CHANGE OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITOR IN THE TREATMENT OF WET FORM OF SENILE MACULAR DEGENERATION: META-ANALYSIS AND LITERATURE REVIEW

Cilj: Provesti sustavni pregled i meta-analizu znanstvenih radova koji su analizirali ishod liječenja u bolesnika s eksudativnom degeneracijom makule povezane s dobi nakon terapijskog prelaska s bevacizumaba / ranibizumaba na afl ibercept. Materijali i metode: Pretražene su proširene baze podataka Pubmed (Medline) i Science Citation Index u posljednjih 5 godina, uz kombinaciju ključnih riječi. Defi nirani su jasni kriteriji i istražene su najbolje korigirane oštrine vida, uz mjerenje središnje debljine makule pomoću koherencijske tomografi je očiju prije i nakon promjene lijeka. Rasprava: U nedavno objavljenim publikacijama koje su analizirale rezultate liječenja rezistentne senilne degeneracije makule konverzijom na afl ibercept objavljene su dvije meta-analize, sa sličnim kriterijima uključivanja, od kojih je najvažniji najmanje šestomjesečno praćenje bolesnika nakon terapijske konverzije. Prva meta-analiza uključivala je 7, a druga 28 studija, prospektivnih i retrospektivnih. Obje meta-analize pokazale su značajno poboljšanje središnje debljine makule nakon prelaska na afl ibercept, dok je poboljšanje oštrine vida u jednoj skromno, a u drugoj nepromijenjeno. Tako je promjena lijeka značajno poboljšala anatomski ishod; međutim, nije primijećeno značajno poboljšanje vidne funkcije. Razlog je kronicitet bolesti i posljedično oštećenje, što podrazumijeva ograničenu mogućnost za oporavak vida. Naša analiza pokazala je, slično rezultatima prethodno spomenutih meta-analiza, da se promjenom terapije može postići poboljšanje anatomske strukture makule. U završnici je u meta-analizu uključeno jedanaest od dvadeset studija koje su istraživale ishod konverzije jednog lijeka protiv vaskularnog endotelnog faktora rasta na drugi lijek. Rezultati su pokazali statistički značajno smanjenje debljine makule nakon konverzije na afl ibercept u svim studijama (ukupna razina značajnosti p <0,001). Zaključci: Provedena analiza pokazala je značajno poboljšan anatomski ishod, ali je skromno poboljšanje vida nađeno u samo nekoliko studija. Taj se rezultat vjerojatno može objasniti činjenicom da dugotrajna kronična bolest uzrokuje nepovratna oštećenja i sprečava značajan funkcionalni oporavak. Prospektivne studije s jednako definiranim ulaznim kriterijima omogućile bi bolju usporedbu rezultata liječenja dobivenih nakon promjene lijeka.The aim was to perform a systematic review and meta-analysis of scientifi c papers that analyzed treatment outcome in patients with exudative age-related macular degeneration after therapeutic switch from bevacizumab/ranibizumab to afl ibercept. Pubmed (Medline) and Science Citation Index expanded databases were searched over the last 5 years, with a combination of keywords. Clear criteria were defi ned, and evaluation of the best corrected visual acuity, with measurement of the central macular thickness by ocular coherence tomography before and after drug conversion was performed. Two meta-analyses have been published in recent literature analyzing studies with the results of treatment of resistant senile macular degeneration by conversion to afl ibercept, with somewhat similar inclusion criteria, the most important of which is the minimum six-month follow-up of patients after conversion therapy. The fi rst meta-analysis included 7 and the second 28 studies, prospective and retrospective. Both meta-analyses showed a signifi cant improvement in the central macular thickness after conversion to afl ibercept, while the improvement in visual acuity was very modest in one and unchanged in the other. Thus, a change in drug signifi cantly improved the anatomic outcome; however, no signifi cant improvement in visual function was observed. The reason is chronic illness and impairment, which implies a limited potential for vision recovery. Similar to the results of the previously mentioned meta-analyses, our analysis showed that improvement in the anatomic structure of the macula can be achieved by changing therapy. Finally, eleven of twenty studies that investigated the outcome of conversion from one anti-vascular endothelial growth factor drug to another were included in meta-analysis. The results showed a statistically signifi cant decrease in macular thickness after conversion to afl ibercept in all studies (overall signifi cance level p<0.001). The analysis performed showed a signifi cantly improved anatomic outcome, but visual improvement was found to be modest in only a few studies. This result could probably be explained by the fact that a longlasting chronic disease causes irreversible damage and prevents signifi cant functional recovery. Prospective studies with uniformly defi ned input criteria would allow better comparison of the results obtained after change in the treatment

