Dávid Líška

Hepatocellular carcinoma (HCC), is one of the most common malignancies around the world, is on the rise and is associated with patient disability. Although HCC can be a devastating disease, regular early detection (surveillance) and diagnosis are the best chance of long-term survival. Cancer's typical consequences and side effects include liver failure, fatigue, loss of muscle mass, reduced muscle strength and functional endurance capacity, reduced flexibility and mobility, nutritional deficiencies, and pain. Rehabilitation is a comprehensive strategy to slow the progression of HCC and reduce functional deficits. Rehabilitation is aimed at patients in all stages of cancer and, as a treatment, provides an improvement in the patient's functional status and quality of life. The purpose of this commentary is to summarise the available information on the rehabilitation of hepatocellular carcinoma. Functional examination and exercise are the mainstays of rehabilitation treatment in HCC. HCC carcinoma and cancer treatment can lead to fragility and sarcopenia. One of the main options to influence sarcopenia and frailty is rehabilitation. Sarcopenia and frailty are two domains that have the potential to be intermediate for patients with personalised and evidence-based HCC rehabilitation. Rehabilitation in patients with HCC can be of significant benefit in improving the clinical condition of patients.

Monografia poukazuje na významný vzťah medzi pohybovou aktivitou, kvalitou spánku a muskuloskeletálnym zdravím vysokoškolských študentov. Výsledky zdôrazňujú potrebu implementácie preventívnych programov zameraných na podporu pravidelnej pohybovej aktivity, ergonomických návykov a optimalizáciu spánkovej hygieny v študentskej populácii.

Objective Hospital admissions for advanced chronic liver disease (ACLD) are associated with increased mortality, disability, a decline in quality of life and significant economic costs. Being admitted to the hospital usually indicates a triggering event that disrupted a previously stable condition, leading to decompensation or complications of ACLD. The most acute and severe manifestation of this imbalance is acute-on-chronic liver failure (ACLF), a syndrome representing a critical juncture. Reliable prognostic stratification of patients admitted with ACLF could facilitate the systematic delivery of tailored care, ranging from palliative care to intensive interventions like extracorporeal liver support devices and prioritised liver transplantation. Disease-specific prognostic tools, such as the Model for End-Stage Liver Disease score, are effective but have limitations, particularly in reflecting a patient’s potential for recovery. The concept of the body’s functional reserve in the context of ACLD/ACLF is gaining attention, with the Liver Frailty Index (LFI) potentially emerging as a recommended diagnostic tool. Methods Patients were selected from our cirrhosis registry (RH7). The LFI serves as an indicator of the patient’s prognosis. The LFI measurement takes place at two time intervals: on the patient’s admission and after 7 days of hospitalisation. Results Our RH7 registry included 154 patients (15.1%) who were diagnosed with ACLF. The primary cause of the underlying ACLD was alcohol-associated liver disease in the majority (79.8%) of cases. The mean value of LFI at admission was 4.50 (± 0.94). When patients with liver cirrhosis were categorised into three subgroups based on the LFI on day 7, survival exhibited a statistically significant decrease (p≤0.05) across all three ACLF grades. This decline in survival was observed from the ‘improved LFI’ cohort, through the ‘stable LFI’ group, to the ‘worsened LFI’ group. Conclusion The impact of day 7 LFI on the survival of patients with ACLF is notable. Nevertheless, it does not markedly enhance the predictive capability of the LFI assessed on admission. Consequently, the initial LFI on day 1 continues to be the most valuable and commonly used instrument for promptly recognising individuals with ACLF.

Physical activity brings us joy, energy, and vitality. It helps us overcome daily stressful situations, improves sleep quality, and promotes healthy self-esteem. It doesn't matter what form of exercise we choose – whether it's running, swimming, cycling, yoga, or simply walking in nature. Every step we take towards a more active lifestyle is a step towards better health. Our scripts are designed to provide you with valuable information, advice, and guidance on how to incorporate physical activity into your daily life. Regardless of your current fitness level or experience, we believe that everyone can find a way to move actively and gain the maximum benefit from exercise.

