ULTRASOUND EVALUTATION OF CERVIX LENGTH BY TRANSPERINEAL AND TRANSVAGINAL ROUTE IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY

SAŽETAK. Cilj ovog istraživanja je ocijeniti mogućnosti primjene transperinealnog ultrazvuka u mjerenju duljine vrata maternice i ocjena izgleda unutarnjeg ušća te usporediti vrijednosti dobivene transperinealnim i transvaginalnim pristupom. Metode. U ispitivanje je uključeno 100 ispitanica s jednoplodnom trudnoćom koje u anamnezi nisu imale cervikalnu insuficijenciju, prijevremeno prsnuće ovoja ili prijevremeni porod. Podatke o duljini cerviksa dobili smo transperinealnim i transvaginalnim ultrazvučnim pregledom. Rezultati. Transperinealnim je ultrazvukom izmjerena prosječna duljina cerviksa od 37,41 mm, s 95-postotnim intervalima pouzdanosti (IP) 35,89 i 38,93 mm i standardnom devijacijom (SD) 7,66. Transvaginalnim ultrazvukom je dobivena srednja vrijednost 37,80 mm, intervali pouzdanosti od 36,34 i 39,26 mm i standardna devijacija 7,35 mm. Statističkom usporedbom spomenutih rezultata Studentovim t-testom dobili smo vrijednost p od 0,681 što je iznad granične vrijednosti p od 0,05, između ova dva pristupa ne postoje statistički značajne razlike u određivanju duljine cerviksa. Zaključak. Transperinealna ultrasonografija je usporediva s transvaginalnom u mjerenju duljine cerviksa u drugom i trećem trimestru te nudi prihvatljivu alternativu za mjerenje duljine cerviksa u ispitanica koje se protive transvaginalnom pregledu, a prihvatljiva je i u situacijama u kojima treba minimalizirati učestalost transvaginalnog pregleda kao što su prijevremeno prsnuće ovoja ili vaginalno krvarenje nepoznata uzroka.Objective. Our primary objective was to evaluate efficacy of transperineal ultrasound in assessment of cervical length in second and third trimester of pregnancy. Additionally, we wanted to compare transperineal and endovaginal approach for this purpose. Methods. One hundred patients with singleton pregnancy and without cervical insufficiency, premature membrane rupture or preterm birth in previous pregnancies were examined. Cervical length has been assessed by both transperineal and endovaginal ultrasound examination. Results. By using a transperineal approach, we measured an average cervical length of 37,41 mm, with 95-percent confidence intervals (CI) of 35,89 and 38,93 mm and standard deviation (SD) of 7,66 mm. In comparison, an endovaginal cervical measurement produced average cervix length of 37,80 mm, (CIs were 36,34 and 39,26 mm and SD was 7,35 mm). Statistical testing by Student’s t-test resulted in p-value of 0,681, thus marking results as being statistically non significantly different. Conclusion. Transperineal ultrasono¬graphic imaging of the cervix is comparable to endovaginal measurement in second and third trimester and is satisfactory alternative to an endovaginal assessment especially in patients that object to endovaginal exam. This approach is especially useful when endovaginal assessment should be avoided as in premature membrane rupture or vaginal bleeding of unknown cause

ULTRASOUND EVALUTATION OF CERVIX LENGTH BY TRANSPERINEAL AND TRANSVAGINAL ROUTE IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY

