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Morbidity and mortality in adults with a Fontan circulation beyond the fourth decade of life
No full textAbstrac
Specific adverse outcomes associated with selective serotonin reuptake inhibitors use in COVID-19 patients might be potentiated by remdesivir use
No full textBackground: Due to non-consistent reports in the literature, there are uncertainties about the potential benefits and harms of selective serotonin reuptake inhibitors (SSRIs) in patients with Coronavirus disease 2019 (COVID-19).
Aim: To investigate associations of SSRIs with clinical characteristics and unwanted outcomes among real-life severe and critical COVID-19 patients and their relationship with remdesivir (RDV) use.
Methods: This retrospective cohort study evaluated a total of 1558 COVID-19 patients of the white race treated in a tertiary center institution, among them 779 patients treated with RDV and 779 1:1 case-matched patients.
Results: A total of 78 (5%) patients were exposed to SSRIs during hospitalization, similarly distributed among patients treated with RDV and matched patients (5.1 and 4.9%). No significant associations of SSRI use with age, sex, comorbidity burden, and COVID-19 severity were present in either of the two cohorts (p < 0.05 for all analyses). In multivariate analyses adjusted for clinically meaningful variables, SSRI use was significantly associated with higher mortality among RDV (adjusted odds ratio (aOR) 2.0, p = 0.049) and matched patients (aOR 2.22, p = 0.044) and with higher risk for mechanical-ventilation (aOR 2.57, p = 0.006), venous-thromboembolism (aOR 3.69, p = 0.007), and bacteremia (aOR 2.22, p = 0.049) among RDV treated patients.
Conclusions: Adverse outcomes associated with SSRI use in COVID-19 patients might be potentiated by RDV use, and clinically significant interactions between these two drug classes might exist. Although our findings raise important considerations for clinical practice, they are limited by retrospective nature of the study, lack of ethnic diversity, and the potential for unmeasured confounding factors. Future studies exploring underlying biological mechanisms are needed
Optimizing growth and development: a nutritional biochemical approach to pediatric health
No full textOptimizing pediatric growth and development through a nutritional biochemical lens highlights the essential importance of proteins, lipids, vitamins, and minerals in maintaining child health. Each nutrient category is vital for specific physiological functions, and their deficiencies can lead to significant health issues. The choice between breastfeeding and formula feeding is crucial, with breast milk's comprehensive nutrition being the preferred start for infants. Pediatric nutrition faces challenges like addressing nutritional deficiencies and adapting to modern dietary trends, including the increased intake of processed foods. External factors like climate change and food security add complexity by affecting food availability and quality. Moving forward, a collaborative effort among healthcare professionals, researchers, policymakers, and caregivers is vital to promote healthy eating from infancy. The nutritional biochemical approach provides a framework for meeting children's nutritional needs, aiming for a future where all children can reach their full potential, underpinned by sound nutrition
Switching from Nusinersen to Risdiplam: A Croatian Real-World Experience on Effectiveness and Safety
No full textAbstract: (1) Background: Data on combination or sequential treatment of spinal muscular atrophy (SMA) with disease-modifying drugs (DMDs) are missing and the latter field is poorly understood. The currently available data of patients on risdiplam previously treated with nusinersen are coming from exploratory research mainly focused on safety. Our aim was to investigate the real-world effectiveness (hypothesising non-inferiority) and safety profile of risdiplam in a paediatric-and-adult nusinersen–risdiplam spinal muscular atrophy switch cohort. (2) Methods: A retrospective and anonymous collection of relevant demographic and clinical data for all Croatian SMA patients switched from nusinersen to risdiplam up to September 2023 (reimbursed by Croatian Health Insurance Fund—CHIF) was performed using the CHIF database and associated reimbursement documentation. Patients were included in effectiveness and safety analysis if they met the following inclusion criteria: (i) risdiplam was reimbursed by the CHIF; (ii) the patient received at least six doses of nusinersen before the switch to risdiplam; (iii) there was no relevant pause between the latter disease-modifying drugs; (iv) availability of all prespecified studied data and parameters. (3) Results: In total, 