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Tjemena uš (Pediculus humanus var. capitis)
No full textPedikuloza je parazitarna bolest uzrokovana tjemenim ušima (Pediculus humanus var. capitis), predstavlja dugotrajan javnozdravstveni problem, osobito među djecom predškolske i školske dobi. Uši su prisutne kroz povijest kao paraziti na ljudima te se lako šire direktnim kontaktom ili putem kontaminiranih predmeta poput češljeva i posteljine. Pedikuloza se najčešće prenosi direktnim kontaktom u zajednicama gdje ljudi provode dulje vrijeme u bliskoj međusobnoj interakciji. Životni ciklus tjemene uši karakterizira nepotpuna preobrazba odnosno razvoj kroz tri stadija presvlačenja: od gnjide preko nimfe do odrasle jedinke. Uši su obligatni hematofagi i hrane se nekoliko puta dnevno. Pedikuloza se primarno dijagnosticira determinacijom prisutne uši tijekom mokrog češljanja i vizualnog pregleda. Liječenje se temelji na mehaničkom uklanjanju uši i upotrebi kemijskih sredstava (pedikulicida), no sve veća otpornost ušiju na insekticidne preparate zahtijeva upotrebu kombiniranih metoda. Učinkovito liječenje uključuje pravovremeno praćenje prisutnosti i pridržavanje preporuka kako bi se spriječio ponovni prijenos ušiju. Preventivne mjere, poput redovitih pregleda u školama i vrtićima, edukacije djece, roditelja i osoblja o pravilnom prepoznavanju i liječenju infestacije, ključne su za smanjenje širenja pedikuloze. Edukacija također pomaže ukloniti stigmu povezanu s ušima i podići svijest o važnosti pravovremene reakcije
Inositols in the Treatment of Polycystic Ovary Syndrome in Reproductive Age
No full textPolycystic ovary is part of an endocrine syndrome in which different pathophysiological mechanisms lead to a similar reproductive outcome: anovulation, irregularity of the menstrual cycle, and infertility. Hormonal and metabolic disorders are associated with reproductive adverse outcomes, which represent a vicious circle with dysfunctional ovaries. Hyperandrogenemia, disorder of carbohydrate metabolism, and sex hormone synthesis led to reproductive abnormalities. One of the most crucial questions still remains, whether the polycystic ovary is the cause or the consequence of all known disorders. Inositols are in the treatment of PCOS capable of restoring ovulation with the impact on the carbohydrate metabolism, by increasing the sensitivity of cells to insulin, which releases the sex hormones-binding protein and improves hyperandrogenemia. Nine stereoisomers of inositol are known, myo-inositol and chiro-inositol are the most studied in the reproductive age. By normalizing the level of androgens in the blood, the growth of and the balance of sex hormones is established. A variety of metabolic pathways of these molecules are recognized in different tissues, such as fat, muscle, or ovarian tissue. Still, it is not clear which isomer has better reproductive or metabolic effects, and there are controversies about their effectiveness in the treatment of reproductive disorders
From Liburnia Toponymy to Mountaineering Terminology: Contributions of Stanislav Gilić to Croatian Linguistics
No full textStanislav Gilić široj je javnosti uglavnom poznat kao vrstan alpinist, planinar i penjač. U ovom se pak radu ističe njegov velik doprinos hrvatskomu jezikoslovlju – predstavlja se i valorizira njegov plodan onomastički (ponajprije toponomastički) opus, a ističu se i važni terminološki prinosi, za koje se može reći da nadilaze okvire lokalnoga i regionalnoga, odnosno da su relevantni u nacionalnom, pa čak i u nadnacionalnom kontekstu. Pregledom i kritičkim osvrtom najprije su obuhvaćeni radovi u kojima je predstavio rezultate svojih sustavnih istraživanja toponimā na području Liburnije – na potezu od Lovranštine preko Mošćeništine do Brseštine. Zatim se nudi osvrt na druge njegove toponomastičke radove čija su tema toponimijski sustavi različitih područja – od Rijeke i Grobništine, preko područja općina Kostrena, Klana i Matulji, do širega teritorija Istre. Naposljetku se zasebno ističe i valorizira vrijednost njegovih radova u području planinarske i alpinističke terminologije, koji su do danas – što je malo poznato čak i akademskoj javnosti – nezaobilazne referentne točke i relevantni prinosi pri razvoju planinarske terminologije.The general public knows Stanislav Gilić primarily as an exceptional alpinist, mountaineer, and climber. However, this paper emphasizes his significant contribution to Croatian linguistics is highlighted – his extensive work in the field of onomastic, with a focus on toponomastic, is presented and valorized. The emphasis is also placed on important terminological contributions, as they can be considered to go beyond the local and regional level – that is, they can be considered relevant in national and even in a supranational context. The review first tackles the papers in which Stanislav Gilić presented the findings of his systematic toponomastic research in the area of Liburnia – spanning from Lovran region through Mošćenice region to Brseč region. It then offers a review of his other toponomastic works, the subject of which are the toponymic systems of various areas, including Rijeka and Grobnik area, as well as the municipalities of Kostrena, Klana and Matulji, and reaching to the broader territory of Istria. Finally, the review underscores and valorizes valuable contributions of his papers in the field of mountaineering and alpinist terminology, which have remained essential reference points and relevant contributions to the development of mountaineering terminology to this day (which is relatively unknown even to the academia)
Cognitive Decline in Women or Brain Aging?