SAŽETAK. Cilj ovog istraživanja je ocijeniti mogućnosti primjene transperinealnog ultrazvuka u mjerenju duljine vrata maternice i ocjena izgleda unutarnjeg ušća te usporediti vrijednosti dobivene transperinealnim i transvaginalnim pristupom. Metode. U ispitivanje je uključeno 100 ispitanica s jednoplodnom trudnoćom koje u anamnezi nisu imale cervikalnu insuficijenciju, prijevremeno prsnuće ovoja ili prijevremeni porod. Podatke o duljini cerviksa dobili smo transperinealnim i transvaginalnim ultrazvučnim pregledom. Rezultati. Transperinealnim je ultrazvukom izmjerena prosječna duljina cerviksa od 37,41 mm, s 95-postotnim intervalima pouzdanosti (IP) 35,89 i 38,93 mm i standardnom devijacijom (SD) 7,66. Transvaginalnim ultrazvukom je dobivena srednja vrijednost 37,80 mm, intervali pouzdanosti od 36,34 i 39,26 mm i standardna devijacija 7,35 mm. Statističkom usporedbom spomenutih rezultata Studentovim t-testom dobili smo vrijednost p od 0,681 što je iznad granične vrijednosti p od 0,05, između ova dva pristupa ne postoje statistički značajne razlike u određivanju duljine cerviksa. Zaključak. Transperinealna ultrasonografija je usporediva s transvaginalnom u mjerenju duljine cerviksa u drugom i trećem trimestru te nudi prihvatljivu alternativu za mjerenje duljine cerviksa u ispitanica koje se protive transvaginalnom pregledu, a prihvatljiva je i u situacijama u kojima treba minimalizirati učestalost transvaginalnog pregleda kao što su prijevremeno prsnuće ovoja ili vaginalno krvarenje nepoznata uzroka.Objective. Our primary objective was to evaluate efficacy of transperineal ultrasound in assessment of cervical length in second and third trimester of pregnancy. Additionally, we wanted to compare transperineal and endovaginal approach for this purpose. Methods. One hundred patients with singleton pregnancy and without cervical insufficiency, premature membrane rupture or preterm birth in previous pregnancies were examined. Cervical length has been assessed by both transperineal and endovaginal ultrasound examination. Results. By using a transperineal approach, we measured an average cervical length of 37,41 mm, with 95-percent confidence intervals (CI) of 35,89 and 38,93 mm and standard deviation (SD) of 7,66 mm. In comparison, an endovaginal cervical measurement produced average cervix length of 37,80 mm, (CIs were 36,34 and 39,26 mm and SD was 7,35 mm). Statistical testing by Student’s t-test resulted in p-value of 0,681, thus marking results as being statistically non significantly different. Conclusion. Transperineal ultrasono¬graphic imaging of the cervix is comparable to endovaginal measurement in second and third trimester and is satisfactory alternative to an endovaginal assessment especially in patients that object to endovaginal exam. This approach is especially useful when endovaginal assessment should be avoided as in premature membrane rupture or vaginal bleeding of unknown cause

DAVYDOV’S LAPAROSCOPY ASSISTED NEOVAGINOPLASTY

U radu su prikazana tri bolesnice s Mayer – von Rokitansky-Küster-Hauserovim sindromom koje su nakon obrade operirane laparoskopski asistiranom metodom neovaginoplastike po Davydovu. U sva tri slučaja postoperacijski tijek je bio uredan, uz zadovoljavajući kozmetski učinak, funkcionalnost pri kohabitaciji i zadovoljstvo u seksualnosti oba partnera, što i jesu glavni ciljevi stvaranja neovagine.Presentation is made of three cases of the Mayer-von Rokitansky-Küster-Hauser syndrome, operated after complete work-up by the laparoscopy assisted method of neovaginoplasty according to Davydov. In all three cases, the postoperative course was uneventful, with satisfactory cosmetic effect, functional cohabitation and sexual satisfaction in both partners, as the main goals of neovagina creation

A REPORT OF SEVERE OVARIAN HYPERSTIMULATION SYNDROME CASE IN THE ASSISTED REPRODUCTION PROCEDURE

Prikazana je primarno neplodna pacijentica s dijagnosticiranim sindromom policističnih jajnika, koja je u postupku potpomognute oplodnje stimulirana GnRh agonistom i gonadotropinima, te koja je razvila teški oblik sindroma hiperstimulacije jajnika. Stanje pacijentice se dodatno pogoršalo nakon što je nastupila trudnoća. Na odjelu intenzivne njege provela je 21 dan, u bolnici ukupno 55 dana. Trudnoća je završila porodom zdravog djeteta carskim rezom u 38. tjednu trudnoće.We present a case of a primary infertile patient with diagnosed polycystic ovary syndrome, who in an assisted reproduction procedure was stimulated with GnRh agonists and gonadotropins, and who subsequently developed a severe ovarian hyperstimulation syndrome. The patient’s condition was further worsened after the pregnancy was confirmed. She spent 21 day at the intensive care unit and 55 days in the hospital. The pregnancy resulted in the birth of the healthy child, delivered by caesarean section at 38th week of pregnancy

