Approach to a child with elevated lactates

Koncentracija laktata danas je jedan od najvrjednijih dijagnostičkih markera. Laktat se proizvodi u većini organa i tkiva tijekom glikolize iz piruvata u anaerobnim uvjetima, a najveća proizvodnja nalazi se u skeletnim mišićima, eritrocitima i mozgu. Uobičajeno se laktat brzo po sintezi metabolizira u jetri i, u manjoj mjeri, bubrezima. U pojedinim patološkim stanjima se laktat nakuplja, bilo zbog povećane proizvodnje, smanjenog metabolizma, a u nekim slučajevima zbog njihove kombinacije. Koncentracija laktata može se mjeriti u serumu i cerebrospinalnom likvoru. Uzorak krvi uzet iz vene ili arterije miješa se s hladnom 8% perklornom kiselinom i skladišti u hladnom okolišu. Uzorak CSL-a se uzima lumbalnom punkcijom i obrađuje na isti način. Vrijednost serumske koncentracije laktata i koncentracije u CSL-u koja se smatra graničnom je 2 mmol/L, a za visoku vrijednost uzima se 4 mmol/L. Uz lažno pozitivan nalaz pretrage, do kojeg može doći zbog greške u predanalitičkoj ili analitičkoj fazi, postoje mnogi drugi uzroci koji mogu dovesti do povišenja koncentracije laktata. Načelno, možemo ih podijeliti u primarne i sekundarne. Primarni uzroci uključuju metaboličke bolesti kao što su poremećaji respiratornog lanca, manjak piruvat-dehidrogenaze, glikogenoze i poremećaji glukoneogeneze. U sekundarne uzroke ubrajamo šok, ishemiju, konvulzije, lijekove i tako dalje. Za pravilno liječenje uzroka koji dovodi do povećane koncentracije laktata, potrebno je pacijenta pravilno procijeniti. Različita stanja zahtijevaju različitu terapiju, ali je uvijek cilj sniziti koncentraciju laktata budući da je ista povezana s lošim ishodom pacijenta.Lactate levels are one of the most valuable diagnostic markers today. Lactate is produced by most tissues in the human body, via anaerobic glycolysis from pyruvate, with the highest level of production found in skeletal muscles, erythrocytes and brain. Under normal conditions, lactate is rapidly cleared by the liver with a small amount of additional clearance by the kidneys. Lactate levels may rise due to either overproduction, reduced metabolism or both. Lactate levels can be measured in blood or in cerebrospinal fluid .Blood sample obtained from a vein or an artery is mixed with 8% perchloric acid and kept cold. CSF sample ought to be obtained in aseptic conditions and treated as the blood sample. 2 mmol/L is blood and CSF lactate cut-off value, while lactate levels higher than 4 mmol/L are defined as high levels. Alongside falsely elevated lactate levels due to mistakes made during preanalytical or analytical faze, there are a multitude of causes for elevated lactate. In general, they can be divided into primary and secondary. Primary causes include various metabolic diseases such as mitochondrial respiratory chain defects, pyruvate-dehydrogenase deficiency, glycogenoses and disorders of gluconeogenesis. Secondary causes include shock, ischemia, seizures, medications etc. In order to correctly treat the cause of elevated lactate levels, proper assessment is crucial. The therapies may vary, but the goal stays the same: to decrease lactate levels as elevated lactate levels are associated with poorer outcomes

