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Biljana Kuzmanović Elabjer, Leon Marković, Mirjana Bjeloš, Mladen Bušić, Daliborka Miletić, Eva Kos University Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaCorrespondence: Mladen BušićUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, WHO Collaborating Centre for Child Eye Care, Sveti Duh 64, Zagreb 10 000, CroatiaTel +385913712167Email mbusic@kbsd.hrBackground: Inflammation is among the most important mechanisms in the pathogenesis of dry eye disease (DED), triggering the vicious circle of the disease. Reducing inflammation is an important target in dry eye disease treatment. Hydrocortisone is a low-potency corticosteroid with a low ocular penetration potential.Aim: To document the effect of topical preservative-free hydrocortisone 0.335% (PFH, Softacort®, Laboratoires Théa, France) on DED.Methods: Retrospective data review of patients with mild to moderate DED, treated with PFH for 15 days. Clinical evaluations at Days 0 and 15 included the assessment of the central precorneal tear film thickness (CPTFT), fluorescein tear breakup time, Schirmer test, corneal grading staining (Oxford schema), ocular surface disease index (OSDI) spatial distribution of the precorneal tear film thickness, intraocular pressure (IOP) and local tolerance.Results: Data from 13 women and 2 men were collected. Mean age±SD was 51± 5 years for women and 53± 4 years for men. Clinical signs and symptoms significantly (all p< 0.05) improved after 15 days of treatment. A significant positive correlation between the percentage of change in left eye CPTFT and that in the contralateral eye CPTFT was observed (p=0.003) as well as for both eyes and the left eye FTBUT (p=0.03). For the percentage of change in OSDI, the only significant correlation was with the percentage of change in right eye and FTBUT (p=0.03). IOP remained unchanged. No adverse events were recorded.Conclusion: This retrospective data review confirms that topical PFH twice daily for 2 weeks significantly improves clinical signs and symptoms in patients with mild to moderate DED with no safety issues.Keywords: dry eye disease, inflammation, topical preservative-free hydrocortisone, corticosteroids, central precorneal tear film, ocular surface disease index

Service-Learning (SL) as a growing innovative pedagogical model, has recently become more popular in higher education area dedicated to physical activity. Since physical education (PE) students are oriented toward society, it is extremely important for them to develop a sense of connection and responsibility toward society during their studies. This research was carried out on a sample of 58 students of a PE study program, aged between 20 and 22. The first step of the research was to determine six different groups of students using the poly-structured interview about their previous motor experience while considering the type of activity, the length of time engaged in a certain activity and the level of motor skills. Six investigated groups were formed according to their dominant previous motor activity: artistic and aesthetic activities, society-oriented recreational activities, self-directed recreational activities, team sports, individual sports, and martial arts. In order to determine the students' perception of SL Benefits, the SELEB questionnaire was used. The original 27 items generated for the SELEB scale that measure the benefit categories were divided into six categories: civic responsibility, interpersonal skills, leadership ability, ability to apply knowledge, general life skills and critical thinking. One-way Analysis of Variance was used to analyse the differences in investigated groups defined by previous motor experience on SL attitudes among students. The results showed significant differences between groups in SL experience (F5,52 = 3,19; p=0,014). The highest value on the SELEB scale was recorded in the group with dominant artistic and aesthetic activities, and the lowest value on the SELEB scale was recorded in a group with dominant previous experience in individual sports. Significant differences were determined with the post-hoc Tukey HSD test between groups with minimal previous experience in individual sports and groups with dominant previous experience in society-oriented recreational activities, team sports, and artistic/aesthetic activities.

