Objective: To compare the effects of intravenous (IV) ferric carboxymaltose (FCM), IV ferric derisomaltose (FDI), and oral ferrous sulfate on hypophosphatemia in women with postpartum anemia. Methods: Single-centre, open-label, randomized trial. Women were randomly allocated to receive IV FCM, IV FDI, or oral ferrous sulfate. IV iron was infused in one or two doses (on days 0 and 7 postpartum), while ferrous sulfate once daily. Serum phosphate level was measured at enrollment and 6 weeks postpartum. Serum phosphate level and the proportion of women with hypophosphatemia were analyzed. The Kruskal-Wallis test was used for comparison of phosphate levels and the Chi-squared test for comparison of proportions (p < 0.05). Results: Three-hundred women with postpartum anemia (Hb < 100 g/L within 48 h postpartum) were included. Phosphate levels at six weeks postpartum did not differ between groups: 1.24 mmol/L (inter-quartile range (IQR) 1.10-1.35; equivalent to 3.84 mg/dL, IQR 3.41-4.19) in the FCM group, 1.23 mmol/L (IQR 1.09-1.35; equivalent to 3.81 mg/dL, IQR 3.38-4.19) in the FDI group, and 1.25 mmol/L (IQR 1.15-1.34; equivalent to 3.88 mg/dL, IQR 3.57-4.15) in the ferrous sulfate group (p = 0.86). The proportion of women with hypophosphatemia was similarly low in all three groups (3 (3.1%) vs. 2 (2.2%) vs. 2 (2.2%); p = 0.89). At six weeks postpartum, hemoglobin levels were slightly higher in both IV iron groups compared with oral iron, but the differences were small and unlikely to be clinically meaningful. Conclusions: Treatment of postpartum anemia with IV FCM, IV FDI, and oral ferrous sulfate had similar impact on phosphate levels and incidence of hypophosphatemia at six weeks postpartum.

Patients who undergo autologous hematopoietic stem cell transplantation (autoHSCT) often experience reduced oral intake and wasting. We examined their daily nutritional intake, assessed alterations in body composition and muscle strength, and explored associations between decreased nutritional intake and treatment outcomes. This retrospective study included 64 patients. Their food record charts and parenteral nutrition (PN) prescriptions from medical records were used to assess nutritional intake. Body composition and handgrip strength data were obtained from dietitian records. Patients consumed >75% of their nutritional requirements through an oral diet in 6.7 days, 50-75% in 4.8 days, 25-50% in 5.0 days, and <25% in 3.1 days. The average oral intake was 62% of the requirement and was partially supplemented with PN. Patients experienced a mean decrease in body weight of 2.9 ± 3.0 kg, with 2.3 ± 3.4 kg of lean mass, and a mean reduction in handgrip strength of 3.5 ± 3.6 kg. We found a positive correlation of caloric deficits with weight loss and handgrip strength reduction and negative correlation with time to neutrophil engraftment and duration of hospitalization. This study highlighted a notable reduction in oral nutritional intake following autoHSCT. While caloric deficits might affect outcomes, further investigation is warranted to explore this observation.

(1) Background: Postpartum anemia is a common maternal complication and is recognized as a cause of impaired quality of life, reduced cognitive abilities, and fatigue. Efficient iron supplementation for the treatment of postpartum anemia is an essential component of high-quality maternal care. The optimal mode of iron supplementation has not been determined yet, whether oral or intravenous. The objective of this study was to compare postpartum anemia treatment with intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate. (2) Methods: A single-center, open-label, randomized controlled trial. Women with hemoglobin < 100 g/L within 48 h postpartum were randomly allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose, or oral ferrous sulfate. Intravenous iron was given in one or two doses, while ferrous sulfate was given as two 80 mg tablets once daily. The primary outcome was maternal fatigue measured by the Multidimensional Fatigue Inventory (MFI) six weeks postpartum. Hemoglobin, ferritin, and transferrin saturation levels were analyzed as secondary outcomes. A Kruskal–Wallis test was used for group comparison (p < 0.05 significant). (3) Results: Three hundred women were included. The MFI score at six weeks postpartum did not differ between groups (median 38 (inter-quartile range (IQR) 29–47) in the ferric carboxymaltose group, median 34 (IQR 26–42) in the ferric derisomaltose group, and median 36 (IQR 25–47) in the ferrous sulfate group; p = 0.26). Participants receiving oral iron had lower levels of hemoglobin (135 (131–139) vs. 134 (129–139) vs. 131 (125–137) g/L; p = 0.008), ferritin (273 (198–377) vs. 187 (155–246) vs. 24 (17–37) µg/L; p < 0.001) and transferrin saturation (34 (28–38) vs. 30 (23–37) vs. 24 (17–37) %; p < 0.001) than those receiving ferric carboxymaltose or ferric derisomaltose. (4) Conclusions: Intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate had similar impacts on maternal fatigue at six weeks postpartum despite improved laboratory parameters in the intravenous groups.

florio® HAEMO is a hemophilia treatment monitoring application (app) offering activity tracking and wearable device connectivity. Its use might support everyday activities for people with hemophilia. The aim of this study was to evaluate user satisfaction, long-term usage and the impact on data entry when pairing a wearable with a hemophilia monitoring app. This is a follow-up of a two-part user survey conducted in Central Europe. People with hemophilia and parents/caregivers of children with hemophilia using florio HAEMO and who completed part one were invited to complete a second online questionnaire at least 4 months later. Fifty participants (83.3

