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Serum cytokine dysregulation signatures associated with COVID-19 outcomes in high mortality intensive care unit cohorts across pandemic waves and variants
No full textAbstract The aim of this study was to characterize the systemic cytokine signature of critically ill COVID-19 patients in a high mortality setting aiming to identify biomarkers of severity, and to explore their associations with viral loads and clinical characteristics. We studied two COVID-19 critically ill patient cohorts from a referral centre located in Central Europe. The cohorts were recruited during the pre-alpha/alpha (November 2020 to April 2021) and delta (end of 2021) period respectively. We determined both the serum and bronchoalveolar SARS-CoV-2 viral load and identified the variant of concern (VoC) involved. Using a cytokine multiplex assay, we quantified systemic cytokine concentrations and analyzed their relationship with clinical findings, routine laboratory workup and pulmonary function data obtained during the ICU stay. Patients who did not survive had a significantly higher systemic and pulmonary viral load. Patients infected with the pre-alpha VoC showed a significantly lower viral load in comparison to those infected with the alpha- and delta-variants. Levels of systemic CTACK, M-CSF and IL-18 were significantly higher in non-survivors in comparison to survivors. CTACK correlated directly with APACHE II scores. We observed differences in lung compliance and the association between cytokine levels and pulmonary function, dependent on the VoC identified. An intra-cytokine analysis revealed a loss of correlation in the non-survival group in comparison to survivors in both cohorts. Critically ill COVID-19 patients exhibited a distinct systemic cytokine profile based on their survival outcomes. CTACK, M-CSF and IL-18 were identified as mortality-associated analytes independently of the VoC involved. The Intra-cytokine correlation analysis suggested the potential role of a dysregulated systemic network of inflammatory mediators in severe COVID-19 mortality
Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study
No full textCardiovascular diseases, which are the leading cause of death in Croatia, are linked to the high prevalence of hypertension. Both are associated with high salt intake, which was determined almost two decades ago when Croatian Action on Salt and Health (CRASH) was launched. The main objective of the present study was to evaluate salt, potassium, and iodine intake using a single 24 h urine sample in a random sample of the adult Croatian population and to analyse trends in salt consumption after the CRASH was intensively started. Methods: In this study, we analysed data on 1067 adult participants (mean age 57.12 (SD 13.9), men 35%). Results: Mean salt and potassium intakes were 8.6 g/day (IQR 6.2–11.2) and 2.8 g/day (IQR 2.1–3.5), respectively, with a sodium-to-potassium ratio of 2.6 (IQR 1.8–3.3). We detected a decrease of 17.6% (2 g/day less) in salt consumption compared with our previous salt-mapping study. However, only 13.7% and 8.9% met the WHO salt and potassium recommended targets of 5 g/day and 3.5 g/day, respectively. Salt intake was higher, and potassium ingestion was lower, in rural vs. urban regions and in continental vs. Mediterranean parts of Croatia. Moderate to severe iodine insufficiency was determined in only 3% of the adult participants. Conclusion: In the last fifteen years, salt consumption has been significantly reduced in the Croatian adult population because of the intensive and broad CRASH program. However, salt intake is still too high, and potassium ingestion is too low. Salt reduction programs are the most cost-effective methods of cardiovascular disease prevention and merit greater consideration by the government and health policy makers
Employing the Aviation Model to Reduce Errors in Robotic Gynecological Surgery: A Narrative Review
