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Tekuća biopsija kao opcija za terapijsku i dijagnostičku optimizaciju kod kolorektalnog karcinoma u nesveučilišnoj bolnici - pilot studija
No full textObjectives: This study aims to evaluate the feasibility and reliability of ctDNA analysis via liquid biopsy in a non-university clinical setting for patients with mCRC. Material and Methods: A total of 15 patients with mCRC were included in the study. Eleven patients had confirmed KRAS or BRAF mutations in tumor tissue, while four patients had KRAS/BRAF wild-type tumors. Peripheral blood samples were collected and analyzed for ctDNA to assess concordance with tumor tissue mutation status. Seven of the 11 mutation-positive patients underwent a second blood draw after several months to evaluate the reproducibility of ctDNA detection over time. All analyses were performed in a non-university clinical setting to determine the practicality of implementing liquid biopsy for ctDNA analysis outside of specialized research institutions. Results: This study demonstrates the feasibility of ctDNA analysis in a non-university hospital for detecting tumor mutations in mCRC, with a statistically significant association between tumor mutation status and ctDNA detection (Fisher’s Exact Test, p = 0.014; Chi-square, p = 0.013). The assay showed high specificity (100% in wild-type patients) and a PPV of 100%, with NPV of 75.1%. Limitations include a small sample size (n = 15), short follow-up, and variability in ctDNA shedding Conclusion: This study demonstrates that ctDNA analysis is feasible in a non-university hospital setting and effectively detects tumor mutations in mCRC patients. While its high specificity supports its diagnostic value, limitations reduce its reliability for therapy monitoring. Further large-scale studies are needed to validate its role in treatment adaptation and prognosis assessment.Ciljevi: Ova studija ima za cilj procijeniti izvedivost i pouzdanost analize cirkulirajuće tumorske DNK (ctDNA) putem tečne biopsije u ne-univerzitetskom kliničkom okruženju kod pacijenata s metastatskim kolorektalnim karcinomom (mCRC). Materijal i metode: U studiju je uključeno ukupno 15 pacijenata s mCRC-om. Jedanaest pacijenata imalo je potvrđene KRAS ili BRAF mutacije u tumorskom tkivu, dok su četiri pacijenta imala KRAS/BRAF divlji tip tumora. Uzorci periferne krvi prikupljeni su i analizirani na prisutnost ctDNA radi procjene podudarnosti s mutacijskim statusom tumorskog tkiva. Kod sedam od jedanaest pacijenata s mutacijom ponovljeno je uzimanje krvi nakon nekoliko mjeseci kako bi se procijenila stabilnost detekcije ctDNA tijekom vremena. Sve analize provedene su u ne-univerzitetskom kliničkom okruženju kako bi se ispitala primjenjivost tečne biopsije izvan specijaliziranih istraživačkih institucija. Rezultati: Studija potvrđuje izvedivost analize ctDNA u ne-univerzitetskoj bolnici za detekciju mutacija u mCRC-u, uz statistički značajnu povezanost između mutacijskog statusa tumora i detekcije ctDNA (Fisherov egzaktni test, p = 0,014; hi-kvadrat test, p = 0,013). Test je pokazao visoku specifičnost (100% kod pacijenata s divljim tipom tumora) i pozitivnu prediktivnu vrijednost (PPV) od 100%, dok je negativna prediktivna vrijednost (NPV) iznosila 75,1%. Ograničenja studije uključuju mali uzorak (n = 15), kratak period praćenja i varijabilnost oslobađanja ctDNA. Zaključak: Ova studija pokazuje da je analiza ctDNA izvediva u ne-univerzitetskom kliničkom okruženju te da učinkovito detektira tumorske mutacije kod pacijenata s mCRC-om. Iako visoka specifičnost potvrđuje njenu dijagnostičku vrijednost, ograničenja smanjuju njenu pouzdanost za praćenje terapije. Potrebne su daljnje studije većeg obujma kako bi se potvrdila njena uloga u prilagodbi liječenja i procjeni prognoze
Utjecaj ALPPS postupka na ukupno preživljavanje i postoperativni tijek u nesveučilišnom okruženju: retrospektivna analiza
No full textObjectives: The primary objective of this study was to assess the overall survival and postoperative course of patients undergoing the ALPPS procedure at the Sana Klinikum Coburg. Given the complex nature of ALPPS and its application in patients with advanced or otherwise non-resectable liver tumors, the study aimed to determine whether this two-stage surgical approach could offer meaningful survival outcomes despite its associated risks. In order to place the findings in a broader clinical context, a separate cohort of patients who underwent standard hemihepatectomy during the same period was analysed. Although this group was not intended as a direct control, it served to frame expectations regarding perioperative morbidity and survival following major liver resections. Methods: In total 44 medical records were analysed, containing 23 ALPPS and 21 hemihepatectomy patients between April 2019 and December 2024. Analysed variables included age at first surgery, sex, tumor entity, length of hospital stay, number of ICU days, interval between first and second operation (for ALPPS patients), presence and type of postoperative complications, occurrence of posthepatectomy liver failure (PHLF), and survival status at last follow-up. Statistical analyses were performed using the Mann–Whitney U test for continuous variables, Fisher’s exact test for categorical data, and Kaplan–Meier survival analysis to evaluate overall survival. A significance level of p < 0.05 was set. Results: