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The immunology of sickness metabolism
No full textAbstract Everyone knows that an infection can make you feel sick. Although we perceive infection-induced changes in metabolism as a pathology, they are a part of a carefully regulated process that depends on tissue-specific interactions between the immune system and organs involved in the regulation of systemic homeostasis. Immune-mediated changes in homeostatic parameters lead to altered production and uptake of nutrients in circulation, which modifies the metabolic rate of key organs. This is what we experience as being sick. The purpose of sickness metabolism is to generate a metabolic environment in which the body is optimally able to fight infection while denying vital nutrients for the replication of pathogens. Sickness metabolism depends on tissue-specific immune cells, which mediate responses tailored to the nature and magnitude of the threat. As an infection increases in severity, so do the number and type of immune cells involved and the level to which organs are affected, which dictates the degree to which we feel sick. Interestingly, many alterations associated with metabolic disease appear to overlap with immune-mediated changes observed following infection. Targeting processes involving tissue-specific interactions between activated immune cells and metabolic organs therefore holds great potential for treating both people with severe infection and those with metabolic disease. In this review, we will discuss how the immune system communicates in situ with organs involved in the regulation of homeostasis and how this communication is impacted by infection
The Association between the Firmicutes/Bacteroidetes Ratio and Body Mass among European Population with the Highest Proportion of Adults with Obesity: An Observational Follow-Up Study from Croatia
No full textBackground/Objectives: The phyla Firmicutes and Bacteroidetes are the main constituents of the gut microbiota. An imbalance in the gut microbiota is a sign of dysbiosis, and the Firmicutes-to-Bacteroidetes ratio has been proposed to be a marker of it, especially in the context of obesity. Since Croatia is the country with one of the highest obesity rates in Europe, a pilot observational study was conducted. The aim of the study was to investigate the validity of this potential biomarker in a methodological study using sample processing, DNA sequence analysis and characterization of recruited participants, including various health factors. Methods: A study involving Croatian population was conducted. Participants age, body weight, gender, health history and lifestyle factors were recorded. Gut microbiota composition was analyzed using 16S rRNA sequencing. The F/B ratio was calculated and evaluated in the context of health factors. Statistical analysis was performed to detect the possible association of F/B ratio and excess body weight (kg) and possible impact of certain lifestyle factors. Results: No association between the F/B ratio and excess body weight (kg) was found. Excess body weight was significantly associated with higher age, male gender, and history of appendectomy. No significant health predictors of the F/B ratio were found, but weight gain was positively associated with a higher average F/B ratio. Conclusions: Although this study could not confirm the predictive value of the F/B ratio or any other phyla-related biomarker for excess body weight in the study population, it demonstrated interesting insights into the obesity-associated gut microbiota
Changes in phenols and sensory properties of tofu immersed in virgin olive oil
No full textU ovom je radu simulirano čuvanje komadića tofua (svježeg i liofiliziranog) u naljevu od ekstra djevičanskog maslinovog ulja (EDMU-a) pri 8 °C tijekom sedam dana. Tofu je namirnica rastuće popularnosti zbog visokog sadržaja proteina, dok se EDMU tradicionalno koristi kao naljev za konzerviranje namirnica. EDMU sadrži hidrofilne fenole, a dosadašnja istraživanja ukazuju na moguće interakcije između proteina i fenolnih tvari. Pri kontaktu tofua i EDMU-a moguća je i migracija vode iz tofua u ulje te ulja u tofu. Posljedično, može se očekivati pad udjela hidrofilnih fenolnih tvari u ulju a porast u tofuu, te promjene senzorskih svojstava EDMU-a. Ukupni fenoli u ulju i liofiliziranom tofuu određeni su spektrofotometrijski primjenom reagensa Fast Blue BB, a kod ulja su određeni i standardni fizikalno-kemijski te senzorski pokazatelji kvalitete. Test