ENDOMETRIOSIS, PAIN AND MENTAL HEALTH

Background: Endometriosis is a chronic and progressive disease which can significantly affect a woman\u27s personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. Subjects and methods: An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). Results: Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). Conclusions: This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease

Validation of the UDI-6 and the ICIQ-UI SF – Croatian version

Introduction and hypothesis: Despite the widespread use of UDI-6 and ICIQ-UI SF in Croatia, it remains unknown whether a reliable and valid measure for the population of interest is used. Thus, the aim of this study was to translate, adapt and validate the UDI-6 and the ICIQ-UI SF in Croatia. ----- Methods: The study included a total of 232 consecutive patients with urinary incontinence symptoms. The translation to Croatian followed standardized procedure. All participants underwent urodynamic assessment and completed UDI-6 and ICIQ-UI SF questionnaires at inclusion and 2 weeks after to assess test-retest reliability. Cronbach α coefficient was calculated in order to assess internal consistency. ----- Results: Both questionnaires had high internal consistency (Cronbach α for UDI-6 and ICIQ-UI SF was .83 and .85, respectively) and high test-retest reliability (intraclass correlation coefficient .99 for instruments). Strong correlation was found between urodynamic findings and total scores in UDI-6 and ICIQ-UI SF (ρ = 0.88 and 0.89, respectively). Women with stress urinary incontinence (SUI) and detrusor overactivity (DOA) group had significantly higher scores on UDI-6 (Mdn = 33.33 and Mdn = 50, respectively) compared to women with no urodynamic abnormality (Mdn = 0; p < 0.001). Women with no urodynamic abnormality scored significantly lower on ICIQ-UI SF (Mdn = 0; p < 0.001) compared to women with SUI (Mdn = 14) and DOA (Mdn = 16). Women with DOA scored worse on Irritative and Obstructive symptoms when comparing with two other groups (p < 0.001), while women with SUI had significantly worse score on Stress symptoms subscale (p < 0.001). ----- Conclusions: The UDI-6 and ICIQ-UI SF have very good psychometric characteristics and can be used in Croatian urogynecology practice

ANXIETY AND TREATMENT ADHERENCE AMONG GLAUCOMA PATIENTS DURING COVID-19 PANDEMIC AND EARTHQUAKES IN CROATIA

Background: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. Subjects and methods: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. Results: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). Conclusion: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies

Comparison of efficacy of extracorporeal magnetic innervation and Kegel exercises for stress urinary incontinence in adult women: study protocol for a randomized controlled trial

Stress urinary incontinence (SUI) is defined as a complaint of inadvertent loss of urine occurring as a result of an increase in intraabdominal pressure. Strong evidence supports the use of pelvic floor muscle training (PFMT) as the first-line conservative treatment for SUI. Extracorporeal magnetic stimulation (EMS) is a non-invasive, effective, acceptable, and safe therapeutic modality for SUI. Although PFMT and EMS share most of their influences on the pathophysiology of SUI, it is unclear whether one of these routinely used treatment modalities is superior to another in terms of improvement of clinical outcomes or cost-effectiveness. To the best of our knowledge, no randomized controlled trials have so far directly compared PFMT with EMS. Our aim here is to describe a protocol for such a study. This will be a parallel-group, single-blind, randomised controlled trial compliant with the SPIRIT, CONSORT, and TIDieR reporting guidelines. Participants will be women aged 18 to 65 years who have previously given at least one vaginal delivery (at least 12 months before joining the study) who present with symptoms of SUI lasting at least 6 months yet have not previously received treatment for it. In the first study arm, patients will receive an eight-week, high-intensity, home-based Kegel exercises regimen. In the second study arm, the treatment scheme will consist of 2 sessions of EMS per week for a total of eight weeks. The primary outcome will be effectiveness of treatment as measured by the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form overall score, eight weeks, three months, and six months after commencement of treatment

MATERNITY BLUES AMONG CROATIAN MOTHERS – A SINGLE-CENTER STUDY

Background: Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. Subjects and methods: A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein's Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan's Experiences in Close Relationship Scale, as well as demographic and obstetric data. Results: The prevalence of maternity blues in our study was 19.9%. Higher result on Stein's Maternity Blues Scale was associated with anxious attachment style (r=0.425, p&lt;0.01), oxytocin (r=0.308, p&lt;0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p&lt;0.01). Conclusions: This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population

MATERNITY BLUES AMONG CROATIAN MOTHERS – A SINGLE-CENTER STUDY

Background: Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. Subjects and methods: A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein\u27s Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan\u27s Experiences in Close Relationship Scale, as well as demographic and obstetric data. Results: The prevalence of maternity blues in our study was 19.9%. Higher result on Stein\u27s Maternity Blues Scale was associated with anxious attachment style (r=0.425, p<0.01), oxytocin (r=0.308, p<0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p<0.01). Conclusions: This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population