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S. Loga-Zec, M. Aščerić, Nataša Loga-Andrijić, B. Kapetanović, E. Zerem

Objective: To determine types and frequency of side effects of antihypertensive drugs in patients with diabetes mellitus (DM) type 2 and hypertension. Subjects and Methods: We performed a prospective study of 79 patients with DM type 2 and hypertension, randomly selected by systematic sampling, who were followed over a period of six months. Patients were assessed at baseline and once a month measuring following parameters: types of used antihypertensive drugs and frequency of side effects, the values (mmHg) of systolic (SBP) and diastolic blood pressure (DBP). Results: Out of 79 patients, 48/79 (60.8%) were males and 31/79 (39.2%) were females. The median age in males was 53 years (IQR=48 to 55 years), in females was 53 years (IQR=49 to 56 years). There was no statistically significant difference in median age between males and females (P=0.368). There is a statistically significant difference in the values of SBP [χ2(5)=312.296, P<0.001] and DBP [χ2(5)=216.051, P<0.001] over a period of six months follow-up. The drug side effects were noted in 9/79 (11.4%) patients between 1-2 months, in 6/79 (7.6%) between 2-3 months, in 1/79 (1,3%) between 3-4 months. The most common side effect was cough (11/79 or 13.9%) associated with the combination of ACE inhibitor and thiazide diuretics. In 5/79 (6.3%) patients there were reports of: flushing, palpitations, headache, dizziness and leg edema associated with Ca blockers. Conclusion: The most common side effect of antihypertensive treatment was cough (13.9%) associated with the combination of ACE inhibitor and thiazide diuretic.

Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.

E. Zerem, S. Omerovíc, Zlatko Guzin

T he commendable multicenter study by Dr Tiwari et al1 focuses on the comparison of outcomes of laparoscopic and open appendectomy (OA) in management of uncomplicated and complicated appendicitis. The authors conclude that laparoscopic appendectomy (LA) is superior or comparable to OA in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis, across most illness severity groups and so they recommend it as the preferred technique, irrespective of appendicitis diagnosis or disease severity. On the basis of our long-term experience,2 we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage (PCD) as the treatment modality that can successfully solve acute perforated appendicitis in some patients. Authors specified that the study1 results have clearly demonstrated superiority of LA over OA, as it had shown to be a safe, efficacious, and cost-effective method for complicated (mostly perforated) and uncomplicated appendicitis.

References 1 Saito M, Seo Y, Yano Y, Miki A, Yoshida M, Azuma T. A high value of serum des-g-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment. J Gastroenterol 2012; 47:1134–1142. 2 Toyoda H, Kumada T, Osaki Y, Tada T, Kaneoka Y, Maeda A. Novel method to measure serum levels of des-gamma-carboxy prothrombin for hepatocellular carcinoma in patients taking warfarin: a preliminary report. Cancer Sci 2012; 103:921–925. 3 Murata K, Suzuki H, Okano H, Oyamada T, Yasuda Y, Sakamoto A. Cytoskeletal changes during epithelial-to-fibroblastoid conversion as a crucial mechanism of des-gamma-carboxy prothrombin production in hepatocellular carcinoma. Int J Oncol 2009; 35:1005–1014. 4 Copple BL. Hypoxia stimulates hepatocyte epithelial to mesenchymal transition by hypoxia-inducible factor and transforming growth factor-betadependent mechanisms. Liver Int 2010; 30:669–682.

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