preferencije okusa svježeg tofua proveden je s 47 sudionika metodom rangiranja. Tijekom sedam dana čuvanja udio fenola u EDMU-u statistički se značajno više smanjio u kontaktu sa svježim tofuom (za oko 56 %) u odnosu na kontakt s liofiliziranim tofuom (za oko 25 %), što ukazuje na važnu ulogu migracije vode iz tofua u ulje. Trend i dinamika porasta ukupnih fenola u liofiliziranom tofuu podudarni su s padom ovih tvari u EDMU-u korištenom kao naljev. Sedmodnevni kontakt ulja sa svježim tofuom nije doveo do nepovoljnih promjena fizikalno-kemijskih pokazatelja kakvoće ulja ali je, zbog nastanka nepoželjnih senzorskih svojstava ulja blagog intenziteta te značajnog smanjenja poželjnih svojstava, rezultirao degradacijom u nižu tržišnu kategoriju kvalitete. Primjenom metode rangiranja nisu utvrđene preferencije potrošača prema okusu tofua koji je bio u kontaktu s EDMU-om. Poznavanje interakcija između proteina i fenola važno je zbog mogućeg utjecaja na bioraspoloživost fenola. Međutim, rezultati ovog istraživanja ukazuju na to da uzrok pada fenola u EDMU-u u kontaktu sa svježim tofuom nije samo vezanje fenola na proteine već i otapanje fenola u vodi koja migrira iz tofua u ulje.This study simulated the preservation of tofu pieces (both fresh and freeze-dried) in an infusion of extra virgin olive oil (EVOO) at 8 °C for seven days. Tofu, known for its high protein content, is becoming increasingly popular, while EVOO is traditionally used as a medium for food preservation. EVOO contains hydrophilic phenols and previous studies suggest possible interactions between proteins and phenolic compounds. When tofu and EVOO come into contact with each other, water can migrate from the tofu into the oil and oil into the tofu, resulting in a decrease of hydrophilic phenols in the oil and an increase in the tofu. The sensory properties of the oil can also change. The total phenols in the oil and in the freeze-dried tofu were measured spectrophotometrically using the Fast Blue BB reagent and the physico-chemical and sensory quality indicators for the oil were determined. In addition, the taste preference test of fresh tofu was carried out with 47 participants using the ranking method. During the seven-day storage period, the phenolic content in EVOO in contact with fresh tofu decreased significantly more (approx. 56 %) than with freeze-dried tofu (approx. 25 %). This indicates that water migration from tofu to oil plays an important role. The trend and dynamics of the increase in total phenols in freeze-dried tofu were consistent with the decrease in phenols in the oil infusion. Although the seven-day contact with fresh tofu did not lead to unfavourable changes in the physico-chemical quality indicators of the oil, undesirable slight sensory changes and a reduction in desirable properties placed the oil in a lower market quality category. When applying the ranking method used in the consumer preference test, no preference was found for tofu that had been in contact with EVOO. Understanding the interactions between proteins and phenols is important due to their potential impact on the bioavailability of phenols. However, the results of this study suggest that the decrease in phenol content in EVOO upon contact with fresh tofu is not only due to the binding of the phenol to the proteins, but also to the dissolution of the phenol in the water that migrates from the tofu into the oil
Kvaliteta pitkih voda i voda u prirodi na području Gorskoga kotara
No full textKao izvor pitke vode koriste se različite vrste vode poput atmosferske, površinske ili podzemne vode te svaka od njih ima različite karakteristike. Voda koja se koristi kao voda za piće odgovara najstrožim kriterijima. Atmosferska voda se smatra vodom koja se prirodno destilira te dolazi od kiše, snijega ili drugih oborina. Površinske vode se smatraju vodama poput rijeka, jezera ili mora. Gorski kotar zauzima 35,46% teritorija Primorsko – goranske županije te čak 77% vodotoka se nalazi na području Gorskog kotara. Sama vodoopskrba Gorskog kotara odvija se kroz tri područja: Čabar, Delnice i Vrbovsko. Praćenje zdravstvene ispravnosti vode za piće propisano je zakonom te nadzor provode županijski zavodi za javno zdravstvo. Parametri su propisani zakonima kao što je ''Zakon o vodama'' (NN 66/19, 84/21, 47/27) te ''Pravilnik o parametrima sukladnosti, metodama analiza i monitorinzima vode namijenjene za ljudsku potrošnju'' (NN 64/2023). Propisana je učestalost uzorkovanja vode te MDK vrijednosti za različite parametre.
