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The aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer. Methods: A retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups. Results: A total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLN d group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLN d group. The rate of persistent hypoparathyroidism in the TT and TT + CCLN d groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLN d group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant. Discussion: While its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies. Our results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy., Cilj rada je usporediti incidenciju postoperativnog hipoparatireoidizma između dvije skupine bolesnika liječenih zbog dobro diferenciranog karcinoma štitnjače. Metode: Retrospektivno smo analizirali 179 bolesnika koji su u našoj ustanovi liječeni zbog dobro diferenciranog karicnoma štitnjače u periodu od siječnja 2011 do prosinca 2018. U studiju su bili uključeni samo bolesnici kod kojih je inicijalno učinjena totalna tiroidektomija te oni koji na osnovu preoperativne obrade nisu imali potvrđene metastaze na lateralnom vratu i u regiji VI. Analizirane su dvije skupine bolesnika. U prvu skupinu su uključeni bolesnici kod kojih je u istom aktu učinjena totalna tireoidektomija i disekcija regije VI. Svi ostali bolesnici kod kojih je učinjena samo totalna tireoidektomija uključeni su u drugu skupinu. Stopa tranzitornog i trajnog hipoparatireoidizma je uspoređivana između dvije skupine. Rezultati: Kod ukupno 117 bolesnika (65,4%) učinjena je disekcija regije VI istodobno s totalnom tireoidektomijom. (TT + CCLN d skupina). Kod preostalih 62 bolesnika (34,6%) učinjena je samo totalna tireoidektomija. (TT skupina). Ukupno 22,6% bolesnika iz TT skupine je razvilo postoperativni hipoparatireoidizam usporedno s 25,6% bolesnika iz TT + CCLN d skupine. Stope trajnog hipoparatireoidizma u TT i TT + CCLN d skupinama su iznosile 3,2 i 6 %. Stopa tranzitornog kao i trajnog postoperativnog hipoparatireoidizma nije bila statistički značajna između dvije skupine. Unutar TT + CCLN d skupine, kod 82,9% bolesnika je učinjena disekcija ipsilateralnih paratrahealnih limfnih čvorova, za razliku od 17,1% bolesnika kod kojih je učinjena disekcija bilateralnih paratrahealnih čvorova. Stopa postoperativnog hipoparatireoidizma je analizirana u dvjema podskupinama i nije se pokazala statistički značajnom. Rasprava: Iako je utjecaj elektivne disekcije regije VI na lokoregionalno recidiviranje i dalje kontroverzan, ona može biti odličan alat za probir bolesnika koji mogu imati korist od adjuvantne radiojodne ablacije. S druge strane, disekcija regije VI potencijalno može povećati rizik hipoparatireoidizma zbog nenamjerne ozljede doštitnih žlijezda ili/i njihove krvne opskrbe. Naša studija nije pokazala statistički značajnu razliku u stopi postoperativnog hipoparatireoidizma između skupine bolesnika kod kojih je učinjena disekcija regije VI u usporedbi sa skupinom bolesnika kod kojih je učinjena samo totalna tireoidektomija. Naši podaci su u proturiječju s nekim ranije publiciranim studijama. Naši rezultati su pokazali da je elektivna disekcija regije VI sigurni postupak i značajno ne povećava rizik postoperativnog hipoparatireoidizma kada se izvodi istodobno s totalnom tireoidektomijom.

