bluuebunny/crossref_metadata_2025 huggingface dataset:
A new method for estimating recent adult mortality from summary sibling histories
Authors: Masquelier Bruno , Menashe-Oren Ashira , Reniers Georges , Timæus Ian M.
Published: November 2024

Background

In low- and middle-income countries with limited death registration statistics, adult mortality rates are commonly estimated through sibling survival histories (SSH). In full SSH, respondents are asked about either the age, or the age and time of death, of each of their siblings in turn. Full SSH allow direct mortality estimation but can be time-consuming to collect. In this study, we introduce a new indirect estimation method using summary SSH, requiring only a limited set of questions to produce recent mortality estimates.

Methods

We developed a set of 192 microsimulations representing a wide range of fertility and mortality patterns, and reconstructed summary SSH within these simulations as if they had been collected from adults aged 15–49. For each age group of respondents, we calculated coefficients that convert the proportion of adult siblings who died in the previous 5 years into age-specific mortality rates. We then evaluated the performance of this new method with real data, using 154 Demographic and Health Surveys.

Results

The new indirect method provides mortality rates that are consistent with direct estimates from full SSH. Across all DHS, the mean absolute percentage error in the risk of dying in adulthood (ages 15–49) is 6% for both men and women. In all but one survey, 95% confidence intervals around the direct and indirect estimates overlap. As with direct estimates of adult mortality from SSH, the indirect estimates remain, however, lower than those of the Population Division of the United Nations.

Conclusions

Summary questions on sibling survival can be included in censuses and rapid turn-around surveys for the measurement of recent adult mortality.
A new method to predict return of spontaneous circulation by peripheral intravenous analysis during cardiopulmonary resuscitation: a rat model pilot study
Authors: Balzer Claudius , Eagle Susan S. , Baudenbacher Franz J. , Riess Matthias L.
Published: November 2024

Background

Enhancing venous return during cardiopulmonary resuscitation (CPR) can lead to better hemodynamics and improved outcome after cardiac arrest (CA). Peripheral Intravenous Analysis (PIVA) provides feedback on venous flow changes and may indicate an increase in venous return and cardiac output during CPR. We hypothesize PIVA can serve as an early indicator of increased venous return, preceding end-tidal CO2 (etCO2) increase, before the return of spontaneous circulation (ROSC) in a rat model of CA and CPR.

Results

Eight male Wistar rats were intubated and ventilated, and etCO2 was measured. Vessels were cannulated in the tail vein, femoral vein, femoral artery, and central venous and connected to pressure transducers. Ventilation was discontinued to achieve asphyxial CA. After 8 min, CPR began with ventilation, epinephrine, and automated chest compressions 200 times per minute until mean arterial pressure increased to 120 mmHg. Waveforms were recorded and analyzed. PIVA was calculated using a Fourier transformation of venous waveforms. Data are mean ± SE. Maximum PIVA values occurred in the tail vein 34.7 ± 2.9 s before ROSC, with subsequent PIVA peaks in femoral vein and centrally at 30.9 ± 5.4 and 25.1 ± 5.0 s, respectively. All PIVA peaks preceded etCO2 increase (21.5 ± 3.2 s before ROSC).

Conclusion

PIVA consistently detected venous pressure changes prior to changes in etCO2. This suggests that PIVA has the potential to serve as an important indicator of venous return and cardiac output during CPR, and also as a predictor of ROSC.
Comparing Population-General and Sport-Specific Correlates of Disordered Eating Amongst Elite Athletes: A Cross-Sectional Study
Authors: Fatt Scott J. , George Emma , Hay Phillipa , Jeacocke Nikki , Mitchison Deborah
Published: November 2024

Background

Despite the high prevalence of disordered eating and eating disorders amongst elite athletes, it remains unclear whether risk factors and psychological processes align with those in the general population or if there are unique sport-factors associated with heightened risk. This cross-sectional study investigated if sport-specific factors (including pressures and psychological processes) explained additional variance in elite athletes’ disordered eating symptoms, controlling for established population-general risk factors. Current elite athletes (N = 178, 72.4% female, mean age = 23.9, standard deviation age = 7.0) completed online surveys assessing disordered eating, body dissatisfaction, perfectionistic traits, population-general and sport-specific pressures, as well as general (thin-ideal, muscular-ideal) and athlete-specific (drive for leanness for performance, athletic identity) psychological processes.

Results

Disordered eating was highly prevalent, with 78.2% of athletes reporting at least moderate risk, 46.4% at least high risk, and 20.6% very high risk. Controlling for demographic covariates and population-general pressures, sport-specific pressures explained significant additional variance (13.5%) in disordered eating. Even when controlling for perfectionistic traits, greater weight pressures in sport (β = .35) was uniquely associated with greater disordered eating. In a separate multivariate analysis controlling for covariates and general psychological processes, athlete-specific psychologicalprocesses explained significant additional variance (15.5%) in disordered eating. Even when controlling for body dissatisfaction, greater drive for leanness for performance (β = .17) and athletic identity (β = .13) were uniquely associated with greater disordered eating.

Conclusions

These findings support evidence that elite athletes may experience dual pressures and psychological processes associated with disordered eating: those congruent with appearance-oriented models and others independent of appearance. This duality should be considered in the modification of interventions for disordered eating in elite athletes.

Key points

Disordered eating was highly prevalent in a sample of 178 elite adult athletes, with 78.2% reporting at least moderate risk for having related symptoms or behaviours.

Greater weightpressuresinsport was significantly associated with greater disordered eating, even when controlling for demographic covariates and population-general appearance-related pressures from family and the media.