U ovom radu ispitivani su fizikalno – kemijski parametri za vodu na području Gorskog kotara točnije područja Delnica, Čabra i Vrbovskog kroz godinu dana odnosno kroz 2023. godinu. Fizikalni parametri koji su ispitivanu su: temperatura, boja, mutnoća, miris i okus, pH, elektrovodljivost, utrošak KMnO4, kloridi, nitrati, nitriti i amonij. Cilj ovoga rada bio je utvrditi kvalitetu pitkih i prirodnih voda na području Gorskog kotara
Svi rezultati prikazuju zadovoljavajuću kvalitetu pitkih i prirodnih voda na području Gorskog kotara kada su u pitanju fizikalno – kemijski parametri
Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study
No full textThis study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital (UCH) from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal (NP) swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit (ICU) admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628), or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to NP swabs
Characterization of myocardial perfusion imaging systems - an extension of quality metrics
No full textPurpose: The aim of this study was to evaluate the performance of myocardial perfusion imaging (MPI) systems in detecting perfusion defects (PDs). The defect perfusion index (DPI) was introduced to extend and further advance the current MPI quality metrics. Methods: An anthropomorphic phantom simulating normal and pathological myocardial perfusion conditions was imaged by various NaI-crystal detector systems with and without corrections for scatter (SC) and attenuation (AC) (Symbia, Symbia + SC, Symbia IQ + SCAC, Symbia IQ), and cadmium-zinc-telluride detector systems without corrections (DSPECT, D530c). The extent of PD and the summed score (SS) were obtained by comparing polar maps with ad hoc normal databases created for each MPI system by using phantom polar maps with normal perfusion. The segmental uptake (SU) and the global uniformity (GU) were evaluated. The DPI was calculated on segments included in the PD to minimize attenuation artifacts outside the PD. The 17 segmental model was used. Results: The highest level of uniformity of polar map was obtained for Symbia IQ + SCAC. D530c showed the highest extent of PD and dependence of the extent on the PD position. It showed in general the lowest SU values and the highest GU due to attenuation artifacts. Nevertheless, D530c outperforms other MPI systems in terms of PD detection, showing the highest DPI value. DSPECT system showed the lowest SS value, and DPI values comparable to NaI-crystal detector systems. Conclusion: The DPI can be evaluated to investigate the intrinsic ability of MPI systems to detect PDs, whatever the quantitative post-processing software used
Assessment of Five Patellar Height Measurement Methods on Lateral Knee Radiograph
No full textCilj: Položaj patele ima značajan utjecaj na pojavu kliničkih simptoma boli i oticanja koljenog zgloba, kao i na pojavu nestabilnosti patele. Cilj ovog istraživanja bio je ispitati pouzdanost primjene metoda mjerenja visine patela po Insall-Salvatiju, modificiranom Insall-Salvatiju, Blackburn-Peelu, Caton-Deschampsu te metodom mjerenja kuta plato - patela. Ispitanici i metode: Ispitivanje je izvršeno na 100 profilnih radiograma koljena bolesnika prosječne dobi od 50,14 godina, koji su pregledani na Klinici za ortopediju Lovran u razdoblju od godine dana. Prosječna vrijednost fleksije koljena na analiziranim profilnim radiogramima ispitanika iznosila je 36,57°. Provedena mjerenja učinila su dva istraživača i ponovljena su u dva navrata u razmaku od mjesec dana. U radu su se koristile statističke metode za analizu preciznosti i točnosti dviju metoda, pri čemu je korišten koeficijent korelacije podudarnosti i modificirani Pearsonov koeficijent. Rezultati: Rezultati su pokazali da u broju klinički dijagnosticiranih patela alta ili infera nije postojala značajna razlika između dvaju istraživača kod svake od primijenjenih metoda mjerenja visine patele. Uspoređujući dobivene rezultate mjerenja na temelju izračuna koeficijenta korelacije podudarnosti, Insall-Salvatijeva metoda pokazala se kao najpouzdanija zbog najbolje preciznosti (p1 = 0,8431, p2 = 0,8337) i zadovoljavajuće točnosti (Cb1 = 0,9171, Cb2 = 0,9275). Kod drugih metoda mjerenja rezultati su pokazali da se postiže jako dobra točnost, no slabija preciznost. Zaključak: Metoda mjerenja visine patele po Insall-Salvatiju na profilnom radiogramu koljena mogla bi se preporučiti kao optimalna metoda za potrebe korištenja u svakodnevnoj kliničkoj praksi.Aim: Patella position has a significant effect on the appearance of clinical symptoms of pain and swelling of the knee joint as well as on the appearance of patellar instability. The aim of this study was to evaluate the reliability of patellar height measurement using the methods of Insall-Salvati, Modified Insall-Salvati, Blackburne-Peel, Caton-Deschamps and the plateau–patella