Obese Patients in Medical Intensive Care Unit: Influence of Counseling on Weight Loss and Cardiovascular Parameters

A case series of 12 obese patients admitted to medical intensive care unit (ICU) due to life-threatening diseases and the influence of weight loss on cardiovascular parameters is presented. We assessed body weight, body mass index (BMI), blood pressure, pulse, and laboratory values on admission. At discharge from ICU patients were counseled on how to lose weight. They were examined one and six months later. Statistically significant (p<0.05) decrease of body weight (median at the beginning of a treatment 134 kg, after six months 127.5 kg), BMI (median 41.5 kg/m2 at the beginning of a treatment; 38.9 kg/m2 after six months), systolic blood pressure (medians 145 mmHg and 130 mmHg), diastolic blood pressure (medians 95 mmHg and 85 mmHg) and pulse (medians 104 beats per minute, 78 beats per minute) was found. The reduction of the waist circumference was not significant. One patient died due to severe acute pancreatitis. Patients reported feeling much better after losing weight

Leitmotif: protein motif scanning 2.0

Motivation Motif-HMM (mHMM) scanning has been shown to possess unique advantages over standardly used sequence-profile search methods (e.g. HMMER, PSI-BLAST) since it is particularly well-suited to discriminate proteins with variations inside conserved motifs (e.g. family subtypes) or motifs lacking essential residues (false positives, e.g. pseudoenzymes). Results In order to make mHMM widely accessible to a broader scientific community, we developed Leitmotif, an mHMM web application with many parametrization options easily accessible through intuitive interface. Substantial improvement of performance (ROC scores) was obtained by using two novel parameters. To the best of our knowledge, Leitmotif is the only available mHMM applicatio

Prospektivno istraživanje prevencije kontrastne nefropatije u Republici Hrvatskoj

Aim: To explore the protective role of hydration, urine alkalization (Na bicarbonate) and high doses of antioxidant (N-acetylcysteine) in the prevention of CIN. Material and methods: In a prospective, randomized, single-blinded study patients were divided into three groups: 1) peroral hydration, 2) Na bicarbonate infusion and 3) N-acetylcysteine (NAC) plus NaHCO3 infusion. Serum creatinine (SCr), blood urea nitrogen (BUN), and neutrophil gelatinase-associated lipocalin (NGAL) were measured before and 48 hours after the angiography. Mehran score was calculated for each patient. Results: The study included 106 patients. Groups were comparable regarding the baseline characteristics. According to Mehran risk score 70 % of patients had a low risk, 24% medium and 6% high risk score for development of CIN. After the procedure renal function was preserved in all patients (SCr 103(87.0-121.5), BUN 5.8 (4.9-7.6), creatinine clearance 74.7(55.3-97.6), NGAL 11.4(5.4-19.9)) regardless of the Mehran risk score. The follow up was completed for 73 patients (68 %). Twenty two patients (32 %) developed chronic kidney disease, mostly classified as G3a and G3b according to KDIGO guidelines. Chronic kidney disease developed in patients with the positive history of diabetes and in patients who had higher Mehran score before the diagnostic procedure. Conclusion: The study showed that patients with preserved renal function are not prone to CIN. Regardless of the protocol used, no case of CIN was observed. Our results indicate that adequate hydration is a key component in maintaining the renal function. Higher Mehran score might be useful in predicting the development of chronic kidney disease.Cilj: Ispitati protektivnu ulogu hidracije, alkalizacije mokraće (natrijevim bikarbonatom) i visokih doza antioksidansa (N-acetilcistein) u prevenciji kontrastne nefropatije. Materijali i metode: U prospektivnom istraživanju pacijenti su bili podijeljeni u tri skupine: 1) peroralna hidracija, 2) infuzija natrijevog bikarbonata i 3) infuzija N-acetilcisteina (NAC) i NaHCO3. Serumska vrijednost kreatinina, ureje i neutrophil gelatinase-associated lipocalin (NGAL) izmjerene su prije i 48 sati nakon angiografije. Svakom pacijentu izračunati su Mehran bodovi koji predstavljaju rizik razvoja kontrastne nefropatije. Rezultati: U istraživanje je uključeno 106 pacijenata. Sve tri skupine pacijenata imale su usporedive osnovne karakteristike. Prema bodovima po Mehranu, 70 % pacijenata imalo je niski rizik, 24 % srednji i 6 % visoki rizik razvoja kontrastne nefropatije. Nakon kontrastne pretrage bubrežna funkcija bila je očuvana u svih pacijenata (serumski kreatinin 103 (87.0 – 121.5), urea 5.8 (4.9 – 7.6), klirens kreatinina 74.7 (55.3 – 97.6), NGAL 11.4 (5.4 – 19.9)) neovisno o riziku procijenjenom bodovima po Mehranu. Praćenje je završeno za 73 pacijenta (68 %). Dvadeset i dva pacijenta (32 %) razvila su kroničnu bubrežnu insuficijenciju, klasificiranu prema KDIGO smjernicama kao G3a i G3b. Kronična bubrežna insuficijencija razvila se u pacijenata sa šećernom bolesti i u pacijenata koji su imali viši broj bodova prema Mehranu prije dijagnostičke pretrage. Zaključak: Istraživanje je pokazalo da pacijenti s normalnom bubrežnom funkcijom imaju mali rizik razvoja kontrastne nefropatije. U ispitivanoj skupini pacijenata nije zabilježen niti jedan slučaj kontrastne nefropatije bez obzira na vrstu protokola koji je korišten za hidraciju. Naši rezultati ukazuju na to da je adekvatna hidracija ključna u prevenciji kontrastne nefropatije. Nadalje, postoji mogućnost da viši broj bodova po Mehranu može poslužiti kao prediktor razvoja kronične bubrežne bolesti

