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Bite wounds and specificity of expertise in forensic practice
No full textUgrizna rana (vulnus morsum) predstavlja specifičnu mehaničku ozljedu koja može nastati djelovanjem zubi ljudi i različitih životinja. U forenzičkoj praksi, ugrizne rane predstavljaju kompleksan izazov zbog velike varijabilnosti u izgledu, mehanizmu i okolnostima nastanka. Dok su ljudski ugrizi često prepoznatljivi, životinjski ugrizi izgledom mogu varirati od površinskih ozljeda do teških traumatskih amputacija. Poseban dijagnostički problem predstavlja postmortalna predacija životinja, koja može značajno otežati identifikaciju žrtve i preciznu rekonstrukciju uzroka i načina smrti.
Kako bi se očuvala forenzička vrijednost ugrizne rane, ključno je pravovremeno i pravilno dokumentiranje. Osim određivanja težine tjelesne ozljede, vještačenje ugriznih rana može uključivati i pokušaj identifikacije počinitelja ugriza, iako ta metoda nosi brojna ograničenja u pogledu pouzdanosti. Budućnost forenzičke analize ugriznih rana ne leži samo u razvoju tehnologije, već i u dubljem razumijevanju konteksta i značenja ovakvih ozljeda. Stoga su dodatna istraživanja i izrada preciznijih dijagnostičkih kriterija od velike važnosti za unaprjeđenje forenzičke prakse.Bite marks represent a specific type of forensic trace caused by the teeth of humans or various animals. In forensic practice, they present a complex challenge due to their high variability in appearance, mechanism, and circumstances of occurrence. While human bite marks are often more recognizable, those caused by animals may range in appearance from superficial injuries to severe traumatic amputations. A particular diagnostic problem is postmortem animal predation, which can significantly complicate the identification of the victim and the precise reconstruction of the cause and manner of death.
Preserving the forensic value of bite marks requires timely and proper documentation. In addition to assessing the severity of bodily harm, forensic evaluation may also include attempts to identify the biter, although such methods come with significant limitations in terms of reliability. The future of bite mark analysis depends not only on technological advances but also on a deeper understanding of the context and forensic meaning of such injuries. Therefore, further research and the development of precise diagnostic criteria are of great importance for improving forensic practice
Reference Intervals for Common Biochemistry and Hematology Parameters in Early Pregnancy—A Prospective Study
No full textBackground: The aim of this study was the determination of reference values for the common laboratory parameters in early pregnancy using a direct method and to assess their clinically significant difference, which was compared to the reference intervals for non-pregnant women with respect to the reference change value (RCV). Methods: This study was conducted from September 2022 to December 2023 at the Clinical Department of Laboratory Diagnostics, Clinical Hospital Centre RIJEKA, Croatia. The inclusion criteria were as follows: age ≥ 18 years, singleton pregnancy, normal ultrasound examination, and prenatal screening. The exclusion criteria were as follows: recent illness, pregnancy-related complications, medically assisted reproduction, and medication use. The reference intervals were established using the non-parametric percentile method according to the CLSI EP28-A3c recommendation. The reference values were compared to those of non-pregnant women and judged against RCV values based on biological variation. Additionally, we tested the influence of food consumption and oral supplements. Results: The data of 299 participants were included in the study. Laboratory tests whose changes are clinically relevant lower in early pregnancy are as follows: hemoglobin, MCV, hematocrit, MCH, urea, creatinine, albumin, alkaline phosphatase, lactate dehydrogenase, sodium, and magnesium. The clinically relevant higher values are as follows: RDW, total leukocyte count, neutrophil granulocytes, monocytes, CRP, total cholesterol, triglycerides, and amylase. UIBC has a wider reference range. The consumption of food and supplements has no clinically significant influence in relation to the RCV. Conclusions: Establishing reference intervals in pregnancy remains a challenge due to the metabolic changes during pregnancy, as well as its clinical significance
Seasonal Shifts and Smart Stats: Improving Biodrying in Waste Management