No full textKognitivno zdravlje omogućuje svakom pojedincu adekvatan uvid u svoje sposobnosti i dobru prilagodbu svojih kognitivnih, emocionalnih i bihevioralnih funkcija na različite životne događaje. Svaki pojedinac ne održava jednako dugo svoje kognitivno zdravlje jer ljudski mozak u pojedinaca stari različitom brzinom. Kod nekih se bilježi brzi kognitivni pad, dok drugi zadržavaju kognitivne funkcije duže od tipičnih za životnu dob. Još su evolucijski teoretičari predvidjeli da bi ženski mozak mogao biti mlađi u usporedbi s muškim, a recentna istraživanja sugeriraju da je tome tako zbog manjeg gubitka cerebralnog protoka krvi nakon puberteta, veće moždane glikolize tijekom mlađe odrasle dobi, manjeg gubitka ekspresije gena povezanih sa sintezom proteina tijekom starenja te značajno kasnijom vršnom točkom ekspresije moždanih gena. Čimbenici identificirani kao pogoršavajući rizik za starenje i kognitivno propadanje uključuju depresiju, dijabetes tipa 2, hipertenziju srednjih godina, pretilost u srednjim godinama, pušenje kod muškaraca, ali ne i žena, tjelesnu neaktivnost i niska obrazovna postignuća, smrt roditelja u ranoj dobi i kronične poremećaje spavanja u srednjim godinama. Zaštitni faktori koji se povezuje s mlađim izgledom mozga su: godine obrazovanja, tjelesna vježba, vježbanje meditacije, socijalna aktivnost, konzumiranje umjerenih količina alkohola, adekvatna prehrana (mediteranska, nordijska, DASH i MIND), tj. prehrane povezane s malim udjelom masti uz prisustvo korisnih mikronutrijenata kao što su vitamin B, željezo i mnogi polifenoli. U mnogim istraživanjima dokazano je kako je obrazovanje najveći nebiološki čimbenik zaštite kognitivnog propadanja u starijoj dobi. Pouzdan biomarker starenja još uvijek ne postoji, ali nedavno su razvijene multivarijatne metode za definiranje statističkih modela zdravog starenja mozga. Tako se kronološka dob zdravih osoba može predvidjeti korištenjem analize neuroimaging podataka s pomoću strojnog učenja.Cognitive health enables each individual to have adequate insight into their abilities and a good adaptation of their cognitive, emotional and behavioral functions to various life events. Each individual does not maintain their cognitive health for the same length of time because the human brain ages at different rates in every individual. Some have a rapid cognitive decline, while others retain cognitive functions longer than is typical for their age. Even evolutionary theorists predicted that the female brain might be younger compared to male, and recent research suggests that this is due to lesser loss of cerebral blood flow after puberty, greater brain glycolysis during young adulthood, lesser loss of expression of genes related to protein synthesis during aging, and a significantly later peak of brain gene expression. Factors identified as exacerbating risk for aging and cognitive decline include depression, type-2 diabetes, midlife hypertension, midlife obesity, smoking in men but not women, physical inactivity and low educational attainment, early parental death, and chronic sleep disorders in middle age. Protective factors associated with a younger appearance of the brain are: years of education, physical exercise, practicing meditation, social activity, consumption of moderate amounts of alcohol, adequate diet (Mediterranean, Nordic, DASH and MIND), i.e. diet associated with a low proportion of fat and with the present beneficial micronutrients such as vitamin B, iron and many polyphenols. It has been proven in many studies that education is the greatest non-biological factor in the protection of cognitive decline in old age. A reliable biomarker of aging still does not exist, but recently multivariate methods have been developed to define statistical models of healthy brain aging. Thus, the chronological age of healthy individuals can be predicted using machine learning analysis of neuroimaging data
Uvodnik: Zdravlje žene
No full textVeliko nam je zadovoljstvo predstaviti tematski broj časopisa Medicus posvećen zdravlju žena, u kojemu vrhunske stručnjakinje iz različitih područja medicine dijele najnovija saznanja u prevenciji, dijagnozi i liječenju različitih zdravstvenih stanja. U ovom broju naglasak je na integriranom pristupu koji uzima u obzir biološke, psihološke i socijalne aspekte zdravlja žena, te omogućava sveobuhvatan uvid u specifične potrebe žena u različitim životnim razdobljima.