Obese Patients in Medical Intensive Care Unit: Influence of Counseling on Weight Loss and Cardiovascular Parameters

A case series of 12 obese patients admitted to medical intensive care unit (ICU) due to life-threatening diseases and the influence of weight loss on cardiovascular parameters is presented. We assessed body weight, body mass index (BMI), blood pressure, pulse, and laboratory values on admission. At discharge from ICU patients were counseled on how to lose weight. They were examined one and six months later. Statistically significant (p<0.05) decrease of body weight (median at the beginning of a treatment 134 kg, after six months 127.5 kg), BMI (median 41.5 kg/m2 at the beginning of a treatment; 38.9 kg/m2 after six months), systolic blood pressure (medians 145 mmHg and 130 mmHg), diastolic blood pressure (medians 95 mmHg and 85 mmHg) and pulse (medians 104 beats per minute, 78 beats per minute) was found. The reduction of the waist circumference was not significant. One patient died due to severe acute pancreatitis. Patients reported feeling much better after losing weight

Microbial Anchoring Systems for Cell-Surface Display of Lipolytic Enzymes

Rezultati istraživanja ovojnica mikrobnih stanica, proteina na njihovoj površini i mehanizama što usmjeravaju njihovu lokalizaciju omogućuju ciljano izlaganje odabranih homolognih i heterolognih proteina na površini mikroorganizama (engl. cell surface display). Fuzioniranjem proteina lokaliziranih na površini stanice ili njihovih domena za usidravanje (engl. anchoring domains) s odabranim proteinima dolazi do njihove tzv. genetičke imobilizacije. Stanice domaćina eksprimiraju hibridne proteine, a specifični ih mehanizmi izlučuju na površinu stanice te uklapaju u staničnu stijenku ili ovojnicu, čime se izbjegava mukotrpan i često za aktivnost enzima štetan postupak kemijske imobilizacije proteina. Ovaj je mehanizam dosad ispitan u stanicama bakterija i kvasaca, a opisane su brojne mogućnosti njegove primjene u biotehnologiji. Jedan je od najčešće primjenjivanih postupaka, zahvaljujući njegovom velikom tehnološkom značaju, imobilizacija lipolitičkih enzima na površini stanica. U ovom su revijalnom radu sažete dostupne informacije o mehanizmima i molekularnim sustavima za izlaganje lipolitičkih enzima na površini stanica bakterija i kvasca.Studies of microbial cell envelopes and particularly cell surface proteins and mechanisms of their localization brought about new biotechnological applications of the gained knowledge in surface display of homologous and heterologous proteins. By fusing surface proteins or their anchoring domains with different proteins of interest, their so-called genetic immobilization is achieved. Hybrid proteins are engineered in a way that they are expressed in the host cells, secreted to the cell surface and incorporated into the wall/ envelope moiety. In this way, laborious and often detrimental procedure of chemical immobilization of the protein is avoided by letting the cells do the whole procedure. Both bacterial and yeast cells have been used for this purpose and a number of potential biotechnological applications of surface-displayed proteins have been reported. Among the most frequently used passenger proteins are lipolytic enzymes, due to their great technological significance and numerous important applications. In this review, our current knowledge on mechanisms and molecular systems for surface display of lipolytic enzymes on bacterial and yeast cell surfaces is summarized

