Veterinary medicine - Repository of PHD, master's thesis
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Complications of placentation
No full textOvaj rad obrađuje komplikacije placentacije, kao jedno od najvažnijih područja u opstetriciji, koje ima izuzetno veliki utjecaj na ishod trudnoće, ali i perinatalni, fetalni i maternalni, morbiditet i mortalitet. Detaljno se opisuje cijeli proces uredne placentacije kao i mehanizmi koji dovode do njezina patološka oblika. Poseban naglasak stavlja se na neodgovarajuću invaziju trofoblasta i poremećenu promjenu spiralnih arterija, s posljedičnom smanjenom perfuzijom posteljice, razvojem ishemije te nedovoljnim dotokom hranjivih tvari i kisika do fetusa. To sve zajedno dovodi do vrlo značajnih kliničkih entiteta kao što su preeklampsija,
nisko sijelo posteljice (placenta praevia), spektar urasle posteljice (placenta accreta spectrum), abrupcija posteljice i zastoj u fetalnom rastu. S obzirom na to da svaki od navedenih kliničkih entiteta može imati teške posljedice na zdravstveno stanje majke i fetusa, ono zahtjeva pravovremeno otkrivanje i odgovarajuće, multidisciplinarno zbrinjavanje. Rad uključuje i pregled patofizioloških procesa na molekularnoj razini, brojnih etioloških i drugih čimbenika rizika, kao i prikaz dijagnostičkih i terapijskih pristupa. Kroz analizu recentne literature kao i posljednjih kliničkih smjernica, rad naglašava važnost prevencije i ranog otkrivanja abnormalne
placentacije u svrhu poboljšanja opstetričkih i neonatalnih ishoda.This paper addresses placentation disorders as one of the most critical areas in obstetrics, with a profound impact on pregnancy outcomes, as well as on perinatal, fetal and maternal morbidity and mortality. It provides a detailed description of the physiological process of normal placentation and the mechanisms leading to its pathological forms. Particular emphasis is placed on inadequate trophoblast invasion and abnormal remodeling of spiral arteries, resulting in reduced placental perfusion, ischemia and insufficient delivery of oxygen and nutrients to the fetus. These alterations give rise to a range of clinically significant conditions, including preeclampsia, low-lying placenta (placenta praevia), placenta accreta spectrum, placental abruption and fetal growth restriction. Given that each of these clinical entities can have severe consequences for both maternal and fetal health, timely detection and appropriate multidisciplinary management are essential. The paper also includes a review of the underlying molecular pathophysiological processes, various etiological and risk factors, as well as current diagnostic and therapeutic approaches. Through an analysis of recent scientific literature and current clinical guidelines, the study underscores the importance of prevention and early detection of abnormal placentation to improve obstetric and neonatal outcomes
New potential drugs in the treatment of Alzheimer's disease
No full textAlzheimerova bolest je prvi puta opisana 1906. godine kada je Alois Alzheimer opisao svoj opažaj “neobično teškog procesa bolesti cerebralnog korteksa” nad postmortalnom analizom mozga svoje pacijentice.
Od tada je prošlo više od jednog stoljeća te je cjelokupno shvaćanje patologije, patofiziologije i terapijskih mogućnosti daleko napredovalo. Unatoč tomu, otkriće je novih lijekova za liječenje Alzheimerove bolesti (AB) oskudno. Sve do 2021 godine, osnova terapije AB je bila lijekovima poput AChEi i memantinom, koji za učinak imaju samo ublažavanje simptoma. 2021. godine adukanumab je odobrila američka agencija za lijekove (FDA) i kao takav je postao prvi lijek odobren za liječenje AB u skoro 20 godina, od 2003. godine. Kasnije se ta odluka pokazala kontroverznom, zbog upitne djelotvornosti lijeka i ozbiljnih nuspojava koje liječenje sa sobom nosi. Sam proizvođač je kasnije zaustavio daljni razvoj i primjenu aducanumaba, ali ubrzno nakon pojave adukanumaba registrirana su dva nova lijeka, lekanemab i donanemab, koja su pokazana djelotvornim i kao takvi postali prva terapija za AB koja mijenja tijek bolesti.