No full textThe operating room is the environment where harm to the patient is most likely. Robotic surgery was listed as one of the top 10 health hazards as late as 2020. Taking inspiration from other fields of application, such as aeronautics, checklists have been increasingly implemented in medical practice over the years, becoming essential components of the operating theatre. In addition to checklists, simulation has taken on a fundamental importance in reducing errors. This paper aims to provide a narrative review to assess the importance of checklists and training in robotic surgery and how they improve the outcome. A comprehensive literature search from January 2000 to September 2023 was conducted. A total of 97 articles were included in the initial search. Eleven studies were deemed relevant and were considered eligible for full-text reading. Among these, ten studies focused on the analysis of training effectiveness. An article in our review assessed the benefits of introducing checklists in the operating room. Innovations created in aviation, such as checklists and simulation, have entered the medical field to prevent human error. Developing dedicated checklist and surgical teams, through theoretical and practical training, has become essential in modern medicine. Tools such as checklists, training, and simulation are among the best methods to reduce adverse medical events
Surgical treatment of testicular cancer
No full textTumori testisa predstavljaju jedno od važnijih zdravstvenih pitanja koje pogađa mlade muškarce širom svijeta. Iako su relativno rijetki u usporedbi s drugim vrstama karcinoma, njihova učestalost raste, posebno među muškarcima starosti između 15 i 35 godina. Svaka vrsta tumora ima svoje specifične karakteristike, prognozu i terapijske opcije, što naglašava važnost detaljnog histopatološkog pregleda i individualiziranog pristupa liječenju. Ultrasonografija skrotuma preferirana je inicijalna slikovna metoda za procjenu testikularne tvorbe. Radikalna orhiektomija je i dijagnostička i terapijska metoda koja se koristi kod sumnje na rak testisa. Odluka o nastavku operativne intervencije kod muškarca sa sumnjom na rak testisa donosi se nakon pažljivog razmatranja svih dostupnih podataka, uključujući kliničke nalaze, slikovne pretrage i tumorske markere u serumu. Inguinalna eksploracija s radikalnom orhidektomijom (RO) zlatni je standard za početno liječenje bilo koje tvorbe testisa sumnjive na malignost. Dugotrajne psihološke ili socijalne komplikacije zbog odsutnosti testisa mogu se ublažiti upotrebom testikularne proteze. Iako se velika većina relapsa javlja unutar prvih pet godina i za seminom i za NSGCT, mogu se pojaviti kasni recidivi. Stoga je praćenje najintenzivnije prve godine do dvije nakon liječenja, a zatim se postupno smanjuje. Operacija koja štedi organe, također poznata kao poštedna operacija testisa (TSS) ili djelomična orhiektomija, kirurški je pristup kojem je cilj ukloniti tumor uz očuvanje zdravog tkiva i funkcije testisa. Kada se štedi dio testisa koji nosi tumor, veliki je problem visoka prevalencija susjednih žarišta neoplazije zametnih stanica in situ, koja je prisutna u čak 85 posto bolesnika. Poštedna operacija testisa smatra se održivom opcijom za bolesnike sa sumnjom na benigne tumore ili nesigurne tvorbe s negativnim tumorskim markerima, u slučajevima istovremenih bilateralnih tumora ili tumora u jednom testisu, ali samo u kombinaciji s pregledom zamrznutog reza.Testicular tumors represent one of the most important health issues affecting young men worldwide. These tumors are considered relatively rare compared to other types of cancer, but their incidence is increasing, especially among men between the ages of 15 and 35. Each type of tumor has its own specific characteristics, prognosis and therapeutic options, which emphasizes the importance of a detailed examination and an individualized approach to treatment. Scrotal ultrasonography is the preferred initial imaging method for testicular mass assessment. Radical orchiectomy is both a diagnostic and therapeutic method used in suspected testicular cancer. After detailed clinical findings, imaging studies and serum tumor markers, the decision to proceed with operative intervention is made. Inguinal exploration with radical orchidectomy (RO) is the gold standard for the initial management of any testicular mass that is suspected to be malignant. Testicular prosthesis can alleviate long-term psychological or social impact due to the absence of a testicle. Although most relapses occur within the first five years for seminomas and NSGCT, late relapses can also occur. Therefore, patients are monitored most intensively for the first one to two years after treatment, and then rarely as time passes by. Testicular-sparing surgery (TSS) or partial orchiectomy, is a surgical approach that aims to remove the tumor while preserving healthy testicular tissue and function. When the part of the testis with the tumor is spared, a big problem is the high prevalence of germ cell neoplasia in situ found nearby, which is present in as many as 85 percent of cases. Testis-sparing surgery is considered a viable option for patients with suspected benign tumors or uncertain masses with negative tumor markers, in cases of simultaneous bilateral tumors or tumors in one testis, but only in combination with frozen section examination
