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Sources of information about complementary and alternative medicine commonly used by oncology patients and healthcare professionals
No full textComplementary and Alternative Medicine (CAM) is increasingly utilized in oncology care; however, significant disparities exist regarding the trusted sources of CAM information among oncology patients and healthcare professionals. This study aimed to systematically evaluate these information sources, their credibility, and their influence on medical decision-making. A cross-sectional study was conducted at the Sisters of Mercy University Hospital Center in Zagreb from November 2022 to May 2023. The sample consisted of 832 respondents, comprising 411 oncology patients and 421 healthcare professionals, including 100 physicians, 321 nurses, and technicians. Data were collected using a survey questionnaire based on modified CHBQ and IMAQ instruments. Descriptive and inferential statistical methods were applied, including one-way analysis of variance (ANOVA) and Tukey's test to identify differences among groups. The most common sources of CAM information for patients were family and friends (82.6%), while healthcare professionals were more inclined to use the internet and media (61.4%). Statistically significant differences in attitudes were identified between patients and healthcare professionals regarding their information sources (p < 0.05). These findings underscore a pressing need for standardized, evidence-based complementary and alternative medicine (CAM) education that is tailored to both patients and healthcare providers. Addressing these disparities through targeted educational interventions could enhance informed decision-making, reduce misinformation, and optimize the delivery of integrative oncology care. Future research should focus on developing verified CAM information frameworks to ensure a more consistent and scientifically grounded approach in oncology settings
The Role of Oxidative Stress in the Etiology of Male Infertility
No full textNeplodnost pogađa 10-15 % parova, a u 30 % slučajeva uzrok je muški faktor. Među ključnim uzrocima muške neplodnosti nalazi se oksidacijski stres, stanje poremećene ravnoteže između oksidacije i redukcije koje rezultira stvaranjem reaktivnih kisikovih spojeva (ROS). Molekule ROS imaju važne fiziološke uloge, uključujući kapacitaciju spermija, hiperaktivaciju i fuziju s oocitom, no njihovo prekomjerno stvaranje uzrokuje štetu, poput lipidne peroksidacije, fragmentacije DNA i apoptoze. Značajne količine ROS-a nastaju u stanicama spermatogenetske loze, ali i kao nusprodukt aerobnog metabolizma te u leukocitima s peroksidaznom aktivnošću. Stanja poput varikokele, infekcija, dijabetesa, alkoholizma i pretilosti, zajedno s pušenjem, izloženosti toksinima i ftalatima dodatno pogoršavaju oksidacijski stres. Iatrogeni čimbenici, uključujući tehnike potpomognute oplodnje, krioprezervaciju i liječenje malignih bolesti radioterapijom i kemoterapijom, također povećavaju rizik. Obranu protiv oksidacijskog stresa pružaju antioksidansi koji neutraliziraju ROS. Enzimski antioksidansi, poput superoksid-dismutaze (SOD), katalaze i glutation-peroksidaze, prisutni su u spermijima i sjemenoj tekućini. Neenzimski antioksidansi, poput vitamina E, vitamina C, cinka i selena, unose se prehranom. Nedostatak antioksidansa zbog neuravnotežene prehrane povećava rizik od oksidacijskog stresa, stoga je pravilna i uravnotežena prehrana ključna za očuvanje plodnosti. Učinkovita strategija za prevenciju uključuje i smanjenje izloženosti rizičnim čimbenicima te primjenu dodataka prehrani s antioksidansima u odabranim slučajevima.Infertility affects 10-15% of couples, with male factors accounting for 30% of cases. Oxidative stress, a disruption in redox balance leading to the production of reactive oxygen species (ROS), is a significant contributor to male infertility. ROS play crucial physiological roles, such as sperm capacitation, hyperactivation, and oocyte fusion, but excessive ROS levels cause damage, including lipid peroxidation, DNA fragmentation, and apoptosis. ROS are generated in spermatogenic cells, as byproducts of aerobic metabolism, and in leukocytes with peroxidase activity. Conditions like varicocele, infections, diabetes, alcoholism, and obesity, along with smoking, toxin exposure, and phthalates, exacerbate oxidative stress. Iatrogenic factors, including assisted reproduction techniques, cryopreservation, radiotherapy, and chemotherapy, further increase the risk. Defense against oxidative stress is provided by antioxidants, which neutralize ROS. Enzymatic antioxidants, such as superoxide dismutase (SOD), catalase, and glutathione peroxidase, are found in sperm and seminal fluid. Non-enzymatic antioxidants, such as vitamins E and C, zinc, and selenium, are obtained through diet. Antioxidant deficiency due to poor nutrition heightens the risk of oxidative stress, making a balanced diet essential for fertility. Preventive strategies include reducing exposure to risk factors and, in selected cases, the use of antioxidant supplements
