Hemoragijski pneumonitis tijekom leptospiroze uspješno liječen venovenskom izvantjelesnom membranskom oksigenacijom: prikaz bolesnika

Leptospirosis is an endemic zoonosis of continental parts of Croatia with a seasonal distribution pattern. On some occasions, in the infection\u27s severe form (Weil\u27s disease), acute respiratory distress syndrome with pulmonary hemorrhage can occur. Here we present a case of Weil\u27s disease with multiorgan failure, including hemorrhagic pneumonitis. The patient was succesfully treated by veno-venous extracorporeal membrane oxygenation, with standard anticoagulation, without enhancing the risk of bleeding, despite hemorrhagic pneumonitis in leptospirosis.Leptospiroza je endemska zoonoza kontinentalne Hrvatske sa sezonskom distribucijom. Teški oblik bolesti, poznat kao Weilova bolest, može se komplicirati akutnim respiratornim distres sindromom i hemoragijskim pneumonitisom. Prikazujemo bolesnicu s Weilovom bolesti i multiorganskim zatajenjem koje je uključivalo teški hemoragijski pneumonitis. Usprkos hemoragičnom pneumonitisu, bolesnica je uspješno liječena uz pomoć venovenske izvantjelesne membranske oksigenacije koristeći standardne antikoagulacijske mjere

THE EXPLORATION OF THE FORAGE BASE FOR BREED COWS IN CENTRAL CROATIA

For this exploration 40 individual farms have been selected totaling 147 cows of the Siementhal race. The explorations have been performed in 1968 and 1969. On the basis of the results obtained we have drawn the following conclusions: 1. Because of the great share of cornstraw (28,36%) and because of the bad quality hay and because of the low share of silage in the winter feeding, the share of concentrate was very high (28,80%) from the total quantity of energy), the lactation being moderate (10,03 kg a day) Table 3. 2. Because of the low amounts of green fodder available in summer feeding the share of concentrate was rather ligh (17,72% of the total amount of energy) this amount being especially high taking the moderate lactation of 11,5 kg of milk per day in consideration. Table 4. 3. When the shares of each of groups of fodders in the total digestive protein amount in the course of the whole year 1968 are compared to their shares in the energy, we find out that the share of roughages increasced to 84,02% of the total amount of the digestive proteins, and that share of concentrate decreased to 15,98%. Table 5. 4. The high share of cornstraw and of bad quality hay in winter feeding and the the low quantity silage have stipulated rather still high share of concentrates (23,40%). Table 6. If sufficient amounts of high quality rouhages are available silage and good quality) no concentrate will be required providing the day lactation is cca 10 kg of milk. 5. In summer feeding share of rounhages increased (as related to the total energy) to 89,12% and the share of concentrates decreased to only 10,88% of the total digestive proteins. (Table 7). If the cows are continouosly fed with the green forage no concentrates are required providing day milk production is maintained on 11,5 kg of milk

Hemoragijski pneumonitis tijekom leptospiroze uspješno liječen venovenskom izvantjelesnom membranskom oksigenacijom: prikaz bolesnika

Leptospirosis is an endemic zoonosis of continental parts of Croatia with a seasonal distribution pattern. On some occasions, in the infection\u27s severe form (Weil\u27s disease), acute respiratory distress syndrome with pulmonary hemorrhage can occur. Here we present a case of Weil\u27s disease with multiorgan failure, including hemorrhagic pneumonitis. The patient was succesfully treated by veno-venous extracorporeal membrane oxygenation, with standard anticoagulation, without enhancing the risk of bleeding, despite hemorrhagic pneumonitis in leptospirosis.Leptospiroza je endemska zoonoza kontinentalne Hrvatske sa sezonskom distribucijom. Teški oblik bolesti, poznat kao Weilova bolest, može se komplicirati akutnim respiratornim distres sindromom i hemoragijskim pneumonitisom. Prikazujemo bolesnicu s Weilovom bolesti i multiorganskim zatajenjem koje je uključivalo teški hemoragijski pneumonitis. Usprkos hemoragičnom pneumonitisu, bolesnica je uspješno liječena uz pomoć venovenske izvantjelesne membranske oksigenacije koristeći standardne antikoagulacijske mjere

