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Retrospektivna analiza učinka primjene protamin sulfata na krvarenje nakon venskog pristupa velikog promjera u bolesnika koji su podvrgnuti transkateterskim postupcima popravka od ruba do ruba (TEER)
No full textBackground: Major bleeding is a common and severe complication of transcatheter edge-to-edge repair (TEER) for mitral regurgitation, affecting procedural outcomes and patient recovery. While protamine is routinely used in transcatheter aortic valve replacement to reverse heparin effects and reduce bleeding, its role in TEER remains unclear. This study evaluates the impact of protamine administration on bleeding complications and transfusion requirements in TEER procedures. Methods: A single-center, retrospective analysis was conducted on 231 patients with severe symptomatic MR who underwent TEER between January 2021 and December 2023. Patients were divided into a test and a control group. The patients in the test group received protamine, whereas the control group was managed conventionally. The primary endpoints included the incidence of major and minor bleeding, defined by BARC criteria, and transfusion requirements. Secondary endpoints assessed thromboembolic events, procedural safety, and overall outcomes. Results: The administration of protamine significantly reduced major bleeding complications (p = 0.042) without increasing thromboembolic risks. The need for blood transfusions showed a trend toward reduction (p = 0.051). Minor bleeding rates and vascular complications remained comparable between groups. No ischemic strokes were observed in the protamine group, and no increase in procedural complications, including cardiac tamponade, was noted. Conclusions: Protamine administration in TEER appears to be a safe and effective strategy to minimize major bleeding complications without increasing thromboembolic risk. Further multicenter studies with larger cohorts are needed to confirm these findings and guide anticoagulation management protocols for TEER patients.Pozadina: Velika krvarenja česta su i ozbiljna komplikacija transkateterskog popravka mitralnog zaliska (TEER), što utječe na ishod zahvata i oporavak pacijenata. Iako se protamin rutinski koristi u transkateterskoj zamjeni aortnog zaliska za neutralizaciju učinka heparina i smanjenje krvarenja, njegova uloga u TEER postupcima ostaje nejasna. Ova studija procjenjuje učinak primjene protamina na komplikacije povezane s krvarenjem i potrebu za transfuzijama tijekom TEER postupaka. Metode: Provedena je retrospektivna analiza u jednom centru na 231 pacijentu s teškom simptomatskom mitralnom regurgitacijom koji su podvrgnuti TEER-u između siječnja 2021. i prosinca 2023. Pacijenti su podijeljeni u testnu i kontrolnu skupinu. Pacijenti u testnoj skupini primili su protamin, dok je kontrolna skupina liječena konvencionalnim pristupom. Primarni ishodi uključivali su učestalost velikih i manjih krvarenja, definiranu prema BARC kriterijima, te potrebu za transfuzijama. Sekundarni ishodi procjenjivali su tromboembolijske događaje, sigurnost postupka i ukupne ishode. Rezultati: Primjena protamina značajno je smanjila učestalost velikih krvarenja (p = 0,042) bez povećanja tromboembolijskog rizika. Potreba za transfuzijama pokazala je trend smanjenja (p = 0,051). Stope manjih krvarenja i vaskularnih komplikacija bile su usporedive između skupina. U skupini pacijenata koji su primili protamin nije zabilježen nijedan slučaj ishemijskog moždanog udara, a nije uočeno ni povećanje proceduralnih komplikacija, uključujući srčanu tamponadu. Zaključak: Primjena protamina u TEER postupcima pokazuje se kao sigurna i učinkovita strategija za smanjenje velikih komplikacija s krvarenjem bez povećanja tromboembolijskog rizika. Potrebne su daljnje multicentrične studije s većim brojem pacijenata kako bi se potvrdili ovi nalazi i optimizirali protokoli za upravljanje antikoagulacijom kod TEER pacijenata
Clinical, laboratory, and epidemiological characteristics of neonates treated at the Department of Pediatrics, University Hospital of Split due to suspected serious bacterial infection
No full textCiljevi: Cilj ovog istraživanja bio je analizirati klinička, laboratorijska i epidemiološka obilježja novorođenčadi hospitalizirane zbog sumnje na ozbiljnu bakterijsku infekciju te utvrditi razlike između novorođenčadi s potvrđenom i nepotvrđenom infekcijom. Materijali i metode: Ispitanici su bili novorođenčad starosti do 28 dana koji su hospitalizirani u Klinici za dječje bolesti Kliničkog bolničkog centra (KBC) Split u periodu od 1. siječnja 2023. do 31. prosinca 2024. zbog sumnje na ozbiljnu bakterijsku infekciju (OBI). Na temelju otpusne dijagnoze podijeljeni su u dvije skupine: potvrđena OBI i isključena OBI. Istraživanje je provedeno retrospektivnom analizom medicinske dokumentacije hospitalizirane novorođenčadi. Etičko povjerenstvo KBC-a Split odobrilo je provođenje ovog istraživanja. Rezultati: Rezultati ovog istraživanja pokazali su da klinička slika i većina laboratorijskih parametara u novorođenčadi nisu dovoljno pouzdani za razlikovanje OBI od benignih, najčešće virusnih stanja. C-reaktivni protein (CRP) je bio jedini laboratorijski parametar koji je pokazao statistički značajnu razliku među skupinama, ali i njegova dijagnostička vrijednost nije dovoljna za samostalnu kliničku odluku. Nisu pronađene značajne razlike u osnovnim demografskim i vitalnim parametrima između skupina s i bez OBI, osim duljine hospitalizacije, koja je bila veća u