PATHOPHYSIOLOGY OF DELIRIUM

Danas je razumijevanje patofizioloških mehanizama delirija još uvijek ograničeno, ali postoji više obećavajućih hipoteza. Smatra se da biomarkeri osjetljivi na smrt neurona ili glija stanica dobro ukazuju na delirij. Za više neurotransmitera se podrazumijeva da su uključeni u stanje delirija s najvećim naglaskom na acetilkolin i dopamin koji djeluju na suprotne načine, acetilkolin smanjuje podražljivost neurona, a dopamin je povećava. Ostali neurotransmiteri koji vjerojatno imaju ulogu u patogenezi delirija su: gama-aminobutirična kiselina, glutamat kao i svi monoamini. Sepsa koja vodi do sindroma sustavnog upalnog odgovora često se prezentira delirijem i možda je i najčešći uzročni čimbenik za delirij u JIL-u uz sedative i analgetike kao najzastupljenije jatrogene čimbenike rizika. Bolesnici koji su dobivali benzodiazepine imaju veću vjerojatnost da će imati postoperativni delirij nego oni koji nisu. Postoperativne kognitivne promjene su češće u starijih nego u mlađih bolesnika, a može ih se kategorizirati kao postoperativni delirij, postoperativna kognitivna disfunkcija i demencija. Mehanizmi odgovorni za postoperativne kognitivne promjene nisu u potpunosti poznati, ali sigurno je da su multifaktorski. Čimbenici rizika mogu se vezati uz karakteristike bolesnika, vrstu operacije i tip anestezije.Today’s understanding of the pathophysiological mechanisms of delirium is still limited, but there are several promising hypotheses. It is believed that biomarkers sensitive to death of neurons or glial cells indicate delirium. Several neurotransmitters are considered to be involved in the state of delirium, with greatest emphasis on acetylcholine and dopamine acting in opposite ways; acetylcholine reduces, while dopamine increases neuron excitability. Other neurotransmitters that probably play a role in the pathogenesis of delirium are GABA, glutamate and monoamines. Sepsis leading to systemic inflammatory response syndrome often presents with delirium and perhaps is the most common causal factor for delirium in intensive care unit; sedatives and analgesics are also common iatrogenic risk factors. Patients receiving benzodiazepines are more likely to have postoperative delirium than those who do not. Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia. The mechanisms responsible for postoperative cognitive changes are not fully understood, but it is certain that they are multifactorial. Risk factors may be associated with patient characteristics, type of surgery and type of anesthesia

Liver injury after the intravenous amiodarone administration in patient with impaired heart function

While many adverse effects have been associated with long-term oral amiodarone therapy, acute hepatotoxicity from intravenous administration of amiodarone is a rare side effect. This case report focuses on a 78-year-old critically ill female, who underwent several urgent surgical procedures and had elevated liver aminotransferases concentrations after the intravenous administration of amiodarone for the treatment of atrial fibrillation. Also, the patient developed heart failure with reduced left ventricular systolic function. Immediately after the discontinuation of amiodarone therapy, liver aminotransferases levels began to decline. Our case suggests that regular monitoring of hepatic function is required in patients receiving intravenous amiodarone, especially in the setting of impaired heart function and possible liver hypoperfusion

Tomato Pomace Powder as a Functional Ingredient in Minced Meat Products—Influence on Technological and Sensory Properties of Traditional Serbian Minced Meat Product Cevapi

The aim of this research is to evaluate the impact of tomato pomace (TP) on the technological and sensory properties of ćevapi. Four treatments were prepared as follows: control (CON) and samples with the addition of TP in amounts of TP5 (0.5%—5 g/kg), TP10 (1%—10 g/kg), and TP20 (2%—20 g/kg). Technological properties (pH values, water activity (aw) cooking loss, length reduction), instrumental colour and texture, and sensory properties were examined. The addition of TP powder did not result in significant differences in pH and aw values between CON and modified treatments (in both raw and grilled). The addition of TP in the amounts higher than 10 g/kg significantly reduced cooking loss, while length reduction was observed when 20 g/kg was added. Also, significantly higher values of yellowness were observed in both the raw and grilled ćevapi, when 10 g/kg and more of TP was added. Significantly higher hardness and chewiness were observed in all experimental treatments. However, differences in instrumental colour and texture were not negatively perceived by the assessors, and there were no significant differences in any observed sensory properties between the CON and experimental treatments. Moreover, all the experimental treatments received a relatively high mark of around seven and higher on a nine-point hedonic scale. Further research could focus on the examination of salt/meat reduction as well as oxidative stability during freeze storage