ZANIMLJIV PRIMJERAK Leptidea duponcheli (Staudinger, 1871) U SREDIŠNJOJ ZBIRCI DANJIH LEPTIRA HRVATSKOG PRIRODOSLOVNOG MUZEJA U ZAGREBU

A specimen of the Eastern Wood White Leptidea duponcheli (Staudinger, 1971) collected on the island of Unije in 1964 and deposited in the Central Butterfly Collection of the Croatian Natural History Museum in Zagreb is analyzed. The analysis shows, so far, that Leptidea duponcheli Staud. cannot be considered a member of the Croatian butterfly fauna, although it might be found in the Mediterranean part of Croatia, on the Croatian islands or in southern Croatia (Konavle region).Pregledom Središnje zbirke danjih leptira Hrvatskog prirodoslovnog muzeja u Zagrebu utvrđen je jedan primjerak leptira koji je određen kao vrsta Leptidea duponcheli Staud. Budući da ova vrsta nije zabilježena na području Hrvatske, navedeni primjerak koji je prema podacima na etiketi prikupljen na otoku Unije, bio bi prvi nalaz ove vrste u fauni Hrvatske. Nalazi većeg broja novih vrsta danjih leptira u fauni Hrvatske u posljednjih 15-tak godina ukazuju da je moguć nalaz i nekih drugih, manje očekivanih vrsta u našoj fauni, pa tako i vrste L. duponcheli Staud. Ti nalazi mogu se očekivati u mediteranskom području posebice na području otoka i juga Hrvatske (Konavle). Osim toga, promjena klimatskih značajki koja je očita i na prostoru Hrvatske zasigurno će dovesti do promjena i u našoj fauni. Neke će se nove vrste koje šire svoje areale ili su introducirane s tropskih ili subtropskih područja pojaviti i postati sastavni element naše faune. S druge strane, neke koje su elementi hrvatske faune, ako se ne uspiju prilagoditi na novonastale uvjete, gotovo će sigurno nestati s ovog područja. Zbog toga, je u našoj fauni moguć i nalaz vrste L. duponcheli Staud., ali za sada na temelju analiziranog primjerka iz Središnje zbirke danjih leptira Hrvatskog prirodoslovnog muzeja u Zagrebu nije je moguće brojati kao element faune Hrvatske

Nealkoholna masna bolest jetre povezana je s većom smrtnošću kod odraslih bolesnika s invazivnom bolešću uzrokovanom streptokokom grupe B

