Bolnička infekcija je svaka infekcija pacijenta koja se javlja nezavisno o primarnom oboljenju ili svaka infekcija zdrave osobe, za koju se utvrdi da je do nje došlo kao posljedica dijagnostike, ...liječenja ili skrbi, a razvije se tijekom liječenja i skrbi, nakon dijagnostičkog ili terapijskog postupka i otpusta iz bolnice/pružatelja usluga socijalne skrbi u određenom vremenskom periodu. Bolničke infekcije u suvremenoj zdravstvenoj zaštiti postaju sve važniji problem jer im broj i učestalost rastu, povećavaju morbiditet i komplikacije bolesti, a smatra ih se i jednim od vodećih uzroka mortaliteta. Značajan su uzrok povećanja troškova bolničkog liječenja, a time i dodatnog opterećenja sustava zdravstvene zaštite. Kvalitetno i stručno organiziran sustav kontrole infekcija predstavlja najvažnije sredstvo u ograničavanju njihova učinka. Sve pravne osobe koje obavljaju zdravstvenu djelatnost, privatni zdravstveni radnici te ustanove za socijalnu skrb obvezni su osigurati higijenske i druge uvjete te provoditi odgovarajuće sanitarno-tehničke, higijenske i druge mjere za zaštitu od širenja zaraznih bolesti (bolnička infekcija). Ispravni postupci u provođenju zdravstvene njege, dakle u radu medicinskih sestara i tehničara, koji su usmjereni ka prevenciji i pomoći pri liječenju već postojeće infekcije su iznimno važni.
Summary
Protein quality control mechanisms, required for normal cellular functioning, encompass multiple functions related to protein production and maintenance. However, the existence of ...communication between proteostasis and metabolic networks and its underlying mechanisms remain elusive. Here, we report that enhanced chaperone activity and consequent improved proteostasis are sensed by TORC1 via the activity of Hsp82. Chaperone enrichment decreases the level of Hsp82, which deactivates TORC1 and leads to activation of Snf1/AMPK, regardless of glucose availability. This mechanism culminates in the extension of yeast replicative lifespan (RLS) that is fully reliant on both TORC1 deactivation and Snf1/AMPK activation. Specifically, we identify oxygen consumption increase as the downstream effect of Snf1 activation responsible for the entire RLS extension. Our results set a novel paradigm for the role of proteostasis in aging: modulation of the misfolded protein level can affect cellular metabolic features as well as mitochondrial activity and consequently modify lifespan. The described mechanism is expected to open new avenues for research of aging and age‐related diseases.
In cells living under optimal conditions, protein folding defects are usually prevented by the action of chaperones. Here, we investigate the cell-wide consequences of loss of chaperone function in ...cytosol, mitochondria or the endoplasmic reticulum (ER) in budding yeast. We find that the decline in chaperone activity in each compartment results in loss of respiration, demonstrating the dependence of mitochondrial activity on cell-wide proteostasis. Furthermore, each chaperone deficiency triggers a response, presumably via the communication among the folding environments of distinct cellular compartments, termed here the cross-organelle stress response (CORE). The proposed CORE pathway encompasses activation of protein conformational maintenance machineries, antioxidant enzymes, and metabolic changes simultaneously in the cytosol, mitochondria, and the ER. CORE induction extends replicative and chronological lifespan in budding yeast, highlighting its protective role against moderate proteotoxicity and its consequences such as the decline in respiration. Our findings accentuate that organelles do not function in isolation, but are integrated in a functional crosstalk, while also highlighting the importance of organelle communication in aging and age-related diseases.