Both appearance-based (drive for thinness, body dissatisfaction) and non-appearance (drive for leanness for performance, athletic identity) psychological processes were uniquely associated with greater disordered eating.
A rare case of endotracheal tube cuff leakage with no detectable decrease in cuff pressure
Authors: Nagasawa Keiichi , Nishibata Masayuki , Luthe Sarah Kyuragi , Kawamata Tomoyuki
Published: November 2024

Background

Common causes of air leakage around an endotracheal tube include insufficient endotracheal tube cuff inflation and damage to the cuff, while damage to the pilot balloon or pilot balloon tubing is relatively rare.

Case presentation

A 74-year-old female with vertebral osteomyelitis was scheduled for an extreme lateral interbody fusion followed posterior fixation. A fiber-optic light was utilized as part of the surgical illuminator. A sudden decrease in tidal volume and airway pressure was noted intraoperatively. We suspected leakage around the endotracheal tube cuff; however, no decrease in cuff pressure was detected. Despite the normal cuff pressure, we decided to inject a small amount of air which led to a significant increase in the cuff pressure. Upon careful inspection of the endotracheal tube, we discovered that the pilot balloon tubing was damaged as a result of thermal energy emitted by the fiber-optic light, which had ignited the surgical drape. The pilot balloon tubing was partially severed in which the section proximal to the endotracheal tube cuff was burned and punctured, causing the cuff leak. Meanwhile, the section proximal to the pilot balloon had melted and occluded the lumen, resulting in a falsely normal cuff pressure reading followed by an elevated cuff pressure when a small amount of air was injected into the pilot balloon during troubleshooting. Appropriate ventilation was resumed after extubation and re-intubation with a new endotracheal tube.

Conclusions

We experienced an endotracheal tube cuff leakage caused by a damaged pilot balloon tubing due to thermal energy of the fiber-optic light. Our case report emphasizes the importance of suspecting damage to the endotracheal tube cuff and inflation system despite a normal cuff pressure reading, given that the measurement may be falsely elevated depending on the specific location of the damage. In addition, all operating personnel should be familiarized with safety warnings and cautions related to handling.
Serum lipid profile of patients with gallstone disease in rural Western Uttar Pradesh
Authors: Siva Kundrapu Veera Venkata , Agrawal Puneet , Kumar Prashant , Fatima Anam , Ahmad Naved
Published: November 2024

Introduction

Gallstone disease is a common gastrointestinal disorder with varying prevalence across regions. This study explores the demographics and lipid profiles of individuals with cholelithiasis, emphasizing the association between metabolic syndrome and gallstone formation.

Methodology

A prospective study was conducted, including 100 outpatients with cholelithiasis. Demographic data, lipid profiles, and comorbidities were recorded, and statistical analysis was performed.

Results

A higher prevalence of gallstones was recorded in the 20–29 age group and among females. Lipid profiles revealed elevated levels of total cholesterol, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and triglycerides in individuals with metabolic syndrome. High-density lipoprotein (HDL) levels were notably lower in those with metabolic syndrome. Age and gender disparities in metabolic syndrome prevalence were observed, with statistical significance noted in gender-based differences. Serum thyroid-stimulating hormone (TSH) levels did not significantly differ between individuals with and without metabolic syndrome.

Conclusion

The findings indicated elevated lipid profiles, particularly low HDL, are associated with metabolic syndrome in gallstone patients. Further understanding of these associations can aid in preventive strategies and targeted interventions.
Polyploidy-mediated resilience in hepatic aging: molecular mechanisms and functional implication
Authors: Addissouky Tamer A.
Published: November 2024

Background

Polyploidization, a process where cells acquire additional chromosome sets, is a unique characteristic of hepatocytes. This process has been increasingly recognized as an adaptive mechanism for maintaining liver function during aging, a period characterized by cellular senescence, DNA damage, and metabolic dysregulation.

Purpose

This review explores the molecular mechanisms underlying hepatocyte polyploidization and its potential role in promoting resilience against the aging-related decline in liver function. We assess how polyploid hepatocytes contribute to genomic stability, stress resistance, and metabolic adaptation, highlighting their relevance to liver aging.

Main body

Hepatocyte polyploidization occurs through mechanisms such as cytokinesis failure and endoreplication, leading to binuclear or mononuclear polyploid cells. Polyploid hepatocytes exhibit enhanced DNA repair capacity, which helps mitigate the accumulation of age-related genomic damage. The increased gene dosage in polyploid cells facilitates better stress responses, particularly against oxidative stress and genotoxic insults. Metabolic adaptations, including enhanced xenobiotic metabolism and lipid regulation, further support the liver’s ability to maintain homeostasis during aging. Additionally, polyploid cells demonstrate altered epigenetic landscapes and proteostasis mechanisms, contributing to improved cellular function and reduced susceptibility to senescence. These adaptations collectively enhance liver resilience against age-related metabolic and structural challenges.

Conclusion

Hepatocyte polyploidization represents a critical protective mechanism in liver aging, promoting cellular adaptations that safeguard against genomic instability, metabolic dysfunction, and oxidative stress. Understanding the molecular pathways driving polyploidization could pave the way for novel therapeutic strategies to combat age-related liver disorders and enhance health span.

