Veterinary medicine - Repository of PHD, master's thesis
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The effect of liver steatosis on the course and outcome of sepsis
No full textOvo prospektivno opservacijsko istraživanje u trajanju od 16 mjeseci uključilo je odrasle bolesnike koji su bili hospitalizirani zbog sepse stečene u vanbolničkim uvjetima. Od 378 uključenih, u njih 46% dijagnosticiran je NAFLD. Bolesnici s NAFLD-om bili su stariji te su češće ispunjavali kriterije metaboličkog sindroma. Nisu uočene razlike u ishodištu i etiologiji sepse. Bolesnici s NAFLD-om pokazali su veću prevalenciju akutne bubrežne insuficijencije, potrebe za hemodijalizom te povećanu potrebu za invazivnom mehaničkom ventilacijom. Bolnički mortalitet bio je gotovo dvostruko viši u grupi s NAFLD-om. Multivarijatna analiza pokazala je neovisnu povezanost NAFLD-a s mortalitetom bez obzira na druge čimbenike metaboličkog sindroma. Također je FAST skor identificiran kao precizan prediktor mortaliteta. Nadalje, eksperimentalni biomarkeri CK-18 i adiponektin evaluirani su kao markeri statusa jetre. U bolesnika s NAFLD-om razine CK-18 u krvi bile su povišene, dok su razine adiponektina snižene i obrnuto za non-NAFLD skupinu, što bi moglo biti korisno u probiru, dijagnostici i praćenju bolesnika s jetrenom steatozom. Ovo istraživanje ističe učestalost NAFLD-a među bolesnicima sa sepsom te značajan utjecaj NAFLD-a na ishod liječenja. Specifični biomarkeri kao što su CK-18 i adiponektin mogu biti korisni u dijagnostici i praćenju bolesnika s jetrenom steatozom, dok FAST skor može koristiti kao prediktor mortaliteta.This prospective observational study, conducted over 16 months, included adult patients who were hospitalized due to community-acquired sepsis. Of the 378 patients, 46% were diagnosed with NAFLD. These patients were older and more frequently met the criteria for metabolic syndrome. No differences were observed in the etiology of sepsis. Patients with NAFLD showed a higher prevalence of acute kidney injury, need for hemodialysis, and the need for invasive mechanical ventilation. Hospital mortality was almost twice as high in the NAFLD group. Multivariate analysis showed an independent association of NAFLD with mortality regardless of other factors of metabolic syndrome. Also the FAST score as an accurate
predictor of mortality was identified. Furthermore, biomarkers CK-18 and adiponectin were evaluated as markers of liver status. In patients with NAFLD, blood levels of CK-18 were elevated, while adiponectin levels were decreased, and vice versa for the non-NAFLD group. Our study highlights the prevalence of NAFLD among patients with sepsis and the significant
impact of NAFLD on treatment outcomes. Specific biomarkers such as CK-18 and adiponectin may be useful in diagnosing and monitoring patients with hepatic steatosis, while the FAST score can serve as a predictor of mortality
Poslijediplomski tečajevi stalnog medicinskog usavršavanja I. kategorije
No full textPoslijediplomski tečajevi stalnog medicinskog usavršavanja I. kategorije Medicinskog fakulteta Sveučilišta u Zagreb
Životinje u službi znanosti: nevidljivi junaci medicinskih otkrića : Noć knjige 2025. godine
No full textEksperimenti na životinjama dio su biomedicinskih istraživanja već tisućama godina. Zbog anatomskih i fizioloških sličnosti između ljudi i životinja, osobito sisavaca, određeni lijekovi, cjepiva i terapije najprije se ispituju na životinjskim modelima. Razumijevanje načina funkcioniranja ljudskog organizma i povezane spoznaje koje su dovele do iznimnog napretka medicinske prakse izravni su rezultat takvih istraživanja.
Zanimljivo je istaknuti da se čak 188 od ukupno 225 Nobelovih nagrada za fiziologiju i medicinu temelji na rezultatima ostvarenim upravo na životinjskim modelima.
Kako su se tijekom povijesti razvijala istraživanja na životinjama? U kojim područjima kliničke medicine ne bismo mogli napredovati bez takvih eksperimenata? Koje se životinje koriste, uzgajaju li se posebno za te svrhe? Kako je regulirano njihovo korištenje i pod kojim zakonskim okvirom? I na kraju – hoće li biomedicinska istraživanja u budućnosti biti moguća bez korištenja životinjskih modela?
