University of Split School of Medicine Repository
Not a member yet
2312 research outputs found
Sort by
Syndecans, exostosins and sulfo-transpherases as potential synovial inflammation moderators in patients with hip osteoarthritis
No full textPozadina istraživanja: Uvriježeno je mišljenje da je postupno propadanje zglobne hrskavice središnji događaj u nastanku i progresiji osteoartritisa (OA), no nedavne su studije pokazale iznimnu važnost sinovitisa niskog stupnja u progresiji OA. Poznato je da sindekanska (SDC) obitelj membranskih proteoglikana sudjeluje u regulaciji upale, ali postoje ograničeni dokazi koji razmatraju ulogu sindekana u OA sinovitisu. Cilj mog rada bio je istražiti obrasce ekspresije sindekana-1 (SDC1), sindekana-2 (SDC2) i sindekana-4 (SDC4) u sinovijalnoj membrani (intimi i subintimi) OA kuka, kao i egzostozina (EXT) i sulfotransferaza (NDST) (enzima uključenih u polimerizaciju i modifikaciju heparan-sulfatnih lanaca sindekana). Metode: kirurški prikupljene uzorke sinovijalne ovojnice pacijenata s OA podijelio sam u dvije skupine s obzirom na izraženost sinovitisa ocijenjenog histološkim bodovanjem sinovitisa po Krennu. Zatim sam analizirano imunohistokemijsku ekspresiju SDC1, SDC2, SDC4, EXT1, EXT2, NDST1 i NDST2 u sinovijalnoj intimi i subintimi i potom je usporedio s kontrolnom skupinom (pacijenti s prijelomom vrata bedrene kosti, bez OA). Dodatno sam istražio povezanost ekspresije ovih molekula s kliničkim i radiološkim pokazateljima težine osteoartritisa kuka. Rezultati: prema mojoj studiji, imunoekspresija SDC1, NDST1 i EXT2 značajno je povećana u stanicama intime OA sinovijalne membrane u bolesnika s nižim histološkim rezultatom sinovitisa, i SDC4 u bolesnika s višim rezultatom sinovitisa, u usporedbi s kontrolama bez OA. Razlika u ekspresiji SDC2 između OA i ne-OA skupine je beznačajna. Nasuprot tome, klinički i radiološki pokazatelji težine OA najbolje koreliraju s ekspresijom sindekana-2, od svih ispitivanih molekula, kako u intimalnom tako i u subintimalnom sloju sinovijalne ovojnice. Zaključci: Čini se da SDC1, SDC4, NDST1 i EXT2 imaju ulogu kao moderatori upale u OA sinovitisu niskog stupnja. Tumačenje rezultata je teško zbog delikatnih interakcija između testiranih molekula i njihovih potencijalnih pro- i protuupalnih učinaka. Usprkos tome, mišljenja sam da rezultati moje studije dokazuju da bi upalne mehanizme povezane sa sindekanima trebalo dodatno istražiti kao potencijalne markere progresije bolesti i terapijskog cilja u OA.Background: The gradual deterioration of articular cartilage was thought to be the central event in osteoarthritis (OA), but recent studies demonstrated importance of low-grade synovitis in progression of OA. Syndecan (SDC) family of membrane proteoglicans is known to be involved in regulation of inflammation but there is a limited evidence considering the role of syndecans in OA synovitis. The aim of my study was to investigate hip OA synovial membrane expression patterns (intimal and subintimal) of syndecan-1 (SDC1), syndecan-2 (SDC2), and syndecan-4 (SDC4) as well as exostosins (EXT) and sulfotransferases (NDST) (enzymes involved in polimerisation and modification of syndecans’ heparan-sulfat chains). Methods: surgically collected synovial membrane samples of patients with OA were divided into two groups according to their Krenn synovitis score grading. Immunohistochemical expression of SDC1, SDC2, SDC4, EXT1, EXT2, NDST1, and NDST2 in synovial intima and subintima was then analyzed and compared with control group (patients with femoral neck fracture, without OA). Additionally, I investigated the association of the expression of these molecules with clinical and radiological indicators of hip osteoarthritis severity. Results: according to my study, immunoexpression of SDC1, NDST1 and EXT2 is significantly increased in intimal cells of OA synovial membrane in patients with lower histological synovitis score, and SDC4 in patients with higher synovitis score, in comparison with non-OA controls. Difference in expression of SDC2 among OA and non-OA group is insignificant. Contrary, clinical and radiological indicators of OA severity correlate best with syndecan-2 expression, of all investigated molecules, both in intimal and subintimal layers of synovial membrane. Conclusions: SDC1, SDC4, NDST1 and EXT2 seem to be involved as inflammation moderators in low-grade OA synovitis. The interpretation of the results is difficult due to the delicate interactions between the tested molecules and their potential pro- and anti-inflammatory effects. However, I am of the opinion that the results of my study prove that syndecan related inflammation pathways should be further investigated as potential markers of disease progression and therapeutic goal in OA
