TREATING ACUTE KIDNEY INJURY USING CONTINUOUS AND INTERMITTENT RENAL REPLACEMENT THERAPY

Akutno zatajenje bubrega (AZB) nagli je gubitak ekskretorne funkcije bubrega. Analizirani su podatci bolesnika koji su bili hospitalizirani u jedinici intenzivnog liječenja od 2009. do 2011. godine, kod kojih je došlo do razvoja AZB-a i čije je stanje bilo takvo da je zahtijevalo primjenu jedne od mehaničkih metoda liječenja AZB-a – kontinuiranu ili intermitentnu. Obuhvaćena su 63 bolesnika, 46 na kontinuiranoj metodi, 17 na intermitentnoj. Cilj je bio analizirati povezanost između metode liječenja i ishoda, šećerne bolesti tipa 2 i ishoda, maligne bolesti i ishoda, analizirati postoji li statistički značajna razlika između tih i ostalih parametara (kalij, urea, kreatinin, krvni tlak, dob, spol). Ishod je bio trenutačno preživljenje – je li bolesnik preživio ili nije. Rezultati su pokazali da je stopa mortaliteta veća kod bolesnika na kontinuiranoj metodi. Ipak, ti su bolesnici bili hemodinamski nestabilniji u usporedbi s bolesnicima na intermitentnoj metodi.Acute kidney injury (AKI) is the sudden kidney excretory function loss. Patient data of patients hospitalized on intensive care unit from 2009 to 2011 and had to undergo one sort of renal replacement therapy (RRT) – continuous or intermittent – was used. 63 patients were in this study, 46 on continuous RRT (CRRT) and 17 on intermittent RRT (IRRT). The aim was to analyze connection between RRT method and outcome, DM type 2 and outcome, malignant disease and outcome, to analyze whether there is statistically significant difference between these and other parameters (potassium, urea, creatinine, blood pressure, age, and sex). Outcome was momentary survival – whether patient did or didn’t survive. Results have shown that mortality rate was higher at patients on CRRT. However, these patients were haemodynamically unstable compared to patients on IRRT

THERAPEUTIC MECHANISMS OF KETAMINE

Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it\u27s use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it\u27s ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit

CAESAREAN SECTION AND THE RISK OF POSTPARTAL DEPRESSION: IS THERE A POSSIBLE ROLE OF HEAT SHOCK PROTEINS?

Data on the potential connection between surgical stress during caesarean section and the role of heat shock proteins in development of postpartal depression is lacking in the literature. This is a narrative review with a goal to establish the potential role of heat shock proteins during caesarean section and development of postpartal depression. Systemic hyperinflammatory state, such as the one that occurs during surgery, may trigger protective cell reaction, which is usually called the heat shock response. Results of several researches bring strong evidence of correlation between expression of genes coding for family of heat shock proteins with the onset of depressive symptoms. Also, a recent meta-analysis established caesarean section as a risk factor for development of postpartal depression. It is obvious that heat shock proteins play a certain role in development of psychiatric disorders. However, a role of heat shock proteins in development of postpartal depression remains open for debate. We emphasise the need for a randomised control trial which would enable an answer to the mentioned issue

ANAPHYLAXIS DURING PREGNANCY

Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy

Target-lesions of the liver on the ultrasound scan

S obzirom na brojne prednosti pred ostalim postupcima oslikavanja, ultrazvučni je pregled najčešći dijagnostički postupak današnjice. Kod ultrazvučnog praćenja onkoloških bolesnika ponekad se vide avaskularne ili hipovaskularne prstenaste ("target") promjene jetrenog parenhima koje imaju hipoehogeni obrub ("halo") i, manje ili više, hiperehogeno središte. U diferencijalnoj dijagnostici solitarnih prstenastih jetrenih promjena uglavnom treba misliti na hemangiom, te pseudoleziju (pseudotumor), osobito kod lokacije u IV. segmentu lijevoga režnja difuzno steatotične jetre. Multifokalne su prstenaste jetrene promjene najčešće sekundarne etiologije, porijeklom od različitih neoplastičnih procesa, pretežno bronhogenog i kolorektalnog karcinoma. Svakako se preporučuje daljnja slikovna obrada, prvenstveno računalna tomografija (CT) s primjenom kontrastnoga sredstva prema višefaznom protokolu ili, katkad, magnetna rezonancija (MR), te, eventualno, biopsija jetre u slučaju nepoznatog sijela primarnoga tumora, te istodobnog postojanja nekoliko različitih novotvorina.Given the numerous advantages over other imaging methods, ultrasound scanning is today’s most common diagnostic procedure. In ultrasound monitoring of oncologic patients sometimes avascular or hypovascular target-lesions of the liver parenchyma with hypoechoic border ("halo"), and, more or less, hyperechoic center are found. In the differential diagnosis of the solitary target-lesions of the liver one must usually think of hemangioma and pseudolesion (pseudotumor), particularly if located in the IV segment of the left lobe in the diffuse hepatosteatosis. Multifocal target-lesions of the liver are mostly of secondary etiology, due to various neoplastic processes, namely bronchogenic and colorectal carcinoma. Further imaging is certainly recommended, above all computed tomography (CT) with the application of contrast agent according to the multiphase protocol, and, sometimes, magnetic resonance (MR), as well as, eventually, liver biopsy in case of an unknown location of the primary tumor or the coexistence of a number of different neoplasms