Na ova, kao i brojna druga pitanja pokušat će odgovoriti Središnja medicinska knjižnica Medicinskog fakulteta Sveučilišta u Zagrebu svojim programom „Životinje u službi znanosti: nevidljivi junaci medicinskih otkrića“. Osim u sklopu Noći knjige 23. travnja, programom će se simbolično obilježiti i Svjetski dan eksperimentalnih životinja, 24. travnja, kojim se nastoji podići svijest o eksperimentiranju na životinjama
Frequency and type of renal damage in children and young adults with haemophilia A and B
No full textUvod: Stupanj bubrežnog oštećenja u djece i mladih odraslih ispitanika s hemofilijom nepoznat je i nedovoljno istražen. Svrha ovog rada je istražiti učestalost bubrežnog oštećenja u ispitanika s hemofilijom A/B laboratorijskim, ultrazvučnim i metodama nuklearno medicinske dijagnostike. Svi su ispitanici bili bez simptoma bubrežnog oštećenja s normalnim vrijednostima kreatinina i ureje.
Metode: U istraživanje je uključeno 73 muška ispitanika s hemofilijom A ili B. Od toga 34 mlađih do 18 godina i 39 odraslih muškaraca do 32 godine liječenih u KBC Zagreb. Metode procjene bubrežnog oštećenja bile su ultrazvuk bubrega, dinamička scintigrafija bubrega, mjerenje korigiranog klirensa kreatinina, cistatina C, eritropoetina i procjena tubularne funkcije bubrega pomoću parametara iz 24-satnog urina (kreatinin, klirens kreatinina, proteinurija, kalciurija, natriurija, kaliurija, magnezurija).
Rezultati: Najveća učestalost poremećene bubrežne funkcije utvrđena je mjerenjem radioizotopnog klirensa s 99m Tc-DTPA i to u 45,3% ispitanika. Mjerenjem poremećaja tubularne funkcije nađeno je odstupanje od normale u 36,9 % ispitanika, a povišeni cistatin C utvrđen je u 17,4 % ispitanika. UZV analizom urotrakta morfološko oštećenje bilo je prisutno u 7,5% ispitanika. U svega 6,3% ispitanika bio je snižen klirens kreatinina. Statistički je značajna povezanost morfološkog oštećenja bubrega s prisutnim inhibitorima na FVIII/FIX. Oštećenje je prisutno u 4,9 % bolesnika bez i 33,3 % bolesnika s inhibitorima. Osim toga, statistički je značajna povezanost morfološkog oštećenja s tipom terapije i prisutno je u 40% bolesnika na „ostaloj terapiji“.
Zaključak: Kao najbolja metoda za procjenu pa i najmanjeg otklona bubrežne funkcije od normale u djece i mladih odraslih s hemofilijom utvrđena je metoda dinamičke scintigrafije bubrega. Mjerenje DTPA iGF i u našem istraživanju potvrdilo je ranije dokazanu visoku osjetljivost i specifičnost.. Analizom ROC krivulje vidi se kako različite metode procjene bubrežnog oštećenja ne posjeduju dobra diskriminatorna svojstva za prepoznati ispitanike s poremećenim DTPA iGF.Introduction: The extent of kidney damage in children and young adults with haemophilia is not well studied and a lot is still unknown. The aim of this study is to evaluate the incidence of kidney damage in subjects with haemophilia A/B using laboratory, ultrasound, and nuclear medicine diagnostic methods. None of the subjects had renal damage symptoms and all of them had normal creatinine and urea values.
Methods: We included 73 male subjects with haemophilia A or B. Among them, 34 were minors, while 39 were young adults, all treated in UHC Zagreb. To estimate renal damage ultrasound, dynamic renal scintigraphy, corrected creatinine clearance, cystatin C, erythropoietin, and 24 urine excretion to evaluate tubular renal function were performed. All subjects were examined, and blood samples and 24-hour urine were collected (creatinine, creatinine clearance, proteinuria, calcuria, natriuria, kaliuria, magnesuria).
Results: The highest prevalence of impaired renal function was determined by measuring the radioisotope clearance with 99m Tc-DTPA in 45,3% of the subjects. Tubular function measurement discovered a deviation in 36,9% of subjects, and elevated cystatin C was found in 17,4% of subjects. Urinary tract imaging damage showed morphological abnormalities in 7,5% of subjects. Only 6,3% of the subjects had decreased creatinine clearance. There was a statistically significant association between morphological kidney damage and the presence of FVIII/FIX inhibitors. Damage was present in 4,9% of patients without and 33,3% of patients with inhibitors. Additionally, there was a statistically significant association between morphological damage with the type of therapy and was present in 40% of patients treated with "other" therapy. Conclusion: Dynamic renal scintigraphy was established as the best method for assessing even the smallest renal function deviation in children and young adults with haemophilia. DTPA iGF measurement was also in our research shown to be highly sensitive and specific. The ROC curve analyses showed that the different methods of kidney damage assessment do not have good discriminatory characteristics for recognizing subjects with impaired DTPA iGF
Arterial stiffness assessed with oscillometry considering dynamic or static type of exercise in children athletes
No full textCiljevi: ciljevi ovog istraţivanja bili su izmjeriti parametre arterijske krutosti u skupini djece i adolescenata sportaša u ovisnosti o vrsti sporta i usporediti ih s istima u skupini djece i adolescenata koji se nisu aktivno bavili sportom.
