Ketamine is a dissociative anaesthetic used to induce general anaesthesia in humans and laboratory animals. Due to its hallucinogenic and dissociative effects, it is also used as a recreational drug. ...Anaesthetic agents can cause toxic effects at the cellular level and affect cell survival, induce DNA damage, and cause oxidant/antioxidant imbalance. The aim of this study was to explore these possible adverse effects of ketamine on hepatocellular HepG2 and neuroblastoma SH-SY5Y cells after 24-hour exposure to a concentration range covering concentrations used in analgesia, drug abuse, and anaesthesia (0.39, 1.56, and 6.25 µmol/L, respectively). At these concentrations ketamine had relatively low toxic outcomes, as it lowered HepG2 and SH-SY5Y cell viability up to 30 %, and low, potentially repairable DNA damage. Interestingly, the levels of reactive oxygen species (ROS), malondialdehyde (MDA), and glutathione (GSH) remained unchanged in both cell lines. On the other hand, oxidative stress markers superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) pointed to ketamine-induced oxidant/antioxidant imbalance.
Background and Objectives: A potential role of vascular endothelial growth factor (VEGF) in the pathophysiology of infantile hemangiomas (IH) is thought to be plausible. The primary objective of this ...study was to investigate the importance of determining VEGF serum levels at various stages of IH growth in children. Materials and Methods: A nested case–control study was conducted. For the purposes of the researched target group, samples of fifty (N = 50) children with IH without associated diseases at different stages of hemangioma growth (proliferative and involutional stages) were used. The control group consisted of one hundred (N = 100) healthy children comparable in terms of age and sex, in whom the existence of IH and vascular malformations was ruled out via clinical examination. An immunoassay (ELISA) was used to determine VEGF serum levels in hemangioma growth’s proliferation and involution phases. Results: A comparison of serum levels of VEGF in the phases of proliferation and involution in the group of patients with IH did not show a statistically significant difference (p = 0.171). The control group had significantly higher serum VEGF levels than the patient group in both the proliferation phase (p = 0.009) and the involution phase (p = 0.019). In the proliferation phase, a multivariate regression model explained 15% of the variance in the dependent variable, without significant predictor variables, while in the involution phase, it explained 21% of the variance in the dependent variable, and the history of invasive prenatal procedures stood out as a significant predictor variable positively associated with serum VEGF levels (beta coefficient = 0.33; p = 0.043). Conclusions: Although IH is thought to be the result of the dysregulation of angiogenesis and vasculogenesis under the influence of angiogenic factors, especially VEGF, this study did not demonstrate that VEGF serum levels in the proliferation phase of hemangioma growth were higher than those in the involution phase, or in relation to the control group.
We characterised accidental ingestion of non-steroidal anti-inflammatory drugs and non-opioid analgesics in children aged 0–5 years between 2009 and 2019 by analysing records of telephone ...consultations with the Croatian Poison Control Centre (CPCC) and cases treated at the Children’s Hospital Zagreb (CHZ). Among the total of 466 identified cases (411 from CPPCC records and 55 from CHS hospital records), the most frequently ingested drugs were ibuprofen (47 %), paracetamol (20 %), ketoprofen (15 %), and diclofenac (11 %). In 94 % of the cases unsupervised children ingested the drug left within their reach. The remaining 6 % were dosing errors by parents or caregivers and involved liquid formulations as a rule. Our findings can serve as real-life examples informing preventive measures.
A 8-month-old female infant, weighing 7kg, with persistent cloaca, anal atresia, right renal agenesis, grade 3 vesicoureteral reflux, double-barrel colostomy and left nephrostomy was admitted to ...Department of Nephrology of Children’s Hospital Zagreb for a urinary tract infection. On the sixth day, due to clinical deterioration and inadequate response to given antibiotic therapy she underwent a central venous catheter placement, amikacin was replaced with cefepime. That night, around midnight, she got a high fever and, as antipyretic, 100 ml of intravenous acetaminophen solution was administered. Shortly after, the nurse contacted the doctor on call and admitted to making a therapeutic error – instead of 100 mg of acetaminophen, she administered 100 ml of intravenous acetaminophen solution (10mg/ml), thus administering 1000 mg (142 mg/kg). Four hours after the administration serum acetaminophen concentration was 465 mcg/ml. She was transferred to intensive care unit and intravenous N-acetylcysteine (NAC) was started immediately, starting with loading dose of 1 gram in 25 ml 5% glucose solution over 1 hour, then 350mg in 50 ml 5% glucose solution, continued with maintenance dose of 700mg in 100 ml 5% glucose solution over the next 16 hours, following the 21-hour NAC protocol. Blood tests (liver and kidney functions, ammonia, prothrombin time, blood gas analysis) were performed daily, all values were in normal range. Infant remained well and without hepatic impairment. The treatment of NAC infusion over 21 hours was efficacious. This was a case of unintentional overdose, error in dose calculation and therapeutic error. Therapeutic errors such as 10-fold overdosing are common, especially during the night shift, so additional caution is needed. Dose of intravenous acetaminophen on medication order has to be written both in milligrams and millilitres to avoid dosing and administration errors.