17 patients met the inclusion criteria (58.9% female; median age 12.75 (3.0–44.5) years). In our ‘switch’ cohort, we demonstrated a non-inferiority of risdiplam to nusinersen in the SMA 1 (+1.0 in CHOP INTEND; p = 0.067), SMA 3p (+0.7 in HFMSE; p = 0.897), and SMA 3a (+0.8 in RHS; p = 0.463) subpopulations, during a one-year follow-up period. There were no reports on respiratory function worsening, feeding worsening, and no lethal events. No new safety concerns were identified, except for the weight gain that arose as a new potential adverse drug reaction ‘signal’ in two patients. (4) Conclusions: We have reported pivotal real-world findings on switching SMA patients from nusinersen to risdiplam and demonstrated its effectiveness (non-inferiority), safety, and tolerability in a heterogenous paediatric-and-adult ‘switch’ cohort; this will further increase the quality and standards of care as well as safety of a notable portion of SMA patients, especially for those who demand the switch from nusinersen to other DMDs for clinical or personal reasons
Cherry Pit as a Cause of Ileus in Colonic Stenosing Carcinoma - a Case Report
No full textCilj: Cilj ovog rada je podići svijest o tome kako koštice trešnje mogu uzrokovati opstrukciju crijeva kod pacijenata koji boluju od karcinoma debelog crijeva. Prikaz slučaja: Muškarac starosti 68 godina javio se u hitnoći s anamnezom konstipacije i boli paraumbilikalno lijevo. Nativni radiogram abdomena u stojećem stavu pokazuje aerolikvidne nivoe tankog i debelog crijeva koji upućuju na ileus te se indicira CT pregled na kojem se potvrdi distenzija vijuga tankog i debelog crijeva s aerolikvidnim nivoima te stenozirajuća neoplazma silaznog kolona. Uzak, nepravilan lumen tumora bio je opstruiran okruglim stranim tijelom. Na CT pregledu okruglo strano tijelo ima hipodenzno ovoidno središte i hiperdenzni pokrov, što po opisu odgovara koštici trešnje. Napravljen je kirurški otvor na trbušnoj stijenci kroz koji je izveden segment crijeva (anus praeter) te je pacijent nakon oporavka otpušten iz bolnice. Dva mjeseca kasnije pacijent je zaprimljen na odjel kirurgije. Nakon učinjene prijeoperacijske obrade pristupilo se planiranom operacijskom zahvatu. Međutim, intraoperacijski je pronađena karcinoza peritoneuma te se odustalo od planiranog radikalnog zahvata. Upućen je na Kliniku za radioterapiju i onkologiju gdje su uvedeni ciklusi kemoterapije. Iduće godine u rujnu pacijent dolazi na aplikaciju 12. ciklusa. Osjećao se dobro te je otpušten kući uz preporuku da nastavi s dosadašnjom terapijom. Zaključak: Ileus izazvan košticom trešnje rijetko je stanje, ali treba biti uključeno u diferencijalnu dijagnozu u pacijenata s rizičnim čimbenicima kao što je zloćudna novotvorina debelog crijeva. Karcinom debelog crijeva ozbiljna je bolest koja zahtijeva pažljivu prehranu i brigu o prohodnosti crijeva.Aim: The aim of this paper is to raise awareness of how cherry pits can cause bowel obstruction in patients with colon cancer. Case report: A 68-year-old male presented to the emergency department with a history of constipation and left paraumbilical pain. A standing abdominal x-ray revealed air-fluid levels in the small and large bowel suggestive of ileus, and the CT scan confirmed the dilation of the small and large bowel with air-fluid levels and a stenosing neoplasm in the descending colon. The narrow, irregular lumen of the tumor was obstructed by a round foreign body. The CT scan showed a hypodense oval center and hyperdense shell consistent with a cherry pit. A surgical opening was made in the abdominal wall and a segment of the bowel was extracted (anus praeter), and the patient was discharged after recovery. Two months later, the patient was readmitted to the surgical department, and a planned surgery was performed after preoperative evaluation. However, peritoneal carcinomatosis was found intraoperatively, and the planned radical procedure was abandoned. He was referred to the Department of Radiotherapy and Oncology where he received chemotherapy cycles. The following year in September, the patient returned for the 12th cycle application. He felt well and was discharged with the recommendation to continue his current therapy. Conclusion: Bowel obstruction caused by a cherry pit is a rare condition but should be included in the differential diagnosis in patients with risk factors such as colon cancer. Colon cancer is a serious disease that requires careful nutrition and bowel management
Raw Vegan Diet in the Context of SARS-CoV-2 Infection
