Effect of care transfer model led by the hospital clinical pharmacist on reduction of hospital readmissions in the elderly.

Transfer of care is a critical point for patient safety and requires an optimal care transfer model in order to ensure safe pharmacotherapy transfer. Polypharmacy among elderly is associated with adverse health consequences such as hospital readmissions. Hospital readmissions represent priorities in health care research and are one of the measures for assessing patient safety. Medication-related problems among elderly are associated with polypharmacy. The aim of the study was to show the impact of a developed model of care transfer led by a hospital clinical pharmacist on the number of hospital readmissions in the 12-months period in the elderly. A randomized controlled study of patients aged 65 or more was conducted at Dubrava University Hospital, Community Health Centre Zagreb - East and community pharmacies in the City of Zagreb and Zagreb County, Croatia. An intervention group received specially designed care transfer led by the hospital clinical pharmacist. Model included high-intensity pharmacotherapy interventions delivered at admission, during hospital stay and discharge, transition to primary care and post-discharge and cooperation between all healthcare professionals. In all, 182 patients in the intervention and 171 in the control group were analysed. The total number of hospital readmissions and emergency readmissions, within one year from the hospital discharge, was lower in the intervention group than in the control group (41.7% vs. 58.3%, p=0.005; 40.8% vs. 59.2%, p=0.008). The model of the health care transfer applied in this research thus significantly reduced hospital readmissions in the 1-year period in elderly patients. Therefore, the hospital clinical pharmacists should design and coordinate the transfer between hospital and primary care.

Pain associated with psoriasis: a qualitative study.

BACKGROUND: Pain is a major factor in the psychosocial impact of psoriasis. There is a paucity of qualitative reports of dermatologists' views on psoriasis-related pain. OBJECTIVES: The aim of this study was to explore the views of dermatologists on the presence and importance of pain associated with psoriasis. METHODS: This qualitative study, based on semi-structured interviews, included dermatologists from different cities working in the hospital and private sector in Croatia between May and July, 2022. We collected demographic and occupational data on participants and information about their experiences and attitudes toward psoriasis-related pain. Data were analysed by applying interpretative descriptive and thematic analysis using the 4-stage method for systematic text condensation. RESULTS: We included 19 dermatologists, all women, aged 38 (range: 31 to 63 years). Most dermatologists acknowledged the presence of pain in patients with psoriasis. They indicated that they sometimes do not sufficiently address this pain in daily practice. Some indicated that pain was a neglected symptom in psoriasis, while for others it was not crucial. Most indicated that it is necessary to focus more on psoriasis-related pain in clinical practice, to disambiguate between skin pain and joint pain in psoriatic conditions, and to better educate family physicians about psoriasis-related pain. They emphasized the importance of considering pain during psoriatic patient assessment and management. Further research on psoriasis-related pain was suggested. CONCLUSIONS: More emphasis is needed on psoriasis-related pain for effective management of psoriasis, informing decision-making in the context of patient-centric care and improving the quality of life in patients with psoriasis.

Assessment of Electromagnetic Field Exposure on European Roads: A Comprehensive In Situ Measurement Campaign.

The rapid evolution of wireless communication technologies (such as fifth-generation (5G) cellular networks) in the last years has allowed connecting different objects (from wearable electronics to vehicles) and people through communication networks, and at the same time, has led to widespread deployment of base stations. Along with this growth, questions about the potential adverse effects on human health due to electromagnetic fields (EMFs) from base station antennas have also been raised. In this paper, we focus on the assessment of EMFs in automobiles during short (between cities) and long (between countries) trips on several European roads. Comprehensive measurement campaigns were carried out in several European countries: Austria, Bulgaria, Croatia, Hungary, Italy, Slovenia, and the Republic of Serbia. The results show that the median total electric field is 0.23-0.24 V/m in Bulgaria, Croatia, Hungary, Italy, and the Republic of Serbia. In Austria and Slovenia, the median is 0.28-0.31 V/m. Austria demonstrated the highest value for the total electric field, at 17.4 V/m.