Detection of sarcopenia in patients with liver cirrhosis using the bioelectrical impedance analysis
No full textUvod: Bioelektrična impedancija (BIA, engl. bioelectrical impedance analysis) je metoda procjene sastava tijela. Cilj istraživanja bio je utvrditi njenu točnost u detekciji sarkopenije u bolesnika s cirozom jetre. Kao referentna metoda korišten je indeks skeletnog mišićnog tkiva (SMI, engl. skeletal muscle index) na razini trećeg lumbalnog kralješka (L3-SMI) dobiven korištenjem višeslojne kompjutorizirane tomografije. Ispitanici i metode: Bolesnici s cirozom jetre uključeni su u razdoblju od listopada 2019. do ožujka 2022. te su praćeni do siječnja 2023. Njihovi BIA parametri uspoređeni su s vrijednostima L3-SMI te su korištenjem ROC (engl. receiver operating characteristic curve) analize predložene granične vrijednosti BIA parametara u detekciji sarkopenije. Temeljem dobivenih kliničkih karakteristika analizirani su i ishodi bolesnika. Rezultati: Uključeno je ukupno 106 bolesnika. Pronašli smo značajnu korelaciju između BIA parametara i L3-SMI. Odredili smo granične vrijednosti od ≤11,1 kg/m2 za BIA-SMI (Se 73%, Sp 66%, AUROC 0,737, p < 0,001) i ≤5,05° za PA (Se 79%, Sp 60%, AUROC 0,762, p < 0,001) u detekciji sarkopenije. Relativni rizik od smrti bio je 2,2 puta veći u bolesnika sa skeletno-mišićnom masom (SMM, engl. skeletal muscle mass) ≤36,5 kg. SMM je ujedno pokazao značajnu povezanost s ishodima u Kaplan-Meierovoj analizi. Zaključak: Ova neinvazivna i jednostavna metoda, koja je pokazala dobre dijagnostičke mogućnosti i vrlo dobro predviđanje ishoda, mogla bi ispuniti potrebu za brzim i pristupačnim otkrivanjem sarkopenije u bolesnika s cirozom jetre.Background: Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3- SMI) obtained using the multislice computed tomography as the reference method. Patients and methods: Patients with LC were enrolled in the period October 2019–March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. Results: A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI.We determined cut-off values of ≤11.1 kg/m2 for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤36.5 kg. SMM was significantly associated with outcome in Kaplan–Meier analysis. Conclusion: This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated
Effect of Moderate Consumption of Red Wine on Serum Hepcidin Concentrations and Other Iron Homeostasis Parameters in Healthy Subjects and Individuals with Type 2 Diabetes
No full textUvod i ciljevi istraživanja: Smanjena ekspresija hepcidina, ključnog regulatora sustavne homeostaze željeza, važan je dio patogeneze nakupljanja željeza u tijelu povezanim s konzumacijom alkohola. Visoka razina željeza predstavlja čimbenik rizika za nastanak šećerne bolesti tipa 2 (ŠBT2) jer utječe na važne sastavnice patogeneze bolesti kao što su inzulinska rezistencija, pojačana glukoneogeneza i smanjeno lučenje inzulina. Više epidemioloških istraživanja je pokazalo kako je umjerena konzumacija crnog vina povezana s nižim rizikom razvoja ŠBT2, pri čemu se naglašava uloga polifenola prisutnih u crnom vinu. Navedeni spojevi pokazuju učinke na ekspresiju hepcidina i apsorpciju željeza suprotne učincima alkohola. S obzirom na opisane fiziološke učinke hepcidina kao i njegovu potencijalnu ulogu u patofiziologiji ŠBT2, glavni cilj istraživanja bio je ispitati učinak umjerene konzumacije crnog vina na serumske koncentracije hepcidina u skupini zdravih ispitanika i u skupini ispitanika sa ŠBT2. Kako je hepcidin najvažniji čimbenik regulacije homeostaze željeza, u ovom istraživanju također je ispitan učinak umjerene