Graphical Abstract
Clinical Management of Ovarian Function Suppression in Premenopausal Women With Breast Cancer: A Survey of Members of ASCO
Authors: Kelly Catherine M. , Bennett Kathleen E. , Cahir Caitriona , Eisen Andrea , Pusztai Lajos
Published: November 2024

PURPOSE

Ovarian function suppression (OFS) with gonadotropin-releasing hormone agonists (GnRHas) is a standard of care for premenopausal patients with high-risk stage II/III hormone receptor–positive breast cancer (BC). Practical guidance on the optimal choice of GnRHa, timing, schedule, and monitoring is limited. Our aim was to determine how oncologists use OFS in routine care.

METHODS

We designed a questionnaire to determine the choice of GnRHa, schedule, duration, initiation, use of bone modifiers, and monitoring of estradiol (E2). The questionnaire was sent to oncologists treating BC, in practice for >1 year and participating in the ASCO Research Survey Pool (RSP). It was also forwarded by investigators to oncologists meeting these criteria. The survey was open between November 14, 2023, and January 5, 2024.

RESULTS

Of 996 oncologists participating in the ASCO RSP, 178 (18%) completed the survey. An additional 56 oncologists contacted by investigators responded. Respondents were from the United States (57%), Asia (15%), and Europe (14%). Goserelin (54%) and leuprolide (39%) were the most frequently used GnRHas and were administered once every month by 46%. Approaches to starting GnRHas were varied. Most continued them for the duration of aromatase inhibitor therapy (57%). Estradiol monitoring was performed regularly, sometimes, or never by 43%, 27%, and 27%, respectively. The E2 assays used were standard (65%), ultrasensitive (16%), and unknown (14%). Interpreting E2 assay results were considered difficult by 55%; however, 62% of oncologists changed treatment on the basis of them. A total of 92% of respondents would like ASCO guidance on the practical use of OFS.

CONCLUSION

Considerable practice variation exists for similar clinical scenarios in OFS administration. Respondents would welcome ASCO guidance on all aspects of OFS.
Widespread Adoption of Precision Anticancer Therapies After Implementation of Pathologist-Directed Comprehensive Genomic Profiling Across a Large US Health System
Authors: Dowdell Alexa K. , Meng Ryan C. , Vita Ann , Bapat Bela , Hanes Douglas , Chang Shu-Ching , Harold Lauren , Wong Cliff , Poon Hoifung , Schroeder Brock , Weerasinghe Roshanthi , Leidner Rom , Urba Walter J. , Bifulco Carlo B. , Piening Brian D.
Published: November 2024

PURPOSE

Precision therapies and immunotherapies have revolutionized cancer care, with novel genomic biomarker-associated therapies being introduced into clinical practice rapidly, resulting in notable gains in patient survival. Despite this, there is significant variability in the utilization of tumor molecular profiling that spans the timing of test ordering, comprehensiveness of gene panels, and clinical decision support through therapy and trial recommendations.

METHODS

To standardize testing, we designed a pathologist-directed test ordering system at the time of diagnosis using a 523-gene DNA/RNA hybrid comprehensive genomic profiling (CGP) panel and extensive clinical decision support tools. To comprehensively characterize the clinical impact of this protocol, we developed a novel natural language processing (NLP)–based approach to extract clinical features from physician chart notes. We assessed test actionability rates, therapy choice, and outcomes across a set of 3,216 patients with advanced cancer.

RESULTS

We observed 49% of patients had at least one actionable genomic biomarker-driven–approved and/or guideline-recommended targeted or immunotherapy (IO) and 53% of patients would have been eligible for a precision therapy clinical trial from three large basket trials. When assessing CGP versus an in silico 50-gene panel, 67% of tumors compared with 33% harbored actionable alterations including clinical trials. Among patients with 6 months or more of follow-up, over 52% received a targeted therapy (TT) or IO, versus 32% who received conventional chemotherapy alone. Furthermore, patients receiving TT had significantly improved overall survival compared with patients receiving chemotherapy alone (
P
< .001).

CONCLUSION

Overall, these data represent a major shift in standard clinical practice toward molecularly guided treatments (targeted and immunotherapies) over conventional systemic chemotherapy. As guidelines continue to evolve and more precision therapeutics gain approval, we expect this gap to continue to widen.
Developing a Family Medicine Program in Jordan: appraisal of trainees and trainers and final assessment outcomes
Authors: Schoenmakers Birgitte , Virji Safiya , Colton Benjamin , Alhalaseh Lana , van Ewijk, Marleen Jiskoot , Spitaels David , Al Shdaifat Amjad
Published: November 2024

Introduction Curriculum development in medical education, particularly in family medicine, is essential for preparing healthcare professionals to meet evolving patient needs. This article examines the development of a Family Medicine program in Jordan, focusing on challenges, methodologies, and outcomes. Methods The curriculum was developed through collaboration between Jordanian and European universities, emphasizing core family medicine principles, evidence-based practice, and local context. Two cohorts of trainees participated in the one-year program, which used a 'whole task learning model' covering communication, clinical knowledge, and community health. Feedback was gathered through focus group interviews with trainers and trainees, and pre- and post-test data were analyzed to assess effectiveness. Results Feedback indicated positive perceptions among trainers and trainees. Trainees valued the transition to Arabic-led lectures, improved primary care understanding, and trainer engagement. Strengths included evidence-based guidelines and patient interaction emphasis. Areas for improvement included more face-to-face training and practical opportunities. Trainers suggested enhancing practical skills training and increasing Arabic materials. Despite pretest score variations, both cohorts showed significant improvement. Challenges such as non-participation and cheating highlighted the need for regular attendance and academic integrity. Conclusion The research underscores the importance of feedback from trainees and trainers in curriculum development. Continuous improvement, comprehensive assessment, and prioritizing linguistic and cultural relevance are crucial for enhancing primary care delivery in Jordan.
Air pollution and skin aging
Authors: Sieradocha Kamila
Published: November 2024

