Scales for assessment of coma severity

Poremećaji svijesti česta su pojava kod bolesnika u hitnim službama i jedinicama intenzivnog liječenja. U svakodnevnom se govoru, pojmovi koma i poremećaj svijesti koriste kao istoznačnice, no koma je samo krajnja kategorija u spektru poremećaja svijesti. Osim kome, drugi poremećaji svijesti, koji su detaljnije objašnjeni u ovom radu, su minimalno svjesno stanje (engl. minimally conscious state, MCS), vegetativno stanje (engl. vegetative state, VS) i locked-in sindrom. Radi standardizacije procjene stanja svijesti kod tih bolesnika, olakšanja komunikacije među zdravstvenim osobljem i praćenja neurološkog oporavka bolesnika, razni autori i radne skupine stvaraju ocjenske ljestvice koje pomažu u tim postupcima. Iako su ocjenske ljestvice za procjenu stupnja poremećaja svijesti neizravni način procjene stanja svijesti, još uvijek predstavljaju zlatni standard u svakodnevnom kliničkom radu. Od svih ocjenskih ljestvica za procjenu stupnja poremećaja svijesti, najpoznatija je i najviše korištena Glasgowska ljestvica kome (engl. Glasgow Coma Scale, GCS). Osim nje, u ovom su radu prikazane i Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japanska ljestvica kome (engl. Japan Coma Scale, JCS) i Coma Recovery Scale-Revised (CRS-R). Napretkom tehnologije javljaju se funkcionalne metode oslikavanja mozga kao novi, sofisticirani način procjene stanja svijesti. Njihovo korištenje u ovim indikacijama još je uvijek skupo i zahtijeva daljnja istraživanja, no omogućilo bi precizniju procjenu stanja svijesti, pa čak i mogućnost komunikacije s ovim bolesnicima.Disorders of consciousness are commonly seen in patients in emergency departments and intensive care units. In everyday speech, the terms coma and disorder of consciousness are used interchangeably, but coma is only the final category in the spectrum of these disorders. Besides coma, other consciousness disorders that are presented in this paper are minimally conscious state (MCS), vegetative state (VS) and locked-in syndrome. In order to standardize the approach to evaluation and monitoring of patients with altered levels of consciousness and improve the communication among health workers, different authors and task forces have developed assessment scales for disorders of consciousness. Although these scales present only an indirect method to evaluate the levels of consciousness, they are still the gold standard in everyday clinical work. Among all assessment scales for disorders of consciousness, the best known and the most used one is the Glasgow Coma Scale (GCS). In addition to the GCS, this paper includes explanations of Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japan Coma Scale (JCS) and Coma Recovery Scale-Revised (CRS-R). Improvement of technology leads to development of neuroimaging techniques which present new, sophisticated methods for the assessment of consciousness. Their use in these indications is still expensive and requires further research, but in the future it could also provide more precise ways to evaluate the level of consciousness and provide a possibility of communication with the affected patients

Scales for assessment of coma severity

Poremećaji svijesti česta su pojava kod bolesnika u hitnim službama i jedinicama intenzivnog liječenja. U svakodnevnom se govoru, pojmovi koma i poremećaj svijesti koriste kao istoznačnice, no koma je samo krajnja kategorija u spektru poremećaja svijesti. Osim kome, drugi poremećaji svijesti, koji su detaljnije objašnjeni u ovom radu, su minimalno svjesno stanje (engl. minimally conscious state, MCS), vegetativno stanje (engl. vegetative state, VS) i locked-in sindrom. Radi standardizacije procjene stanja svijesti kod tih bolesnika, olakšanja komunikacije među zdravstvenim osobljem i praćenja neurološkog oporavka bolesnika, razni autori i radne skupine stvaraju ocjenske ljestvice koje pomažu u tim postupcima. Iako su ocjenske ljestvice za procjenu stupnja poremećaja svijesti neizravni način procjene stanja svijesti, još uvijek predstavljaju zlatni standard u svakodnevnom kliničkom radu. Od svih ocjenskih ljestvica za procjenu stupnja poremećaja svijesti, najpoznatija je i najviše korištena Glasgowska ljestvica kome (engl. Glasgow Coma Scale, GCS). Osim nje, u ovom su radu prikazane i Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japanska ljestvica kome (engl. Japan Coma Scale, JCS) i Coma Recovery Scale-Revised (CRS-R). Napretkom tehnologije javljaju se funkcionalne metode oslikavanja mozga kao novi, sofisticirani način procjene stanja svijesti. Njihovo korištenje u ovim indikacijama još je uvijek skupo i zahtijeva daljnja istraživanja, no omogućilo bi precizniju procjenu stanja svijesti, pa čak i mogućnost komunikacije s ovim bolesnicima.Disorders of consciousness are commonly seen in patients in emergency departments and intensive care units. In everyday speech, the terms coma and disorder of consciousness are used interchangeably, but coma is only the final category in the spectrum of these disorders. Besides coma, other consciousness disorders that are presented in this paper are minimally conscious state (MCS), vegetative state (VS) and locked-in syndrome. In order to standardize the approach to evaluation and monitoring of patients with altered levels of consciousness and improve the communication among health workers, different authors and task forces have developed assessment scales for disorders of consciousness. Although these scales present only an indirect method to evaluate the levels of consciousness, they are still the gold standard in everyday clinical work. Among all assessment scales for disorders of consciousness, the best known and the most used one is the Glasgow Coma Scale (GCS). In addition to the GCS, this paper includes explanations of Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japan Coma Scale (JCS) and Coma Recovery Scale-Revised (CRS-R). Improvement of technology leads to development of neuroimaging techniques which present new, sophisticated methods for the assessment of consciousness. Their use in these indications is still expensive and requires further research, but in the future it could also provide more precise ways to evaluate the level of consciousness and provide a possibility of communication with the affected patients