novorođenčadi s OBI. Analiza urina pokazala se korisnom u dijagnostici infekcije mokraćnog sustava, s visokom specifičnošću pozitivnih nalaza (bakterije, leukocitna esteraza, nitriti). Ukupno, rezultati potvrđuju da ne postoji pojedinačan klinički ni laboratorijski pokazatelj koji bi pouzdano isključio OBI. Zaključci: Ni klinički simptomi ni većina standardnih laboratorijskih parametara nisu dovoljni za pouzdanu diferencijaciju novorođenčadi s OBI od onih bez nje. CRP se pokazao statistički značajnim, ali nedovoljno specifičnim za donošenje konačne dijagnoze, čime se naglašava potreba za dodatnim istraživanjima i razvojem preciznijih dijagnostičkih alata.Objectives: The aim of this study was to analyze the clinical, laboratory, and epidemiological characteristics of neonates hospitalized due to suspected serious bacterial infection (SBI) and to determine differences between neonates with confirmed and unconfirmed infections. Materials and Methods: The study included neonates up to 28 days of age who were hospitalized at the Department of Pediatrics, University Hospital of Split, between January 1, 2023, and December 31, 2024, due to suspected SBI. Based on discharge diagnosis, they were divided into two groups: confirmed SBI and excluded SBI. The study was conducted through a retrospective analysis of the medical records of hospitalized neonates. The Ethics Committee of the University Hospital of Split approved the implementation of this study. Results: The results of this study showed that the clinical presentation and most laboratory parameters in neonates are not sufficiently reliable to distinguish SBI from benign, mostly viral conditions. C-reactive protein (CRP) was the only laboratory parameter that showed a statistically significant difference between the groups, but its diagnostic value was insufficient for independent clinical decision-making. No significant differences were found in basic demographic or vital parameters between the SBI and non-SBI groups, except for the length of hospitalization, which was longer in the SBI group. Urinalysis proved useful in diagnosing urinary tract infections, with high specificity of positive findings (bacteria, leukocyte esterase, nitrites). Overall, the results confirm that no single clinical or laboratory indicator can reliably rule out SBI. Conclusions: Neither clinical symptoms nor most standard laboratory parameters are sufficient for reliable differentiation between neonates with and without SBI. CRP showed statistical significance but lacked the specificity needed for a definitive diagnosis, highlighting the need for further research and the development of more accurate diagnostic tools
Istraživanje dnevnih i godišnjih varijacija razina tireotropnog hormona: sveobuhvatna analiza kroz dvanaest mjeseci
No full textObjectives: The primary objective of this study was to examine the relationship between thyroidstimulating hormone (TSH) plasma levels at different times of the day and across different seasons. The study also aimed to compare these levels among different sexes and age groups. The hypotheses were that TSH levels vary significantly during morning, day, and night times, the largest differences occur between day and night, and the necessity to consider the time of day when measuring TSH levels. Materials and Methods: This retrospective study included all cases from REGIOMED Hospital Coburg where TSH levels were measured between January 2021 and December 2021. Each case received a new case number per admission, disregarding the number of previous hospital visits. Patients with known thyroid diseases (ICD-10 codes E00-E07) and those outside the reference range of 0.27- 4.20 μU/mL were excluded. The analysis included TSH levels, time of blood test, age, and gender. Blood samples were taken upon admission, prior to CT scans with contrast medium, on the ward, and in the emergency room. Samples were analyzed using the cobas™ 6000 analyzer via electrochemiluminescence immunoassay. Results: The study included 49,870 cases, with 23,208 (46.5%) female and 26,662 (53.5%) male patients, and a mean age of 67±20 years. Significant diurnal variations in TSH levels were observed, with the highest levels at night and the lowest during the day. This pattern was consistent across all demographic groups, indicating a robust circadian rhythm in TSH secretion. Female patients had slightly higher median TSH levels in the morning and night compared to males, with significant differences at night. Patients aged 30 to 50 years showed higher median TSH levels at all times, compared to those aged 51 to 75 years. No significant seasonal changes in TSH levels were observed. Conclusions: TSH plasma levels show a clear circadian rhythm, with higher levels at night and lower during the day across all demographics. Females had slightly higher TSH levels in the morning and night. Younger patients showed higher TSH levels. These findings highlight the importance of considering the time of day in TSH measurements to improve diagnostic accuracy and suggest potential benefits for personalized reference ranges and treatment approaches for thyroid dysfunction. Further research is necessary to understand the clinical implications of these variations.Ciljevi: Primarni cilj ove studije bio je ispitati odnos između razina tireostimulirajućeg hormona (TSH) u plazmi u različita doba dana i kroz različita godišnja doba. Studija je također imala za cilj usporediti ove razine među različitim spolovima i dobnim skupinama. Hipoteze su