angle. Subjects and methods: The study was conducted on 100 lateral knee radiographs of patients with a mean age of 51.14 years, who were examined at the Clinic for Orthopedics Surgery Lovran, over a period of one year. The average value of knee flexion on the analyzed lateral radiographs of the subjects was 36.57o. The measurements were done by two researchers and were repeated on two occasions at one-month intervals. Statistical methods were performed to analyze the precision and accuracy of the two methods using the Concordance Correlation Coefficient and the modified Pearson Correlation Coefficient. Results: The results showed that in the number of clinically diagnosed patella alta or infera there was no significant difference between the measurements of the two researchers in each of the applied patellar height measurement methods. Comparing the obtained measurement results based on calculations of the Concordance Correlation Coefficient, the Insall-Salvati method demonstrated to be the most reliable due to the highest precision (p1= 0.8431, p2=0.8337) and satisfactory accuracy (Cb1= 0.9171, Cb2=0.9275). The results of other measurement methods demonstrated that very good accuracy is achieved, but lower precision. Conclusion: The Insall-Salvati patellar height measurement method on lateral knee radiographs could be recommended as an optimal tool in daily clinical practice
Surgical Management of Late Complications After Endovascular Treatment of Abdominal Aortic Aneurysm
No full textAneurizma abdominalne aorte (AAA) čest je problem u starije populacije, a rizik rupture korelira s promjerom aneurizme. Tradicionalno su se bolesnici s aneurizmom abdominalne aorte većeg promjera liječili otvorenim kirurškim tehnikama, dok u posljednjih 20 godina pratimo porast korištenja tehnike endovaskularnog popravka aneurizme aorte (EVAR-a), koja uključuje postavljanje prostetskog nepropusnog grafta unutar lumena abdominalne aorte s ciljem isključenja aneurizme iz protoka i sprječavanja rupture. Sigurnosni profil i dugoročni podatci metode EVAR rezultirali su značajnim porastom korištenja EVAR-a, unatoč studijama koje dugoročnim praćenjem nisu pokazale bolje preživljavanje ili kvalitetu života. Zbog porasta broja bolesnika liječenih EVAR-om, očekujemo porast broja komplikacija i potrebu za sekundarnim intervencijama. U najčešće komplikacije nakon EVAR-a ubrajamo endoleak, migraciju stent-grafta, kinking-proteze, trombozu te infekciju grafta. Sekundarne komplikacije prvenstveno treba zbrinjavati endovaskularno, no kasne komplikacije koje zahtijevaju otvorenu kiruršku operaciju možemo očekivati u do 9 % bolesnika kojima je učinjen EVAR. Operacije aneurizme abdominalne aorte nakon nezadovoljavajućeg rezultata EVAR-a prati veći broj komplikacija, zbog atrofije zida aorte, periaortalne upale i fibroze te otežanog postizanja proksimalne i distalne vaskularne kontrole zbog pozicije stent-grafta, što često zahtijeva suprarenalno klemanje. Otvorena kirurgija gotovo je uvijek potrebna kod sekundarne rupture AAA, ako endovaskularne opcije odmah nisu dostupne ili tehnički moguće, kao i kod infekcije grafta, gdje je poželjna potpuna ekstrakcija protetskog materijala. Ključno je praćenje bolesnika nakon EVAR-a te pravovremeno i elektivno zbrinjavanje komplikacija.Abdominal aortic aneurysm (AAA) is more common in the elderly population, and the risk of rupture correlates with the diameter of the aneurysm. Traditionally, patients with larger AAA were treated with open surgical techniques, but over the last 20 years, there has been an increase in the use of the endovascular aneurysm repair technique (EVAR), which involves placing a prosthetic impermeable graft within the lumen of the abdominal aorta to exclude the aneurysm from circulation and prevent rupture. The safety profile and long-term data of the EVAR method have resulted in a significant increase in the use of EVAR, despite studies that have not shown better survival or quality of life with long-term follow-up. Due to the increasing number of patients treated with EVAR, we expect an increase in the number of complications and the need for secondary interventions. The most common complications after EVAR include endoleak, stent graft migration, kinking of the prosthesis, thrombosis, and graft infection. Complications secondary to EVAR should primarily be managed endovascularly, but late complications requiring open surgery can be expected in up to 9% of patients who have undergone EVAR. Surgeries of the abdominal aorta secondary to failed EVAR are accompanied by a greater number of complications than the primary open procedures. Open surgery is almost always necessary for secondary rupture of AAA if endovascular options are not immediately available or technically feasible, as well as for graft infection, where complete extraction of the prosthetic material is desirable. The monitoring of patients after EVAR and the timely and elective management of complications are crucial