The median overall survival was 438 days in the ALPPS group and 476 days in the hemihepatectomy group. Statistical comparison using the log-rank test showed no significant difference in survival between the two cohorts (p = 0.881), despite the more advanced disease burden typically present in ALPPS. In the ALPPS group, the one-year and two-year survival rates were 58.6% and 32.5%, respectively, while in the hemihepatectomy group, they were 61.5% and 41.0%. The median overall survival was 438 days for the ALPPS cohort and 476 days for the hemihepatectomy group. Statistical comparison using the log-rank test revealed no significant difference in overall survival between the two cohorts (p = 0.881). These results were visualized using a Kaplan–Meier survival curve, which graphically illustrated the overall survival of both groups over time. Postoperative complications were observed in both cohorts, however, posthepatectomy liver failure occurred exclusively in the ALPPS group, highlighting the increased physiological demands of this two-stage procedure. Additionally, there was a statistically significant association between the occurrence of complications and prolonged hospital stay in the ALPPS group (p = 0.010), a pattern not observed among patients treated with standard hemihepatectomy. Conclusion: All in all, the ALPPS procedure demonstrated promising overall survival outcomes in a non-university setting, suggesting its potential as a curative approach in selected patients. Nonetheless, the notable occurrence of posthepatectomy liver failure and its clinical impact emphasize the importance of thorough preoperative risk assessment.Ciljevi: Primarni cilj ove studije bio je procijeniti ukupno preživljenje i postoperativni tijek kod pacijenata podvrgnutih ALPPS postupku na Klinici Sana Coburg. S obzirom na složenost ALPPS-a i njegovu primjenu kod bolesnika s uznapredovalim ili kirurški nepristupačnim tumorima jetre, studija je imala za cilj utvrditi može li ovaj dvofazni kirurški pristup osigurati značajno preživljenje unatoč povezanim rizicima. Kako bi se rezultati stavili u širi klinički kontekst, analizirana je posebna kohorta pacijenata koji su podvrgnuti standardnoj hemihepatektomiji u istom razdoblju. Iako ova skupina nije služila kao izravna kontrola, pružila je referentni okvir za očekivanja u pogledu perioperativne morbiditeta i preživljenja nakon većih resekcija jetre. Metode: Analizirano je ukupno 44 medicinska dokumenta, koji uključuju 23 pacijenta liječenih ALPPS-om i 21 pacijenta liječenog standardnom hemihepatektomijom od travnja 2019. do prosinca 2024. godine. Analizirane varijable uključivale su dob pri prvoj operaciji, spol, entitet tumora, trajanje boravka u bolnici, broj dana provedenih na jedinici intenzivne njege (ICU), interval između prve i druge operacije (za ALPPS pacijente), prisutnost i tip postoperativnih komplikacija, pojavu post-hepatektomijskog zatajenja jetre (PHLF) i status preživljenja pri posljednjem praćenju. Statističke analize provedene su korištenjem Mann–Whitney U testa za kontinuirane varijable, Fisherovog egzakt testa za kategorizirane podatke, te Kaplan–Meier analize preživljenja. Granična vrijednost značajnosti (alfa) postavljena je na p < 0,05. Rezultati: Medijan ukupnog preživljenja iznosio je 438 dana u ALPPS skupini i 476 dana u hemihepatektomskoj skupini. Statistička usporedba log-rank testom pokazala je da nema značajne razlike u preživljenju između ovih kohorti (p = 0,881), unatoč većem stadiju bolesti u ALPPS pacijenata. Jednogodišnje stope preživljenja bile su 58,6 % za ALPPS i 61,5 % za hemihepatektomiju, dok su dvogodišnje stope bile 32,5 % i 41,0 %, redom. Ovi rezultati prikazani su Kaplan–Meier preživljenskom krivuljom koja grafički ilustrira trend preživljenja obje skupine tokom vremena. Postoperativne komplikacije javljale su se u obje kohorte; međutim, PHLF se pojavio isključivo u ALPPS grupi, što ukazuje na povećane fiziološke zahtjeve ovog dvofaznog postupka. Dodatno, statistički je značajna povezanost postojanja komplikacija s produljenim boravkom u bolnici u ALPPS skupini (p = 0,010), što nije bio slučaj u skupini pacijenata podvrgnutih standardnoj hemihepatektomiji. Zaključak: Sve u svemu, ALPPS-procedura pokazala je obećavajuće rezultate ukupnog preživljenja u ne-sveučilišnom okruženju, što upućuje na njezin potencijal kao kurativni pristup kod pažljivo odabranih pacijenata. Ipak, značajna pojavnost posthepatične insuficijencije jetre i njezin klinički učinak naglašavaju važnost temeljite preoperativne procjene rizika
Targeted therapy for patients with advanced ALK-positive non-small cell lung cancer – experiences of the Department of oncology and radiotherapy and the Department of pulmonary diseases, University hospital center Split