konzumacije vina i na druge pokazatelje homeostaze željeza. Budući da je eritropoeza dominantni potrošač željeza kod ljudi, ispitao se učinak umjerene konzumacije crnog vina na glavni eritropoetski put eritropoetin-eritroferon-hepcidin. Ispitanici i postupci: Radi se o prospektivnom, nerandomiziranom, kliničkom istraživanju učinka prehrambenog proizvoda na ispitanike. Bile su određene dvije skupine ispitanika, skupina zdravih ispitanika i skupina ispitanika sa ŠBT2 bez drugih značajnih komorbiditeta i bez anamneze ranije zloporabe alkohola. Ispitanicima je nakon njihovog pristanka nakon uvodnog razdoblja od 2 tjedna bez konzumacije alkoholnih pića određena dnevna konzumacija 300 ml studijskog crnog vina podijeljeno uz 2 dnevna obroka tijekom slijedeća 3 tjedna. Neposredno prije i poslije opisane intervencije svim ispitanicima su urađena antropometrijska mjerenja i uzorkovanje krvi te laboratorijska analiza uzoraka. Analizirane su serumske razine hepcidina, biokemijski pokazatelji statusa željeza, hematološki parametri, eritropoetski parametri te ostali značajni biokemijski parametri. Ukupno je 31 ispitanik ispunio predviđeni protokol istraživanja, od čega 13 zdravih ispitanika te 18 ispitanika sa ŠBT2. Rezultati: Rezultati istraživanja pokazali su kako je trotjedna umjerena konzumacija crnog vina dovela do sniženja serumske koncentracije hepcidina. Statistički značajno smanjenje koncentracije serumskog hepcidina je izmjereno u skupini zdravih ispitanika (30,0 ± 17,3 vs. 21,0 ± 12,1 ng/mL, P = 0,045) i u skupini ispitanika sa ŠBT2 (17,9 [11,9-25,2] vs. 13,2 [8,2-18,3] ng/mL, P = 0,001). Pad serumskih koncentracija hepcidina nije se odrazio na serumsko željezo, njegove razine ostale su nepromijenjene u obje skupine, u skupini zdravih ispitanika (P=0,328) i u skupini ispitanika sa ŠB (P=0,177). Drugi značajni pokazatelji povezani sa željezom ostali su uglavnom nepromijenjeni nakon intervencije, osim statistički značajnog pada razine feritina u skupini zdravih ispitanika (173,0 [126,4-259,8] vs. 118,0 [90,5-232,6] ng/mL, P = 0.017). Smanjenje hepcidina bilo je popraćeno povećanjem razine eritropoetina (10,6 [7,7-12,1] vs. 12,5 [10,2-14,1] mlU/ml, P = 0,001) u skupini zdravih ispitanika te (7,6 [6,4-9,4] vs. 8,9 [8,4-11,1] mlU/ml, P = 0,024) u skupini ispitanika sa ŠBT2, dok je povećanje eritroferona doseglo statističku značajnost samo u skupini ispitanika sa ŠBT2 (0,044 ± 0,075 vs. 0,12 ± 0,12 ng/mL, P = 0,028). Veličina i smjer promjena u razinama EPO, ERFE i hepcidina kao odgovor na intervenciju s vinom nisu se razlikovala između skupina. U konačnici, primijećeno je statistički značajno povećanje RDW u obje ispitivane skupine, u skupini zdravih ispitanika (13,0 ± 0,5 vs. 13,2 ± 0,5 %, P = 0,013) te u skupini ispitanika sa ŠBT2 (13,5 ± 0,4 vs. 13,6 ± 0,5 %, P = 0,033) uz značajno povećanje broja retikulocita (60 ± 16 vs. 70 ± 15x109, P = 0,005) uskupini ispitanika sa ŠBT2. Zaključak: Rezultati dobiveni ovim istraživanjem pokazuju kako promijenjena kinetika hepcidina, eritropoetina i eritroferona uz utvrđene promjene eritrocitnih parametara (RDW, retikulociti) ukazuje na aktivaciju puta eritropoetin-eritroferon-hepcidin što se može objasniti učinkom provedene intervencije, trotjedne umjerene konzumacije crnog vina. Ovo istraživanje ukazuje na novi biološki učinak vina koji bi mogao biti važan u stanjima i bolestima u podlozi kojih je poremećaj homeostaze željeza i funkcije hepcidina.Background and aim: Reduced expression of hepcidin, a key regulator of systemic iron homeostasis, is an important element in the pathogenesis of iron accumulation in the body associated with alcohol consumption. High levels of iron are a risk factor for type 2 diabetes mellitus (T2DM) as it affects important components of the pathogenesis of the disease such as insulin resistance, increased gluconeogenesis and reduced insulin secretion. Several epidemiological studies have shown that moderate consumption of red wine is associated with a lower risk of developing T2DM, indicating potential role of the polyphenols present in red wine. These compounds exhibit effects on hepcidin expression and iron absorption opposite to those of alcohol. Given the