Protected areas can only deliver their environmental, social and economic benefits if they are effectively managed. The aim of the paper is to analyze the management of nature parks entrusted to the State Enterprise for Forest Management “Srbijašume”, identify management problems and opportunities, and provide management and other reform proposals in order to improve the efficiency of management of protected areas. SE “Srbijašume” manages 5 nature parks on an area of 280,497 ha, which makes up 94% of the total area of nature parks in Serbia. Managerial organization of protected areas in SE “Srbijašume” is in accordance with the Law on Nature Protection, which prescribes the conditions that must be met by the manager in terms of professional, personnel and organizational qualifications to perform the tasks of protection, improvement, promotion and sustainable development of the protected areas. The management of protected areas is coordinated with the three-level organizational structure of the Enterprise (General Directorate, Forest Estates, Forest Administrations). For the management of nature parks “Stara planina”, “Golija”, “Zlatibor” and “Radan” special work units have been formed.

Purpose: To evaluate, by ultrasound biomicroscopy (UBM), changes in scleral thickness after ruthenium-106 CCB and CCC plaque (Eckert & Ziegler BE-BIG GmbH, Berlin, Germany) therapy for anterior ciliary melanoma.Methods: Eleven patients with anterior ciliary melanoma underwent ruthenium-106 CCB and CCC plaque radiation with a radiation dose at the tumor apex of 80-100 Gy. UBM measurements performed prior to and after treatment were as follows: the largest prominence of the tumor perpendicular to the sclera and scleral thickness at scleral spur, 1.0 mm, and 2.0 mm posteriorly.Results: The article presents one year follow-up results for each of the 11 patients. The mean regression of the tumor of 24.3±9.31% was observed. The thinning of the sclera was statistically significant at the scleral spur (t=1.80, p ≤ 0.05) and at maximal tumor thickness (t=1.35, P=0.05).Conclusion: UBM documented significant thinning of the sclera at the scleral spur and overlying the maximal tumor thickness after Ru-106 CCB and CCC plaque radiation. Taking into consideration the shortcomings of the study-small sample size, insufficient probe resolution, and subjectively determined anatomic landmarks-observed minimal thickness change of the sclera does not necessarily mean its necrosis. However, thinning of the sclera documented at one year follow-up associated with very slow regression of the tumor indicates the need for the introduction of the CIA plaque treatment in our patients with anterior ciliary melanoma. [ABSTRACT FROM AUTHOR]

Clinically relevant potential drug-drug interactions are considered preventable adverse drug reactions.

Aim: To invastigate intra- and interobserver reliability of interferometry, tear meniscus height (TMH) measurement and meibography (MBG) of an ocular surface analyzer, LacryDiag (Quantel Medical, France)., Methods: Five consecutive measurements and subsequent analysis of interferometry, TMH, and MBG were recorded by two examiners using the LacryDiag. To assess intra- and interobserver reliability, we used Cohen's kappa for categorical variables (interferometry), or intraclass correlation coefficient for continuous variables (TMH, MBG)., Results: Thirty eyes of 30 examinees were included. For both observers, there was excellent intraobserver reliability for MBG (0.955 and 0.970 for observer 1 and 2, respectively). Intraobserver reliability for observer 1 was substantial for interferometry (0.799), and excellent for TMH (0.863). Reliability for observer 2 was moderate for interferometry (0.535) and fair to good for TMH (0.431). Interobserver reliability was poor for interferometry (0.074) and fair to good for TMH (0.680) and MBG (0.414)., Conclusion: LacryDiag ocular surface analyzer in our study proves to be a reliable noninvasive tool for the evaluation of TMH and MBG. As for interferometry, poor interobserver reliability, fair to good intraobserver reliability for observer 1, and moderate for observer 2, leave room for improvement., Competing Interests: Conflicts of Interest: Kos E, None; Cigić V, None; Bušić M, None; Bjeloš M, None; Miletić D, None; Kuzmanović Elabjer B, None., (International Journal of Ophthalmology Press.)

