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Nephrotic syndrome (NS) is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Apart from the traditional causes of NS, such as minimal change disease, focal segmental glomerulosclerosis, diabetes, infections, malignancies, autoimmune conditions, and nephrotoxic agents, there are also rare causes of NS, whose knowledge is of the utmost importance. The aim of this article was to highlight the less well-known causes that have a significant impact on diagnosis and treatment. Genetic syndromes such as Schimke immuno-osseous dysplasia, familial lecithin-cholesterol acyltransferase deficiency with two clinical variants (fish-eye Disease and the p.Leu364Pro mutation), lead to NS through mechanisms involving podocyte and lipid metabolism dysfunction. Congenital disorders of glycosylation and Nail–Patella Syndrome emphasize the role of deranged protein processing and transcriptional regulation in glomerular injury. The link of NS with type 1 diabetes, though rare, suggests an etiology on the basis of common HLA loci and immune dysregulation. Histopathological analysis, particularly electron microscopy, shows mainly podocyte damage, mesangial sclerosis, and alteration of the basement membrane, which aids in differentiating rare forms. Prompt recognition of these novel etiologies by genetic analysis, renal biopsy, and an interdisciplinary panel is essential to avoid delays in diagnosis and tailored treatment.

Background and Objectives: Inflammatory Bowel Disease, including Crohn’s Disease and Ulcerative Colitis, affects patients’ Quality of Life through various and complex chronic gastrointestinal symptoms. When medical treatment protocols are ineffective, surgical options like a colectomy, ileostomy, or Ileal Pouch Anal Anastomosis may be necessary, offering symptom relief but presenting new psychological, emotional, and social issues. Objectives: This systematic review evaluates the impact of surgery on quality of life in Inflammatory Bowel Disease patients from 2018 to 2023, focusing on physical, emotional and social outcomes as well as long-term quality of life predictors. Materials and Methods: We searched PubMed, Scopus, and Cochrane Library for studies assessing Quality of Life in surgically treated Inflammatory Bowel Disease patients, including physical and psychological outcomes. Non-English studies were excluded. Risk of bias was evaluated using Cochrane and Newcastle–Ottawa tools, with data synthesized narratively and via random-effects meta-analysis. Results: Of 2450 records screened, 58 studies (45 in meta-analysis) were included, covering colectomy, ileostomy and Ileal Pouch Anal Anastomosis. Surgery significantly improved physical quality of life in 90% of patients, but psychological and social challenges persisted, with 38% reporting body image issues and 34% experiencing social isolation. Psychological support improved emotional quality of life by 20–30%. Long-term quality of life varied, with IPAA patients showing higher satisfaction (70% at 5 years) than Crohn’s Disease patients with resections. Conclusions: Surgery enhances physical quality of life in Inflammatory Bowel Disease patients, but requires multidisciplinary care to address persistent psychological and social challenges, ensuring optimal long-term outcomes.

Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology in which genetic factors contribute to development of disease. Single nucleotide polymorphisms (SNPs) in multidrug resistance 1 (MDR1) gene encoding transporter P-glycoprotein have been associated with IBD, but their role in disease susceptibility remains unclear. Therefore, the aim of this study was to investigate the association of three MDR1 polymorphisms, C1236T (rs1128503), G2677T/A (rs2032582) and C3435T (rs1045642), with Serbian IBD patients. A total of 206 IBD patients, 107 Crohn's disease (CD) and 99 ulcerative colitis (UC), and 255 healthy controls were included in the study. All subjects were genotyped using TaqMan SNP genotyping assays. Comparisons between the groups were performed using the Pearson Chi-square test. False discovery rate according to Benjamini-Hochberg procedure was applied to adjust for multiple comparisons. Carriers of T allele of all three MDR1 SNPs were more common in UC patients compared to healthy controls, suggesting predisposing role of T allele of these SNPs in UC pathogenesis. Consistently, TT genotype of C1236T and TTT haplotype were also found more frequently in UC patients. On the other hand, C allele and CC genotype of C1236T and C3435T, as well as G allele and GG genotype of G2677T/A were more frequent in healthy subjects, implying protective role of these variants in UC. Likewise, CGC haplotype and CGC/CGC diplotype were more frequent in controls. Contrary to UC, no statistical difference was observed between CD patients and controls in any of the SNPs analyzed. MDR1 gene variants and haplotypes were associated with UC in Serbian IBD patients, further supporting their potential role in susceptibility to UC.

