<p><strong>Aim </strong>To evaluate the clinical impact of corticosteroids (CS) overuse in inflammatory bowel disease (IBD) patients. Excessive use of CS could delay more efficacious treatment and may indicate poor quality of care.<br /><strong>Method </strong>This is a two-phase study that used Steroid Assessment Tool (SAT) to measure corticosteroid exposure in IBD patients. In the first phase data from 211 consecutive ambulatory patients with IBD (91 with ulcerative colitis, 115 with Crohn's disease, and five with unclassified inflammatory bowel disease) were analyzed by SAT. In the second phase, one year after data entry, clinical outcome of patients with cortico-steroids overuse was analysed.<br /><strong>Results </strong>Of the 211 IBD patients, 132 (62%) were not on corticosteroids, 45 (22%) were cortico-steroid-dependent and 34 (16%) used corticosteroids appropriately, according to the European Crohn's and Colitis Organization guidelines. In the group of patients with ulcerative colitis, 57 (63%) were not on cortico-steroids, 18 (20%) were corticosteroid-dependent, and 16 (16%) used cortico-steroids appropriate-ly; in the group of patients with Crohn's disease 70 (61%), 27 (23%) and 18 (16%), respectively. Overall, 24 (out of 45; 53%) patients with IBD could avoid the overuse of cortico-steroids if they had a timely change of the treatment, surgery or entered a clinical trial.<br /><strong>Conclusion </strong>An excessive corticosteroid use can be recognized on time using the SAT. We have proven that excessive corticosteroid use could be avoided in almost half of cases and thus the overuse of CS may indicate poor quality of care in those patients.</p>

liver

The social significance and quality of every human activity are proportional to its usefulness to the social community. Science belongs to the very top of the processes and events in the history of humankind that strongly influenced the development of society, which over time transformed it and contributed to the common good. Science produced new knowledge that made it possible for billions of people to rise out of poverty, develop industrialization and mass communication, eradicate many dangerous diseases for humankind, and enable humans to leave their footprints on the moon. Science is a human activity that produces new knowledge presented through innovations, patents, and publications, aimed at solving the problems facing humanity. Read more in the PDF.

Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases. In the last seven years, there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging. The aim of this review is to provide a comprehensive update of PVA, including aetiology, epidemiology, and clinical assessment, along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

Background: A bezoar is a collection of indigestible substances that, after swallowing, form a mass in the gastrointestinal tract, most often in the stomach. A trichobezoar is a mass made of ingested, undigested hairs and food remains, while ingestion of hair is called trichophagia. This is an extremely rare condition, with 90% of cases occurring among women, out of which 80% are under the age of 30. The diagnosis is based on clinical examination, findings obtained through radiological modalities (ultrasound and computed tomography) and endoscopy. Objective: The aim of this article is to present the case of a 17-year-old female patient who visited the doctor due to abdominal pain and a visible mass in the projection of the stomach. Case presentation: The patient, accompanied by her parents, and following the instructions of a general practitioner who suspected the presence of a tumour in the abdomen, reported to the surgical clinic. The US examination revealed the presence of a heteroechoic mass in the stomach area, but it could not be determined with certainty where it belonged (Samsung Medison V8 ultrasound system). The CT scans revealed the presence of an inhomogeneous structure in the stomach area occupying the entire volume of the stomach. The mentioned structure included the presence of internal air particles and marginal imbibition of the orally applied contrast agent. The described structure did not infiltrate the stomach wall and, based on the CT scan, the diagnosis established was a bezoar. Under general anaesthesia, a laparotomy with a gastrotomy was performed, and a hard hook shaped mass composed of hair and remains of undigested food was removed from the stomach. Conclusion: A mobile, palpable mass located in the abdomen of younger female patients accompanied by abdominal symptoms, especially in patients where there is information about hair pulling and swallowing, may suggest trichobezoar. The golden standard for trichobezoar presentation is upper endoscopy. If unavailable, the diagnosis is established by a CT scan, preferably with oral application of a contrast agent. Treatment of larger trichobezoars is surgical, while endoscopic and laparoscopic removal is possible only in the case of small trichobezoars.