VENTILATOR ASSOCIATED PNEUMONIA TREATED WITH COLISTIN – RETROSPECTIVE 4-YEAR ANALYSIS

Cilj istraživanja je utvrditi učestalost i obilježja upale pluća povezane sa strojnom ventilacijom kod bolesnika koji imaju multirezistentne uzročnike (MDR). Retrospektivno se analiziralo podatke iz bolničkog informacijskog sustava i medicinske dokumentacije. U istraživanje je uključeno 58 bolesnika (dob 70,41±13,0 godina) liječenih u jedinici intenzivnog liječenja Klinike za anesteziologiju reanimatologiju i intenzivno liječenje od siječnja 2013. do prosinca 2016. godine koji su imali dijagnozu upale pluća sa strojnom ventilacijom (VAP), uzročnik je bio gram negativan (GN) i liječeni su kolistinom. Najčešći je uzročnik MDR-GN VAP-a je Pseudomonas aeruginosa kod 46 (79,3 %) bolesnika, slijedi Acinetobacter baumannii kod 28 (48,3 %) bolesnika, Klebsiella pneumoniae kod 7 (12,1 %) bolesnika. Osnovnu abdominalnu dijagnozu imalo je 34 bolesnika (58,6 %). Medijan ASA vrijednosti (engl. American Society of Anesthesiology) iznosio je 3. Hitno je operirano 27 (46,6 %) bolesnika. Prosječna vrijednost prema klasifi kaciji SAPS II (engl. Simplifi ed Acute Physiology Score) je 53,57±13,8 s medijanom 53,0 (raspon 38-73). Zaključno, dominantan uzročnik MDR-GN VAP-a infekcija u JIL-u je multirezistentni Pseudomonas aeruginosa. Od karakteristika bolesnika se izdvaja dob starija od 70 godina, po klasifi kaciji ASA su s ozbiljnom sistemskom bolesti koje svrstavamo u ASA III, 47 % su hitno operirani i po klasifi kaciji SAPS II s medijanom od 53.The aim of the study was to determine the incidence and characteristics of ventilator associated pneumonia (VAP) in patients with multi-drug resistant gram-negative (MDR-GN) pathogens. Retrospective data from the hospital information system and medical charts were analyzed. The study included 58 patients (age 70.41±13.0 years) treated in the Intensive Care Unit (ICU) of the Department of Anesthesiology, Resuscitation and Intensive Care from January 2013 till December 2016, diagnosed with VAP caused by GN pathogens and treated with colistin. The most common cause of MDR-GN VAP was Pseudomonas aeruginosa in 46 (79.3%) patients, followed by Acinetobacter baumannii in 28 (48.3%) and Klebsiella pneumoniae in 7 (12.1%) patients. Thirty-four (58.6%) patients had abdominal diagnosis. The median ASA value was 3. Twenty-seven (46.6%) patients had emergency operation. The mean Simplifi ed Acute Physiology Score (SAPS II) was 53.57±13.8, median 53.0 (range 38-73). In conclusion, the predominant cause of MDR-GN VAP infection in our ICU was multi-resistant Pseudomonas aeruginosa that is treated with colistin. The major patient characteristics were age older than 70, ASA III classifi cation implying serious systemic illness, urgent operation in 47% of patients, and median SAPS II classifi cation 53

Inhalation plus intravenous colistin versus intravenous colistin alone for treatment of ventilator associated pneumonia

In the setting of intensive care units the incidences of multi-drug resistant gram-negative (MDR-GN) pathogens causing ventilator associated pneumonia (VAP) has increased, leading clinicians to use colistin. Our aim was to assess outcomes associated with the use of inhalation and intravenous colisitn versus only intravenous colistin in patients with MDR-GN VAP. A retrospective, single centre study at University Hospital Centre, Zagreb. Patients were divided in two groups, according to their administration of antibiotics – inhalation and intravenous (INH+IV) administration for 8 patients or intravenous only (IV) administration for 23 patients. The results showed that demographic and clinical characteristics and the gram negative pathogens isolated were similar between the two groups, except for K. pneumoniae, which was higher in the IV group. No statistically significant difference between the two groups were observed regarding intensive care unit mortality (P=0.951), sepsis (P=0.474), acute respiratory distress syndrome (P=0.548), length of ICU stay (P=0.686) and length of mechanical ventilation (P=0.858). A statistically significant difference was found regarding the eradication of pathogens in respiratory cultures (P= 0.018). The addition of inhalation to intravenous colistin in MDR-GN VAP improves microbiologic outcome, but does not improve ICU mortality in these patients. Larger prospective trials are warranted to confirm the benefit of adjunctive inhalation colistin as a MDR-GN VAP therapy in the critically ill