bile da se razine TSH značajno razlikuju tijekom jutra, dana i noći, da su najveće razlike između dana i noći, te da je potrebno uzeti u obzir doba dana prilikom mjerenja razina TSH. Materijali i metode: Ova retrospektivna studija uključila je sve slučajeve iz REGIOMED bolnice u Coburgu gdje su razine TSH bile mjerene između siječnja 2021. i prosinca 2021. Svaki slučaj dobio je novi broj slučaja po prijemu, bez obzira na broj prethodnih posjeta bolnici. Pacijenti s poznatim bolestima štitnjače (ICD-10 kodovi E00-E07) i oni izvan referentnog raspona od 0,27-4,20 μU/mL su isključeni. Analiza je uključivala razine TSH, vrijeme uzimanja uzorka krvi, dob i spol. Uzorci krvi uzimani su prilikom prijema, prije CT pregleda s kontrastnim sredstvom, na odjelu i u hitnoj službi. Uzorci su analizirani korištenjem cobas™ 6000 analizatora putem elektrohemiluminescentne imunotest metode. Rezultati: Studija je uključila 49.870 slučajeva, s 23.208 (46,5%) žena i 26.662 (53,5%) muškaraca, i prosječnom dobi od 67±20 godina. Uočene su značajne dnevne varijacije u razinama TSH, s najvišim razinama noću i najnižim tijekom dana. Ovaj obrazac bio je konzistentan u svim demografskim skupinama, što ukazuje na robustan cirkadijalni ritam u izlučivanju TSH. Žene su imale nešto više srednje razine TSH ujutro i noću u usporedbi s muškarcima, s značajnim razlikama noću. Pacijenti u dobi od 30 do 50 godina pokazali su više srednje razine TSH u svim vremenima, u usporedbi s onima u dobi od 51 do 75 godina. Nisu uočene značajne sezonske promjene u razinama TSH. Zaključci: Razine TSH u plazmi pokazuju jasan cirkadijalni ritam, s višim razinama noću i nižim tijekom dana u svim demografskim skupinama. Žene su imale nešto više razine TSH ujutro i noću. Mlađi pacijenti pokazali su više razine TSH. Ovi nalazi naglašavaju važnost uzimanja u obzir doba dana pri mjerenju razina TSH kako bi se poboljšala dijagnostička točnost i sugeriraju potencijalne koristi za personalizirane referentne raspone i pristupe liječenju disfunkcije štitnjače. Potrebna su daljnja istraživanja kako bi se razumjele kliničke implikacije ovih varijacija
Management and Incidence of Enterobius vermicularis Infestation in Appendectomy Specimens: A Cross-Sectional Study of 6359 Appendectomies
No full textCilj istraživanja: Cilj je istraživanja ispitati incidenciju i ishode liječenja infestacije crvuljka Enterobius vermicularisom u djece te razlike između demografskih, kliničkih i laboratorijskih podataka bolesnika s akutnim apendicitisom povezanim s Enterobius vermicularisom i onih s infestacijom crvuljka Enterobius vermicularisom bez znakova akutnog apendicitisa. Ispitanici i postupci: U vremenskom razdoblju od 1. siječnja 2009. do 1. siječnja 2024. godine, provedeno je ukupno 6359 apendektomija u dva velika pedijatrijska centra u Hrvatskoj. Nakon detaljne retrospektivne analize medicinske dokumentacije i patohistoloških nalaza, u 61 djeteta (0,96%) dijagnosticiran je Enterobius vermicularis, te su ti slučajevi daljnje analizirani. Skupine su uspoređivane s obzirom na demografske karakteristike, laboratorijske vrijednosti, kliničku prezentaciju i patohistološki nalaz. Rezultati: Ukupna incidencija enterobijaze crvuljka ostala je konzistentna tijekom godina, uz manje varijacije. Medijan dobi bolesnika iznosio je 11 (Interkvartilni raspon [IQR] 8,5; 13), s većom prevalencijom među djevojčicama (60,7%). Akutni apendicitis je primjećen u 34% patohistoloških uzoraka. Bolesnici s E. vermicularis infestacijom, a bez apendicitisa, bili su mlađi (9 godina (IQR 8, 13) naspram 12 godina (IQR 10, 15); p=0,020), imali su duže trajanje simptoma (36 sati (IQR 12, 48) naspram 24 sata (IQR 12, 36); p=0,034), nižu tjelesnu temperaturu (37 °C (IQR 36,8, 37,4) naspram 37,6 °C (IQR 37, 38,6); p=0,012), nižu incidenciju povratne osjetljivosti (n=12; 57,1% naspram n=8; 20%; p=0,003) i nižu učestalost povraćanja (n=5; 12,5% naspram n=10; 47,6%; p=0,004) u usporedbi s bolesnicima s E. vermicularis povezanim apendicitisom. Svi su akutni upalni markeri u labratorijskim nalazima pokazali značajno veće vrijednosti u bolesnika s E. vermicularis povezanim apendicitisom nego u bolesnika s enterobijazom, ali bez apendicitisa: C-reaktivni protein (p=0,009), leukociti (p=0,001) i neutrofili (p<0,001). Eozinofilija nije bila zabilježena ni u jednoj grupi bolesnika, iako je zabilježeno statistički značajno povećanje eozinofila u bolesnika s enterobijazom nego u bolesnika s E. vermicularis povezanim apendicitisom (2,5%; IQR 0,9, 4,3 naspram 1,8%; IQR 0,7, 2,1; p=0,040). Zaključak: Dječji bi kirurzi uvijek trebali razmotriti E. vermicularis infestaciju kao diferencijalnu dijagnozu pri apendektomiji. Prediktivni faktori poput mlađe životne dobi, duljeg trajanja simptoma, niže tjelesne temperature i vrijednosti na AIR ljestvici te manji promjer crvuljka i uredni upalni parametri mogli bi pomoći u dijagnozi E. vermicularis infestacije u pedijatrijskoj populaciji, koja se prezentira bolnošću u donjem desnom kvadrantu abdomena, čime bi se mogao smanjiti broj nepotrebnih apendektomija.Objectives: Although often underrecognized in clinical practice, Enterobius vermicularis is occasionally identified as a notable finding during appendectomies. This study aimed to assess the prevalence of Enterobius vermicularis in surgically removed appendices and to compare the clinical and histological characteristics between cases of appendiceal infestation with and without associated acute appendicitis. Subjects and Methods: A retrospective review was conducted on