Aim of the study Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. Material and methods Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. Results PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. Conclusions PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.

It is very well known that science is world activity and that there is no good and bad work in the field of scientific research. Nowadays scientific productivity of the individuals, learned societies on regional or state level are measurable parameters. In most of the systems it does include the number of original scientifi papers, quality of journals measured by impact factor and scientific citation index (1-4). There are also additional measurable parameters but for the purpose of this meeting we will avoid discussion about them. New field of scientometrics using the help of impartial and ruthless machines (computers) do help very significantly in evaluation of scientific productivity anywhere in the world. Unfortunately, there are many misused conclusions and interpretation on the data offered by computers. It is clear that some vital important changes are urgently needed. Today’s conference should use rare opportunity having together experts in the field to discuss the problems visible now. This author intends to discuss facts and doubts in writing review articles and chapters in the book (5). Some important flexibility in citation, in particular self citation, should be analyzed. An illustrative examples from author’s own experience will be shown and discussed at the meeting.

The social significance and quality of scientific research largely depend on the usefulness of research results for the social and scientific community. The lack of funds and the desire to allocate funding to high-quality research projects make the assessment of the quality of research and the valorization of knowledge increasingly important. However, it is very difficult to apply criteria that can objectively assess scientific research, providing precise qualitative and quantitative data on which funding agencies could base their decisions. The product of scientific research is mainly information published in scientific journals. They are the basis for the dissemination of knowledge and the basic criteria for academic and scientific evaluation, fundraising for scientific research and career advancement. In addition to the evaluation of scientific publications, there is a wide range of other activities that reflect the scientific credibility of scientists, such as: number and quality of grants for scientific research projects, leadership in national or international academic societies, membership in editorial boards of reputable journals, doctoral dissertation mentorships and the like. Although these activities are important and give credibility to the scientist, the relevant scientometric systems cover only publications, neglecting other criteria of scientific importance in evaluation for purpose of academic advancement of a scientist, as well as competitions for grants for financial support of scientific research. The reason for this is the fact that these activities, regardless of their importance, are very heterogeneous, with specific characteristics, and require very diverse parameters for evaluation. Therefore, there are no universal evaluation criteria for these activities and their quality is generally assessed individually, depending on the purpose of the assessment. Regardless of the shortcomings, university ranking systems are important comparative parameters for assessing the quality of scientific and educational value of universities.

Društveni značaj i kvalitet naučnog istraživanja u velikoj mjeri ovise o korisnosti rezultata istraživanja za društvenu i naučnu zajednicu. Nedostatak sredstava i želja da se sredstva dodijele visokokvalitetnim istraživanjima čine sve značajnijim procjenu kvaliteta istraživanja i valorizaciju znanja. Međutim, vrlo je teško primijeniti kriterije koji mogu objektivno procijeniti naučna istraživanja, pružajući precizne kvalitativne i kvantitativne podatke na kojima bi agencije za finansiranje mogle temeljiti svoje odluke. Proizvod naučnog istraživanja uglavnom su informacije objavljene u naučnim časopisima. One su temelj širenja znanja i osnovni kriterij za akademsku i naučnu evaluaciju, regrutovanje sredstava za naučna istraživanja i napredovanje u karijeri. Pored evaluacije naučnih publikacija, postoji širok spektar drugih aktivnosti koji odražavaju naučni kredibilitet znanstvenika, kao što su: broj i kvalitet grantova za naučnoistraživačke projekte, liderstvo u nacionalnim ili međunarodnim akademskim društvima, članstvo u redakcijama uglednih časopisa, mentorstva u doktorskim disertacijama i slično. Mada su te aktivnosti važne i daju kredibilitet znanstveniku, relevantni scientimetrijski sistemi pokrivaju samo publikacije, izostavljajući druge kriterije od naučne važnosti, u ocjenjivanju prilikom akademskog napredovanja znanstvenika, kao i konkursima za dobijanje grantova za finansijsku potporu naučnim istraživanjima. Razlog tome je činjenica da su ove aktivnosti, bez obzira na važnost, vrlo heterogene, sa specifičnim karakteristikama i zahtijevaju veoma raznolike parametre za ocjenu. Stoga, za ove aktivnosti ne postoje univerzalni kriterijumi vrednovanja i njihov se kvalitet, uglavnom, procjenjuje individualno, ovisno o namjeni procjene. Bez obzira na manjkavosti, sistemi rangiranja univerziteta su važni komparativni parametri za procjenu kvaliteta naučne i edukativne vrijednosti univerziteta.

