Croatian Medical Journal最新文献

{"title":"Interpreting antidepressant prescribing trends in Croatia: a letter to the editor.","authors":"Hiba Zeeshan, Muhammad Faisal Shabbir, Inshira Noor","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"324"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early departures from the emergency department in a high-volume tertiary center: the first report from Croatia.","authors":"Josip Krnić, Kristina Vidović, Petra Jerković, Benjamin Benzon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To determine the characteristics of early emergency department (ED) departures, including patients leaving without being seen and leaving during treatment, in a large tertiary center in Croatia.</p><p><strong>Methods: </strong>We retrospectively reviewed ED visits at University Hospital Center Split from July 12, 2023, to July 12, 2024. The study enrolled patients who had been triaged but left before physician evaluation or before completing diagnostic workup. Pediatric, gynecologic, psychiatric, and infectious disease ED visits were excluded because these specialties are managed separately. Data on demographics, Australasian Triage Scale category, referral type, specialty routing, seasonal/circadian patterns, and 48-hour return visits were extracted from the hospital information system.</p><p><strong>Results: </strong>Among 110?547 patients visiting the ED, 1420 (1.3%) departed early. Their median age was 40 years (interquartile range 25-59); 55.6% were male. Most were low-acuity patients (category 4: 60%; category 5: 29%). Early departures peaked in August-September and between 2 pm and 10 pm daily (maximum at 7 pm). Self-referred patients accounted for 65% of early departures, and 26% had been routed to orthopedics/trauma specialists. Only 5% left during treatment. Within 48 hours, 20% returned to the ED and 12% required other hospital evaluations.</p><p><strong>Conclusion: </strong>Early ED departure rate was low. The patients were mostly young, male, low-acuity, and self-referred with trauma-related conditions, presenting during tourist surges and evening hours. These findings underscore the need for dynamic staffing, enhanced triage communication, targeted patient education, and seasonal preparedness to sustain efficient ED performance.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"255-263"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of MCC950 on lipid profiles, glycemic control, and sympathetic dysfunction in a streptozotocin-induced type 1 diabetic rat model.","authors":"Shamala Devi Subramaniam, Xin Yi, Rajesh Ramasamy, Nurul Izzati Uda Zahli, Siti Saleha Masrudin, Razif Abas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effects of MCC950, a selective NLRP3 inflammasome inhibitor, on glycemic control, lipid profiles, and sympathetic dysfunction in a streptozotocin (STZ)-induced type 1 diabetes mellitus (T1DM) rat model.</p><p><strong>Methods: </strong>Male Wistar rats were rendered diabetic by intraperitoneal injection of STZ (50 mg/kg). T1DM induction was confirmed by persistent hyperglycemia, reduced serum C-peptide, and pancreatic histopathological changes. Diabetic cardiac autonomic neuropathy was established by elevated serum noradrenaline (NA) before treatment. Diabetic rats subsequently received MCC950, insulin, or normal saline for four weeks. Fasting blood glucose, serum lipid profiles, C-peptide, pancreatic histology, and serum NA were evaluated before and after treatment.</p><p><strong>Results: </strong>MCC950-treated rats showed significantly reduced fasting blood glucose, total cholesterol, triglycerides, and LDL-cholesterol (all P<0.0001) levels compared with untreated diabetic rats, while HDL levels remained unchanged, which suggests an improvement in diabetes-associated dyslipidemia. MCC950 treatment also partially restored C-peptide concentrations, improved pancreatic histology, and reduced serum NA levels.</p><p><strong>Conclusion: </strong>These findings suggest that NLRP3 inflammasome inhibition may improve metabolic disturbances associated with experimental T1DM. Further studies incorporating direct functional assessments of cardiac autonomic function are required to determine its role in diabetic cardiac autonomic neuropathy.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"285-296"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital privatization in Georgia: lessons from a radical market reform.","authors":"Tengiz Verulava","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"320-321"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet use in all-cause dementia and dementia subtypes among older adults: a population-based retrospective study.","authors":"Zehra Sarikaya Demirbas, Mehmet Ilkin Naharci","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the appropriateness of antiplatelet use across dementia subtypes in older adults and to identify factors associated with inappropriate antiplatelet use.