Undiagnosed hypertension in Croatia.

AIM: To determine the prevalence of undiagnosed hypertension in Croatia, and to assess its association with various demographic, socioeconomic, lifestyle, and health care usage factors. METHODS: We used the data from European Health Interview Survey wave 3, conducted in Croatia in 2019. The representative sample consisted of 5461 individuals aged 15 years and older. The association of undiagnosed hypertension with various factors was assessed with simple and multiple logistic regression models. The factors that contribute to undiagnosed hypertension were identified by comparing undiagnosed hypertension with normotension in the first model and with diagnosed hypertension in the second model. RESULTS: In the multiple logistic regression model, women and older age groups had lower adjusted odds ratio (OR) for undiagnosed hypertension than men and the youngest age group. Respondents living in the Adriatic region had a higher adjusted OR for undiagnosed hypertension than those living in the Continental region. Respondents who did not consult their family doctor in the previous 12 months and those who did not have their blood pressure measured by a health professional in the previous 12 months had a higher adjusted OR for undiagnosed hypertension. CONCLUSION: Undiagnosed hypertension was significantly associated with male sex, age from 35 to 74, overweight, lack of consultation with a family doctor, and living in the Adriatic region. The results of this study should be used to inform preventive public health measures and activities.

Study of health information needs among adolescents in Croatia shows distinct gender differences in information seeking behaviour.

BACKGROUND: Understanding the health information needs of adolescents is the first step towards providing them with relevant information to aid them in their decision making regarding health issues. OBJECTIVE: The goal of this study is to assess adolescents' needs, perceptions and sources of health information. METHODS: Four hundred sixty-nine high school students in Osijek, Croatia, participated in this study by answering a questionnaire. The collected data were analysed using basic frequency and non-parametric statistical methods. RESULTS: The most popular health topics identified by adolescents in our study were nutrition, diseases, depression, relationships, sexual intercourse and alcohol. Adolescents consider their parents the most reliable personal source of health information (72.0%), while they perceive the Internet as the main non-personal source of health information (29.8%). Adolescents wish to get more education about health issues at school (54.4%). Significant gender differences were found in adolescents' needs, perceptions and sources of health information. CONCLUSIONS: It is important to provide adolescents with systematic institutional health education and improve health advisory services and library/information services to assist adolescents in locating health information and resolving their health related questions.

What Contributes to Public Stigma Towards Problem Gambling?: A Comparative Analysis of University Students in Australia, Canada, Croatia and Israel.

Stigma refers to the attribution of negative sentiments towards a particular entity, object or individual. Stigma can be public, perceived, or self-referential and can have negative consequences for individuals, including losses of self-esteem, self-efficacy, social isolation and a reluctance to seek help. Problem gambling is known to be a stigmatized activity, but less is known about what factors are associated with this perception and how it might vary in different countries. The current study examines the relationship between perceived stigma towards problem gamblers and gambling attitudes. perceptions of gambling regulations, gambling involvement, perceived accessibility to gambling, and exposure to people with gambling problems. The sample comprised 1787 university students aged 18-30 years from four countries: Australia, Canada, Croatia and Israel. The results indicated that greater perceived stigma was associated with more negative gambling attitudes, less engagement with gambling, and lower perceived social accessibility (the perception that others approve of the activity). Respondents from Croatia, the country with a newer gambling market, reported the most stigma towards problem gamblers as compared with Australia and Canada where gambling is longer established. The findings appear consistent with exposure-adaptation theory, in which tolerance towards people with problem gambling can develop over time in line with greater social acceptance or familiarity with the activity and its consequences. It is suggested that community campaigns and educational programs draw a distinction between attitudes towards gambling in general and those who are negatively affected by the activity.

How effective is a brief educational intervention on prescribing first-line antibiotics in acute cystitis? A quasi-experimental study among general practitioners in Croatia.