described physiological effects of hepcidin as well as its potential role in the pathophysiology of T2DM, the main objective of the study was to examine the effect of moderate consumption of red wine on serum concentrations of hepcidin in the group of healthy subjects and in the group of subjects with T2DM. As hepcidin is the most important factor in the regulation of iron homeostasis, this study also examined the effect of moderate wine consumption on other indicators of iron balance. Since erythropoiesis is the main iron consumer in humans, the study examined how moderate red wine consumption affected the main erythropoietic pathway: erythropoietin-erythroferrone-hepcidin. Subjects and methods: This was a prospective, non-randomized, clinical study of the effect of a food product. Two groups of participants were established, a group of healthy subjects and a group of subjects with T2DM with no other significant comorbidities and without a history of previous alcohol abuse. After a drive-in period of 2 weeks, in which consumption of any alcoholic beverage was prohibited, subjects were instructed to drink 300 mL of red wine daily, split between lunch and dinner and consumed with meals, for 3 weeks. Immediately before and after the intervention, every participant underwent anthropometric measurements and blood sampling, as well as laboratory analysis of samples. Analyzed were serum levels of hepcidin, biochemical markers of iron status, hematological parameters, erythropoietic parameters, and other important biochemical markers. A total of 31 subjects completed the study protocol, of which 13 were healthy subjects and 18 subjects were with T2DM. Results: The results of the study showed that three weeks of moderate consumption of red wine led to a decrease in serum hepcidin concentration in both the group of healthy subjects (30,0 ± 17,3 vs. 21,0 ± 12,1 ng/mL, P = 0,045) and in the group of subjects with T2DM (17,9 [11,9- 25,2] vs. 13,2 [8,2-18,3] ng/mL, P = 0,001). The decrease in serum hepcidin concentrations was not reflected in serum iron as its levels remained unchanged in both groups (healthy: P=0.328; diabetics: P=0.177). Other iron-related indicators also remained largely unchanged after the intervention, except for a statistically significant decrease in ferritin levels in the group of healthy subjects (173,0 [126,4-259,8] vs. 118,0 [90,5-232,6] ng/mL, P = 0.017). The decrease in hepcidin was accompanied by an increase in the level of erythropoietin in both groups, in the group of healthy subjects (10,6 [7,7-12,1] vs. 12,5 [10,2-14,1] mlU/ml, P = 0,001) and (7,6 [6,4-9,4] vs. 8,9 [8,4-11,1] mlU/ml, P = 0,024) in the group of subjects with T2DM, while the increase in erythroferrone reached statistical significance only in the group of subjects with T2DM (0,044 ± 0,075 vs. 0,12 ± 0,12 ng/mL, P = 0,028). The magnitude and direction of change in the levels of EPO, ERFE and hepcidin in response to the wine intervention did not differ between groups. Finally, a statistically significant increase in RDW was observed in both study groups, in the group of healthy subjects (13,0 ± 0,5 vs. 13,2 ± 0,5 %, P = 0,013) and (13,5 ± 0,4 vs. 13,6 ± 0,5 %, P = 0,033) in the group of subjects with T2DM with increase in the reticulocytes count (60 ± 16 vs. 70 ± 15x109, P = 0,005) in the T2DM group. Conclusion: Our results indicate activation of the erythropoietin-erythroferrone-hepcidin pathway by moderate red wine consumption for 3 weeks. As an indicator of erythropoietic response to the activation of erythropoietin-erythroferrone-hepcidin pathway two significant increases were observed: of the red cell distribution width in both groups, and of the reticulocyte count in the T2DM group. This study reveals a novel biological effect of wine that may be important in conditions influencing iron homeostasis and functions of hepcidin in general
Intracerebral hemorrhage in patients treated with direct oral anticoagulants
