Croatian Medical Journal最新文献

Aim: To determine age and gender patterns of alcohol use among Croatian pupils and assess whether alcohol use was associated with factors related to school, peers, family, and the COVID-19 pandemic.

Methods: Data were collected from the 2022 Health Behavior in School-aged Children cross-sectional study conducted in Croatia involving 5338 pupils. Pearson χ2 test and multivariate logistic regression were performed.

Results: At the age of 11, boys were drinking alcohol more than girls (P<0.001), while 13- and 15-year-old girls aligned with boys. Lifetime alcohol use was positively associated with schoolwork pressure in 11-year-old girls (OR 3.28, CI 1.36-7.75) and boys (OR 1.87, CI 1.03-3.37). The COVID-19 pandemic negatively affected mental health in 13- (OR 2.21, 1.56-3.13) and 15-year-old girls (OR 1.50, CI 1.01-2.23), and life in 15-year-old boys (OR 1.83, 1.03-3.27). Recent alcohol use was positively associated with hospitalization of a close family member for COVID-19 in 11-year-old girls (OR 2.35, 1.05-5.28), low peer support in 13-year-old boys (OR 1.49, 1.01-2.20), difficult communication with father in 15-year-old girls (OR 1.49,1.05-2.12), negative COVID-19 impact on mental health in 13-year-old girls (OR 1.67,1.13-2.47), and negative COVID-19 impact on life in 15-year-old boys (OR 1.79, 1.08-2.98). Lifetime drunkenness was positively associated with negative COVID-19 impact on mental health in 13- (OR, 2.03,1.28-3.21) and 15-year-old girls (OR 2.12, 1.49-3.01), and with positive or neutral COVID-19 impact on life in 15-year-old girls (OR 0.65, 0.43-0.97).

Conclusion: Preventive activities should offer support systems to minimize the negative COVID-19 impact, with special attention to girls' needs.

Aim: To investigate histopathological changes in the lung tissue of long-COVID patients.

Methods: In this cross-sectional study, transbronchial lung biopsy was performed in long-COVID patients with persisting symptoms and radiological abnormalities. Histopathologic analyses were performed by using hematoxylin-eosin, Martius, Scarlet and Blue, Movat's, thyroid transcription factor 1, CD34, and CD68 staining.

Results: Adequate biopsy samples were obtained from 29/32 patients. The median (Q1-Q3) time from disease onset to biopsy was 13 (9-20) weeks. We observed several histopathologic patterns: DAD with vascular abnormalities (VA) (n=8); VA with inflammatory pattern (n=4); inflammatory pattern (n=13), and fibrotic pattern (n=4). VA included capillary thrombi, dilated venules, and dissection of small pulmonary arteries. DAD with VA was detected up to the 9th week from the onset of disease; inflammatory pattern from the 8th to 28th week (4 patients with this pattern biopsied in the 11th-13th week had accompanying VA); and a predominantly fibrotic pattern was found at weeks 8, 10, 48, and 49.

Conclusion: Our study observed a slow recovery of lung tissue with long-lasting DAD and VA, likely followed by interstitial inflammation or focal fibrosis. These findings might be the underlying cause of the slow recovery of long-COVID patients.

Aim: To evaluate outcomes after percutaneous coronary intervention (PCI) in patients with cancer and atrial fibrillation (AF).

Methods: Data of all adult discharges undergoing PCI between October 2015 and December 2018 were obtained from the National Inpatient Sample (NIS) database. Adjusted odds ratios (aOR) of adverse complications were calculated using binominal logistic regression.

Results: 1387320 patients were detected, out of which 15.4% had AF but no cancer, 1.9% had cancer but no AF, and 0.6% had both cancer and AF. Compared with cancer patients without AF, those with AF had a greater aOR of mortality (aOR 1.20, 95%CI 1.08-1.33), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.18, 95%CI 1.07-1.29), and bleeding (aOR 1.23, 95%CI 1.08-1.39). However, the risk of ischemic stroke was similar between the two groups. Patients with solid cancer and AF had a higher aOR for all outcomes, including mortality (aOR 1.28, 95%CI 1.09-1.50), MACCE (aOR 1.37, 95%CI 1.19-1.57), ischemic stroke (aOR 1.48, 95%CI 1.10-1.99), and bleeding (aOR 1.66, 95%CI 1.39-1.98) compared with the solid cancer group without AF. In patients with hematological cancer, AF was associated only with significantly increased risk of mortality (aOR 1.40, 95%CI 1.16-1.70) and MACCE (aOR 1.26, 95%CI 1.06-1.49).

