Search

Aim To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. Methods A multicenter prospective study was performed on 2467 participants of both sexes ⩾40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. Results Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P<0.001), obesity (P=0.001), increased waist circumference (P<0.001), and more intense physical activity (P=0.020). Participants from coastal rural areas had higher HDL-cholesterol, participants from continental rural and coastal urban areas had higher LDL-cholesterol, and participants from rural continental had significantly higher BMI and waist circumference. Conclusion Prevalence of CVD risk factors in Croatian population is high. Greater burden of risk factors in continental region and rural areas may be partly explained by lifestyle differences. [ABSTRACT FROM AUTHOR]

Aim To collect cancer epidemiology data in South Eastern European countries as a basis for potential comparison of their performance in cancer care. Methods The South Eastern European Research Oncology Group (SEEROG) collected and analyzed epidemiological data on incidence and mortality that reflect cancer management in 8 countries - Croatia, Czech Republic, Hungary, Romania, Poland, Slovakia, and Serbia and Montenegro in the last 20-40 years. Results The most common cancer type in men in all countries was lung cancer, followed by colorectal and prostate cancer, with the exception of the Czech Republic, where prostate cancer and colorectal cancer were more common. The most frequent cancer in women was breast cancer followed by colorectal cancer, with the exceptions of Romania and Central Serbia where cervical cancer was the second most common. Cancer mortality data from the last 20-40 years revealed two different patterns in men. In Romania and in Serbia and Montenegro, there was a trend toward an increase, while in the other countries mortality was declining, after increasing for a number of years. In women, a steady decline was observed over many years in the Czech Republic, Hungary, and Slovakia, while in the other countries it remained unchanged. Conclusions There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors which provides a clear challenge to prevention. There are some differences in incidence and mortality that cannot be explained by exposure to known risk factors or treatment availabilities. [ABSTRACT FROM AUTHOR]

Describes the case of a patient with glioblastoma progressing after surgery, radiotherapy and nitrosourea-based chemotherapy. Symptoms; Results of the neurological examinations performed on the patient; Treatments administered to the patient.

An introduction is presented in which the editor discusses various articles within the issue on topics including epidemiological analysis, oncology status of Croatia and cancer in Croatia.

Aim To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia. Methods A cross-sectional study was conducted among 987 patients in 10 family medicine practices in Croatia. Patients from both urban (n = 496) and rural (n = 482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics. Results Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P < 0.001 for both). Conclusion Our finding that patients consider a physician's opinion to be the most reliable source of healthrelated information could be used for promotion of highquality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary. [ABSTRACT FROM AUTHOR]

Aim To expand our previous findings by increasing the number of patients in a study characterizing medicinal signaling cells (MSC) of stromal vascular fraction from lipoaspirate (SVF-LA) and from microfragmented lipoaspirate (SVF-MLA) applied for the treatment of osteoarthritis (OA). Methods Twenty OA patients, including 8 new patients, acquiring autologous microfragmented adipose tissue were enrolled. In-parallel immunophenotyping of SVF-LA and SVF-MLA was performed. The samples were incubated in a DuraClone SC prototype tube targeting the CD31, CD34, CD45, CD73, CD90, CD105, and CD146 surface markers, stained with the DRAQ7 cell nuclear dye and Live/Dead Yellow Fixable Stain, and analyzed by flow cytometry. Results The population phenotypes in SVF-LA and SVFMLA samples included CD31+CD34+CD73±CD90±CD1 05±CD146± endothelial progenitors (EP), CD31+CD34- CD73±CD90±CD105-CD146± mature endothelial cells, CD31-CD34-CD73±CD90+CD105-CD146+ pericytes, CD31- CD34+CD73±CD90+CD105-CD146+ transitional pericytes, and CD31-CD34+CD73highCD90+CD105-CD146- supra-adventitial- adipose stromal cells. Compared with the autologous SVF-LA samples, the prevailing cell type in SVF-MLA were EP, which outnumbered leukocytes and supra-adventitial- adipose stromal cells (SA-ASC). The ratio of progenitor cells in SVF-MLA samples differed between female and male patients, showing a higher EP-pericyte and pericyte- SA-ASC ratio in men. Conclusion Our results, hallmarked by EP-enriched antiinflammatory features and indicating a possible sex-specific impact, contribute to defining the cellular composition of the clinically applied MSC serving as a regenerative cell therapy in OA. [ABSTRACT FROM AUTHOR]

