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Artificial intelligence as a new answer to old challenges in maternal-fetal medicine and obstetrics.

Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms "artificial intelligence in obstetrics", "maternal-fetal medicine", and "machine learning" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.

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Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up.

Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.

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Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P&lt;0.001), and admission body temperature (ρ=0.386, P&lt;0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women &gt;35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

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The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season.

Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity. Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination. Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.

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Open Access
Left atrial strain in fetal echocardiography- could it be introduced to everyday clinical practice?

Prenatal cardiology is a part of preventive cardiology based on fetal echocardiography and fetal interventional cardiology, which facilitates treatment of congenital heart defects (CHD) in pediatric patients and consequently in adults. Timely prenatal detection of CHD plays a pivotal role in facilitating the appropriate referral of pregnant women to facilities equipped to provide thorough perinatal care within the framework of a well-structured healthcare system. The aim of this paper is to highlight the role of left atrial strain (LAS) in prenatal evaluation of fetal heart and prediction of structural and functional disorders. We conducted a comprehensive literature review searching PubMed for articles published from inception up until August 2023, including the search terms "left atrial strain", "fetal echocardiography", and "prenatal cardiology" combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. Our review underscores the significance of LAS parameters in fetal echocardiography as a screening tool during specific gestational windows (starting from 11 to 14 weeks of gestation, followed by better visualization between 18 and 22 weeks of gestation). The left atrial strain technique and its parameters serve as valuable indicators, not only for identifying cardiac complications but also for predicting and guiding therapeutic interventions in cases of both cardiac and noncardiac pregnancy complications in fetuses. Evidence suggests establishment of second-trimester reference strain and strain rate values by speckle-tracking echocardiography in the healthy fetal cohort is essential for the evaluation of myocardial pathologies during pregnancy. Finding of LAS of fetal heart is feasible and probably can have potential for clinical and prognostic implications.

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Hrvatska elektronička medicinska edukacija – HeMED

HeMED je akronim od pojma HRVATSKA ELEKTRONIČKA MEDICINSKA EDUKACIJA koja predstavlja suvremeno tehnološko multimodalno rješenje na hrvatskom jeziku za trajnu digitalnu edukaciju liječnika, studenata i građana putem internetskih (mrežnih) stranica i mobilnih aplikacija. Idejni začetnik projekta je dr. Željko Ivančević, koji ga je uz pomoć HLK i inovativne farmaceutske inicijative uspješno pokrenuo i uspostavio. Ciljevi HeMED-a su poticanje zdravstvene pismenosti građana, pružanje suvremene literature studentima na hrvatskom jeziku i podrška liječnicima u njihovom svakodnevnom radu. Na stranicama hemed. hr medicinskim profesionalcima i javnosti prevedeni su značajni međunarodni udžbenici i uvijek je ažurna baza lijekova. Dostupna izdanja za pretraživanje i čitanje jesu: MSD priručnik za pacijente (2019.), MSD priručnik za profesionalce (2018.), MSD priručnik simptoma bolesti (2010.), Farmakogenetika u kliničkoj praksi (2021.), Harrison: Principi interne medicine (džepni priručnik, 2019.) i Harrison: Principi interne medicine (udžbenik, 2013.). Sva su navedena izdanja povezana s bazom lijekova koja je redovno ažurirana. Svaki lijek koji je naveden, može se direktno otvoriti u bazi lijekova te se pregledom lijeka mogu otvoriti svi tekstovi u kojima se spominje lijek. Dnevno hemed.hr koristi 6000 korisnika s tendencijom rasta. U budućnosti su planirana ažuriranja svih prijevoda najnovijim izdanjima, uz dodatno uvrštavanje i ostalih značajnih izdanja. Zaključno, HeMED je plod volonterskog rada oko 400 doktora medicine svih specijalnosti i svih dobnih skupina koji su vrijedno preveli oko 20.000 stranica medicinske literature kako bi pomogli svojim kolegama i pacijentima.

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Open Access
Educational Role of the Croatian Medical Chamber

Hrvatska liječnička komora brine za postizanje i održavanje stručne osposobljenosti liječnika prema standardima suvremene medicinske znanosti kroz originalne projekte koji su članovima lako dostupni i besplatni. U sklopu sufinanciranog projekta EU-a Kontinuirano stručno usavršavanje liječnika opće/obiteljske medicine tiskana su četiri priručnika te je izrađena edukacijska elektronička platforma na kojoj polaznici mogu pogledati stotinjak predavanja iz različitih područja medicine. Kroz projekt se provode i trodnevne praktične radionice na naprednim modelima i simulatorima za vježbanje kliničkih vještina i usavršavanje u snalaženju u hitnim medicinskim stanjima. Digitalna platforma e-Akademija pruža mogućnost pristupa stručnim edukacijama i stjecanja bodova potrebnih za relicenciranje. Kroz e-Akademiju pristupa se elektroničkoj medicinskoj nakladi, bazi lijekova, bazi medicinskih smjernica, razvoju vještina, brige o mentalnom i fizičkom zdravlju. HeMED je internetski portal i mobilna aplikacija koja liječnicima, studentima medicine, ostalim zdravstvenim djelatnicima, ali i svima zainteresiranima na hrvatskome jeziku, u digitalnom obliku, osigurava besplatan pristup najnovijim, kontinuirano ažuriranim, izdanjima kapitalnih medicinskih knjiga. Također omogućava interaktivno pretraživanje knjiga i baza lijekova. Kroz Tečaj osnova medicinskog prava Pravna služba i dužnosnici Komore upoznaju mlade liječnike s osnovnim pravnim aktima iz zdravstvenog zakonodavstva, uključujući i Kodeks medicinske etike i deontologije. Komora je autor i vlasnik Digitalnog atlasa hrvatskog liječništva, najopsežnije i najkompleksnije digitalne baze podataka o liječnicima u Hrvatskoj koja prikazuje brojne sociodemografske pokazatelje i podatke u realnom vremenu te se kontinuirano nadopunjava novim analizama i prikazima podataka. Glavna edukacijska svrha ovog projekta jest opremiti donositelje odluka u zdravstvenoj administraciji valjanim i točnim podatcima, neophodnima za uspješno upravljanje elementima zdravstvenog sustava.

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Open Access