No full textVećina osoba zaraženih virusom SARS-CoV-2 razvije blagu do umjerenu koronavirusnu bolest (COVID-19), ali klinička prezentacija i opći tijek bolesti uvelike se razlikuju i uglavnom ovise o zdravstvenom stanju pacijenta prije infekcije. Određeni broj ljudi, posebno onih koji su imali teški COVID-19, ima multiorganske simptome koji traju tjednima, a u nekim slučajevima i dulje od 12 mjeseci nakon infekcije, a neki pokazuju imunofenotip koji podržava kroničnu upalu i može dovesti do razvoja autoimunosti i neuroinflamacije. Nezdrav način života i s njim povezana zdravstvena stanja, posebice pretilost, hipertenzija, dijabetes tipa 2 i hiperlipidemija, povezani su s težim oblicima bolesti COVID-19, ali podatci o utjecaju prehrane na klinički tijek bolesti još uvijek nedostaju. Sirova veganska prehrana ograničava unos nepoželjnih sastojaka hrane kao što su zasićene i nezasićene masti, natrij i dodani šećeri, a istovremeno je bogata voćem, povrćem i cjelovitim žitaricama te stoga ima mnoge pozitivne učinke na zdravlje. Svrha ovog članka je dati pregled čimbenika povezanih s težinom i ishodom bolesti COVID-19, istaknuti sve važne učinke sirove veganske prehrane na zdravlje pojedinca i raspravljati o njima u kontekstu infekcije virusom SARS-CoV-2.Most individuals infected with SARS-CoV-2 experience mild to moderate coronavirus disease 2019 (COVID-19), but the clinical presentation and general course varies widely and depends mainly on the patient's health status before the infection. Certain number of people, particularly those who had a severe COVID-19, experience multiorgan symptoms lasting weeks, months, or even years after infection and some exhibit an immunophenotype that supports chronic inflammation and may trigger autoimmunity and neuroinflammation. An unhealthy lifestyle and associated health conditions, particularly obesity, hypertension, type 2 diabetes, and hyperlipidemia, have been associated with the severity of COVID-19, but the data on the role of diet are still lacking. A raw vegan diet limits the intake of unhealthy food components such as saturated and unsaturated fats, sodium, and added sugars while being rich in fruits, vegetables, and whole grains, giving it some serious health benefits. The purpose of this review article is to give an overview of the factors associated with the severity and the outcome of COVID-19, to highlight all the important effects of raw vegan diet on individual health and to discuss them in the context of SARS-CoV-2 infection
Lipid Rafts: The Maestros of Normal Brain Development
No full textLipid rafts, specialised microdomains within cell membranes, play a central role in orchestrating various aspects of neurodevelopment, ranging from neural differentiation to the formation of functional neuronal networks. This review focuses on the multifaceted involvement of lipid rafts in key neurodevelopmental processes, including neural differentiation, synaptogenesis and myelination. Through the spatial organisation of signalling components, lipid rafts facilitate precise signalling events that determine neural fate during embryonic development and in adulthood. The evolutionary conservation of lipid rafts underscores their fundamental importance for the structural and functional complexity of the nervous system in all species. Furthermore, there is increasing evidence that environmental factors can modulate the composition and function of lipid rafts and influence neurodevelopmental processes. Understanding the intricate interplay between lipid rafts and neurodevelopment not only sheds light on the fundamental mechanisms governing brain development but also has implications for therapeutic strategies aimed at cultivating neuronal networks and addressing neurodevelopmental disorders
Antithrombotic Usage, Including Three-Year Outcomes With Dabigatran and Vitamin K Antagonists for Atrial Fibrillation, in Eastern Europe: A Descriptive Analysis From Phase 3 of the GLORIA-AF Registry
No full textBACKGROUND: Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is a prospective registry of outcomes from patients with newly diagnosed AF at risk of stroke. In the propensity score (PS)-matched global population of phase 3 GLORIA-AF, at 3 years, dabigatran-treated patients experienced reduced risk for major bleeding, and similar risk for stroke and myocardial infarction, compared with vitamin K antagonist (VKA)-treated patients. STUDY QUESTION: Do patients in Eastern Europe benefit from treatment with dabigatran versus VKA? STUDY DESIGN: Descriptive analysis, without PS matching. To contextualize the Eastern Europe results of GLORIA-AF phase 3, we also descriptively analyzed the global population without PS matching. Consecutive patients with newly diagnosed AF and CHA2DS2-VASc-score ≥1 were enrolled until December 2016 in 38 countries (9 in Eastern Europe). MEASURES AND OUTCOMES: Three-year outcomes with dabigatran and VKA. RESULTS: In Eastern Europe, 1341 patients were eligible (6% of patients globally), and incidence rates (per 100 patient-years) for