Zagreb School of Business

We present the report of disease in a child with severe restrictive cardiomyopathy (RCM) resulting in the development of veno-occlusive pulmonary arterial hypertension (PAH) and cardiopulmonary insufficiency with NYHA II-III. Due to borderline criteria for heart transplantation (HT), it was difficult to find justification for the procedure, although it was the only way to save the child’s life. The boy was monitored for hepatomegaly one year before admission. At the age of 11, significant dilatation in both atria, accompanied by a reduced cavity of both ventricles led to the recognition that the clinical symptoms were attributed to restrictive cardiomyopathy (RCM) with preserved left ventricular ejection fraction (LVpEF – LV with preserved EF). Because of the evidence suggesting that it is a secondary development of veno-occlusive PAH, before the HT decision it was required to clarify distinguish from reactive PH, in accordance with the latest 6WSPH criteria (6th World Symposium on pulmonary hypertension) [1]. Pulmonary hypertension is considered when the mean pulmonary artery pressure (mPA) is >20 mmHg, transcapillary gradient (PAWP) > 15 mmHg and pulmonary vascular resistance (PVR) ≥ 3 iWJ. Since the patient did not meet the criteria for passive (isolated) precapillary PAH (mPA>20 mmHg, PAWP >15 mmHg and PVR < 3iWJ) with preserved LVEF /IpcPH/LVpEF=Isolated precapillary PH with LVpEF/, but according to the same criteria, he had reactive, or combined veno-occlusive pulmonary hypertension (PVR ≥ 3iWJ) /CpcPH/LVpEF= Combined precapillary PH with LV preserved EF)/. Diagnosis indicated that it was a contraindication for HT. This position is valid only if the discussion about possible reversible changes in PAS (Pulmonary artery small – the former name of arteriole) are ignored. Aware of the fact that HT is risky, but also of the probability that changes caused by the Kitajew phenomenon are reversible [2] contrary to precapillary PH caused by CHD (Euler Ljiljestrand fenomen) [3], we decided to proceed with HT. We are predicting a difficult postoperative course but which can be overcome with adequate measures (strict supervision of the Frank-Starling law) [4] with mechanical and pharmacology support. Encouraged by reports from the literature indicating a significantly higher incidence of passive postcapillary than reactive pulmonary hypertension as well as rapid regression of pulmonary hypertension after elimination of the cause of PAS self perpetuation [5-7], we decided on HT as the only perspective for the survival of a severely ill child. Our arguments also included a discussion on the irreversibility of PAH before the development of Eisenman’s syndrome (ES) (“gray area”, 6-8 iWJ) [8,9]. HT decision despite the inconsistency of the criteria for defining pulmonary hypertension and the type of pulmonary vascular resistance according to the previous international criteria’s [10-13], including the 6WSPH criteria [1,8,14,15]. Our arguments were accepted by the EUROTRANSPLANT committee. A HT was successfully performed and boy was discharged home with good follow up more than > 10 years in good condition (NYHA I).

A rise in infections associated with carbapenem-resistant Providencia species (CRPS) has been observed worldwide. This study presents a genomic analysis of CRPS isolates from four hospitals in Croatia and the outpatient setting, in order to determine the extent of the spread of CRPS in Croatia. In the present study, we applied a combination of phenotypic characterization and molecular analysis of resistance traits to determine the mechanisms and the routes of spread of CRPS. The antibiotic susceptibility testing was performed using disk-diffusion and broth dilution methods. The nature of extended-spectrum β-lactamases (ESBLs), carbapenemases, and fluoroquinolone resistance determinants was investigated by polymerase chain reaction (PCR). In order to obtain an insight into the whole resistome, selected isolates were subjected to the Interarray Genotyping Kit CarbaResist and whole genome sequencing (WGS). In total, 30 isolates were collected from four centers, located in different geographic regions of Croatia. There was uniform resistance to piperacillin-tazobactam, cefuroxime, expanded-spectrum cephalosporins (ESCs), imipenem, ertapenem, meropenem, and ciprofloxacin. Immunochromatographic testing and PCR revealed OXA-48 and NDM carbapenemase in 15 isolates, respectively. Phenotypic tests for ESBLs were positive in all OXA-48 and one NDM-positive organism (16 isolates). The isolates were categorized as extensively drug-resistant (XDR). OXA-48-producing isolates were susceptible only to ceftazidime-avibactam, whereas NDM producers were susceptible to cefiderocol and, in the majority of cases, also to amikacin. WGS identified a plethora of genes encoding resistance to aminoglycosides, such as aadA1 and aadA2, (aph(3″)-Ib and aph(6)-Id, sulfonamides sul1 and sul2, trimethoprim dfrA1, dfrA10, and dfrA12, tetracyclines tet(A) and tet(B), and chloramphenicol catA3 and catA5. Providencia spp., in spite of being a rare pathogen, should be included in the surveillance studies across the medical centers in Croatia.

