Zeljko Mijailovic

Cytokine profile in chronic hepatitis C: An observation

HighlightsCytokine levels in patients group were heterogeneous, spread in wide range of values.Grouping data according to disease‐relevant factors showed high intragroup diversity.There was no correlation between cytokine levels and each disease‐relevant factor.Inconsistency of literature data is a result of individual differences of patients. Abstract The data addressing cytokine profile in chronically infected HCV patients are conflicting, ranging from Th1 or Th2 cytokine prevalence to the expression of both types of cytokines. Therefore, the aim of this study was to evaluate cytokine profile in these patients. Cytokine sera levels in HCV patients and healthy controls were evaluated using 13plex FlowCytomix Multiplex. Median values of both proinflammatory and anti‐inflammatory cytokines were lower in HCV patients then in controls. In addition, the number of subjects producing detectable quantities of cytokines was significantly lower in the group of HCV patients. Yet, cytokine levels in those patients were remarkably heterogeneous ranging from low to extremely high, much higher than the maximal values in control group. Similarly, grouping data according to HCV genotype, HCV RNA load, ALT/AST ratio and the stage of fibrosis showed marked standard deviations, reflecting high intragroup diversity. No correlation was found between each disease‐related factor and cytokine levels. Patients investigated in our and similar studies were disparate pursuant to characteristics of the hosts, pathogen and course of the disease. Therefore, the inconsistency of the literature data regarding cytokine pattern in chronic HCV patients may be a consequence of the disregarded/overlooked heterogeneity of these patients.

Applying the Molecular Adsorbent Recirculating System (MARS) in the Treatment of Acute Liver Failure (ALF) Case Report

Abstract Acute liver failure (ALF) is a rare but life-threatening illness with multiple organ failure. The short-term mortality rate exceeded 80 % despite modern approaches in treatment. Drugs, infections by hepatic viruses and toxins are the most common causes of ALF. Progressive jaundice, coagulation disorder and hepatic encephalopathy are dominated as a clinical signs of the illness. We present a case of a 36-year-old Caucasian woman hospitalized in ICU due to yellow discoloration of the skin and sclera, severe disseminated coagulopathy and hemodynamic instability. ALF is developed due to Hepatitis B Virus infection, resulting in hepatic toxicity as well as coma. General condition rapidly improved after applying of Molecular Adsorbent Recirculating System (MARS), an extracorporeal liver support system based on albumin dialysis. It is relatively expensive treatment that is used for the patient with hepatic encephalopathy grade 3 or 4 in our institution. In conclusion, an early administration of MARS significantly reveals subjective and objective clinical improvement in the case we presented.

Life-Threatening Plasmodium Falciparum Malaria in Patient after Visiting Angola-Case Report

Abstract Malaria is a potentially life-threatening disease, especially when complicated by a septic shock. It is caused by infection of erythrocytes with protozoan parasites of the genus Plasmodium that are inoculated into the humans by a feeding female anopheline mosquito. Of the four Plasmodia species, infection with Plasmodium (P.) falciparum is often associated with different types of complications and significant mortality. Most imported cases of malaria are not in tourists but in immigrants and their children who have returned to the country of their family’s origin to visit friends and relatives (so-called VFR travelers) and have forgone chemoprophylaxis. We described a case of a 52 year old patient who came from Angola, an African country with endemic malaria before the occurrence of the first symptoms of the disease. The first symptoms were not recognized by the presence of nonspecific symptoms. Very soon the patient was gone under the hemodynamic unstability that eas followed by shock and high percentage parasitemia of 25%. A global health disorder was developed accompanied with hemodynamic instability and cerebral dysfunction. He performs pulmonary ventilation disorder and renal failure. Only data from social epidemiological survey of travel to the African country, was sufficient to cast doubt on malaria. The diagnosis was conducted using the standard method - peripheral blood smear. After turning antimalarial drugs, improvement of health status with complete recovery within 10 days was noticed. The only consequence of the disease is persistent hypertension that is sensitive to standard antihypertensive therapy.

Hepatitis C Therapy – Related Haematological Side Effects are Associated with Treatment Outcome / Hematološka Neželjena Dejstva Terapije Hepatitisa C Su Povezana Sa Ishodom Lecenja

Abstract Treatment of patients suffering from chronic hepatitis C with standard pegylated interferon alpha 2a plus ribavirin has limited efficacy. Therapy outcome is dependent on several factors of both the host and virus, including age, sex, stage of fibrosis, viral genotype, viral load, and occurrence of haematological adverse events during chronic hepatitis C treatment. The aim of this study was to determine the relationship between the viral and host factors and the haematological side effects of therapy with sustained virological response. Fifty-four patients were treated with combined pegylated interferon alpha 2a plus ribavirin therapy. Hepatitis C virus genotyping, viral load, histopathological liver changes and biochemical parameters were evaluated for each patient before beginning treatment. Each patient’s blood count was analysed during each clinical visit. Sustained virological response was achieved in 75,9% of patients. Baseline AST and ALT levels were significantly higher in patients with a poor response to therapy (p<0,05). Other clinical and laboratory parameters did not reach statistical significance. Both responders and non-responders developed anaemia. A decrease in thrombocytes, neutrophils and white blood cells was significantly associated with a sustained response to therapy (p<0,05, p<0,05 and p<0,001, respectively). Sustained virological response was associated with lower baseline AST and ALT values and thrombocytopenia, leucopenia and neutropenia at the end of the treatment. All treated patients developed anaemia.