Tematski broj posvećen je zdravlju žena iz različitih medicinskih gledišta, iz područja interne medicine, kardiologije, reumatologije, onkologije, ginekologije, anesteziologije, kliničke farmakologije, neurologije i psihijatrije, a koje su obradile naše uvažene stručnjakinje u sveobuhvatnom i cjelovitom obliku referirajući se na epidemiologiju, etiologiju, liječenje, rehabilitaciju i prevenciju na složenoj platformi biopsihosocijalnog pristupa.
Od metaboličkih i hormonalnih promjena preko utjecaja na imunološki sustav i zdravlje kostiju, migrene, depresije i anksioznog poremećaja, poremećaja spavanja, kognitivnog popuštanja, liječenja boli, prevencije i liječenja raka dojke do pitanja seksualnog zdravlja – cilj nam je pružiti duboko razumijevanje tih izazova i poduprijeti razvoj ciljanih, spolno osjetljivih terapijskih strategija koje mogu značajno poboljšati kvalitetu života žena
THE EFFECT OF CORTICOSTEROIDS ON BONE METABOLISM DURING INFLAMMATORY BOWEL DISEASE IN RATS
No full textCilj istraživanja: Upalna bolest crijeva (UBC) povećava rizik od osteoporoze i
patoloških prijeloma kostiju, što utječe na porast morbiditeta i mortaliteta u ovih
bolesnika i povećava ekonomsko opterećenje zdravstvenog sustava. Gubitak koštane
mase u UBC najvećim je dijelom pod utjecajem RANKL/RANK/OPG sustava, a
pogoršava se terapijskom primjenom kortikosteroida (KS). Koštani morfogenetski
protein 7 (BMP7, eng. bone morphogenetic protein 7) ima složenu ulogu u koštanom
metabolizmu i upalnim procesima, ali nedovoljno je poznata njegova protuupalna i
osteoprotektivna uloga u kroničnom kolitisu. Istražili smo utjecaj sustavne primjene
BMP7 i KS na težinu upalnih promjena, diferencijaciju makrofaga i regeneraciju kosti
u pokusnom modelu kolitisa.
Materijali i metode: Akutni i kronični kolitis induciran je u muških Sprague Dawley
štakora intrarektalnom primjenom 2,4,6-trinitrobenzenesulfonske kiseline (TNBS), a
zatim je slijedila primjena BMP7 i KS kroz pet dana. Akutni kolitis induciran je
jednokratnom primjenom TNBS-a, a kronični kolitis tjednom primjenom TNBS-a kroz
21 dan. U tkivu crijeva i serumu ispitali smo razine inflamatornih citokina, molekula
RANKL/RANK/OPG sustava te markere polarizacije makrofaga pomoću RT-qPCR,
ELISA i imunohistokemijske metode. Koštane morfometrijske parametre analizirali
smo pomoću mikrokompjuterizirane tomografije (micro-CT).
Rezultati: Nakon primjene BMP7 ublažena je upala crijeva i povećane su vrijednosti
OPG i RANK-a u tkivu crijeva, uz smanjenje razine TNF-α i povećanje razine IL-10 i
TGF-β. U usporedbi s kolitisom, nakon BMP7 tretmana utvrđen je smanjen izražaj
CD163, biljega M2 makrofaga, a za iNOS, biljeg M1 makrofaga, nije nađena razlika
među grupama. BMP7 je također poboljšao morfometrijske parametre trabekularne
kosti.