Societal importance and the quality of scientific research highly depend on the usefulness of the results of research for the societal and scientific community. The wish to allocate the funds to high-quali-ty research and to establish right criteria for scientific evaluation and academic career progression, make scientific criteria increasingly important to measure the quality of research and knowledge valorization. However, it is very difficult to apply the right criteria which can objectively assess scientific research. For many years, there has been a great interest in scientific ranking and evaluation of scientific journals, but also of sci-entific contribution of scientists. It is generally accepted that the IF (WoS) and the total number of citations of articles published in the journal, are the most relevant parameters of the journal's significance. However, the significance of a scientist and the value of their scientific production are much more complicated to evaluate and they cannot be directly reflected by the importance of the journals in which their articles are published. In this article, the authors describe and evaluate the most known scientific databases which are used in science. The majority of existing science metric systems, which evaluate the achievement of scientists are focused solely on the number of citations of their articles. For example, H-index, which is calculated as the lowest ranked ar-ticle which number of citations matches its ranking number, has considerable shortcoming because it does not take into account the individual contribution of each author and allows expanding author lists with authors whose contribution may be insignificant or none. Therefore, the authors propose Z-score, as a new science met-ric system, which takes into account the author's contribution to the scientific article and greatly remedy major discrepancies in evaluating scientific production of individual authors and institutions.

The small intestine is a challenging organ for clinical and radiological evaluation. The introduction of radiological imaging techniques, which do not significantly disturb patients’ comfort and safety, attempts to obtain an adequate diagnosis and valuable information. The aim is to determine the capabilities and potential of ultrasound, computed tomography (CT), diffusion-weighted imaging (DWI), and contrast-enhanced magnetic resonance (MR) enterography to establish the diagnosis and to evaluate the severity and activity of intestinal inflammation. Conventional ultrasound is a suitable orientation method in the initial evaluation of patients with Crohn’s disease. At the same time, contrast-enhanced MR enterography provides an excellent assessment of disease activity, as well as the complications that accompany it. Contrast-enhanced MR enterography, combined with DWI, allows for excellent evaluation of disease activity and problems or difficulties following it. The examination can be repeated, controlled and can monitor patients with this disease.

It is very well known that science is world activity and that there is no good and bad work in the field of scientific research. Nowadays scientific productivity of the individuals, learned societies on regional or state level are measurable parameters. In most of the systems it does include the number of original scientifi papers, quality of journals measured by impact factor and scientific citation index (1-4). There are also additional measurable parameters but for the purpose of this meeting we will avoid discussion about them. New field of scientometrics using the help of impartial and ruthless machines (computers) do help very significantly in evaluation of scientific productivity anywhere in the world. Unfortunately, there are many misused conclusions and interpretation on the data offered by computers. It is clear that some vital important changes are urgently needed. Today’s conference should use rare opportunity having together experts in the field to discuss the problems visible now. This author intends to discuss facts and doubts in writing review articles and chapters in the book (5). Some important flexibility in citation, in particular self citation, should be analyzed. An illustrative examples from author’s own experience will be shown and discussed at the meeting.