Air pollution is a leading environmental health risk worldwide, with detrimental effects not only on human health but also on skin aging. This review explores the link between air pollution and skin aging, focusing on the harmful effects of particulate matter (PM) and other pollutants such as polycyclic aromatic hydrocarbons (PAHs), nitrogen oxides (NO2), and ozone (O3). These pollutants penetrate the skin, inducing oxidative stress and inflammation, which accelerates the degradation of collagen and elastin in the extracellular matrix. This contributes to premature aging, wrinkles, hyperpigmentation, and inflammatory skin conditions. The smallest fractions of PM, particularly PM2.5, are the most harmful, causing significant cellular damage. Long-term exposure to these pollutants also disrupts the skin's microbiome, leading to dysbiosis and further weakening the skin's protective barrier. Current therapeutic strategies focus on protecting the skin using antioxidants, such as Vitamin C and Vitamin E, as well as probiotics and moisturizers that support the skin's natural defenses. Sunscreens also play a vital role in protecting the skin from UV-induced oxidative stress, further mitigating pollution-related damage. This review highlights the importance of developing comprehensive skincare regimens that target both pollution-induced oxidative stress and the maintenance of a healthy skin barrier. It also emphasizes the need for further research into personalized approaches to counteract the aging effects of air pollution on the skin.
Optimal Control of Service Systems with Heterogeneous Servers and Priority Customers
Authors: Chen David , Chen Ruoran , Wang Rowan , Wang Xuan
Published: November 2024

We study service systems with parallel servers and random customer arrivals and focus on the waiting cost of customers. Using a Markov decision process (MDP) modeling approach, we analytically characterize the structures of the optimal dynamic server assignment policies for two important systems, one consisting of multiple homogeneous servers and two classes of customers and the other consisting of two heterogeneous servers and multiple classes of customers. Based on the obtained results, we propose a threshold-type heuristic policy for the generalized system consisting of multiple heterogeneous servers and multiple classes of customers. To design such a heuristic policy, we first develop techniques for the performance evaluation of general threshold-type policies with any given threshold values. We then construct a path to search for the optimal threshold values. We compare the performance of the best threshold-type heuristic policy with that of the optimal policy and show that our proposed heuristic policy is computationally efficient yet generates great performance. To derive additional managerial insights, we compare the system under our threshold-type dynamic server assignment policy with other commonly seen and simple systems, such as the dedicated system and the work-conserving flexible priority system. The clear performance advantage observed from extensive numerical experiments demonstrates the importance and usefulness of dynamic server assignment control for systems serving multiple classes of customer arrivals. Finally, we extend our analysis to incorporate customer-dependent service rates and sojourn-time minimization performance metrics.

This paper was accepted by Chung Piaw Teo, optimization.

Funding: This work was supported by the Hong Kong Research Grants Council [16500921, 16505819] and the National Natural Science Foundation of China [72201233, 72301222].

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.01228 .
Media Conglomeration, Local News, and Capital Market Consequences
Authors: Dyer Travis , Lang Mark , Oh Jun
Published: November 2024

We examine the effect of news media consolidation on local business coverage and its consequences for firms, investors, and capital markets. Using television transcripts, we find a substantial drop in coverage of local firms following the consolidation of local television stations associated with Sinclair acquisitions. Local information search, institutional portfolio local bias, and overall retail trading decrease for firms in treated geographic areas. Results are most pronounced for small firms, for stations with higher ex ante viewership, and for stations with greater reductions in local coverage. Our results provide insight into the consequences of media consolidation for local business coverage, firms, investors, and capital markets.

This paper was accepted by Eric So, accounting.

Funding: Financial support from the Brigham Young University Marriott School of Business, Purdue University Mitch Daniels School of Business, and Kenan-Flagler Business School is gratefully acknowledged.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.02247 .
A Squared Smoothing Newton Method for Semidefinite Programming
Authors: Liang Ling , Sun Defeng , Toh Kim-Chuan
Published: November 2024

This paper proposes a squared smoothing Newton method via the Huber smoothing function for solving semidefinite programming problems (SDPs). We first study the fundamental properties of the matrix-valued mapping defined upon the Huber function. Using these results and existing ones in the literature, we then conduct rigorous convergence analysis and establish convergence properties for the proposed algorithm. In particular, we show that the proposed method is well-defined and admits global convergence. Moreover, under suitable regularity conditions, that is, the primal and dual constraint nondegenerate conditions, the proposed method is shown to have a super-linear convergence rate. To evaluate the practical performance of the algorithm, we conduct extensive numerical experiments for solving various classes of SDPs. Comparison with the state-of-the-art SDP solvers demonstrates that our method is also efficient for computing accurate solutions of SDPs.