pediatric patients who underwent appendectomy between January 1, 2009, and January 1, 2024, at two major children's hospitals in Croatia. Out of 6,359 appendectomies, 61 cases (0.96%) had histopathological confirmation of Enterobius vermicularis and were included in the analysis. Comparative evaluation was performed across demographic data, clinical presentation, laboratory parameters and pathological findings. Results: The yearly occurrence of enterobiasis varied slightly but remained relatively stable throughout the study period. The median age of affected children was 11 years (Interquartile range [IQR] 8.5, 13), with a female predominance (60.7%). Acute appendicitis was present in 34% of the cases. Children without signs of appendicitis but with E. vermicularis infestation were generally younger (median age 9 vs. 12 years; p=0.020), had more prolonged symptoms (36 vs. 24 hours; p=0.034), lower body temperature (37.0°C vs. 37.6°C; p=0.012), and lower Appendicitis Inflammatory Response (AIR) scores (3 vs. 7; p<0.001). They also exhibited less rebound tenderness (20% vs. 57.1%; p=0.003) and less frequent vomiting (12.5% vs. 47.6%; p=0.004). Inflammatory markers such as C-reactive protein (p=0.009), white blood cells (p=0.001), and neutrophil count (p<0.001) were significantly elevated in the group with true appendicitis. While eosinophilia was not prominent in either group, children with simple infestation had a statistically higher eosinophil percentage (2.5% vs. 1.8%; p=0.040). Conclusion: In pediatric patients with right lower quadrant pain, Enterobius vermicularis infestation should be considered as a potential diagnosis. Clinical features such as younger age, prolonged but mild symptoms, low-grade or absent fever, minimal inflammatory response, and lower AIR scores may help differentiate parasitic infestation from true acute appendicitis, possibly preventing unnecessary surgical interventions
Caustic injuries of the upper part of gastrointestinal tract in patients treated at the University Hospital of Split
No full textCilj istraživanja: Cilj istraživanja bio je utvrditi demografske i kliničke karakteristike te ishode liječenja bolesnika hospitaliziranih zbog kaustičnih ozljeda gornjeg dijela probavnog sustava u Kliničkom bolničkom centru Split. Ispitanici i metode: U ovo retrospektivno istraživanje uključeno je ukupno 76 punoljetnih bolesnika koji su hospitalizirani zbog kaustičnih ozljeda gornjeg dijela probavnog sustava u Zavodu za gastroenterologiju Klinike za unutarnje bolesti KBC-a Split u razdoblju od 1. siječnja 2015. do 31. prosinca 2024. godine. Prikupljeni su podatci o demografskim i kliničkim karakteristikama bolesnika kao i ishodima liječenja (duljina hospitalizacije, pojava komplikacija, smrtnost i potreba za kirurškim liječenjem). Specifični ciljevi bili su: usporediti karakteristike i ishode liječenja bolesnika s ingestijom kiseline i lužine, usporediti karakteristike i ishode liječenja u bolesnika sukladno namjeri ingestije te utvrditi ishode liječenja sukladno težini endoskopski zabilježene ozljede. Podatci su prikupljeni uvidom u protokol Zavoda za gastroenterologiju, povijesti bolesti te Bolnički informacijski sustav. Rezultati: Od ukupno 76 sudionika ove studije 61% bile su žene, a prosječna dob svih bolesnika bila je 62,5 ± 17,7 godina. Ingestirano sredstvo u 47% slučajeva bile su kiseline, a u 41% lužine. U 58% slučajeva radilo se o namjernoj ingestiji. Namjerna ingestija statistički je značajno češće zabilježene kod ingestije kiseline (84% vs 39%, P < 0,001). Endoskopski pregled učinjen je u 83% bolesnika, od kojih je u 59% pretraga realizirana unutar 12 h od ingestije. Akutne su komplikacije zabilježene u četvrtine bolesnika, a najčešće je bila riječ o pneumoniji (17%). Ukupni mortalitet bio je 13% (10/76) uz kumulativnu šestotjednu smrtnost od 17%. U skupini bolesnika s namjernom ingestijom zabilježena je značajno duža hospitalizacija (13 dana vs 4 dana, P < 0,001). Veći stupanj endoskopski zabilježene ozljede (Zargar ≥3a) značajno korelira s vjerojatnošću smrtnog ishoda (P = 0,004). Empirijska antibiotska terapija primijenjena je u 71% bolesnika, uz značajno dulju hospitalizaciju u skupini koja je primala antibiotsku terapiju (P = 0,027). Zaključak: Nije utvrđena značajna razlika u ishodima liječenja između bolesnka s ingestijom kiseline i bolesnika s ingestijom lužine. Rani endoskopski pregled (<12 h) nije utjecao na poboljšanje ishoda liječenja. Veći stupanj endoskopski zabilježene ozljede povezan je većom stopom mortaliteta. Upotreba antibiotske profilakse ne pospješuje ishode liječenja.Objectives: The study aimed to determine demographic and clinical characteristics as well as treatment outcomes of patients who were hospitalized due to caustic injuries of the upper part of gastrointestinal tract at the University hospital of Split. Materials and methods: This retrospective study included a total of 76 adult patients who were hospitalized because of caustic injuries of the upper part of gastrointestinal tract at the Department of Gastroenterology, Clinic for Internal medicine at the University hospital of Split from January 1st, 2015 to December 31st, 2024. Data were collected on the patients' demographic and clinical characteristics, as well as treatment outcomes (length of hospitalization, occurence of complications, mortality and need for surgical treatment). The specific objectives were comparing characteristics and treatment outcomes of patients with acid vs. alkali ingestion, comparing characteristics