Totalna sinteza aflatoksina

Aflatoksini su skupina toksičnih gljivičnih metabolita koji kod ljudi i životinja izazivaju mnoge teške posljedice trovanja, uključujući kronične bolesti, razvoj karcinoma i smrt. Aflatoksini su česti kontaminanti prehrambenih proizvoda te zbog svoje rasprostranjenosti predstavljaju veliku opasnost za javno zdravstvo. Toksikologija aflatoksina i dalje većinom nije razjašnjena te ih je potrebno izolirati iz prirodnog izvora ili sintetizirati kako bi se mogla provoditi istraživanja s ciljem boljeg razumijevanja aflatoksina. Iz tog je razloga razvoj totalnih sinteza aflatoksina bitan cilj istraživanja u organskoj kemiji. Od otkrića aflatoksina objavljeno je nekoliko totalnih i formalnih sinteza aflatoksina. U ovom su radu opisane prve racemične te prve enantioselektivne sinteze aflatoksina B1 i B2

Scales for assessment of coma severity

Poremećaji svijesti česta su pojava kod bolesnika u hitnim službama i jedinicama intenzivnog liječenja. U svakodnevnom se govoru, pojmovi koma i poremećaj svijesti koriste kao istoznačnice, no koma je samo krajnja kategorija u spektru poremećaja svijesti. Osim kome, drugi poremećaji svijesti, koji su detaljnije objašnjeni u ovom radu, su minimalno svjesno stanje (engl. minimally conscious state, MCS), vegetativno stanje (engl. vegetative state, VS) i locked-in sindrom. Radi standardizacije procjene stanja svijesti kod tih bolesnika, olakšanja komunikacije među zdravstvenim osobljem i praćenja neurološkog oporavka bolesnika, razni autori i radne skupine stvaraju ocjenske ljestvice koje pomažu u tim postupcima. Iako su ocjenske ljestvice za procjenu stupnja poremećaja svijesti neizravni način procjene stanja svijesti, još uvijek predstavljaju zlatni standard u svakodnevnom kliničkom radu. Od svih ocjenskih ljestvica za procjenu stupnja poremećaja svijesti, najpoznatija je i najviše korištena Glasgowska ljestvica kome (engl. Glasgow Coma Scale, GCS). Osim nje, u ovom su radu prikazane i Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japanska ljestvica kome (engl. Japan Coma Scale, JCS) i Coma Recovery Scale-Revised (CRS-R). Napretkom tehnologije javljaju se funkcionalne metode oslikavanja mozga kao novi, sofisticirani način procjene stanja svijesti. Njihovo korištenje u ovim indikacijama još je uvijek skupo i zahtijeva daljnja istraživanja, no omogućilo bi precizniju procjenu stanja svijesti, pa čak i mogućnost komunikacije s ovim bolesnicima.Disorders of consciousness are commonly seen in patients in emergency departments and intensive care units. In everyday speech, the terms coma and disorder of consciousness are used interchangeably, but coma is only the final category in the spectrum of these disorders. Besides coma, other consciousness disorders that are presented in this paper are minimally conscious state (MCS), vegetative state (VS) and locked-in syndrome. In order to standardize the approach to evaluation and monitoring of patients with altered levels of consciousness and improve the communication among health workers, different authors and task forces have developed assessment scales for disorders of consciousness. Although these scales present only an indirect method to evaluate the levels of consciousness, they are still the gold standard in everyday clinical work. Among all assessment scales for disorders of consciousness, the best known and the most used one is the Glasgow Coma Scale (GCS). In addition to the GCS, this paper includes explanations of Full Outline of UnResponsiveness Score (FOUR), The Swedish Reaction Level Scale-1985 (RLS85), Japan Coma Scale (JCS) and Coma Recovery Scale-Revised (CRS-R). Improvement of technology leads to development of neuroimaging techniques which present new, sophisticated methods for the assessment of consciousness. Their use in these indications is still expensive and requires further research, but in the future it could also provide more precise ways to evaluate the level of consciousness and provide a possibility of communication with the affected patients