No full textCilj istraživanja: Utvrditi postoji li značajna razlika u incidenciji i ishodima liječenja u bolesnika koji su doživjeli hemoragijski moždani udar na terapiji varfarinom u odnosu na bolesnike na terapiji DOAC-ima. Ispitanici i metode: U ovo retrospektivno kohortno istraživanje uključena su 52 bolesnika koji su tijekom dvogodišnjeg razdoblja (2023. – 2024.) doživjeli moždani udar tijekom uzimanja antikoagulantne terapije. Rezultati: U skupini bolesnika liječenih DOAC-ima nije zabilježena statistički značajna razlika u kliničkoj slici, stupnju oštećenja nakon moždanog udara niti u ishodima liječenja u odnosu na bolesnike liječene varfarinom. Od ukupnog broja bolesnika uključenih u istraživanje, 34 (65,4 %) uzimalo je DOAC-e, a 18 (34,6 %) varfarin. Pronađena je statistički značajno veća učestalost arterijske hipertenzije kod bolesnika na DOAC-ima (P=0,041). Također, bolesnici liječeni varfarinom imali su statistički značajno (P<0,001) izraženije poremećaje testova koagulacije u usporedbi s bolesnicima na DOAC-ima. Bolesnici koji su pri prijemu bili boljeg kliničkog statusa (GCS=15, mRS=4 i NIHSS=7) liječeni su suportivnim metodama te su pri otpustu također imali statistički značajno bolje kliničke parametre. Trajanje hospitalizacije bilo je kraće u bolesnika liječenih konzervativno (P=0,006). Zaključak: Broj bolesnika koji su doživjeli hemoragijski moždani udar na terapiji DOACima veći je od broja bolesnika na terapiji varfarinom. Nije utvrđena statistički značajna povezanost između lošeg ishoda liječenja i uzimanja varfarina. Nije utvrđena statistički značajna razlika u ishodima liječenja između bolesnika na različitim DOAC-ima (rivaroksaban i apiksaban). Nije utvrđena statistički značajna razlika u veličini krvarenja i lokalizaciji u odnosu na DOAC i varfarin. Bolesnici liječeni varfarinom imaju statistički značajan poremećaj u testovima koagulacije.Aim of the Study: The primary objective of this study was to examine whether there was a significant difference in early outcomes among patients who suffered a hemorrhagic stroke while being treated with either warfarin or direct oral anticoagulants (DOAC). Subjects and Methods: This retrospective cohort study included 52 patients who experienced intracerebral hemorrhage while on anticoagulant therapy, over a two-year period (2023–2024). Results: There was no statistically significant difference between patients treated with DOACs and those treated with warfarin in terms of clinical presentation, level of disability, or early outcomes. Of the total study population, 34 patients (65.4%) were on DOAC therapy, while 18 (34.6%) were taking warfarin. A statistically significant higher incidence of arterial hypertension was observed in the DOAC group (P=0.041). Additionally, patients treated with warfarin showed significantly more pronounced coagulation marker disorders compared to those on DOACs (P<0.001). Patients with a milder clinical presentation of intracerebral hemorrhage (GCS=15, mRS=4, NIHSS=7) were managed conservatively and demonstrated significantly better clinical parameters at discharge. The length of hospital stay was shorter in patients treated with supportive care (P=0.006). Conclusion: More patients in this study experienced hemorrhagic stroke while on DOAC therapy compared to those on warfarin. However, there was no statistically significant association between adverse clinical outcomes and warfarin use. No significant differences in early outcomes were found between patients taking different DOACs (rivaroxaban vs. apixaban). Furthermore, there were no statistically significant differences in hematoma volume or location between the DOAC and warfarin groups. Patients treated with warfarin did, however, exhibit significantly more pronounced coagulation abnormalities
Susceptibility and resistance of Acinetobacter baumannii at the University Hospital Center Split in the period 2017–2023