No full textThe biodrying process is a well-established method in solid waste management for reducing the moisture content of municipal solid waste (MSW), facilitating its mechanical treatment, enhancing energy recovery efficiency, and simplifying disposal. However, challenges such as variability in drying efficiency, seasonal fluctuations, and operational inconsistencies limit its optimization and broader applicability. This study undertakes a detailed evaluation of biodrying operations using Statistical Process Control (SPC) techniques to improve process stability and identify key factors influencing efficiency. Data collected over a one-year period from a waste management facility employing Herhoff Rotteboxes® reveal an average drying efficiency of 28%, with notable seasonal trends showing reduced efficiency during summer and fall. A regression model analyzing waste load, operational parameters, and seasonal effects accounted for 25% of the variability in drying efficiency, suggesting additional factors like waste composition and microbial activity significantly impact the process. This study highlights the value of SPC tools in monitoring process stability and demonstrates how targeted optimization strategies—such as seasonal adjustments and refined loading practices—can enhance biodrying outcomes. By addressing gaps in current practices, these findings contribute to the advancement of waste management technologies and support the development of more efficient and sustainable systems for handling municipal solid waste
Survey of Clinical Practice in Chronic Myeloproliferative Neoplasms in Croatia: A Study by the MPN Working Group Party of the Croatian Cooperative Group for Hematologic Diseases (KROHEM)
No full textBackground/Objectives: Chronic myeloproliferative neoplasms (MPNs), essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), are hematopoietic stem cell disorders characterized by increased proliferation of mature myeloid cells, a chronic inflammatory state, and high cardiovascular risk. The diagnostic and therapeutic landscape in the field of MPNs is rapidly evolving. Therefore, it is important to assess the behavior of physicians involved in the management of MPN patients to gain insight into how they embrace the current diagnostic and treatment landscape in real-life settings. Methods: An online anonymous survey consisting of 50 questions regarding their MPN practice and divided into four major domains (physician characteristics, diagnostic procedures, therapeutic decisions, and patient follow-up) was sent through the Croatian Cooperative Group for Hematologic Diseases’ (KROHEM’s) e-mailing list to all Croatian hematologists. Results: Thirty-one out of ninety adult hematologists (34.4% response rate) from KROHEM responded to this survey. There was a very high rate of self-proclaimed abidance to current international diagnostic and therapeutic recommendations, with no major differences among academic and community practices. However, some areas of uncertainty have been highlighted, especially in the frequency of cytogenetic and molecular testing, as well as very low implementation of the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) questionnaire in everyday practice. Conclusions: This study provides an important snapshot of the current MPN practice in Croatia. Similar studies from other countries are needed to provide a more detailed overview of real-life MPN practice globally
Atypical Presentation of Methicillin Sensitive Staphylococcus Aureus Spondylodiscitis – a Case Report
No full textCilj: Prikazati atipičnu kliničku i radiološku sliku spondilodiscitisa izazvanog meticilin-senzitivnim sojem bakterije Staphylococcus aureus (MSSA) te ukazati na važnost ranog postavljanja dijagnoze zbog pravovremenog ciljanog terapijskog pristupa i izbjegavanja komplikacija, prvenstveno epiduralnih i paravertebralnih apscesnih kolekcija. Prikaz slučaja: Prikazujemo slučaj pacijenta (77. g.) koji se na objedinjeni hitni bolnički prijam javio s nespecifičnom kliničkom slikom oštre boli u abdomenu sa širenjem prema leđima u trajanju 7-8 dana, uz nagli nastup oduzetosti obiju nogu. Kliničkim pregledom utvrđen je ispad osjeta od razine devetog torakalnog kralješka na niže uz gubitak kontrole sfinktera. S obzirom na podatak o operaciji aneurizme abdominalne aorte, učinjena je CT aortografija koja je ukazala na patološki proces na sedmom (Th7) i osmom (Th8) torakalnom segmentu, uz potpuno očuvanu koštanu strukturu kralježaka te opsežan mekotkivan supstrat paravertebralno. Indicira se hitni MR torakalne kralježnice na kojem se prikazao opsežan edem koštane srži kralježaka Th7 i Th8, prvenstveno upalnih karakteristika uz nalaz velike epiduralne kolekcije koja uvjetuje kompresivnu mijelopatiju. S obzirom na opisano pristupilo se operativnom zahvatu i dekompresiji spinalnog kanala na kojem izostaju tipični makroskopski markeri upale te se postavila sumnja na tumorski proces. Iz tkivnih uzoraka za patohistološku i mikrobiološku analizu ne potvrđuju se elementi maligne tumorske infiltracije. Iz hemokulture je izoliran MSSA. Daljnji klinički tijek kod pacijenta komplicira se razvojem pneumonije i, nažalost, smrtnim ishodom nakon šest tjedana od početka liječenja. Zaključci: Postavljanje dijagnoze spondilodiscitisa često je izazovno zbog širokog raspona kliničke i morfološke prezentacije te zahtijeva visok indeks sumnje, posebice kod starijih pacijenata s komorbiditetima zbog rizika razvoja komplikacija i fulminantnog tijeka bolesti.Aim: To present the atypical clinical and radiological findings of methicillin-sensitive strain of Staphylococcus aureus (MSSA) spondylodiscitis