Trends in Lipid‐Lowering Agent Consumption in Croatia: A 25‐Year Observational Study
No full textCardiovascular diseases are the leading cause of mortality worldwide, with dyslipidemia as a major modifiable risk factor. This study aimed to assess 25‐year trends in lipid‐lowering agent consumption in Croatia from 2000 to 2023. We conducted a population‐based analysis using IMS and IQVIA databases, calculating drug utilization in defined daily doses per 1000 inhabitants per day (DDD/1000) and evaluating financial expenditures and prescribing patterns. Over the study period, total lipid‐lowering drug consumption increased more than 30‐fold, from 4.91 DDD/1000 in 2000 to 152.56 DDD/1000 in 2023. Statins, particularly atorvastatin and rosuvastatin, drove this trend, while the uptake of PCSK9 inhibitors and ezetimibe reflected an evolving therapeutic landscape. Financial expenditures peaked in 2010, declined until 2015, and rose again by 2023, with average drug prices per DDD decreasing significantly. The observed increase in lipid‐lowering therapy correlated with enhanced adherence to international guidelines and expanded patient access. However, administrative barriers and restrictive reimbursement policies continue to limit optimal utilization of newer agents. These findings underscore the importance of evidence‐based policy development to address clinical inertia and improve cardiovascular outcomes in Croatia
Asthenozoospermia in a patient with reciprocal translocation t(12;15): A case report
No full textReciprocal translocation is a chromosomal aberration where fragments are exchanged between two non-
homologous chromosomes. Its prevalence is estimated at 0.16–0.2 % in the general population, rising to 1.3
% among infertile men. We report a 34-year-old Caucasian male with asthenozoospermia who was admitted for
genetic testing. G-banding revealed a reciprocal translocation between chromosomes 12 and 15, with a karyo
type of 46,XY,t(12;15)(p13.2?q15). Fluorescence in situ hybridisation confirmed this translocation using specific
probes for chromosomes 12 and 15. This case highlights a rare chromosomal translocation t (12; 15) (p13.2?
q15) associated with asthenozoospermia. Further sequencing analysis is needed to determine the precise
breakpoints and assess potential genotype-phenotype correlations
Comparing the Impact of Different Antiarrhythmic Classes on Clinical Outcomes Following Atrial Fibrillation Catheter Ablation
No full textBackground/Objectives: Catheter ablation has become the standard of care for patients with symptomatic and drug-refractory atrial fibrillation (AF). Both Class IC and Class III antiarrhythmic drugs (AADs) are effective in preventing early recurrences of AF, but not late recurrences, compared with the usual care. We aimed to compare the effects of two months of Class IC versus Class III AADs following AF catheter ablation on clinical outcomes, including arrhythmia recurrence and safety endpoints. Methods: All patients undergoing AF catheter ablation between January 2015 and November 2024 were screened, and cases meeting the inclusion criteria were included. Primary outcome was defined as atrial tachycardia recurrence-free survival. Results: A total of 98 patients (mean age 54.2 ± 14.0 years; 55.1% male) were enrolled, with 66.3% presenting with paroxysmal atrial fibrillation (AF). The mean left atrial diameter was 38.7 ± 5.1 mm, and 78.6% underwent cryoballoon ablation. Class IC AADs were administered to 62 cases, while the remaining 36 patients received amiodarone following catheter ablation. The rate of atrial tachycardia (ATa) recurrence was comparable between the patients treated with Class IC and Class III AADs (9.7% vs. 19.4%; p = 0.169). Predictors of ATa recurrence were identified as history of direct current cardioversion—DCCV (HR: 5.86; 95%CI: 1.44–23.82)—and LA diameter (HR: 1.17; 95%CI: 1.04–1.31). The most frequent AAD-related adverse event was symptomatic bradycardia (6.1%), which resolved in all cases following dose reduction. Conclusions: Class IC and Class III antiarrhythmics show comparable efficacy in terms of preventing ATa recurrence following AF catheter ablation. AAD-related adverse event rates are negligible for short-term use
COMPARISON OF EXPRESSION AND SIGNIFICANCE OF PROGRAMMED DEATH LIGAND 1 IN PREINVASIVE LESIONS AND LARYNGEAL SQUAMOUS CELL CARCINOMA
No full textCilj istraživanja: Unatoč značajnom napretku u području medicine, karcinom grkljana i dalje
predstavlja izazov obzirom da se petogodišnje preživljenje nije značajnije mijenjalo u zadnjim
desetljećima. Područje imunološke onkologije stvorilo je obećavajuće imunomodulacijske
terapije i otvorilo nove načine liječenja. Programirani ligand smrti 1 (PD-L1) transmembranski
je protein koji se veže na protein programirane stanične smrti 1 (PD-1) smješten na površini
citotoksičnih limfocita. Vezivanje uzrokuje niz kaskadnih reakcija koje dovode do smanjenog
imunološkog odgovora. Cilj ove studije je utvrditi razinu izražaja PD-L1 kao i stanica
mikrookoliša (CD4, CD8, CD68 i CD163) u skvamoznim lezijama grkljana, njihov međusobni
odnos te utjecaj na preživljenje kod skvamoznih karcinoma ili progresiju bolesti u slučaju
displazija.