No full textCILJ ISTRAŽIVANJA: Primarni cilj istraživanja je ispitati učinkovitost i sigurnost primjene ciljane terapije u bolesnika s uznapredovalim ALK (engl. Anaplastic Lymphoma Kinase) pozitivnim NSCLC (engl. Non-Small Cell Lung Cancer) liječenih u Klinici za onkologiju i radioterapiju i Klinici za plućne bolesti Kliničkog bolničkog centra Split te dobivene rezultate usporediti s rezultatima iz međunarodnih znanstvenih izvora. MATERIJALI I METODE: Retrospektivno su analizirani podatci iz povijesti bolesti 30 bolesnika s dijagnozom ALK pozitivnog NSCLC koji su liječenje ciljanom terapijom započeli u periodu od studenog 2015. godine do kraja prosinca 2024. godine. Prikupljeni podatci o bolesnicima su uključivali: datum rođenja, spol, ECOG (engl. Eastern Cooperative Oncology Group) i pušački status, datum i tehniku dijagnoze bolesti, broj linija kemoterapije prije iniciranja ciljanog liječenja, histološki podtip karcinoma te mjesto i broj zahvaćenih organskih sustava tumorom. Karakteristike liječenja koje su praćene su: datum početka istog, odabrani lijek u pojedinoj liniji, odgovor na liječenje, sijelo eventualne progresije, razlog eventualnog prekida i/ili redukcije doze te pojava i gradus pojedine nuspojave. REZULTATI: Medijan praćenja za cjelokupnu populaciju iznosi 1052 dana, za subpopulaciju liječenu prvolinijskim alektinibom, odnosno krizotinibom iznosi 1086 i 881,5 dana. Medijan preživljenja bez progresije za bolesnike liječene prvolinijskim alektinibom iznosi 1387 dana, a one liječene prvolinijskim krizotinibom iznosi 207 dana. Medijan ukupnog preživljenja iznosi 2442 dana. Za bolesnike liječene prvolinijskim alektinibom nije dosegnuta vjerojatnost od 50% preživljenja potrebna za izračun medijana, dok za one liječene prvolinijskim krizotinibom medijan ukupnog preživljenja iznosi 854 dana. Stopa odgovora (RR) kod naših bolesnika liječenih prvolinijskim alektinibom je 76%, a RR prvolinijskog krizotiniba iznosi 63%. U skupini inicijalno liječenoj alektinibom 14 bolesnika (67%) je primilo samo prvolinijsku terapiju, a sedam bolesnika (33%) je primilo drugu liniju liječenja. U skupini liječenoj prvolinijskim krizotinibom su tri bolesnika primala samo inicijalnu liniju liječenja, jednak broj primio je dvije linije liječenja dok su dva bolesnika (25%) primila tri linije liječenja ciljanom terapijom. Toksičnost ciljane terapije u našem istraživanju bila je u skladu s nuspojavama ranije spominjanih kliničkih istraživanja. ZAKLJUČAK: Ovo retrospektivno istraživanje o liječenju bolesnika s uznapredovalim ALK pozitivnim NSCLC ciljanom terapijom pokazalo je usporedive rezultate učinkovitosti i toksičnosti s rezultatima kliničkih istraživanja ciljane terapije iz dostupnih međunarodnih znanstvenih izvora.OBJECTIVES: The primary objective of the study is to evaluate the efficacy and safety of targeted therapy in patients with advanced ALK (Anaplastic Lymphoma Kinase)-positive NSCLC (Non-Small Cell Lung Cancer) treated at the Department of Oncology and Radiotherapy and the Department of Pulmonary Diseases at University Hospital of Split, and to compare the obtained results with those from international scientific sources. MATERIALS AND METHODS: A retrospective analysis was conducted on medical records of 30 patients diagnosed with ALK-positive NSCLC who were treated with targeted therapy from November 2015 to the end of December 2024. Collected patient data included: date of birth, sex, ECOG performance status, smoking status, date and method of disease diagnosis, number of chemotherapy lines prior to targeted treatment initiation, histological subtype of carcinoma, as well as the location and number of organ systems affected by the tumor. Treatment characteristics monitored were: treatment start date, selected drug in each treatment line, response to therapy, site of any progression, reason for treatment discontinuation and/or dose reduction, and occurrence and grade of individual adverse events. RESULTS: The median follow-up for the entire population was 1,052 days. For the subpopulation treated with first-line alectinib and crizotinib, the median follow-up was 1,086 and 881.5 days, respectively. The median progression-free survival (PFS) for patients treated with first-line alectinib was 1,387 days, while for those treated with first-line crizotinib it was 207 days. The median overall survival (OS) was 2,442 days. For patients treated with first-line alectinib, the probability of 50% survival required to calculate the median OS was not reached, while for those treated with first-line crizotinib, the median overall survival was 854 days. The response rate (RR) among our patients treated with first-line alectinib was 76%, and the RR for first-line crizotinib was 63%. In the group initially treated with alectinib, 14 patients (67%) received only first-line therapy, while seven patients (33%) received second-line treatment. In the group treated with first-line crizotinib, three patients received only initial therapy, the same number received two lines of therapy, and two patients (25%) received three lines of targeted therapy. The toxicity of targeted therapy in our study was consistent with the adverse events previously reported in clinical trials. CONCLUSION: This retrospective study on targeted therapy treatment in patients with advanced ALK-positive NSCLC demonstrated efficacy and toxicity results comparable to those reported in clinical trials of targeted therapy from available international scientific sources
Impact of therapy adherence in patients with obstructive sleep apnea on daytime sleepiness, sleep quality, and anthropometric measures