and emphasize the importance of early diagnosis to assure timely targeted therapeutic approach and avoid complications, primarily epidural and paravertebral inflammatory collections. Case report: We present the case of a patient (age 77) admitted to the emergency hospital admission with a non-specific clinical symptom of sharp abdominal pain spreading towards the back lasting for 7-8 days, followed by a sudden onset of paraplegia. A clinical examination revealed loss of sensation from the level of the ninth thoracic vertebra downwards and loss of sphincter control. Considering the history of abdominal aortic aneurysm surgery, a CT aortography was performed, which demonstrated a pathological process involving the seventh (Th7) and eighth (Th8) thoracic segments with completely preserved bone structure of the vertebra and extensive paravertebral soft tissue mass. An urgent MRI of the thoracic spine showed extensive bone marrow oedema of Th7 and Th8 vertebra, likely inflammatory in nature, and large epidural collection resulting in compressive myelopathy. During the subsequent surgical decompression of the spinal canal no typical macroscopical markers of inflammation were observed and the suspicion of tumor process was raised. The pathohistological and microbiological analysis of the surgical specimens did not confirm malignant tumor infiltration. The MSSA was isolated from hemoculture. The future clinical course was complicated by pneumonia and unfortunately the patient died 6 weeks after starting the treatment. Conclusion: The diagnosis of spondylodiscitis is often challenging due to a wide range of clinical and morphological findings requiring high index of suspicion, especially in elderly patients with comorbidities due to risk of developing complications and fulminant course of the disease
Comedones and Atrophic Scarring as a Rare Presentation of Chronic Cutaneous Lupus Erythematosus – a Case Report
No full textCilj: Prikazati slučaj pacijentice s komedonalnim lupusom – izuzetno rijetkim oblikom kroničnog kutanog eritemskog lupusa (engl. chronic cutaneous lupus erythematosus; CCLE). Naglasak je stavljen na specifičnosti kliničke prezentacije i dijagnostičke izazove koji prate ovu bolest. Prikaz slučaja: 37-godišnja pacijentica zaprimljena je u dermatološku ambulantu zbog pojave eritematozne infiltracije na lijevoj strani brade, uz prisutnost otvorenih komedona te atrofičnih ožiljaka i tamnijih komedona periaurikularno. Inicijalno je postavljena dijagnoza subakutnog apscesa brade te je pacijentici propisana antibiotska terapija i planirano daljnje kirurško liječenje, no promjena u izgledu lezije potaknula je sumnju u inicijalnu radnu dijagnozu. Stoga je učinjena incizijska biopsija lezije te je korelacijom kliničke slike, patohistološkog nalaza i rezultata naknadne laboratorijske obrade utvrđeno da pacijentica ima komedonalnu varijantu CCLE-a. Propisana joj je terapija hidroksiklorokinom uz intralezionalnu primjenu triamcinolona. Nakon pojave makularnih promjena terapija hidroksiklorokinom je ukinuta te je uveden metotreksat. Tri mjeseca kasnije doza metotreksata povećana je zbog peristentnog eritema i edema lezije te je intenzivirana terapija intralezionalnim triamcinolonom, što je u periodu od šest mjeseci rezultiralo poboljšanjem kliničke slike. Zaključak: Komedonalni lupus iznimno je rijedak podtip CCLE-a. Do danas ovo je 20. opisani slučaj koji ukazuje na izazove u dijagnostici i terapiji zbog nedostatka tipičnih dermatoloških obilježja i neizvjesnosti prognoze. Patohistološka analiza i korelacija s kliničkom slikom ključne su u potvrdi dijagnoze. Bitna je važnost pravovremenog postavljanja dijagnoze uz individualiziran terapijski pristup te kontinuirano praćenje bolesnika radi mogućnosti progresije u sistemski oblik bolesti.Aim: To present a case of a patient with comedonal lupus, an exceptionally rare form of chronic cutaneous lupus erythematosus (CCLE). Emphasis is placed on the clinical presentation and diagnostic challenges associated with this condition. Case report: A 37-year-old woman presented to the dermatology clinic with an erythematous infiltration localized on the left side of her chin, accompanied by open comedones. Additionally, periauricular atrophic scarring and darker comedones were noted. Initially, a diagnosis of a subacute abscess was made, and the patient was prescribed antibiotic therapy with planned further surgical treatment. However, a change in the lesion’s appearance prompted suspicion of the initial diagnosis, resulting in an incisional biopsy. After correlating clinical presentation, histopathological findings, and laboratory results, the patient was diagnosed with the comedonal variant of CCLE. Treatment with hydroxychloroquine, along with intralesional injection of triamcinolone, was initiated. After the onset of macular changes, hydroxychloroquine was replaced with methotrexate. Three months later, the dose of methotrexate was increased due to persistent erythema and edema of the lesion, and intralesional triamcinolone therapy was intensified, resulting in improvement of the clinical picture over six months. Conclusion: Comedonal lupus is an extremely rare subtype of CCLE. This report represents the 20th documented case, highlighting the diagnostic and therapeutic challenges due to the lack of typical dermatological features and uncertainty of prognosis. Histopathological analysis and correlation with the clinical presentation are crucial for confirming the diagnosis. Timely diagnosis is essential, along with an individualized therapeutic approach and continuous patient monitoring for the possibility of progression to systemic disease