and treatment outcomes based on the intent of ingestion and to determine treatment outcomes based on the severity of endoscopically recorded injury. Data were collected by reviewing Department of Gastroenterology's protocols, medical histories and Hospital information system. Results: Out of 76 participants in this study, 61% were female and the average age of all participants was 62.5 ± 17.7 years. Ingested substances were acids in 47% of cases and in 41% alkalis. The ingestion was intentional in 58% of cases. Intentional ingestion was significantly more often recorded with acid ingestion (84% vs 39%, P < 0.001). Endoscopy was performed in 83% of patients, out of which 59% were conducted within 12 houre of ingestion. Acute complications were recorded in one quarter of the patients and most common complication was pneumonia (17%). The overall mortality rate was 13% (10/76) with cumulative six week mortality rate of 17%. Patients with intentional ingestion had significantly longer hospital stays (13 days vs 4 days. P < 0.001). A higher degree of endoscopic injury (Zargar ≥3a) significantly correlates with the likelihood of death (P = 0.004). Empirical antibiotic therapy was administered in 71% of patients with significantly longer hospital stay in a group that recieved antibiotics (P = 0.027). Conclusion: There were no significant differences in treatment outcomes between patients with acid vs. alkali ingestion. Early endoscopic examination (<12 h) doesn't improve treatment outcomes. A higher extent of injury correlates with increased mortality. The use of antibiotic prophylaxis doesn't improve treatment outcomes
Using artificial intelligence in writing medical ethics essays during medical school education
No full textCiljevi: Cilj prvog istraživanja bio je provesti lingvističku analizu i usporedbu eseja studenata medicine s esejima generiranim pomoću UI-ja (ChatGPT i Bard) na temu etičke, profesionalne ili moralne dileme. Jezične varijable su analizirane uz pomoć LIWC softvera, a izvor eseja je ispitan pomoću softvera za prepoznavanje UI-ja. Hipoteze su pretpostavljale razlike u izražavanju emocija i kognitivnim procesima između studentskih i UI-generiranih eseja. U drugom istraživanju cilj je bio ispitati utjecaj korištenja ChatGPT-a na stavove studenata prema UI-ju, uz predpostavku da će studenti koji sami pišu eseje kao i oni s višom intrizičkom motivacijom pokazati snažniju promjenu postojećih stavova. Ispitanici i postupci: U prvom istraživanju sudjelovali su studenti 5. i 6. godine Medicinskog fakulteta u Splitu koji su napisali reflektivne eseje. Uz pomoć LIWC programa eseji su potom uspoređeni s istim brojem eseja generiranih pomoću ChatGPT-a i Barda. Drugo istraživanje uključivalo je također studente medicinskog fakulteta podijeljenih u dvije skupine: jedna je pisala eseje koristeći ChatGPT, a druga samostalno. Prije i poslije pisanja, studenti su ispunjavali upitnike o stavovima prema UI-ju i o svojoj intrinzičnoj motivaciji. Rezultati: Lingvistička analiza ukazala je da su eseji koje je generirao UI imali višu razinu analitičkog mišljenja, autentičnosti i veću upotrebu dugih riječi u usporedbi s esejima studenata. Studentski eseji pokazivali su više izraza kognitivnih procesa i duže rečenice, kao i veću raznolikost izražavanja neslaganja i kognitivnih procesa. Eseji potencijalno napisani uz pomoć UI-ja pokazivali su mješovite karakteristike, bliže UI-generiranim esejima nego originalnim studentskim esejima. U drugom istraživanju, promjena stavova prema UI-ju nije bila statistički značajna između grupa. Međutim, studenti koji su pisali bez pomoći ChatGPT-a temeljitije su proučili dodijeljeni članak i posvetili više napora u izvršavanju zadatka. Intrinzična motivacija bila je povezana s pozitivnijim stavovima prema UI-ju. Zaključci: Rezultati istraživanja pokazuju da, iako UI vrlo uspješno stvara stilski kvalitetne i sadržajno bogate eseje, i dalje postoje uočljive lingvističke razlike između eseja napisanih od strane studenata i onih kreiranih pomoću UI. Te razlike posebno se očituju u područjima analitičkog razmišljanja, izražavanja emocija i kognitivnih procesa. Iako UI pokazuje izuzetnu sposobnost pisanja, ljudsko pisanje zadržava složenije izražavanje misli i emocija. Korištenje UI alata bilo je povezanom sa načinom na koji studenti pristupaju zadacima, ali nije značajno promijenilo njihove stavove prema UI-ju. Budući izazovi uključuju razvoj novih načina ocjenjivanje studentskog rada, uz etičku upotrebu UI-ja u obrazovanju.Objectives: The first study aimed to conduct a linguistic analysis and comparison of essays written by medical students with essays generated by AI (ChatGPT and Bard) on the topic of an ethical, professional, or moral dilemma. Linguistic variables were analyzed using the LIWC software, and the origin of the essays was examined using AI detection tools. The hypotheses assumed differences in the expression of emotions and cognitive processes between student-written and AI-generated essays. The second study aimed to examine how the use of ChatGPT affects students' attitudes toward AI, with the hypothesis that students who wrote essays independently and those with higher intrinsic motivation would show a stronger change in their existing attitudes. Participans and procedures: In the first study, participants were 5th- and 6th-year medical students from the University of Split School of Medicine who wrote reflective essays. Using the LIWC software, these essays were compared with an equal number of essays