Background: Metabolic bone disease in patients with chronic liver disease is called hepatic osteodystrophy and is primarily a sequel to osteopenia/osteoporosis, and rarely secondary to osteomalacia. The aim of this work was to define the influence of vitamin D3 and parathyroid hormone (PTH) in the pathogenesis of hepatic osteodystrophy, as well as the predictive significance of biochemical bone markers. Methods: This prospective study included 58 male patients with alcoholic (49) and viral (9) cirrhosis. The concentrations of serum vitamin D3, PTH, osteocalcin and ß-carboxy-terminal cross-linked telopeptide of type I collagen (ß-CTX) were determined. Bone density was measured by dual energy X-ray absorptiometry in the L1-L4 spinal segment and the femoral neck. Results: Lower bone mineral density (BMD) was measured in 41 patients (70.7%). There was no significant correlation between PTH and vitamin D3 values and T score in the femoral neck (p = 0.51; p = 0.063) and lumbar spine (p= 0.49; 0.064). Also, no significant correlation was found between the osteocalcin values in lumbar spine BMD (p= 0.944) and femoral neck (p= 0.161), or with ß-CTX values and BMD in the lumbar spine (p=0.347) and femoral neck (p=0.73). Statistically significant difference was confirmed between the stage A osteocalcin (p=0.000) and ß-CTX (p=0.008) values in relation to advanced stages B and C. Conclusions: PTH and vitamin D3 do not influence the development of hepatic osteodystrophy. In patients with cirrhosis, osteocalcin and ß-CTX are not valid indicators of decreased BMD, but their values correlate with the degree of liver insufficiency.

Background/Objectives: Cirrhosis is an irreversible state of chronic liver disease. Systemic inflammatory response syndrome (SIRS) is a severe complication and significantly contributes to lethal outcomes in cirrhotic patients. We studied a group of cirrhotic patients with SIRS admitted to our centre, assessing the relationship with in-hospital outcomes. Methods: The study population included 102 patients with alcoholic cirrhosis and SIRS. Laboratory biomarkers, the model for end-stage liver disease, the model for end-stage liver disease—natrium, the Acute Physiology and Chronic Health Evaluation II score, CLIF-C organ failure, the systemic immune-inflammation index score (S II), and the Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score were tested in relation to the mortality risk using receiver operating characteristic (ROC) curves. Results: Our results demonstrated that values of sodium, chlorides, and albumin significantly correlated with 7-day survival. The area under the curve’s (AUCs) values for sodium, chlorides, and albumin were 0.542, 0.627, and 0.610, respectively, for 7-day mortality prediction. The CAGIB score significantly correlated with 7-day mortality, with the cut-off value of −7.86 (AUC: 0.674, 95% CI (0.555–0.794)). For the assessment of 28-day mortality, the AUC values for sodium, chlorides, and albumin were 0.630, 0.654, and 0.661, respectively. Additionally, the cut-off value of the CAGIB score was found to be −7.84 (AUC: 0.625, 95% CI (0.509–0.740)) in 28-day mortality prediction. Conclusions: Sodium, chlorides, albumin, and the CAGIB score are reliable predictors of 7-day and 28-day in-hospital mortality in patients with advanced alcoholic liver disease and SIRS.

Recently, there has been a growing interest in the application of artificial intelligence (AI) in medicine, especially in specialties where visualization methods are applied. AI is defined as a computer’s ability to achieve human cognitive performance, which is accomplished through enabling computer “learning”. This can be conducted in two ways, as machine learning and deep learning. Deep learning is a complex learning system involving the application of artificial neural networks, whose algorithms imitate the human form of learning. Upper gastrointestinal endoscopy allows examination of the esophagus, stomach and duodenum. In addition to the quality of endoscopic equipment and patient preparation, the performance of upper endoscopy depends on the experience and knowledge of the endoscopist. The application of artificial intelligence in endoscopy refers to computer-aided detection and the more complex computer-aided diagnosis. The application of AI in upper endoscopy is aimed at improving the detection of premalignant and malignant lesions, with special attention on the early detection of dysplasia in Barrett’s esophagus, the early detection of esophageal and stomach cancer and the detection of H. pylori infection. Artificial intelligence reduces the workload of endoscopists, is not influenced by human factors and increases the diagnostic accuracy and quality of endoscopic methods.

The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), includes a clinical spectrum of diseases from mild to severe progressive pneumonia, which has affected and still affects the human population worldwide. Most commonly, it is presented by respiratory symptoms, but studies have shown that about 50% of patients with SARS-CoV-2 infection have at least one gastrointestinal symptom (GI), predominantly nausea, diarrhea, vomiting, or loss of appetite. In addition, abnormal liver functional tests are commonly present in the SARS-CoV-2 virus. The aim of our study was to examine the GI and hepatic manifestations of COVID-19 in patients hospitalized due to COVID-19 pneumonia in “COVID hospital Batajnica”, University Clinical Center of Serbia in Belgrade. The study included 498 consecutive patients, and the data was obtained from the patient’s electronic medical history. GI symptoms included nausea, vomiting, diarrhea, and anorexia. Collected laboratory values included baseline and peak values of blood count, inflammatory parameters, liver function tests, renal function tests, and cardiac enzyme tests. The results have shown that GI symptoms occurred in 26% of cases at diagnosis, which indicates the great susceptibility of the GI system to SARS-CoV-2. There was a high risk of liver injury in patients with COVID-19 pneumonia (>60%). The level of AST is more often increased compared to ALT, which is different from other virus-induced liver lesions and may be a useful indicator of SARS-CoV-2 infection. Further research should focus on the causes of liver damage in SARS-CoV-2 virus and the impact on treatment and outcome of COVID-19 disease.