Ispitanici i metode: U prospektivnoj studiji sudjelovalo je 238 djece i adolescenata, dobne skupine između 13 i 18 godina, podijeljenih u dvije skupine. Prvu skupinu činila su djeca sportaši (N=138; 80 u dinamičkoj, 58 u statičkoj skupini sportova), dok se druga skupina sastojala od djece iste dobi koja se nisu aktivno bavila sportom (N=100). Mjerenja arterijske krutosti u djece sportaša provodila su se prije početka tjelesne aktivnosti, u 60-oj minuti treninga, i ponovljena su nakon dvije godine, u mirovanju.
Rezultati: U skupini djece i adolescenata koja s nisu aktivno bavili sportom, zabiljeţili smo statistički značajno više vrijednosti PWVao u usporedbi sa skupinom djece sportaša (P< 0,000, PWVao 6,28 (IQ 5,70-7,00), vs 5,74 (IQ 5,1-6,23)). Skupina djece i adolescenata koji se nisu aktivno bavili sportom imala je statistički značajno više vrijednosti indeksa tjelesna mase u odnosu na skupinu djece i adolescenata sportaša (P=0,046). Mjerenja provedena nakon dvije godine u skupini djece sportaša, pokazala su statistički značajno niţe vrijednosti PWVao u skupini djece koja su se bavila aktivnošću visokog dinamičkog i niskog statičkog opterećenja, u odnosu na skupinu djece i adolescenata koji su se bavili aktivnošću visokog statičkog i niskog dinamičkog opterećenja (P=0,040, PWVao 5,64 (IQ 5,10-6,10) vs 5,95 (IQ 5,50-6,50)).
Zaključak: Tjelesna aktivnost osobito dinamičkog tipa, povoljno utječe na parametre arterijske krutosti.Objectives: This study aims to assess the parameters of arterial stiffness in children according to the type of exercise and compare them with those who do not participate in sport.
Materials and methods: There were 238 subjects divided into two groups. One included children who practiced sports (N=138; 80 in the dynamic, 58 in the static group of sports), and the other included children of the same age who did not practice sport (N=100). Measurements were performed before physical activity, in the 60th minute of exercise and repeated after two years, in rest only.
Results: The control group had statistically significantly higher values of PWVao in comparison with the group of children athletes (P< 0.000, mean PWVao 6,28 (IQ 5,70-7,00), vs 5,74 (IQ 5,1-6,23)). This group had a significantly higher body mass index than children athletes (P=0,046). Children who practiced sports with a high level of dynamic and low level of static load after two years showed significantly lower values of PWVao in comparison with those who practiced sports with a high level of static and low level of dynamic exercise (P=0,040, PWVao 5,64 (IQ 5,10-6,10) vs 5,95 (IQ 5,50-6,50)).