generated by ChatGPT and Bard. The second study involved 80 students divided into two groups: one group wrote essays using ChatGPT, while the other wrote independently. Before and after the writing task, students completed questionnaires on their attitudes toward artificial intelligence and their intrinsic motivation. Results: The linguistic analysis showed that AI-generated essays exhibited higher levels of analytical thinking, authenticity, and greater use of long words compared to student essays. Student essays demonstrated greater expression of cognitive processes and longer sentence lengths. Furthermore, student essays showed greater variation in the expression of disagreement and cognitive processes. Essays potentially written with AI assistance exhibited mixed characteristics, being more similar to AI-generated essays than to original student essays. In the second study, changes in attitudes toward AI were not statistically significant between groups. However, students who wrote essays without the help of ChatGPT engaged more thoroughly with the assigned article and demonstrated greater effort in completing the task. Intrinsic motivation was associated with more positive attitudes toward AI. Conclusions: The results indicate that although AI is highly successful in producing stylistically polished and content-rich essays, recognizable linguistic differences still exist between student-written and AI-generated texts. These differences are particularly evident in aspects of analytical thinking, emotional expression, and cognitive processing. While AI demonstrates exceptional writing capabilities, human writing retains a more complex expression of thoughts and emotions. The use of AI tools influenced the way students approached academic tasks but did not significantly alter their attitudes toward AI. Future challenges include developing new methods for assessing student work, alongside promoting the ethical use of AI in education
Neurological symptoms of decompression sickness
No full textCilj istraživanja: Utvrditi najčešće neurološke simptome dekompresijske bolesti u rekreativnih ronioca, ispitati povezanost dobi, dubine i broja zarona s neurološkim statusom te procijeniti stupanj oporavka nakon liječenja HBOT-om. Ispitanici i postupci: U retrospektivno istraživanje uključena su 52 bolesnika (40 muškaraca, 12 žena; dob 19–70 g, medijan 47 g) liječena u Klinici za neurologiju KBC-a Split od 2020. do 2024. godine. Podaci o demografiji, ronilačkom profilu, kliničkim manifestacijama, trajanju hospitalizacije i ishodu nakon HBOT-a izvučeni su iz bolničkog informacijskog sustava. Provedena je deskriptivna statistika. Rezultati: Najčešći neurološki simptomi bili su vrtoglavica (38,5 %) i parestezije (28,8 %); gubitak svijesti zabilježen je u 11,5 %, dok su ostali simptomi (glavobolja, ataksija, nestabilnost, retencija urina, dezorijentiranost, omaglice, hipoestezije) pojedinačno bili prisutni u <10 % slučajeva. Potpuni oporavak postignut je u 90,4 % bolesnika, djelomični u 9,6 %. Starija dob i dulja hospitalizacija značajno su povezane s djelomičnim oporavkom (p < 0,05). Dubina i broj zarona nisu korelirali s ishodom, premda je veća dubina bila povezana s duljim boravkom u bolnici. Zaključci: Vrtoglavica i parestezije najčešće su neurološke manifestacije dekompresijske bolesti, a rana primjena HBOT-a rezultira vrlo visokom stopom potpunog oporavka. Starija dob i dulje liječenje upućuju na veći rizik za rezidualni neurološki deficit. Buduća prospektivna istraživanja trebala bi uključiti rutinski probir za PFO kako bi se preciznije odredili čimbenici rizika za neurološki oblik bolesti.Objective: To determine the most common neurological symptoms of decompression sickness in recreational divers, examine the correlation between age, dive depth, and number of dives with neurological status, and assess the degree of recovery following hyperbaric oxygen therapy (HBOT). Participants and Methods: This retrospective study included 52 patients (40 men, 12 women; age range 19–70 years; median 47 years) treated at the Department of Neurology, University Hospital Centre Split, from 2020 to 2024. Data on demographics, diving profile, clinical manifestations, hospitalization duration, and outcome after HBOT were collected from the electronic hospital information system. Descriptive statistical analysis was performed. Results: The most frequent neurological symptoms were dizziness (38.5 %) and paraesthesia (28.8 %); loss of consciousness occurred in 11.5 %, while other symptoms (headache, ataxia, imbalance, urinary retention, disorientation, light-headedness, and hypoesthesia) were each present in <10 % of cases. Complete recovery was achieved in 90.4 % of patients, and partial recovery in 9.6 %. Older age and longer hospital stay were significantly associated with partial recovery (p <0.05). Dive depth and the number of dives were not correlated with the outcome, although greater depth was associated with longer hospitalization. Conclusions: Dizziness and paraesthesia are the most common neurological manifestations of DCS, and early initiation of HBOT results in a very high rate of full recovery. Older age and prolonged treatment are associated with increased risk of residual neurological deficit. Future prospective studies should include routine screening for patent foramen ovale (PFO) to more precisely identify risk factors for the neurological form of the disease
Outcomes and treatment of extremely low birth weight neonates over a five-year period at the Department of Neonatology, University Hospital of Split