Iako djelotvorna, učinak je trenutno dostupne terapije skroman. Prevalencija AB raste i bolest predstavlja sve veći zdravstvenoekonomski problem s obzirom na demografske promijene koje se događaju u svijetu, odnosno sa sve starijim stanovništvom i produljenjem životnog vijeka. S porastom znanja o samim patofiziološkim procesima u pozadini AB sposobnost kreiranja lijekova koji precizno ciljaju te mehanizme raste. U zadnje vrijeme sve se više mogućih lijekova registrira za klinička ispitivanja u terapiji AB. Cilj je ovog rada prikazati neke od mogućih lijekova, njihovu farmakodinamiku, efikasnost i trenutni stupanj razvoja te na taj način što bolje opisati trenutno stanje u razvoju efikasne terapije za AB.Alzheimer's disease was first described in 1906 when Alois Alzheimer described his observation of an "unusually severe disease process of the cerebral cortex" in a postmortem analysis of his patient's brain.
More than a century has passed since then, and the overall understanding of the pathology, pathophysiology, and therapeutic options has advanced considerably. Nevertheless, the discovery of new drugs to treat Alzheimer's disease (AB) is a serious challenge. Until 2021, the mainstay of AD therapy were drugs such as AChEi and memantine, which only have an effect on symptom relief. In 2021, aducanumab was approved by the US Food and Drug Administration (FDA), becoming the first drug approved for the treatment of AD in almost 20 years, since 2003. This decision later proved controversial, due to the questionable efficacy of the drug and the serious side effects that the treatment entails. The manufacturer itself later stopped further development and use of aducanumab, but soon after the appearance of aducanumab, two new drugs, lecanemab and donanemab, were registered, which proved to be effective and as such became the first therapy for AD that changes the course of the disease.
Although effective, their effect is modest. The prevalence of AD is increasing and the disease represents an increasing health and economic problem given the demographic changes taking place in the world, i.e. with an increasingly older population and an increase in life expectancy. With the increase in knowledge about the pathophysiological processes underlying AD, the ability to create drugs that precisely target these mechanisms is increasing. Recently, more and more potential drugs have been registered for clinical trials in the treatment of AD. The aim of this paper is to present some of the potential drugs, their pharmacodynamics, efficacy and current stage of development, and thus better describe the current state of development of effective therapy for AD
Pregnancy in kidney transplant recipients and in women on chronic dialysis
No full textTrudnoća kod pacijentica s krajnjim stadijem bubrežne bolesti koje su na dijalizi ili nakon transplantacije bubrega rijetka je, ali moguća. Plodnost može biti smanjena zbog hormonalnih i ne-hormonalnih faktora. Nakon transplantacije bubrega, reproduktivna funkcija često se poboljšava, a menstrualni ciklusi mogu se ponovno uspostaviti. Unatoč potencijalnim komplikacijama, trudnoće kod ovih pacijentica mogu biti uspješne uz pažljivo, multidisciplinarno praćenje.
Prema podacima Kliničkog bolničkog centra Zagreb (1988.–2024.) zabilježeno je 15 trudnoća među 12 žena u dobi od 25 do 43 godina. Od tih su trudnoća dvije bile tijekom nadomještanja bubrežne funkcije hemodijalizom, jedna tijekom kontinuirane ambulatorne peritonealne dijalize, a 12 ih je zabilježeno nakon transplantacije. Pacijentice s transplantiranim bubregom koristile su imunosupresive, većinom kombinaciju ciklosporina + azatioprina + metilprednizolona/prednizona ili kombinaciju takrolimusa + azatioprina + prednizona.
Jedanaest trudnoća dovršeno je carskim rezom, a 4 vaginalnim porodom. Zabilježena su 4 spontana pobačaja. Pet trudnoća bilo je prijevremeno, s porodom između 31. i 36. tjedna trudnoće. Šestero novorođenčadi imalo je nisku porođajnu masu (<2500g), iako je samo troje od njih bilo prijevremeno rođeno.
Opstetričke komplikacije uključivale su omotanu pupčanu vrpcu oko vrata djeteta pri 4 porođaja. Troje novorođenčadi imalo je komplikacije: jedno je imalo kongenitalnu dijafragmalnu herniju, drugo je imalo nekrotizirajući enterokolitis, a treće je imalo asfiksiju i sepsu, što je zahtijevalo reanimaciju koja je bila uspješna. Komplikacije u majki bile su rijetke, jedna pacijentica imala je povišen krvni tlak, dok je druga imala urinarnu infekciju.