Introduction: The markers of inflammations are a significant predictor of postoperative outcome after colorectal cancer surgery. Along with leukocytes, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil/lymphocyte ratio (NLR) we tried to test the role of immature granulocytes (IG) counts and trends in the postoperative period. Methods: We recorded matched three patient according to their sex, age, and tumor localization who had an uneventful recovery with three patients who had an anastomotic leak required reoperation. We obtained the IG count with every complete blood count and correlated these with CRP, PCT, NLR. For the best prediction we calculated the potential Zagreb score by adding 1 point for elevated NLR ratio for more than 75%, minimally three consecutively elevated % IG, doubling of immature granulocytes relative value to absolute neutrophils count ratio (IG ratio) and immature granulocytes relative value to leucocytes count ratio (IT ratio) at three consecutive time points. Results and Conclusion: Potential Zagreb score seems to predict the need for reoperation in time. Herein we introduce its concept, and we plan the retrospective study to test its feasibility and precision., Uvod: Markeri upale su važni čimbenici u predviđanju poslijeoperacijskog tijeka u kolorektalnoj kirurgiji. Uz leukocite, C reaktivni protein, prokalcitonin i neutrofilno/limfocitni omjer, uvodimo mogućnost korištenja broja i trendova nezrelih granulocita u postoperacijskom periodu. Metode: Zabilježili smo kliničke podatke tri pacijenta koja su imala uredan poslijeopracijski tijek i tri koja su imala dehiscencu anastomoze. Pacijenti su upareni po dobi, spolu, i lokalizaciji karcinoma kolorektuma. Obradili smo podatke o broju nezrelih granulocita koji je integralni dio kompletne krvne slike na analizatoru Sysmex XN 1000, te korelirali podatke sa CRP-om, PCT-om, NLR-om. Najbolje predviđanje smo dobili kada je ustanovljen potencijalni Zagreb score: povećan NLR za više od 75%, tri povećanja % IG zaredom i udvostručenje IG-a and IT-a u tri mjerenja zaredom. Rezultati i zaključak: Potencijalni Zagreb score je predvidio potrebu za reoperacijom na vrijeme. Ova serija slučajeva je uvela koncept i planiramo retrospektivno, na većem uzorku, testirati izvedivost i preciznost potencijalnog Zagreb scorea.

This study aimed to identify and quantify the clinical significance of the HE4 and ROMA index in patients with an adnexal tumour. We recruited 159 women and the HE4 and CA125 were measured with an electrochemiluminescence immunoassay in the sera. We used the Kolmogorov-Smirnov test, Mann-Whitney's test and logistic regression to interpret the data. In the premenopausal group (n = 57), the ROC analysis (with cut-off: 86.1 pmol/L for HE4 ; 40.7 U/L for CA125 and 21.9% for ROMA) demonstrated the superior prognostic potential of those markers when the higher cut-offs used are compared to producers. The AUC for HE4/CA125/ROMA were 0.846/0.867/0.846, respectively. The HE4/ROMA showed 85.7% sensitivity and 94% specificity. In the postmenopausal group (n = 102), the ROC analysis cut-off values were: 99.8 pmol/L for HE4 ; 45.8 U/L for CA125 and 38.4% for ROMA. AUC for HE4/CA125/ROMA were 0.928/0.899/0.927, respectively. HE4 had an 86.1% sensitivity at 92.4% specificity, while ROMA showed an 88.9% sensitivity at a 90.9% specificity. Impact Statement What is already known on this subject? The incidence of ovarian cancer has been increasing, despite the improvement of diagnostic, operative and therapeutic procedures. As a part of the multiparametric approach, the HE4 and ROMA index improve the diagnostic sensitivity and specificity of CA125 in the detection of ovarian cancer. What the results of this study add? The evaluation of HE4 and ROMA efficacy in the preoperative stratification was made by logistic regression analysis. The better prognostic potential of ROMA index, in patients with present adnexal mass, was obtained using our higher cut-offs for the ROMA index (21.9% for premenopausal and 38.4% for postmenopausal) in comparison to the producer's (11.7% for premenopausal and 29.9% for postmenopausal). The HE4 and ROMA index had 14.29 +LR, 0.15 -LR, 67% PPV and 97.9% NPV in the premenopausal patients. In the postmenopausal group, the HE4 had 11.37 +LR, 0.15 -LR, 75.6% PPV and 92.4% NPV, the ROMA showed 9.78 +LR, 0.12 -LR, 91.2% PPV and 95.2% NPV. What the implications are of these findings for clinical practice and/or further research? Application of a higher cut-off for HE4/CA125/ROMA index can significantly reduce the percentage of FP and FN in the preoperative stratification of ovarian cancer and justify speculations about this subject in the future.

