Pharmacogenomics (PGx) is one of the core elements of personalized medicine. PGx information reduces the likelihood of adverse drug reactions and optimizes therapeutic efficacy. St Catherine Specialty Hospital in Zagreb/Zabok, Croatia has implemented a personalized patient approach using the RightMed® Comprehensive PGx panel of 25 pharmacogenes plus Facor V Leiden, Factor II and MTHFR genes, which is interpreted by a special counseling team to offer the best quality of care. With the advent of significant technological advances comes another challenge: how can we harness the data to inform clinically actionable measures and how can we use it to develop better predictive risk models? We propose to apply the principles artificial intelligence to develop a medication optimization platform to prevent, manage and treat different diseases.
With the constant increase in energy demand, using renewable energy has become a priority. Geothermal energy is a widely available, constant source of renewable energy that has shown great potential as an alternative source of energy in achieving global energy sustainability and environment protection. When exploiting geothermal energy, whether is for heating or cooling buildings or generating electricity, a ground heat exchanger (GHE) is the most important component, whose performance can be easily improved by following the latest design aspects. This article focuses on the application of different types of GHEs with attention directed to deep vertical borehole heat exchangers and direct expansion systems, which were not dealt with in detail in recent reviews. The article gives a review of the most recent advances in design aspects of GHE, namely pipe arrangement, materials, and working fluids. The influence of the main design parameters on the performance of horizontal, vertical, and shallow GHEs is discussed together with commonly used performance indicators for the evaluation of GHE. A survey of the available literature shows that thermal performance is mostly a point of interest, while hydraulic and/or economic performance is often not addressed, potentially resulting in non-optimal GHE design.
Aim: Obesity is a well-known risk factor in the cardiovascular disease continuum. However, its clinical effects are multimodal, perplexed and non-unanimously understood. Our aim was to assess the prevalence and effects of obesity on the cardiometabolic risk factors and systolic function of left ventricle ejection fraction (LVEF) in patients scheduled for cardiovascular rehabilitation. Methods: A cohort of 302 consecutive patients recently treated for ischaemic or valvular heart disease was matched according to the existence of obesity, defined with body mass index (BMI ≥ 30 kg/m 2 ; n = 90 vs. 212), and the advanced grade of obesity (BMI ≥ 35 kg/m 2 ; n = 19 vs. 283). Nutritional risk screening was performed using the standardised NRS-2002 tool. Results: The mean age of patients was 62.4 AE 11.2 (range 23-86) years; there were more men than women 244 (80.8%) : 58 (19.2%). Group of obese conveyed higher prevalence of ischaemic heart disease than non-obese (OR = 2.69; 95% CI: 1.01-7.20; p = 0.048); while the difference was insignificant for the advanced grade of obesity (n = 17; 89.5%) vs. controls (n = 233; 82.3%; p > 0.05). There was no significant difference in prevalence of other comorbidities (diabetes, glucose intolerance, hypercholesterolaemia, chronic renal and chronic obstructive pulmonary disease) between studied groups (p > 0.05). Utilisation of lipid-lowering drugs was of similar range between the studied groups (p > 0.05), respectively. LVEF (%) was 50.5 AE 8.2 vs. 50.7 AE 7.7 (p > 0.05) and 50.6 AE 7.8 vs. 49.6 AE 10.9 (p > 0.05; Rho = 0.001; p > 0.05), respectively. Conclusion: In studied set of patients, BMI positively correlated with left ventricle dimension and thickness. No significant connection of obesity was found with the prevalence of chronic comorbidities, increased nutritional risk, laboratory diagnostics or systolic function of left ventricle. Existence of obesity paradox in clinical practice was in part reaffirmed with our study. What's known• Obesity is a well-established risk factor and an important chronic comorbidity in cardiovascular diseases continuum.• However, obese individuals time and again have more fortunate prognosis than normal weighted individuals, known as the obesity paradox.• Obesity paradox is repeatedly found in reports from observational trials.• Modifications in lifestyle, healthy diet and treatment of obesity represent beneficial evidence-based medical interventions.
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