Funding: The research of D. Sun was supported in part by the Hong Kong Research Grants Council under Grant 15307523, and the research of K.-C. Toh was supported by the Ministry of Education, Singapore, under its Academic Research Fund Tier 3 grant call [MOE-2019-T3-1-010].
Limfatičke malformacije
Authors: Kralj Rok , Cvetko Danijel , Tripalo Batoš Ana , Baudoin Tomislav , Kreković Elvira , Rajačić Nada , Stepan Giljević Jasminka , Višnjić Stjepan
Published: November 2024

Lymphatic malformations are abnormal cystic dilatations of lymphatic vessels. They are present at birth, but often can only be detected later in life. Simple lymphatic malformations are limited to certain anatomical regions, while complex diffuse abnormalities can affect the entire organism. Simple lymphatic malformations are divided into macrocystic (cysts >1cm) and microcystic (cysts <1cm). According to the ISSVA classification from 2015, the term lymphangioma is abandoned and the term lymphatic malformation is introduced, which is intended to clearly indicate that it is not a tumor formation. The clinical course is characterized by long asymptomatic periods with short-term inflammatory or infectious episodes and episodes of intracystic bleeding. In the case of voluminous changes, the diagnosis can be made at the transition from the second to the third trimester of pregnancy by ultrasound examination or fetal magnetic resonance. Ultrasound and magnetic resonance imaging are diagnostic methods of choice in the postpartum period as well. The purpose of the treatment is not to completely remove the formation, but to limit the symptoms to the extent that would preserve functionality and provide an appropriate appearance. Treatment methods are the expectant method for asymptomatic disease, sclerotherapy, surgical resection, drug treatment, laser treatment and physical therapy measures. When there is no life-threatening airway obstruction, sclerosing is the method of choice. Bleomycin as a sclerosant provides good results with mild side effects. Therapy with rapamycin (sirolimus) allows for a large percentage of reduction in formation, but it is important to monitor possible side effects
Effect of treatment on quality of life of rural asthmatic children
Authors: Muley Dr Prasad , Dave Dr Hemal , Dave Dr Hardik , Bhatt Dr Sargam , Mithaiwala Dr Vaibhavi
Published: November 2024

Introduction: Medications relieve symptoms of asthma but affected children are significantly bothered by physical, educational and emotional impairments. Urban studies from India evaluated on how this disease affects quality of life. Aim of our study was to evaluate quality of life of rural asthmatic children both before as well as after the treatment. Methods: Asthmatic children 7 to 17 years visiting to rural tertiary care teaching hospital were included. Tool used for the study was Pediatric Asthma Quality of Life Questionnaire - Standard (PAQLQS) which were measured at the time of inclusion and four weeks after treatment. It assessed the QOL (Quality of Life) under symptoms, activity limitation and emotional function domains. Mean difference in pre and post treatment PAQLQ score was assessed. Results: Total 46 children were included from rural setup. Majority were male 60% and had a normal BMI (54%) which was followed by undernutrition (28%). Majority children in both age group 7-11year and 12-17 year, presented with moderate asthma (80%) and (62%) (according to GINA 2022) respectively followed by mild. The rural cohort post treatment showed significant improvement in individual (p<0.005) as well as in overall PAQLQ post treatment (p<0.002). Conclusion: The study has highlighted that good asthma control even after short duration of treatment helped in improvement quality of life of affected children. To maintain quality of life it is expected that the patient remains adhered to proper treatment.
Excessive Pharmaceutical Pricing and Repercussions on Paediatric Health Services
Authors: Vuletić Dominik
Published: November 2024

Context: Paediatric pharmaceutics have a significant share in expensive drugs. Recent years have seen significant calls for intervention against high prices for pharmaceutical products. The prohibition of prices that are excessive as a form of abuse of dominance is considered as Competition law violation in the European Union Law and national legal orders of its Member States. Majority of the Organization for Economic Cooperation and Development (OECD) member countries have similar prohibitions in their respective Competition laws with important exemption of United States (US) Antirust Law, although there is some indication of change in US exactly in the area of pharmaceutical sector. Regulation of excessive prices also exists in Competition laws of all BRICS (Brazil, Russian Federation, India, China, and South Africa) countries. The problem of excessive prices in pharmaceutics is one of the emerging themes in Competition law literature and case law development. This is the area where intellectual property rights, usually patent protection, collide with competition rules. Costs of research and development for such pharmaceutics are often very high emphasizing the need for balance between colliding legitimate interests: access to health and research development.     Aim: To present regulatory and case law development of application of excessive prices as form of abuse of dominance in pharmaceutical sector with emphasis on paediatric health services.    Data source: OECD, PubMed, Google Scholar, Scopus.     Conclusion: Balance between competition rules on excessive prices as form of abuse of dominance and intellectual property rights in the area of expensive paediatric pharmaceutics can be regarded as suboptimal. Thus, there is a need for further regulatory development and application of rules on excessive prices in that field.
AMBLYOPIA
Authors: Bajtl Dunja , Bjeloš Mirjana , Bušić Mladen , Ćurić Ana , Bajt Vladimir , Barać Josip
Published: November 2024

Context: Assessment of visual function often poses a challenge for a paediatrician in primary practice. However, due to the simplicity of basic visual assessment methods, paediatricians have the means to evaluate a child’s visual function. As a crucial part of everypreventive physical examination of a child, the red refl ex test is the most important tool for discovering obstruction of the visual axisas the cause of deprivational amblyopia. The visual axis can be obstructed due to various vision - or even life-threatening conditions.Aim: To present visual assessment methods available to the paediatrician in primary practice.Data source: PubMed, Google Scholar, Scopus, and available Internet screening guidelines.Conclusion: If obstruction of the visual axis is suspected, immediate referral to a paediatric ophthalmologist is mandatory
From phenotype to biological treatment of severe asthma
Authors: Bukvić Blaženka Kljaić , Ivković-Jureković Irena , Navratil Marta , Rogulj Marijana , Bandić Davor , Kelečić Jadranka , Šegulja Silvije , Richter Darko
Published: November 2024

Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and different underlining endotypes. According to different studies, there are several clinical phenotypes of severe asthma in children. Most children are allergic to multiple aeroallergen sensitization (house dust mites, pollen, molds) and have high levels of total and specific IgE, reversible airflow obstruc- tion and early signs of remodelation. A small subgroup of children has persistent airflow limitation (FEV1 <80% predicted). There are two major underlining functional or pathophysiologic mechanisms for different phenotypes of asthma and severe asthma accord- ing to the immune mechanism: Type 2 asthma (Th2-high asthma, eosinophils in serum and sputum, high IgE levels, high FeNO; key cytokines IL-4, IL-5, IL-13) and non-Type 2 asthma (Th2-low asthma, neutrophilic, paucigranulocytic and mixed granulocytic inflam- mation; key cytokines IL-8, IL-17, IL-22). The type 2 asthma endotype is more common in children, while biomarkers involved in the pathogenesis, such as IgE and IL-5 have become targets for biological therapy. The non-type 2 asthma endotype, less frequent in children with severe asthma, has fewer therapeutic options. The effect of azithromycin is still under investigation. Severe asthma, although uncommon, is a complex and high-risk phenotype of childhood asthma. Close monitoring of the patient and precise definition of underlying endotype during evaluation enables identification and use of personalized, endotype-targeted treatment.
Suspicion of tooth aspiration during general anaesthesia in a paediatric patient – a case report
Authors: Zidarić Višnja Majić , Markić Ana , Striber Neda
Published: November 2024

Foreign body aspiration or suspicion of it is a serious medical condition, which can cause life-threatening complications, especially in paediatric population. More than 80% of foreign body aspirations occur in children under three years of age. Children are a particularly vulnerable group due to specifi c anatomy of the airway. Symptoms of aspiration vary from suff ocation, coughing to complete absence of symptoms, which is why a diff erential diagnosis between aspiration and ingestion is sometimes very diffi cult. A six-year-old boy was admitted for elective surgery to correct vertical strabismus. At the pre-anaesthesia evaluation, the child was classifi ed as an ASA II patient, due to frequent laryngitis and bronchitis. The Mallampati score was 1 with no wobbly teeth recorded. After anaesthesia induction, the airway was secured with a laryngeal masksize 3.0 without complications. Upon awakening of the patient and removal of the laryngeal mask, blood was observed in the lodge of the lower left incisor and a lack thereof. The patient was without signs of respiratory distress. An emergency chest X-ray ruled out a foreign body in the airway, and subsequent X-rays of the abdomen revealed the presence of teeth in the projection of the stomach. The child was discharged to home care without complications. The clinical picture of foreign body aspiration under anaesthesia may be atypical and asymptomatic. Therefore, even the slightest suspicion of aspiration, especially in anaesthesia procedures, should be ruled out or confi rmed. Complications are most often the result of late-recognized aspiration.
Association of vitamin D insufficiency and low physical activity with fatigue, headaches and psychological distress in college students, North-Mediterranean Croatia – a pilot study
Authors: Kehler Tatjana , Kezele Tanja Grubić , Fužinac-Smojver Ariana , Kauzlarić-Živković Tamara
Published: November 2024

The aim of the study was to investigate serum vitamin D level in undergraduate students of health studies and its relationship with the frequency of vitamin D rich food consumption, sun exposure, study-related fatigue, headache and psychopathological status, and the relationship of the latter three parameters with the type of physical activity. A blood level of 25-hydroxyvitamin D (25(OH)D), Migraine Disability Assessment (MIDAS), Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), nutrition and physical activity were surveyed in randomly chosen students. Study results showed that 49% of students had 25(OH)D insufficiency/deficiency. The MIDAS values were higher in the insufficient/ deficient group (p=0.035) and were associated with hours of weekly cardio exercises (r=-0.48, p=0.031). CORE-OM and total fatigue correlated with 25(OH)D (r=-0.59, p=0.024; r=0.51, p=0.023). Students with sufficient 25(OH)D had a significantly higher vitamin D intake by consuming sardines in their monthly nutrition (p=0.048). 25(OH)D correlated with the amount of monthly consumed sardines (r=0.59, p=0.006) in general. Our results provide initial evidence that an appropriate lifestyle along with proper physical activity, especially cardio exercise, and vitamin D rich nutrition is important to reduce fatigue, headaches and psychological distress.
Pompeova bolest – progresivna multiorganska bolest: dijagnostički i terapijski izazovi
Authors: Ramadža Danijela Petković
Published: November 2024

Pompeova bolest je progresivna multiorganska bolest koja nastaje zbog nedostatka lizosomskog enzima kisele alfa-glukozidaze teposljedičnog nakupljanja glikogena i kaskade patoloških procesa. Klinički se očituje rasponom fenotipova, od fatalnog infantilnogdo blažih oblika bolesti. Infantilni oblik je obilježen progresivnom hipertrofi čnom kardiomiopatijom, propadanjem mišića i, ako sene liječi, neizbježnom smrću najčešće u prvoj godini života. Enzimskim nadomjesnim liječenjem postignuti su izvanredni rezultati:promijenjen je prirodni tijek bolesti i izbjegnuta rana smrt. Preživljenjem djece s infantilnim oblikom razotkrio se novi fenotip. Pacijenti razvijaju nove znakove bolesti i brojne poteškoće za koje tek treba pronaći novo terapijsko rješenje. Kasni oblik bolesti kliničkimože biti vrlo raznolik. Premda su slabost mišića koštanog sustava i onih dišnih vodeći simptomi, riječ je o multiorganskoj bolesti.Karakteristični klinički trijas (slabost pojasne, paravertebralne i dišne muskulature) razvija se u kasnijim fazama bolesti, dok su u ranim fazama često prisutni samo neki od navedenih ili drugi, netipični, simptomi i znakovi. Zbog toga se bolest kasno prepoznaje igubi se dragocjeno vrijeme za početak liječenja, koje je najučinkovitije ako se započne u početnim fazama bolesti. Jednostavan putdo dijagnoze je mjerenje aktivnosti enzima kisele alfa-glukozidaze iz suhe kapi krvi, što je uputno učiniti u svih osoba s pozitivnomobiteljskom anamnezom, nejasno povišenom kreatin kinazom i drugim znakovima Pompeove bolesti. Rezultati dugogodišnje primjene enzimske nadomjesne terapije u bolesnika s kasnim oblikom pokazali su da liječenje usporava bolest, stabilizira plućnufunkciju i pokretljivost te produljuje život bolesnika. S obzirom na ograničenja u učinkovitosti dostupne terapije i novootkrivena klinička obilježja, razvijaju se novi modaliteti liječenja.
Dijagnostički, klinički i terapijski izazovi u oboljelih od Duchenneove mišićne distrofi je - prikaz serije bolesnika
Authors: Šamija Radenka Kuzmanić , Plejić Marta
Published: November 2024