Zaključak: Utvrdili smo da BMP7 smanjuje upalni odgovor u kroničnoj upalnoj bolesti
crijeva, u ovom radu Crohnovoj bolesti, uglavnom modulacijom citokinskog profila i
molekula RANKL/RANK/OPG sustava, bez utjecaja na polarizaciju makrofaga. S
obzirom na pozitivan utjecaj na koštani metabolizam, BMP7 bi mogao imati važnu
ulogu u ublažavanju osteoporoze u upalnoj bolesti crijeva te bi njegov terapijski
potencijal trebalo detaljnije istražiti u daljnjim studijama.Objectives: Patients with inflammatory bowel disease (IBD) have an increased risk of
osteoporosis and fractures, which rises morbidity and mortality rates and poses a high
economic burden on healthcare systems. Bone loss in IBD is a process mostly
controlled by the RANKL/RANK/OPG system and is aggravated by corticosteroid
treatment. Bone morphogenetic protein 7 (BMP7) has a complex role in bone
metabolism and inflammation but little is known about its anti-inflammatory and
osteoprotective potential in chronic colitis. We investigated the effect of systemically
administered BMP7 and corticosteroids on the severity of inflammation, macrophage
differentiation, and bone regeneration in a colitis model.
Material and methods: Acute and chronic colitis were induced in male Sprague
Dawley rats via intrarectal administration of 2,4,6-trinitrobenzenesulfonic acid (TNBS)
following BMP7 or corticosteroid systemic treatment for five days. Acute colitis was
induced by a single TNBS administration while chronic colitis was induced by weekly
TNBS administration for 21 days. The levels of serum and colon tissue inflammatory
cytokines, RANKL/OPG system components, as well as markers of macrophage
polarization, were detected using RT-qPCR, ELISA, or immunohistochemistry. Long
bone analyses were performed using microcomputed tomography (micro-CT).
Results: BMP7 ameliorated inflammation and led to elevated OPG and RANK in the
colon with a simultaneous decrease in TNF-α and an increase in IL-10 and TGF-β.
Decreased expression of the M2 macrophage marker CD163 was found in the BMP7
treated rats compared with the colitis group, whereas the number of M1 marker iNOS
positive cells did not differ between the groups. BMP7 also improved morphometric
parameters of trabecular bone.
Conclusions: We showed that BMP7 suppressed inflammatory response in IBD, in
this study in Crohn colitis, mainly by shifting the cytokine balance and by triggering
alterations in the RANKL/OPG system rather than through a macrophage polarization
imbalance. In addition, considering the demonstrated effect of BMP7 on bone
morphology and structure, it can be suggested that BMP7 plays a role in improving
osteoporosis in IBD, and thus, its therapeutic potential in the treatment of IBD should
be evaluated in further studies
THE EFFECT OF GASEOUS OZONE ON MULTIDRUG RESISTANT MICROORGANISMS IN HOSPITAL ENVIRONMENT
No full textCiljevi istraživanja: Biofilm višestruko otpornih mikroorganizama i kontaminacija
bolničkog okoliša biofilmom predstavlja izazov u provođenju dezinfekcije kao mjere
sprječavanja i kontrole infekcija. Cilj ovog istraživanja bio je ispitati učinak plinovitog ozona
kao potencijalnog alternativnog dezinfekcijskog sredstva na biofilm predstavnika višestruko
otpornih mikroorganizama iz bolničke sredine.
Metode: Istraživanje je obuhvaćalo in vitro ispitivanje učinka plinovitog ozona na 24
satnom biofilmu model organizama: K. pneumoniae, A. baumannii i S. aureus na keramici
i polistirenu uz prisustvo različitog organskog opterećenja. Ispitivane su fizikalno-kemijske
karakteristike materijala i površine model organizama. Praćeni su parametri učinka
plinovitog ozona na ukupan broj kultivabilnih bakterija, ukupan broj vijabilnih bakterija
uporabom ATP bioluminiscencije i Dead/Live bojenja te učinak na ukupnu biomasu putem
kristal violet bojenja. Praćen je i učinak na ukupan broj reaktivnih kisikovih vrsta te
morfološke promjene na biofilmu korištenjem digitalne mikroskopije, mikroskopije
atomskih sila i pretražne elektronske mikroskopije. In situ učinak plinovitog ozona praćen
je na biofilmu odabranih referentnih sojeva model organizama u Općoj bolnici dr. Ivo
Pedišić, Sisak uz popratno praćenje mikrobiološke čistoće prostora i broja bakterija u zraku.