Approach to a child with elevated lactates

Koncentracija laktata danas je jedan od najvrjednijih dijagnostičkih markera. Laktat se proizvodi u većini organa i tkiva tijekom glikolize iz piruvata u anaerobnim uvjetima, a najveća proizvodnja nalazi se u skeletnim mišićima, eritrocitima i mozgu. Uobičajeno se laktat brzo po sintezi metabolizira u jetri i, u manjoj mjeri, bubrezima. U pojedinim patološkim stanjima se laktat nakuplja, bilo zbog povećane proizvodnje, smanjenog metabolizma, a u nekim slučajevima zbog njihove kombinacije. Koncentracija laktata može se mjeriti u serumu i cerebrospinalnom likvoru. Uzorak krvi uzet iz vene ili arterije miješa se s hladnom 8% perklornom kiselinom i skladišti u hladnom okolišu. Uzorak CSL-a se uzima lumbalnom punkcijom i obrađuje na isti način. Vrijednost serumske koncentracije laktata i koncentracije u CSL-u koja se smatra graničnom je 2 mmol/L, a za visoku vrijednost uzima se 4 mmol/L. Uz lažno pozitivan nalaz pretrage, do kojeg može doći zbog greške u predanalitičkoj ili analitičkoj fazi, postoje mnogi drugi uzroci koji mogu dovesti do povišenja koncentracije laktata. Načelno, možemo ih podijeliti u primarne i sekundarne. Primarni uzroci uključuju metaboličke bolesti kao što su poremećaji respiratornog lanca, manjak piruvat-dehidrogenaze, glikogenoze i poremećaji glukoneogeneze. U sekundarne uzroke ubrajamo šok, ishemiju, konvulzije, lijekove i tako dalje. Za pravilno liječenje uzroka koji dovodi do povećane koncentracije laktata, potrebno je pacijenta pravilno procijeniti. Različita stanja zahtijevaju različitu terapiju, ali je uvijek cilj sniziti koncentraciju laktata budući da je ista povezana s lošim ishodom pacijenta.Lactate levels are one of the most valuable diagnostic markers today. Lactate is produced by most tissues in the human body, via anaerobic glycolysis from pyruvate, with the highest level of production found in skeletal muscles, erythrocytes and brain. Under normal conditions, lactate is rapidly cleared by the liver with a small amount of additional clearance by the kidneys. Lactate levels may rise due to either overproduction, reduced metabolism or both. Lactate levels can be measured in blood or in cerebrospinal fluid .Blood sample obtained from a vein or an artery is mixed with 8% perchloric acid and kept cold. CSF sample ought to be obtained in aseptic conditions and treated as the blood sample. 2 mmol/L is blood and CSF lactate cut-off value, while lactate levels higher than 4 mmol/L are defined as high levels. Alongside falsely elevated lactate levels due to mistakes made during preanalytical or analytical faze, there are a multitude of causes for elevated lactate. In general, they can be divided into primary and secondary. Primary causes include various metabolic diseases such as mitochondrial respiratory chain defects, pyruvate-dehydrogenase deficiency, glycogenoses and disorders of gluconeogenesis. Secondary causes include shock, ischemia, seizures, medications etc. In order to correctly treat the cause of elevated lactate levels, proper assessment is crucial. The therapies may vary, but the goal stays the same: to decrease lactate levels as elevated lactate levels are associated with poorer outcomes

THE ANALYSIS OF ENTREPRENEURIAL ACTIVITY IN THE AREA OF BROD-POSAVINA COUNTY FOR THE PERIOD FROM THE YEAR 2014 TO THE YEAR 2018

The main objective of this paper is to determine total investments by activities in Brod-Posavina County, revenues and expenditures level, number of entrepreneurs by activities, including the achieved financial results of entrepreneurs of the Brod-Posavina County over the past five years. During research of facts and possibilities that currently exist, the following research methods are used in a different combination: historical method, the method of analysis and synthesis, classification, description method and generalization

Acceptability and perception of environmentally friendly products by student population in Croatia

Purpose: The purpose of this paper is to point out the perceptions of the student population toward environmentally friendly products and examine if they are willing to pay higher prices for those products. Methodology: The research conducted in the second half of 2020 included the student population, i.e. a sample of 114 respondents. The close-ended questions offered answers ranging from the level of knowledge related to general concepts to the factors related to purchasing decisions. Data were collected through an online survey. The collected data were analyzed by statistical software packages MedCalc Statistical Software version 19.1.7 and SPSS. Results: Respondents are familiar with the concepts of sustainable development, a socially responsible business and green consumers, which they define correctly. There are no major differences between male and female respondents. When choosing a product, respondents of both genders mention product quality as the most important factor. The second most important factor is the price, followed by the brand of the product and the environmental friendliness of the product. The brand of the product and environmental acceptability of the product are somewhat more important to male respondents than to female respondents. Corporate social responsibility of the company that produces a product is described as least important by respondents of both genders when choosing a product. Conclusion: It is evident that the student population changed their attitudes towards environmentally friendly products compared to year 2009, but the trend has not changed since 2015. It is a market segment that takes into account this factor when choosing a product

Persistent left-sided pleural effusion – rare manifestation of iatrogenic pulmonary vein stenosis

Radiofrequency (RF) ablation is a method of choice for treating patients with paroxysmal and persistent atrial fibrillation (AFib) refractory to antiarrhythmics. Pulmonary vein stenosis (PVS) is a rare complication of RF ablation that occurs in 1-3%. Patients may be asymptomatic, or present with dyspnea, cough, hemoptysis, and chest pain