Abstract This paper examines the extent to which Croatia relies on a cost-based export strategy by analyzing the link between cost competitiveness, measured by unit labor cost (ULC) and exports of manufacturing firms from 2002 to 2022. Using a panel first-differences OLS approach, the study finds that cost competitiveness significantly shapes export activity of firms of all sizes and technological intensities, but with considerable heterogeneity. The results show a non-linear relationship between ULC and exports that is not asymmetrical. The relationship is weaker for firms with lower export intensity and for high-tech firms. Higher ULC is associated with greater export sensitivity and lower productivity, confirming that export sensitivity is lower for more productive firms. In the future, a further strengthening of the link between costs and exports can be expected, i.e. exports will react more sensitively to cost fluctuations. As a result, price and cost stability will become even more crucial. Overall, this analysis provides the most comprehensive study to date on how cost factors affect Croatian merchandise exports, implying that boosting product quality and productivity can reduce cost pressures and promote long-term competitiveness.

Background: The purpose of this study was to analyze the accuracy of two apex locators using seven different canal irrigants. Methods: Forty multi-rooted extracted teeth were included in this study. The actual canal length (ACL) was determined using a #10 file until the tip was visualized (12× magnification) just within the apical foramen (AF). The teeth were placed in a conductive medium of alginate to test the ACL and electronic canal length (ECL) using both apex locators in various conditions. Seven irrigant solutions were used in the root canal: 0.9% saline, FileEZE EDTA 19%, Glyde EDTA 17%, Consepsis V Chlorhexidine 2% CHX, Chlorcid 3%, citric acid 20%, and EDTA 18%. Results: Within a range of ±0.5 mm from the ACL, Raypex showed an accuracy of 87.5% with 0.9% saline solution, 82.5% with Chlorcid 3%, and 75% with Consepsis V CHX 2% solution. The Ipex showed an accuracy of 82.5% with 0.9% saline solution, 80% with Chlorcid 3%, and 70% with Consepsis V CHX 2% solution. The differences among the canal irrigants were significant for both the Raypex (p = 0.021) and Ipex (p < 0.0001) devices. The mean values showed the greatest variations in ECL accuracy with the combination of Raypex and EDTA 18% (p = 0.042) and with the Ipex and Glyde EDTA 17% (p = 0.026). Conclusions: Canal irrigants have an impact on the accuracy of apex locators. The apex locators showed an accuracy of 80% and greater when 0.9% saline and Chlorcid 3% solutions were used.

Cardiac amyloidosis (CA) is a progressive disease in which amyloid fibrils infiltrate the heart muscle. This study aimed to identify features from cardiac biomarkers, electrocardiography (ECG), and echocardiography that may distinguish between transthyretin amyloidosis (ATTR) scintigraphy-positive and negative patients. Seventy-eight consecutive patients, median age 69 years (range 34-81), with suspected CA, negative serum free light chains, and negative serum and urine protein electrophoresis with immunofixation, referred to cardiac scintigraphy between 2021 and 2024, were retrospectively enrolled. Cardiac uptake was assessed by Perugini grades. Troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and various ECG and echocardiographic features were compared between ATTR scintigraphy-positive and negative participants using the t-test, Mann-Whitney U-test, and χ2-test as appropriate. Multivariable stepwise logistic regression created the prediction model for ATTR-positive scintigraphy. The significance level was 0.05. Scintigraphy was ATTR-positive in 24 participants (30.77%). The variables significantly connected with ATTR-positive testing were atrial fibrillation (p = 0.010), first- or second-degree atrioventricular block (p = 0.041), left ventricle (LV) end-diastolic dimension (p = 0.018), LV global longitudinal strain (GLS) (p = 0.040), a restrictive transmitral inflow pattern (p = 0.025), LV posterior wall thickness (p < 0.001), interventricular septum (IVS) thickness (p < 0.001), QRS voltages (p < 0.001), the pseudo- infarct pattern (p < 0.001), and relative apical sparing of the GLS ratio (p < 0.001). The latter four were incorporated into the prediction model for ATTR-positive scintigraphy. ECG and echocardiography remain the essential diagnostic procedures that raise the suspicion of CA and trigger further diagnostics. Low QRS voltages, the pseudo-infarct pattern, IVS thickness, and relative apical sparing of the GLS ratio are sensitive predictors of ATTR-positive scintigraphy findings.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has underscored the significant role of cardiovascular risk factors in determining the severity and outcomes of the disease. Pre-existing conditions such as hypertension, diabetes, obesity, and cardiovascular diseases have emerged as key contributors to increased susceptibility to severe forms of COVID-19, influencing both short-term and long-term health outcomes. This review examines the complex interplay between these risk factors and the virus’s direct impact on the cardiovascular system. Key findings suggest that conditions like hypertension, diabetes, and obesity not only predispose individuals to more severe disease but also exacerbate complications such as myocardial injury, arrhythmias, and heart failure. Furthermore, the long-term cardiovascular effects of COVID-19, including myocarditis and pericarditis, are of growing concern, particularly in patients with pre-existing cardiovascular conditions. The virus’s ability to induce myocardial damage through mechanisms involving ACE2 receptor binding and inflammatory cytokine storms has been well-documented. The pandemic has also highlighted significant cardiovascular complications, including left and right ventricular dysfunction, myocardial injury, and elevated pulmonary arterial pressure, with the right ventricle being particularly affected due to pulmonary damage. Imaging modalities such as echocardiography and cardiac magnetic resonance have proven valuable for diagnosing myocardial injury and complications, although accessibility may be limited in routine clinical practice. Survivors of severe COVID-19, especially those with pre-existing cardiovascular conditions, face an elevated risk of major adverse cardiovascular events for up to two years post-infection. Evaluation of post-COVID patients includes ECGs, laboratory tests, echocardiography, and cardiac MRI, which provide critical insights into myocardial injury and complications. Preventive measures, including vaccination, regular monitoring of cardiovascular health, and lifestyle modifications, play a crucial role in reducing the long-term risk of cardiovascular complications. The role of vaccination in mitigating the risk of severe disease and cardiovascular complications is well-established, despite rare cases of vaccine-related myocarditis. Understanding these interactions is essential for developing targeted management strategies, improving patient outcomes in both acute and long-term COVID-19 effects, and addressing the broader challenges posed by COVID-19’s impact on cardiovascular health.