Rezultati: Plinoviti ozon u koncentraciji od 25 ppm tijekom 1 sata izloženosti uzrokuje
statistički značajnu redukciju ukupnog broja kultivabilnih i vijabilnih bakterija u biofilmu
odabranih model organizama te značajnu redukciju ukupne biomase na oba materijala te uz
manje i veće organsko opterećenje. Najosjetljiviji model organizam na djelovanje ozona na
oba materijala i uz različite vrste organskog opterećenja bio je A. baumannii, najmanje
osjetljiv S. aureus. Plinoviti ozon uzrokuje statistički značajno povećanje reaktivnih
kisikovih vrsti u svim model organizmima te morfološke promjene na biofilmu i na
pojedinačnim bakterijskim stanicama u smislu deformacija stanica i ulegnuća na staničnoj
membrani te razaranja stanica.
Zaključak: Plinoviti ozon je učinkovito dezinfekcijsko sredstvo, međutim samostalno ne
uspijeva u potpunosti ukloniti biofilm model organizama s keramike i polistirena te se za
uspješno uklanjanje biofilma preporučuje obvezno redovito mehaničko čišćenje i pranje
prije dezinfekcije ozonom u kombinaciji s još jednim dezinfekcijskim sredstvom.Research objectives: Biofilm of multidrug-resistant organisms and contamination of the
hospital environment with biofilm is a challenge in the implementation of disinfection as
infection prevention and control measure. The aim of this research was to examine the effect of
gaseous ozone as a potential alternative disinfectant on the biofilm of multidrug-resistant
organisms from the hospital environment as model organisms.
Methods: In vitro part of the research included examining of the effect of gaseous ozone on
the 24-hour biofilm of K. pneumoniae, A. baumannii and S. aureus on ceramics and polystyrene
with the presence of different organic load. The physico-chemical characteristics of the material
and the surface of the model organisms were examined. The parameters of the biocidal effect
of gaseous ozone included the total number of cultivable bacteria, the total number of viable
bacteria using ATP bioluminescence and Dead/Live staining and the effect on the total biomass
using crystal violet staining. The effect on the total number of reactive oxygen species and
morphological changes on the biofilm were monitored using digital microscopy, atomic force
microscopy and scanning electron microscopy. The in situ effect of gaseous ozone was
monitored on the biofilm of selected standard strains of model organisms in the dr. Ivo Pedišić
General Hospital, Sisak, with accompanying monitoring of the microbiological cleanliness of
the surfaces and the number of bacteria in the air.
Results: Gaseous ozone in the concentration of 25 ppm during 1 hour of exposure causes a
statistically significant reduction of the total number of cultivable and viable bacteria and a
significant reduction of the total biomass in the biofilm on both materials and different organic
load. The most sensitive model organism to the effect of ozone on both materials and with
different types of organic load was A. baumannii, the least sensitive was S. aureus. Gaseous
ozone causes a statistically significant increase in reactive oxygen species in all model
organisms and morphological changes in the biofilm and individual bacterial cells in the sense
of cell deformation and deposition on the cell membrane and cell destruction.