Metabolic syndrome prevalence is between 24 and 27% and poses a significant risk for the development of atherosclerotic cardiovascular disease (ASCVD), type 2 diabetes (T2D), or other comorbidities. ...Currently, no drugs are approved for metabolic syndrome treatment itself, so the risk factors are treated with therapies approved for cardiac and metabolic conditions. These are approved drugs for dyslipidemia treatment such as statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, cornerstone antihypertensive drugs, or novel class glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RA) for T2D and overweight or obesity treatment. We have also evaluated new pharmacological interventions in clinical development that have reached Phase 2 and/or Phase 3 randomized clinical trials (RCTs) for the management of the risk factors of metabolic syndrome. In the pipeline are glucose-dependent insulinotropic polypeptide (GIP), GLP-1, glucagon receptor (GCGR), amylin agonists, and a combination of the latter for T2D and overweight or obesity treatment. Non-entero-pancreatic hormone-based therapies such as ketohexokinase (KHK) inhibitor, growth differentiation factor 15 (GDF15) agonists, monoclonal antibodies (mAbs) as activin type II receptors (ActRII) inhibitors, and a combination of anti-α-myostatin (GFD8) and anti-Activin-A (Act-A) mAbs have also reached Phase 2 or 3 RCTs in the same indications. Rilparencel (Renal Autologous Cell Therapy) is being evaluated in patients with T2D and chronic kidney disease (CKD) in a Phase 3 trial. For dyslipidemia treatment, novel PCSK9 inhibitors (oral and subcutaneous) and cholesteryl ester transfer protein (CETP) inhibitors are in the final stages of clinical development. There is also a surge of a new generation of an antisense oligonucleotide (ASO) and small interfering RNA (siRNA)-targeting lipoprotein(a) Lp(a) synthesis pathway that could possibly contribute to a further step forward in the treatment of dyslipidemia. For resistant and uncontrolled hypertension, aldosterone synthase inhibitors and siRNAs targeting angiotensinogen (AGT) messenger RNA (mRNA) are promising new therapeutic options. It would be interesting if a few drugs in clinical development for metabolic syndrome such as 6-bromotryptophan (6-BT), vericiguat, and INV-202 as a peripherally-acting CB1 receptor (CB1r) blocker would succeed in finally gaining the first drug approval for metabolic syndrome itself.
Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children's health and society as a whole. The main objective of this study ...was to determine whether obesity has an effect on the severity of supracondylar humerus fracture in children, regardless of whether it is a low- or high-energy trauma.
The electronic records of patients treated for the supracondylar fracture of the humerus in the ten-year period from 1 January 2013 to 1 January 2023 were reviewed retrospectively.
In the observed period, 618 children, including 365 (59.06%) boys and 253 (40.94%) girls, were hospitalized and treated surgically with the diagnosis of supracondylar fracture. The distributions according to the observed parameters were as follows: age (months) = 88.18 ± 32.64; height (cm) = 123.42 ± 16.83; weight (kg) = 27.18 ± 11.32; body mass index = 17.18 ± 3.06; body mass index-for-age percentile = 57.34 ± 32.11. Overall, 141 (22.82%) fractures were classified as Gartland II, while 477 (77.18%) were classified as Gartland III. A total of 66 (10.68%) fractures were flexion type, while 552 (89.32%) were extension type. The left elbow was affected in 401 (64.89%) children, while the right was affected in 217 (35.11%) children. The main mechanism of injury was a fall at ground level (33.33%). In relation to gender, a statistically significant difference was recorded in body mass index and percentile (
< 0.05). According to Gartland, the proportion of children below and above the 85th percentile in relation to the type of injury was statistically significant (
< 0.05). It was determined that the energy level does not significantly influence the injury's severity:
(GII) = 0.225;
(GIII) = 0.180.
In our study, we found that the proportion of overweight and obese children requiring surgical treatment was higher in Gartland type III injury, so there is no doubt that as a society we must prevent further increases in the prevalence of childhood obesity for this reason as well.
Citations are used to assess the importance of authors, articles and journals in the scientific community, but do not examine how they affect general public journal readership. The Altmetric ...Attention Score (AAS) is a new metric for measuring media attention of the published paper.
We examined cardiovascular (CV) randomized clinical trials (RCTs), published in the 3 highest Web of Science Impact Factor journals (Journal Citation Reports 2019: category "Medicine, General & Internal") and in the 3 highest Web of Science Impact Factor CV journals (Journal Citation Reports 2019: category "Cardiac & Cardiovascular Systems"), through the calendar year of 2017, 2018 and 2019. The primary outcomes were the assessment of the difference between number of citations and AAS among positive and negative CV RCTs.
Among the included 262 RCTs, more positive CV RCTs were published (
= 0.002). There was no significant statistical difference between the positive and negative trials, considering the number of citations (
= 0.61). Interestingly, positive trials had a tendency towards a higher AAS (
= 0.058). The correlation between the AAS and the number of citations was moderate positively correlated (ρ = 0.47,
< 0.001).
We did not find any differences between CV RCTs with positive vs CV RCTs with negative results considering the number of their citations. A tendency towards a higher AAS among positive CV RCTs could indicate higher activity on social media regarding CV trials with positive results. A higher number of published positive CV RCTs among all published CV RCTs could indicate the presence of publication bias but further investigation of unpublished RCTs in trial registries (e.g., clinicaltrials.gov) is needed.
The goal of every organisation is to have employees with high self-esteem and employees with a good work-related quality of life (WRQoL), given that such employees are more satisfied and provide ...better service, which is ultimately a benefit for the organization. In order for employees to have the best possible WRQoL, the responsibility lies with the administration or health system of a particular country, which is obliged to improve the organisation in all aspects. A sample of 409 participants in the Children’s Hospital Zagreb examined their self-esteem and WRQoL. The research included both health and non-health employees. For the purpose of the research, the Rosenberg self-esteem scale and the WRQoL scale were used. The Pearson correlation coefficient between these two variables was calculated, which is the first such study. The results showed that we have employees with a high level of self-esteem, which is an excellent resource given the fact that high self-esteem has positive implications for job satisfaction and job performance. In contrast to self-esteem, employees were extremely dissatisfied with the quality of life-related to work, especially in the following categories; Working Conditions, Job and Career Satisfaction, and Control at Work. Following the above, and qualitative research, key factors were found that the management needs to address to raise the WRQoL of employees.
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