No full textCiljevi: Analizirati ishode i liječenje novorođenčadi izrazito niske porođajne mase (engl. extremely low birth weight - ELBW) na Zavodu za neonatologiju KBC-a Split u petogodišnjem razdoblju. Cilj je bio ispitati utjecaj različitih varijabli na ishod liječenja, učestalost komplikacija te usporediti parametre između glavnih skupina ishoda, smrt i preživljenje. Ispitanici i metode: Provedena je retrospektivna presječna studija u kojoj su analizirani demografski, klinički i laboratorijski podatci iz medicinske dokumentacije. Uključena su sva ELBW novorođenčad (<1000 g) liječena na Zavodu u navedenom razdoblju, osim onih s teškim kongenitalnim malformacijama, kromosomopatijama, kompleksnim srčanim greškama ili genetskim sindromima. Rezultati: U istraživanje je uključeno 146 novorođenčadi (51 % muškog, 49 % ženskog spola). Smrtni ishod zabilježen je kod 58 %, dok je 42 % preživjelo. Prosječna gestacijska dob bila je 25 tjedana, a porodna težina 735 g. Preživjeli su imali veću gestacijsku dob (+2 tjedna), veću porođajnu masu (+245 g), veći opseg glave i bolje Apgar indekse (+3 u 1. minuti, +2 u 5. minuti). U skupini preživjelih češće su korišteni antenatalni kortikosteroidi i dovršetak poroda carskim rezom. Najčešća komplikacija bio je respiratorni distres sindrom (81 %), dok je intrahospitalna sepsa dijagnosticirana u 51 %. Najčešće izoliran uzročnik iz svih inicijalno vađenih hemokultura bio je meticilin-rezistentni Staphylococcus epidermidis (MRSE) u 21 %. Uočeni su i ostali karakteristični morbiditeti poput bronhopulmonalne displazije, intraventrikularnog krvarenja i retinopatije prematuriteta, uz visoku učestalost invazivne ventilacije (89 %) i potrebu za suvremenim standardima skrbi. Preko 97% ispitanika primilo je surfaktant, antibiotike i parenteralnu prehranu. Zaključak: Mortalitet ELBW novorođenčadi u ovom istraživanju je visok (58 %) u usporedbi s razvijenim zemljama. Pozitivni prediktori preživljenja su veća gestacijska dob, porođajna masa, opseg glave, Apgar indeks, antenatalni kortikosteroidi i porod carskim rezom. Nalazi ukazuju na potrebu za unaprjeđenjem prenatalne i neonatalne skrbi te većom dostupnosti intervencija dokazanog učinka kako bi se poboljšali ishodi ove visokorizične populacije.Objectives: To analyze the outcomes and treatment of extremely low birth weight (ELBW) neonates at the Department of Neonatology, University Hospital Split, over a five-year period. The aim was to assess the impact of various factors on treatment outcomes, the incidence of complications, and to compare parameters between the main outcome groups: death and survival. Subjects and Methods: A retrospective cross-sectional study was conducted, analyzing demographic, clinical, and laboratory data from medical records. All ELBW neonates (<1000 g) treated at the Department during the study period were included, except those with severe congenital malformations, chromosomopathies, complex cardiac anomalies, or confirmed genetic syndromes. Results: The study included 146 neonates (51 % male, 49 % female). Mortality was recorded in 58 %, while 42 % survived. The mean gestational age was 25 weeks, and the mean birth weight was 735 g. Survivors had a higher gestational age (+2 weeks), higher birth weight (+245 g), larger head circumference, and better Apgar scores (+3 at 1 minute, +2 at 5 minutes). In this group, antenatal corticosteroid use and cesarean delivery were more common. The most frequent complication was respiratory distress syndrome (81 %), while nosocomial sepsis was diagnosed in 51 %. The most frequently isolated pathogen from all initially drawn blood cultures was methicillin-resistant Staphylococcus epidermidis (MRSE) in 21 %. Other typical morbidities included bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity, along with a high rate of invasive ventilation (89 %) and the need for modern standards of care. More than 97 % of neonates received surfactant, antibiotics, and parenteral nutrition. Conclusions: The mortality rate of ELBW neonates in this study was high (58 %) compared to developed countries. Positive predictors of survival were higher gestational age, birth weight, head circumference, Apgar score, antenatal corticosteroid administration, and cesarean delivery. These findings highlight the need to improve prenatal and neonatal care and increase the availability of evidence-based interventions to improve outcomes in this high-risk population
Cochrane - Evidence Based Medicine : Uz bok vodećim autoritetima za medicinu utemeljenu na dokazima: Korak bliže GRADE centru u Splitu
No full textEfficacy and tolerability of dabrafenib and trametinib in the adjuvant treatment of locoregional BRAF-mutated skin melanoma – experience of University Hospital Centre Split