BACKGROUND: Individuals diagnosed with liver cirrhosis typically experience a variety of symptoms. Decompensation, a critical stage in the disease’s progression, is characterized by the emergence of prominent clinical signs. These signs typically include ascites, bleeding tendencies, hepatic encephalopathy, and jaundice. Furthermore, it is noteworthy that regions in the sensorimotor cortex responsible for practical and gnostic functions are closely situated within the parieto-occipital part of the cortex. Liver cirrhosis may also have an impact on this aspect of human motor function. OBJECTIVES: The main objective of the study is to compare the gnostic function and stereognostic function in individuals with liver cirrhosis and those in a healthy population. METHODS: The patients included in our registry, known as RH7, were enrolled in our study. The first group consisted of 74 liver cirrhosis patients (including 25 women and 49 men). The control group consisted of a 63 healthy population (including 23 women and 40 and men). Both groups underwent both the Petrie and kinaesthesia tests. RESULTS: The results of the Petrie test, which compared healthy participants with those with liver cirrhosis, indicate that the healthy population achieved a significant difference in both right and left upper limb compared to those with liver cirrhosis patients (p< 0.05). The healthy population showed a significant difference compared to liver cirrhosis patients in the kinesthesia test (p< 0.05), except for the second attempt with the left upper limb (p= 0.267). According to the LFI, there was no significant difference in either upper limb during both the initial and second attempts of Petrie test (p> 0.05). CONCLUSION: Patients with liver cirrhosis exhibited significantly poorer gnostic functions compared to the healthy population. This condition also leads to notable impairments in motor functions, affecting both the precision and coordination of movements. Despite these deficits, frailty alone does not appear to be an indicator of worsened gnostic or stereognostic functions. Therefore, while liver cirrhosis has a clear negative impact on motor and cognitive abilities, the presence of frailty does not necessarily exacerbate these specific cognitive deficits. This distinction is crucial for clinical assessments and interventions targeting motor and cognitive rehabilitation in patients with liver cirrhosis.

Alcohol consumption can influence an individual's quality of life, with the impact varying based on several factors such as the amount of alcohol consumed, frequency of consumption, individual tolerance, and overall health. Slovakia is among the countries with the highest incidence of liver cirrhosis in the world, with alcohol representing a significant risk factor. Therefore, it is important to identify at-risk groups and the potential impact of various factors. The primary objective of this study is to examine the relationship between alcohol consumption and quality of life among college students in the Slovak Universities. A cross-sectional study was conducted in December 2021 and January 2022. The study included college students with an average age of 22.3 years. Participants were surveyed about their alcohol consumption and quality of life using the standardized Alcohol Use Disorders Identification Test (AUDIT) and EuroQol-5D (EQ-5D) questionnaires. These questionnaires were distributed through online school systems. In the study, 88.7% of the students reported drinking alcohol. A low AUDIT score was recorded for 67.1% of the total participants (2573 students). A medium score was found in 23.3% of the participants (893 students). High scores were identified in 2.4% of the participants (92 students), and very high scores were found in 2.2% of the total participants (86 students). Mild pain was reported in 33.8% of cases, while moderate pain was reported in 5.2% of cases. Mild depression and anxiety were reported in 31.1% of the cases, and moderate depression and anxiety were reported in 13.5% of the cases. There is a statistically significant relationship between AUDIT and EuroQOL variables (p < 0.001). This suggests that the association between alcohol use (measured by AUDIT) and health-related quality of life (measured by EuroQOL) is unlikely to be due to chance. Higher alcohol consumption was associated with a poorer quality of life in Slovak college students. Our results suggest a meaningful connection between alcohol consumption behaviors and overall quality of life, highlighting the potential impact of alcohol use on health outcomes. Further research is warranted to explore the nature and causality of this relationship, which could inform interventions aimed at improving health-related quality of life through alcohol use reduction strategies. The association between higher alcohol consumption and poorer quality of life in Slovak college students raises important questions about causality and the complex interplay between alcohol consumption and one’s overall well-being. The significant relationship between higher alcohol consumption and poorer quality of life suggests the need for targeted public health interventions aimed at reducing alcohol consumption among college students. Programs focusing on awareness and education about the negative impacts of excessive drinking could be implemented to promote healthier lifestyles.

Skriptá sú venované pohybovej aktivite, základnému stavebnému kameňu zdravého a plnohodnotného života. Pohybová aktivita nie je len o udržiavaní kondície alebo dosahovaní ideálnej postavy. Je to kľúčový faktor, ktorý prispieva k celkovému zdraviu, zvyšuje odolnosť voči chorobám, zlepšuje náladu a podporuje psychickú pohodu. Skriptá sú navrhnuté tak, aby poskytli cenné informácie, rady a návody, ako začleniť pohybovú aktivitu do každodenného života.