Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia.

Viral hepatitis is a significant cause of morbidity and mortality worldwide. In Croatia, hepatitis B virus (HBV) and hepatitis C virus (HCV) are widely distributed, especially in some high-risk groups such as people who inject drugs (PWID), prisoners, and highly promiscuous groups. The seroprevalence of HBV ranges from 7.0% in the general population to 38.8% in PWID, depending on the region. The seroprevalence of HCV is highest among PWID (29-75.5%) as compared to 0.9% in the general population. Analyzing the distribution of HCV genotypes, no substantial changes in the molecular epidemiology of the two most frequent HCV genotypes (1 and 3) in the past 20 years were observed. However, the predominance of subtype 1b compared to subtype 1a as detected in 1996-2005 was not confirmed in 2008-2015. Hepatitis A virus (HAV) incidence was high in the past with a decreasing trend since the 2000s, except for an outbreak in 2017-2018 as part of the large European outbreak, which was mainly among men who have sex with men. Hepatitis E virus (HEV) is an emerging virus detected for the first time in Croatia in 2012. The seroprevalence of HEV is high among hemodialysis patients (27.9%) and liver transplant recipients (19.3-24.4%). In addition, higher seroprevalence rates were observed in animal-related professions (e.g., veterinarians, 15.2%; hunters, 14.9%). All detected HEV strains belonged to genotype 3.

Liver regeneration as treatment target for severe alcoholic hepatitis.

Severe alcoholic hepatitis (AH) is a distinct entity in the spectrum of alcohol-related liver disease, with limited treatment options and high mortality. Supportive medical care with corticosteroids in selected patients is the only currently available treatment option, often with poor outcomes. Based on the insights into the pathogenetic mechanisms of AH, which are mostly obtained from animal studies, several new treatment options are being explored. Studies have implicated impaired and deranged liver regeneration processes as one of the culprit mechanisms and a potential therapeutic target. Acknowledging evidence for the beneficial effects of granulocyte colony-stimulating factor (G-CSF) on liver regeneration and immunomodulation in animal models, several human studies investigated its role in the treatment of advanced alcohol-related liver disease and AH. Contrary to the previously published studies suggesting benefits of G-CSF in the outcomes of patients with severe AH, these effects were not confirmed by a recently published multicenter randomized trial, suggesting that other options should rather be pursued. Stem cell transplantation represents another option for improving liver regeneration, but evidence for its efficacy in patients with severe AH and advanced alcohol-related liver disease is still very scarce and unconvincing, with established lack of efficacy in patients with compensated cirrhosis. In this review, we summarize the current knowledge on the pathogenesis and experimental therapies targeting liver regeneration. The lack of high-quality studies and evidence is a major obstacle in further treatment development. New insights into the pathogenesis of not only liver injury, but also liver regeneration processes are mandatory for the development of new treatment options. A reliable experimental model of the pathogenesis of AH and processes involved in liver recovery is still missing, and data obtained from animal studies are essential for future research.

Impact of Covid-19 Pandemic on Undergraduate Medical Students: Lessons for the Future.

BACKGROUND: The implementation of public health measures is a key aspect of the fight against the pandemic. However, the current literature suggests that the effectiveness of measures is influenced by various factors, and these factors are most pronounced among young people. Finding the causes and reasons for non-compliance is essential for increasing the effectiveness of measures and reducing their negative effects. SUBJECTS AND METHODS: We evaluated the degree of non-comopliance with epidemiological measures and the reasons for such behaviour among students attending medical colleges at four universities in Croatia (Zagreb, Split, Osijek, Rijeka) in view of altered social, academic, mental, and economic conditions during the pandemic by using an anonymous online questionnaire with 36 Likert scale based questions which was distributed to students in Croatia in March of 2021. RESULTS: A total of 605 students filled out the questionnaire. Female students reported a higher negative impact of social distancing (3.24±1.08 vs 2.95±1.11; p=0.006) and were more concerned about getting infected with SARS-CoV-2 (2.81±1.06 vs. 2.46±0.94; p=0.0005) and about the health of their family and friends during the pandemic (3.83±1.09 vs. 3.50±1.04; p=0.0005). Simultaneously, they were more compliant with the mitigation measures (4.06±0.71 vs. 3.85±0.83; p=0.0413) and were more aware that irresponsible behaviour can place other people at risk. In contrast, male students considered COVID-19 more often as a threat affecting only the elderly (3.11±1.1 vs. 2.78±1.23; p=0.0036). While all students reported high responsibility levels, they did describe violating the measures at times they wanted to socialise. CONCULSIONS: Gender, working status, care for their health, and the health of loved ones were modifying factors for young people behaviour. Assessing social, economic, and health factors must be applied when tailoring public health policies during crisis management.

Superficial abdominal reflexes.

The superficial abdominal reflexes are often omitted from neurological examination, but their absence or asymmetry may support a lesion involving the thoracic spinal cord, especially in young, nulliparous and thin people.