No full textCilj istraživanja: Cilj ovog istraživanja bio je analizirati osjetljivost i rezistenciju sojeva Acinetobacter baumannii u Kliničkom bolničkom centru Split u razdoblju od 2017. do 2023. godine, s naglaskom na promjene u obrascima rezistencije tijekom 2020. i 2021. godine koje su bile obilježenje pandemijom bolesti COVID-19. Materijali i metode: Provedeno je retrospektivno, presječno istraživanje. Prikazani i obrađeni podaci odnose se na kliničke izolate prikupljene u rutinskom radu u promatranom razdoblju. Podaci su prikupljeni iz bolničkog informatičkog sustava koji koristi Klinički zavod za mikrobiologiju i parazitologiju Kliničkog bolničkog centra Split. U istraživanje uključeni su samo sojevi Acinetobacter baumannii s dostupnim podacima o osjetljivosti i rezistenciji na antibiotike. Rezultati: U razdoblju od 2017. do 2023. godine primjećen je pad broja uzoraka A. baumannii u KBC-u Split. Najveći je broj kliničkih izolata u KBC-u Split bio 2017. godine (N=809), a najamnji 2023. godine (N=333). U razdoblju od 2019. do 2021. godine uočen je porast od 19,61%, iako to predstavlja pad broja ukupnog broja izolata od 9.5% u odnosu na 2017. godinu. Rezistencija se na ampicilin-sulbaktam prema podacima ove studije kretala oko 10%. U KBCu Split rezistencija na meropenem u ovom sedmogodišnjem periodu kretala se od 88,82% do 97,72%, dok se za imipenem kretala od 88,82% do 97,51% što je bilo u skladu s trendom koji se pratio u na razini Republike Hrvatske. Prosječna je rezistencija u KBC-u Split na kolistin u ovom sedmogodišnjem periodu bila 2.74% sa standardnom devijaciom ±1.94%. 8. Prosječna je rezistencija na amikacin bila oko 90,83%. Primjećen je pad rezistencije s 91,09% u 2022. na 84,38% u 2023. godini, što predstavlja statistički značajan pad (P = 0.001). Prosječna je rezistencija na levofloksacin 95,95%. U 2023. godini primjećen je pad rezistencije s 96,58% u 2022. na 90,00% u 2023. godini, što predstavlja statistički značajan pad (P < 0.001). Prosječna osjetljivost na cefiderokol u KBC-u Split bila je 98% sa standardnom devijacijom ±2.36%. Zaključci: Rezultati ovog istraživanja pokazuju da je u ovom sedmogodišnjem razdoblju došlo do pada broja izolata. Sukladno očekivanjima, došlo je do povećanja broja izolata za vrijeme pandemije bolesti COVID-19. Rezistenciija na većinu antimikrobnih lijekova kretala se u skladu s ostatkom Republike Hrvatske, s iznimkom ampicilin-sulbaktama na koji izolati iz KBC-a Split imaju značajno bolju osjetljivost u odnosu na ostatak RH.Objectives: The aim of this study was to analyze the susceptibility and resistance patterns of Acinetobacter baumannii strains isolated at the University Hospital Center Split (KBC Split) between 2017 and 2023, with a particular focus on changes in resistance patterns during the COVID-19 pandemic years, 2020 and 2021. Materials and methods: A retrospective cross-sectional study was conducted. The presented and analyzed data refer to clinical isolates collected during routine diagnostic work within the observed period. Data were obtained from hospital archives. Only Acinetobacter baumannii strains with available antibiotic susceptibility and resistance data were included in the study. Results: Between 2017 and 2023, a decreasing trend in the number of A. baumannii isolates was observed at KBC Split. The highest number of clinical isolates was recorded in 2017 (N = 809), and the lowest in 2023 (N = 333). From 2019 to 2021, an increase of 19.61% in isolate numbers was noted; however, this still represents a 9.5% decrease compared to 2017. According to this study, resistance to ampicillin-sulbactam was around 10%. Resistance to meropenem during this seven-year period ranged from 88.82% to 97.72%, and for imipenem from 88.82% to 97.51%, aligning with national trends observed across Croatia. The average resistance rate for colistin at KBC Split over the seven-year period was 2.74%, with a standard deviation of ±1.94%. Amikacin resistance averaged 90.83%. A statistically significant decrease in resistance was recorded between 2022 (91.09%) and 2023 (84.38%) (P = 0.001). Levofloxacin resistance averaged 95.95%, with a significant reduction in 2023, falling from 96.58% in 2022 to 90.00% (P < 0.001). The average susceptibility to cefiderocol was 98%, with a standard deviation of ±2.36%. Conclusions: The results of this study show that there was a decrease in the number of isolates over the seven-year period. As expected, the number of isolates increased during the COVID-19 pandemic. Resistance to most antimicrobial agents followed trends similar to those observed in the rest of Croatia, with the exception of ampicillin-sulbactam, to which isolates from University Hospital Centre Split showed significantly higher susceptibility compared to the national average