Background: Group B Streptococcus (GBS) is a significant cause of invasive disease among adult non-pregnant patients with increasing incidence and mortality rates. Although non-alcoholic fatty liver disease (NAFLD) is associated with components of metabolic syndrome previously recognized as risk factors for GBS, the impact of NAFLD on GBS course and outcomes is unknown. Methods: We conducted a retrospective cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection during a 15-year period. Results: 102 patients were included in the study (46.1% males; median age 69, IQR 58-78 years). Disease primarily presented as bacteremia without a defined source (37; 36.3%), cellulitis/erysipelas (35; 34.3%), pneumonia (13; 12.7%) and endocarditis (8; 7.8%). The most common comorbidities were diabetes (42; 41.2%), dyslipidemia (39; 38.2%), cardiovascular disease (34; 33.3%), peripheral vascular disease (21; 20.6%), obesity (21; 20.6%) and malignancy (10; 9.8%). Based upon the results of abdominal ultrasound, the patients were divided into two groups: the ones with steatosis (44; 43.1%) and the ones without steatosis (58; 56.9%). There were no significant differences in clinical presentations and comorbidities between groups. In-hospital mortality was 29.5% (13/44) in patients with NAFLD and 10.3% (6/58) in the control group (p=0.0200). Endocarditis (OR 6.69; 95%CI 1.045-44.46, p=0.0410), acute renal failure (OR 13.92; 95%CI 3.00-77.71, p=0.0013), qSOFA > 2 (OR 23.93; 95%CI 4.66-171.2) and NAFLD (OR 6.64; 95%CI 1.23-47.88, p=0.0258) were independently associated with in-hospital mortality. Conclusions: NAFLD is associated with higher mortality in patients suffering from invasive GBS disease which appears to be independent of other components of the metabolic syndrome, such as obesity and diabetes mellitus.Uvod: Streptokok grupe B (GBS) značajan je uzrok invazivne bolesti kod odraslih bolesnika s porastom incidencije i smrtnosti. Iako je nealkoholna masna bolest jetre – NAFLD (engl. non-alcoholic fatty liver disease) povezana s komponentama metaboličkog sindroma koji su prepoznati kao čimbenici rizika za GBS, utjecaj NAFLD na tijek i ishode invazivne GBS bolesti još uvijek nije poznat. Metode: Proveli smo retrospektivno kohortno istraživanje svih odraslih bolesnika koji nisu trudni, a kojima je dijagnosticirana invazivna GBS infekcija tijekom 15-godišnjeg razdoblja. Rezultati: U istraživanje je uključeno 102 bolesnika (46,1% muškaraca; srednja dob 69, IQR 58-78 godina). Bolest se primarno prezentirala kao bakterijemija nepoznatog ishodišta (37; 36,3%), celulitis/erizipel (35; 34,3%), pneumonija (13; 12,7%) i endokarditis (8; 7,8%). Najčešći komorbiditeti bili su dijabetes (42; 41,2%), dislipidemija (39; 38,2%), kardiovaskularne bolesti (34; 33,3%), periferne vaskularne bolesti (21; 20,6%), pretilost (21; 20,6%) i maligna bolest (10; 9,8%). Prema nalazu ultrazvuka abdomena, bolesnici su podijeljeni u dvije skupine: bolesnici s NAFLD (44; 43,1%) i bolesnici bez steatoze jetre (58; 56,9%). Nije bilo značajnih razlika u kliničkoj prezentaciji i komorbiditetima među skupinama. Smrtnost za vrijeme hospitalizacije iznosila je 29,5% (13/44) kod bolesnika s NAFLD i 10,3% (6/58) u kontrolnoj skupini (p = 0,0200). Endokarditis (OR 6,69; 95% CI 1,045-44,46, p = 0,0410), akutno zatajenje bubrega (OR 13,92; 95% CI 3,00-77,71, p = 0,0013), qSOFA> 2 (OR 23,93; 95% CI 4,66-171,2) i NAFLD (OR 6,64; 95% CI 1,23-47,88, p = 0,0258) bili su neovisno povezani sa smrtnošću. Zaključci: NAFLD je povezan s većom smrtnošću kod bolesnika s invazivnom GBS bolešću i čini se da je to neovisno o drugim komponentama metaboličkog sindroma, kao što su pretilost i dijabetes melitus

Critically ill patients with COVID-19 treated in the Intensive Care Unit atthe University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ in Zagreb