The research objectives was to establish pre-operative values of the tumor marker CA 15-3 in serum and to establish onnection between serum level of the tumor marker CA 15-3 in patients with breast cancer with other prognostic factors for breast cancer (age, tumor size, lymph node status, histological grading, hormone receptor status). In this work, a retrospective study in 100 breast cancer patients who started their medical treatment in year 2007. on Department of Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice Clinical Hospital Center, has been made. The concentration of tumor marker CA 15-3 was measured in serum by immunochemical method. When breast cancer was diagnosed, 11 patients had elevated tumor marker CA 15-3, while 89 patients had CA 15-3 within the normal range (values ≤28 kUI/L were considered within the reference range and values >28 kUI/L were considered elevated). Patients who developed metastases had signifi cantly higher values of pre-operative tumor marker CA 15-3 and that patients died from the same disease (mean, CA 15-3=30.67 kUI/L) . High levels of CA 15-3 had patients with positive lymph nodes (status N3, mean CA 15-3=52,78). Results from this research shown that correlation between pre-operativne value tumor marker CA 15-3 with age, ER expression, HER2 status and histologic grade were not found. Elevated value of tumor marker CA 15-3 is at the time of diagnosis unfavorable prognostic factor, connected with other unfavorable prognostic factors. Justifi cation of this study was confi rmed by the value of preoperative tumor marker CA 15-3 in breast cancer patients and after determining its connection with other prognostic factors CA 15-3 indicates that is safer to extract subgroup of breast cancer patients in which metastases can be expected. As such, CA 15-3 can early focus on access to treatment by aggressive protocol., Cilj istraživanja bio je utvrditi predoperativne razine tumorskog biljega CA 15-3 u serumu te ustanoviti povezanost razine tumorskog biljega CA 15-3 kod bolesnica s rakom dojke s ishodom liječenja, te s drugim prognostičkim čimbenicima za rak dojke (dob, veličina tumora, status limfnih čvorova, histološki i hormonski status tumora). U ovom se radu izradila retrospektivna studija na uzorku od 100 bolesnica koje su započele liječenje zloćudnog tumora dojke na Zavodu za onkološku kirurgiju, Klinike za tumore, KBC Sestre milosrdnice tijekom 2007. godine. Koncentracija tumorskog biljega CA 15-3 mjerena je u serumu imunokemijskom metodom. U trenutku dijagnoze karcinoma dojke, 11 bolesnica imalo je povišen tumorski marker CA 15-3, dok je 89 bolesnica imalo vrijednosti CA 15-3 unutar granica normale (gdje su vrijednosti ≤28 kUI/L smatrane u granicama referentnih vrijednosti a vrijednosti >28 kUI/L povišene). Bolesnice koje su razvile metastaze imale su značajno veće predoperativne vrijednosti tumorskog biljega CA 15-3 te su iste imale i smrtni ishod liječenja (srednja vrijednost, CA 15-3=30.67 kUI/L ). Veće vrijednosti CA 15-3 imale su i bolesnice s zahvaćenim limfnim čvorovima (status N3, srednja vrijednost CA 15-3=52,78 ). Povezanost predoperativne razine tumorskog biljega CA 15-3 s dobi, statusom estrogenskih receptora, HER2 receptorom i histološkim gradusom nije nađena. Povišena vrijednost tumorskog biljega CA 15-3 je u trenutku dijagnoze nepovoljan prognostički pokazatelj, povezan s drugim nepovoljnim prognostičkim pokazateljima. Ovo istraživanje je potvrdilo opravdanost određivanja predoperativne razine tumorskog biljega CA 15-3 kod bolesnica oboljelih od raka dojke jer je nakon određivanja njegove povezanosti s ostalim prognostičkim pokazateljima ukazalo da taj tumorski biljeg sigurnije izdvaja podgrupu bolesnica kod kojih se može očekivati pojava udaljenih metastaza. Kao takav, CA 15-3 može rano usmjeriti na pristup liječenja prema agresivnijem protokolu.