Ispitanici i metode: Ova retrospektivna studija uključila je 179 bolesnika, a od toga 102 s
dijagnozom skvamoznog karcinoma grkljana, 41 s displazijom grkljana te 36 s polipima
glasnica. Za procjenu izražaja PD-L1 kao i stanica tumorskog mikrookoliša (CD4, CD8, CD68
i CD163) korištena je imunohistokemijska analiza.
Rezultati: PD-L1 izražaj kao i izražaj stanica tumorskog mikrookoliša statistički je značajno
veći u karcinomima grkljana u odnosu na displazije te u displazijama u odnosu na benigne
lezije. Nije nađena statistički značajna razlika u PD-L1 izražaju niti u izražaju stanica tumorskog
mikrookoliša između displazija koje su progredirale u karcinom i onih koje to nisu. Dokazana
je statistički značajna pozitivna korelacija PD-L1 sa svim ispitivanim stanicama tumorskog
mikrookoliša. Bolesnici s visokim intraepitelnim izražajem CD68 i CD163 (p=0.0005 i p=0.006)
imali su statistički značajno kraće preživljenje specifično za bolest. Nadalje, statistički kraće
vrijeme do pojave recidiva bolesti pronađeno je u bolesnika s visokim intratepitelnim CD68 i
visokim ukupnim CD8 (p=0.049 i p=0.019). Pojačan ukupni izražaj CD8 (>23%) i pojačan
intraepitelni izražaj CD68 (>2,7%) također su bili statistički značajni prediktori recidiva
(p=0.028, OR=3.11 i p=0.019, OR=3.13).
Zaključak: Rezultati ove studije ukazuju da su stanice mikrookoliša tumora značajni
prognostički čimbenici kod skvamoznog karcinoma grkljana. Pojačani izražaji CD68 i CD163
prediktori su lošijeg preživljenja kod bolesnika sa skvamoznim karcinomom grkljana.Objectives: Despite significant progress in the field of medicine, laryngeal cancer continues
to represent a challenge, given that the five-year survival rate has not significantly changed in
recent decades. The field of immune oncology has created promising immunomodulation
therapies and opened up new ways of treatment. Programmed death ligand 1 (PD-L1) is a
transmembrane protein that binds to the programmed cell death protein 1 (PD-1) located on
the surface of cytotoxic lymphocytes. The binding causes a series of cascade reactions that
lead to a reduced immune response. The aim of this study is to determine the expression level
of PD-L1 as well as microenvironmental cells (CD4, CD8, CD68 and CD163) in laryngeal
squamous lesions, their mutual relation and influence on survival in squamous carcinomas or
disease progression in the case of dysplasia.
Patients and methods: This retrospective study included 179 patients, of which 102 were
diagnosed with squamous laryngeal carcinoma, 41 with laryngeal dysplasia, and 36 with vocal
fold polyps. Immunohistochemical methods were used to evaluate the expression of PD-L1 as
well as the cells of the tumor microenvironment (CD4, CD8, CD68 and CD163).
