the OGTT results, pregnant women were divided into 4 groups. We analyzed the prevalence of GDM, characteristics of pregnant women and their newborns and perinatal outcomes. Results: We found significantly higher prevalence of GDM according to the IADPSG criteria compared to the WHO criteria. Pregnant women with GDM were significantly older, had higher pre- pregnancy BMI, fasting and 2-h plasma glucose. Pregnant women with GDM had worse pregnancy outcomes compared to control group. The overall proportion of overweight and obese pregnant women was the highest in the group of untreated pregnant women with GDM according to the IADPSG criteria. In this group we found significantly higher rate of fetal macrosomia and LGA. The rate of caesarean section was significantly higher in comparison to control group. Pre-eclampsia was significantly more common in groups of pregnant women with GDM compared to control group. Conclusion: IADPSG diagnostic criteria reveals more women with hyperglycemic disorders in pregnancy. A group of pregnant women who were normoglycemic according to the WHO criteria, but according to the IADPSG were diagnosed GDM, had adverse pregnancy outcomes. Lower values of glycemia, than those defined for diabetes in pregnancy, are associated with adverse pregnancy outcomes.

Background: patients with different types of dementia may experience changes in nutritional status, which are manifested by specific eating habits. The aim of this study was to determine the nutritional status and eating habits of patients at the time of confirmed diagnosis of primary progressive dementia. Subject and methods: The study included 40 outpatients (63% women) diagnosed with either form of dementia. The mean age at diagnosis was 77􀂓6 years and the mean time between the onset of first symptoms of the disease and diagnosis was 3-36 months. Nutritional assessment was determined at the time of confirmed diagnoses and included dietary habits (non-quantitative modified food frequency questionnaire (FFQ)), anthropometric (body weight and height and body mass index-BMI) and biochemical parameters (serum concentrations of vitamin B12, folic acid and 25-hydroxy vitamin D). Dietary habits were collected over a 12- month period with the help of a spouse or close family member. Results: The results showed that none of the outpatients were malnourished, the largest number of outpatients (43%) were in the normal body mass category followed by 33% in the overweight category. The results of this study confirmed previous findings of higher preference for sweet foods observed in 53% of patients with dementia. Low status of vitamin B12 was observed in 57% of outpatients, folic acid in 24% and 25 (OH) D in 75% of outpatients. Lower frequency of consumption of dark green leafy vegetables and lower consumption of poultry meat, fish and eggs could have an impact on nutrient deficiency. Conclusions: The poor nutritional status of outpatients with primary progressive dementia is associated with unhealthy dietary habits that may lead to micronutrient deficiencies. Dietary monitoring and intervention should be initiated immediately after the diagnosis of primary progressive dementia with the goal of reducing nutritional deficiencies and preventing further and more severe impairment of cognitive function.

Anaphylaxis is an unanticipated systemic hypersensitivity rea ction which can produce deleterious effects, even death, if not treated promptly. Preventive approach implies taking a thorough anamnesis with the emphasis on previously diagnosed allergies. If an allergic reaction occurred during previous surgery, a detailed documentation of administered anaesthetic agents and drugs would be crucial for the following anaesthesiologic management. Preoperative planning and avoiding cross-reactivity with drugs commonly used during anaesthesia are the key points to prevent an anaphylaxis. In case of emergency surgery when the exact identification of allergens is not possible, premedication prophylaxis should be considered. General measures for prevention of anaphylaxis could be undertaken as well, such as the choice of anaesthesiologic drugs and techniques in the operating theatre adequately equipped for the management of predictable anaphylaxis.

Transplant-acquired food allergy is a well known phenomenon especially linked to liver transplants. Risk factors lie both in transplant recipient and transplant donor - age of recipient and the maturity of immune regulatory mechanisms, family history of atopy in recipient, young age of the donor and atopic history in donor. The exact mechanism has not yet been established and there are many different explanations of this pathophysiologic process. Transplanted liver is a large and well perfused organ, rich in pluripotent hematopoietic stem cells and donor's IgE antibodies that can alter immunological response in the host. Some studies suggest that post-transplant immunosuppression with tacrolimus is linked to an increased occurrence of IgE-mediated sensitization and manifestation of allergic disease. Research in the field of transplant-acquired food allergy is not important only for transplant patients and physicians involved but also for understanding the mechanism of food allergy development in general population and potentially reducing this global health concerning issue.