Conclusions: The presence of AF in solid cancer patients increases the risk of mortality, MACCE, stroke, and major bleeding, while in the setting of hematological cancer it is only associated with a higher risk of mortality and MACCE.

Aim: To determine the rate of and predictive factors for postacute in-hospital survival of older adults after successful weaning from extremely prolonged mechanical ventilation (e-PMV).

Methods: This pilot retrospective study involved patients who were weaned from e-PMV in Bayit Balev Geriatric and Rehabilitation Center, Maccabi Health Services, Bat Yam, Israel between January 2010 and May 2022. In-hospital survival was measured.

Results: Out of 488 patients (of all ages) treated in our geriatric rehabilitation center (GRC) during the study period, only 181 patients aged 65 years and older were conscious and were candidates for weaning from e-PMV. Seventy-three patients (40.3%) were weaned and therefore recruited to this study. Six patients (8.2%) were weaned but died before discharge. Out of the 67 (91.8%) who were alive and weaned, 18 (24.7%) were decanulated and discharged to their homes, and the remaining 49 (75.3%) were weaned and discharged from our GRC with tracheostomy canula to other long-term care institutions. Univariate analysis showed that in-hospital survival was significantly dependent on age and the presence of tracheomalacia, both in a time-independent and time-dependent manner. In a time-dependent (adjusted) multivariate analysis, there were no independent predictive factors for in-hospital mortality.

Conclusions: A dedicated GRC team can wean a substantial number of patients after e-PMV and return them to their community and even homes.

Aim: To evaluate the effect of 5 alpha-reductase inhibitor (5-ARI) treatment on prostate cancer detection by multiparametric magnetic resonance imaging (mpMRI).

Methods: We retrospectively collected data on 429 patients who underwent mpMRI before prostate biopsy in the Urology Department of Giresun University Training and Research Hospital between March 2018 and December 2021. The patients were categorized as those who had never been treated with 5-ARI (n=359) and those who were treated with 5-ARI for more than six months (n=70). The two groups were compared in terms of age, mpMRI findings, and pathology results.

Results: The number of patients with Prostate Imaging-Reporting and Data System (PIRADS) 3 score was significantly higher in the 5-ARI group (37.1% vs 20.6%; P=0.009). The groups did not differ in terms of malignant pathological findings (48.5% in the non-5-ARI vs 47.1% in the 5-ARI group; P=0.505). The detection rates of malignant pathological findings in PIRADS 3 and PIRADS 5 patients were similar between the 5-ARI and non-5-ARI group. However, malignancy detection rate in PIRADS 4 patients was significantly higher in the non-5-ARI group (P=0.031). In the non-5-ARI group, the sensitivity was 56.4% and the specificity was 79.7%. In the 5-ARI group, the sensitivity was 84.9% and the specificity was 56.8%.

Conclusion: In patients with suspected prostate cancer, 5-ARI intake may alter lesion mpMRI characteristics and PIRADS distribution on mpMRI. 5-ARI intake should be reported to the radiologist.

Alpha-1 antitrypsin deficiency (AATD) is a rare autosomal co-dominant disease caused by mutations in the SERPINA1 gene. The alleles most frequently associated with AATD are protease inhibitors S and Z. Here, we report on a 35-year-old woman diagnosed with Kartagener's syndrome and subsequently referred for bronchiectasis testing. She was identified with a hitherto unreported AATD mutation: a heterozygous variant rs1460874866 in a previously undefined exon 4 (NM_001127701.1) of the SERPINA1 gene. Although Kartagener's syndrome is a genetic cause of bronchiectasis, patients with this syndrome are recommended to undergo AATD testing.

We systematically reviewed the current research literature to 1) investigate whether there was a difference in bone mineral density (BMD) between chronic obstructive pulmonary disease (COPD) patients and non-COPD controls, 2) determine the influence of severity and subtype of COPD on BMD, and 3) determine the risk factors for lower BMD in COPD patients. The Web of Science and PubMed databases were searched on September 25, 2023. Studies where BMD was evaluated with computed tomography (CT) or quantitative CT in patients with COPD were included in the review. We collected data on the number of COPD patients, the average age, average body mass index, average predicted forced expiratory volume in one second (%) or Global Initiative for Chronic Obstructive Lung Disease stage, the average of low attenuation areas, the use of corticosteroid therapy, the use of osteoporosis therapy, the average BMD, and the location of BMD measurement. Twelve studies met our review criteria. Although in several studies COPD was associated with a decreased BMD, most of the studies suggested that COPD, especially in its milder forms, was not strongly associated with osteopenia or osteoporosis of the thoracic and lumbar spine.