AIM: To assess the effectiveness of a brief educational intervention on prescribing first-line antibiotics in acute cystitis. METHODS: This quasi-experimental before-after study was conducted over a period of eight months. We collected prescribing data related to urinary tract infections four months before the educational intervention and four months after it. Aggregate data on office visits, diagnoses, and issued prescriptions were collected from each practice's electronic medical records based on monthly reports. RESULTS: Overall, 3581 prescriptions were issued: 1717 before and 1864 after the intervention. The total number of prescriptions increased by 8.5%. The use of first-line antibiotics increased by 21.2%, the use of fluoroquinolones decreased by 6.6%, while the use of beta-lactams remained unchanged. After the intervention, nitrofurantoin was the most prescribed first-line antibiotic. The proportion of women who were prescribed first-line antibiotic did not reach the acceptable range (80%-100%) according to the European Surveillance of Antimicrobial Consumption quality indicators. The proportion of fluoroquinolones (17.9%) use was well above the acceptable range (0%-5%). CONCLUSION: A brief educational intervention proved to be a useful method in adopting better prescribing habits. Of particular importance is the considerable increase in the use of nitrofurantoin due to its reliable efficacy against multidrug-resistant urinary pathogens.

FAMILY PHYSICIAN OPINIONS ON ELECTRONIC TOOLS AND CARDIOVASCULAR DISEASE PREVENTION GUIDELINE AVAILABILITY, USAGE AND ADHERENCE IN CROATIA.

Family physicians are burdened with a great number of guidelines considering different conditions they treat. We analyzed opinions of family physicians on electronic tools which help managing chronic conditions and their influence on patient care by cardiovascular disease (CVD) prevention guideline availability, usage and adherence. A descriptive study was performed on a convenient sample of 417 (response rate 56.0%) Croatian family physicians. Data on physician characteristics and availability, usage and adherence to CVD prevention guidelines were analyzed. The χ2-test was used for comparisons. Significance was defined as p<0.05. Family physicians who used additional electronic tools in Electronic Health Record software on more than 80% of their patients had CVD prevention guidelines more available (p<0.01) and used them more frequently (p<0.01). A group who used electronic tools on more than 80% of their patients had CVD prevention guidelines available to them frequently and used them on more than 60% of their patients, also strictly adhering to the guidelines (p<0.01). Physicians who used CVD prevention guidelines on more than 60% of their patients spent more time doing patient education (p=0.036). Using electronic tools helps Croatian family physicians in terms of availability, usage and adherence to the guidelines and quality improvement.

Consumption of high-dose statins in patients older than 65 years in the Republic of Croatia in the period 2005 - 2015.

OBJECTIVE: Patients over 65 years of age on high-dose statins are most sensitive to the development of adverse effects of statins. The objective of this study is to analyze the consumption of high-dose statins in this patient group in Croatia in the period of 2005 - 2015. MATERIALS AND METHODS: For the period of January 1, 2005 to December 31, 2015, the Croatian Institute for Health Insurance provided us with the total number of: all insured, insured over 65 years of age, insured using statins, insured using high-dose statins, insured over 65 using statins, insured over 65 using high-dose statins, number of packages dispensed through all community pharmacies for all statins registered in Croatia divided by year and sex. Studied high-dose statins were: simvastatin 40 mg; atorvastatin 40 mg, 60 mg, 80 mg; fluvastatin 80 mg; rosuvastatin 40 mg. The yearly consumption of each form of statin was calculated in DDD/1,000 insured/day and was statistically processed. RESULTS: The consumption of all statins increased by 194%, while the consumption of high-dose statins in patients over 65 increased by 296%. The number of all patients on statin therapy increased by 58%, the number of patients over 65 on statin therapy increased by 87%, and the number of patients over 65 on high-dose statins increased by 326%. 60% of all patients over 65 receiving high-dose statins were women. The most used high-dose statins were atorvastatin and simvastatin. CONCLUSION: Consumption of all statins increased, mostly high-dose statins in the 65+ age group, the most sensitive population for adverse effects. The number of 65+ patients on high-dose statins grew much faster than the general statin user group, thus increasing the risk potential. Women are dominating all age and dose groups of statin users.

