Croatian Medical Journal (CROAT MED J)

Publications in this journal

• Article: Novel duplication on chromosome 16 (q12.1-q21) associated with behavioral disorder, mild cognitive impairment, speech delay, and dysmorphic features: case report. Odak L, Barisić I, Morozin Pohovski L, Riegel M, Schinzel A. Croat Med J. 2011 Jun;52(3):415-22.

  Odak L, Barisić I, Morozin Pohovski L, Riegel M, Schinzel A
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  ABSTRACT: We report on the 10-year follow-up and clinical, cytogenetic, and molecular investigation of a girl admitted for evaluation because of speech delay, learning difficulties, aggressive behavior, and dysmorphic facial features that included high forehead, round face, epicanthic folds, low-set dysplastic ears, flat nasal bridge, long flat philtrum, thin upper lip, small mouth, and short neck. The analysis of high-resolution GTG- and CTG-banding chromosomes suggested a de novo direct duplication of 16q12-q21 region and fluorescence in situ hybridization analysis with whole-chromosome specific 16 probe confirmed that the duplicated genetic material originated from the chromosome 16. Subsequently, array-based comparative genomic hybridization analysis with a≈75 kb resolution showed a 9.92 Mb gain on the long arm of chromosome 16 at bands q12.1 through q21. To the best of our knowledge, this is the first case of duplication 16q12.1q21 described in literature. Several genes within the duplicated region are possibly correlated with clinical features present in our patient. Clinical and cytogenetic findings were compared with the small number of reported patients with pure duplications 16q, partially overlapping the one in our patient. Clinical phenotype seems to be distinctive between the proximal-intermediate and intermediate-distal regions of the long arm of the chromosome 16. In particular, we observed a set of dysmorphic features that could present a characteristic dup 16q11.2-q13 phenotype. The present study illustrates the advantages of an integrative approach using both conventional and molecular techniques for the precise characterization and genotype-phenotype correlation in patients with dysmorphism, behavioral problems, and learning difficulties.
  Croatian Medical Journal 01/2011; 52(3):415-22.
• Article: Richard Horton, editor of the Lancet, visits Croatia to support the Croatian Medical Journal

  Marusic M
  Croatian Medical Journal 01/2008; 49(3):422.
• Article: Foresnic botany: Potential Usefullness of Microsatelite- Based Genotyping of Croatian Olive (Olea Europea L) in Forensic Casework

  S.Štambuk, D. Sutlović, P. Bakarić, S. Petričević, D. Primorac, Š. Anđelinović
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  ABSTRACT: To assess genotyping with microsatellite-based markers of the olive (Olea europaea L.) for potential application of olive as legal case evidence, with regard to the degree of variability within the Croatian olive genomic pool and to the effectiveness of the chosen set of microsatellite-based markers in revealing olive divergence. Methods: The total of 44 autochthonous Croatian olive specimens were subjected to genotyping with 16 previously described and developed microsatellite-based markers. According to previous morphological analyses, 44 specimens were classified into 30 cultivars with the exception of an additional, previously unassigned specimen. Results: Genotyping of 44 specimens distinguished a total of 44 different genotype profiles by 16 microsatellite-based loci. Average expected heterozigosity amounted to 0.758, which points to significant diversity of Croatian olives. Conclusion: Croatian olive genotyping showed strong varietal discrimination up to the single tree and considerable potential application of olive as evidence in investigation of crime, accident, and suicide circumstances.
  Croatian Medical Journal 11/2007; 48(4):556-562.
• Article: In-hospital cardiac arrest and resuscitation outcomes: rationale for sudden cardiac death approach.