Conclusion: Physical activity, especially dynamic, has a beneficial impact on arterial stiffness
Pregnancy after heart transplantation
No full textTrudnoća u pacijentica nakon transplantacije organa, pa tako i srca, danas je aktualna tema u suvremenoj opstetriciji. Zahvaljujući razvoju transplantacijske kardiologije i kardijalne kirurgije te posljedično sve većem broju transplantacija, puno veći broj pacijentica ulazi u reproduktivnu dob i u skladu s time prirodno se nameće želja za trudnoćom. S obzirom na moguće specifične maternalne i fetalne komplikacije skrb trudnice s transplantiranim srcem zahtijeva individualiziran i multidisciplinaran pristup u centrima tercijarne zdravstvene skrbi. Poten cijalne maternalne komplikacije uključuju hipertenziju, razvoj preeklampsije, eklampsije, infekcije, gestacijskog dijabetesa i tromboembolije te odbacivanje presatka. Najčešće fetalne komplikacije u ovoj skupini trudnica su intrauterini zastoj u rastu, prijevremeni porođaj i povećan rizik razvojnih malformacija.Pregnancy in patients after organ transplantation, including heart, is a current topic in modern obstetrics. Due to the development of transplant cardiology, cardiac surgery and the increasing number of transplants, a lot of woman experience reproductive age and the desire to become pregnant naturally arises. Considering possible specific feto maternal complications, the management of pregnancies in women with heart transplants requires an individualized and multidisciplinary approach in tertiary health care centers. Potential maternal complication in pregnant women after heart
transplantation include hypertension, development of preeclampsia, eclampsia, infection, gestational diabetes, thromboemboli sm and graft rejection. The most common fetal complications in this group are fetal growth restriction, premature delivery and increased risk of fetal malformations
Epidemiological and Entomological Study After the Possible Re-Emergence of Dengue Fever in Croatia, 2024
No full textAutochthonous dengue cases have been continuously recorded in Europe in the past two decades. The first autochthonous dengue case in Croatia was reported in 2010 on the Pelješac Peninsula, while imported cases were recorded continuously thereafter. In 2024, dengue re-emerged in Croatia. An epidemiological and entomological study was conducted after receiving information on dengue virus (DENV) infection in a German tourist probably acquired on Dugi Otok Island in Croatia in May 2024. Serum samples were collected from 30 residents of the Veli Rat region where the patient had stayed. In addition, mosquitoes were collected in the same area. Human samples were tested for the presence of DENV antibodies (ELISA and IFA) and DENV RNA (RT-qPCR), while mosquito samples were tested for DENV RNA (RT-qPCR). DENV IgM or IgG antibodies were found in 8 serum samples, while no one sample was RT-qPCR positive. No cross-reactivity with flaviviruses was detected in seropositive samples, supporting DENV infection. One patient was classified as a confirmed dengue case (IgG seroconversion in paired serum samples) and five as probable cases (IgM detection in a single serum sample). One additional patient, sampled only once, was IgG seropositive. Two of the seropositive individuals reported fever and rash three weeks before testing. The re-emergence of dengue in Croatia highlights the need for continuous monitoring of DENV circulation in both humans and vectors
Glucagon-like peptide-1 in treatment of type 2 diabetes
No full textŠećerna bolest tip 2 je kronična metabolička bolest višestruke etiologije, u kojoj prevladava inzulinska rezistencija, uz relativni manjak inzulina. U novije vrijeme prepoznati su i dodatni patofiziološki mehanizmi, među kojima se ističe smanjeni odgovor na inkretine. Radi navedenog razvijaju se lijekovi koji djeluju upravo na taj patofiziološki poremećaj. Među inkretine ubrajamo glukagonu sličan peptid-1 (eng. Glucagon-like peptide 1, GLP-1) i inzulinotropni polipeptid ovisan o glukozi (eng. Glucose-dependent insulinotropic polypeptide, GIP). Kako bi se iskoristio njihov terapijski potencijal, razvijeni su agonisti GLP-1 receptora (GLP-1 RA), lijekovi koje primarno koristimo u liječenju šećerne bolesti tipa 2, a sve češće i kao terapiju za regulaciju tjelesne mase. Riječ je o sintetskim peptidima koji oponašaju djelovanje prirodnih GLP-1 molekula koje luče stanice crijeva kao odgovor na unos hrane. Djelujući na svoje receptore, potiču lučenje inzulina, usporavaju pražnjenje crijeva te stvaraju osjećaj sitosti. Na taj način poboljšavaju glukoregulaciju i smanjuju tjelesnu masu. Zbog svojih učinaka na regulaciju glukoze, dodatno smanjuju rizik od razvoja komplikacija što ih čini korisnima i u prevenciji sekundarnih promjena povezanih s ovom bolešću. Kako su ovi receptori izraženi i na drugim tkivima, prepoznali su se njihovi pozitivni učinci na srčanožilni sustav, bubrege i imunosni sustav. Nedugo zatim, na tržištu su se pojavili dvojni agonisti-lijekovi koji ciljano djeluju na GLP-1 i GIP receptor, dodatno povećavajući metaboličke koristi. Očekuje se pronalazak novih terapijskih opcija, primjerice onih koje bi kombinirale učinak na inkretinske i glukagonske receptore.Type 2 diabetes mellitus is a chronic metabolic disease of multifactorial etiology, predominantly characterized by insulin resistance with a relative deficiency of insulin. In recent years, additional pathophysiological mechanisms have been identified, among which a reduced response to incretins stands out. As a result, drugs have been developed that specifically target this pathophysiological disturbance. Incretins include glucagon-like peptide