Cilj: Cilj ovoga rada je prikazati bolesnika s teškim oblikom infekcije COVID-19 koji je razvio miopatiju i polineuropatiju kritične bolesti, uz tešku funkcijsku onesposobljenost te proces ...rehabilitacije, uz pregled literature. Prikaz slučaja: Bolesnik u dobi od 58 godina razvija teški oblik infekcije COVID-19 uz razvoj akutne respiratorne insuficijencije zbog obostrane COVID pneumonije. Zbog pogoršanja kliničke slike mehanički je ventiliran, razvija septički šok te se liječi polifarmakološkom terapijom uz suportivno liječenje i doziranu rehabilitaciju. Nakon poboljšanja kliničkog statusa, bolesnik postaje vitalno i hemodinamski stabilan, na suplementaciji kisikom od 4L/min. Zbog razvoja miopatije i polineuropatije kritične bolesti (engl. Critical-Illness Related Myopathy and Neuropathy; CRYMNE) s posljedičnom generaliziranom teškom mišićnom slabosti uz tešku onesposobljenost, započinje post-COVID multidisciplinarnu rehabilitaciju po individualnom rehabilitacijskom programu (IRP). IRP se sastoji od respiratorne i neuromišićne rehabilitacije te rehabilitacije funkcije za osposobljavanje u aktivnostima svakodnevnog života. Nakon provedenog IRP-a bolesnik je bez zaduhe i zamora pri opterećenju. Saturacija kisikom je postojana te nema razloga za daljnjom oksigenoterapijom. Napredak u rehabilitacijskim ishodima prati se funkcijskim alatima te se registrira smanjenje bolova u zglobovima, jačanje mišićne snage velikih skupina mišića, povećanje snage stiska obiju šaka te smanjenje općeg umora. Bolesnik hoda samostalno pomoću hodalice i peronealne ortoze radi zaostale pareze obaju peroneusa, a mjere funkcijske neovisnosti također su poboljšane, što pridonosi boljoj kvaliteti života. Zaključak: Miopatija i polineuropatija kritične bolesti posljedice su složenih patofizioloških mehanizama uslijed dugotrajne vitalno ugrožavajuće bolesti uz razvoj teške onesposobljenosti i gubitka funkcije. Individualni rehabilitacijski program provodi se kontinuirano, prilagođen je težini kliničke slike, a provodi ga multidisciplinarni tim.
Aim: The aim of this paper is to present a patient with severe COVID-19 infection who has developed critical illness myopathy and polyneuropathy (CRYMNE), with severe functional disability as well as the rehabilitation process, with a review of literature. Case report: A 58-year-old patient develops a severe form of COVID-19 infection with the development of acute respiratory failure due to bilateral COVID-19 pneumonia. Due to the worsening of the clinical condition, he is mechanically ventilated, develops septic shock and is treated with polypharmacological therapy with supportive treatment and gradually progressive rehabilitation. Upon improvement of clinical status, the patient becomes vital and hemodynamically stable, on oxygen supplementation of 4L/min. Due to the development of critical-illness related myopathy and neuropathy (CRYMNE) and the consequent generalized severe muscle weakness with severe disability, he started post- COVID-19 multidisciplinary rehabilitation according to an individual rehabilitation program (IRP). IRP consists of respiratory and neuromuscular rehabilitation, and rehabilitation of the training function in everyday life activities. According to the performed IRP, the patient is free of shortness of breath and fatigue. Oxygen saturation is persistent and there is no reason for further oxygen therapy. Progress in rehabilitation outcomes is monitored by functional tools and a reduction in joint pain, strengthening of muscle strength of large muscle groups, increase in the grip strength of both hands and reduction of general fatigue are registered. The patient walks independently with a walker and peroneal orthoses due to residual paresis of both peroneal nerves. Functional independence indexes as assessment tools of function have also been improved, which is proof of a better quality of life. Conclusion: CRYMNE is the consequence of complex pathophysiological mechanisms due to long-term, life-threatening disease with the development of severe disability and loss of function. The individual rehabilitation program is implemented continuously, adjusted to the severity of the clinical condition under supervision of a multidisciplinary team.
Summary
Protein quality control mechanisms, required for normal cellular functioning, encompass multiple functions related to protein production and maintenance. However, the existence of ...communication between proteostasis and metabolic networks and its underlying mechanisms remain elusive. Here, we report that enhanced chaperone activity and consequent improved proteostasis are sensed by
TORC
1 via the activity of Hsp82. Chaperone enrichment decreases the level of Hsp82, which deactivates
TORC
1 and leads to activation of Snf1/
AMPK
, regardless of glucose availability. This mechanism culminates in the extension of yeast replicative lifespan (
RLS
) that is fully reliant on both
TORC
1 deactivation and Snf1/
AMPK
activation. Specifically, we identify oxygen consumption increase as the downstream effect of Snf1 activation responsible for the entire
RLS
extension. Our results set a novel paradigm for the role of proteostasis in aging: modulation of the misfolded protein level can affect cellular metabolic features as well as mitochondrial activity and consequently modify lifespan. The described mechanism is expected to open new avenues for research of aging and age‐related diseases.