No full textCilj istraživanja: Cilj ovog istraživanja bio je ispitati pridržavanje terapije kontinuiranim pozitivnim tlakom u dišnim putovima (CPAP) u bolesnika s teškom opstrukcijskom apnejom tijekom spavanja (OSA) te utjecaj pridržavanja na kvalitetu spavanja i dnevnu pospanost. Ispitanici i postupci: Uključeno je 87 bolesnika s teškom OSA-om. Svi su prije i nakon praćenja ispunili upitnike o dnevnoj pospanosti (engl. Epworth Sleepiness Scale, ESS) i kvaliteti spavanja (engl. Pittsburgh Sleep Quality Index, PSQI). Prikupljeni su podaci o kroničnim bolestima (arterijska hipertenzija, šećerna bolest, astma, depresija, GERB) i antropometrijske mjere. Adherencija na CPAP terapiju je procijenjena analizom memorijskih kartica uređaja. Rezultati: Od ukupno 87 bolesnika, 41 imalo je dobru adherenciju na CPAP terapiju, dok je 46 imalo lošu adherenciju. Dobra adherencija definirana kao korištenje CPAP uređaja ≥4 sata po noći u najmanje 70% dana tijekom godine. Nije bilo značajnih razlika u dobi, spolu ni početnim vrijednostima AHI-ja između skupina. Prisutnost kroničnih bolesti nije se značajno razlikovala između skupina. U skupini s dobrom adherencijom prosječan udio dana korištenja u godini dana jest 94,62 ± 7,19% dana, dok je u ispitanika s lošom adherencijom 30 ± 33,94% dana (P<0,001). Također se razlikuje korištenje CPAP pomagala ≥4 sata/dan u intervalu od godine dana. U skupini s dobrom adherencijom je 89,45 ± 10,27% dana u godini, dok je u skupini s lošom adherencijom 22,74 ± 25,17% dana u godini (P<0,001). U danima korištenja CPAP-a, prosječan broj sati upotrebe CPAP pomagala u danu se također razlikuje među skupinama. U skupini s dobrom adherencijom, prosječan broj sati korištenja u danu iznosi 6,65 ± 1,17 sati, dok je u skupini s lošom adherencijom 2,49 ± 2,67 sati u danu (P<0,001). Bolesnici s dobrom adherencijom imali su značajno smanjenu dnevnu pospanost (ESS: sa 7,38±5,23 na 3,03±2,13; P<0,001) i poboljšanu kvalitetu spavanja (PSQI: sa 6,95±2,60 na 3,89 ± 2,77; P<0,001). Tijekom jednogodišnjeg praćenja nije utvrđena značajna promjena u antropometrijskim mjerama u obje skupine. Zaključak: Korištenje CPAP terapije u bolesnika s teškom OSA-om značajno smanjuje dnevnu pospanost i poboljšava kvalitetu spavanja, dok nije dokazana značajna povezanost adherencije u zadnjih godinu dana s promjenama antropometrijskih mjera.Objectives: The aim of this study was to examine the impact of adherence to continuous positive airway pressure (CPAP) therapy in patients with severe obstructive sleep apnea (OSA) on the course and outcome of chronic diseases associated with OSA, as well as on sleep quality and daytime sleepiness. Subjects and methods: A total of 87 patients with severe OSA were included. All participants completed questionnaires on daytime sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) before and after the follow up period. Data on chronic diseases (arterial hypertension, diabetes, asthma, depression, GERD) and anthropometric measurements were collected. Adherence to CPAP therapy was assessed by analyzing the device’s memory cards. Results: Out of a total of 87 patients, 41 had good adherence to CPAP therapy, while 46 had poor adherence. Good adherence was defined as using the CPAP device for ≥4 hours per night on at least 70% of days during the year. There were no significant differences in age, sex, or baseline AHI values between the groups. The presence of chronic diseases did not differ significantly between the groups. In the good adherence group, the average number of days of CPAP use over one year was 94.62 ± 7.19%, whereas in the poor adherence group it was 30 ± 33.94% (P < 0.001). There was also a significant difference between the groups in the use of CPAP devices for ≥4 hr/day over the one year period. In the good adherence group, this was 89.45 ± 10.27% of days per year, while in the poor adherence group it was 22.74 ± 25.17% of days per year (P < 0.001). On the days CPAP was used, the average number of hours of CPAP use per day also differed between groups. In the good adherence group, the average daily usage was 6.65 ± 1.17 hours, while in the poor adherence group it was 2.49 ± 2.67 hours per day (P < 0.001). Patients with good adherence had a significantly greater reduction in daytime sleepiness (ESS: from 7.38 ± 5.23 to 3.03 ± 2.13; P < 0.001) and improvement in sleep quality (PSQI: from 6.95 ± 2.60 to 3.89 ± 2.77; P < 0.001). During the one year follow up, no significant changes were observed in anthropometric measures in either group. Conclusions: Good adherence to CPAP therapy in patients with severe OSA significantly reduces daytime sleepiness and improves sleep quality, while no significant association was found between adherence and changes in anthropometric measures during the last-year follow-up
Dynamics of inflammatory parameters in hospitalized and surgically treated patients with odontogenic abscesses
No full textCiljevi: Cilj je bio ispitati vremensku dinamiku serumske razine hs-CRP-a i PCT-a tijekom bolničkog liječenja bolesnika s odontogenim apscesima. Ispitanici i postupci: U istraživanje je uključeno 30 bolesnika s radiološki i klinički potvrđenim odontogenim apscesima. Mjerenja PCT-a i hs-CRP-a provedena su neposredno prije kirurškog zahvata incizije i drenaže kolekcije, te nakon 6, 24, 48 i 96 sati. Provedena je analiza promjena realnih vrijednosti i relativnih udjela u odnosu na početnu razinu. Rezultati: Početna vrijednost PCT-a iznosila je 0,775 ± 0,253 ng/mL, a hs-CRP-a 124,8 ± 86,3 mg/L. Nakon 24 sata, PCT je pao na 0,338 ± 0,161 ng/mL (p = 0,038), dok je hs-CRP smanjen na 92,9 ± 81,2 mg/L (p = 0,014). Do 96. sata PCT je dodatno pao na 0,110 ± 0,061 ng/mL, a hs-CRP na 19,5 ± 16,4 mg/L. Srednji udio smanjenja po satu bio je 1,90% za PCT i 1,66% za hs-CRP (p = 0,321). Statistički značajno veća promjena relativnog udjela prokalcitonina u usporedbi s hs-CRP-om je pronađena tijekom prvih 