Background Metabolic bone disease in patients with chronic liver disease is called hepatic osteodystrophy and is primarily a sequel to osteopenia/osteoporosis, and rarely secondary to osteomalacia. The aim of this work was to define the influence of vitamin D3 and parathyroid hormone (PTH) in the pathogenesis of hepatic osteodystrophy, as well as the predictive significance of biochemical bone markers. MethodsThis prospective study included 58 male patients with alcoholic (49) and viral (9) cirrhosis. The concentrations of serum vitamin D3, PTH, osteocalcin and b-carboxy-ter - minal cross-linked telopeptide of type I collagen (b-CTX) were determined. Bone density was measured by dual energy X-ray absorptiometry in the L1-L4 spinal segment and the femoral neck. Results Lower bone mineral density (BMD) was measured in 41 patients (70.7%). There was no significant correlation between PTH and vitamin D3 values and T score in the femoral neck (p=0.51; p=0.063) and lumbar spine (p=0.49; 0.064). Also, no significant correlation was found between the osteocalcin values in lumbar spine BMD (p=0.944) and femoral neck (p=0.161), or with b-CTX values and BMD in the lumbar spine (p=0.347) and femoral neck (p=0.73). Statistically significant difference was confirmed between the stage A osteocalcin (p=0.000) and b- CTX (p=0.008) values in relation to advanced stages B and C. Uvod: Metabolička bolest kostiju kod pacijenata sa hro- ničnim oboljenjem jetre naziva se hepatička osteodistrofija i primarno je posledica osteopenije ili osteoporoze a ređe osteomalacije. Cilj rada je bio da se determine uloga para- tireoidnog hormona (PTH) i vitamina D3 u patogenezi he- patičke osteodistrofije, kao i prediktivni znaCaj biohemijskih koštanih markera. Metode: U prospektivnoj studiji, obuhvaćeno je 58 pacijena- ta muSkog pola sa alkoholnom (49) i virusnom (9) cirozom jetre. Odredivane su serumske koncentracije vitamina D3, PTH, osteokalcina i p-C-terminalnog telopeptida tip I kola- gena (p-CTX). Koštana gustina je merena dvostrukom X-zračnom apsorpciometrijom na L1-L4 segmentu kičme i vratu butne kosti. Rezultati: Smanjena mineralna koStana gustina (BMD) izmerena je kod 41 (70,7%) pacijenta. Nije bilo značajne korelacije vrednosti PTH i vitamina D sa T skorom na vratu butne kosti (p=0,51; p=0,063) i lumbalnoj kičmi (p=0,49; p=0,064). Statistička značajnost nije uočena ni prilikom uporedivanja vrednosti osteokalcina i BMD lumbalne kičme (p=0,944) i vrata butne kosti (p=0,161), kao ni vrednosti p-CTX i BMD lumbalne kičme (p=0,547) i vrata butne kosti (p=0,75). Međutim, statistički značajna razlika je potvrđena korelisanjem vrednosti osteokalcina (p=0,000) i p-CTX (p=0,008) u stadijumu A u odnosu na odmakle stadijume bolesti B i C.

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease which is characterized by extremely complex pathogenetic mechanisms and multifactorial etiology. Some of the many pathophysiological mechanisms involved in the development of NAFLD include oxidative stress, impaired mitochondrial metabolism, inflammation, gut microbiota, and interaction between the brain-liver-axis and the regulation of hepatic lipid metabolism. The new therapeutic approaches in the treatment of NAFLD are targeting some of these milestones along the pathophysiological pathway and include drugs like agonists of peroxisome proliferator-activated receptors (PPARs), glucagon-like peptide-1 (GLP-1) agonists, sodium/glucose transport protein 2 (SGLT2) inhibitors, farnesoid X receptor (FXR) agonists, probiotics, and symbiotics. Further efforts in biomedical sciences should focus on the investigation of the relationship between the microbiome, liver metabolism, and response to inflammation, systemic consequences of metabolic syndrome.

ObjectivesThe long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut–brain interaction after hospitalisation for SARS-CoV-2 infection.DesignGI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires.ResultsThe study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls.ConclusionCompared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls.Trial registration number NCT04691895.