  Drago Rakić, Zvonko Rumboldt, Vedran Carević, Jugoslav Bagatin, Stojan Polić, Nediljko Pivac, Ruzica Avelini-Perković
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  ABSTRACT: To assess the frequency of cardiac arrest and outcomes and predictors of survival after cardiopulmonary resuscitation in hospitalized patients. We prospectively analyzed the data on all patients who experienced cardiac arrest while hospitalized at the Split University Hospital between January and December 2003. Data were collected on patients' demographic characteristics, etiology and presentation of cardiac arrest, time, site, methods, and outcomes of cardiopulmonary resuscitation. Out of 120 cases of cardiac arrest among 32,861 hospitalized patients, 76.7% were witnessed. Ninety-six (80.0%) patients with cardiac arrest underwent resuscitation, and 22.5% of them were discharged alive. The survival rate was 20.0% at the Department of Internal Medicine, 29.2% in the Coronary Care Unit, and only 7.1% in other departments (P=0.058, chi2 test). Out of 92 patients with witnessed cardiac arrest, 28.3% survived to discharge, whereas only one of 28 patient with unwitnessed cardiac arrest survived to discharge (P=0.004, Fisher's exact test). More patients with cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia survived than patients with asystole and pulseless electrical activity (47.6% vs 10.7%, respectively, P<0.001, Fisher's exact test). None of the patients with unclassified cardiac arrest survived until discharge. Cardiac arrest survivors were significantly younger (60.8+/-12.9 vs 71.1+/-11.7 years, P<0.001, Student t-test). Sex had no influence on survival. There were no significant circadian or hospital shift differences in the frequency rate of cardiac arrest, but the rate of successful resuscitation was lower during the night shift. The rate of successful resuscitation was higher in the coronary care unit, during the day and in younger witnessed cardiac arrest patients with ventricular fibrillation or pulseless ventricular tachycardia.
  Croatian Medical Journal 01/2006; 46(6):907-12.
• Article: After all, that is "science"--the Fifth International Congress on Peer Review and Biomedical Publication, Chicago 2005.

  Farrokh Habibzadeh
  Croatian Medical Journal 01/2006; 46(6):1003-4.
• Source

  Available from: cmj.hr

  Article: Working for peace through health--ethical values and principles.

  Joanna Santa Barbara
  Croatian Medical Journal 01/2006; 46(6):1007-9.
• Source

  Available from: cmj.hr

  Article: Statistical analysis for occupational exposure measurements.

  John H Lange, Alessandra Buja, Emanuela Fadda, Giuseppe Mastrangelo
  Croatian Medical Journal 01/2006; 46(6):1001-2; discussion 1002.
• Article: Early detection of left ventricular diastolic dysfunction in hypertensive heart disease by color Doppler myocardial imaging.

  Jadranka Separović-Hanzevacki, Maja Cikes, Martina Lovric-Bencić, Zdenko Sonicki, Sanja Ceković, Aleksander Ernst, Nikca Drinković, Ivo Cikes
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  ABSTRACT: To determine if Color Doppler myocardial imaging could provide evidence of diastolic dysfunction in patients with hypertension whose pulse-wave Doppler parameters were normal. The study included 33 patients (mean age 48+/-7.3 years) and a control group of 13 sex- and age-matched healthy individuals. Patients were divided into two groups according to mean blood pressure (BP) values during 24-hour blood pressure monitoring while under antihypertensive therapy: those with uncontrolled hypertension (n=22) and those with controlled hypertension (n=11). All study participants underwent complete standard echocardiography (2D, M-mode, pulsed and continuous Doppler) and a Color Doppler myocardial imaging study. Conventional Doppler parameters indicated relaxation disturbances in patients with uncontrolled hypertension, but were within a normal range in patients with controlled hypertension at baseline and follow-up. Parameters of global diastolic function measured by Color Doppler myocardial imaging revealed that E'/A', the ratio between E'-wave (early filling phase) and A'-wave (late diastolic wave due to atrial contraction), was <1 in 57% of segments at baseline in patients with uncontrolled hypertension, and did not significantly change at follow-up. In patients with controlled hypertension, E'/A'<1 was noted in 4.7% of segments at baseline and in 28.6% of segments at follow-up. Regional diastolic dysfunction measured by Color Doppler myocardial imaging was the first sign of myocardial dysfunction due to arterial hypertension, while the parameters of global diastolic dysfunction measured by conventional Doppler and Color Doppler myocardial imaging were still normal. Furthermore, in patients with uncontrolled hypertension with manifested global diastolic dysfunction, there was a change in late diastolic parameters. Our results point to a potentially important role of Color Doppler myocardial imaging in diagnosing hypertensive heart disease as well as in follow-up of treatment.
  Croatian Medical Journal 01/2006; 46(6):913-21.
• Source