Aim To assess the prevalence of actionable pharmacogenetic interventions in patients who underwent pharmacogenetic testing with a multi-gene panel. Methods We retrospectively reviewed single-center electronic health records. A total of 319 patients were enrolled who underwent pharmacogenomic testing with the RightMed test panel using TaqMan quantitative real-time PCR method and copy number variation analysis to determine the SNPs in the 27 target genes. Results Actionable drug-gene pairs were found in 235 (73.7%) patients. Relevant guidelines on genotype-based prescribing were available for 133 (56.7%) patients at the time of testing. Based on the patients’ genotype, 139 (43.6%) patients were using at least one drug with significant pharmacogenetic interactions. Conclusion Two out of three patients had at least one drug-gene pair in their therapy. Further studies should assess the clinical effectiveness of integrating pharmacogenomic data into patients’ electronic health records. [ABSTRACT FROM AUTHOR]

Aim To investigate the population genetics of 17 short tandem repeat (STR) loci on the Y chromosome in the population of eastern Croatia. Methods We carried out a statistical analysis of the data from previously performed genetic analysis collected during routine forensic work by the Forensic Science Centre "Ivan Vucetic". A total of 220 unrelated healthy men from eastern Croatia were selected for the purpose of this study. Genomic DNA was extracted by Chelex from FTA® cards. Y-chromosomal STRs were determined using the AmpFISTR Yfiler PCR amplification kit. The haplotype frequencies were determined by direct counting and analyzed using Arlequin 3.1 and analysis of molecular variance calculated with the Y-chromosome haplotype reference database online analysis tool. Results A total of 207 haplotypes were recorded, 197 of which were unique (90%). Haplotype diversity was 0.9993, with the most frequent haplotype found in 4 of 220 men (1.8%). Average locus diversity was 0.600, and it ranged from 0.256 for DYS392 to 0.780 for DYS458. Our results were compared with the pattern of Y-chromosome variability in publicly available population samples based on a minimal European haplotype set of 9 STRs and the greatest resemblance was found with samples from the Croatian capital of Zagreb, from Bosnia and Herzegovina, and from Serbia. Conclusion This is the first description of Y chromosome haplotyping of the population of eastern Croatia, which may serve as a basis for genetic epidemiology and forensic studies. Further studies are needed for characterization of the genetic structure of the Y-chromosome in the modern Croatian population. [ABSTRACT FROM AUTHOR]

Aim To assess secular trends in birth weights of liveborn infants in Croatia from 1983 to 2003. Methods Of a total of 959 591 liveborn infants in the study period, 384 367 were born in the prewar (1983-1989), 226 226 during the war (1991-1995), and 348 998 in the postwar (1996-2003) period. The birth weight of liveborn infants was assessed by 500 g weight groups on the basis of data provided by the Croatian National Institute of Public Health. Results The gradual and significant increase in the share of infants with birth weight ≥3500 g (P<0.001) was paralleled by a reduction in the share of infants with birth weights 2500-3449 g (P<0.001) and <2500g (P<0.05) in the study period. There was a positive trend in the proportion of 4000-4499 g, ≥4500 g (P<0.001 for both), and 500-999 g (P = 0.002) birth weight groups and negative trend in 1000-1499 g, 2500-2999 g, and 3000-3499 g weight groups (P<0.001 for all). During the war period, the proportion of liveborn infants in the 2500-3499 g weight group decreased in comparison with prewar proportion; this trend continued in the postwar period (P<0.001 for both). In the war period, the proportion of liveborn infants with birth weights of 2000-2499 g was significantly larger (P<0.001) and that of ≥4500 g significantly smaller in comparison with the prewar and postwar proportions (P<0.001 for both). Conclusion Positive secular changes in infant birth weights observed in the prewar and postwar period contrasted negative changes during the war period in Croatia. This finding may suggest the association between war suffering and stress and changes in birth weights of newborns. [ABSTRACT FROM AUTHOR]

Aim: To assess lifestyle habits and self-reported stress levels among type 2 diabetes mellitus (T2DM) patients and their association with hemoglobin A1c (HbA1c) in general practitioners' (GP) offices in Croatia. Methods: 449 GPs from all Croatian regions from 2008 to 2010 consecutively recruited up to 20-25 participants diagnosed with T2DM at least 3 years prior to the study, aged ≥40 years, and scheduled for diabetes control check-ups. The recruitment period lasted six months. Lifestyle habits and self-reported stress were assessed using the questionnaire from the Croatian Adult Health Survey. Results: The study included 10 285 patients with T2DM with mean (±standard deviation) age of 65.7 ± 10.05 years (48.1% men). Mean HbA1c level was 7.57 ± 1.58%. 79% of participants reported insufficient physical activity, 24% reported inappropriate dietary patterns, 56% reported current alcohol consumption, 19% were current smokers, and 85% reported at least medium level of stress. Multivariate analysis showed that having received advice to stop drinking alcohol, inadequate physical activity, consumption of milk and dairy products, adding extra salt, and high level of stress were significantly associated with increased HbA1c (P < 0.05). Conclusion: Poor glycemic control was more frequent in patients who had several "unhealthy" lifestyle habits. These results suggest that diabetes patients in Croatia require more specific recommendations on diet, smoking cessation, exercise, and stress control. [ABSTRACT FROM AUTHOR]