Liquid biopsy represents innovation in the fi eld of oncology diagnosis. It refers to non-invasive blood collection method with isolation of circulating tumor cells, cell-free DNA (with circulating tumor cell free DNA fraction), circulating exosomes or micro RNA. Although requires specific methods for isolation and analysis of targets of interest, liquid biopsy could be of benefit in preoperative prediction od overall survival of patients with carcinoma, for monitoring of disease and progression, along with surveillance of therapy response and early recurrence of cancer. The review describes methods for liquid biopsy analysis, together with concerns and achievements in implementing liquid biopsy in clinical practice., Tekuća biopsija predstavlja inovaciju na području onkološke dijagnostike. Neinvazivna je metoda kojom se iz uzorka krvi izoliraju cirkulirajuće tumorske stanice, slobodna cirkulirajuća DNA (uz frakciju tumorske DNA), cirkulirajući exosomi ili mikroRNA. Iako zahtjeva specifi čne metode izolacije i analize pojedinih elemenata od interesa, tekuća biopsija se može primijeniti u predoperativnoj predikciji preživljenja pacijenata s karcinomom, za praćenje tijeka i progresije bolesti, kao i za praćenje odgovora na terapiju ili ranog povratka bolesti. Članak se bavi opisom do danas poznatih metoda analize komponenata tekuće biopsije, kao i problematikom i postignućima u uvođenju tekuće biopsije u kliničku praksu.

Antioxidant supplementation and serum lipids in patients with Graves' disease: Effect on LDL-cholesterol The effect of supplementation with a fixed combination of antioxidants (beta-carotene, selenium, vitamins C and E) on serum lipids was monitored in patients with newly detected Graves' disease. Measurements were made prior to the commencement of therapy and after 30 and 60 days. Patients were randomized into two groups. Test group comprised patients who received antioxidant supplementation in addition to methimazole, while patients treated with methimazole only were in the control group. The concentration of total and HDL-cholesterol increased significantly in test and control groups (p < 0.05) but these groups did not differ significantly. Concentration of LDL-cholesterol increased significantly in the test group only (p < 0.005) and was significantly different from the control group 60 days after the commencement of therapy (p < 0.005). Significant increase in the LDL-cholesterol concentration in the test group requires further investigations.

The development of technology has enabled fast and easy determination of tumor markers and hormones at all levels of medical and biochemical diagnostics. Markers and hormones are most commonly determined by immunoassays and methods of molecular diagnostics. Immunoassays are based on the specifi c antibody-antigen reaction. Numerous factors during analysis may aff ect the measurement of tumor markers and hormones in patient samples (1). Although immunoassays are sensitive and reproducible they can miss the specifi city and accuracy. Immunoassays are infl uenced by various interferences and most common of them will be explained in text below., Razvoj tehnologije je omogućio brzo i jednostavno određivanje hormona i markera. Najčešće se određuju imunokemijskim i metodama olekularne biologije. Imunokemijski testovi se temelje na specifi čnoj reakciji protutijelo-antigen. Brojni faktori mogu utjecati na određivanje tumorskih markera i hormona u uzorku krvi. Iako su imunokemijske metode osjetljive i reproducibilne može im nedostajati specifi čnosti i točnosti. Najčešće interferencije su opisane u tekstu.

