Croatian Medical Journal最新文献

Medical education has undergone a significant reform in response to evolving health care demands, technological advancements, and emerging research in biomedical and education sciences. The teaching methods in anatomy, a core component of medical education, have notably changed, with traditional cadaveric dissection being increasingly replaced by digital and hybrid alternatives. Despite research indicating no significant difference in short-term knowledge retention between students who engaged in cadaveric dissection and those engaging in alternative methods, dissection uniquely fosters professionalism, empathy, and ethical awareness - traits essential for holistic medical education. This review critically examines the dichotomy between traditional and innovative teaching methods in anatomy education, questioning the assumption that traditional methods hinder progress in modern health care. The findings suggest that changes in medical education are primarily influenced by organizational issues, which frequently results in an incomplete implementation of innovative teaching approaches. The inconsistent application of innovative teaching methods makes it difficult to assess their effectiveness and compare them with traditional methods. Reliable data on their long-term impact can only be generated by randomized controlled trials and longitudinal studies. In the meantime, we need to ensure that current medical students receive high-quality education by incorporating best practices from diverse teaching methods based on valuable insights from experienced educators and current students' learning preferences.

Chiari malformation type 1 (CM 1) is a rare and complex neurological condition. This congenital condition affects the lower posterior fossa, where the brain connects to the spinal cord. Although the exact cause of CM 1 remains unclear, genetic predisposition plays a considerable role in structural defects of the cerebellum. Here, we report on a 15-year-old female patient with CM 1 who exhibited both nuclear and mitochondrial genetic variants, a combination that has not been previously described. We identified a silent mutation in exon 2 (c. 556 G>A, p. Lys185=) of PAX1 and a DKK1 variant in intron 3 (548-3 t>C) in the nuclear DNA. We also screened the D-loop region of mitochondrial DNA as it exhibits a higher susceptibility to mutations than other mitochondrial DNA regions. Several hotspot variants were revealed, including those in positions 303-309 and 16519 (t>C), as well as some variants that had not been documented in MITOMAP. Our findings highlight the potential role of genetic alterations in D-loop in CM 1.

The Testicular Tissue Bank has been operating at the University Hospital Center (UHC) Zagreb since 2013. It aims to cryopreserve testicular tissue from patients with azoospermia. If spermatozoa are found in the collected tissue, a combined procedure known as testicular sperm extraction (TESE)/intracytoplasmic sperm injection (ICSI) is performed. During the last 10 years, our bank has deposited samples from 443 patients collected either by conventional TESE or microsurgical TESE procedure. Among them, 9% were from oncological patients whose samples were stored to preserve fertility. According to pathohistological analysis, 17% of patients were diagnosed with complete spermatogenesis or hypospermatogenesis, 11% with spermatogenic arrest, 48% with mixed atrophy of seminiferous tubules, and 24% with Sertoli cell-only phenotype or tubular fibrosis. Overall, the presence of testicular spermatozoa was found in 58% of patients, which makes them suitable for the ICSI procedure. In 21 out of 59 patients (36%) who underwent a salvage TESE, the outcome was different than that of the first spermatozoa retrieval attempt. Considering that the male factor is one of the leading causes of infertility, the results of Testicular Tissue Bank activity confirm its important role in improving the demographic picture of Croatia.

Aim: To rate the level of patients' satisfaction with responses on questions regarding mental health provided by human psychiatrists, pharmacists, and chatbot platforms.

Methods: This cross-sectional study enrolled 89 patients who were pharmacologically treated for their mental disorder in one institution in Croatia and one in Bosnia and Herzegovina during October 2023. They asked psychiatrists, pharmacists, ChatGPT, and one Croatian chatbot questions about their mental disorder and medications and rated the satisfaction with the responses.

Results: Almost half of the patients had used ChatGPT before the study, and only 12.4% had used the Croatian platform. The patients were most satisfied with the information provided by psychiatrists (4.67 out of 5 about mental disorder and 4.51 about medications), followed by pharmacists (3.94 about medications), ChatGPT (3.66 about mental disorder and 3.45 about medications), and the Croatian platform (3.66 about mental disorder and 3.44 about medications). Almost half of the participants believed it was easier for them to put a question to a psychiatrist than to a chatbot, and only 10% claimed it was easier to ask ChatGPT.

Conclusion: Patients with mental health disorders were more satisfied with responses from their psychiatrists than from chatbots, and satisfaction with chatbots' knowledge on mental disorders and medications was still too low to justify their usage in these patients.

Aim: To assess the effect of oxygen reserve index (ORi)-guided titration of fraction of inspired oxygen (FiO2) on the incidence of postoperative delirium (POD) and the frequency of hyperoxemia episodes, assuming a potential link between hyperoxemia and POD.