TEMPORARY AND PERMANENT CENTRAL VENOUS CATHETERS FOR HEMODIALYSIS

Iako se arteriovenska fistula smatra optimalnim pristupom krvožilju, uporaba trajnih i privremenih dijaliznih katetera za hemodijalizu je u stalnom porastu. Razlog tomu je sve starija populacija kod koje se započinje postupak trajnog bubrežnog nadomjesnog liječenja i kao posljedica toga starija i neprikladna vaskulatura za izradu arterio-venskih fistula. Komplikacije su moguće prilikom postavljanja katetera, ali i kod postavljenih katetera što prije svega uključuje tromboze i infekcije. Na ozbiljnost komplikacija utječe iskustvo osobe koja postavlja kateter, ali i kvaliteta te lokalizacija krvne žile na kojoj se zahvat izvodi. U ovom preglednom članku opisano je praćenje kvalitete rada dijaliznih katetera, mjesto izbora postavljanja te metode rješavanja tromboziranih katetera i lokalnih i sistemnih infekcija. Preporučuju se svakodnevna procjena funkcije, pravilna njega i higijena dijaliznih katetera.The usage of temporary and permanent dialysis catheters for hemodialysis vascular access has been on continual increase. The reason for this increase is aging population on hemodialysis with blood vessels inappropriate for arteriovenous fistula creation. Complications may occur during catheter insertion as well as in the already inserted catheters, e.g., thrombosis and infections. The severity of complications is determined by experience of the operator as well as the quality and localization of blood vessels. Monitoring of dialysis catheter function, choice of the site of catheter insertion and methods of salvaging catheters from thrombosis and treating catheter-related local and systemic infections are described in this paper. Constant evaluation, proper care and hygiene of dialysis catheters are highly recommended

One approach in using multivariate statistical process control in analyzing cheese quality

The objective of this paper was to investigate possibility of using multivariate statistical process control in analysing cheese quality parameters. Two cheese types (white brined cheeses and soft cheese from ultra-filtered milk) were selected and analysed for several quality parameters such as dry matter, milk fat, protein contents, pH, NaCl, fat in dry matter and moisture in non-fat solids. The obtained results showed significant variations for most of the quality characteristics which were examined among the two types of cheese. The only stable parameter in both types of cheese was moisture in non-fat solids. All of the other cheese quality characteristics were characterized above or below control limits for most of the samples. Such results indicated a high instability and variations within cheese production. Although the use of statistical process control is not mandatory in the dairy industry, it might provide benefits to organizations in improving quality control of dairy products