6 sati (19,6 (13,6-27,7) % vs 7,4 (0,2-25,7) %; p = 0,004) dok je statistički značajno veća promjena relativnog udjela hs-CRP pronađena u periodu 24-48 sati nakon kirurškog zahvata (31,9 (28,9-35,0) % vs 51,7 (30,5-57,4) %; p < 0,001). Najčešće izolirani patogen bio je Streptococcus spp. (70%). Svi bolesnici liječeni su kirurškom drenažom i antibiotskom terapijom. Zaključci: Serumske razine PCT-a i hs-CRP-a značajno opadaju nakon kirurške incizije i drenaže, pri čemu PCT pokazuje bržu dinamiku smanjenja u ranom postoperativnom razdoblju. Serijsko praćenje ovih biomarkera može imati dodatnu vrijednost u procjeni odgovora na terapiju kod bolesnika s odontogenim apscesima.Objectives: The aim of this study was to evaluate the temporal dynamics of serum hs-CRP and PCT levels during hospital treatment of patients with odontogenic abscesses. Subjects and methods: Thirty patients with clinically and radiologically confirmed odontogenic abscesses were included. Serum levels of PCT and hs-CRP were measured at admission and at 6, 24, 48, and 96 hours postoperatively. Changes in absolute values and relative percentages compared to baseline were analyzed statistically. Results: Initial PCT levels were 0.775 ± 0.253 ng/mL, and hs-CRP levels were 124.8 ± 86.3 mg/L. After 24 hours, PCT decreased to 0.338 ± 0.161 ng/mL (p = 0.038), and hs-CRP to 92.9 ± 81.2 mg/L (p = 0.014). By 96 hours, PCT further declined to 0.110 ± 0.061 ng/mL, and hs- CRP to 19.5 ± 16.4 mg/L. The average rate of decrease per hour was 1.90% for PCT and 1.66% for hs-CRP (p = 0.321). A statistically significant greater change in the relative proportion of procalcitonin compared to hs-CRP was found during the first 6 hours (19.6 (13.6-27.7) % vs 7.4 (0.2-25.7) %; p = 0.004) while a statistically significant greater change in the relative proportion of hs-CRP was found in the period 24-48 hours after surgery (31.9 (28.9-35.0) % vs 51.7 (30.5-57.4) %; p < 0.001). Streptococcus spp. was the most frequently isolated pathogen (70%). All patients underwent surgical drainage and received empirical antibiotic therapy. Conclusions: Serum levels of PCT and hs-CRP significantly decrease during treatment, with PCT demonstrating a faster decline in the early postoperative period. Serial monitoring of these biomarkers may provide additional value in assessing therapeutic response in patients with odontogenic abscesses
Obrada bolesnika sa sumnjom na demenciju putem dnevne bolnice na Klinici za Neurologiju, Klinički bolnički centar (KBC) Split
No full textObjectives: The aim of this thesis was to evaluate the diagnostic process for patients referred to the Day Hospital of the Department of Neurology at the University Hospital Centre Split due to suspected dementia. The study sought to assess the frequency and type of recommended and performed diagnostic procedures, identify patterns in clinical decision-making, and evaluate the level of adherence to standard diagnostic guidelines. Materials and Methods: This retrospective study included 32 patients who were admitted to the Day Hospital in 2024 with suspected cognitive decline. Medical records were reviewed to collect data on demographic characteristics, recommended and performed diagnostic procedures, and documentation of clinical decision-making. Descriptive statistics were used to present frequencies and distributions of tests performed. Results: The most frequently recommended diagnostic procedures were neuropsychological testing (68.8%), MSCT of the brain (43.8%), laboratory testing (vitamin B12, folic acid, TSH), and neck ultrasound. However, 18.8% of patient records lacked any documented diagnostic recommendations. Among procedures performed, MSCT of the brain (59.4%) and neuropsychological testing (43.8%) were most common. Less frequently performed diagnostics included EEG, MRI, and psychiatric evaluations. Several specialized tests, though clinically relevant in certain contexts, were rarely recommended or utilized. A discrepancy was noted between suggested and actually performed procedures in some cases. Conclusions: The Day Hospital provides an effective and resource-efficient setting for the initial diagnostic evaluation of suspected dementia. Most patients were recommended with appropriate core diagnostics; however, inconsistencies in documentation and limited use of interdisciplinary evaluations suggest a need for more standardized diagnostic protocols. Structured documentation, clear diagnostic pathways, and better interdisciplinary collaboration could further improve the quality and consistency of outpatient dementia care.Ciljevi: Cilj ovog diplomskog rada bio je evaluirati dijagnostički proces bolesnika upućenih u
Dnevnu bolnicu Zavoda za neurologiju Kliničkog bolničkog centra Split zbog sumnje na
demenciju. Istraživanje je imalo za cilj ispitati učestalost i vrstu preporučenih i provedenih
dijagnostičkih postupaka, prepoznati obrasce u kliničkom odlučivanju te ocijeniti razinu
usklađenosti s važećim dijagnostičkim smjernicama.
Materijali i metode: Ovo retrospektivno istraživanje obuhvatilo je 32 bolesnika koji su
tijekom 2024. godine bili dijagnostički obrađeni u Dnevnoj bolnici zbog sumnje na kognitivni
pad. Medicinska dokumentacija analizirana je s ciljem prikupljanja podataka o demografskim
karakteristikama, preporučenim i provedenim dijagnostičkim postupcima te dokumentaciji
kliničkih odluka. Za prikaz rezultata korištena je deskriptivna statistika.