CONSERVATIVE TREATMENT OF CERVICAL PREGNANCY Review and case report

Cervikalna trudnoća je najrjeđi, ali i najopasniji oblik ektopične trudnoće. U prošlosti se cervikalna trudnoća liječila kirurškim metodama koje su često završavale histerektomijom. Danas se u terapiji cervikalne trudnoće primjenjuju konzervativne medikamentozne metode. Najčešće korišten lijek je metotreksat. Prikazana je 33-godišnja nulipara koja je primljena u Kliniku zbog klinički i ultrazvučno dijagnosticirane cervikalne trudnoće u 6. tjednu amenoreje. Unutar cerviksa nađen je embrionalni odjek od 4 mm, s pozitivnom srčanom akcijom, a betahCG bio je 9970 IU/L. Započeta je terapija metotreksatom 75 mg iv u infuziji na koju se nadovezala terapija Leukovorinom. Ista terapija je ponavljana 8. i 17. dan. Nakon prve doze betahCG je porastao na 12650 IU/L i potom je kontinuirano padao do 33. dana kada je bio 52,6 IU/L. Pacijentica je 36. dan otpuštena iz bolnice, dva tjedna kasnije je klinički i ultrazvučni nalaz uredan, a betahCG negativiziran.Cervical pregnancy is a rare but very dangerous site of ectopic pregnancy. In the past cervical pregnancy was treated by various surgical methods that often ended with hysterectomy. Today cervical pregnancy is treated conservatively, mainly with local or systemic application of methotrexate. We present a case of 33 years old nullipara who was admitted to our department with clinical and ultrasonographic finding of cervical pregnancy in 6 weeks of gestation. Inside the cervix we found the gestational sac with the embryonic echo 4 mm with positive heart beats. The betaHCG level was 9970 IU/L and we started with administration of methotrexate, 75 mg iv in infusion followed by Leucovorin. The same therapy was given on Day 8 and Day 17. After the first dose of methotrexate betaHCG was higher (12650 IU/L) followed by a continious drop until Day 33 when was 52,6 IU/L. The patient was discharged from the hospital on day 36 and two weeks thereafter had normal clinical and ultrasonographic findings and negative betaHCG

Spontana heterotopična, ektopična cervikalna i ektopična tubarna trudnoća - uvijek prisutna dijagnostička poteškoća: prikaz triju slučajeva

The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.Incidencija heterotopičnih/ektopičnih trudnoća se u posljednje vrijeme povećava između ostalog i zbog sve veće upotrebe metoda pomognute oplodnje, ali ovi slučajevi, a naročito cervikalna trudnoća, iznimno su rijetki u spontanim zanošenjima. Prikazujemo tri bolesnice koje su se javile u našu Kliniku u tjedan dana: bolesnica sa spontanom heterotopičnom trudnoćom, druga s cervikalnom i treća s tubarnom trudnoćom. Sve su spontano zanijele, pravodobno dijagnosticirane i izliječene, ali naglašavamo da je osobita pozornost potrebna u dijagnozi i liječenju potencijalno fatalnih posljedica izvanmaterničnih trudnoća ako nisu prepoznate i liječene dovoljno rano, unatoč tako iznimno rijetkoj pojavnosti

Smjernice za reanimaciju Europskog vijeća za reanimatologiju 2015. godine [European resuscitation council guidelines for resuscitation 2015]

