Croatian Medical Journal最新文献

Cerebrofacial arteriovenous metameric syndrome (CAMS) is a rare nonhereditary disease, amounting to only 0.5% of all cerebral vascular malformations. It is characterized by vascular malformations in a metameric distribution involving the cerebrofacial region. We present a case of a 14-year-old girl in whom the first vascular lesion appeared on the tip of her nose at the age of 18 months. This lesion reoccurred on several occasions during her childhood, with exacerbations coinciding with common rhinitis and several nose bleeds. She was unsuccessfully treated with laser therapy and topical selective beta-blockers prior to further investigations. Combined cerebrofacial arteriovenous malformation (CAMS I+II) was diagnosed by magnetic resonance imaging of the paranasal sinuses, orbits, and brain with cerebral angiography and confirmed by digital subtraction angiography. Clarifying the correct diagnosis enabled us to abort a potential surgical approach and to assume an expectant approach unless the patient develops neurological symptoms. Timely, complete, and adequate imaging investigations are necessary in cases of facial vascular malformations. This report for the first time describes the specific angioarchitecture involving two types of CAMS.

Aim: To systematically review the latest pharmacoeconomic evidence regarding the costs associated with myasthenia gravis (MG) care and treatment.

Methods: We searched the National Health Service Economic Evaluation Database and PubMed for articles in English from any country reporting health economic analyses of pharmacological treatments, hospitalization, or surgical procedures related to MG.

Results: The study included 31 articles showing a considerable variability in the costs and cost-effectiveness of MG treatments across regions, therapies, and health care settings. Traditional therapies such as plasma exchange (PLEX) and intravenous immunoglobulin (IVIg) differ notably in cost, with PLEX generally being less expensive. Newer clinically effective treatments such as efgartigimod and eculizumab raise concerns about their economic sustainability, whereas rituximab might be a more affordable alternative in certain contexts.

Conclusion: Future research should compare cost-effectiveness across health care systems, incorporating local pricing and reimbursement, and collecting real-world data.

Aim: To evaluate the feasibility, participation rate, diagnostic pathway performance, and early detection outcomes of the first year of the Croatian pilot prostate cancer screening program (CROState) implemented in Zagreb.

Methods: This prospective pilot program invited men aged 55-69 years without a prior prostate cancer diagnosis or prostate-specific antigen (PSA) testing in the past 12 months. Recruitment was conducted by general practitioners. Men with PSA>4 ng/mL underwent repeat testing, and if PSA was elevated again, they were referred to one of two university hospitals for further evaluation. The diagnostic pathway included multiparametric magnetic resonance imaging, urological examination, and transperineal fusion biopsy when indicated. All confirmed cancer cases were reviewed by a multidisciplinary team.

Results: A total of 5251 men were invited to the program, of whom 4930 (93.9%) participated in PSA testing. Elevated PSA was detected in 419 (8.5%). Only 157 (37.5%) men completed repeat PSA testing, and 123 men were referred for hospital evaluation. Eighty-eight patients completed advanced diagnostics, with 83 undergoing magnetic resonance imaging. Forty-two men proceeded to biopsy, of whom 27 had positive results (64.3%). Most cancers were clinically significant; only two men fulfilled criteria for active surveillance. The main challenge was incomplete adherence to repeat PSA testing.

Conclusion: The CROState pilot demonstrated high initial participation and high detection rate of prostate cancer, with a few clinically insignificant tumors, when combining PSA testing with advanced imaging and targeted biopsy. Limited compliance with repeat PSA testing must be addressed before wider national implementation.

Aim: To compare the accuracy, scientific adequacy, and clarity of responses provided by ChatGPT-4o and Gemini to frequently asked patients' questions about warfarin use.

Methods: Forty patients' questions were posed to ChatGPT and Gemini using the zero-shot method. Four cardiovascular surgeons evaluated the responses for adequacy, scientific accuracy, and clarity on a 5-point Likert scale. The first and second set of data evaluations were separated by seven days to minimize any memory effect. The experts were blinded to the type of LLM that created the response.

Results: ChatGPT responses were significantly shorter (187.3±47.6 vs 291.4±98.1 words; P<0.001) but scientifically more adequate (4.38±0.30 vs 4.17±0.35; P=0.004). Gemini scored higher in terms of clarity (4.69±0.24 vs 4.48±0.33; P<0.001). The two models did not significantly differ in terms of accuracy (P = 0.606).

Conclusion: Both LLMs provide reliable and understandable information for warfarin counseling. While ChatGPT provides dense and scientifically detailed responses, Gemini excels in clarity and user-friendly communication. However, expert supervision and appropriate clinical guidance are critical for safe and comprehensive guidance.