</p><p><strong>Methods: </strong>This population-based retrospective study enrolled adults aged ?65 years with dementia evaluated at a tertiary geriatric outpatient clinic at Gulhane Training and Research Hospital between 2016 and 2025. Antiplatelet (aspirin or clopidogrel) use was categorized as appropriate use, underuse, overuse, or appropriate non-use according to the 2021-2024 European Society of Cardiology guidelines. Multivariable logistic regression analyses were performed to identify the factors associated with inappropriate antiplatelet use.</p><p><strong>Results: </strong>Among 683 older adults with dementia, 40.7% received antiplatelet therapy. Antiplatelet underuse and overuse were observed in 16.8% and 16.1% of the participants, respectively. Underuse was most prevalent in vascular dementia (38.9%), whereas overuse was most prevalent in Alzheimer disease (20.2%) and frontotemporal dementia (19.0%). In multivariable analyses, antiplatelet overuse was independently associated with diabetes mellitus (odds ratio [OR] 4.31; 95% confidence interval [CI] 1.66-11.16) and inversely associated with current smoking (OR 0.06; 95% CI 0.06-0.67). Antiplatelet underuse was independently associated with female sex (OR 4.44; 95% CI 1.52-12.92).</p><p><strong>Conclusions: </strong>Our findings highlight the gaps between guideline recommendations and real-world practice and support the need for individualized dementia-sensitive antiplatelet treatment strategies.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"297-305"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early urinary sodium vs B-type natriuretic peptide for predicting 30-day outcomes in acute decompensated heart failure: a prospective cohort study.","authors":"Ahmet Cagdas Acara, Kursat Kaan Kerimoglu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To compare the prognostic performance of early urinary sodium (UNa) and B-type natriuretic peptide (BNP) for predicting 30-day adverse outcomes in emergency department (ED) patients with acute decompensated heart failure (ADHF).</p><p><strong>Methods: </strong>This prospective observational study was conducted in the ED of Dokuz Eylül University Hospital, Izmir, between January 2025 and July 2025. The study enrolled adults presenting with dyspnea, diagnosed with ADHF, and treated with intravenous loop diuretics. Baseline and 2-hour spot UNa and serum BNP levels were measured. The primary outcome was a composite of intensive care unit admission at the index visit, ED revisit due to ADHF within 30 days, or 30-day all-cause mortality. Patients were compared according to the presence or absence of the composite outcome. Logistic regression and receiver operating characteristic analyses were performed.</p><p><strong>Results: </strong>A total of 117 patients were enrolled, and the composite outcome occurred in 41 (35.0%). Baseline BNP and UNa levels did not differ significantly between the groups. However, 2-hour UNa was significantly lower in patients with the composite outcome than in patients without it (88.0±29.1 vs 107.3±16.6 mmol/L, P<0.001), whereas 2-hour BNP was comparable between the groups. In multivariable analysis, 2-hour UNa remained independently associated with the composite outcome (adjusted odds ratio 0.963; 95% confidence interval 0.942-0.986; P=0.001), while 2-hour BNP did not. In receiver operating characteristic curve analysis, 2-hour UNa showed significant discriminative ability (area under the curve [AUC] 0.739), whereas 2-hour BNP did not (AUC 0.542). The AUC of 2-hour UNa was significantly greater than that of 2-hour BNP (P=0.003).</p><p><strong>Conclusion: </strong>Lower 2-hour UNa was independently associated with 30-day adverse outcomes in ED patients with ADHF and may provide early prognostic information on natriuretic response. These findings require validation in larger multicenter studies.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"273-284"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply to: Interpreting antidepressant prescribing trends in Croatia.","authors":"Katarina Gvozdanović, Roberto Mužić, Helena Orehovački, Danijela Štimac Grbić","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"325-326"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features, genetic analysis, and efficacy evaluation of hematopoietic stem cell transplantation in a case of osteopetrosis caused by compound heterozygous variations in the TNFRSF11A gene: a case study.","authors":"Xiaoyun Dong, Jiping Lv, Hui Dong, Linfei Li, Xuan Zheng, Zongyuan Liu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Osteopetrosis is an uncommon inherited skeletal condition arising from impaired osteoclast activity, with its autosomal recessive forms being linked to mutations in the TNFRSF11A gene. This study reports on a three-year-old Chinese girl presenting with recurrent fractures, short stature, and macrocephaly. Radiological examinations revealed diffusely elevated bone mineral density and constricted medullary spaces. Meanwhile, whole-exome sequencing detected compound heterozygous alterations in the TNFRSF11A gene: c.1567?