The aim of our study was to investigate iodine density (ID) and fat fraction (FF) on dual-energy computed tomography (DECT) in patients with acute pancreatitis (AP). This retrospective study included 72 patients with clinically confirmed AP and 62 control subjects with DECT of the abdomen. Two radiologists assessed necrosis and measured attenuation values, ID, and FF in three pancreatic segments. We used receiver operating characteristic (ROC) analysis to determine the optimal threshold for ID for the differentiation between AP groups. The ID was significantly higher in interstitial edematous AP compared to necrotizing AP and the control group (both p < 0.05). The ROC curve analysis revealed the thresholds of ID for detecting pancreatic necrosis ≤ 2.2, ≤2.3, and ≤2.4 mg/mL (AUC between 0.880 and 0.893, p > 0.05) for the head, body, and tail, respectively. The FF was significantly higher for pancreatitis groups when compared with the control group in the head and body segments (both p < 0.001). In the tail, the difference was significant in necrotizing AP ( p = 0.028). The ID values were independent of attenuation values correlated with the FF values in pancreatic tissue. Iodine density values allow for differentiation between morphologic types of AP.

The aim of this study was to provide a chemical profile and determine the antioxidant and antimicrobial activity of the essential oil (EO) and lipid extracts of Thymus serpyllum L. herbal dust obtained via conventional (hydrodistillation (HD) and Soxhlet extraction (SOX)) and novel extraction techniques (supercritical fluid extraction (SFE)). In addition, a comparative analysis of the chemical profiles of the obtained EO and extracts was carried out, as well as the determination of antioxidant, antibacterial and antifungal activity of the lipid extracts. According to the aforementioned antioxidant and antimicrobial activities and the monoterpene yield and selectivity, SFE provided significant advantages compared to the traditional techniques. In addition, SFE extracts could be considered to have great potential in terms of their utilization in the pharmaceutical and cosmetic industries, as well as appropriate replacements for synthetic additives in the food industry.

Bacterial cellulose (BC) is a highly pure polysaccharide biopolymer that can be produced by various bacterial genera. Even though BC lacks functional properties, its porosity, three-dimensional network, and high specific surface area make it a suitable carrier for functional composite materials. In the present study, BC-producing bacteria were isolated from kombucha beverage and identified using a molecular method. Two sets of the BC hydrogels were produced in static conditions after four and seven days. Afterwards, two different synthesis pathways were applied for BC functionalization. The first method implied the incorporation of previously synthesized HAp/TiO 2 nanocomposite using an immersion technique, while the second method included the functionalization of BC during the synthesis of HAp/TiO 2 nanocomposite in the reaction mixture. The primary goal was to find the best method to obtain the functionalized material. Physicochemical and microstructural properties were analyzed by SEM, EDS, FTIR, and XRD methods. Further properties were examined by tensile test and thermogravimetric analysis, and antimicrobial activity was assessed by a total plate count assay. The results showed that HAp/TiO 2 was successfully incorporated into the produced BC hydrogels using both methods. The applied methods of incorporation influenced the differences in morphology, phase distribution, mechanical and thermal properties, and antimicrobial activity against Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Proteus mirabilis (ATCC 12453), and Candida albicans (ATCC 10231). Composite material can be recommended for further development and application in environments that are suitable for diseases spreading.

The aim of our study was to establish and compare the diagnostic accuracy and clinical applicability of published chest CT severity scoring systems used for COVID-19 pneumonia assessment and to propose the most efficient CT scoring system with the highest diagnostic performance and the most accurate prediction of disease severity. This retrospective study included 218 patients with PCR-confirmed SARS-CoV-2 infection and chest CT. Two radiologists blindly evaluated CT scans and calculated nine different CT severity scores (CT SSs). The diagnostic validity of CT SSs was tested by ROC analysis. Interobserver agreement was excellent (intraclass correlation coefficient: 0.982-0.995). The predominance of either consolidations or a combination of consolidations and ground-glass opacities (GGOs) was a predictor of more severe disease (both p < 0.005), while GGO prevalence alone was not. Correlation between all CT SSs was high, ranging from 0.848 to 0.971. CT SS 30 had the highest diagnostic accuracy (AUC = 0.805) in discriminating mild from severe COVID-19 disease compared to all the other proposed scoring systems (AUC range 0.755-0.788). In conclusion, CT SS 30 achieved the highest diagnostic accuracy in predicting the severity of COVID-19 disease while maintaining simplicity, reproducibility, and applicability in complex clinical settings.