Introduction: Education in medicine faces a number of challenges and dilemmas and the onus is on Medical hodegetics, an important but almost forgotten discipline, to address them effectively. The task and final goal of education in medicine is to coach students into professionals, effective and ethical practitioners of medicine, giving them the best available knowledge, skills and attitudes and providing them with a professional identity so that they are able to think, speak, act and feel like medical doctors. During the life course human beings organize their experiences into a meaningful narrative that involves their personal, private, public and professional selves. The self can be defined as a distinct principle of identity, as a narrative construction and as an experiential dimension. Aim: The aim of this paper is to address the actuality and vitality of the hodegetic approach in medical education and professionalism. Methods: By cross-sectional study authors of the paper searched on-line scientific data-bases and analyzed references about Medical hodegetics subject. Results: Drawing on the literature on psychology of self, identity formation and personality styles as well as on own experience in medical education, the authors stress the increasing importance of medical hodegetics, very useful, but almost completely forgotten discipline. Medical hodegetics which involves all evidence-based medicine, values-based medicine, narrative medicine and person-centered medicine can significantly improve the quality of medical education. The identity of any person in any moment reflects its three domains: individual identity, relational identity, and collective identity, all relevant to medical education. The concept of professional identity formation has recently emerged and attracted great attention in literature on medical education and professionalism. Hodegetics, as a discipline that trains it, seems to us that the essential part of life and what every person should follow. Concluson: Medical hodegetics is an important pillar of the triad of medical deontology as well as it could be an important discipline in medical education and professional identity formation.

Background: Chemo preventive and antitumor role of vitamin D is manifested through genetic and non genetic ways with a powerful antproliferatory and proapopoptic effect, which is proven by numerous epidemiologic studies. The genetic activity of vitamin D is determined through vitamin D receptors (VDR), a member of stero-thyreoidal family of nuclear receptors, which with vitamin D form a cell nucleus complex responsible for the chemo preventive and antitumor effect. VDR in tissue cells is present in the cytoplasm and the nucleus and manifests its genetic activity after transfer from the cytoplasm to the nucleus. The mechanisms for the transport and genetic control of the transport of VDR from cytoplasm to the nucleus in not yet completely understood. Subjects and methods: By using immunohystochemistry we are evaluating the correlation of cytoplasmic and nuclear expression of VDR during different stages of colorectal carcinoma: normal colorectal mucosa, hyperplasic polyp, low grade adenoma (LGD), high grade adenoma (HGD) and colorectal cancer. Results: Our results confirm that the nuclear VDR expression is strongest in normal colorectal mucosa and in hyper plastic polyps, is gradually weakened in low and high grade adenoma while it is extremely weak or absent in colorectal carcinoma. At the same time the expression of cytoplasm VDR is weakest in normal colorectal mucosa and hyper plastic polyps while it grows during the adenoma stage and is most expressed during colorectal carcinoma Conclusion: We conclude that vitamin D has a strong chemo preventive and antitumor effect in normal colorectal mucosa and hyper plastic polyps, while its antitumor and chemopreventive effect is progressively weakened and ultimately absent in colorectal carcinoma.

There is a strong connection between man and nature, ever since his first origins, the man discovered the benefits of the plant kingdom, which he used to feed himself, to heal and to survive. Following the use of eatable, medicinal and poisonous plants takes us into the distant past. The man’s first knowledge about plants passed from generation to generation. The ancients Chinese, Egyptians, Indians, Greeks, Romans and the Old Slavs knew a large number of medicinal plants. That knowledge was carried over to other nations as well. Thanks to its geographical location and climate condition, our country is abundant and very rich in variety of species of medicinal plants. In the Middle Ages, there were written many herbal manuals that described the use and procedures in healing with medicinal plants. Many plants were known by the oldest civilizations and they were used by the people for thousands of years. Moreover, today’s science has confirmed their effectiveness in the treatment of different diseases.

