Acta clinica Croatica
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Acta clinica Croatica · Feb 2022
ReviewCAMPTODACTYLY AND CLINODACTYLY - NEW UNDERSTANDING OF KNOWN DEFORMITIES.
Camptodactyly and clinodactyly are most commonly considered just cosmetic defects, but they can pose a major diagnostic and therapeutic challenge, mainly because of their apparently similar clinical presentation. For years, experts have been arguing over definitions, descriptions, and therapeutic approaches to these deformities, with some favoring surgical approach, some advocating conservative treatment, while others are prone to use a combination of the aforementioned approaches. This article provides an overview of the current literature on two different entities, with emphasis on differences in clinical presentation and treatment modalities. This may improve the understanding and recognition of these deformities in children, and help the attending physician select the most appropriate therapy for the individual patient.
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Recent clinical and scientific evidence confirms the negative impact of long-term periodontitis on the clinical course and progression of various liver diseases. Periodontitis is a chronic, slow-progressing infectious disease of the tooth supporting tissues caused mainly by the gram-negative bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola and Tannerella forsythia. These specific pathogens can be easily translocated from oral cavity to the intestine. ⋯ Recent epidemiologic studies have demonstrated that individuals with liver cirrhosis have considerably poorer periodontal clinical parameters than those without cirrhosis. Periodontal therapy in cirrhosis patients favorably modulates oral and gut microbiome, the course of systemic inflammation, cirrhosis prognostic factors, and cognitive function. Therefore, future clinical researches should be focused on detailed examination of the biological mechanisms, strength and direction of the association between advanced liver disease and periodontitis.
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Acta clinica Croatica · Feb 2022
ReviewTREATMENT OF MYASTHENIA GRAVIS PATIENTS WITH COVID-19: REVIEW OF THE LITERATURE.
Coronavirus disease 2019 (COVID-19), caused by the late 2019 outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a respiratory disease which could put myasthenia gravis (MG) patients at a greater risk of developing severe disease course, since infections and some drugs are a well-recognized trigger of symptom exacerbation in MG patients. Out of ten most commonly used past and present drugs used in COVID-19 treatment, two (quinolone derivatives and azithromycin) are known to worsen MG symptoms, whereas another two (tocilizumab and eculizumab) might have positive effect on MG symptoms. Colchicine, remdesivir, lopinavir, ritonavir and favipiravir seem to be safe to use, while data are insufficient for bamlanivimab, although it is also probably safe to use. ⋯ The only exception is rituximab since the resulting B cell depletion can lead to more severe COVID-19 disease. Concerning plasmapheresis and intravenous immunoglobulins, both can be used in COVID-19 while taking into consideration thromboembolic properties of the former and hemodynamic disturbances of the latter. As current data suggest, all known COVID-19 vaccines are safe to use in MG patients.
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Acta clinica Croatica · Feb 2022
ReviewREVIEW OF THE BLADDER CANCER MOLECULAR CLASSIFICATION PROPOSED: A NEW ERA - NEW TAXONOMY.
The management of bladder cancer patients largely depends on pathologic staging and grading, and current morphological classification does not always show the individual patient's risk. Despite modern surgical techniques, pre- and postoperative therapies, clinical outcomes of these patients have not changed over decades. ⋯ Assessment of multiple biomarkers associated with those pathways offers new understanding of tumor behavior while identifying important panels of predicting patient management and outcomes. In this review, the most important molecules and basics of the novel molecular classification of bladder cancer are presented.
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Acta clinica Croatica · Feb 2022
COMPARISON OF CAROTID STENOSIS GRADING BY CT ANGIOGRAPHY AND DOPPLER ULTRASONOGRAPHY: HOW THE STATISTICAL METHODS APPLIED INFLUENCE THE RESULTS.
In this study, we compared the measurement of carotid stenosis by computed tomography angiography (CTA) based on the narrowest diameter versus cross sectional area (CSA) with the measurement by color Doppler ultrasonography (CDUS) as a reference standard, and analyzed how the application of different statistical methods affected the result. On 113 carotid arteries with ≥50% stenosis, we quantified the level of correlation among the three measurements, sensitivity, specificity, and differences in the estimated stenosis level. Correlation between both CTA measurements was good with Pearson's ρ between 0.87 and 0.91 (p<0.001). ⋯ A good correlation between CSA and diameter measurement just means that these are two related features of stenosis, it does not mean good agreement. CTA (CSA) method better detected surgical stenoses, whereas CTA (diameter) systematically underestimated stenosis level. The study of differences between the measurements indicated agreement better than the calculation of correlation coefficients.