Duchenneova mišićna distrofi ja najčešća je mišićna distrofi ja koja se javlja u djece.Cilj istraživanja: Procijeniti pravodobno prepoznavanje kliničke slike, provođenje multidisciplinskog pristupa prema najnovijimsmjernicama te analizirati klinički tijek u oboljelih na suvremenoj terapiji.Materijali i metode: Retrospektivnom analizom medicinske dokumentacije izdvojeni su bolesnici s distrofi nopatijama. Izdvojeni supodatci o kliničkom tijeku bolesti, kliničkoj slici u trenutku postavljanja dijagnoze, metodama njene potvrde, tipovima mutacija iterapiji koju primaju.Rezultati: U istraživanje je uključeno ukupno devet ispitanika, osam s dijagnozom Duchenneove i jedan s dijagnozom Beckerovemišićne distrofi je. Dob pri postavljanju dijagnoze Duchenneove mišićne distrofi je bila je u rasponu između dvije i šest i pol godina,dok je kod ispitanika s Beckerovom mišićnom distrofi jom postavljena u dobi od jedanaest godina. Od tipova mutacija četvorica ispitanika ima delecije, trojica duplikacije i dvojica točkaste mutacije. Samostalno pokretna su šestorica ispitanika, dok su trojicaovisna o uporabi kolica. Plućna funkcija uredna je kod sedmorice ispitanika, dok su dvojica razvila kroničnu plućnu insufi cijenciju ikod njih se primjenjuju metode neinvazivne ventilacije. Na glukokortikoidnoj terapiji ukupno je šestorica ispitanika i svi primjenjujudefl azacort.Zaključak: Pacijenti s Duchenneovom mišićnom distrofi jom uz osnovnu progresivnu slabost mišića, razvijaju i komplikacije drugihorganskih sustava, što zahtijeva multidisciplinsku skrb. Pojava genske terapije kao uzročne terapije Duchenneove mišićne distrofi jestavila je dodatni naglasak na što ranijem postavljanju dijagnoze. Time se postiže dodatno produljenje životnog vijeka te podizanjekakvoće života u bolesnika s Duchenneovom mišićnom distrofi jom.
The aims of this study were to determine the intake and sources of total, animal and plant protein in toddlers, as well as difference in protein intake in terms of demographic and anthropometric characteristics and socioeconomic status. The study was cond
Authors: Ilić Ana , Ištvanić Tea , Sokolić Darja , Keser Irena , Šakić Dragica , Niseteo Tena , Barić Irena Colić , Rumbak Ivana
Published: November 2024

Cilj ovog rada je utvrditi unos ukupnih proteina u male djece i proteina s obzirom na podrijetlo te identificirati njihove glavne izvoreu ranom djetinjstvu. Cilj je također utvrditi postoji li razlika u unosu proteina s obzirom na demografske i antropometrijske karakteristike te socioekonomski status ispitanika. U istraživanju je sudjelovalo 130-ero male djece (49,2% djevojčica i 50,8% dječaka)prosječne dobi od 23,5 ± 0,7 mjeseci. Podatci o ispitanicima su se prikupljali općim upitnikom i dnevnikom prehrane što su ga dvaneuzastopna dana vodili roditelji. Djeca unose 3,5 ± 0,1 g/kgTM proteina na dan, a to znači više od preporuka. Pritom unose višeproteina životinjskog (2,3 ± 0,1 g/kgTM) podrijetla nego biljnog (1,2 ± 0,05 g/kgTM). Skupina namirnica od mesa, peradi, ribe i jaja(32,1%) pridonosi najvećem unosu proteina, potom od mlijeka i mliječnih proizvoda (28,1%) te skupina s krumpirom i žitaricama(15,7%). Razlika u unosu proteina te omjer onih životinjskih naprama biljnih s obzirom na spol, indeks djetetove tjelesne mase, trajanje isključivog dojenja te dobi u trenutku početka dohrane nije se pokazala statistički značajnom. S obzirom na socioekonomskistatus analizom podataka je zamijećeno da porastom socioekonomskog statusa djeca konzumiraju značajno više (p=0,012) biljnihproteina (1,1 ± 0,1 g/kgTM, 1,2 ± 0,1 g/kgTM, 1,6 ± 0,1 g/kgTM). Unos proteina u ovom uzorku male djece s područja Hrvatske višestruko premašuje važeće preporuke. Unos životinjskih proteina dvostruko je veći od unosa biljnih, što je posebice izraženo u obiteljima nižeg socioekonomskog statusa.
Povezanost selektiranih čimbenika sa stavom trudnica prema cijepljenju
Authors: Franjić Darjan , Franjić Ivana , Ravlija Jelena
Published: November 2024