Relationship Between Gut Microbiota and the Clinical Course of COVID-19 Disease
No full textPossible early detection of people at increased risk for severe COVID-19 clinical course is extremely important so that appropriate therapy can be initiated promptly to prevent numerous deaths. Our study included 45 patients treated for COVID-19 at Dubrava University Hospital, with clinical course analysed from medical records and stool samples collected for determination of the gut microbiota diversity using 16S rRNA analysis. Sequencing was successful for 41 samples belonging to four clinical course groups (WHO guidelines): 12 samples—critical, 12—severe, 9—moderate and 8—mild group. Microbial composition was assessed between groups using two approaches—ANCOM (QIIME2) and Kruskal–Wallis (MicrobiomeAnalyst). On the genus level, two taxa were found to be differentially abundant: archaeal Halococcus and Coprococcus (for both W = 37)—the two were most abundant in the critical group (10% and 0.94% of entire abundance, respectively). Coprococcus catus was the only species identified by both methods to be differentially abundant between groups and was most abundant in the critical group. Alpha diversity indicated greater evenness of features in the critical group. Beta diversity showed clustering of samples from the critical group. A relationship between gut microbiota composition and the clinical course of COVID-19 disease was indicated, pointing towards specific distinct features of the critical group. In a broader sense, our findings might be useful in combating potential future similar pandemics and emerging virus outbreaks
Microbiome Dysbiosis as a Driver of Neurodegeneration: Insights into Alzheimer’s and Parkinson’s Diseases
No full textMicrobiome dysbiosis—an imbalance in gut microbial communities—has emerged as a critical factor in the pathogenesis of neurological disorders, particularly Alzheimer’s and Parkinson’s diseases. This review examines the role of gut microbiota in neurodegeneration, emphasizing how dysbiosis disrupts gut–brain communication through mechanisms such as impaired gut permeability, systemic inflammation, and neuroinflammation. The gastrointestinal and central nervous systems interact bidirectionally, with microbial metabolites like short-chain fatty acids playing a pivotal role in maintaining gut and brain health. Dysbiotic shifts in microbial composition can compromise the blood–brain barrier, enabling inflammatory molecules to alter brain biochemistry and potentially accelerate neurodegenerative processes. Additionally, this review explores therapeutic strategies—including probiotics, prebiotics, and dietary modifications—designed to restore microbial balance, reduce neuroinflammation, and slow disease progression. Further research is essential to refine microbiome-targeted therapies and fully elucidate their potential in managing neurodegenerative diseases
Key priorities for the implementation of the 2023 ESC Guidelines for the management of endocarditis in low-resource settings
No full textAbstract European Society of Cardiology (ESC) Guidelines provide best practice, evidence-based recommendations for diagnosing and treating patients with cardiovascular diseases. It is not always possible for best practices to be followed, however, particularly in low-resource settings. To address this issue, a set of guideline-related documents were created to identify key priorities for users in these settings. The documents highlight the related recommendations and describe key strategies for clinicians to approach implementation of these recommendations or discuss alternatives which are in line with the intention of the recommendations, if not having all of the same advantages. The suggestions cannot be used as exact substitutes for the original recommendations in the guidelines, which have not been altered and continue to reflect best practice. This document on key priorities for low-resource settings was developed by the task force chairs and other members of the task force who produced the 2023 ESC Guidelines for the management of endocarditis, which are freely available on the ESC website (https://www.escardio.org/Guidelines). This document also underwent external review including international experts from within and beyond Europe and ESC partner organizations, including the Interamerican Society of Cardiology (IASC), The Pan-African Society of Cardiology (PASCAR), the Asian Pacific Society of Cardiology and the ASEAN Federation of Cardiology