Rezultati: Najčešće preporučene dijagnostičke pretrage bile su neuropsihološko testiranje
(68,8%), MSCT mozga (43,8%), laboratorijske pretrage (vitamin B12, folna kiselina, TSH) i
ultrazvuk vratnih krvnih žila. U 18,8% slučajeva nije bila dokumentirana nikakva dijagnostička
preporuka. Od provedenih postupaka, najzastupljeniji su bili MSCT mozga (59,4%) i
neuropsihološko testiranje (43,8%). Rjeđe su izvođene pretrage poput EEG-a, magnetske
rezonancije i psihijatrijske procjene. Uočen je nesrazmjer između preporučenih i stvarno
provedenih dijagnostičkih postupaka u određenom broju slučajeva.
Zaključci: Dnevna bolnica pokazala se učinkovitim i resursno racionalnim okruženjem za
početnu dijagnostičku obradu bolesnika sa sumnjom na demenciju. Većina bolesnika prošla je
temeljne dijagnostičke postupke, no uočene su nedosljednosti u dokumentiranju i ograničena
primjena multidisciplinarnog pristupa. Standardizacija protokola, poboljšanje dokumentacije i
jačanje suradnje među stručnjacima mogli bi dodatno unaprijediti kvalitetu i konzistentnost
dijagnostičke obrade u ambulantnim uvjetima
Myocardial work characteristics in patients with multivessel coronary artery disease assessed by advanced echocardiographic methods at the University Hospital of Split
No full textCilj istraživanja: Glavni cilj istraživanja je utvrditi ehokardiografske karakteristike bolesnika s višežilnom koronarnom bolesti (MVCAD) liječenih na Klinici za bolesti srca i krvnih žila Kliničkog bolničkog centra Split služeći se naprednom speckle tracking ehokardiografijom i myocardial work (MW) analizom te usporediti konvencionalne i napredne parametre između bolesnika s MVCAD-om i kroničnom totalnom okluzijom (CTO) i bez nje. Ispitanici i metode: Ovo presječno i retrospektivno istraživanje provedeno je u Kliničkom bolničkom centru Split na bolesnicima s MVCAD-om hospitaliziranim između 1.1.2023. i 1.1.2025. Uključeno je 140 odraslih bolesnika s potvrđenim MVCAD-om, podijeljeni u skupine s i bez CTO-a. Svi su podvrgnuti koronarografiji i naprednoj ehokardiografskoj analizi, uključujući speckle tracking ehokardiografiju i analizu globalne logitudinalne deformacije (LVGLS) i MW parametara: globalni indeks srčanog rada (GWI), globalni korisni srčani rad (GCW), globalni izgubljeni srčani rad (GWW) i globalna srčana učinkovitost (GWE) pomoću softvera EchoPAC. Analizirani su i klasični parametri: ejekcijska frakcija (LVEF), volumeni lijeve klijetke na kraju sistole (LVESV) i dijastole (LVEDV). Uz to su prikupljeni klinički, laboratorijski i hemodinamski podatci. Rezultati: U istraživanje je bilo uključeno 140 bolesnika (78,6 % muškaraca, srednja dob 67 godina). Ispitanici se nisu značajno razlikovali prema dobi, spolu, hemodinamskim, laboratorijskim i terapijskim pokazateljima. Analizirani su ehokardiografski parametri 137 ispitanika podjeljenih u skupine MVCAD+CTO i MVCAD bez CTO-a. Ispitanici skupine MVCAD+CTO imali su statistički značajno niže vrijednosti LVEF (P=0,024) i više vrijednosti LVESV (P=0,002) i LVEDV (P=0,003), lošiji LVGLS (-13,62% naspram -15,21%, P=0,024) i granično značajno niže vrijednosti GWE (86,23% naspram 88,41%, P=0,05). GWI, GCW i GWW nisu se razlikovali među skupinama. GWW pokazao je povezanost s CTO-om u lijevom glavnom deblu (P=0,05). Zaključak: LVGLS i GWE pokazali su potencijalnu vrijednost u ranom prepoznavanju mehaničke disfunkcije miokarda kod bolesnika s kompleksnom koronarnom bolesti, osobito u prisutnosti CTO-a. Ovi parametri mogu nadopuniti klasične dijagnostičke metode i pridonijeti boljoj procjeni bolesnika. Potrebna su daljnja istraživanja na većim populacijama kako bi se potvrdila klinička primjenjivost ovih parametara.Objectives: The main aim of this study is to determine the echocardiographic characteristics of patients with multivessel coronary artery disease (MVCAD) treated at the University Hospital of Split, using advanced speckle tracking echocardiography and myocardial work (MW) analysis. Furthermore, the goal is to compare conventional and advanced echocardiographic parameters between patients with MVCAD with and without chronic total occlusion (CTO). Subjects and methods: This cross-sectional and retrospective study was conducted at the University Hospital of Split on patients with MVCAD who were hospitalized between January 1st, 2023, and January 1st, 2025. A total of 140 adult patients with confirmed MVCAD were included, divided into groups with and without CTO. All patients underwent coronary angiography and advanced echocardiographic analysis, including speckle tracking echocardiography and assessment of global longitudinal strain (LVGLS) and MW parameters: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE), using EchoPAC software. Conventional parameters such as left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) were also analyzed. In addition, clinical, laboratory, and hemodynamic data were collected. Results: A total of 140 patients were included in the study (78.6% male, mean age 67 years). There were no significant differences between groups regarding age, sex, hemodynamic, laboratory, or therapeutic indicators. Echocardiographic parameters were analyzed in 137 patients, divided into MVCAD+CTO and MVCAD without CTO groups. Patients in the MVCAD+CTO group had significantly lower LVEF (P=0.024) and higher LVESV (P=0.002) and LVEDV (P=0.003) values, worse LVGLS (-13.62% vs. -15.21%, P=0.024), and borderline significantly lower GWE (86.23% vs. 88.41%, P=0.05). GWI, GCW, and GWW did not differ significantly between groups. However, GWW showed an association with CTO in the left main coronary artery (P=0.05). Conclusion: LVGLS and GWE demonstrated potential value in the early detection of myocardial mechanical dysfunction in patients with complex coronary artery disease, particularly in the presence of CTO. These parameters may complement conventional diagnostic methods and improve patient assessment. Further studies on larger populations are needed to confirm the clinical applicability of these parameters