THE STRUCTURE OF THE IMPACT OF THE ELEMENTS OF THE PROMOTION MIX ON SELECTION OF SPORTS PRODUCTS IN SLAVONSKI BROD

The aim of the paper was to analyze the structure of the effect of the observed elements of the promotional mix on the selection of sports products in Slavonski Brod. The analysis was conducted on a sample of 385 entities. According to the results of the research, no element was considered as dominant in the structure of the influence of the elements of the promotional mix in the choice of practicing a sports product. Propaganda was slightly highlighted as the most important element of the promotional mix. It should also be emphasized that in selecting a sports product, the promotion factor, as one of the 4 marketing mix factors, achieves relatively small, only 14.5% of the frequency. The results also show that the sports product in Slavonski Brod is price-sensitive and contentually acceptable, that sporting is extremely important, but the problems of resource allocation as time are quite questionable, which is surprising. It can be said that both the product and the price are dominant as a choice which is expected from the aspect of sports consumers. This is a direct message to the sports program providers what needs to be directed on. Indirectly, however, it can be said that the promotion could and should be significantly more qualitative and quantitatively represented. First and foremost, this refers to a set of activities that enable consumers to inform about the product on market or to promote their sports products, which is probably missing out

CONNECTION OF SPORT RESULT WITH SPORT CONSUMER

Contemporary sport and in particular football has become a wide range of today\u27s social life, which is embedded in all the vital elements of the social structure, especially economic elements. Therefore arose a great need for scientific research of "this phenomenon" as it can be found in the literature. Sport - economy - society has a diverse and changing mutual relations in accordance with the present time. In order to increase the sports market, it is necessary for sport teams to be present in the communication with their consumers on social networks. The primary objective of this paper is to analyze the connection between sport result as a sport product to the final sport consumer on the example of football clubs and their fans. This connection is sought through social networks. The paper also aims to show that sport result is not the only criterion of proximity to the sports consumer, and that the result itself does not provide the largest number of consumers, for example the \u27fives\u27\u27 in football at least when it comes to social networks. Through regression analysis it is shown that consumers via social networks are not fully connected with the result that clubs realize, at least when it is viewed by selected characteristics used in this paper in a single time point. Definitely for searching more reliable connection of results with sport consumers through social networks, must be used an extended period of time and several indicators which can be the subject of some future research. It should be noted that economic elements are increasingly affecting the sport itself but also the sport result, especially the top one

The Influence of Processing on Physico-chemical Parameters, Phenolics, Antioxidant Activity and Sensory Attributes of Elderberry (Sambucus nigra L.) Fruit Wine

Production of elderberry fruit wine in Croatia is very limited and primarily conducted in small family farms, so the aim of this research was to determine the quality parameters of elderberry fruit and elderberry fruit wine as the fi nal product. Six types of elderberry fruit wines (A, B, C, D, E and F) were produced with addition of different amounts of sugar (0, 0.5, 1, 1.5, 1.5 and 0.5 kg per 4 kg of elderberry fruit) and water (wines C, D, E). Quality of wines was evaluated using physico-chemical analysis, determination of phenolic compounds (total phenols, total flavonoids, hydrolised tannins and anthocyanins), antioxidant activity and sensory evaluation. According to the amount of total sugar after the fermentation, wines A, B, C and F can be considered as dry wines while wines D and E can be categorized as semi-dry wines. Total acidity in all wines was higher when compared to fresh elderberry fruit. Fresh elderberry fruit as well as wines had high concentration of phenolic compound with anthocyanins in the highest extent, although the winemaking process decreased the amount of phenolics. Both elderberry fruit and wine show high antioxidant activity and present a rich source of biologically active compounds. Consumers found the wine with high sugar amount and low acidity to be the most acceptable