Results: PD-L1 expression as well as the expression of cells in the tumor microenvironment
is statistically significantly higher in laryngeal carcinomas compared to dysplasias and in
dysplasias compared to benign lesions. No statistically significant difference was found in PD
L1 expression or in the expression of cells in the tumor microenvironment between dysplasias
that progressed to cancer and those that didn’t. A statistically significant positive correlation of
PD-L1 with all examined cells of the tumor microenvironment was demonstrated. Patients with
high intraepithelial expression of CD68 and CD163 (p=0.0005 and p=0.006) had statistically
significantly shorter disease-specific survival. Furthermore, a statistically shorter time to
recurrence was found in patients with high intraepithelial CD68 and high overall CD8 (p=0.049
and p=0.019). Increased overall expression of CD8 (>23%) and increased intraepithelial
expression of CD68 (>2.7%) were also statistically significant predictors of recurrence
(p=0.028, OR=3.11 and p=0.019, OR=3.13).
Conclusion: The results of this study indicate that tumor microenvironment cells are significant
prognostic factors in squamous laryngeal carcinoma. Increased expression of CD68 and
CD163 are predictors of worse survival in patients with squamous laryngeal carcinoma
Eosinophilic Esophagitis: From Rising Prevalence to Novel Diagnostics and Therapeutic Strategies
No full textWhile EoE presents as a progressively more commonly encountered disease, the importance of clinicians becoming familiar with this entity has dramatically increased. Raising awareness of the disease and educating physicians to recognize esophageal inflammatory processes early on significantly influences the patient’s outcome. The progression of EoE can be hindered, and thus, the number of fibrostenotic phenotypes reduced. Therefore, gaining a more profound understanding of disease development becomes integral to future research. Similarly, optimizing diagnostic algorithms aims to provide less invasive approaches, offering new ways of treatment control. Even though, up to today, there is no cure, new therapeutic options allow control of the disease and aim to address symptoms and prevent further progression. Novel treatment approaches open up entirely new pathways in the treatment of EoE. Therefore, it can be aimed at a future where novel research findings allow an entirely new approach to the management of EoE
Occurrence of total coliform bacteria in a coastal sea loaded with inflows
No full textKakvoća mora za kupanje predstavlja važan javnozdravstveni pokazatelj koji može biti narušen fekalnim i sekundarnim onečišćenjem. Cilj ovog istraživanja bio je ispitati pojavnost ukupnih koliformnih bakterija (UKB) u priobalju Rijeke, s naglaskom na vrste koje nisu obuhvaćene standardnim monitoringom, ali mogu ukazivati na prisutnost oportunističkih patogena i bolničkog zagađenja.
Istraživanje je provedeno u sklopu projekta EUROBATH na 12 lokacija, a obuhvatilo je ukupno 1119 uzoraka morske vode. Od toga je 117 uzoraka (10,5 %) bilo pozitivno na UKB. Najzastupljeniji je bio rod Citrobacter (79,5 %), a slijedili su rodovi Klebsiella, Enterobacter i Morganella. Identificirane su vrste poput Citrobacter freundii, Klebsiella pneumoniae i Enterobacter cloacae, poznate po višestrukoj antimikrobnoj rezistenciji i kliničkoj važnosti.
Statistička analiza pokazala je značajnu povezanost roda Citrobacter s kategorijom kakvoće mora „dobar“ prema koncentraciji E. coli, dok takva povezanost nije utvrđena za crijevne enterokoke, što upućuje na potencijalni nesklad među fekalnim indikatorima. Salinitet je bio jedini okolišni čimbenik koji je pokazao značajan utjecaj na pojavnost UKB, dok temperatura mora i zraka nisu imale značajnu povezanost.
Rezultati potvrđuju da se pojedine vrste UKB mogu pojavljivati i u odsutnosti izravnog fekalnog zagađenja, ali unatoč tome mogu imati važnu ulogu u dodatnim programima praćenja kakvoće obalnog mora, osobito u kontekstu praćenja antimikrobne rezistencije i sekundarnog onečišćenja bolničkog porijekla. Iako njihovo uvođenje u rutinski monitoring zasad nije opravdano zbog financijskih i dijagnostičkih ograničenja, praćenje vrsta poput Citrobacter spp. i Klebsiella spp. preporučljivo je u visokorizičnim i ciljanima istraživanjima.Bathing water quality is an important public health indicator that can be affected by both fecal and secondary contamination. The aim of this study was to examine the occurrence of total coliform bacteria (TCB) in the coastal waters of Rijeka, with a focus on species not included in standard monitoring but potentially indicative of opportunistic pathogens and hospital-related pollution.