  Available from: irb.hr

  Article: Evaluation of single intensive care unit performance by simplified acute physiology score II system.

  Kristian Desa, Alan Sustić, Zeljko Zupan, Bozidar Krstulović, Vesna Golubović
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  ABSTRACT: To evaluate effectiveness and quality of care in a single intensive care unit (ICU) by the Simplified Acute Physiology Score II (SAPS II). A prospective study included 395 patients from the ICU at Rijeka University Hospital, Croatia. The sum of the SAPS II points was used for calculating predicted mortality for each patient. The observed death rate was compared with predicted mortality calculated by SAPS II system. The ability of the SAPS II prognostic system to predict probability of hospital mortality was assessed with discrimination (receiver operating characteristic [ROC] curve) and calibration (Hosmer-Lemeshow test) measures. The SAPS II score on the first ICU day was low (median, 20; range, 3-83). SAPS II system showed a good ability to separate the patients predicted to live from those predicted to die, as shown by an area under the ROC curve of 0.827. The calibration curve demonstrated under-prediction of the actual death rate (Hosmer-Lemeshow goodness-of-fit test, C=22.961; df=8; P=0.003). The observed mortality was higher than predicted (observed-to-predicted ratio was 1.6). SAPS II system is a useful tool for the assessment of ICU performance. This system demonstrated a good ability of discrimination, but an under-prediction of the actual mortality rate in our ICU.
  Croatian Medical Journal 01/2006; 46(6):964-9.
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  Available from: cmj.hr

  Article: Myocardial protective effect of warm blood, tepid blood, and cold crystalloid cardioplegia in coronary artery bypass grafting surgery.

  Edmundas Sirvinskas, Linas Nasvytis, Laima Raliene, Jolanta Vaskelyte, Adolfas Toleikis, Sonata Trumbeckaite
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  ABSTRACT: To compare the myocardial effects of cardioplegia by warm blood, tepid blood, and cold crystalloid during coronary artery bypass grafting (CABG). Patients undergoing CABG surgery at Kaunas University Hospital between 2000 and 2004 were randomized into three groups (n=156), receiving a different method of cardioplegia. Intermittent antegrade warm blood cardioplegia was used in 51 patients, tepid blood cardioplegia in 50 patients, and cold crystalloid cardioplegia in 55 patients. Mitochondrial function, myocardial ultrastructure, troponin T, and hemodynamic and clinical data were analyzed after surgery. All cardioplegic methods similarly affected structural and functional properties of mitochondria and coupling of oxidative phosphorylation, and all lowered the capacity of mitochondria to synthesize ATP. Ultrastructure of myocytes showed slight to moderate injury in the cold crystalloid cardioplegia group. The concentration of troponin T was significantly lower in the warm blood cardioplegia group than in the tepid blood cardioplegia and cold crystalloid cardioplegia groups at 12 hours (0.8+/-0.1 ng/mL, 1.9+/-0.2 ng/mL, and 2.8+/-0.3 ng/mL, respectively; P<0.001) and 24 hours after surgery (1.0+/-0.1 ng/mL, 2.2+/-0.3 ng/mL, and 2.5+/-0.3 ng/mL, respectively; P<0.001). Echocardiographic examination after surgery revealed that the changes in the left ventricle diastolic function were similar in all groups, and that systolic function did not change. The warm blood cardioplegia group showed shorter duration of intubation and hospitalization. There were no differences in the need of catecholamine administration, incidence of complications, and duration of stay in the intensive care unit. Intermittent antegrade warm blood cardioplegia provides better myocardial protection during CABG surgery, as assessed by the lower release of troponin T, lower fluid balance, shorter duration of tracheal intubation and hospital stay.
  Croatian Medical Journal 01/2006; 46(6):879-88.
• Source

  Available from: cmj.hr

  Article: Transient left ventricular apical ballooning mimicking acute coronary syndrome in four patients from central Europe.