Sarcoidosis or miliary tuberculosis – a case report

Prikazan je bolesnik u dobi od 59 godina s dugotrajnim febrilitetom i kašljem koji je razvio oštećenje jetre. Biopsijom jetre je dokazana nekazeozna granulomatozna upala. Vrijednost angiotenzin konvertirajućeg enzima je bila povišena (85 U/L). Opetovano uzimane hemokultura, kultura urina i kultura likvora su bile sterilne. U iskašljaju nije detektiran mikobakterij. Obzirom na navedeno, postavljena je sumnja na sarkoidozu te je započeta terapija kortikosteroidom. Usprkos terapiji, stanje bolesnika se pogoršavalo. Razvilo se akutno zatajenje bubrega do potrebe za hemodijalizom te parcijalna respiratorna insuficijencija. MSCT toraksa je pokazao sitnonodularni intersticijski infiltrat, pretežno u gornjim režnjevima pluća, uz povećane medijastinalne limfne čvorove, te konglomerat uvećanih mjestimično kolikviranih limfnih čvorova subkarinarno. Direktni preparat bronhoalveolarnog lavata u dva navrata i transbronhalna aspiracija iglom bili su negativni na bacil tuberkuloze. Nakon pregleda očne pozadine postavljena je sumnja na diseminiranu tuberkulozu. Mycobacterium tuberculosis, osjetljiv na streptomicin, izonijazid, etambutol, rifampicin, pirazinamid, naknadno je porastao u kulturi koštane srži. Uz antituberkulotsku terapiju bolesnik je trajno bio febrilan 21 dan. Nakon pet mjeseci terapije bolesnik se potpuno oporavio, uključujući i potpuni oporavak bubrežne funkcije.We present a previously healthly 59-year-old patient with fever, cough and liver disease. Liver biopsy showed non-necrotizing ("non-caseating") granulomas. The level of angiotensin-converting enzyme was above the reference range (85 U/L). Blood, urine and cerebrospinal fluid cultures were repeatedly sterile. No mycobacteria were detected in the sputum. Given the above findings, sarcoidosis was suspected and corticosteroid therapy was initiated. However, the patient was getting worse and developed acute kidney injury together with partial respiratory insufficiency. The chest CT showed interstitial infiltrate, mainly in the upper lobes of the lung, mediastinal lymph node enlargement with partial colliquation. Bronchoscopic aspiration and bronchoalveolar lavage was performed two times; no Mycobacterium was detected. Transbronchial needle aspiration also found no Mycobacterium. Ophthalmologic examination revealed choroiditis and antituberculosis therapy was initiated. Mycobacterium tuberculosis was later detected in culture of bone marrow. After five months of antituberculosis therapy the patient completely recovered, his liver tests were normal as well as renal function

Multiple myeloma presenting with lower extremity gangrene and hyperviscosity syndrome

Hyperviscosity syndrome and cryoblobulinemia associated with lymphoproliferative disorder is a rare but life threatening condition. The delay of diagnosis can lead to severe mutilation and multiple organ damage. The plasma exchange therapy and the targeted treatment of the underlying disorder can lead to significant improvement. We present a patient who developed extensive soft tissue necroses, mimicking the peripheral artery disease. Despite surgical treatment, the skin lesions progressed involving fingers, earlobes and scrotum. Finally, the patient was diagnosed with multiple myeloma and hyperviscosity syndrome. The clinical condition improved after plasma exchange and myeloma treatment with thalidomide and dexamethasone