Background: To explore correlation between clinical and endoscopic indices in inflammatory bowel disease (IBD) patients. Subjects and methods: There were 112 patients with inflammatory bowel disease. All patients with diagnosed IBD was established a degree of clinical and endoscopic disease activity. CDAI (Crohn's disease activity index) was used as clinical and SESCD (Simplified Endoscopic Crohn Disease Index) as endoscopic index for Crohn's disease. For ulcerative colitis Truelov & Witts index was used as clinical and Baron as endoscopic activity index. Correlation of clinical and endoscopic indices were compared in Crohn disease (CD) and ulcerative colitis (UC). Patients were analyzed by clinical entities - CD and UC, according to sex, age, parameters of anemia, duration of disease and education. Results: In the total of 112 IBD patients there were 69 patients diagnosed as ulcerative colitis (61.6%) and 43 as Crohn's disease (38.4%). There were 58 (51.8%) women and 54 (48.2%) men. Comparison between endoscopic and clinical indices in CD and UC demonstrated no significant differences in ilnness activity. Endoscopic and clinical disease activity was associated with a higher inflammatory parameters (CRP and leucocytes, L) and lower parameters of hemoglobin (Hb) and MCV. Conclusion: Our research has established a good correlation between clinical and endoscopic index of disease activity in the CB and UC in inflammation. Clinical indices can be used for monitoring inflammation.

Aim: The main goal of this study was to compare the biochemical and histopathological findings in patients with sustained virological response (SVR) before and two years after the therapy with pegylated interferon α-2a and ribavirin in chronic hepatitis C. Subjects and methods: The study was conducted at the Department of Internal Medicine and the Clinic for Infectious Diseases of the Clinical Hospital Mostar. The study included 48 patients whose treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin was finished two years prior to the achieved SVR at the end of the treatment. The main criterion for inclusion was a negative result of HCV RNA, determined by the RealTime HCV assay. After taking a history, physical examination, laboratory tests: AST, ALT, GGT, a liver biopsy were performed with the help of the ultrasound. The assessment of necroinflamatory score was determined by histologic activity index (HAI) score, and the stage of fibrosis according to Knodell's numerical score. Results: The values of AST and ALT levels were statistically significantly decreased after the successful treatment (p

Background: A cross-sectional study in the Primary Care Medical Centre Mostar and Regional Medical Center "Safet Mujić" was conducted. Family physicians randomly surveyed, examined, and analyzed laboratory tests from 300 subjects divided into three age groups from 20-39, 40-54 and 55-65 years, totally 100 subjects. Data for age, sex, smoking status, alcohol consumption, body mass index, blood pressure, blood glucose, triglycerides and cholesterol, and the presence of chronic non-communicable diseases, including diagnosis of depression and the presence of stress were entered in medical records. Results: Levels of cholesterol were significantly higher in rural population as well as among students, and high triglyceride levels most frequently were presented in the student population. A group of farmers had a significantly higher prevalence of hypertension, DM and CVD compared to other investigated groups. The largest number of smokers and people who drink alcohol was present in group with the highest incomes, while obesity was significantly expressed in people with lower incomes. The group of examinees with the highest incomes had the greatest exposure to stress. Conclusions: Socioeconomic processes have an impact on risk behavior of the adult population, and the presence of a number of chronic diseases that are accompanied with increased laboratory blood glucose, cholesterol and triglycerides levels.

Introduction. Multiple symmetric lipomatosis, or Madelung's disease, is a rare condition which is characterized with large symmetrical accumulation of noncapsulated fat tissue in upper arms, neck, and shoulder areas. The disease etiology is unknown, with the highest incidence in the Mediterranean region. Case Presentation. Here, we present the case of Madelung's disease with symmetric fat distribution throughout the neck and history of alcoholism. The patient was treated from several diseases associated with alcoholism and hospitalized several times, but the diagnosis of Madelung's disease was omitted. The thyroid gland disease was excluded, while enlargement of the neck adipose tissue was attributed to obesity. Conclusions. This study points out possible diagnostic mistakes when a physician is not aware of a differentiation diagnosis of symmetrically enlarged neck masses, especially in geographic regions with high incidence of this disease.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with gastrointestinal and gynecologic tumors. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells intraperitoneally (ip) inducting peritoneal carcinomatosis. In preventional model biological response modifiers (BRM), interleukin-2 (IL-2) at dose of 4.1 x 104 IU/mouse was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells, heated saline at 37°C or at 43°C was injected ip (hyperthermia treatment). Following this mice were ip treated with doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination of them. In therapeutic model cytostatics were injected on day 5 after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Results showed significant difference in surviving time (engl. increased life span ; ILS%) of mice pretreated with IL-2 and treated with hyperthermic chemotherapy compared with control: IL-2+ CIS (ILS%=260, 50) ; IL-2+ DOX + CIS (ILS%=200) ; IL-2 + MIT (ILS%=178, 05) ; IL-2 + CDL (ILS%=70, 20) ; IL-2+ DOX (ILS%=67, 92) ; IL-2 + 5-FU (ILS%=62, 69) ; IL-2+ 5-FU+ DOX (ILS%=55, 22). Treatment with IL-2+ 5-FU+ CIS was shown to be toxic to mice since all mice died before control group. Conclusion: The results suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy ; IL-2 significantly increases antitumor activity of hyperthermic chemotherapy and survival rate of mice with peritoneal carcinomatosis. It is likely that stimulative effect of IL-2 on hematopoiesis, differentiation and proliferation on stem cells as well as immunomodulation may be possible mechanism of protection of mice from development of peritoneal carcinomatosis.These treatments reduce side effect of chemotherapy treatment increasing life spin of mice.

