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What can we learn from each other about undergraduate medical education in general practice/family medicine?
Get PDFINTRODUCTION: There is a dearth of published literature on the organisation of family medicine/general practice
undergraduate teaching in the former Yugoslavia. -----
METHODS: A semi-structured questionnaire was sent to the addresses of 19 medical schools in the region.
Questions covered the structure of Departments of Family Medicine (DFM), organisation of teaching, assessment
of students and their involvement in departmental activities. -----
RESULTS: Thirteen medical schools responded, of which twelve have a formal DFM. Few DFM have full-time staff,
with most relying upon external collaborators. Nine of 13 medical schools have family doctors teaching other
subjects, covering an average of 2.4 years of the medical curriculum (range: 1-5). The total number of hours
dedicated to teaching ranged from 30 - 420 (Md 180). Practice-based teaching prevails, which is conducted
both in city and rural practices in over half of the respondent schools. Written exams are conducted at all but
two medical schools, with the written grade contributing between 30 and 75 percent (Md=40%) of the total
score. Nine medical schools have a formal method of practical skills assessment, five of which use Objective
Structured Clinical Examinations. Student participation is actively sought at all but three medical schools,
mainly through research. -----
CONCLUSION: Most medical schools of the former Yugoslavia recognise the importance of family medicine in
undergraduate education, although considerable variations exist in the organisation of teaching. Where DFM do
not exist, we hope our study will provide evidence to support their establishment and the employment of more
GPs by medical schools
Genes associated with anhedonia: a new analysis in a large clinical trial (GENDEP)
Get PDFA key feature of major depressive disorder (MDD) is anhedonia, which is a predictor of response to antidepressant treatment. In order to shed light on its genetic underpinnings, we conducted a genome-wide association study (GWAS) followed by investigation of biological pathway enrichment using an anhedonia dimension for 759 patients with MDD in the GENDEP study. The GWAS identified 18 SNPs associated at genome-wide significance with the top one being an intronic SNP (rs9392549) in PRPF4B (pre-mRNA processing factor 4B) located on chromosome 6 (P = 2.07 × 10-9) while gene-set enrichment analysis returned one gene ontology term, axon cargo transport (GO: 0008088) with a nominally significant P value (1.15 × 10-5). Furthermore, our exploratory analysis yielded some interesting, albeit not statistically significant genetic correlation with Parkinson's Disease and nucleus accumbens gray matter. In addition, polygenic risk scores (PRSs) generated from our association analysis were found to be able to predict treatment efficacy of the antidepressants in this study. In conclusion, we found some markers significantly associated with anhedonia, and some suggestive findings of related pathways and biological functions, which could be further investigated in other studies
Identification and diagnosis of patients with familial chylomicronaemia syndrome (FCS): expert panel recommendations and proposal of an “FCS score”
Get PDFFamilial chylomicronaemia syndrome (FCS) is a rare, inherited disorder characterised by impaired clearance of triglyceride (TG)-rich lipoproteins from plasma, leading to severe hypertriglyceridaemia (HTG) and a markedly increased risk of acute pancreatitis. It is due to the lack of lipoprotein lipase (LPL) function, resulting from recessive loss of function mutations in the genes coding LPL or its modulators. A large overlap in the phenotype between FCS and multifactorial chylomicronaemia syndrome (MCS) contributes to the inconsistency in how patients are diagnosed and managed worldwide, whereas the incidence of acute hypertriglyceridaemic pancreatitis is more frequent in FCS. A panel of European experts provided guidance on the diagnostic strategy surrounding FCS and proposed an algorithm-based diagnosis tool for identification of these patients, which can be readily translated into practice. Features included in this FCS score comprise: severe elevation of plasma TGs (fasting TG levels >10 mmol/L [885 mg/dL] on multiple occasions), refractory to standard TG-lowering therapies, a young age at onset, the lack of secondary factors (except for pregnancy and oral oestrogens) and a history of episodes of acute pancreatitis. Considering 53 FCS patients from three cohorts and 52 MCS patients from three cohorts, the overall sensitivity of the FCS score (≥10) was 88% (95% confidence interval [CI]: 0.76, 0.97) with an overall specificity of 85% (95% CI: 0.75, 0.94). Receiver operating characteristic curve area was 0.91. Pragmatic clinical scoring, by standardising diagnosis, may help differentiate FCS from MCS, may alleviate the need for systematic genotyping in patients with severe HTG and may help identify high-priority candidates for genotyping
Arterial calcium stimulation with hepatic venous sampling predicts the localization and size of the insulinoma as well as postoperative weight loss
Get PDFHemothorax as the first manifestation of idiopathic pulmonary arteriovenous malformation
Get PDFBACKGROUND:
Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular anomalies and hemothorax as a presenting feature of PAVM is a very rare occurrence. ----- CASE PRESENTATION:
A 45-year old woman presented with chest pain and breathlessness. A chest x-ray showed left-sided pleural effusion. An emergency MSCT scan with contrast showed no signs of pulmonary embolism but instead a probable AV malformation was shown. Diagnostic thoracocentesis revealed hemorrhagic exudate with negative cytology and microbiology findings. Thoracic drainage was performed resulting with complete regression of hemothorax. Three months later, patient was treated with transcatheter embolization of PAVM with good clinical outcome. ----- CONCLUSIONS:
We have shown that management of PAVM related hemothorax initially by thoracic drainage followed by later on performed catheter embolization of the PAVM could lead to a successful outcome
Vegetarijanska i veganska prehrana u dječjoj dobi - smjernice Hrvatskog društva za pedijatrijsku gastroenterologiju, hepatologiju i prehranu Hrvatskog liječničkog zbora [Vegetarian and vegan diet in children - guidelines of the Croatian society for pediatric gastroenterology, hepatology and nutrition of the Croatian Medical Association]
Get PDFThe influence of vegetarian and vegan diet on children’s health has been discussed not only by pediatricians
but also by other professionals who take care of children. Therefore, the aim of this recommendations, based on presented
and summarized scientific evidences on the effect of vegetarian and vegan diet on children’s and adolescents’ health,
was to state the instructions of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the
Croatian Medical Association. Vegetarian, and especially vegan diet, is not only the omission of meat and other food of
animal origin, but has to represent balanced nutrition adjusted for children. Such a child requires continuous supervision
not only by primary health physician but also by pediatric nutritionist, who both have to be specially educated in the
field. As restrictions in diet significantly increase the risk for nutritional deficiencies, parents who decide to follow such
a diet, and all professionals who take care of such children, have to be aware of possible nutritional risks that are much
bigger than in adulthood
Combining information on C reactive protein and serum albumin into the Glasgow Prognostic Score strongly discriminates survival of myelofibrosis patients
Get PDFRecombinant human bone morphogenetic protein 6 delivered within autologous blood coagulum restores critical size segmental defects of ulna in rabbits
Get PDFBMP2 and BMP7, which use bovine Achilles tendon-derived absorbable collagen sponge and bovine bone collagen as scaffold, respectively, have been approved as bone graft substitutes for orthopedic and dental indications. Here, we describe an osteoinductive autologous bone graft substitute (ABGS) that contains recombinant human BMP6 (rhBMP6) dispersed within autologous blood coagulum (ABC) scaffold. The ABGS is created as an injectable or implantable coagulum gel with rhBMP6 binding tightly to plasma proteins within fibrin meshwork, as examined by dot-blot assays, and is released slowly as an intact protein over 6 to 8 days, as assessed by ELISA. The biological activity of ABGS was examined in vivo in rats (Rattus norvegicus) and rabbits (Oryctolagus cuniculus). In a rat subcutaneous implant assay, ABGS induced endochondral bone formation, as observed by histology and micro-CT analyses. In the rabbit ulna segmental defect model, a reproducible and robust bone formation with complete bridging and restoration of the defect was observed, which is dose dependent, as determined by radiographs, micro-CT, and histological analyses. In ABGS, ABC scaffold provides a permissive environment for bone induction and contributes to the use of lower doses of rhBMP6 compared with BMP7 in bovine bone collagen as scaffold. The newly formed bone undergoes remodeling and establishes cortices uniformly that is restricted to implant site by bridging with host bone. In summary, ABC carrier containing rhBMP6 may serve as an osteoinductive autologous bone graft substitute for several orthopedic applications that include delayed and nonunion fractures, anterior and posterior lumbar interbody fusion, trauma, and nonunions associated with neurofibromatosis type I
Biomarkers in chronic graft-versus-host disease: quo vadis?
Get PDFBiomarkers are increasingly used for diagnosis and treatment of transplant-related complications including the first biomarker-driven interventional trials of acute graft-versus-host disease (GvHD). In contrast, the development of biomarkers of chronic GvHD (cGvHD) has lagged behind due to a broader variety of manifestations, overlap with acute GvHD, a greater variation in time to onset and maximum severity, and lack of sufficient patient numbers within prospective trials. An international workshop organized by a North-American and European consortium was held in Marseille in March 2017 with the goal to discuss strategies for future biomarker development to guide cGvHD therapy. As a result of this meeting, two areas were prioritized: the development of prognostic biomarkers for subsequent onset of moderate/severe cGvHD, and in parallel, the development of qualified clinical-grade assays for biomarker quantification. The most promising prognostic serum biomarkers are CXCL9, ST2, matrix metalloproteinase-3, osteopontin, CXCL10, CXCL11, and CD163. Urine-proteomics and cellular subsets (CD4+ T-cell subsets, NK cell subsets, and CD19+CD21low B cells) represent additional potential prognostic biomarkers of cGvHD. A joint effort is required to verify the results of numerous exploratory trials before any of the potential candidates is ready for validation and subsequent clinical application