Conclusion: Gaseous ozone is an effective disinfectant, however, it does not manage to
completely remove biofilm of model organisms from ceramics and polystyrene on its own, and
for successful biofilm removal, mandatory regular mechanical cleaning and washing before
ozone disinfection in combination with another disinfectant is recommended
Prognostic Value of Apparent Diffusion Coefficient (ADC) in Patients with Diffuse Gliomas
No full textThis study aimed to evaluate potential posttreatment changes in ADC values within the tissue surrounding the enhancing lesion, particularly in areas not exhibiting MRI characteristics of involvement. Additionally, the objective was to investigate the correlations among ADC values, treatment response, and survival outcomes in individuals diagnosed with gliomas. This retrospective study included a total of 49 patients that underwent either stereotactic biopsy or maximal surgical resection. Histologically confirmed as Grade III or IV gliomas, all cases adhered to the 2016 and 2021 WHO classifications, with subsequent radio-chemotherapy administered post-surgery. Patients were divided into two groups: short and long survival groups. Baseline and follow-up MRI scans were obtained on a 1.5 T MRI scanner. Two ROI circles were positioned near the enhancing area, one ROI in the NAWM ipsilateral to the neoplasm and another symmetrically in the contralateral hemisphere on ADC maps. At follow-up there was a significant difference in both ipsilateral and contralateral NAWM between the two groups, −0.0857 (p = 0.004) and −0.0607 (p = 0.037), respectively. There was a weak negative correlation between survival and ADC values in ipsilateral and contralateral NAWM at the baseline with the correlation coefficient −0.328 (p = 0.02) and −0.302 (p = 0.04), respectively. The correlation was stronger at the follow-up. The findings indicate that ADC values in normal-appearing white matter (NAWM) may function as a prognostic biomarker in patients with diffuse gliomas
Nanoplastics increase in vitro oestrogenic activity of neurotherapeutic drugs
No full textAbstract
Environmental pollution with plastic nanoparticles (PNPs) has rendered hazard assessment of unintentional human exposure to neurotherapeutic drugs through contaminated water and food ever more complicated. Due to their small size, PNPs can easily enter different cell types and cross different biological barriers, while their high surface-to-volume ratio enables higher adsorption of chemicals. This is how PNPs take the role of a Trojan horse as they enhance bioaccumulation of many different pollutants. One of the health concerns related to water pollution with neurotherapeutic drugs is endocrine disruption, already evidenced for the anticonvulsant drug carbamazepine (Cbz) and antidepressant fluoxetine (Flx). Our study aimed to evaluate endocrine disrupting effects of Cbz and Flx in mixtures with polystyrene nanoparticles (PSNPs) using the
luciferase assay to measure oestrogen receptor activity in T47D-KBluc cells treated with Cbz-PSNPs or Flx-PSNPs mixtures and compare it with the activities observed in cells treated with individual mixture components (Cbz, Flx, or PSNPs). Dose ranges used in the study were 0.1–10 mg/L, 1–100 µmol/L, and 0.1–10 µmol/L for PSNPs, Cbz, and Flx, respectively. Our findings show that none of the individual components activate oestrogen receptors, while the mixtures induce oestrogen receptor activity starting with 0.1 mg/L for PSNPs, 10 µmol/L for Cbz, and 0.5 µmol/L for Flx. This is the first study to evidence that PSNPs increase oestrogen receptor activity induced by neurotherapeutic drugs at their environmentally relevant concentrations and calls for urgent inclusion of complex mixtures in health hazard assessments to inform regulatory response
Use of CPAP Ventilation in Non-ICU Wards May Influence Outcomes in Patients with Severe Respiratory COVID-19
No full textBackground and Objectives: The COVID-19 disease has significantly burdened the healthcare system, including all units of severe patient treatment. Non-intensive care units were established to rationalize the capacity within the Intensive Care Unit (ICU) and to create a unit where patients with Acute Respiratory Distress Syndrome (ARDS) could be treated with non-invasive Continuous Positive Air Pressure (CPAP) outside the ICU. This unicentric retrospective study aimed to assess the efficacy of NIV Treatment in Patients of the fourth pandemic wave and how its application affects the frequency and mortality of ICU-treated patients at University Hospital Rijeka compared to earlier waves of the COVID-19 pandemic. Furthermore, the study showcases the effect of the Patient/Nurse ratio (P/N ratio) on overall mortality in the ICU. Materials and Methods: The study was conducted on two groups of patients with respiratory insufficiency in the second and third pandemic waves, treated in the COVID Respiratory Centre (CRC) (153 patients). We also reviewed a cohort of patients from the fourth pandemic wave who were initially hospitalized in a COVID-6 non-intensive unit from 1 October 2021 to 1 November 2022 (102 patients), and some of them escalated to CRC. Results: The introduction of the CPAP non-invasive ventilation method as a means of hypoxic respiratory failure treatment in non-intensive care units has decreased the strain, overall number of admissions, and CRC patient mortality. The overall fourth wave mortality was 29.4%, compared to the 58.2% overall mortality of the second and third waves. Conclusions: As a result, this has decreased CRC patient admissions and, by itself, overall mortality