Risk factors among ischemic stroke patients undergoing mechanical thrombectomy in Department of Neurology of University Hospital Centre Split
No full textCilj istraživanja: Cilj ovog istraživanja je analiza rizičnih čimbenika bolesnika sa ishemijskim moždanim udarom koji su liječeni mehaničkom trombektomijom u Klinici za neurologiju Klinikčkog bolničkog centra Split u jednogodišnjem razdoblju te utvrditi postoje li neke razlike kod ove grupe bolesnika u odnosu na oboljele od ishemijskog moždanog udara liječenih drugim metodama. Ispitanici i postupci: Retrospektivno opservacijsko istraživanje za koje su prikupljeni i analizirani podatci iz BIS-a bolesnika oboljelih od ishemijskog moždanog udara liječenih mehaničkom trombektomijom u Kliničkom bolničkom centru Split tijekom 2023. godine. Podatci su uključivali dob, spol, anamnezu fibrilacije atrija i arterijske hipertenzije, bodove na TICI i mRS ljestvici te mjesto okluzije. Rezultati: Od 76 pacijenata 44 (57,9%) su bile žene, a 32 (42,1%) muškarca. Medijan dobi je bio 76 godina. Medijan dobi žena je bio 78, a muškaraca 71 iako nije utvrđena statistički značajna razlika u dobi (P=0,262). Arterijsku hipertenziju je imalo 53 (69,7%), fibrilaciju atrija (56,6%), a njih 36 (47,4% ) je imalo oba čimbenika rizika. Pronađena je veća učestalost fibrilacije atrija kod starijih dobnih skupina (P=0,003). Pronađena je povezanost između starije dobi i lošeg kliničkog ishoda (P=0,004). M1 segment je najčešće zahvaćen (64,4%). Zaključci: Istraživanje je pokazalo da je arterijska hipertenzija najčešći rizični čimbenik te da je fibrilacija atrija visoko zastupljena u pacijenata liječenih mehaničkom trombektomijom. Starija dob je značajno povezana sa lošim kliničkim ishodom. Ishemijski moždani udari kod ove grupe pacijenta su najviše zastupljeni u prednjoj cirkulaciji.Objectives: To analise risk factors of patients with acute ischemic stroke undergoing mechanical thrombectomy in Neurology Department University Hospital of Split and to determine if there is any differences between this group of patients and others with same diagnosis but treated differently Subjects and methods: Retrospective observational study for which data has been collected from medical documentation in University Hospital of Split. Dana include age, gender, history of arterial hypertension and atrial fibrillation, TICI and mRS score and site of occlusion. Results: Of total 76 patients there were 44 (57.9%) women and 32 (42.1%) men. Median age of all patients was 76. Median age of women was 78 and median age of men was 71 but there was not any statistical significant age difference (P=0.262). Arterial hypertension was present among 53 patients (69.7%), atrial fibrillation among 43 (56.6%) patients and 36 patients had both risk factors (47.4%). Prevalence of atrial fibrillation was higher in older patients (P=0.003). It has been established that age had effects on clinical outcome (P=0.004). M1 segment was the most prevalent one (64.4%). Conclusions: This study shows that arterial hypertension is most common risk factor and atrial fibrillation has great prevalence in patients undergoing mechanical thrombectomy. Older age is significantly associated with bad clinical outcome. Ischemic stroke in this grouo of patients mainly affects anterior circulation
Screening for chronic kidney disease in patients hospitalized for hyperglycemia as part of newly discovered or previously known unregulated diabetes
No full textCilj istraživanja: Cilj ovog istraživanja bio je analizirati povezanost između KBB-a, šećerne bolesti te njihovih kliničkih i laboratorijskih obilježja s tim da istraživanje stavlja naglasak na prevalenciju i čimbenike rizika za razvoj mikrovaskularnih komplikacija i dijabetičke retinopatije. Ispitanici i metode: U studiju je uključeno ukupno 100 bolesnika hospitaliziranih zbog hiperglikemije. Prikupljeni su demografski, klinički i laboratorijski podaci, uključujući vrijednosti eGFR, albumin-kreatinin omjera (ACR), HbA1c, lipidnog profila i AIP indeksa. Analizirane su razlike između bolesnika s i bez dijabetičke