1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). To harness their therapeutic potential, glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been developed—medications primarily used in the treatment of type 2 diabetes mellitus, and increasingly also as therapy for weight loss. These are synthetic peptides that mimic the action of natural GLP-1 molecules secreted by intestinal cells in response to food intake. By activating their receptors, they stimulate insulin secretion, delay gastric emptying, and promote a feeling of satiety. In doing so, they improve glycemic control and contribute to body weight reduction. Due to their effects on glucose regulation, they further reduce the risk of diabetes-related complications, making them useful in the prevention of secondary changes associated with the disease. Since these receptors are also expressed in other tissues, their beneficial effects on the cardiovascular system, kidneys, and immune system have been recognized. Shortly afterward, dual agonists emerged on the market—drugs that act on both GLP-1 and GIP receptors, further enhancing metabolic benefits. New therapeutic options are anticipated, such as those combining effects on incretin and glucagon receptors
Intraoperative monitoring
No full textIntraoperativni monitoring uključuje skup postupaka, kojima se tijekom operativnog zahvata kontinuirano prate vitalne funkcije pacijenata, osiguravajući individualizirano i sigurno vođenje anestezije. Osnovni cilj intraoperativnog monitoringa je sigurnost pacijenta tijekom zahvata kroz pravodobno prepoznavanje i korekciju odstupanja od fizioloških parametara, s naglaskom na očuvanje funkcije vitalnih organa. Intraoperativni monitoring obuhvaća osnovni monitoring, koji se primjenjuje kod svih pacijenata, te multimodalni monitoring, koji uključuje dodatne, napredne metode praćenja. Temelji se na neinvazivnim i invazivnim tehnikama, a opseg određuje zdravstveno stanje pacijenta, kao i složenost samih zahvata. Preoperativni pregled čini neizostavni dio pripreme, omogućujući procjenu funkcionalnog statusa pacijenta, procjenu rizika i organizaciju individualnog anesteziološkog plana uz odabir potrebnog opsega intraoperativnog monitoringa. Monitoring kardiovaskularnih, respiratornih i neuroloških funkcija, zajedno s kontinuiranim praćenjem temperature, metaboličkih pokazatelja i održavanje hemodinamske stabilnosti, smatra se ključnim za provedbu učinkovite intraoperativne skrbi i postizanje povoljnijih terapijskih rezultata. Ovo je ključno u sprječavanju nastanka komplikacija u perioperativnom razdoblju, što je važan faktor u bržem postoperativnom oporavku i zadovoljstvu pacijenata. Primjena smjernica međunarodnih anestezioloških društava, poput standarda Američkog društva anesteziologa i preporuka Europskog odbora za anesteziologiju, omogućuje dosljedan i učinkovit pristup intraoperativnom monitoringu. Intraoperativni monitoring ne završava napuštanjem operacijske dvorane, već se proteže i na postoperativni period, čime se dodatno povećava sigurnost pacijenata i poboljšava ishod liječenja. Ovaj rad prikazuje postupke suvremenog intraoperativnog monitoringa, uz analizu indikacija za primjenu osnovnih i naprednih metoda praćenja tijekom operacijskog zahvata.Intraoperative monitoring encompasses a set of procedures used to continuously track patients' vital functions during surgery, ensuring individualized and safe anesthesia management. The primary goal of intraoperative monitoring is patient safety during the procedure, achieved through timely recognition and correction of deviations from physiological parameters, with an emphasis on preserving vital organ function. Intraoperative monitoring includes basic monitoring, applied to all patients, as well as multimodal monitoring, which involves additional advanced tracking methods. It is based on both noninvasive and invasive techniques, with the scope determined by the patient's medical condition and the complexity of the procedure. Preoperative evaluation is an essential part of preparation, allowing for assessment of the patient's functional status, risk evaluation, and development of an individualized anesthetic plan, including the selection of appropriate intraoperative monitoring measures. Monitoring of cardiovascular, respiratory, and neurological functions, alongside continuous tracking of temperature, metabolic indicators, and maintenance of hemodynamic stability, is considered crucial for effective intraoperative care and achieving favorable therapeutic outcomes. This is key to preventing complications during the perioperative period, which significantly contributes to faster postoperative recovery and greater patient satisfaction. The implementation of guidelines from international anesthesiology societies, such as the standards of the American Society of Anesthesiologists and the recommendations of the European Board of Anaesthesiology, enables a consistent and effective approach to intraoperative monitoring. Intraoperative monitoring does not end with the patient leaving the operating room but extends into the postoperative period, further enhancing patient safety and improving treatment outcomes. This paper presents the procedures of modern intraoperative monitoring, along with an analysis of the indications for the application of basic and advanced monitoring methods during surgery