Uvod i cilj: Peritonejska karcinomatoza (PK) je prognostički izrazito loš znak i čest uzrok smrti u bolesnika s karcinomom debelog crijeva i želuca, kao i drugih gastrointestinalnih i ginekoloških zloćudnih tumora. Drugi problem je izrazito visok rizik PK za vrijeme operacije uznapredovalog tumora, kad se tumorske stanice “otkidaju” od površine tumora koji je zahvatio i serozu trbušnog organa u kojem je nastao, pa nastaje tzv. jatrogena PK. Imajući u vidu činjenicu da je medijan preživljenja pacijenata s PK 2, 2 do 8, 8 mjeseci, a petogodišnje preživljenje manje od 2%, pokušavaju se iznaći terapijski kao i profilaktički modaliteti koji bi eventivno i kada nema znakova PK suzbili ili barem usporili nastanak i razvitak PK. Izvješćima u literaturi manjka objektivnost i primjeren broj ispitanika. Dakle, cilj nam je bio na jedinstvenom animalnom modelu inducirane PK u miša istražiti i usporediti valjanost raznih oblika lokoregionalne kemoimunoterapije i hipertermičke intraperitonejske kemoterapije (HIPEC). Materijal i metode: Miševima soja CBA smo u trbušnu šupljinu uštrcavali tumorske stanice i na taj način izazivali PK. U takozvanom prevencijskom modelu miševima smo sedam i tri dana prije unosa tumorskih stanica ip uštrcavali MBO (IL-2 i biljni iscrpak CDL), te neposredno nakon unosa tumorskih stanica vršili ispiranje trbušne šupljine fiziološkom otopinom zagrijanom na 37 ili 430C (hipertermička obrada) te potom dodavali citostatike (doksorubicin, cisplatin, mitomicin i 5-FU) pojedinačno ili u kombinaciji. U takozvanom terapijskom modelu, uz imunomodulatore koji su davani prije uštrcavanja tumorskih stanica, peti dan nakon njihovog unosa, kad se već razvila PK, uštrcavali smo citostatike pojedinačno ili u kombinaciji, i pri tome ispirali trbušnu šupljinu fiziološkom otopinom zagrijanom na 37 ili 430C. Pratili smo preživljenje životinja i nuspojave koje se javljaju uz različite oblike liječenja. Rezultati: Izvrstan prevencijski protutumorski učinak (doslovce potpuno 95-dnevno preživljenje, bez znakova PK u žrtvovanih životinja) pokazala je kombinacija CDL-a i doksorubicina. Među terapijskim modelima upada u oči da je doksorubicin lijek izbora sam ili u kombinaciji s CDL-om, 5-FU i cisplatinom, uz pojačani učinak izazvan hipertermijom. Zaključci: U prevenciji i liječenju PK vrlo dobri rezultati se mogu postići kombinacijom hipertermije, doksorubicina i biljnog iscrpka CDL-a. Kad se rabi hipertermija i kombinacija citostatika valja sniziti doze lijekova kako bi se izbjegle ili bar smanjile nuspojave, a zadržao antineoplastički učinak. Naravno, za provjeru ovih rezultata potrebne su opsežne kontrolirane kliničke studije više kooperativnih grupa.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomach carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrates serosa of abdominal cavity in which it has developed, so iatrogen peritoneal carcinomatosis develops. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells into abdominal cavity and consecutive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), interleukin-2 (IL-2) at dose of 4.1 x 104 IU/mouse was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdominal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics: doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination. In therapeutic model cytostatics were injected on day 5th after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Results of these studies showed significant difference in surviving time (engl. increased life span ; ILS%) of mice pretreated with IL-2 and treated with hyperthermic chemotherapy compared with control: IL-2+ CIS (ILS%=260, 50) ; IL-2+ DOX + CIS (ILS%=200) ; IL-2 + MIT (ILS%=178, 05) ; IL-2 + CDL (ILS%=70, 20) ; IL-2+ DOX (ILS%=67, 92) ; IL-2 + 5-FU (ILS%=62, 69) ; IL-2+ 5-FU+ DOX (ILS%=55, 22). Treatment of mice with IL-2+ 5-FU+ CIS was toxic to mice ; all mice died before control group. Conclusion: The results suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy ; IL-2 significantly increase antitumor activity of hyperthermic chemotherapy and survival rate of mice with peritoneal carcinomatosis. It is likely that stimulative effect of IL-2 on hematopoiesis, differentiation and proliferation on stem cells as well as immunomodulation may be possible mechanism which protect mice from development of peritoneal carcinomatosis and reduce side effect of chemotherapy treatment increasing life spin of mice. However, the exact antitumor mechanism mechanisms of hyperthermic chemoimmunotheraphy effectiveness have to be elucidated.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomach carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrates serosa of abdominal cavity in which it has been developed, so iatrogen peritoneal carcinomatosis develops. The aim of this study was to explore and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and methods: CBA mice were injected with mammary carcinoma (MCa) cells into abdominal cavity and consecutive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), plant extract from Caucalis platycarpos (CDL) at dose of 200 mg kg-1 was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdominal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics: doxorubicin (DOX) 20 mg kg-1, cisplatin (CIS) 10 mg kg-1, mitomicyn (MIT) 5 mg kg-1, 5- fluorouracil (5-FU) 150 mg kg-1 either separately or in combination. In therapeutic model BRMs were injected on day 5th after injection of tumor cells. Hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Combination of doxorubicin and plant extract CDL was very effective in prevention consindering survival and pathological signs of peritoneal carcinomatosis. Doxorubicin as a drug of choice alone or in combination with either CDL or 5-FU or cisplatin with reinforced influence caused by hyperthermia, popped up among therapy models. Conclusion: These investigations suggest the synergistic effect of hyperthermia, chemotherapy and immunotherapy with plant extract from Caucalis pltycarpos. The possible mechanism of this treatment should be investigated.