Cochrane - Evidence Based Medicine : Leading medical guidelines expert visits Split: ‘Certainty in evidence is key to treatment’
No full textIntracerebral hemorrhage in patients treated with warfarin versus novel oral anticoagulants (NOACs) and treatment outcomes over a 6-year period (2019–2024)
No full textCilj istraživanja: Odrediti postoji li značajna razlika u incidenciji intracerebralnog krvarenja, funkcionalnim ishodima nakon liječenja, prediktivnim parametrima i incidenciji smrtnih ishoda kod bolesnika s ICH-om koji uzimaju varfarin u odnosu na bolesnike koji uzimaju nove oralne antikoagulantne lijekove. Ispitanici i metode: U ovo retrospektivno kohortno istraživanje uključen je 91 bolesnik koji je tijekom šestogodišnjeg razdoblja (2019. – 2024.) doživio intracerebralno krvarenje za vrijeme uzimanja antikoagulantne terapije. Rezultati: Od ukupnog broja ispitanika s ICH na antikoagulantnoj terapiji, 47 (51,65 %) ih je uzimalo varfarin, a 44 (48,35 %) je uzimalo NOAK-e. Zabilježena je statistička značajna promjena udjela ICH kroz godine u skupini bolesnika s ICH-om na NOAK-ima (P=0,044). U skupini bolesnika s ICH-om koja je uzimala varfarin zabilježena je statistički veća incidencija smrtnog ishoda u odnosu na one koji su uzimali NOAK-e (78,72 %; P=0,043) te veće vrijednosti ICH score-a u odnosu na bolesnike na NOAK-ima (P=0,021). Zabilježene su statistički značajne razlike u vrijednosti koagulacijskih parametara između bolesnika s ICH-om na varfarinu i na NOAK-ima (PV; P=0,047, INR; P<0,001). Funkcionalni ishodi nisu se statistički značajno razlikovali između bolesnika s ICH-om na varfarinu i onih na NOAK-ima, a razlike nisu uočene ni među bolesnicima s ICH-om na različitim NOAK-ima. Zaključak: Broj bolesnika koji je doživio intracerebralno krvarenje u promatranom razdoblju bio je veći za skupinu bolesnika koja je uzimala varfarin u odnosu na NOAK-e. Zabilježen je statistički značajan porast udjela ICH-a među bolesnicima na NOAK-ima, što je u skladu s većom primjenom NOAK-a i promjenama smjernica. Nije utvrđena značajna razlika u funkcionalnim ishodima i prediktivnim neurovaskularnim score-ovima između bolesnika s ICH-om na varfarinu i NOAK-ima. ICH score bio je značajno viši u skupini bolesnika s ICH-om na varfarinu, iako razlika u volumenu krvarenja nije bila značajna. Mortalitet je bio statistički značajno viši u skupini bolesnika s ICH-om na varfarinu u odnosu na one na NOAK-ima. Među bolesnicima s ICH-om koji su bili na terapiji različitim NOAK-ima, nije utvrđena statistički značajna razlika u volumenu krvarenja, funkcionalnim ishodima ni stopi smrtnosti.Aim of the Study: The primary objective of this study was to determine whether there is a significant difference in the incidence of intracerebral hemorrhage (ICH), functional outcomes after treatment, predictive scores and mortality rates among patients who suffered intracerebral hemorrhage while taking warfarin or novel oral anticoagulants (NOACs). Subjects and Methods: This retrospective cohort study included 91 patients who experienced an intracerebral hemorrhage during anticoagulant therapy over a six-year period (2019–2024). Results: Among the patients with ICH while on anticoagulant therapy, 47 (51.65 %) were taking warfarin and 44 (48.35 %) were taking NOACs. A statistically significant increase in the proportion of ICH cases over time was observed in the NOAC group (P=0.044). The warfarin group showed a significantly higher mortality rate compared to the NOAC group (78.72 %; P=0.043), as well as significantly higher ICH scores (P=0.021). Significant differences in coagulation parameters were found between the warfarin and NOAC groups (PT: P=0.047; INR: P<0.001). No statistically significant difference was found in functional outcomes between the warfarin and NOAC groups, nor between different NOACs. Conclusion: During the observed period, more patients experienced intracerebral hemorrhage while on warfarin compared to those on NOACs. A statistically significant increase in the proportion of ICH was observed in the NOAC group, in line with updated guidelines and increased use of NOACs in clinical practice. No significant difference was found in functional outcomes or predictive neurovascular scores between the two groups. The ICH score was significantly higher in the warfarin group, although the difference in hemorrhage volume was not statistically significant. Mortality was significantly higher among patients taking warfarin compared to those taking NOACs. In patients with ICH receiving different NOAC therapies, no statistically significant differences were observed in hematoma volume, functional outcomes, or mortality rates