Vasoactive stress hormone (adrenaline, noradrenaline and cortisol) concentration in plasma after administration of low doses of S-(+)-ketamine epidurally

Background and Purposes: The aim of this study was to investigate the effect of epidurally administered S-(+)-ketamine on vasoactive stress hormones. It was a prospective study conducted after approval of the Ethical Committee and informed consent of patients. Materials and Methods: The study was performed on 80 patients: 40 patients in Group 1 (0.5% bupivacaine) and 40 patients in Group 2 (0.5% bupivacaine + 25 mg S-(+)-ketamine – 0.326 mg/kg-bm). All patients were adults aged between 18 and 45 years, ASA I and II with epidural anaesthesia for a surgical procedure. Vasoactive parameters: concentrations of adrenaline, noradrenaline and cortisol were measured 30 minutes before setting the vein pathway and 17–25 min. after application of anaesthetics. Results: There were no statistically significant changes in vasoactive stress hormones (adrenaline, noradrenaline and cortisol) plasma concentrations after administering 0.5% bupivacaine, 0.5% bupivacaine + S-(+)- -ketamine epidurally. Conclusion: Setting central nervous block before skin incision, using local anaesthetic, and S-(+)-ketamine, leaves concentrations of stress hormones in plasma within referent values. Adding a low dose of S-(+)- -ketamine into the epidural space in combination with 0.5% bupivacaine does not have an effect on the concentration of stress hormones in plasma

Vasoactive stress hormone (adrenaline, noradrenaline and cortisol) concentration in plasma after administration of low doses of S-(+)-ketamine epidurally

Background and Purposes: The aim of this study was to investigate the effect of epidurally administered S-(+)-ketamine on vasoactive stress hormones. It was a prospective study conducted after approval of the Ethical Committee and informed consent of patients. Materials and Methods: The study was performed on 80 patients: 40 patients in Group 1 (0.5% bupivacaine) and 40 patients in Group 2 (0.5% bupivacaine + 25 mg S-(+)-ketamine – 0.326 mg/kg-bm). All patients were adults aged between 18 and 45 years, ASA I and II with epidural anaesthesia for a surgical procedure. Vasoactive parameters: concentrations of adrenaline, noradrenaline and cortisol were measured 30 minutes before setting the vein pathway and 17–25 min. after application of anaesthetics. Results: There were no statistically significant changes in vasoactive stress hormones (adrenaline, noradrenaline and cortisol) plasma concentrations after administering 0.5% bupivacaine, 0.5% bupivacaine + S-(+)- -ketamine epidurally. Conclusion: Setting central nervous block before skin incision, using local anaesthetic, and S-(+)-ketamine, leaves concentrations of stress hormones in plasma within referent values. Adding a low dose of S-(+)- -ketamine into the epidural space in combination with 0.5% bupivacaine does not have an effect on the concentration of stress hormones in plasma

RESTful application Programming Interface for Preparation of Image Datasets for Machine Learning

RESTful aplikacijsko programsko sučelje je sučelje temeljeno na REST principima. U okviru ovog diplomskog rada implementirano je RESTful sučelje kao podrška za pripremu skupova slika za strojno učenje. Prilikom izrade programskog dijela rada bilo je potrebno zadovoljiti sve zahtjeve implementacije, kako bi korisnik sučelja imao na raspolaganju sve mogućnosti potrebne za uspješnu pripremu skupova slika za daljnje uporabe. Dokumentacija krajnjih točaka sučelja priložena je u radu.A RESTful application programming interface is an interface based on REST principles. Within this thesis, the RESTful interface has been implemented to support the preparation of image sets for machine learning. When creating the software part of the thesis, it was necessary to meet all the requirements of the implementation, so that the user of the interface had all the options necessary for the successful preparation of sets of images for further use. All interface endpoints have been documented

Creation of false needs in post-industrial and digital network society

Rad se bavi analizom potrošačkog društva, definiranjem potrošača i kao glavnom temom analiziranjem pojma lažnih potreba čiji je autor Herbert Marcuse. Najprije se objašnjava što pojam podrazumijeva, koje su bile njegove posljedice na tadašnje društvo, i kako je nastao tzv. čovjek jedne dimenzije. Prikazani su ukratko i radovi drugih autora koji su se bavili srodnim temama utjecaja lažnih podražaja na ljudska osjetila. Uz nekoliko primjera lažnih potreba prije 50-ak godina, prelazi se na definiranje prestižne robe koja je povezana s primjerom sneakerheadsa kao moderne fizičke lažne potrebe, a na primjeru računalne igre Counter Strike: Global Offensive i plave kvačice na društvenim mrežama se detaljnije prikazuju neke moderne lažne potrebe umreženog digitalnog društva. Na kraju se postavlja pitanje budućnosti kapitalizma čiju propast prognozira Immanuel Wallerstein