Adult basic life support and automated external defibrillation – Interactions between the emergency medical dispatcher, the bystander who provides CPR and the timely deployment of an AED is critical. All CPR providers should perform chest compressions, those who are trained and able should combine chest compressions and rescue breaths in the ratio 30:2. Defibrillation within 3–5 min of collapse can produce survival rates as high as 50–70%. Adult advanced life support – Continued emphasis on minimally interrupted high-quality chest compressions, paused briefly only to enable specific interventions, including interruptions for less than 5 s to attempt defibrillation. Use of self-adhesive pads for defibrillation. Waveform capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide an early indication of return of spontaneous circulation. Cardiac arrest in special circumstances – Special causes: hypoxia; hypo-/hyperkalemia, and other electrolyte disorders; hypo-/hyperthermia; hypovolemia; tension pneumothorax; tamponade; thrombosis; toxins. Special environments are specialised healthcare facilities, commercial airplanes or air ambulances, field of play, outside environment or the scene of a mass casualty incident. Special patients are those with severe comorbidities and with specific physiological conditions. Post resuscitation care is new to the ERC Guidelines. Targeted temperature management remains, now aiming at 36°C instead of the previously recommended 32 – 34°C. Pediatric life support – For chest compressions, the lower sternum should be depressed by at least one third the anterior-posterior diameter of the chest (4 cm for the infant and 5 cm for the child). For cardioversion of a supraventricular tachycardia (SVT), the initial dose has been revised to 1 J kg–1. Resuscitation and support of transition of babies at birth – For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery of the infant, is now recommended for term and preterm babies. Tracheal intubation should not be routine in the presence of meconium and should only be performed for suspected tracheal obstruction. Ventilatory support of term infants should start with air. Acute coronary syndrome (ACS) – Pre-hospital recording of a 12-lead electrocardiogram (ECG) is recommended in patients with suspected ST segment elevation acute myocardial infarction (STEMI). Patients with acute chest pain with presumed ACS do not need supplemental oxygen unless they present with signs of hypoxia, dyspnea, or heart failure. In geographic regions where PCI facilities exist and are available, direct triage and transport for PCI is preferred to pre-hospital fibrinolysis for STEMI. First aid is included for the first time in the 2015 ERC Guidelines. Principles of education in resuscitation – Directive CPR feedback devices are useful for improving compression rate, depth, release, and hand position. Whilst optimal intervals for retraining are not known, frequent ‘low dose’ retraining may be beneficial. Training in non-technical skills is an essential adjunct to technical skills. The ethics of resuscitation and end-of-life decisions – Ethical principles in the context of patient-centered health care: autonomy, beneficence, non-maleficence; justice and equal access. The need for harmonisation in legislation, jurisdiction, terminology and practice still remains within Europe

COMBINED ULTRASOUND-BIOCHEMICAL SCREENING OF FETAL TRISOMIA IN THE FIRST TRIMESTER AND DOUBLE BIOCHEMICAL SCREENING IN THE SECOND TRIMESTER AT NONRISK PREGNANCIES