Zaključno, iako trudnoća kod pacijentica sa završnim stadijem kronične bubrežne bolesti na dijalizi ili nakon transplantacije bubrega ostaje visokorizična, nije nemoguća. Napredak u dijaliznim tehnologijama i imunološkoj terapiji poboljšao je ishode za majku i dijete. Multidisciplinarni pristup ključan je za osiguranje najbolje moguće skrbi i ishoda za ove visokorizične trudnoće.Pregnancy in patients with end-stage renal disease (ESRD) who are on dialysis or who have undergone kidney transplantation is rare but possible. Fertility may be affected by both hormonal and non-hormonal factors. However, after kidney transplantation, reproductive function often improves, and many women resume regular menstrual cycles. Despite the potential for complications, successful pregnancies can occur in these patients with careful, multidisciplinary management.
A study conducted at the University Hospital Centre Zagreb from 1988 to 2024 analyzed 15 pregnancies among 12 women aged 25 to 43 years. Of these pregnancies, two occurred while the patients were on hemodialysis, one during continuous ambulatory peritoneal dialysis, and 12 after kidney transplantation. Most of the transplant recipients were treated with immunosuppressive medications such as cyclosporine combined with azathioprine and methylprednisolone/prednisone, or tacrolimus combined with azathioprine and prednisone.
The outcomes revealed that 11 pregnancies resulted in deliveries via cesarean section, while four were delivered vaginally. There were four miscarriages. Five pregnancies were preterm, with deliveries occurring between 31 and 36 weeks of gestation. Six children were born with low birth weight (less than 2500 grams), although only three of these were preterm.
Obstetric complications included umbilical cord issues in four deliveries. Three newborns experienced complications: one had a Bochdalek hernia, another was suspected of having necrotizing enterocolitis, and one suffered from asphyxia and sepsis, requiring successful resuscitation. Maternal complications were relatively rare, with one patient experiencing elevated blood pressure and another suffering from a urinary tract infection.
In conclusion, while pregnancy in patients with ESRD on dialysis or after kidney transplantation carries significant risks, it is not impossible. Advances in dialysis and immunosuppressive therapy have improved outcomes for both mothers and their children. A multidisciplinary approach is essential to provide the best possible care and outcomes for these high-risk pregnancies
The developmental origin of subclasses of subthalamic neurons
No full textSubtalamička jezgra mala je, dobro ograničena subkortikalna struktura uključena u kontrolu motoričkih, asocijativnih i limbičkih krugova bazalnih ganglija. Patofiziološki je uključena u različite neuropsihijatrijske poremećaje te je razumijevanje njezinog razvoja, specifikacije i diferencijacije važno za humanu medicinu. Ovi temeljni podaci o razvojnom podrijetlu i molekularnim markerima koji određuju subtalamičke neurone nedostaju za ljudsku subtalamičku jezgru, dok su za animalne modele podaci često nepotpuni. Prema tome, cilj je ove disertacije utvrditi razvojnu zonu zaduženu za produkciju subtalamičkih neurona kod miša i čovjeka te utvrditi molekularne markere važne za specifikaciju subtalamičkih neurona. U istraživanju su korišteni uzorci fetalnog ljudskog postmortalnog moždanog tkiva u dobi od 11 tjedana nakon začeća pa do novorođenačke dobi te je imunohistokemijskim metodama analizirana ekspresija odabranih markera. Dobivene rezultate o razvoju ljudske subtalamičke jezgre usporedili smo s podacima dostupnima iz literature te podacima dobivenima na miševima dobi P0. Rezultati ove disertacije ukazuju na to da ljudska i mišja subtalamička jezgra dijele sličan niz transkripcijskih faktora (PITX2, FOXA1, BARHL1, FOXP1, FOXP2) kalcij-vezujućih proteina (kalretinin, parvalbumin) te neuronske sintaze dušikovog oksida (nNOS-a) zadužen za diferencijaciju i specifikaciju subtalamičkih neurona. Specifična kombinacija transkripcijskih faktora određuje razvojne (progenitorske) zone tako da posredno možemo zaključiti da ljudski i mišji subtalamički neuroni dijele zajedničko razvojno podrijetlo iz bazalne ploče hipotalamusa, odnosno retromamilarne regije. Ipak, rezultati upućuju i na moguće razlike između ljudske i mišje subtalamičke jezgre, poput rane ekspresije nNOS-a i ekspresije transkripcijskih faktora NKX2-1 i PAX6 samo kod ljudi, čiji se funkcionalni