Aim To analyze clinical and functional effects of intra-articular injection of autologous micro-fragmented lipoaspirate (MLA) in patients with late stage knee osteoarthritis (KOA). Secondary aims included classifying cell types contributing to the treatment effect, performing detailed MRIbased classification of KOA, and elucidating the predictors for functional outcomes. Methods This prospective, non-randomized study was conducted from June 2016 to February 2018 and enrolled 20 patients with late stage symptomatic KOA (Kellgren Lawrence grade III, n = 4; and IV, n = 16) who received an intra-articular injection of autologous MLA in the index knee joint. At baseline radiological KOA grade and MRI were assessed in order to classify the morphology of KOA changes. Stromal vascular fraction cells obtained from MLA samples were stained with antibodies specific for cell surface markers. Patients were evaluated at baseline and 12-months after treatment with visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results Three patients (15%) received a total knee replacement and were not followed up completely. Seventeen patients (85%) showed a substantial pattern of KOOS and WOMAC improvement, significant in all accounts. KOOS score improved from 46 to 176% when compared with baseline, WOMAC decreased from 40 to 45%, while VAS rating decreased from 54% to 82% (all P values were <0.001). MLA contained endothelial progenitor cells, pericytes, and supra-adventitial adipose stromal cells as most abundant cell phenotypes. Conclusion This study is among the first to show a positive effect of MLA on patients with late stages KOA. [ABSTRACT FROM AUTHOR]

Aim: To estimate the incidence and mortality trends of gastric and colorectal cancers in Croatia between 1988 and 2008. Methods: Incidence data for the period 1988-2008 were obtained from the Croatian National Cancer Registry. The number of deaths from gastric and colorectal cancers were obtained from the World Health Organization mortality database. Joinpoint regression analysis was used to describe changes in trends by sex. Results: Gastric cancer incidence rates declined steadily during the study period, with estimated annual percent change (EAPC) of -3.2% for men and -2.8% for women. Mortality rates in men decreased, with EAPC of -5.0% from 1988-1995 and -2.5% from 1995-2008. Mortality rates in women decreased, with EAPC of -3.2% throughout the study period. For colorectal cancer in men, joinpoint analysis revealed increasing trends of both incidence (EAPC 2.9%) and mortality (EAPC 2.1%). In women, the increase in incidence was not significant, but mortality rates in the last 15 years showed a significant increase (EAPC 1.1%). Conclusion: The incidence and mortality trends of gastric cancer in Croatia are similar to other European countries, while the still increasing colorectal cancer mortality calls for more efficient prevention and treatment. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effect of vitamin D3 receptor (VDR)gene Bsml/Apal/Taql restriction fragment length polymorphisms on Graves' disease susceptibility in a subset of patients from Eastern Croatia. Methods Graves' disease patients (n=110) and ethnically matched euthyroid controls (n=99) with no clinical evidence or family history of thyroid or autoimmune diseases were genotyped for VDR gene polymorphisms by Bsm Apa Taq endonuclease digestion after polymerase chain reaction amplification with sequence-specific primers. Data were analyzed by χ²-test, and crude odds ratios (OR)with 95%confidence interval (95%CI)were calculated. Results The Apa "AA" (14.5% vs 30.3%, patients vs controls,respectively, OR=0.39, 95% CI [0.2-0.77 ], P=0.01)and Bsm "BB" (7.3% vs 23.2%, OR=0.26 [0.11-0.61 ], P=0.002) genotypes were significantly underrepresented in patients, whereas Apa "aa" (28.2% vs 9.1%, OR=3.92 [1.76-8.74 ], P=0.001) and Taq "TT" (51.8% vs 31.3%, OR=2.36 [1.34-4.16 ], P=0.004) genotypes were significantly more frequent in patients than controls. The genotype combination, which conferred the strongest protection against Graves' disease, was "BBAAtt" (2.7% vs 17.2%, OR=0.14 [0.04-0.48 ], P= 0.001). Conclusion These findings suggest that VDR gene Bsml/Apal/Taql polymorphisms are associated with Graves' disease susceptibility in a subset of patients from Eastern Croatia. The Apa Bsm "AA" and "BB" genotypes, respectively, as well as combined "BBAAtt" genotype, appeared to confer protection against Graves' disease, whereas Apa "aa" and Taq "TT" genotypes were associated with an increased risk for Graves' disease. However, the true mechanisms of association remain to be elucidated. [ABSTRACT FROM AUTHOR]