Background/aims: Peritoneal carcinomatosis is prognostically a very bad sign and common cause of death in patients with intestinal and stomac carcinoma as well as other gastrointestinal and gynecologic tumors. During a tumor surgery risk of peritoneal carcinomatosis is high because tumor cells are "dropping off" from the tumor surface which infiltrate serosa of abdomenal cavity in which it has been developed, so iatrogen peritoneal carcinomatosis develops. Considering the fact that mean surviving of patients with peritoneal carcinomatosis is between 2.2 and 8.8 months and five years survival period has been found less than 2%, therapeutic and prophylactic modalities which would eventually stop or slow down occurance and development of peritoneal carcinomatosis are investigated. The aim of this study was research and compare different models of locoregional immunochemotherapy, hyperthermial intraperitonal chemotherapy (HIPEC) in unique animal model of induced peritoneal carcinomatosis in mice. Material and mathods:CBA mice were injected with mammary carcinoma (MCa) cells into abdomenal cavity and consequtive peritoneal carcinomatosis was induced. In so called prevention model biological response modifiers (BRM), combination of IL-2 and plant extract from Caucalis platicarpos (CDL) was injected into abdominal cavity seven and three days before injection of tumor cells, respectively. Immediately after the injection of tumor cells we rinsed abdomenal cavity with saline that was heated to 37°C or 43°C (hyperthermial treatment) and injected cytostatics (doxorubicyn, cisplatin, mitomicyn, 5-FU) either separately or in combination. In therapeutic model BRMs were injected on day 5th after injection of tumor cells ; hyperthermia treatment was performed immediately before injection of cytostatic drugs. Results: Combination of doxorubicyn and plant extract CDL was very effective in prevention consindering survival and pathological signs of peritoneal carcinomatosis. Doxorubicyn as a drug of choice alone or in combination with either CDL or 5-FU or cisplatin with reinforced influence caused by hyperthermia poped up among therapy models. Conclusion: Excellent results can be obtained by combing hyperthermia, doxorubicyn and plant extract CDL in prevention and treatment of peritoneal carcinomatosis. When hyperthermia and combination of cytostatics are used drug dosage should be reduced to at least to avoid or to decrease side effects but still keep antineoplastic effect. Naturally, to check these results huge controled clinical studies in more cooperative groups should be conducted.