The research was conducted as part of the EUROBATH project at 12 locations, with a total of 1119 seawater samples analyzed. Of these, 117 samples (10.5%) tested positive for TCB. The most prevalent genus was Citrobacter (79.5%), followed by Klebsiella, Enterobacter, and Morganella. Identified species included Citrobacter freundii, Klebsiella pneumoniae, and Enterobacter cloacae, all known for their multidrug resistance and clinical relevance.
Statistical analysis revealed a significant association between the presence of Citrobacter and the "good" bathing water quality category according to E. coli levels, but not according to intestinal enterococci, indicating a potential mismatch between standard fecal indicators. Salinity was the only environmental factor that showed a statistically significant influence on TCB occurrence, while sea and air temperature did not.
The results confirm that certain TCB species can be present even in the absence of direct fecal contamination, yet may still play an important role in supplementary coastal water quality monitoring programs, especially in the context of antimicrobial resistance and secondary pollution of hospital origin. While their inclusion in routine monitoring is currently not justified due to financial and diagnostic constraints, tracking species such as Citrobacter spp. and Klebsiella spp. is recommended in high-risk and targeted investigation
Relationship Between Complex PTSD Symptoms and Levels of Perceived Social Support : graduation thesis
No full textBackground: Complex post-traumatic stress disorder is a newly recognized psychiatric condition characterized by core PTSD symptoms alongside disturbances in self-organization, including emotional dysregulation, negative self-concept, and interpersonal difficulties. Perceived social support is a well-established protective factor in trauma recovery, yet its specific relationship with cPTSD symptomatology, particularly in war veterans, warrants further exploration. Methods: This cross-sectional study examined the relationship between cPTSD symptoms and perceived social support in a sample of 62 male war veterans (aged 44–66) undergoing long-term psychiatric treatment in Rijeka, Croatia. Participants completed the International Trauma Questionnaire and the ISEL-12. Spearman correlations, ANOVA, and post-hoc analyses were used to explore associations between symptom severity, perceived social support, and sociodemographic variables. Results: Higher overall cPTSD symptom severity was significantly associated with lower levels of perceived social support, with DSO symptoms showing the strongest inverse correlation. Among PTSD clusters, avoidance was the only subdomain significantly associated with lower perceived social support. Employment status emerged as a significant sociodemographic factor. Employed participants reported higher perceived social support, whereas marital status and number of children showed no significant associations. Conclusions: These findings highlight a robust inverse relationship between cPTSD symptoms and perceived social support, particularly regarding DSO symptoms. Employment appears to serve as a crucial source of social support in this veteran population. Clinical interventions should incorporate strategies to enhance social support—especially beyond the family context—and consider occupational engagement as a potential therapeutic avenue in the treatment of cPTSD
Relationship Between Complex PTSD Symptoms and Emotion Dysregulation : graduation thesis
No full textBackground: Complex posttraumatic stress disorder is characterized by core PTSD symptoms along with disturbances in self-organization, including affective dysregulation, negative self- concept, and interpersonal difficulties. Emotion dysregulation is considered a central component of cPTSD, yet the specific relationship between emotion dysregulation and distinct cPTSD symptom clusters warrant further exploration. Methods: A cross-sectional study was conducted among military veterans (N = 62) using the DERS-16 to assess emotion dysregulation and the International Trauma Questionnaire to measure cPTSD symptoms. Descriptive statistics, the Kolmogorov-Smirnov test, and box plots were used to evaluate variable distributions. Due to non-normality, Spearman correlation coefficients were calculated to assess associations between emotion dysregulation and cPTSD symptom severity. ANOVA tests were conducted to examine further correlations. Analyses were performed using JASP version 0.19.3, with significance set at p f 0.05. Results: Strong positive correlations were found between overall cPTSD severity and emotion dysregulation. DSO symptom clusters were significantly more correlated with emotion dysregulation than core PTSD clusters. Among PTSD symptoms, avoidance showed moderate correlation with emotion dysregulation, re- experiencing showed a weak correlation, and threat-related symptoms were not significantly associated. Furthermore, longer combat duration was significantly related to higher emotion dysregulation and more severe DSO symptoms, particularly impulsivity, emotional clarity, and lack of regulation strategies. Conclusions: The findings reinforce the conceptualization of cPTSD as a disorder fundamentally rooted in emotion dysregulation. DSO features, especially affective dysregulation and negative self-concept, appear intrinsically linked to difficulties in managing emotional responses. Additionally, prolonged trauma exposure (e.g., extended combat) contributes significantly to these difficulties