Totalna sinteza aflatoksina

Aflatoksini su skupina toksičnih gljivičnih metabolita koji kod ljudi i životinja izazivaju mnoge teške posljedice trovanja, uključujući kronične bolesti, razvoj karcinoma i smrt. Aflatoksini su česti kontaminanti prehrambenih proizvoda te zbog svoje rasprostranjenosti predstavljaju veliku opasnost za javno zdravstvo. Toksikologija aflatoksina i dalje većinom nije razjašnjena te ih je potrebno izolirati iz prirodnog izvora ili sintetizirati kako bi se mogla provoditi istraživanja s ciljem boljeg razumijevanja aflatoksina. Iz tog je razloga razvoj totalnih sinteza aflatoksina bitan cilj istraživanja u organskoj kemiji. Od otkrića aflatoksina objavljeno je nekoliko totalnih i formalnih sinteza aflatoksina. U ovom su radu opisane prve racemične te prve enantioselektivne sinteze aflatoksina B1 i B2

Does shifting to professional emergency department staffing affect the decision for chest radiography?

Background: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. ----- Methods: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). ----- Results: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1. ----- Conclusions: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care

Associations between Endothelial Lipase, High-Density Lipoprotein, and Endothelial Function Differ in Healthy Volunteers and Metabolic Syndrome Patients

Metabolic syndrome (MS) is characterized by endothelial- and high-density lipoprotein (HDL) dysfunction and increased endothelial lipase (EL) serum levels. We examined the associations between EL serum levels, HDL (serum levels, lipid content, and function), and endothelial function in healthy volunteers (HV) and MS patients. Flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), serum levels of HDL subclasses (measured by nuclear magnetic resonance (NMR) spectroscopy), and EL serum levels differed significantly between HV and MS patients. The serum levels of triglycerides in large HDL particles were significantly positively correlated with FMD and NMD in HV, but not in MS patients. Cholesterol (C) and phospholipid (PL) contents of large HDL particles, calculated as HDL1-C/HDL1-apoA-I and HDL1-PL/HDL1-apoA-I, respectively, were significantly negatively correlated with FMD in HV, but not in MS patients. Cholesterol efflux capacity and arylesterase activity of HDL, as well as EL, were correlated with neither FMD nor NMD. EL was significantly negatively correlated with HDL-PL/HDL-apoA-I in HV, but not in MS patients, and with serum levels of small dense HDL containing apolipoprotein A-II in MS patients, but not in HV. We conclude that MS modulates the association between HDL and endothelial function, as well as between EL and HDL. HDL cholesterol efflux capacity and arylesterase activity, as well as EL serum levels, are not associated with endothelial function in HV or MS patients

Učinak ukupne tjelesne aktivnosti na mikrovaskularne komplikacije u bolesnika s dijabetesom tip 1

The incidence of diabetes is increasing worldwide, emphasizing an emerging need for blood glucose control optimization to prevent the development of chronic complications and improve the quality of life. This retrospective cohort study aimed to investigate the effects of total physical activity on microvascular diabetic complication development in patients with type 1 diabetes mellitus (T1DM). The study included 71 T1DM patients, average age 41 years and HbA1c 7.78%. Most patients (82.1%) reported having hypoglycemia, while the minority of patients developed microvascular complications, mostly nonproliferative retinopathy (17.7%). All subjects included in the study were moderately or vigorously physically active. No association was observed between total physical activity and regulation of glycemia, hypoglycemic incidents, or development of microvascular complications. Until sufficient data from prospective studies become available, our data support the findings of no negative effect of higher intensity physical activity on the development of microvascular complications in T1DM patients.Učestalost šećerne bolesti globalno raste, što naglašava potrebu za optimizacijom kontrole glukoze u krvi kako bi se spriječio razvoj kroničnih komplikacija i poboljšala kvaliteta života. Cilj ove retrospektivne kohortne studije bio je istražiti učinke tjelesne aktivnosti na razvoj mikrovaskularnih dijabetičkih komplikacija u bolesnika s dijabetes melitusom tip 1 (T1DM). U studiju je uključen 71 bolesnik s T1DM prosječne starosti 41 godina i HbA1c od 7,78%. Većina bolesnika (82,1%) imala je hipoglikemiju, dok je kod manjeg broja bolesnika došlo do mikrovaskularnih komplikacija, uglavnom neproliferativne retinopatije (17,7%). Svi ispitanici uključeni u istraživanje bili su umjereno ili intezivno tjelesno aktivni. Nije primijećena povezanost između ukupne tjelesne aktivnosti i regulacije glikemije, hipoglikemijskih incidenata ili razvoja mikrovaskularnih komplikacija. Sve dok ne postanu dostupni dovoljni podaci iz prospektivnih studija, naši podaci potkrepljuju dokaze da nema negativnog učinka intenzivnije tjelesne aktivnosti na razvoj mikrovaskularnih komplikacija u bolesnika s T1DM