+?2T>A inherited from the father and c.630C>G from the mother. The child underwent haploidentical hematopoietic stem cell transplantation (HSCT) from the father. Post-transplant follow-up showed improved growth (height/weight), resolved anemia, and alleviated optic foramen stenosis. The patient remained free of hepatosplenomegaly. This case report suggests that HSCT holds therapeutic potential for TNFRSF11A-related osteopetrosis and highlights the clinical value of early genetic diagnosis and timely transplantation for optimizing patient prognosis. Larger studies are required to confirm these findings and further guide the clinical management of similar rare disease cases.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"315-319"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship of laryngopharyngeal reflux-related signs and symptoms to vocal complaints in professional classical singers.","authors":"Marin Čargo, Željka Laksar Klarić, Ana Đanić Hadžibegović","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To examine the relationship between laryngopharyngeal reflux-related signs, symptoms, and self-reported vocal complaints in professional classical singers.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 111 classically trained singers. Participants completed a questionnaire on vocal habits and complaints, as well as the validated Reflux Symptom Score (RSS). Data were collected at the phoniatrics departments of the University Hospital Center Zagreb and the University Hospital Center Osijek in 2023. LPR signs were assessed using flexible nasopharyngolaryngoscopy and the Reflux Sign Assessment (RSA). Spearman's rank correlation, multivariable regression, and multivariate analysis of variance were used to examine associations according to RSA and RSS cutoff values.</p><p><strong>Results: </strong>A total of 29 (26.13%) participants exceeded the RSA cutoff value. Fifty-seven (51.35%) exceeded the RSS cutoff. RSA and RSS total scores were weakly but significantly positively correlated. The total RSS score emerged as a significant predictor of higher RSA scores, although the explained variance was modest. Compared with singers who did not exceed the RSA or RSS cutoff values, singers exceeding RSA or RSS cutoff values demonstrated a different pattern of vocal complaints, with more frequent throat clearing, hoarseness, and other vocal disturbances, vocal fatigue, and post-performance deterioration of voice quality.</p><p><strong>Conclusion: </strong>LPR-related signs and symptoms were common in professional classical singers, with subjective symptom burden exceeding objective laryngoscopic findings. The weak concordance between signs and symptoms highlights the multifactorial nature of voice complaints in this population. These findings support an integrated approach combining reflux-oriented management with targeted voice therapy rather than reliance on isolated laryngoscopic findings.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"264-272"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping patient complaints to the World Health Organization patient safety rights charter: a retrospective study from Croatia.","authors":"Jure Krstulović, Zrinka Hrgović, Ante Krešo, Franko Batinović, Ante Mihanović, Petra Dulčić Kardum, Ana Marušić","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate patient complaints submitted to the Split-Dalmatia County Committee for the Protection of Patients' Rights, classify them according to the World Health Organization (WHO) Patient Safety Rights Charter, and evaluate the impact of public awareness interventions on reporting patterns.</p><p><strong>Methods: </strong>We retrospectively reviewed 36 written patient complaints submitted from 2022 to 2024. Complaints were independently coded by two reviewers according to the ten categories of the WHO Charter. Public interventions to enhance awareness and accessibility of reporting channels included poster campaigns, media coverage, and community discussions in 2023-2024. Statistical analyses assessed temporal trends, distribution of violations, and provider categories associated with reported breaches.</p><p><strong>Results: </strong>From 36 complaints, we identified 60 WHO Charter violations, most frequently concerning the right to timely, effective, and appropriate care (38%), dignity, privacy, and non-discrimination (22%), and access to medical records (12%). Two-thirds of reported incidents involved primary care providers, while one-third involved hospital-based providers. Reporting significantly increased following visibility campaigns: charter violations increased from 11 (2022) to 36 (2024), with monthly reporting rates tripling compared with the baseline (rate ratio 3.3; 95% confidence interval 1.7-6.4; P?=?0.001). The range of reported rights also broadened, encompassing all ten Charter categories by 2024.</p><p><strong>Conclusion: </strong>This is the first study in Croatia to evaluate systematically coded, committee-reviewed complaints according to the WHO Patient Safety Rights Charter. Our findings suggest that transparent complaint systems and sustained public education are crucial for empowering patients, strengthening accountability, and enhancing patient safety.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"306-314"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}