Navigating the Neuroimmunomodulation Frontier: Pioneering Approaches and Promising Horizons—A Comprehensive Review
No full textThe research in neuroimmunomodulation aims to shed light on the complex relationships that exist between the immune and neurological systems and how they affect the human body. This multidisciplinary field focuses on the way immune responses are influenced by brain activity and how neural function is impacted by immunological signaling. This provides important insights into a range of medical disorders. Targeting both brain and immunological pathways, neuroimmunomodulatory approaches are used in clinical pain management to address chronic pain. Pharmacological therapies aim to modulate neuroimmune interactions and reduce inflammation. Furthermore, bioelectronic techniques like vagus nerve stimulation offer non-invasive control of these systems, while neuromodulation techniques like transcranial magnetic stimulation modify immunological and neuronal responses to reduce pain. Within the context of aging, neuroimmunomodulation analyzes the ways in which immunological and neurological alterations brought on by aging contribute to cognitive decline and neurodegenerative illnesses. Restoring neuroimmune homeostasis through strategies shows promise in reducing age-related cognitive decline. Research into mood disorders focuses on how immunological dysregulation relates to illnesses including anxiety and depression. Immune system fluctuations are increasingly recognized for their impact on brain function, leading to novel treatments that target these interactions. This review emphasizes how interdisciplinary cooperation and continuous research are necessary to better understand the complex relationship between the neurological and immune systems
Regeneration of Critical Calvarial Bone Defects Using Bovine Xenograft, Magnesium-Enriched Bovine Xenograft and Autologous Dentin in Rats: Micro-CT, Gene Expression and Immunohistochemical Analysis
No full textThe aim of this study was to evaluate the efficacy of autologous dentin (AD), bovine xenograft (BX) and magnesium-enriched bovine xenograft (BX + Mg) in the healing of critical cranial bone defects (CCBDs) in rats. Eighty male Wistar rats were divided into four groups: BX, BX + Mg, AD and the control group (no intervention). Eight mm CCBDs were created and treated with the respective biomaterials. Healing was assessed 7, 15, 21 and 30 days after surgery by micro-computed tomography (micro-CT), real-time polymerase chain reaction (RT-PCR) and immunohistochemical analysis. Micro-CT analysis showed that AD had the highest bone volume and the least amount of residual biomaterial at day 30, indicating robust bone formation and efficient resorption. BX + Mg showed significant bone volume but had more residual biomaterial compared to AD. RT-PCR showed that the expression of osteocalcin (OC), the receptor activator of nuclear factor κB (RANK) and sclerostin (SOST), was highest in the AD group at day 21 and vascular endothelial growth factor (VEGF) at day 15, indicating increased osteogenesis and angiogenesis in the AD group. Immunohistochemical staining confirmed intense BMP-2/4 and SMAD-1/5/8 expression in the AD group, indicating osteoinductive properties. The favorable gene expression profile and biocompatibility of AD and BX + Mg make them promising candidates for clinical applications in bone tissue engineering. Further research is required to fully exploit their potential in regenerative surgery
Assessing external exposome by implementing an Environmental Data Management System using Open Data
No full textAbstract
Due to the increasing importance of exposome in environmental epidemiology, feasibility and usefulness of an Environmental Data Management System (EDMS) using Open Data was evaluated. The EDMS includes data from 10 European cities (Celje (Slovenia), Łódź (Poland), Manchester (UK), Palermo (Italy), Paris (France), Porto (Portugal), Regensburg (Germany), Reus (Spain), Rijeka (Croatia), Thessaloniki (Greece)) about external non-specific and specific exposome factors at the city or country level (2017–2020). Findings showed that the highest values of life expectancy were in Reus females (86 years) and Palermo males (81 years). UK had the highest obesity rate (28%), Croatia the highest prescribed drug consumption (62%), Greece and Portugal the highest smoking rates (37%, 42%) and daily alcohol consumption (21%), respectively. The most polluted cities were Thessaloniki for PM
(38 µg/m
), Łódź for PM