Uvod: Laboratorijski nalaz kliničaru pruža većinu informacija potrebnih za objektivnu procjenu zdravstvenog stanja pacijenta. Cilj svakog laboratorija je omogućiti što bržu obradu uzoraka uz stalnu kontrolu kvalitete i trajno poboljšanje sustava. Prostorno uređenje trebalo bi doprinijeti uspostavljanju i održavanju takvog sustava te omogućiti daljnju prilagodbu. Klinički laboratorij često je smješten u prostoru koji nije primarno namijenjen svrsi što ponekad otežava rad prema postavljenim standardima. Cilj: Ispitati zadovoljstvo djelatnika novim prostorom Klinike za tumore KBC „Sestre milosrdnice“ na Odjelu za transfuzijsku medicinu i koagulaciju onkoloških bolesnika (TR) te Kliničkoj jedinici za medicinsku biokemiju u onkologiji (B). Materijali i metode: Anketirano je 10 djelatnika s transfuzije (TR) i 6 djelatnika biokemijskog laboratorija. Prvi dio pitanja odnosio se na zadovoljavanje minimalnih uvjeta u pogledu prostora definiranih pravilnikom („Narodne novine“, broj 61/11 i 128/12). Odgovor DA - zadovoljava potpuno ili približno, NE- ne zadovoljava uopće. Rezultati: U prvom dijelu, djelatnici oba laboratorija su pretežno zaokruživali odgovor NE za stari, DA za novi laboratorij. 10/10 (TR), 6/6 (B) ispitanika smatra da je novi laboratorij bolje prilagođen za rad na siguran način. 6/10 (TR), 6/6 (B) smatra da je novi laboratorij bolje organiziran od starog. 10/10 (TR), 5/6 (B) izjavilo je da im je ugodnije raditi u novom laboratoriju. 4/10 (TR), 3/3 (B) smatra da su radna mjesta previše udaljena dok 8/10 (TR), 4/6 (B) ima osjećaj da puno hoda, 8/10 (TR), 4/6 (B) je zadovoljno osvjetljenjem. S kvalitetom zraka nije zadovoljno 6/10 (TR) 5/6 (B) djelatnika. Zaključak: S obzirom na rezultate prema kojima su djelatnici iz dva laboratorija dali slične odgovore može se zaključiti da su zadovoljniji novim prostorom. Ipak, s obzirom na odgovore i komentare vezane uz ventilaciju i raspored prostorija, može se reći da ima prostora za poboljšanje postojećih uvjeta.

Most countries provide national screening programs for early detection and prevention of colorectal cancer (CRC). As a result, the incidence and mortality are becoming slightly divergent. Croatian colorectal cancer screening program has begun in 2007 with overall response rate about 20%. This response rate, may be explained by complexity of fecal occult blood test (FOBT) and availability of colonoscopy for positive results. Recently, European countries started replacing FOBT test in national screening programs with fecal immunochemical test (FIT), which is based on immunochemical method performed by automatic analyzer using the specially designed highly specific antibodies that could detect human hemoglobin exclusively. The main advantages of FIT are higher sensitivity for detection of cancer and higher proportion of true negative. The aim of the national screening program is to detect the disease as early as possible when CRC is curable. Providing information on colorectal cancer to general public, along with current national plan and through the application of current guidelines it is possible to increase response rate, early detection, improve quality of life and increase overall survival. In this paper we discuss a possibility of replacing FOBT with FIT attributing to these goals.

The aim of the study was to assess correlation of atherosclerosis severity as determined by two different methods of screening for atherosclerosis: (A) measurement of the cardio-ankle vascular index-CAVI by use of the VaseraVS-1500 vascular screening device, and (B) Framingham scale scoring. 52 subjects (28 male and 24 female) were enrolled in the study. Classification of study subjects into four quartiles based on theoretically calculated 10-year risk according to Framingham scale (medians: 1%, 3%, 4% and 15%) confirmed the risk increase to be associated with a statistically significant increase in CAVI, age and total cholesterol, and a statistically significant decrease in HDL-cholesterol (p0.001 all). Spearman correlation coefficients showed a statistically significant correlation of 10-year risk with CAVI (p = 0.0242; r = 0.4494). Study results suggested that simultaneous determination of CAVI and 10-year risk might prove justified. They are not contradictory, the more so, these two parameters showed a significant positive correlation. This test panel yields comprehensible, implying all the possible consequences and highly motivating information that may stimulate the person for lifestyle modification.