Cilj rada: Usporediti uspješnost primjene probirnih testova aneuploidija u prvom i drugom tromjesečju trudnoće. Ispitanice i metode: Istraživanu skupinu činilo je 374 trudnica s kombiniranim ultrazvučno-biokemijskim testom u prvom, odnosno dvostrukim biokemijskim testom u drugom tromjesečju. Sve su trudnoće bile jednoplodne i urednog ishoda. U probiru prvog tromjesečja korišteni su biokemijski biljezi u serumu trudnica: plazmatski protein pridružen trudnoći (PAPP-A) i slobodna B-podjedinica humanog korionskog gonadotropina (slobodni B-hCG), uz ultrazvukom izmjerenu debljinu nuhalnog nabora (NT) i dužinu tjeme-trtica (CRL) u ploda. U dvostrukom biokemijskom probiru drugog tromjesečja korišteni su biokemijski biljezi: alfa-fetoprotein (AFP) i slobodni B-hCG, a gestacija je procijenjena prema ultrazvučnoj biometriji. Rezultati: Povećani ultrazvučno-biokemijski rizik trisomije 21 u 1. tromjesečju trudnoće ustanovili smo u 30 trudnica (8.0%). Od ukupnog broja, 70 ispitanica (18.7%) imalo je povećani rizik obzirom na biokemijske biljege u ¬prvom, odnosno njih 56 (15.0%) obzirom na biokemijske biljege u drugom tromjesečju trudnoće. Izvršeno je ukupno 30 postupaka amniocenteze. Od toga je u 19 trudnica (63.3%) indikacija postavljena na osnovi kombiniranog probirnog testa. Nadalje, amniocenteza je izvršena u 11 trudnica (28.2%) zbog povećanog rizika u dvostrukom biokemijskom probiru drugog tromjesečja. Udjel lažno-pozitivnih razultata u kombiniranom probiru prvog tromjesečja bio je statistički značajno niži, nego u biokemijskom probiru drugog tromjesečja (B2=12.02, p=0.0005). Ustanovili smo značajnu pozi¬tivnu povezanost log10 MoM slobodnog B-hCG između prvog i drugog tromjesečja (r2=0.403, p<0.0001). Nismo ustanovili značajnu povezanost između ostalih biokemijskih biljega u prvom, odnosno, drugom tromjesečju. Zaključak: Rezultati našeg istraživanja su pokazali značajno veću specifičnost ranog kombiniranog probirnog testa aneuploidija u odnosu na biokemijski probirni test u prvom, kao i u drugom tromjesečju. Mogućnosti izbora pojedinih probirnih testova trebale bi biti usklađene sa stavovima i potrebama samih trudnica, kao i sa smjernicama koje su preporučile nadležne institucije za fetalnu medicinuObjective: To evaluate the performance of screening tests for aneuploidy in the first and second trimesters of pregnancy in Croatian pregnant women. Study Design and Methods: Study population comprised 374 pregnant women who underwent the combined ultrasound-biochemical in the first and double-test in the second trimester of pregnancy, respectively. All were singleton pregnancies with normal outcomes. The first-trimester screening was performed combining serum markers, pregnancy associated plasma protein-A (PAPP-A) and free B-subunit of human chorionic gonado¬tropin (free B-hCG) with fetal nuchal translucency thickness (NT) and crown-rump length (CRL), measured by ultrasound. For the second-trimester screening, maternal serum alpha-fetoprotein and free B-hCG were used as biochemical markers in relation to fetal biometry diagnosed by ultrasound. Results: In 30 pregnant women (8.0%) elevated risk for trisomy 21 was found after combined ultrasound-biochemical screening. Out of total, 70 pregnant women (18.7%) were classified ’at risk’ on the basis of biochemical markers in the first and 56 (15.0%) in the second trimester. In 30 pregnant women amniocentesis was performed. In 19 cases (63.3%) the indication was elevated risk in the first-trimester combined test. In 11 women (28.2%) amniocentesis is recommended because of the elevated second-trimester biochemical risk. The proportion of false-positive results in combined first-trimester screening test was significantly lower than with second-trimester biochemical markers (B2=12.02, p=0.0005). We found the significant positive relationship between log10 MoM F B-hCG in the first and second trimester (r2=0.403, p<0.0001). There was no significant relationship between PAPP-A and second-trimester biochemical markers. Conclusion: Results of this preliminary study confirmed better specificity of the combined first-trimester screening in relation to biochemical screening in the second trimester of pregnancy. The decision and choice of the most appropriate screening test should consider woman’s personal attitude and preferences, as well as follow the guidelines recommended by the competent associations for the fetal medicine

Prevalencija infekcije Neisseriom gonorrhoeae ili Chlamydiom trachomatis kod akutnoga mukopurulentnog cervicitisa