Cultural characteristics differ from nation to nation, and often by provinces, cities,villages - each group of people has its own traditions, beliefs and behaviors that are oftensimilar to other groups, but again specific to its members. Customs, rituals andsuperstitions as part of a particular culture define and shape the identity of consumerswho belong to that culture - they influence their attitudes, needs, habits and desires. Theseaspects of culture are embedded in consumer behavior, a complex set of preferences andpatterns of an individual, and make up the identity of that individual, which is expressedin his purchasing patterns. As the connection between customs, rituals and superstitionsand consumer behavior has not yet been examined in the scientific literature, nor has theimportance of their influence on consumer habits and characteristics been established, thesubject of this research is precisely to establish this relationship. In Europe, culturaldifferences play a decisive role in shaping consumption patterns. At the same time, globalcompetition tends to have a homogenizing effect on some markets such as music, sports,clothing and entertainment, and multinational companies such as Sony, Pepsi, Nintendo,Nike and Levi Strauss dominate and play an important role in shaping the market. Withthe creation of a single European market, many companies began to consider even morethe possibilities of standardized marketing across national borders in Europe. However,the increasing similarity of brands and products available in Europe does not mean thatconsumers are the same � variables such as personal motivation, cultural context, patternsof family relationships and rhythms of daily life differ significantly from country tocountry and from region to region. This paper will explore the possibilities of improvingthe protection and preservation of rituals, customs, traditions and superstitions as part ofcultural heritage that have an impact on the formation of consumer behavior. Culturalheritage through customs and rituals, traditions and superstitions is recognized as part ofthe historical, cultural, economic and tourist significance for the Republic of Croatia andis important for the preservation of national identity. As a set of permanent material andimmaterial values and human creations, culture is exposed to various problematic,counter-cultural and degrading processes, which arise from conflicts of interests and,sometimes, too fast changes, as well as uncritically accepted immaterial forms of culture,such as rituals, customs, traditions and superstitions of a people. In this sense, thedegradation of traditions and customs, rituals and superstitions can affect the decline inthe quality of life of people in the European Union. The general goal of this research, based on a sample of 206 respondents, is to determine the influence of customs, ritualsand superstitions on consumer behavior in the Republic of Croatia, more precisely, todetermine the frequency of product purchases with regard to different types of rituals.

International Financial Reporting Standard 4 is an interim standard published in 2004. Over the years, as the insurance industry has evolved, several fundamental issues have emerged suggesting that certain provisions of IFRS 4 are outdated or ineffective. Given the importance of the insurance industry, efforts have been made to correct these issues and publish a new standard that provides a simpler, more transparent and standardised determination of insurance contracts. In 2017, the IASB is publishing the new International Financial Reporting Standard 17 - Insurance Contracts, which aims to correct the inconsistencies caused by the application of IFRS 4, i.e. to ensure transparency, standardisation and comparability of the financial statements of insurance companies. The application of IFRS 17 aims to implement the equal treatment of insurance contracts between the companies themselves and within the group in order to carry out consolidation in a standardised manner. The aim is also to harmonise IFRS 17 with other standards, adjust estimates to reflect current market changes and also take into account financial effects and risks. The introduction of the new standard will have an impact on management, administration and employees, but also on external users of the financial statements, who will be able to monitor and compare the company's business in a clearer and more transparent way.