retinopatije te povezanost s bubrežnom funkcijom i primjenom različitih terapijskih skupina lijekova. Rezultati: Bolesnici s dijabetičkom retinopatijom imali su značajno dulje trajanje šećerne bolesti (medijan 15.5 godina, IQR 11,5-23,5) i višu dob (medijan 68 godina, IQR 39-87) u odnosu na bolesnike bez retinopatije kojima je medijan trajanja bolesti 2.0 godine, IQR 0-12,25, dok im je medijan dobi 57 godina, IQR 20-89. U skupini s retinopatijom češće su bili prisutni arterijska hipertenzija (69.23%), koronarna bolest (34.62%) i polineuropatija (46.15%). Vrijednosti eGFR bile su niže (67.0 mL/min/1.73m²), a albumin-kreatinin omjer viši (5.26 mg/mmol) kod bolesnika s retinopatijom u odnosu na skupinu bez retinopatije (eGFR 92.95 mL/min/1.73m², ACR 2.42 mg/mmol). Nije utvrđena značajna razlika u vrijednostima HbA1c (10.6% naspram 11.45%). AIP indeks bio je povišen kod većine bolesnika, neovisno o prisutnosti retinopatije, što ukazuje na povećan kardiovaskularni rizik. Također, primijećena je češća primjena nefroprotektivnih lijekova kod bolesnika s retinopatijom. Zaključci: Ovo istraživanje potvrdilo je značajnu povezanost dijabetičke retinopatije s duljim trajanjem šećerne bolesti, starijom dobi i lošijom bubrežnom funkcijom. Visok AIP indeks ukazuje na povećan kardiovaskularni rizik kod većine bolesnika. Rezultati naglašavaju važnost pravovremene dijagnostike i integriranog pristupa liječenju bolesnika s dijabetesom i kroničnom bubrežnom bolesti radi prevencije mikrovaskularnih komplikacija.Background: The aim of this study was to analyze the association between chronic kidney disease (CKD), diabetes mellitus, and their clinical and laboratory characteristics, with a special focus on the prevalence and risk factors for the development of microvascular complications, including diabetic retinopathy. Methods: A total of 100 patients hospitalized due to hyperglycemia were included in the study. Demographic, clinical, and laboratory data were collected, including values of eGFR, albumin-creatinine ratio (ACR), HbA1c, lipid profile, and AIP index. Differences between patients with and without diabetic retinopathy were analyzed, as well as the association with kidney function and the use of various therapeutic drug groups. Results: Patients with diabetic retinopathy had a significantly longer duration of diabetes (median 15.5 years, IQR 11.5–23.5) and were older (median 68 years, IQR 39–87) compared to patients without retinopathy, whose median duration of disease was 2.0 years, IQR 0–12.25, and median age 57 years, IQR 20–89. In the retinopathy group, arterial hypertension (69.23%), coronary artery disease (34.62%), and polyneuropathy (46.15%) were more frequently present. Estimated glomerular filtration rate (eGFR) values were lower (67.0 mL/min/1.73m²), and albumin-creatinine ratio (ACR) higher (5.26 mg/mmol) in patients with retinopathy compared to those without retinopathy (eGFR 92.95 mL/min/1.73m², ACR 2.42 mg/mmol). No significant difference was found in HbA1c values (10.6% vs. 11.45%). The atherogenic index of plasma (AIP) was elevated in most patients regardless of the presence of retinopathy, indicating an increased cardiovascular risk. Additionally, nephroprotective drugs were more commonly prescribed to patients with retinopathy. Conclusion: This study confirmed a significant association between diabetic retinopathy and longer duration of diabetes, older age, and poorer kidney function. A high AIP index indicates an increased cardiovascular risk in the majority of patients. The results emphasize the importance of timely diagnosis and an integrated approach to the treatment of patients with diabetes and chronic kidney disease to prevent microvascular complications
Znanost za sve : Festival znanosti 2025: Mreže koje spajaju znanje i znatiželju
No full textOd 5. do 10. svibnja 2025. godine diljem Hrvatske održan je Festival znanosti, a ovogodišnja tema bile su – mreže. Iako na prvu zvuče kao nešto tehnološko ili matematičko, znanstvene mreže u biomedicini – kemijske i biološke – pokazale su se kao izvrsna polazišna točka za približavanje kompleksnih pojmova djeci i mladima, i to na jednostavan, zabavan i interaktivan način