AIMS: To compare ranitidine bismuth citrate with omeprazole as to their efficacy to eradicate H. pylori in two different treatment schedules both consisting of a combination of either of above with two antibiotics for 1 week, and to relate these treatment results to primary antibiotic resistance. METHODS: 256 H. pylori positive patients with non-ulcer dyspepsia were randomised to one of the following four treatment groups: omeprazole 20 mg + clarithromycin 500 mg + amoxycillin 1000 mg (OCA) ; ranitidine bismuth citrate 400 mg + clarithromycin 500 mg + amoxycillin 1000 mg (RBCCA) ; omeprazole 20 mg + clarithromycin 500 mg + metronidazole 500 mg (OCM) ; ranitidine bismuth citrate 400 mg + clarithromycin 500 mg + metronidazole 500 mg (RBCCM). All drugs were given twice daily for one week. The patients were assessed for prevalence of H. pylori by CLO test, histology and culture on gastric biopsy samples obtained during upper gastrointestinal endoscopy before randomisation and 4-6 weeks after completion of therapy. Bacterial sensitivity to clarithromycin, metronidazole and amoxycillin was determined by E-test. RESULTS: On per-protocol analysis, overall eradication rates were 96% for RBCCA vs. 85% for OCA (p = 0.03), and 95% for RBCCM vs. 79% for OCM (p = 0.01). Amongst the 196 patients (77% of the entire study group) in whom antibiotic sensitivity testing was technically feasible, primary resistance was found in 8% for clarithromycin, in 33% for metronidazole, and in 0% for amoxycillin. Eradication of clarithromycin sensitive/resistant strains was 89%/40% for OCA (p = 0.0042) and 98%/80% for RBCCA (p = 0.0428). When strains were sensitive to both antibiotics, cure rates with OCM/RBCCM were 87%/96% respectively (p = 0.39), for strains resistant to clarithromycin only, eradication was achieved in 82% with OCM vs. 94% with RBCCM (p = 0.2), and in the case of metronidazole resistance in 85% with OCM vs. 94% with RBCCM (p = 0.09). CONCLUSIONS: Ranitidine bismuth citrate in combination with clarithromycin and either metronidazole or amoxycillin produced higher eradication rates than omeprazole co-administered with the same antibiotics. This appeared especially prominent in the subgroups with clarithromycin resistance without, however, reaching statistical significance. Efficacy of neither eradication regimen was influenced by metronidazole sensitivity to a significant degree.

The multiifactorial ethiopathogenesis if inflammatory bowel disease, activetes immunological system, and the result is the activation of extraintestinal manifestations. The disgnostic criteria and therapeutic approact is described in this review article.

Forty five patients with ulcerative colitis and seronegative spondyloarthropaties were followed up for nine years. Upon randomisation poatients were treated with supfasalazine and mesalazine. None of patioents received steroids. There were no significant difference according to disease localisation. There were no significant difference between the supfasalazine snd mesalazine group according to the type of disease (seronegative spondyloarthropathies or colon only).

Recurring chest pain is an important clinical problem and dilemma because of the possibility of cardiac disease. Non-cardiac chest pain is guite common. According to the different studies overall prevalence for esophageal diseases as causes of chest pain is from 18% to 58% of patients with chest pain and normal coronary arteries. Although esophageal motility disorders are primary esophageal cause of non-cardiac chest pain, recent studies suggest that gastroesophageal reflux disease could be more common than it is believed. In our case we report a patient with recurring angina like chest pain, hypertension, positive familial history for myocardial infarction and hypertension, and long term history of cigarette smoking. We performed standard diagnostic tests including coronary angiogram to exclude cardiac origin of chest pain. All of these tests were negative. Finally, esophageal manometry and prolonged pH-metry revealed gastroesophageal reflux disease. After that, the patient is underwent rigorous antireflux regimen, including proton pump inhibitor and prokinetic agent, and recurrent attacks of chest pain disappeared.