(25 µg/m
), Porto for NO
(62 µg/m
) and Rijeka for O
(92 µg/m
). Thessaloniki had the highest grey space (98%) and Łódź the highest cumulative amount of pollen (39,041 p/m
). The highest daily noise levels ≥ 55 dB was in Reus (81% to traffic) and Regensburg (21% to railway). In drinking water, arsenic had the highest value in Thessaloniki (6.4 µg/L), boron in Celje (24 mg/L) and lead in Paris (46.7 µg/L). Portugal and Greece showed the highest pesticide residues in food (7%). In conclusion, utilizing open-access databases enables the translation of research findings into actionable strategies for public health interventions
Salt, sugar and saturated fats in rusks on the Croatian market - consumer preferences and contribution to recommended intake
No full textDvopek je suhi, hrskavi i lako probavljiv pekarski proizvod, a odlikuje se specifičnim načinom proizvodnje. S ciljem utvrđivanja razlika u sastavu, prosječnoj energijskoj i hranjivoj vrijednosti standardnog i integralnog dvopeka, pregledane su ukupno 44 deklaracije s hrvatskog tržišta u periodu od siječnja do travnja 2024. godine. Integralni dvopek ima povoljniju nutritivnu kvalitetu, statistički značajno manju energijsku vrijednost i udio ugljikohidrata te statistički značajno veći udio prehrambenih vlakana i bjelančevina od standardnog dvopeka. Medijan sadržaja soli kod obje je vrste dvopeka 1,2 g/100 g te bi se jednim obrokom od 37 g unijelo 7,4 % preporučenog unosa soli za odrasle. Kao zaslađivač uglavnom se koristi saharoza, a medijan udjela šećera je 5,1 g/100 g (integralni dvopek) te 6,5 g/100 g (standardni dvopek). Suncokretovo ulje i visokooleinsko suncokretovo ulje sadržano je u najvećem broju proizvoda, a udio zasićenih masti kreće se od 0,5 g/100 g (standardni dvopek) do 5,0 g/100 g (integralni dvopek). U senzorskom testu sudjelovao je 101 netrenirani ispitanik (srednja dob 29 godina). Utvrđeno je da se razlike u intenzitetu slatkog (5,0 g; 6,8 g; 8,0 g šećera/100 g) i slanog okusa (2,3 g; 1,4 g; 1,0 g soli/100 g) uspješno primjećuju jer su sume nizova u testu rangiranja statistički značajno različite (Friedmanov test, p < 0,05). Test preferencije pokazao je da se podjednakom broju ispitanika sviđa dvopek s najvećim i srednjim udjelom šećera. Najmanjem se broju ispitanika sviđa uzorak s najmanjim udjelom šećera, a najvećim udjelom soli (5,0 g šećera i 2,3 g soli/100 g).Rusk is a dry, crispy and easily digestible bakery product that is characterized by a special production method. In order to determine differences in the composition, average energy and nutritional value between standard and wholegrain rusks, a total of 44 labels with nutrition information on the Croatian market were reviewed between January and April 2024. Wholegrain rusks have a better nutritional quality, with a statistically significantly lower energy value and carbohydrate content and a statistically significantly higher content of dietary fiber and protein content compared to standard rusks. The median salt content for both types of rusk is 1.2 g/100 g. A single serving of 37 g would contribute to 7.4 % of the recommended salt intake for adults. The most commonly used sweetener is sucrose and the median sugar content is 5.1 g/100 g (wholegrain rusks) and 6.5 g/100 g (standard rusks). Sunflower oil and high oleic sunflower oil are contained in most of the products, with saturated fat content ranging from 0.5 g/100 g (standard rusks) to 5.0 g/100 g (wholegrain rusks). One hundred and one untrained participants (average age 29 years) took part in a sensory test. It was found that differences in the intensity of the sweet (5.0 g, 6.8 g, and 8.0 g sugar/100 g) and salty taste (2.3 g, 1.4 g, and 1.0 g salt/100 g) are successfully perceived, as the ranked sums in the test are statistically significantly different (Friedman test, p < 0.05). The preference test showed that an equal number of participants like the rusk with the highest and the medium sugar content. The smallest number of participants favours the sample with the lowest sugar content and the highest salt content (5.0 g sugar and 2.3 g salt/100 g)
ODREĐIVANJE LAKOHLAPLJIVIH HALOGENIRANIH UGLJIKOVODIKA U VODAMA
No full textVoda namijenjena za ljudsku potrošnju mora zadovoljiti propisane, biološke, fizičke i
kemijske standarde kvalitete . Zdravstveno ispravna voda se smatra voda koja ne sadrži tvari
koje imaju negativan utjecaj na ljudsko zdravlje. Voda je jedan od najvažnijih resursa koji
uvelike utječu na cjelokupni svijet. Kvaliteta vode je osnovni čimbenik za zdravlje ljudi.
Potrebno je pravilno provoditi dezinfekciju vode kako bi se izbjegla opasnost od štetnih tvari.