značaj treba istražiti.The subthalamic nucleus is a small, well-defined subcortical structure involved in the control of motor, associative, and limbic circuits of the basal ganglia. Pathophysiologically, it is implicated in various neuropsychiatric disorders, and understanding of its development, specification, and differentiation is important for human medicine. Basic data on the developmental origin and molecular markers that define subthalamic neurons are lacking for the human subthalamic nucleus, while data for animal models are often incomplete. Therefore, the aim of this dissertation is to determine the developmental zone responsible for the production of subthalamic neurons in mice and humans and to identify molecular markers important for the specification of subthalamic neurons. Fetal human postmortem brain tissue samples aged from 11 weeks of gestation to postnatal age were used in the study, and the expression of selected markers was analyzed using immunohistochemical methods. The results obtained on the development of the human subthalamic nucleus were compared with data available in the literature and data obtained from mice at postnatal day 0 (P0). The results of this dissertation indicate that the human and mouse subthalamic nuclei share a similar set of transcription factors (PITX2, FOXA1, BARHL1, FOXP1, FOXP2), calcium-binding proteins (CR, PV), and neuronal nitric oxide synthase (nNOS), responsible for the differentiation and specification of subthalamic neurons. A specific combination of transcription factors determines the developmental (progenitor) zones, allowing us to indirectly conclude that human and mouse subthalamic neurons share a common developmental origin from the basal plate of the hypothalamus, specifically the retromamillary region. However, the results also suggest possible differences between human and mouse subthalamic neurons, such as the early expression of nNOS and the expression of NKX2-1 and PAX6 only in humans, the significance of which is yet to be discovered
Pericarditis
No full textPerikarditis označava upalu slojeva perikarda, koja nastaje zbog različitih podražaja koji pokreću imunološki odgovor, a karakterizira ga bol u prsima često povezana s karakterističnim elektrokardiografskim promjenama, čujnim perikardijalnim trenjem, te ponekad i perikardijalnim izljevom. Incidencija perikarditisa nije u potpunosti poznata, pogotovo zbog činjenice da u većine bolesnika bolest prolazi subklinički, zbog čega se teško, ili uopće ne dijagnosticira. U razvijenim zemljama perikarditis je najčešće idiopatskog podrijetla, pri čemu se pretpostavlja da u osnovi ipak leži virusna etiologija. U nerazvijenim zemljama gdje tuberkuloza i dalje predstavlja javnozdravstveni problem, ona je ujedno i vodeći uzrok perikarditisa. Etiološki gledano perikarditis dijelimo prema duljini trajanja ili prema podležećem uzroku tj. bolesti. Akutni perikarditis uglavnom nije po život opasna bolest, no ipak, može uzrokovati značajnu kratkotrajnu onesposobljenost, biti kompliciran velikim perikardijalnim izljevom ili tamponadom, nositi značajan rizik od recidiva, dugoročno uzrokovati konstriktivne smetnje te prijeći u kronični konstriktivni oblik. Specifične promjene vidljive na elektrokardiogramu su depresija PR segmenta i elevacija ST segmenta koje mogu biti lokalizirane ili generalizirane. Ehokardiografija je početna i često jedina potrebna slikovna pretraga kod akutnog perikarditisa, no ponekad se koriste i kompjutorizirana tomografija i kardijalna magnetna rezonancija. Temelj liječenja perikarditisa čine protuupalni lijekovi, a prva linija su nesteroidni antiinflamatorni lijekovi. Jedan od lijekova koji se također koristi je i protuupalni lijek kolhicin koji svoje mjesto nalazi u sprječavanju recidiva. Jedini učinkovit oblik liječenja simptomatskog kroničnog konstriktivnog perikarditisa je kirurška perikardiektomija. U većini slučajeva perikarditis je samoograničavajuća bolest koja prolazi unutar 1-3 tjedna i ima dobru prognozu.Pericarditis refers to inflammation of the pericardial layers, caused by various stimuli that trigger an immune response. It is characterized by chest pain often associated with characteristic electrocardiographic changes, audible pericardial friction rub, and sometimes a pericardial effusion. The exact incidence of pericarditis is not fully known, especially because in most patients the disease runs a subclinical course, making it difficult or even impossible to diagnose. In developed countries, pericarditis