University Clinical Centre

Older adults living with neurocognitive disorders (NCD) face a higher risk of polypharmacy, exposure to potentially inappropriate medications and related adverse events. Pharmacists can help manage these issues and improve the appropriateness of pharmacotherapy. To evaluate the impact of pharmacists' interventions, as members of primary care interprofessional teams, on medication use and patient-reported outcome measures among older adults living with or under investigation for a neurocognitive disorder. The effect of a six-month follow-up by a primary care interprofessional team pharmacist on the number of medications, potentially inappropriate medications (PIMs) and anticholinergic burden for older adults living at home under evaluation for or living with a NCD was assessed through a controlled quasi-experimental study. Eligible older adults were 65 years or older and were enrolled between September 2021 and February 2025. The patient-reported outcomes were the evolution of participants' quality of life, treatment burden and satisfaction with care. The outcomes were evaluated using difference in differences (D-I-D) and their 95% confidence interval (95% CI). Pharmacist interventions significantly reduced the mean anticholinergic burden in the intervention arm (n=177) compared to the control arm (n=128) (D-I-D: -0.29; 95% CI: -0.56 - -0.11). A non-statistically significant trend toward a reduction was also observed for the mean number of PIMs (D-I-D: -0.11; [-0.22; 0.00]). The interventions also improved participants' satisfaction with care (6.97; [0.23; 13.72]). The mean number of medications used, as well as the burden of treatment and quality of life were stable after follow-up. Pharmacist-led interventions in interprofessional primary care settings contributed to the appropriateness of pharmacotherapy and satisfaction of older adults under evaluation for or living with a NCD after a six-month follow-up.

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the most aggressive malignancies with a very poor prognosis. Currently, there is no standardized therapeutic approach for third-line systemic treatment. The aim of this retrospective/prospective study was to evaluate survival outcomes in patients treated in the third-line setting and to analyze the impact of nutritional and inflammatory biomarkers on overall survival (OS) and progression-free survival (PFS). The analysis retrospectively and prospectively included 95 patients with mPDAC treated with third-line systemic therapy. Data were collected from the Slovak Pancreas Registry. Data were collected from 13 hospitals. Baseline chemotherapy regimens, ECOG, nutritional, and inflammatory parameters were recorded and used to calculate prognostic scores (PNI, CRP, NLR, SII, SIRI, GPS). Their association with OS and PFS was analyzed using the log-rank test and Kaplan-Meier survival analysis. The most frequently used regimen was FOLFOX/CAPOX (56 patients), followed by nanoliposomal irinotecan (nal-IRI, 24 patients) and capecitabine (11 patients). The median OS was 5.55 months and the median PFS was 3.29 months. A PNI > 40.5 was significantly associated with longer OS (6.34 vs. 3.32 months, p=0.001) and PFS (3.71 vs. 2.76 months, p=0.009). Lower GPS scores were significantly associated with improved OS (p=0.006) and PFS (p=0.027). Other inflammatory markers (NLR, SIRI, SII, CRP) did not show a statistically significant impact on OS or PFS. Third-line systemic therapy may offer clinical benefit in selected mPDAC patients, particularly in those with favorable nutritional-inflammatory profiles. The Prognostic Nutritional Index (PNI) and Glasgow Prognostic Score (GPS) appear to be potentially useful tools for identifying candidates suitable for further systemic treatment. However, further prospective studies are needed to confirm these findings.

<h3>Background and Importance</h3> Fluorescein sodium ophthalmic strips are sterile paper strips infused with fluorescein sodium dye, used by healthcare professionals to evaluate corneal abrasions and tear film stability, and to measure intraocular pressure. Since fluorescein sodium ophthalmic strips are not commercially available in our market, they must be prepared in the hospital pharmacy unit. However, the method of preparation and the quantity of released fluorescein sodium are not yet standardised. <h3>Aim and Objectives</h3> To standardise the method of preparation of fluorescein sodium ophthalmic strips by comparing the differences in the amount of released fluorescein sodium related to the impregnated surface area. <h3>Material and Methods</h3> One edge of each paper strip is dipped into 10% sterile fluorescein sodium solution, prepared by dissolving fluorescein sodium into sterile water for injection and autoclaved. The paper strips are further air-dried for about 15 minutes in a laminar-flow hood. Using this method, strips with four different fluorescein-impregnated surface areas (15 mm², 25 mm², 35 mm², and 50 mm²) were prepared. The quantity of fluorescein sodium extracted from the strips in aqueous solution was determined spectrophotometrically at 492 nm. <h3>Results</h3> We established a direct correlation between the quantity of fluorescein sodium and the impregnated surface area, as the amounts of fluorescein sodium extracted from the strips with surface area of 15 mm², 25 mm², 35 mm² and 50 mm² were 235 μg, 366 μg, 617 μg and 1100 μg, respectively. In relation to the standardised amount of fluorescein sodium of 300 μg, the percentages of fluorescein sodium released from the strips of surface area of 15 mm², 25 mm², 35 mm² and 50 mm² were 78%, 122%, 206% and 367%, respectively. Therefore, only the amount of fluorescein sodium released from the strip of 25 mm² met the requirements of USP-NF 2025 monography (100-160% of the labelled amount of fluorescein sodium). <h3>Conclusion and Relevance</h3> Modification of the impregnated surface area provides the possibility of achieving the desirable amount of released fluorescein sodium, thus reducing excessive dye use and waste, as well as ensuring reliable and consistent results. These results could lead to the optimal use of fluorescein sodium ophthalmic strips for diagnostic purposes and consequently improve patient outcomes. <h3>Conflict of Interest</h3> No conflict of interest