STROKE VOLUME AND PULSE PRESSURE VARIATION ARE GOOD PREDICTORS OF FLUID RESPONSIVENESS IN SEPSIS PATIENTS

Tehnologijom LiDCOPlusTM ispitali smo vrijednost varijacije udarnog volumena (SVV - Stroke Volume Variation) i tlaka pulsa (PPV - Pulse Pressure Variation) u predviđanju odgovora na liječenje nadoknadom volumena u bolesnika sa sepsom nakon velikih abdominalnih kirurških zahvata. Ukupno je bilo 46 bolesnika (22 muškaraca u dobi od 46±6 godina, APACHE II zbroj 26±5; 24 žene u dobi od 41±6 godina, APACHE II zbroj 24±4). Sepsa je definirana prema međunarodnim kriterijima. Pozitivan odgovor na bolus 500 mL 6 % hidroksietil škroba smatrao se porast indeksa udarnog volumena (SVI - Stroke Volume Index) ≥15 %. Rezultati su uspoređeni Studentovim t-testom, korelacija Pearsonovim koeficijentom. Pozitivni odgovor primijećen je u 26 (57,4 %) bolesnika. Početne vrijednosti SVV korelirale su sa početnim vrijednostima PPV (r=0,92, P<0,001). SVV i PPV su bili značajno viši kod bolesnika s pozitivnim odgovorom. SVV: 14,4 ±3,3 vs. 7,1 ±3,1; P <0,001. PPV: 15,2±4,1 vs. 7,4±4,5; P<0,001. Nije bilo razlike između AUROC (Area Under Receiver Operating Characteristic) krivulja za SVV (0,96; 95 % confidence interval 0,859-0,996) i PPV (1,000; 95 % confidence interval 0,923-1,000). Optimalna vrijednost diskriminacijskog praga bila je 10 % za SVV (osjetljivost 96,15 %, specifičnost 100 %) i 12 % za PPV (osjetljivost 100 % i specifičnost 100 %). Rezultati upućuju da su SVV i PPV dobri pokazatelji hemodinamskog odgovora na nadoknadu tekućine u sepsi.Stroke volume variation (SVV) and pulse pressure variation (PPV) are dynamic preload indicators. Specific interactions of the cardiovascular system and lungs under mechanical ventilation cause cyclic variations of SVV and PPV. Real time measurement of SVV and PPV by arterial pulse contour analysis is useful to predict volume responsiveness in septic patients. Results of a prospective, 2-year observational study conducted at Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, are presented. Volume responders and non-responders were defined. Correlation between SVV, PPV, stroke volume index (SVI) and other hemodynamic data in septic patients was analyzed. The study was conducted from September 2009 to December 2011. Sepsis group included 46 patients (22 male, age 46±6, APACHE II score 26±5, and 24 female, age 41±6, APACHE II score 24±4) undergoing major abdominal surgery with clinically and laboratory confirmed sepsis, defined according to the international criteria. Exclusion criteria: patients with LVEF <45%, atrial fibrillation, aortic insufficiency, pulmonary edema, children, pregnant women, patients on lithium therapy, and patients who did not sign informed consent. Septic patients were divided into volume responders (VR) and volume non-responders (VNR). Responders were defined as patients with an increase in SVI of ≥15% after fluid loading. SVV, PPV and SVI were assessed by arterial pulse contour analysis using the LiDCOTM plus system continuously for 8 hours. Simultaneously, cardiac index (CI), mean arterial pressure (MAP), heart rate (HR), oxygen delivery (DO2), oxygen consumption (VO2) and central venous oxygen saturation (ScvO2) were assessed. Hemodynamic data were recorded before and after fluid administration of 500 mL of 6% hydroxyethyl starch over 30 min. All patients were sedated with midazolam (0.05-0.15 mg/kg/h). Analgesia was maintained with sufentanil (0.2-0.6 μg/kg). All patients were intubated and mechanically ventilated (IPPV; FiO2 0.4; TV 7 mL/kg; PEEP 5 cm H2O) in sinus cardiac rhythm. Circulatory unstable patients had vasoactive support and SOFA scores calculated. Ventilator settings and dosage of vasoactive drugs were all kept constant during the study. Data were compared using Student’s t-test. Correlation was estimated using Pearson’s coefficient. The level of statistical significance was set at P<0.05. Positive response to fluid loading was present in 26 (57.4%) patients. Baseline SVV correlated with baseline PPV (r=0.92, P<0.001). SVV and PPV were significantly higher in responders than in nonresponders. SVV: 14.4±3.3 vs. 7.1±3.1; P<0.001. PPV: 15.2±4.1 vs. 7.4±4.5; P<0.001. Other hemodynamic parameters measured were statistically different between the two groups. Only DO2 values showed no statistical significance between the responders and non-responders. There was no difference between the area under receiver operating characteristic curves of SVV (0.96; 95% confidence interval 0.859-0.996) and PPV (1.000; 95% confidence interval 0.93-1.000). Optimal threshold value for discrimination between VR and VNR was 10% for SVV (sensitivity 96.15%, specificity 100%) and 12% for PPV (sensitivity 100%, specificity 100%). In conclusion, SVV and PPV measured by LiDCOTM plus system are reliable predictors of fluid responsiveness in mechanically ventilated septic patients in sinus cardiac rhythm

Use of culled goat meat in frankfurter production – effect on sensory quality and technological properties

Four different levels (25–100%) of culled goat meat were used in frankfurter formulation (frankfurters G25, G50, G75 and G100) instead of beef (CON). Technological properties, fatty acid profile and sensory properties were examined during the 6-week cold storage. The formulation had significant impact of fatty acids profile – n-6/n-3 ratios progressively decrease from 14.63 in CON to 6.63 in G100. Higher goat meat content led to progressively higher lightness and lower redness in frankfurters. This was also observed by consumers but not negatively perceived. Check-all-that-apply (CATA) analysis shows that more than 80% of consumers marked pleasant colour as present in goat frankfurters and CON. The similar was observed for pleasant appearance, pleasant odour, tasty, soft and juicy. Moreover, atypical taste and odour were mostly not marked as present (73.8% and 62.5%, respectively). The panellists pointed at G50 as the most preferred, while consumers most frequently marked G75

Data Collection Protocol for the Multi-platform Aggregated Dataset of Online Communities (MADOC)

This protocol specifies the data collection process for the Multi-platform Aggregated Dataset of Online Communities (MADOC). The resulting dataset will study different aspects of online social media dynamics, user interactions, and content across different platforms: Twitter, Bluesky, Koo, Reddit, and Voat