is most commonly of idiopathic origin, although it is generally presumed to have an underlying viral etiology. In developing countries, where tuberculosis remains a public health issue, it is also the leading cause of pericarditis. Etiologically, pericarditis can be classified according to the duration of the disease or the underlying cause. Acute pericarditis is generally not life-threatening; however, it can cause significant short-term disability, be complicated by large pericardial effusion or cardiac tamponade, carry a substantial risk of recurrence, lead to constrictive physiology in the long term, and potentially evolve into chronic constrictive pericarditis.Specific electrocardiographic changes include PR segment depression and ST segment elevation, which may be localized or generalized. Echocardiography is the initial and often the only imaging modality required for the diagnosis of acute pericarditis, although computed tomography and cardiac magnetic resonance imaging may also be used in some cases.The cornerstone of pericarditis treatment is anti-inflammatory therapy, with nonsteroidal anti-inflammatory drugs (NSAIDs) being the first-line option. Another important medication is colchicine, an anti-inflammatory agent that plays a key role in preventing recurrences. The only effective treatment for symptomatic chronic constrictive pericarditis is surgical pericardiectomy. In most cases, pericarditis is a self-limiting disease that resolves within 1 to 3 weeks and has a favorable prognosis
A comparative cross-sectional study of the impact of COVID-19 pandemic on obstetrics and gynecology admissions in Croatia
No full textBackground: The COVID-19 pandemic placed unprecedented pressure on healthcare systems worldwide and altered patients' perceptions of the system's ability to protect them from virus transmission. One significant consequence was a marked decline in hospital activity, a trend observed globally. This study aims to evaluate the impact of COVID-19 on hospitalization rates among patients with gynecological disorders in Croatia. It compares the number of patients treated surgically vs. conservatively before the pandemic (2017-2019) and during the pandemic (2020-2022) using the Diagnostic-Related Group (DRG) patient classification system. The DRG system is designed to group patients based on similar clinical conditions, complexity, and resource utilization. Hospital activity categorized by DRGs was analyzed to assess the impact of the COVID-19 pandemic on case volumes within DRG groups associated with gynecological and obstetric disorders.
Materials and methods: We conducted a comparative descriptive cross sectional study of the pre-post type according to STROBE guidelines to determine the impact of COVID-19 pandemic on hospital admission rates for patients with conditions associated with illnesses and abnormalities of the female reproductive system, as well as pregnancy, delivery, and the puerperium. The publicly available data collected by Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF) were the main data source for this study. All gynecological hospital admissions in Croatia were grouped based on the Australian Refined Diagnosis Related Groups (AR-DRGs) and analyzed over two time periods: before (2017-2019) and during the pandemic (2020-2022).
Results: The average number of gynecological patients in all hospitals during the pandemic was 62,257 compared to pre-pandemic when the average number of patients was 71,519, a decrease of 15.5%. The results show a 10.56% decrease in the total number of non-surgical admissions and 12.8% decrease of surgical admissions across the hospital network during the pandemic (2020-2022).
Conclusion: The COVID-19 pandemic led to a significant decline in inpatient treatments in gynecology and obstetrics departments in Croatia. Our findings highlight the need for obstetrics and gynecology practitioners to develop innovative strategies to maintain or enhance patient access to appropriate care while ensuring stringent infection prevention measures for both patients and healthcare personnel. Furthermore, investing in healthcare system resilience is crucial to maintaining core functions during future crises. The lessons learned from the COVID-19 pandemic provide a valuable opportunity to fortify healthcare systems and must not be ignored
Short-Term In Vitro Exposure of Human Blood to 5G Network Frequencies: Do Sex and Frequency Additionally Affect Erythrocyte Morphometry?