Heat-induced hormesis is a well-known conserved phenomenon in aging, traditionally attributed to the benefits conferred by increased amounts of heat shock (HS) proteins. Here we find that the key ...event for the HS-induced lifespan extension in budding yeast is the switch from glycolysis to respiratory metabolism. The resulting increase in reactive oxygen species activates the antioxidant response, supported by the redirection of glucose from glycolysis to the pentose phosphate pathway, increasing the production of NADPH. This sequence of events culminates in replicative lifespan (RLS) extension, implying decreased mortality per generation that persists even after the HS has finished. We found that switching to respiratory metabolism, and particularly the consequent increase in glutathione levels, were essential for the observed RLS extension. These results draw the focus away solely from the HS response and demonstrate that the antioxidant response has a key role in heat-induced hormesis. Our findings underscore the importance of the changes in cellular metabolic activity for heat-induced longevity in budding yeast.
Aim
To assess trends in thrombolysis rates and door-to-needle times in University Hospital Mostar.
Methods
Data from the University Hospital Mostar Registry were used. Information on the number of ...ischaemic stroke patients, intravenous thrombolysis rates and „door-to-needle times“ (DNT) were collected between January 2013 and December 2021.
Results
Out of the total of 3100 ischaemic stroke patients, alteplase was given to 130 patients giving a thrombolysis rate of 4.2%.
The mean hospital thrombolysis rate increased from 2.4% in 2013 to 10.6% in 2021.
Conclusion
Although the hospital thrombolysis rate more than quadrupled, there is still a low proportion of acute ischaemic stroke
patients who received intravenous thrombolysis therapy. Education and interventions indicating the importance of recognition and treatment of acute ischemic stoke are necessary for all physicians.
The aim of this paper is to examine the frequency of non-lexicalized fillers in the repeated task of retelling a structured story narration. The subjects were 33 students of the Faculty of Electrical ...Engineering, Mechanical Engineering and Naval Architecture in Split who performed the same narrative task twice in the English language (L2). The speech was recorded usingthe computer program Audacity and transcribed. All non-lexicalized fillers were recorded, and statistically analyzed, pointing to a significantly less frequent occurrence in the repeated speech. The results are explained by Levelt’s model,
i.e. the reduced processing requirements at all levels of speech production and greater opportunities for speech monitoring. The obtained results have practical implications, as they point to the positive impact of immediate repetition aiming at developing more fluent speech, even in the case of more proficient speakers.
Akutni respiracijski distresni sindrom (ARDS) se uobičajeno razvija u bolesnika s prisutnim rizičnim čimbenicima (npr. sepsa, pneumonija, akutni pankreatitis, politrauma, višestruke transfuzije krvi ...i krvnih pripravaka i sl.) koji aktiviraju sustavni upalni odgovor. Sepsa je jedan od najčešćih čimbenika koji može dovesti do razvoja ARDS-a. ARDS povezan sa sepsom pokazuje sporiji oporavak plućne funkcije uz manju uspješnost odvajanja bolesnika od strojne ventilacije. Vrlo je važno uz sve ostale mjere liječenja sepse obratiti posebnu pozornost optimalizaciji strojne respiracijske potpore u skladu s trenutnim stanjem pluća. Svake je godine dostupno sve više podataka o mogućnostima liječenja bolesnika s ARDS-om uz pomoć posebno prilagođenih načina strojne ventilacije pri čemu važnu ulogu imaju: izbor optimalnog poštednog modaliteta, primjena potpomognute ventilacije i adekvatno podešavanje pozitivnog tlaka na kraju izdaha (engl. positive end-expiratory pressure - PEEP). Međutim, što iz ovih eksperimentalnih i kliničkih podataka možemo prenijeti u svakodnevnu kliničku praksu? U ovom članku izneseni su načini adekvatne prilagodbe poštedne ventilacije kao mjere s dokazanim učinkom na smanjenje mortaliteta ove skupine bolesnika ako se sustavno i dosljedno primjenjuje.
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