The role of the European Union in health policies of member states - an example of the rare diseases policy in Croatia.

AIM: To assess the European Union's (EU) impact on the Croatian health policy, and identify which mechanisms and processes were used to shape a particular health policy on the EU and national levels. The study focused on the rare diseases policy to obtain a better insight into the process of policy shaping, starting at the EU level and moving down to the Croatian national level. METHODS: We conducted actor analysis, policy networks, and semi-structured qualitative interviews with key policy actors at the EU and domestic level. The analysis of actors included actor mapping, the analysis of their relationships, and of their interdependence. Policy networks involved identifying key actors and analyzing them separately to create both policy networks to explain their hierarchy and relationships. Semi-structured interviews included ten key experts at the EU and national health policy levels. RESULTS: The implementation of the EU health policy is complex. Hard and soft law were complementary in the way they affected the translation of EU rare diseases policy into Croatian law. Strong and interconnected EU and domestic actors were significant in this process, which resulted in the creation of Croatia's rare diseases policy. CONCLUSION: Given that the rare diseases policy area is a developing policy area, this study contributes to a better understanding of the implementation of the EU health policy, clarifying a mechanism that can enable national governments to adopt specific health policies.

CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE.

Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.

The effect of a combined intervention on exclusive breastfeeding in primiparas: A randomised controlled trial.

An antenatal/postnatal intervention involving proactive telephone support and written materials was conducted among primiparas. Four hundred women, from the Split-Dalmatia County, Croatia, were randomized between November 2013 and December 2016 into three groups: intervention (IG), active control (ACG) and standard care (SCG). Primary outcome was exclusive breastfeeding (EBF) at 3 months. Secondary outcomes included breastfeeding difficulties, attitudes towards infant feeding, breastfeeding self-efficacy and social support. Practice staff were blinded to group allocation. Of 400 women, 45 (11%) were lost to follow-up, and final analyses were conducted on 129 (IG), 103 (ACG) and 123 (SCG) participants. EBF rates at 3 months were significantly higher for the IG (odds ratio [OR] 4.6, 95% confidence interval [CI], 2.7 to 8.1; EBF 81%) as well as at 6 months (OR 15.7, 95% CI, 9.1 to 27.1; EBF 64%) compared with SCG (EBF 47% at 3 months and 3% at 6 months). Higher rates were also observed for the ACG at 3 months (OR 2.2, 95% CI, 1.3 to 3.8, EBF 68%) and 6 months (OR 2.3, 95% CI, 1.4 to 3.9, EBF 16%). Participants in the IG had the highest increase in positive attitudes towards infant feeding, in comparison to baseline, and significantly higher breastfeeding self-efficacy. Participants in SCG experienced significantly more breastfeeding difficulties, both at 3 and 6 months, in comparison to AC and IGs. Written breastfeeding materials and proactive telephone support among primiparas are an effective means of increasing breastfeeding rates, decreasing breastfeeding difficulties and improving self-efficacy and attitudes towards infant feeding.

A cross-cultural qualitative study of the ethical aspects in the transition from child mental health services to adult mental health services.

BACKGROUND: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) raises novel ethical aspects for healthcare professionals, as well as for young people, their parents and carers. METHOD: Focus groups were conducted in Croatia, Ireland and the United Kingdom with youth mental health groups and youth representatives with no mental health (MH) remit. One hundred and eleven participants, aged from 16 to 60 years, contributed to discussions. RESULTS: Perpetuation of stigma, autonomy and decision-making were central themes as both enablers and deterrents of successful transition. The tension between professional (and at times parental) paternalism and young persons' growing autonomy was well captured in the themes; (a) desired practice, (b) who should decide, (c) the process of decision-making and (d) potential harm(s). CONCLUSIONS: This study provides insight into the ethical values, particularly autonomy and collaboratively working, which people expect to underpin the transition between CAMHS and AMHS. KEY PRACTITIONER MESSAGE: Engaging young people early in making decisions about their future care can enhance trust between practitioner and the young person. In addition to diagnosis, a number of factors (such as moving home; waiting lists and stigma) may need to be taken into account when considering the direction of future health care. When possible, alternatives to AMHS should be considered if considered by the young person to be a less-stigmatising treatment option.