Being John Plasma Volumovich, pecularities of plasma volume estimation in patients with polycythemia vera
No full textGuidelines for evaluation and treatment of gastroesophageal reflux disease in children – Recommendations of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association
No full textGastroezofagealni refluks predstavlja vraćanje sadržaja želuca u jednjak, ponekad praćeno regurgitacijom i/ili povraćanjem. Refluks je patološki ako dovodi do značajnih (zabrinjavajućih) simptoma i/ili komplikacija (gastroezofagealna refluksna bolest, GERB). Simptomi refluksne bolesti nisu specifični, ovise o dobi djeteta i povezanost s refluksom je ponekad teško dokazati. U svakog djeteta sa simptomima refluksne bolesti i upozoravajućim znacima trebalo bi obradom isključiti mogući drugi uzrok tegoba. Višekanalna intraluminalna impedancija jednjaka koristi se u određivanju korelacije simptoma s refluksnim događajima, procjene učinkovitosti antisekretorne terapije i razlikovanja ne-erozivne refluksne bolesti, hipersenzitivnog jednjaka i funkcijske žgaravice. Pasaža probavnog sustava i ultrazvuk abdomena koriste se u isključivanju anatomskih anomalija. Ezofagogastroduodenoskopija s biopsijama sluznice glavna je pretraga za procjenu komplikacija refluksne bolesti i isključivanja druge bolesti sluznice gornjeg dijela probavnog sustava, a manometrija jednjaka u slučaju sumnje u poremećaj
motiliteta. Pokusna primjena inhibitora protonske pumpe (IPP) tijekom 4 – 8 tjedana moguća je u djece s tipičnim simptomima refluksne bolesti (žgaravica, retrosternalna ili epigastrična bol), ali se ne preporučuje u dojenčadi i djece s ekstraezofagealnim simptomima. Nefarmakološko liječenje refluksne bolesti uključuje zagušćivanje obroka, položajne mjere, modifikaciju volumena i učestalosti obroka i primjenu ekstenzivnog hidrolizata tijekom 2 – 4 tjedna u dojenčadi koja su na prehrani dojenačkim mliječnim pripravkom. Antacide/alginate ne bi trebalo koristiti za kronično liječenje dojenčadi i djece s refluksnom bolesti. Inhibitori protonske pumpe preporučuju se kao prva linija terapija erozivnog ezofagitisa povezanog s refluksom, a inhibitori H2-receptora u slučaju njihove nedostupnosti ili kontraindikacije za njihovu primjenu. Isključenje drugih uzroka tegoba preporučuje se u djece koja ne reagiraju na optimalnu terapiju tijekom 4 – 8 tjedana. Terapiju baklofenom trebalo bi razmotriti prije kirurškog liječenja nakon neuspjele primjene drugih farmakoloških mjera. Antirefluksnu operaciju (uključujući fundoplikaciju) trebalo bi razmotriti u djece sa životno ugrožavajućim komplikacijama refluksne bolesti nakon neuspjeha farmakološkog liječenja, refraktornim simptomima i u slučaju neophodne dugotrajne farmakoterapije GERB-a.Gastroesophageal reflux is defined as the passage of gastric contents into the esophagus with or without regurgitation and/or vomiting. Reflux is pathologic when it leads to troublesome symptoms and/or complications (gastroesophageal reflux disease, GERD). Symptoms of GERD are unspecific, age-dependent and sometimes difficult to relate to reflux. Each child with alarm symptoms should be evaluated further to identify a possible disease that may mimic reflux symptoms. Multichannel intraluminal impedance is used to correlate troublesome symptoms with acid and non-acid events, determine the efficacy of acid suppression therapy and differentiate non-erosive reflux disease, hypersensitive esophagus and functional heartburn. Esophagogastroduodenoscopy with biopsies is recommended to assess complications of GERD and if mucosal disease is suspected. Esophageal manometry is indicated when a motility disorder is suspected. Barium contrast studies and ultrasonography are used to exclude anatomical abnormalities. Four to eight week trial of proton pump inhibitors for typical symptoms (heartburn, retrosternal or epigastric pain) may be used as a diagnostic test, except in infants and children with extraesophageal symptoms. Non-pharmacological treatment includes thickened feedings, positional therapy, modification of feeding volumes and frequency and a 2 – 4 week trial of extensively hydrolyzed formula in infants. Antacids/alginates should not be used for chronic treatment of GERD. Proton pump inhibitors are preferred as the first-line treatment of reflux-related erosive esophagitis or, if they are not available or contraindicated, antagonists of histamine-2 receptors. Exclusion of alternative causes of symptoms in infants and children not responding to 4 – 8 weeks of optimal medical therapy is recommended. Baclofen should be considered prior to surgery in children in whom other pharmacological treatments have failed. Antireflux surgery, including fundoplication, should be considered in children with life threatening complications of GERD after failure of optimal medical treatment, refractory symptoms and need for chronic pharmacotherapy