  Johann Auer, Michael Porodko, Robert Berent, Christian Punzengruber, Thomas Weber, Gudrun Lamm, Bernd Eber
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  ABSTRACT: The syndrome of "apical ballooning" consists of an acute onset of transient extensive akinesia of the apical portion of the left ventricle, without significant stenosis on the coronary angiogram. The syndrome is accompanied by chest symptoms, electocardiographic changes, and limited release of cardiac markers disproportionate to the extent of akinesia. So far, the vast majority of cases with this syndrome have been reported among Japanese population and only a few cases among Caucasian population. We describe "apical ballooning" in four Caucasian patients, three women and one man, who presented at a tertiary referral center over a period of eight months. Their age ranged between 64 and 84 years. Three of them presented with chest symptoms. All four patients had electrocardiographic changes and increased concentration of troponin T. One patient developed hemodynamic instability, but none died or showed recurrence of symptoms during the follow-up of 1-8 months. In all patients, a preceding triggering factor was identified, such as emotional or physical stress. In all patients left ventriculography showed extensive akinesia of the apex of the left ventricle ("apical ballooning") in the absence of a significant coronary artery stenosis. Left ventricular systolic function recovered completely within three days to three weeks. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. Despite severe initial presentation, conservative medical management leads to good long term outcome.
  Croatian Medical Journal 01/2006; 46(6):942-9.
• Article: Brains in movement.

  Norman Sartorius
  Croatian Medical Journal 01/2006; 46(6):1005-6.
• Source

  Available from: cmj.hr

  Article: Comparison of on-demand vs planned relaparotomy for treatment of severe intra-abdominal infections.

  Mladen Rakić, Drago Popović, Mislav Rakić, Nikica Druzijanić, Mihajlo Lojpur, Brian A Hall, Brent A Williams, Juraj Sprung
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  ABSTRACT: To compare morbidity and mortality of patients with severe intra-abdominal infections after two types of surgical treatment, on-demand ("wait and see") relaparotomy and modified planned relaparotomy. We prospectively analyzed the outcomes of 65 patients with severe peritonitis surgically treated in two Croatian hospitals. In one hospital, 34 patients were treated on-demand, and in another hospital 31 patients were treated by planned relaparotomy. We compared severe postoperative complications, mortality, and length of hospital stay in the two groups of patients. Severity of patient's disease, as measured from preoperative group-average Acute Physiology and Chronic Health Evaluation (APACHE) II scores, was comparable in both on-demand and planned relaparotomy groups. The mortality rate was higher in patients operated on-demand (59% vs 29%, P=0.024). In nonadjusted model, the relative risk of dying was 2.5-fold higher for patients treated by on-demand operation in comparison with planned relaparatomy (P=0.030). However, after the adjustment of the survival data for individual patient's sex and APACHE II scores, the difference in the relative risk became non-significant (P=0.178). The patients who died had higher APACHE II scores (26.1+/-8.9 vs 19.7+/-5.9, P=0.009). Relative risk of dying per 5-point increase in APACHE II score was 1.24 (95% confidence interval, 1.01-1.51; P=0.039), irrespective of the surgical technique. Patients with severe peritonitis treated with planned relaparotomy seemed to have lower mortality. However, the relative risk of dying was not statistically different between the on-demand and planned relaparotomy groups after adjustment for preoperative APACHE II scores. The severity of disease rather than surgical approach plays more important role in survival of these patients.
  Croatian Medical Journal 01/2006; 46(6):957-63.
• Article: Myocardial infarction and religion: hospital-based case-control study in Tirana, Albania.

