AIM:To evaluate the real-world effectiveness, safety, and tolerability of ofatumumab in people with relapsing multiple sclerosis (pwMS) in Croatia. METHODS:We conducted a retrospective observational study in eight Croatian hospitals (March 2022-March 2025). Clinical, MRI, and laboratory data were collected before treatment initiation and every six months. Effectiveness measures included annualized relapse rate (ARR), MRI activity, and sustained accumulation of disability (SAD), and the proportion achieving no evidence of disease activity (NEDA-3). Safety assessments included adverse events (AEs), immunoglobulin levels, infections, and pregnancy outcomes. RESULTS:The study included 665 pwMS (65.6 % female; mean age 40.2 ± 10.7 years; 59.7 % treatment-naïve). Median follow-up was 1.55 years. ARR decreased from 0.70 ± 0.67 pre-treatment to 0.03 ± 0.18 post-treatment (p < 0.001). MRI activity occurred in 17.1 % of patients; 76.7 % achieved NEDA-3. SAD was observed in 6.3 % of pwMS, with male sex as the only independent predictor. Ofatumumab discontinuation occurred in 4.2 % of patients, mainly due to pregnancy. Injection reactions occurred in 15.8 % and infections in 7.4 % (3 hospitalizations). IgG and IgM declined slightly over time, with low IgM (<0.4 g/L) persisting in >10 % after two years, but without correlation to infection rates. Two malignancies were observed. Pregnancy outcomes were favorable in most cases. CONCLUSION:In a real-world Croatian cohort, ofatumumab demonstrated high effectiveness in reducing relapses and MRI activity, with a favorable safety profile over three years. These findings align with pivotal trial results, supporting ofatumumab as an effective and well-tolerated therapy for active relapsing MS in clinical practice.
Background: In contemporary critical care practice sedation is predominantly maintained with intravenous agents, most notably propofol, benzodiazepines, and dexmedetomidine. More recently, inhalational sedation using volatile anesthetics such as sevoflurane and isoflurane has been increasingly utilized. The advantages of this approach include precise control of drug delivery and elimination, better regulation of sedation depth, faster awakening, and a lower risk of drug accumulation. Methods: Data were collected at the Department of Internal Medicine, University Hospital Centre Split, from the hospital information system and through clinical patient monitoring, with informed consent and approval from the Ethics Committee. A case of a 65-year-old patient admitted due to theophylline intoxication, respiratory failure, and severe metabolic acidosis is presented, requiring intubation and mechanical ventilation. During treatment, vital signs, laboratory parameters, and depth of sedation were monitored. Results: During treatment, stable hemodynamic, adequate sedation depth, and rapid recovery of consciousness following discontinuation of sedation were achieved. Early extubation was successfully performed, with no signs of neurological or renal complications. These findings are consistent with available literature confirming the safety and efficacy of short-term inhalational sedation. Conclusions: Inhalational sedation with sevoflurane represents an effective and safe therapeutic option in intensive care units, particularly for patients with complex comorbidities, offering advantages such. as rapid titration, minimal accumulation, and favorable clinical outcomes
OBJECTIVES:Maternal vascular malperfusion (MVM) refers to dysfunctional uteroplacental circulation and is associated with increased risk of adverse maternal and fetal outcomes. The diagnosis of MVM is one of the most common pathological diagnoses in term placentas. The aim of the study was to test the interrater reliability of the MVM Amsterdam criteria. METHODS:A group of 12 international perinatal pathologists reviewed digital histological sections of placentas (n=29; 20 MVM/ 9 non-MVM controls), applying published Amsterdam workshop consensus criteria. Kappa statistics were used for interobserver agreement analysis. RESULTS:Agreement levels on final MVM diagnosis according to Amsterdam consensus were calculated as slight to fair (K-values of 0.187 and 0.260, p<0.001). Substantial agreement was reached one time for infarcts (K-value of 0.707, p<0.001). Complementary tested criteria achieved none to moderate agreement. CONCLUSIONS:Our results highlight the need to refine current MVM criteria to support consistent international diagnosis.