Cilj: Opisati karakteristike bolesnika, tijek bolesti, terapiju te ishod i komplikacije kod kritično oboljelih s COVID-19 liječenih u jedinici intenzivnog liječenja (JIL) Klinike za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u Zagrebu. Materijali i metode: Opservacijska retrospektivna studija 38 odraslih bolesnika liječenih u JIL KZIB s dokazanim COVID-19 u razdoblju od 11. ožujka do 6. lipnja 2020. godine. Rezultati: Od ukupno 167 bolesnika s COVID-19 liječenih u KZIB, u JIL-u je liječeno 38 bolesnika (22,8%). Medijan dobi JIL bolesnika bio je 69.5 godina (33-85), umrlih 70 (43-85), a preživjelih 66 godina (33-80). Većina je bolesnika bila muškog spola (26 bolesnika ili 68%). Od komorbiditeta najčešći su bili arterijska hipertenzija (20- 53%), šećerna bolest (9-24%) te ishemijska bolest srca (8-21%). Svi su bolesnici primljeni zbog hipoksemijskog respiratornog zatajenja. Osim respiratornog zatajenja s primjenom mehaničke ventilacije u 30 (79%) bolesnika, česti su bili šok (25- 66%) te akutno bubrežno zatajenje (21- 55% bolesnika). Metode kontinuiranog nadomještanja bubrežne funkcije primjenjene su kod 13 (34%) bolesnika. Medijan trajanja hospitalizacije u JIL-u bio je 18 (3-68) dana, a mehaničke ventilacije 17 (5-43) dana. Ukupni je mortalitet bio 50%, a kod bolesnika koji su zahtijevali mehaničku ventilaciju 63%. Smrtnost je bila najveća u dobnoj skupini iznad 65. godine. Zaključak: Bolesnici s COVID-19, liječeni u JIL-u, često su i dugotrajno mehanički ventilirani, a tijekom boravka imaju brojne komplikacije bolesti i intenzivnog liječenja te visoku smrtnost. Najveća je smrtnost kod muškaraca starijih od 65 godina s arterijskom hipertenzijom, šećernom bolesti i ishemijskom bolesti srca.Objective: To describe the characteristics, clinical course, treatment, outcomes and complications in critically ill patients with COVID-19 treated in the intensive care unit (ICU) at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ (UHID) in Zagreb. Materials and methods: A retrospective observational study of 38 adult patients with COVID-19 treated in the ICU at UHID between March 11 and June 6, 2020. Results: Among the 167 patients with COVID-19 treated at the UHID, 38 (22,8%) were admitted to the ICU. The mean age of these patients was 69.5 (33-85) years, 70 (43-85) years in deceased patients and 66 (33-80) in survivors. The majority of patients were male (26 patients- 68%). The mMost common comorbidities were arterial hypertension (20- 53%), diabetes mellitus (9- 24%) and ischaemic heart disease (8- 21%). All patients were admitted for hypoxaemic respiratory failure. In addition to acute respiratory failure with the need for mechanical ventilation (30- 79%), shock (25- 66%) and acute renal insufficiency (21- 55%) were common. Continuous renal replacement therapy was used in 13 (34%) patients. The median duration of ICU stay was 18 (3-68) days and of mechanical ventilation 19 (5-43) days. Overall mortality was 50%, 63% in patients who received mechanical ventilation and it was the highest in patients over 65 years of age. Conclusions: Patients with COVID-19, treated in the ICU, often require prolonged mechanical ventilation, have numerous complications of critical illness and ICU treatment, and high mortality rates. Mortality rate is highest in men over 65 years with comorbiditeies – arterial hypertension, diabetes mellitus and ischaemic heart disease

THE EXPLORATION OF THE FORAGE BASE FOR BREED COWS IN CENTRAL CROATIA

For this exploration 40 individual farms have been selected totaling 147 cows of the Siementhal race. The explorations have been performed in 1968 and 1969. On the basis of the results obtained we have drawn the following conclusions: 1. Because of the great share of cornstraw (28,36%) and because of the bad quality hay and because of the low share of silage in the winter feeding, the share of concentrate was very high (28,80%) from the total quantity of energy), the lactation being moderate (10,03 kg a day) Table 3. 2. Because of the low amounts of green fodder available in summer feeding the share of concentrate was rather ligh (17,72% of the total amount of energy) this amount being especially high taking the moderate lactation of 11,5 kg of milk per day in consideration. Table 4. 3. When the shares of each of groups of fodders in the total digestive protein amount in the course of the whole year 1968 are compared to their shares in the energy, we find out that the share of roughages increasced to 84,02% of the total amount of the digestive proteins, and that share of concentrate decreased to 15,98%. Table 5. 4. The high share of cornstraw and of bad quality hay in winter feeding and the the low quantity silage have stipulated rather still high share of concentrates (23,40%). Table 6. If sufficient amounts of high quality rouhages are available silage and good quality) no concentrate will be required providing the day lactation is cca 10 kg of milk. 5. In summer feeding share of rounhages increased (as related to the total energy) to 89,12% and the share of concentrates decreased to only 10,88% of the total digestive proteins. (Table 7). If the cows are continouosly fed with the green forage no concentrates are required providing day milk production is maintained on 11,5 kg of milk