  Enver Roshi, Ahmet Kamberi, Artan Goda, Genc Burazeri
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  ABSTRACT: To assess the association between religion, Muslim vs Christian, and myocardial infarction in the population of Tirana, capital of Albania. A hospital-based case-control study included all patients with acute non-fatal myocardial infarction hospitalized in Tirana University Hospital Center between October 1999 and June 2001. There were 146 women with the mean age (+/-standard deviation) of 62+/-9 years and 331 men aged 59+/-10 years. Control group consisted of 616 hospital-based patients recruited from University Departments of Orthopedics and Ear, Nose, and Throat. The control group included 227 women aged 60+/-10 years, and 389 men aged 60+/-9 years. A structured questionnaire was administered to all participants to collect self-reported data on socio-demographic factors, life-style and behavioral factors, diet, and pre-existing conditions. All participants had their height and weight measured. Among patients with myocardial infarction, 98 women (67%) and 244 men (74%) identified themselves as Muslims, as compared to 164 women (72%) and 265 men (68%) in the control group. There was no evidence of association between myocardial infarction and religion in women, whereas Muslim men had a higher risk of a first non-fatal myocardial infarction than Christians (age-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 0.95-1.82). Upon adjustment for covariates, there was no evidence of a significant association between religion and myocardial infarction neither in men (OR,1.20; 95% CI, 0.85-1.70), nor in women (OR, 0.97; 95% CI, 0.59-1.60). The occurrence of myocardial infarction among Muslims and Christians in Tirana was similar, suggesting that cardiovascular morbidity is not affected by the religious affiliation of Albanian adults.
  Croatian Medical Journal 01/2006; 46(6):977-83.
• Article: Morbidity of native, immigrant, and returned refugee populations in family medicine practice in Croatia after 1991-1995 war.

  Tatjana Torinek, Milica Katic, Josipa Kern
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  ABSTRACT: To examine the differences in the morbidity among 325 native inhabitants, 231 immigrants, and 145 returned refugees in Komarevo, Croatia. The data on patients older than 45 years and their chronic diseases classified according to the 10th revision of International Classification of Diseases and Related Health Problems were collected from the medical files in a family practice in Komarevo. The patients were grouped according to their status (natives, immigrants, and returned refugees) and age (45-64 and > or =65 years). The differences in diagnoses between the groups of the same age were analyzed by descriptive statistics, Kruskal-Wallis test, and chi2 test. In the 45-64 age group, hypertension was diagnosed in 67 out of 183 (36.6%) natives, 22 out of 108 (20.4%) immigrants, and 12 out of 50 (24%) returned refugees (chi2(2)=9.48; P=0.008). In the same age group, ischemic heart disease was found in 21 out of 183 (11.4%) natives, 3 out of 108 (2.8%) immigrants, and 3 out of 50 (6.4%) returned refugees (chi2(2)=7.34, P=0.025). In those aged > or =65, intervertebral disc disorders, dorsalgia, and dorsopathy were found in 61 out of 169 (36.1%) natives, 26 out of 123 (21.1%) immigrants, and 15 out of 90 (15.8%) returned refugees (chi2(2)=15.44, P<0.001). Ischemic heart disease was found in 20 out of 169 (11.8%) natives, 4 out of 123 (3.3%) immigrants, and 16 out of 90 (16.8%) returned refugees (chi2(2)=11.40, P=0.003). Five (56%) and six (67%) out of nine groups of diagnoses had the lowest prevalence in immigrants aged 45-64 and > or =65, respectively. Native inhabitants had the highest prevalence of observed chronic diseases, whereas the immigrant adult population had the lowest. Such differences should be kept in mind in the approach to war-affected populations.
  Croatian Medical Journal 01/2006; 46(6):990-5.