THE ROLE OF JOHN THE BAPTIST LALANGUE IN THE DEVELOPMENT OF CROATIAN PUBLIC HEALTH AND MIDWIFERY IN THE CONTEXT OF IMPLEMENTATION OF THE IMPERIAL PUBLIC HEALTH LAW FROM 1770.

To understand the development of public health in Croatia, there are newer insights into the life and work of John the Baptist Lalangue. John the Baptist Lalangue is most valued for implementation of the imperial law on public health and promotion of midwifery in Croatia during the second half of the 18th century. Lalangue is the author of the first printed medical textbook in Croatian, published in 1776, entitled Medicina ruralis iliti Vrachtva ladanyszka, za potrebochu musev, y sziromakov Horvatczkoga orszaga y okolu nyega, blisnesseh mest, Trattnern, Varazdin. In the same period, Lalangue published the first Croatian midwifery textbook entitled Brevis institute de reobstetritia iliti kratek navuk od mestrie pupkorezne za potrebochu muskeh y sziromaskeh ladanovskaya horvatskoga orszaga y okolo nyega blisnesseh sztrankih, Trattnern, Zagreb. In 1779, Lalangue published his balneological debut in Croatian, the book Tractatus de aquis medicati Regnorum Croatiae et Slavoniae Iliti Izpiszavanye vrachtvenih vod Horvatzkoga y Slavonskoga orszaga y od nachina nye vsivati za potrebochu lyudih, Trattnern, Zagreb. Lalangue's works were used in systematic training and education of midwives and they, as well as Lalangue, have an inevitable place in the history of Croatian midwifery. During his life and work, John the Baptist Lalangue made immeasurable contribution to the development of Croatian public health.

Through health workers' eyes: a qualitative study of health service provision for migrants at Schengen border.

BACKGROUND: Croatia and Slovenia were the transit countries on the Balkan route for migrants and refugees from Middle East countries in 2015 and 2016. They had to optimize health care delivery in the special circumstances in refugee camps and transit centres. Little is known about health care provision in border camps where a large number of migrants stay for only couple of hours. Previous studies emphasize that language barriers and cultural differences play a central part in the relationship between health workers and migrants inside the transit zone. The aim of the study was to identify specific characteristics of health care provision experienced by primary healthcare providers in order to prepare solutions on how to organise health care in refugee settings. METHODS: Twelve thematic interviews were conducted in the middle of the most intense migration movements to the North-West Europe between November and December 2015 with health workers from Croatia and Slovenia. Interview transcripts were read, coded, reviewed, and labelled. We used qualitative content analysis. RESULTS: Four themes about the health service provision for refugees at Schengen border were identified. The circumstance when mutual understanding is poor and the consultation not successful, cultural differences represent a central barrier. Participants highlighted that the importance of respecting human dignity is crucial for the provision of basic medical care for migrants in transit. CONCLUSION: Successful overcoming language barriers, respecting cultural differences, humanity, susceptibility to social deprivation and traumatic experiences are the key factors important for organisation of health care in transit centers and camps. This article gives some useful tips for healthcare workers and policy makers who are participating in health services provision for migrants and other refugees. Health workers should be prepared to work in special working conditions with a lack of resources. Their work would require timely planning and reflection on the organization of more transit camps. TRIAL REGISTRATION: Ethical Committee of the Republic of Slovenia approved the study as a project number 112/02/16.

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia.

BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.

RECOVERY OF MEMORY AFTER CEREBRAL ARTERY ANEURYSM SURGERY.

