Croatian Medical Journal最新文献

Aim: To assess the independent associations of behavioral factors with many mental health indices among children in Albania.

Methods: This cross-sectional study carried out in Albania in 2022 included a nationwide representative sample of 5454 schoolchildren aged 11, 13, and 15 years (52% girls; response rate: 96%). Data on ten mental health indices were collected, in addition to behavioral characteristics and sociodemographic factors. A general linear model was used to assess the independent associations of behavioral factors with mental health indices.

Results: Irrespective of sociodemographic characteristics, the scores of all mental health indices were significantly worse among schoolchildren who reported lifetime smoking and alcohol consumption, those who engaged less frequently in physical activity, those who skipped breakfast at least on one weekday, and those who consumed fresh fruit less than daily compared with their counterparts who were, respectively, never smokers, had never drunk alcohol, were more physically active, consumed breakfast regularly, and consumed fresh fruit daily.

Conclusions: Irrespective of sociodemographic boundaries, this study showed significant associations between behavioral characteristics and the mental health of Albanian schoolchildren. This highlights the importance of promoting healthy behaviors among children to mitigate the risk of mental health challenges. Interventions aimed at encouraging regular physical activity, consistent breakfast consumption, and daily intake of fresh fruit may enhance the mental resilience of school-aged children.

Aim: To assess the relative efficacy of dapagliflozin and empagliflozin in routinely treated chronic heart failure (CHF) patients.

Methods: Data from a registry of prevalent and incident CHF patients were used to set up cohorts (new-user design) of patients started on dapagliflozin or empagliflozin in addition to other guideline-directed therapy. Cohorts were mutually balanced on a range of characteristics, and were assessed for the incidence of a composite of all-cause death/major adverse cardiac events (primary outcome) over the initial 6 months of treatment, and for New York Heart Association (NYHA) functional class at 6 months (secondary outcome). Frequentist and Bayes estimates were generated for the dapagliflozin vs empagliflozin comparison.

Results: In both prevalent (dapagliflozin n=393, empagliflozin n=328) and incident (dapagliflozin n=124, empagliflozin n=116) patients, those prescribed dapagliflozin had somewhat higher incidence of the primary outcome, but the confidence intervals were wide (RR=1.385, 95%CI 0.882-2.173 [prevalent], RR=2.192, 95%CI 0.765-6.282 [incident]), and were more likely to present with a worse NYHA class at 6 months (OR=1.552, 95%CI 1.142-2.108 [prevalent], OR=1.503, 95%CI 0.844-2.676 [incident]). In the pooled data, primary events (n=102) were more common in dapagliflozin-prescribed patients (frequentist estimate RR=1.519, 95%CI 1.239-1.861; Bayes RR=1.380, 95%CrI 0.981-1.944). Dapagliflozin-prescribed patients were also more likely to have a worse NYHA class at 6 months (OR=1.540, 95%CI 1.208-1.962; Bayes OR=1.425, 95%CrI 1.098-1.781).

Conclusion: CHF patients prescribed with dapagliflozin had poorer outcomes than their empagliflozin-prescribed peers over the initial 6 months of treatment. Data emphasize a need for a direct randomized comparison of the two treatments in this setting.

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.

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.

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 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 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.