Methods: This randomized controlled trial included 114 patients aged 65 years and older, scheduled for elective surgeries lasting over two hours at Health Sciences University Tepecik Training and Research Hospital between October 1, 2023, and July 7, 2024. Patients were randomized into the control group (n=57) or the ORi+pulse oximetry (SpO2) group (n=57). In the ORi+SpO2 group, we dynamically adjusted FiO2 based on the real-time ORi and SpO2 values, targeting 95%

Results: The incidence of POD was significantly higher in the control group than in the ORi+SpO2 group (42.1% vs 12.3%, P<0.001). The average FiO2 levels in the ORi+SpO2 group were significantly lower throughout surgery (P<0.001). The ORi+SpO2 group also exhibited a lower frequency of hyperoxemia episodes.

Conclusion: The ORi-guided oxygenation strategy significantly reduced the incidence of POD in elderly patients by effectively minimizing intraoperative hyperoxemia. Optimizing intraoperative oxygenation through non-invasive monitoring may enhance perioperative outcomes.

Aim- To compare the effectiveness of different biologic medications for the treatment of severe asthma.

Methods: We retrospectively collected data on 74 patients treated with one of four different biologics (omalizumab, mepolizumab, reslizumab, or benralizumab) at the Jordanovac Clinic for Pulmonary Diseases, Zagreb, Croatia for at least two years. The patients were compared in terms of the number of exacerbations, dose of oral corticosteroids (OCS), asthma control test (ACT), forced expiratory volume in 1 second (FEV1), forced vital capacity, fraction of exhaled nitric oxide (FeNO), number of blood eosinophils, and total immunoglobulin E (IgE).

Results: All treatment outcome measures, except FeNO, significantly improved in the two-year period (P<0.001). The number of acute exacerbations decreased in all groups. Reslizumab-treated patients showed the greatest improvement in ACT score, and the omalizumab-treated patients experienced the least (P=0.018). The benralizumab group showed the greatest reduction in eosinophil number, and the omalizumab group the lowest (P<0.001). The mepolizumab group showed the greatest improvement in FEV1.

Conclusion: Both anti-IgE and anti-IL-5 treatments effectively reduced exacerbation rates, OCS daily needs, and symptom burden. Multiple predictive biomarkers are needed for the best individual monitoring.

Aim: To report on treatment outcomes in adult patients with spinal muscular atrophy type 3 (SMA3) who had their nusinersen treatment initiated in adulthood.

Methods: The study enrolled 11 adults treated with nusinersen for SMA3 at the Croatian National Referral Centre for Neuromuscular Disorders from 2019 to 2022. We prospectively collected validated SMA outcome measures: Revised Hammersmith score (RHS), Revised Upper Limb Module, and 6-minute walk test (6MWT) as motor function outcomes and the Individualized Neuromuscular Quality of Life questionnaire. Baseline outcomes were compared with the outcomes after three years of treatment.

Results: All patients reported subjective improvement, and 9/11 reported an increased quality of life. Overall, 10/11 patients experienced clinically significant improvement in at least one measured outcome, while the remaining 1 patient reported the absence of disease progression. The mean increase in RHS was 2.7 points (P=0.062), and the mean increase in 6MWT was 39.7 m (P=0.239). Younger age and shorter disease duration correlated with better treatment outcomes (r=-0.543 and r=-0.666, respectively). After the approval of risdiplam in 2022, a third of patients chose to switch therapies despite observed subjective and objective positive nusinersen treatment effects.

Conclusion: Nusinersen had a positive treatment effect despite missed doses during the COVID-19 pandemic. Although the most significant improvements can be expected in patients treated the earliest, nusinersen treatment can be beneficial even in long-standing SMA.

Aim: To assess awareness, knowledge, and preferences regarding palliative care in two Central European countries (Slovenia and Croatia) and the Austrian federal state of Styria. The study explored differences in the sources of information, public perceptions, and preferred settings for end-of-life care.

Methods: In this descriptive cross-sectional survey, we enrolled a community-based sample of adults (≥18 years) residing in the three regions. Propensity score matching was applied to balance demographic variables in the analysis. Overall and matched samples were reported for the three regions.

Results: The study enrolled 1586 respondents; 78.2% had at least heard of palliative care. In the matched sample (n=462), respondents from Austria had the highest awareness of palliative care goals (74.4%), and those from Slovenia had the highest preference for obtaining information from traditional media (54.4%). Opinions on death discussions varied significantly; in Austria, there was the highest percentage (69.5%) of respondents who felt death was insufficiently discussed in society. The preferred end-of-life care setting was home, with Austrians having the highest preference for this setting (70.8%).

Conclusion: The study revealed notable disparities in awareness, knowledge, and preferences regarding palliative care, although the sample size varied between countries. These differences should be addressed by tailored communication strategies and public health campaigns, which should align health care services with the preferences and needs of the population. The findings provide insights into how to improve end-of-life care and enhance public understanding of palliative services in three Central European regions.