The principal study objective was to define whether memory deficits (numerical, working, verbal-mechanical, verbal-logical and visual memory) occurred in patients submitted to surgery for brain artery aneurysm and whether significant recovery of memory took place with time. The study sample included 92 patients, i.e. 35 (38%) male and 57 (62%) female patients aged 27 to 76 years. Neuropsychological testing was conducted at Zagreb University Hospital Centre, Department of Neurosurgery, from 1998 to 2012, in two time intervals: first within 11 months following surgery, and then 12 to 48 months after surgery. The obtained results showed that verbal-mechanical, verbal-logical, and visual memory deficits were present in the first testing interval. In the second testing, the verbal-logical and visual memory deficits were still present, while the tests of verbal-mechanical memory showed deficits in capacity and learning curve, but the results for short- and long-term memory were within the normal ranges. Neither the first nor the second testing showed deficits of numerical and working memory. Based on our results, we can conclude that long-term verbal-mechanical and visual short- and long-term memory had recovered to a statistically significant level, whereas other types of memory showed no significant recovery.

RECURRENT ATYPICAL OPTIC NEURITIS AS THE LEADING SIGN OF FABRY DISEASE.

Acute optic neuritis has the age and sex adjusted incidence of 1-5/100,000 in general population. It is mostly a disorder affecting young Caucasian women (31-32 years). Patients present to a wide range of clinicians including general practitioner, emergency physician, ophthalmologist, neurologist, etc. There are two main clinical presentations of optic neuritis, typical and atypical. It is of great importance to distinguish these two types of optic neuritis in order to detect the underlying etiology and plan appropriate and timely treatment. We present a young female patient (36 years) admitted to Department of Ophthalmology due to visual loss on the left eye. Magnetic resonance imaging showed demyelinating lesions in frontal and parietal lobe, periventricularly, in mesencephalon and right cerebellar hemisphere, and left optic neuritis; magnetic resonance angiography was normal. The patient's history revealed renal dysfunction, hypothyroidism, and miscarriage in the 6th month of pregnancy due to eclampsia, and Fabry disease in family (mother and two sisters). She was transferred to the Department of Neurology for further evaluation of the demyelinating disorder of the central nervous system. The patient received corticosteroid therapy (methylprednisolone 1 g) for 5 days with regression of visual disturbances on the left eye. After this acute treatment, the question of definitive diagnosis remained, along with further treatment of the underlying cause. Considering renal dysfunction, miscarriage, arterial hypertension, positive genetic and biochemical testing for Fabry disease in close relatives (mother), we suspected that she also had Fabry disease. She was tested and the results were positive. We concluded that optic neuritis was the first sign of Fabry disease in this case, reflecting acute atypical neuroinflammatory disease.

TREATMENT OF UNICAMERAL BONE CYSTS IN CHILDREN: A COMPARATIVE STUDY.

Unicameral bone cysts (UBC) are benign bone tumor-like lesions. Mostly they are located in the metaphyseal-diaphyseal region of long bones in children and adolescents. The etiology of UBC is still unclear. There is no consensus about the protocol of UBC treatment. The aim of this study was to evaluate the effectiveness of three different techniques for the treatment of UBC. This study included 129 pediatric patients with UBC treated at University Children's Hospital in Belgrade during the 8-year period. The mean follow up was 7.14 years. The following parameters were observed: gender, age, site, length of cyst, cyst index, cortical thickness, presentation of pathologic fracture, healing of cyst, treatment complications and length of hospitalization. These parameters were correlated to three treatment modalities, i.e. intracystic methylprednisolone acetate injection (group 1), curettage with bone grafting (group 2) and osteoinductive procedure using demineralized bone matrix (group 3). We found statistically significant differences in healing of the cysts and length of hospital treatment between groups 1 and 2, and between groups 2 and 3. In conclusion, complete healing of UBC can be achieved only using open surgery procedure. Intracystic methylprednisolone acetate instillation can be considered a good option for initial treatment of UBC.