Alloimmunization depends on the type of the erythrocyte antigen, as well as the number of transfused doses of blood and recipient factors reflected in genetic and immunological status, comorbidities and therapy. The aim was to determine the frequency and type of antierythrocyte antibodies, to examine the correlation between the number of transfused doses and the frequency of antibodies, as well as the influence of recipient factors on the prevalence of antierythrocyte antibodies in polytransfused patients. A retrospective study was conducted in the Department of Pretransfusion Testing and Blood Product Therapy at the Polyclinic for Transfusion Medicine of the University Clinical Center Tuzla. The data of patients who received two or more doses of red blood cell concentrate, the frequency of antierythrocyte antibodies, as well as dose and patient factors including age, sex, comorbidity and therapy that influenced alloimmunization were analyzed. The highest percentage of patients developed the anti-E (23%), anti-C (11%) and anti-K (17%) antibodies. The recipient factors that have shown to be positive predictors for the development of antierythrocyte antibodies were: surgical bleeding (OR=3.74) and autoimmune diseases (OR=2.3). The probability that patients will not develop antierythrocyte antibodies was more pronounced in oncological patients (1/OR=7.14), as well as in patients with iron supplementation (1/OR=2.22) and antihypertensive therapy (1/OR=2.32). The results emphasize the importance of pretransfusion testing, illuminate the positive and negative effects of frequent transfusions, and propose strategies for improving transfusion therapy with a focus on the benefits of phenotyping erythrocytes for Rh and Kell antigens.

Introduction &amp; Aim: Sudden cardiac arrest remains a leading cause of mortality, with global survival rates remaining low. High-quality CPR characterized by adequate depth and minimal interruptions, is the cornerstone of survival. Manual CPR quality often declines due to rescuer fatigue and challenging environments. Mechanical chest compression devices (MCCDs) offer a potential solution to ensure consistent quality. This study aims to provide an overview of MCCDs available in the Polish Emergency Medical System, highlighting their advantages, limitations and applications, while evaluating their clinical effectiveness compared to manual CPR. Material and methods: The study consisted of a descriptive and comparative literature review, focusing on the technical data and clinical evidence (up to 2025) for the AutoPulse, LUCAS, and Corpuls CPR systems used in Poland. Data analysis included RCTS, cohort studies, systematic reviews, and meta-analyses evaluating MCCDs, utilizing PubMed, Scopus, and Google Scholar. Results: MCCDs ensure high-quality, uninterrupted compressions, particularly in challenging transport or specific scenarios, freeing up personnel for other tasks. Large-scale randomized controlled trials (RCTs) and recent meta-analyses demonstrate that MCCDs provide comparable survival outcomes to high-quality manual CPR, with survival rates ranging from 6.0% to 9.4%. However, MCCDs show a significant advantage in specialized scenarios - prolonged transport, catheterization labs, or as a bridge to advanced therapies like eCPR and extracorporeal life support. Conclusions: MCCDs are reliable alternatives for specific clinical situations. Although they involve higher costs and different injury patterns, the benefits of maintaining consistent CPR quality in conditions where manual compressions fail are measurable. Current guidelines recommend their use as a viable alternative in specific, difficult circumstances, rather than as a routine replacement for manual CPR.

Background: Microdiscectomy (MLD) has long been considered the standard surgical treatment for lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) has emerged as a minimally invasive alternative aimed at reducing tissue trauma and improving early postoperative recovery. Despite increasing adoption of endoscopic techniques, the relative advantages and limitations of these approaches remain debated [1–4]. Objective: This narrative review provides a concise comparison of microdiscectomy and percutaneous endoscopic lumbar discectomy based on available randomized controlled trials and comparative studies, with emphasis on clinical outcomes, perioperative recovery, complications, and practical considerations. Methods: A focused narrative review of randomized controlled trials and comparative clinical studies evaluating MLD and PELD was performed. Outcomes of interest included pain relief, functional improvement, perioperative recovery, complication profiles, and technical considerations. Results: Available evidence demonstrates comparable clinical outcomes between MLD and PELD in terms of pain relief and functional improvement [1–4]. PELD is associated with reduced postoperative tissue injury, less early postoperative back pain, and faster recovery [2,4,5]. Complication rates are similar overall, although the type of complications differs between techniques [1,4,14]. Outcomes after PELD are more strongly influenced by surgeon experience [19]. Conclusion: MLD and PELD provide comparable effectiveness in the treatment of lumbar disc herniation. PELD offers advantages in early recovery, while MLD remains a reliable and widely applicable technique. These procedures should be regarded as complementary.