Primarni cilj ovog istraživanja bio je usporediti konkomitantnu četverostruku terapiju s ciljanom personaliziranom terapijom kao eradikacijskim liječenjem prve linije infekcije H. pylori u Splitskodalmatinskoj regiji Hrvatske u kojoj postoji visoka rezistencija na klaritromicin (>20%). Sekundarni cilj bio je usporediti usklađenost i stopu štetnih događaja između ova dva terapijska režima. MATERIJALI I METODE U otvorenom, randomiziranom kliničkom ispitivanju, provedenom između siječnja 2019. i siječnja 2020. 80 pacijenata s infekcijom H. pylori nasumično je dobilo ili četverostruku konkomitantnu terapiju (esomeprazol 40 mg, amoksicilin 1 gr, metronidazol 500 mg, klaritromicin 500 mg dva puta dnevno tijekom 14 dana) ili personaliziranu terapiju u skladu s rezultatima ispitivanja osjetljivosti na antimikrobne lijekove. Status eradikacije procijenjen je 4 tjedna nakon liječenja. REZULTATI Stope eradikacije bile su značajno veće u ciljanoj skupini nego u konkomitantnoj skupini, kako u ITT analizi (70 prema 92,5%, p, The primary objective of this study was to compare concomitant quadruple with the tailored, personalized therapy as first-line eradication treatment of H. pylori infection in Split-Dalmatia region of Croatia in which there is a high clarithromycin resistance (>20%). The secondary objective was to compare the compliance and adverse events rate between these two therapeutic regimes. MATERIALS AND METHODS In an open-label,randomised clinical trial, conducted between January 2019 and January 2020, 80 patients with H.pylori infection were randomly assigned to either concomitant (esomeprazole 40 mg, amoxicillin 1 gr, metronidazole 500 mg, clarithromycin 500 mg, twice daily for 14 days) or tailored therapy in accordance with the results of the antimicrobial susceptibility testing. Eradication status was assessed 4 weeks after treatment. RESULTS Eradication rates were significantly higher in tailored group than in concomitant group both in intention-to-treat (70 vs. 92.5%, p

Čokolada je u početku imala ritualni karakter – Maje su pripravljali napitak od kakaovog zrna koji su pili u ritualima kako bi se „približili“ bogovima još u periodu 250. – 900. godine, a običaj ritualnog ispijanja sličnog napitka zadržali su i danas, kao sastavni dio ceremonije vjenčanja. Azteci su također pripravljali napitak od pogače izrađene od kakaove mase, kukuruznog brašna i začina. U Srednjoj Americi kakaovac je u to vrijeme bio vrlo cijenjen te se koristio i kao sredstvo za plaćanje. Ne čudi stoga što je kakaovo zrno privuklo pažnju Kristofora Kolumba, a kasnije i Hernána Cortésa koji je u 16. stoljeću, uz zrna, donio i recept za spravljanje napitka na španjolski dvor. S dolaskom u Europu, čokolada gubi ritualni i sve više poprima hedonistički oblik. Dodaje joj se šećer, kako bi se smanjila gorčina kakaovog zrna, a u 19. stoljeću se, zahvaljujući van Houtenovoj preši, počinje proizvoditi čokolada s većim udjelom kakaovog maslaca, koja se može konzumirati u krutom obliku, ali joj se ujedno značajno povećava kalorijska vrijednost. Nešto kasnije, s proizvodnjom kondenziranog mlijeka, počinje se proizvoditi mliječna čokolada. Dugi niz godina čokoladu se smatra slasticom i ona se konzumira isključivo kao konditorski proizvod. S napredovanjem istraživanja na području bioaktivnih spojeva, naročito polifenola, kakaovo zrno, a s njim i njegov glavni proizvod – čokolada, počinje se promatrati kroz prizmu mogućeg povoljnog utjecaja na zdravlje. Veliki broj istraživanja pokazuje da flavonoidi kakaa imaju povoljan utjecaj na razinu glukoze u krvi, krvni tlak, kolesterol pa EFSA 2012. i 2014. godine izdaje i znanstvena mišljenja, u kojima ističe povoljno djelovanje flavonoida kakaa na endotelijum ovisnu vazodilataciju, ukoliko se svaki dan unose u količini od 200 mg. Ovo pokazuje i potencijal tamne čokolade u proizvodnji funkcionalnih proizvoda. Nadalje, razvoj proizvoda u novije vrijeme omogućuje i proizvodnju čokolade sa smanjenim udjelom ili bez šećera, obogaćivanje polifenolima, vlaknima, probioticima, čime se dodatno širi paleta funkcionalnih proizvoda na bazi kakaa.