the following outcomes were numerically lower with dabigatran (N = 498) versus VKA (N = 466): major bleeding (0.26 vs. 0.90), all-cause death (2.04 vs. 3.50), and a composite of stroke, systemic embolism, myocardial infarction, life-threatening bleeding, and vascular death (1.37 vs. 1.92); stroke was comparable (0.51 vs. 0.50). All incidence rates were numerically lower in Eastern Europe versus the global population for both treatments. Chronic concomitant use of high bleeding risk medications (eg, nonsteroidal anti-inflammatories) was lower in Eastern Europe (dabigatran 3.8%, VKA 9.3%) than globally (dabigatran 14.8%, VKA 20.6%) and persistence with dabigatran was higher in Eastern Europe (76%) than globally (64%). CONCLUSIONS: Dabigatran was associated with numerically reduced major bleeding, all-cause death, and cardiovascular (CV) composite, with comparable risk of stroke versus VKA, in Eastern Europe. Limitations of this descriptive analysis include few CV events (n = 11 for stroke, in the dabigatran and VKA groups combined) and a lack of statistical analysis and PS matching, which precludes definitive conclusions; however, the CV outcomes in Eastern Europe were consistent with the beneficial impact of dabigatran versus VKA in the statistically analyzed global population with PS matching
Elemental Analysis of Particulate Matter Produced During Firework Events in the City of Rijeka, Croatia
No full textABSTRACT Particulate matter (PM) is one of the most important air pollutants that can hurt human health. Fireworks are rare but important sources of ambient PM and can therefore lead to short‐term exposure to high concentrations of PM with potentially toxic components. For the first time in the city of Rijeka, Croatia, the characteristics of fireworks PM during 6 celebrations (New Year 2015, 2017, and 2018 and 3 football events in May 2017) were investigated and compared with the average concentrations during the surrounding period. The elemental composition of the PM samples was determined using the X‐ray fluorescence technique, where the concentrations of 15 elements from S to Pb were determined. Although the total PM concentrations were in the range of values previously measured at the same locations, the concentrations of several elements were substantially larger during the fireworks. A significant increase in concentrations was observed for K, Ti, Cr, Cu, Sr, and Ba, with the largest increase in concentration for Sr and Ba. The most noticeable increase in concentrations compared to the seasonal average was observed during the 2018 New Year's sampling when the average 8‐h concentrations were elevated as follows: 11 times for K, 14 times for Ti, 5 times for Cr, 9 times for Cu, 691 times for Sr, and 243 times for Ba. The increase in concentrations at other events where 24‐h samples were taken was present but not as pronounced and was lowest at football celebration events
Hrvatske smjernice za dijagnostiku i liječenje portalne hipertenzije
No full textLiver diseases are currently the eleventh leading cause of global mortality, and
cirrhosis holds the ninth position among the causes of death in Europe. The progression of cirrhosis
gives rise to complications such as portal hypertension (PH), liver failure, and development of
hepatocellular carcinoma. PH plays a pivotal role in the advancement of chronic liver disease and
stands as an independent predictor of mortality in individuals with cirrhosis. Given the numerous
updates in the classification, diagnosis, and treatment strategies for PH, the adoption of national
guidelines has become imperative to enhance the care of this patient population. In the wake of
Baveno VII consensus, as well as the recently published data, the working group of the Croatian
Society of Gastroenterology drafted the guidelines that were discussed and agreed during 2023.
Herein, we present a condensed version highlighting the key recommendations.Bolesti jetre trenutno su jedanaesti vodeći uzrok globalne smrtnosti, a ciroza zauzima deveto mjesto među uzrocima smrti
u Europi. Progresija ciroze dovodi do razvoja komplikacija poput portalne hipertenzije (PH), zatajenja jetre i hepatocelularnog
karcinoma. PH igra ključnu ulogu u napredovanju kronične bolesti jetre i predstavlja neovisan prediktor smrtnosti kod osoba
s cirozom. S obzirom na brojne novosti u klasifikaciji, dijagnozi i strategijama liječenja PH, usvajanje nacionalnih smjernica
postalo je imperativ kako bi se poboljšala skrb za ovu skupinu bolesnika. U svjetlu Baveno VII. konsenzusa, kao i rezultata
istraživanja objavljenih nakon njega, radna skupina Hrvatskoga gastroenterološkog društva izradila je smjernice koje su
razmatrane i usuglašene tijekom 2023. godine. Ovdje predstavljamo sažetu verziju smjernica s ključnim preporukama