No full textCiljevi: Ciljana terapija BRAF i MEK inhibitorima predstavlja terapiju izbora u adjuvantnom liječenju lokoregionalnog BRAF-mutiranog melanoma kože. Cilj ovog istraživanja bio je ispitati kliničke osobitosti, podnošljivost i ishode liječenja bolesnika s BRAFm lokoregionalnim melanomom kože liječenih adjuvantnim dabrafenibom i trametinibom na Klinici za onkologiju i radioterapiju KBC-a Split. Analizirane su patohistološke značajke melanoma pri inicijalnoj dijagnozi, u uzorcima nakon ekscizije/reekcizije kože te biopsije sentinel limfnog čvora ili disekcije regionalnih limfnih čvorova. Bolesnici i metode: Retrospektivno su prikupljeni i analizirani podaci iz medicinske dokumentacije 27 bolesnika s BRAFm lokoregionalnim melanomom kože, koji su primali adjuvantnu terapiju dabrafenibom i trametinibom u razdoblju od 1. travnja 2020. do 1. siječnja 2025. godine. Podaci su obuhvaćali dob, spol, osobnu i obiteljsku anamnezu na zloćudne bolesti, inicijalni stadij bolesti, patohistološke osobitosti melanoma, nuspojave te ishode liječenja definirane kroz medijan preživljenja bez progresije bolesti (PFS) i ukupnog preživljenja (OS). Rezultati: Medijan dobi bolesnika u trenutku dijagnoze iznosio je 62 godine. U istraživanju je sudjelovalo 17 muškaraca i 10 žena. Niti jedan bolesnik nije imao osobnu anamnezu zloćudne bolesti kože, a dvoje bolesnika imalo je pozitivnu obiteljsku anamnezu na melanom. Lokoregionalna bolest bila je inicijalno dijagnosticirana kod 21 bolesnika (78 %), dok su preostali razvili lokoregionalni recidiv. Najčešća lokalizacija primarne lezije bila je na trupu (70 %). Medijan dubine invazije iznosio je 3,25 mm. Ulceracija je bila prisutna u 52 % uzoraka, satelitske lezije u 11 %, a tumorska regresija u 26 % slučajeva. Najčešće histološke podvrste bile su neklasificirani melanom (33 %) i nodularni melanom (30 %). Među svim BRAFm bolesnicima dominirala je BRAF V600E mutacija (52 %). Svi bolesnici su nakon kirurškog zahvata i potvrde BRAFm lokoregionalne bolesti primili adjuvantnu ciljanu terapiju dabrafenibom i trametinibom (100 %). Medijan broja provedenih ciklusa liječenja bio je 9. Nakon medijana praćenja od 23 mjeseca, 11 bolesnika razvilo je recidiv bolesti (41 %). Medijan preživljenja bez progresije (PFS) iznosio je 19 mjeseci, a medijan OS nije dostignut. Terapija je pokazala prihvatljiv toksični profil. Najčešće prijavljene nehematološke nuspojave bile su pireksija (26 %), probavne smetnje (33 %) i porast jetrenih enzima (48 %), a od hematoloških nuspojava anemija (33 %). Na kraju praćenja, 14 bolesnika bilo je živo bez bolesti (52 %), 7 bolesnika bilo je živo s bolešću (26 %), 5 bolesnika preminulo je (19 %), dok je jedan bolesnik izgubljen iz praćenja (4 %). Zaključak: Rezultati ovog istraživanja usporedivi su s rezultatima faze III registracijske studije COMBI-AD, koja je istraživala učinkovitost i podnošljivost jednogodišnje adjuvantne primjene dabrafeniba i trametiniba. Za relevantniju procjenu učinkovitosti i sigurnosti ove kombinirane terapije potrebno je uključiti veći broj bolesnika i produžiti razdoblje praćenja.Objectives: Targeted therapy with BRAF and MEK inhibitors represents the treatment of choice in the adjuvant management of locoregional BRAF-mutated cutaneous melanoma. The aim of this study was to investigate the clinical characteristics, tolerability, and treatment outcomes of patients with BRAFm locoregional cutaneous melanoma treated with adjuvant dabrafenib and trametinib at the Department of Oncology and Radiotherapy, University Hospital Centre Split. Histopathological features of melanoma at initial diagnosis, in tissue samples following excision or re-excision, sentinel lymph node biopsy, or regional lymph node dissection were analyzed. Patients and Methods: A retrospective analysis was conducted using data from the medical records of 27 patients with BRAFm locoregional cutaneous melanoma who received adjuvant dabrafenib and trametinib therapy between April 1, 2020 and January 1, 2025. Collected data included patient age, sex, personal and family history of malignancy, initial disease stage, histopathological characteristics of the melanoma, treatment-related adverse events, and treatment outcomes, expressed through median progression-free survival (PFS) and overall survival (OS). Results: The median age at initial melanoma diagnosis was 62 years. The study included 17 male and 10 female patients. None of the patients had a prior history of malignant skin disease, while two had a positive family history of melanoma. Locoregional disease was initially diagnosed in 21 patients (78 %), with the remainder developing locoregional recurrence. The most common localization of the primary cutaneous lesion was the trunk (70 %). The median Breslow thickness was 3.25 mm. Ulceration was present in 52 % of samples, satellite lesions in 11 %, and regression in 26 %. The most common histological subtypes were unclassified (33 %) and nodular melanoma (30 %). Among all BRAFm patients, the BRAF V600E mutation predominated (52 %). All patients received adjuvant targeted therapy with dabrafenib and trametinib following surgical treatment (100 %). The median number of treatment cycles administered was 9. After a median follow-up of 23 months, disease recurrence was observed in 11 patients (41 %). The median PFS was 19 months, and the median OS was not reached. The targeted therapy demonstrated an acceptable toxicity profile. Among non-hematological adverse events, the most common were pyrexia (26 %), gastrointestinal toxicity (33 %), and elevated liver enzymes (48 %), while anemia (33 %) was the most common hematological toxicity. At the end of follow-up, 14 patients (52 %) were alive with no evidence of disease, 7 (26 %) were alive with disease, 5 (19 %) had died, and one patient (4 %) was lost to follow-up. Conclusion: The results of this analysis are comparable to those of the phase III COMBI-AD trial, which investigated the efficacy and tolerability of one-year adjuvant therapy with dabrafenib and trametinib. For a more reliable assessment of the efficacy and tolerability of combined BRAF and MEK inhibitor therapy, studies involving a larger number of patients and longer follow-up periods are needed