The aim of this study was to determine the incidence of N. gonorrhoae (NG) and/or C. trachomatis (CT) in acute mucopurulent cervicitis (MPC). The study included 617 non-pregnant women with MPC, who had not been receiving any antimicrobial treatment. The average age of patients was 22.2 years. There were no statistically significant differences according to place of residence, education, and marital status. Samples for laboratory analysis were collected using a routine procedure; NG was identified using the cytochrome oxidase test and Gram staining. CT was isolated on McCoy cell culture and stained with Lugol solution. NG was isolated in three women (0.8 %) and CT in 58 women (9.4 %). Fifty-six of the CT-positive patients were nullipara and only two were unipara. All NG-positive patients were also nullipara. The mean number of sexual partners was 2.2 in all study subjects, 2.4 in CT-positive subjects, and 2.9 in NG-positive subjects. Vaginal discharge purity according to Schröder was significantly deteriorated in CT-positive patients (p=0.011). When asked about the use of contraceptives, as many as 32.7 % patients answered that they did not use any protection, 39 % women used the rhythm method and coitus interruptus, 20 % were taking oral contraceptives, 6.1 % used mechanical devices, and 1.9 % used chemical protection. Previous acute and chronic pelvic infl ammatory diseases correlated with MPC (p<0.01). Our statistical analysis suggests that chlamydial infection significantly reduces the purity of vaginal discharge, which is more pronounced in nulliparae. Pap smear was not specific enough to demonstrate chlamydial infection. In view of the MPC findings, the prevalence of CT and NG infection is low.Cilj istraživanja jest utvrditi koincidenciju N. gonorrhoae (NG) i/ili C. trachomatis (CT) u akutnim mukopurulentnim cervicitisima (MPC). Istraživanje je provedeno na populaciji 617 žena izvan trudnoće koje prethodno nisu uzimale antimikrobnu terapiju. NG i CT su izolirane iz obrisaka vrata maternice primjenom standardnih metoda. NG je transportirana na selektivnoj hranjivoj podlozi i identificirana citokrom-oksidaznim testom bojenjem po Gramu. CT je izolirana McCoyevom staničnom kulturom nakon bojenja Lugolovom otopinom. NG je izolirana u tri ispitanice (0,8 %), a CT u 58 ispitanica (9,4 %). Srednja dob bolesnica iznosila je 22,2 godine. Školovanje i bračno stanje nisu statistički značajno utjecali na rezultate istraživanja. Među bolesnicama s izoliranom CT prevladavaju nulipare, a u slučaju NG sve su pozitivne bolesnice također bile nulipare. Srednja vrijednost broja partnera za čitavu populaciju iznosi 2,2. Bolesnice s potvrđenom CT imale su prosječno 2,4, a one s potvrđenom NG 2,9 partnera. Vrijednost određivanja stupnja čistoće rodničkog iscjetka po Schroderu značajno je povišena u CT-pozitivnih bolesnica (p=0.011). Utvrđeno je da 32.7 % ispitanica uopće nije koristilo kontracepciju, dok je većina (39 %) rabila ritmičke metode i prekinuti snošaj. Preostale ispitanice uzimale su oralne kontraceptive (20 %), mehaničku zaštitu (6,1 %) ili lokalne kemijske kontraceptive (1,9 %). Također je dokazano da prethodna akutna i kronična zdjelična upalna bolest korelira s MPC-om (p<0.01). Zaključeno je da klamidijska infekcija statistički značajno korelira sa stupnjem čistoće rodničkog iscjetka, posebice u nulipara. Papanicolaouov razmaz nije specifičan u određivanju klamidijske infekcije. Rezultati istraživanja pokazuju da je učestalost klamidijske i gonokokne infekcije ipak relativno niska u odnosu na nalaz MPC-a

Croatian Electronic Medical Education

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.HeMED is the acronym for “Croatian electronic medical education” (cro. Hrvatska elektronička medicinska edukacija), which represents the contemporary tehnological solution in the Croatian language for medical profesionals and patients provided on web pages and mobile applications. Inspired by Željko Ivančević, MD, the project was sucessfuly launched and finished with help of the CMC (Croatian medical chamber) and If! (Inovativna framaceutska inicijativa). The aims of HeMED are to encourage citizens’ health literacy, provide students with contemporary literature in the Croatian language, and support doctors in their daily work. On the pages of hemed.hr important international textbooks and an always up-to-date drug database are translated for medical professionals and the public. The editions available for searching and reading are: MSD Handbook for Patients (2019), MSD Handbook for Professionals (2018), MSD Handbook of Disease Symptoms (2010), Pharmacogenetics in Clinical Practice (2021), Harrison: Principles of Internal Medicine of Medicine (pocket manual) (2019) and Harrison: Principles of Internal Medicine (textbook) (2013). All the mentioned editions are connected to the drug database, which is regularly updated. When reading the text, each drug that is listed can be opened directly in the drug database, also by viewing the drug you can see all texts that have that drug in it. Hemed.hr is used daily by 6,000 users with a growing tendency. In the future, we plan to update all translations with the latest editions and include other important editions on hemed.hr. In conclusion, HeMED is the result of the volunteer work of about 400 medical doctors of all specialties and all age groups who diligently translated about 20,000 pages of medical literature to help their colleagues and patients