In vivo study has been conducted on 47 healthy women and men in order to investigate whether daily intake of powdered propolis extract during 30 days has any influence on the following blood parameters: activity of superoxide dismutase, glutathione peroxidase, and catalase, concentration of plasma malondialdehyde, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, glucose, uric acid, ferritin, and transferrin, together with routine red blood cell parameters. The effect of daily propolis intake seems to be time and gender related. For the men test group after the initial 15 days of propolis treatment, 23.2% (p = 0.005) decrease in concentration of malondialdehyde was observed. After 30 days of treatment, statistically significant (p = 0.010) 20.9% increase in superoxide dismutase activity, and change in some of the red blood cell parameters were detected. For the women test group, the propolis treatment did not induce a change in any of the measured parameters.

The effects of supplementation with a fixed combination of antioxidants (vitamins C and E, β-carotene and selenium) on superoxide dismutase activity, copper and zinc concentrations, and total antioxidant status were monitored in erythrocytes derived from a group of patients with Graves' disease treated with methimazole, with respect to the rate of achieving euthyroidism. Thyroid-stimulating hormone (TSH), thyroid hormones and the above-mentioned parameters were measured before therapy, and on days 30 and 60 after therapy initiation. The patients receiving antioxidant supplementation along with methimazole therapy (group A, n=27) achieved euthyroidism at a faster rate than those treated with methimazole alone (group B, n=28). The activity of superoxide dismutase decreased significantly in both patient groups during the treatment; however, there was no significant difference between the groups. There was no significant change in the erythrocyte concentration of copper, whereas the zinc concentration and total antioxidant status showed significant between-group differences. The study results clearly show that antioxidant supplementation in the treatment of Graves' disease is justified, while zinc and total antioxidant status in erythrocytes seem to be sensitive indicators of the efficacy of supplemental therapy.

In this study, the effect of supplementation with a fixed combination of antioxidants (vitamins C and E, beta-carotene and selenium) on concentrations of antioxidative parameters in serum was monitored. Measurements were performed prior to the commencement of therapy and after 30 and 60 days in patients with Graves' disease treated with methimazole. Patients who received extra supplementation with antioxidants (group A, n = 29) attained euthyroidism faster than the patients treated only with methimazole (group B, n = 28). Statistically significant differences were achieved after supplementation with antioxidants for all investigated parameters (uric acid, transferrin, ferritin), except TAS and glucose. Nevertheless, due to the fact that all measured parameters remained within the range of referent values, they may not be proposed as reliable indicators of the level of oxidative stress in Graves' disease.

For many years, cardiac markers have been used to assist cardiologists in the diagnosis and management of patients with cardiovascular disease. At first, enzyme activities of aspartate aminotransferase, lactate dehydrogenase and creatine kinase have been used in diagnosing patients with chest pain in order to differentiate those with acute myocardial infarction. In the field of cardiac markers, emphasis is currently put on the use of protein markers such as myoglobin, and cardiac troponin T or I. Troponins are very highly cardiac specific and their concentration in blood increase only from four to six hours after the onset of chest pain. Today we obligatorily use two markers, the first being the early one (myoglobin, isoform of creatine kinase), which is very sensitive and shows up in the circulation one to two hours after myocardial damage. Confirmation of myocardial damage can be obtained by definite markers (troponin I or T), which are highly specific of myocardial damage.

As a cost-saving measure, the Drug and Therapeutics Committee (DTC) removed ceftriaxone from the list of restricted antibiotics in May, 2008, which permitted its use as a first-line antibiotic. To evaluate the impact of this change, the occurrence of extended-spectrum beta-Iactamase (ESBL)- positive bacterial strains and antibiotic consumption were monitored for 2 years before and after the intervention. In the post- intervention period, ceftriaxone utilization increased, while total antibiotic utilization did not change significantly. The utilization of all restricted antibiotics decreased (p