BACKGROUND Therapeutic options for human epidermal growth factor 2 (HER2)-positive metastatic breast cancer (mBC) are developing rapidly. This study aimed to determine the differences in the survival outcomes of patients with HER2-positive mBC in relation to access to anti-HER therapy at 3 oncology centers in upper-middle-income countries (UMICs) and 1 oncology center in a high-income country (HIC). MATERIAL AND METHODS We retrospectively identified 42 patients from Croatia (HIC), 71 patients from Serbia (UMIC), and 57 from Bosnia and Herzegovina (UMIC) diagnosed with HER2-positive mBC who were treated between January 2015 and December 2020. The pathohistological features of the tumors were obtained from the pathological findings, which were made according to standard procedures for each center. Patients were treated depending on the availability of therapy, which differed for centers in different countries. We evaluated disease-free survival, progression-free survival, and overall survival (OS) based on the availability of first- and second-line anti-HER2 therapy in UMICs vs HIC. RESULTS OS in first-line therapy was better in patients treated with dual HER2 blockade than in patients treated without dual HER2 blockade, P<0.001. OS in second-line therapy was significantly better in patients treated with trastuzumab emtansine than in patients treated with other reported regimens, P=0.004. CONCLUSIONS Results of our study showed superior survival among patients who were treated with dual first-line HER2 therapy as well as second-line trastuzumab emtansine therapy than in those patients in other centers where these drugs were not available. Raising awareness about this could help improve the situation.

Objectives: Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients., Methods: We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed., Results: Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients ( p = 0.006), patients over 55 years ( p < 0.001), and patients on haemodialysis ( p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates ( p = 0.041 and p = 0.039, respectively)., Conclusions: The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor., Advances in Knowledge: Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients.

Background: Virtual monoenergetic (VM) dual-energy computed tomography (DE-CT) enables grey-to-white matter contrast-to-noise ratio optimization, potentially increasing ischaemic brain oedema visibility. The aim of this study was to compare the diagnostic accuracy of VM and standard DE-CT reconstructions for early stroke detection., Methods: Consecutive patients with non-contrast DE-CT of the brain scanned within 12 h of stroke symptom onset were prospectively included in the study. Patients with other significant brain pathology were excluded. Two radiologists jointly evaluated standard and VM reconstructions (from 40 to 190 keV at increments of 10 keV) for early stroke signs on a four-point Likert scale: (a) stroke definitely present, (b) stroke probably present, (c) probably no stroke, and (d) definitely no stroke. Follow-up imaging and clinical data served as the standard of reference. Diagnostic accuracy was evaluated by receiver operating characteristic analysis., Results: Stroke incidence among 184 patients was 76%. In 64 patients follow-up imaging served as the standard of reference: ischemic brain oedema detection was significantly more accurate on VM reconstructions at 80 keV compared with standard DE-CT reconstructions (area under the curve (AUC) = 0.821 vs . AUC = 0.672, p  = 0.002). The difference was most prominent within the first 3 h after symptom onset (at 11%, AUC = 0.819 vs . AUC = 0.709, p  = 0.17) and in patients with National Institutes of Health Stroke Scale above 16 (at 37.5%, AUC = 1 vs . AUC = 0.625, p  = 0.14)., Conclusion: VM DE-CT reconstructions at 80 keV appear to be the optimal non-contrast CT technique for diagnosing early ischaemic stroke, particularly within the first 3 h after symptom onset and in severely ill patients.