Aim: To assess health care professionals' knowledge and opinions regarding extracorporeal membrane oxygenation (ECMO) use, training, standards, and resource availability.

Methods: This cross-sectional study employed an online self-administered survey to evaluate health care professionals' knowledge and opinions concerning ECMO procedures. The survey consisted of multiple-choice and open-ended questions inquiring about demographics, ECMO practices, training and certification experiences, ECMO use during the COVID-19 pandemic, and obstacles to ECMO implementation.

Results: The study enrolled 89 health care professionals from 12 countries. The respondents were most frequently from Kazakhstan (67.4%), Turkey (5.6%), Croatia (5.6%), and Ukraine (5.6%). Notably, 61.8% of respondents supported ECMO procedures performed by certified specialists. The respondents believed that the main ECMO indications were respiratory failure (83.1%), cardiopulmonary failure (69.6%), heart and lung transplantation (64.1%), and cardiogenic shock (58.4%). Major obstacles to ECMO implementation were reported to be high costs (53.9%), inadequately qualified staff (52.8% for physicians, 41.6% for nurses), and restricted availability of ECMO devices (42.7%).

Conclusion: The findings emphasize the need for standardized training, wider availability of ECMO standards, and efforts to address resource-related barriers to ECMO access. Our results primarily reflect practices in Kazakhstan and should be interpreted in light of the study's restricted geographical coverage.

Although the role of pharmacogenomics (PGx) in personalized pharmacotherapy has been well established, its implementation in clinical practice lags behind. In this article, we present an overview of important achievements in the field of PGx of cardiovascular drugs (CVDs), and identify gaps in the existing research. We also present an outline of the PGx-CardioDrug project (ClinicalTrials.gov: NCT05307718) focused on PGx of three major classes of CVDs: P2Y12 antiplatelets, direct oral anticoagulants (DOACs), and statins. The project intends to evaluate pharmacogenes, concomitant treatments, and their combinations as determinants of adverse drug reactions (ADRs). It is based on a pool of around 1200 consecutive adults who were accrued on the case-control principle defined with respect to the CVDs and ADRs of interest (bleeding related to antiplatelets and DOACs, skeletal muscle or liver toxicity related to statins, inefficiency). Possible perpetrator or victim roles of concomitantly used drugs are assessed using the Lexicomp® Clinical Decision Support System. The assembled data provide a basis for a series of case-control type analyses. Considering the mode of data generation and the nature of the exposures of interest (ie, present before the occurrence of the outcome), potentially observed outcome-exposure associations are likely to be causal, provided that confounding is reasonably controlled. The project enables the development of methods and procedures that better reflect the real-life situation of patients with comorbidities and polytherapy, and might better predict the interactions of multiple drugs and genes that affect the frequency and severity of CVD ADRs.

Aim: To examine the relationship between pain conceptualization and treatment outcomes in patients with chronic nonspecific low back pain (CNSLBP) undergoing physiotherapy, and to explore the influence of educational attainment on pain conceptualization.

Methods: This prospective observational study enrolled 84 adults (mean age ≈50 years) receiving exercise-based physiotherapy for CNSLBP in an outpatient setting. Outcome measures included pain intensity (Numeric Pain Rating Scale), disability (Roland-Morris Disability Questionnaire), and health-related quality of life (EQ-5D-5L index and EQ-VAS), assessed before and after treatment. Pain conceptualization was measured with the Croatian version of the Concept of Pain Inventory for Adults (COPI-Adult).

Results: Significant post-treatment improvements were observed in pain (-2.41), disability (-5.27), EQ-5D-5L index (+0.128), and EQ-VAS (+13.79) (all P<0.001). Higher COPI-Adult scores were weakly and negatively correlated with pain (r = -0.273, P = 0.012) and disability (r = -0.259, P = 0.018), and positively with HRQoL (EQ-5D-5L: r = 0.295; EQ-VAS: r = 0.323). However, pain conceptualization did not significantly moderate the magnitude of outcome changes (all interaction effects P > 0.005). Participants with higher education scored significantly higher on COPI-Adult (P = 0.014; d = 0.55).

Conclusions: While pain conceptualization is associated with post-treatment pain, disability, and HRQoL outcomes, it does not predict the degree of improvement after physiotherapy. Educational attainment influences pain conceptualization, which indicates a need for tailored communication strategies in rehabilitation. The Croatian COPI-Adult is a reliable tool for assessing patients' concepts of pain within CNSLBP care.