Jedna od štetnih tvari su i lakohlapljivi halogenirani ugljikovodici. Pod pojmom lakohlapljivi
halogenirani ugljikovodici podrazumijeva se organski spoj koji lako hlapi i sadrži neki od
halogenih elemenata. Predstavljaju opasnost za čovjekovo zdravlje ako prelaze dopuštene
zakonske vrijednosti te tada mogu djelovat kancerogeno. Veliki značaj kod sprječavanja
kontaminacije vode za ljudsku potrošnju lakohlapljivim halogeniranim ugljikovodicima ima
revizijski monitoring koji se redovito provodi. Da bi se odredila prisutnost lakohlapljivih
halogeniranih ugljikovodika u vodi koristi se tehnika kromatografije. Sa njom se odjeljuje,
identificira te kvantitativno određuje kemijske sastojke. Metoda kojom se određuju
lakohlapljivi spojevi je plinska kromatografija. U ovom radu određivali su se lakohlapljivi
halogenirani ugljikovodici u vodama, uzorci vode za ljudsku potrošnju (N=332) tijekom
trogodišnjeg razdoblja (2020.-2022.) na području Primorsko-goranske županije. Svi uzorci
koji su analizirani sadržavali su nisku koncentraciju lakohlapljivih halogeniranih
ugljikovodika koja je manja od granica kvantifikacije te nijedan uzorak nije prelazio
maksimalno dopuštene vrijednosti. Određuju se plinskom kromatografijom sa spektrometrom
masa (GC – MS ) i plinskom kromatografijom s detektorom na bazi zahvata elektrona (GC –
ECD).Water intended for human consumption must meet prescribed biological, physical and
chemical quality standards. Healthy water means water that does not contain substances that
have a negative impact on human health. Water is one of the most important resources
affecting the entire world. Quality water is a basic factor for human health. It is necessary to
carry out water disinfection properly in order to avoid the danger of harmful substances. One
of the harmful substances are volatile halogenated hydrocarbons. The term volatile
halogenated hydrocarbons mean an organic compound that evaporates easily and contains
some of the halogen elements. They represent a danger to human health if they exceed the
permitted legal values, and then they can have a carcinogenic effect. Audit monitoring, which
is carried out regularly, is of great importance in identifying contamination of water for
human consumption with volatile halogenated hydrocarbons. Chromatography technique is
used to determine the presence of volatile halogenated hydrocarbons in water. It is used to
separate, identify and quantitatively determine chemical ingredients. The method used to
determine volatile compounds is gas chromatography. In this work, volatile halogenated
hydrocarbons were determined in water, water samples for human consumption (N=332)
during a three-year period (2020-2022) in the Primorje-Gorski Kotar County. All samples
that were analysed contained a low concentration of volatile halogenated hydrocarbons,
which is lower than the limits of quantification, and no sample exceeded the maximum
allowed values. They are determined by gas chromatography with a mass spectrometer (GCMS) and gas chromatography with an electron capture detector (GC-ECD)
Borderline personality disorder
No full textGranični poremećaj ličnosti karakteriziraju teška funkcionalna oštećenja, visok rizik od samoubojstva, negativan učinak na tijek depresivnih poremećaja, ekstenzivna primjena liječenja i visoki troškovi za društvo. Tijek ovog poremećaja je manje stabilan od očekivanog za ostale poremećaje osobnosti. Konkretni uzroci još nisu u potpunosti jasni, ali čini se da genetski čimbenici i nepovoljni životni događaji i okolnosti, osobito u ranom djetinjstvu, međusobno djeluju i dovode do poremećaja. Neurobiološka istraživanja pokazuju da su abnormalnosti u frontolimbičkim mrežama povezane s mnogim simptomima. Podaci o učinkovitosti ciljane psihofarmakoterapije u liječenju BPD-a variraju i dokazi još nisu čvrsti, ali je poznato da znatno pomažu u liječenju težih oblika bolesti, specifičnih simptoma kao i određenih komorbiditeta. Određeni oblici psihoterapije pokazali su se iznimno korisnima za suočavanje s problemima koji se često javljaju u bolesnika s graničnim poremećajem osobnosti. Potrebna su daljnja istraživanja o dijagnozi, neurobiologiji i liječenju da bi se našao konkretan uzrok, postavile idealne smjernice i kriteriji za dijagnozu te otkrio najadekvatniji terapijski pristup.Borderline personality disorder is characterized by severe functional impairment, a high risk of suicide, a negative impact on the course of depressive disorders, extensive treatment, and high costs to society. The course of this disorder is less stable than expected for other personality disorders. The specific causes are not yet fully understood, but genetic factors and adverse life events and circumstances, especially in early childhood, seem to interact to produce the disorder. Neurobiological research indicates that abnormalities in the frontal limbic networks are associated with many symptoms. Data on the effectiveness of targeted psychopharmacotherapy in the treatment of BPD vary and the evidence is not yet firm, but it is known to be of considerable help in the treatment of severe forms of the disease, specific symptoms as well as certain comorbidities. Certain forms of psychotherapy have proved to be extremely helpful in dealing with the problems that often occur in borderline personality disorder patients. Further research on diagnosis, neurobiology and treatment is needed to identify a specific cause, establish ideal guidelines and criteria for diagnosis, and identify the most appropriate therapeutic approach