No full textBackground/Objectives: This study assessed the effects of 5G radiofrequency electromagnetic radiation (RF-EMR) at different frequencies (700 MHz, 2500 MHz, 3500 MHz) on the complete blood count (CBC), erythrocyte morphometry, and platelet activation after the short-term in vitro exposure of human blood. Methods: Blood samples from 30 healthy volunteers (15 men and 15 women, aged 25–40 years old) were collected at three intervals (14 days apart). For each collection, four tubes of blood were drawn per volunteer—two experimental and two controls. Experimental samples were exposed to 5G RF-EMR for 2 h at room temperature using a half-cone gigahertz transverse electromagnetic cell. The CBC was analysed via a haematology analyser, the erythrocyte morphometry was analysed using the SFORM program, and platelet activation was analysed via flow cytometry. Results: The CBC and platelet activation showed no significant differences between the experimental and control samples. However, the erythrocyte morphometry exhibited notable changes. At 700 MHz, the erythrocyte size, contour, and membrane roughness increased significantly for both sexes, with women’s cells showing greater sensitivity. At 2500 MHz, women exhibited an increased contour index and a decreased solidity and form factor. At 3500 MHz, women showed an increased contour index and outline but a decreased solidity, elongation, and form factor. Cluster analysis identified two erythrocyte subpopulations: smaller, rounder cells with smooth membranes and larger cells with rougher membranes. Conclusions: These results indicate that 5G RF-EMR exposure significantly alters erythrocyte morphometry. The strongest effects were observed at 700 MHz, where men exhibited greater membrane roughness, and women showed larger and rounder erythrocytes. These findings suggest that short-term in vitro 5G RF-EMR exposure disrupts the cytoskeleton, increasing membrane permeability and deformability
Composition of the bacterial microbiota of donated human milk
No full textUvod: Istraživanja su pokazala utjecaj različitih obilježja na sastav bakterijske mikrobiote humanog mlijeka (HMM), no nisu provođena na uzorcima iz mješavina darovanog humanog mlijeka (DHM).
Cilj: Cilj istraživanja bio je identificirati sastav bakterijske mikrobiote DHM-a te istražiti postoje li obilježja koja mogu utjecati na zastupljenost rodova pojedinih bakterija.
Ispitanice i metode: Iz arhivskih uzoraka mješavina DHM-a izolirana je bakterijska deoksiribonukleinska kiselina. Sekvenciranjem nove generacije određena je zastupljenost operativnih taksonomskih jedinica bakterija i uspoređena s poznatim obilježjima darivateljica, njihove djece i darovanog mlijeka.
Rezultati: U istraživanje je uključeno 88 uzoraka DHM-a od 88 darivateljica. U zastupljenosti bakterijskih rodova između skupina uzoraka podijeljenih prema načinu poroda i izloženosti antibioticima nije bilo značajnih razlika. Razlike su nađene s obzirom na tjedne gestacije na porodu i tjedne laktacije, način hranjenja majčinim mlijekom, način izdajanja viška mlijeka, broj bakterija kultiviranih u mlijeku prije pasterizacije te duljinu trajanja i temperaturu pohrane.
Zaključak: Dojenje djece te kraća pohrana na -30 ⁰C u Banci ovim su se istraživanjem pokazali kao pozitivni prediktori za zastupljenost rodova Lactobacillus i Bifidobacetrium kao dio bakterijske HMM-e u uzorcima mlijeka.Introduction: Studies have shown the influence of different characteristics on the composition of the bacterial microbiota of human milk (HMM), they were not conducted on samples from pools of donated human milk (DHM).
Aim: The aim of the research was to identify the composition of the bacterial microbiota of DHM and to investigate whether there are characteristics that can influence the representation of certain bacterial genera.
Subjects and methods: Bacterial deoxyribonucleic acid was isolated from archival samples from pools of DHM. Using next generation sequencing, the representation of operational taxonomic units of bacteria was determined and compared with the known characteristics of donors, their children and DHM.
Results: 88 DHM samples were included in the research. There were no significant differences in the representation of bacterial genera between sample groups divided according to the mode of delivery and exposure to antibiotics. Differences were found regarding weeks of gestation at delivery and weeks of lactation, the method of feeding with breast milk, the method of expressing surplus milk, the number of bacterial colonies cultivated in milk before pasteurization, and the length of time and temperature of storage.
Conclusion: Breastfeeding of children and shorter storage at -30 ⁰C in the human milk bank have been shown as positive predictors for the presence of the genus Lactobacillus and Bifidobactrium as part of bacterial HMM in milk samples
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