Elixhauser's index (EI) of comorbidity and the "weekend effect" as predictors of mortality in patients undergoing endovascular mechanical thrombectomy for ischemic stroke
No full textUvod: Akutni ishemijski moždani udar (AIMU), kao cerebrovaskularna bolest nastala najčešće kao posljedica tromboembolijskog zbivanja, čini osnovu ovog istraživanja kojemu je za cilj bilo istražiti je li vrijeme izvođenja endovaskularne mehaničke trombektomije (EMT) (radni dan ili vikend), zajedno s pridruženim komorbiditetima, utječe na lošiji ishod bolesnika nakon zahvata. Ispitanici i metode: U ovom retrospektivnom istraživanju analizirani su podatci o 249 bolesnika koji su liječeni od akutnog ishemijskog moždanog udara (AIMU) u Kliničkom bolničkom centru Split (KBC). Podatci su dobiveni iz medicinske dokumentacije pohranjene u Radiološkom informacijskom sustavu (RIS) Iz nalaza intervencijskih radiologa dobiveni su rezultati o uspješnosti EMT-e [mTICI bodovanje (engl. Modified treatment in cerebral infarction score)]. Prema podatcima s hitnog prijama određen je NIHSS (engl. National institutes of health stroke scale) broj bodova te su prikupljeni podaci pomoću kojih se računao Elixhauserov indeks (EI) komorbiditeta. Podatci o konačnom ishodu liječenja [ mRS (engl. Modified Rankin scale)] su dobiveni iz otpusnih pisama Klinike za neurologiju KBC-a Split. Rezultati: Od 249 bolesnika, bilo je 108 muškaraca i 141 žena, a medijan dobi bolesnika bio je 76 godina. Dob (P=0.169) i spol (P=0,452) nisu statistički značajno utjecali na smrtnost. Razlika u uspješnosti trombektomije nije bila statistički značajna ni prema dobi (P=0,766), niti je bilo razlike između spolova (P=0,589). Bolesnici s većim EI komorbiditeta nisu imali veću smrtnost u odnosu na one s nižim indeksom (P=0,121). Preminuli bolesnici imali su statistički značajno viši NIHSS broj bodova u odnosu na preživjele (P=0,036). Bolesnici kojima je nakon trombektomije postignuta potpuna rekanalizacija i reperfuzija imaju značajno nižu smrtnost u odnosu na one kojima je ona bila nepotpuna (P=0,001; 20% naprema 42%). Najviše je EMT-a obavljeno tijekom radnog dana (160, 64%), dok je tijekom vikenda taj broj manji (89, 36%). Smrtnost bolesnika nije se značajno razlikovala vikendom u odnosu na radne dane (P=0,273). Najviše je EMT-a obavljeno zimi (97, 39%). Smrtnost je bila statistički značajno veća zimi (P=0,019, 14,3%), za razliku od jeseni za koju je dokazano da je imala statistički značajno manju smrtnost (P=0,010, 34%). Zaključak: Rezultati navedenog istraživanja pokazali su kako su za ishod i prognozu liječenja bolesnika oboljelih od AIMU-a statistički značajni godišnje doba, NIHSS broj bodova te uspješnost obavljene trombektomije, dok ostali faktori nisu pokazali značajnu razliku.Objectives: Acute ischemic stroke (AIS), as a cerebrovascular disease that most often occurs as a result of thromboembolic events, forms the basis of this study, the aim of which was to investigate whether the time of endovascular mechanical thrombectomy (EMT), together with associated comorbidities, have an impact on the worse outcome of patients after the procedure. Subjects and methods: In this retrospective study, data on 249 patients treated for AIS at the University Hospital of Split (UHS), were analyzed. Data were obtained from medical records stored in the Radiological information system (RIS). Results on the success of EMT [mTICI (modified Treatment in Cerebral Infarction score)] were obtained from the findings of interventional radiologists. According to the data from the emergency room, the NIHSS (National Institutes of Health Stroke Scale) score was determined, and comorbidities were found, which were used to calculate the EI of comorbidity. Data about the outcome of treatment, mRS (modified Rankin Scale) were obtained from the discharge letters of the Department of Neurology, UHS. Results: Of the 249 patients, there were 108 men and 141 women, and the median age of the patients was 76 years. The age (P=0.169) and sex (P=0.452) were not statistically significant for mortality. The difference in the success of thrombectomy was not statistically significant by age (P=0.766) neither by sex (P=0.589). Patients with higher EI comorbidities did not have a higher mortality compared to those with a lower index (P=0.121). Deceased patients had a statistically significantly higher NIHSS score compared to survivors (P=0.036). Patients who achieved complete recanalization and reperfusion after thrombectomy had a significantly lower mortality compared to those who had incomplete recanalization and reperfusion (P=0.001; 20% vs. 42%). Most EMTs were performed during the weekday (160, 64%), while the number was lower during the weekend (89, 36%). Patient mortality did not differ significantly on weekends compared to weekdays (P=0.273). Most EMTs were performed in winter (97, 39%). Mortality was statistically significantly higher in winter (P=0.019, 14.3%), in contrast to autumn which was shown to have statistically significantly lower mortality (P=0.010, 34%). Conclusion: The results of the study showed that the season, NIHSS score, and success of thrombectomy are important for the outcome and prognosis of treatment of patients with AIS after EMT, while other factors did not show a significant difference