Cilj je ispitati znanje, informiranost i stav prema cijepljenju u odnosu na selektirane čimbenike kod trudnica. Dodatni cilj je istražitirazlike u obilježjima trudnica sklonih i nesklonih cijepljenju te ispitati izvore njihova informiranja o cijepljenju djece.Za kvantitativni dio istraživanja primijenjen je upitnik, konstruiran prema smjernicama Sage Vaccine Hesitancy Working Group. Uistraživanje su uključene trudnice koje su došle na kontrolni pregled u SKB Mostar na Kliniku za ginekologiju i porodništvo. Za kvalitativni dio istraživanja upotrijebljena je metoda fokus skupine koja se sastojala od 8 trudnica na Klinici za ginekologiju i porodništvo.Veličina uzorka u ispitivanoj skupini je 100 ispitanica. Većina ispitanica, njih 90 (90%), ima pozitivan stav prema cijepljenju, dok njih10 (10%) cijepljenje smatra nepotrebnim. Značajan broj ispitanica, njih 71 (71%), vjeruje da farmaceutske tvrtke proizvode sigurna iučinkovita cjepiva. Ispitanice koje cijepljenje smatraju korisnim, u većem se postotku za izvor informacija služe stručnom literaturom.Ispitanice koje ne vjeruju napisima protiv cijepljenja manje su zabrinute njegovim nuspojavama.Selektirani čimbenici kao što su očekivanje prvog djeteta, življenje u gradu i visoka obrazovanost povezani su s pozitivnim stavomprema cijepljenju i višom razinu zabrinutosti trudnica u odnosu na njegove nuspojave, no razlika nije statistički značajna. Izvorinformacija povezan je sa stavom trudnica prema cijepljenju. Statistički značajno veći broj ispitanica navodi da mediji ne utječu nanjihovu odluku o cijepljenju. Ispitanice koje ne vjeruju napisima protiv cijepljenja statistički su značajno manje zabrinute njegovimnuspojavama. Stoga je nužno unapređenje komunikacije i edukacije zdravstvenih djelatnika o cijepljenju prema trudnicama, što ćepotaknuti veću pokrivenost cijepljenjem.
Adolescencija i doping
Authors: Bašković Marko , Milošević Milan
Published: November 2024

Želja za osvajanjem športskih natjecanja ili opsjednutost postizanjem savršene građe učinila je pojedine adolescente i djecu podložnima uzimanju tvari ili primjeni metoda zabranjenih u športu. U našem smo se pregledu dotakli većine istraživanja iz područjadopinga koja se usko odnose na adolescente kao na vulnerabilnu skupinu. U potrazi za literaturom služili smo se tražilicom PubMed.Pretraga je izvođena po svim poljima na temelju MeSH predmetnica, adolescen*, doping, sport*, youth drug abuse in sport uz upotrebu Booleova operatora AND. Pubmed tražilica ponudila je više od 500 rezultata. Pomnim čitanjem sažetaka i cjelovitih radova, uzdefiniranu tematiku zanimljivu za raspravu odabran je 41 rad. Nesporna je činjenica da sredstva nedopuštena u športu štetno utječuna zdravlje, rast i razvitak u adolescentnoj dobi. Unatoč kreiranju politike i strategije razvijenijih zemalja u borbi protiv dopinga,rezultati jasno upućuju na to da se i dalje intenzivnije mora raditi na programima obrazovanja, prevencije, zabrane i testiranja nasredstva zabranjena u športu.
Kronične promjene plućnog parenhima u djevojčice s Rettovim sindromom
Authors: Šalig Sanela , Batoš Ana Tripalo , Bogović Jasna Čepin , Đuranović Vlasta , Jadrešin Oleg
Published: November 2024

Rettov sindrom je progresivni pervazivni neurorazvojni poremećaj koji pogađa gotovo isključivo djevojčice i drugi je najčešći uzrokintelektualnih poteškoća kod osoba ženskog spola, s pojavnošću od 1:10 000 do 1:15 000 živorođenih djevojčica. Klasični oblik Rettovog sindroma u 95% slučajeva nastaje na kromosomu X de novo mutacijom gena koji kodira metil-CpG-vezajući protein 2. Karakteriziran je razvojnim zaostajanjem/intelektualnim poteškoćama, ataksijom, epilepsijom, karakterističnim stereotipnim kretnjamaruku i gubitkom njihove normalne funkcije te poremećajem disanja. Nema učinkovitog lijeka, ali ranim prepoznavanjem bolesti tepočetkom terapije može se usporiti nastanak daljnjih komplikacija. Poremećaji disanja koji uključuju apneje u budnosti, hiperventilaciju, ubrzano plitko disanje te zadržavanje daha rezultat su brojnih faktora, uključujući oksidativni stres i kroničnu subkliničkuupalu.U ovom radu prikazujemo djevojčicu koja boluje od Rettovog sindroma i u nekoliko je navrata liječena antibioticima zbog radiološkiperzistirajućih promjena gornjeg desnog plućnog režnja sa smetnjama ventilacije i prominentnim desnim hilusom. Nađene promjene gornjeg desnog režnja pluća na kompjuteriziranoj tomografiji toraksa, prema podatcima iz literatrure, mogu se naći u 50% djeces Rettovim sindromom i kroničnog su karaktera te ne zahtijevaju liječenje antibioticima.