UZIMANJE HRANE S CRVENIM MESOM UBRZAVA PROGRESIJU KRONIČNE BUBREŽNE BOLESTI

Reducing protein intake in patients with chronic kidney disease (CKD) can delay progression in terminal stage. There is strong evidence supporting positive effects of replacing red meat protein with other sources of protein. In this study, the impact of replacing red meat protein was investigated in 46 non-dialysis CKD (ND-CKD) patients with resistant hypertension and followed-up for 6 months (19M/27F; mean age 66±9 years, mean eGFR: (43±12) mLmin-11.73 m2.). Patients were divided into two groups: group A was put on a special diet (reduction of red meat intake to 2x weekly and adding 50% more vegetables to the diet with 8-hour time restricted feeding); group B had no reduction of red meat intake alongside consuming less vegetable and without time restricted feeding. A food frequency questionnaire was used to collect information on consumption of foods and number of servings consumed. Patients were evaluated at the beginning and after 6 months of management. Specialized diet caused a decrease in body mass index (from 36.4±5.1 kg/m2 to 33±5 kg/m2), body weight (from 112±13 kg to 106±18 kg), and waist circumference (from 119±11 cm to 112±10 cm). Additionally, the 6-month administration of specialized diet caused a significant decrease in the office systolic blood pressure (SBP) from 147±15 mm Hg to 140±12 mm Hg, while reduction in diastolic blood pressure (DBP) from 89±8 mm Hg to 86±6 mm Hg (p=0.1) and heart rate was not significant (from 79±10 to 77±11 beats/min (p=0.9). After 6 months, kidney function measured with eGFR was 45.2±14 mL/min/1.73 m² in group A and 41.2±11 mL/min/1.73 m² in group B (p<0.05). The findings of this study suggest an association between daily consumption of red meat and the risk of CKD progression. The administration of diet for 6 months can be useful in slowing CKD progression (via interaction with acidification in the kidney), while resulting in significant SBP reduction, possibly via interaction with the autonomic nervous system.U prospektivnoj studiji ispitan je utjecaj promjene prehrambenih navika u bolesnika s kroničnom bubrežnom bolesti u preddijaliznoj fazi. U 46 bolesnika s rezistentnom hipertenzijom tijekom 6 mjeseci crveno je meso zamijenjeno drugom vrstom proteina biljnog podrijetla (19 M/27 Ž; srednje dobi 66±9 godina, eGFR 43±12 mL/min-11,73 m2). Bolesnici su podijeljeni u dvije skupine: skupina A je imala dijetu koja je uključivala redukciju unosa crvenog mesa na samo 2 puta/tjedan, povećan je unos povrća na 50 % više nego prethodno, uz 8-satno razdoblje bez uzimanja hrane. Skupina B nije mijenjala postojeće prehrambene navike. Koristili smo upitnik o broju obroka kao i o vrsti uzimanja proteina. U razdoblju praćenja nije bilo neželjenih događaja, a u skupini A u odnosu na skupinu B postignuta je značajna redukcija tlaka, težine i opsega struka: BMI s 36,4±5,1 na 33±5 kg/m2, tjelesna težina sa 112±13 na 106±18 kg, opseg struka sa 119±11 na 112±10 cm, sniženje sistoličkog krvnog tlaka sa 147±15 na 140±12 mm Hg (p<0,05). Sniženje dijastoličkog tlaka nije bilo statistički značajno (s 89±8 na 86±6 mm Hg (p=0,1)) kao ni frekvencije (sa 79±10 na 77±11/min (p=0,9)) u objema skupinama. Bubrežna funkcija procijenjena pomoću eGFR nakon 6 mjeseci bila je statistički značajna: u skupini A bila je 45,2±14 mL/min/1,73m², a u skupini B 41,2±11 mL/min/1,73m² (p<0,05). Prehrana sa sniženim unosom proteina životinjskog podrijetla uz dodatak proteina biljnog podrijetla te pridržavanje 8-satnog neuzimanja hrane usporava progresiju kronične bubrežne bolesti u bolesnika u preddijalizi

The Influence of Processing on Physico-chemical Parameters, Phenolics, Antioxidant Activity and Sensory Attributes of Elderberry (Sambucus nigra L.) Fruit Wine

Production of elderberry fruit wine in Croatia is very limited and primarily conducted in small family farms, so the aim of this research was to determine the quality parameters of elderberry fruit and elderberry fruit wine as the fi nal product. Six types of elderberry fruit wines (A, B, C, D, E and F) were produced with addition of different amounts of sugar (0, 0.5, 1, 1.5, 1.5 and 0.5 kg per 4 kg of elderberry fruit) and water (wines C, D, E). Quality of wines was evaluated using physico-chemical analysis, determination of phenolic compounds (total phenols, total flavonoids, hydrolised tannins and anthocyanins), antioxidant activity and sensory evaluation. According to the amount of total sugar after the fermentation, wines A, B, C and F can be considered as dry wines while wines D and E can be categorized as semi-dry wines. Total acidity in all wines was higher when compared to fresh elderberry fruit. Fresh elderberry fruit as well as wines had high concentration of phenolic compound with anthocyanins in the highest extent, although the winemaking process decreased the amount of phenolics. Both elderberry fruit and wine show high antioxidant activity and present a rich source of biologically active compounds. Consumers found the wine with high sugar amount and low acidity to be the most acceptable