Background: Congenital erythrocytosis (CE) is increasingly recognized as the cause of erythrocytosis in patients in whom polycythemia vera and secondary acquired causes have been excluded. The aim of our study was to determine possible genetic background in patients with idiopathic erythrocytosis. Methods: 40 patients with idiopathic erythrocytosis, referred to our institution in a 5-year period, were analyzed. We collected data on erythropoietin (Epo) levels, hemoglobin (Hgb), hematocrit (Hct), erythrocyte count, age, gender, past thrombotic events, concomitant diseases, and smoking status. CE was tested using next-generation sequencing (NGS), in the majority of patients also measurement of P50 and Hgb electrophoresis were performed. Patients with signs of iron overload were tested for genetic variants in the HFE gene. Results: The median patient age at analysis was 46.5 years (range 22-73), with 37 out of 40 being males (93 %). The median Hgb, Hct and red blood cells count were 180 g/L, 0.51, 5.985 x 10(12)/L in men and 171 g/L, 0.50 and 5.68 x 10(12)/L in women, respectively. Epo levels were decreased in three, increased in one patient and within the normal range in the rest (median 7.55 mIU/mL; range 2.90-19.50). Eight patients (20 %) smoked. 32 (80 %) were treated with low-dose aspirin, and 20 (50 %) underwent at least one phlebotomy. Thromboembolic events were recorded in 2 patients (5 %). P50 was measured in 20 out of 40 patients, and it was above 24 mm Hg (3.12 kPa) in all of them. Hemoglobin electrophoresis was performed in 73 % of patients, with no abnormal Hgb detected. Variants in the HFE gene were found in 8 out of 40 patients (20 %), but in only one patient the results were associated with an increased risk for hemochromatosis. Although no pathogenic variants for CE were detected by NGS, two variants of uncertain significance, namely EGLN1 (NM_022051.2):c.1072C>T (p.(Pro358Ser)) and EGLN1 (NM_022051.2):c.1124A>G (p.(Glu375Gly)) were identified as strong etiologic candidates. Conclusion: CE is an extremely rare condition. Genetic testing is advised in young individuals with a long-standing persistent erythrocytosis, possibly with a family history and after exclusion of more frequent secondary causes and polycytemia vera.

Pri hematoloških bolnikih obstaja veliko tveganje za razvoj podhranjenosti in s prehranjenostjo povezanih motenj (sarkopenija, krhkost). Prevalenca podhranjenosti se giblje med 30 % in 50 %. Zmanjšani vnos hrane, malabsorpcija hranil ter presnovne spremembe vodijo v slabše prehransko stanje oz. v podhranjenost bolnika, kar poveča tveganje za zaplete, okužbe, podaljša čas hospitalizacije, poveča stroške zdravljenja ter vpliva na slabše delovanje vseh organskih sistemov v telesu, slabšo kakovost življenja in slabši izid zdravljenja. Tega smo se vse bolj začeli zavedati na Kliničnem oddelku za hematologijo (KOH), UKC Ljubljana, kjer smo leta 2020 pričeli izvajati sofinancirani triletni program »Implementacija klinične poti prehranske podpore na terciarni ravni«, ki smo ga odobrili na javnem razpisu Ministrstva za zdravje (MZ). Z zaposlitvijo kliničnega dietetika na oddelku smo uvedli redno prehransko obravnavo bolnikov in oblikovati dokument klinične poti prehranske podpore. Klinični dietetik v obdobju od maja 2020 do junija 2022 opravil 1.593 individualnih prehranskih obravnav, od tega 377 prvih pregledov in 1.216 kontrolnih pregledov. Začeli smo tudi ambulantno obravnavo in izvedli 16 pregledov. Ob vsakem bolnišničnem zdravljenju bi bolnik moral imeti možnost zgodnjega prepoznavanja prehranske ogroženosti in dostopnost do zgodnjih prehranskih ukrepov, saj gre za ključne postopke preprečevanja velikih izgub puste mišične mase, za ohranjanje sposobnosti bolnika za izvajanje vsakodnevnih aktivnosti in za ohranjanje kakovosti življenja. Pomembno je, da je klinična pot prehranske obravnave dobro vpeljana in se izvaja na vseh oddelkih, saj le tako bolnikom lahko zagotovimo standardizirano, pravočasno, individualno prilagojeno ter multidisciplinarno obravnavo.

Objective: To compare intravenous ferric carboxymaltose, intravenous ferric derisomaltose and oral ferrous sulphate for treatment of postpartum anemia. Design: Single-center, open-label, randomized trial. Setting : Tertiary perinatal center. Population: Three-hundred women with postpartum anemia (hemoglobin < 100 g/L within 48-hours postpartum) were included between September 2020 and March 2022. Methods: Women were randomly allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose or oral ferrous sulphate. Intravenous iron was given in one or two doses, while ferrous sulphate as two 80 mg tablets once daily. Main outcome measures: Primary outcome was maternal fatigue measured by Multidimensional Fatigue Inventory (MFI) six weeks postpartum. Hemoglobin, ferritin and transferrin saturation levels were analyzed as secondary outcomes. Kruskal-Wallis test was used for group comparison (p<0.05 significant). Results: MFI score at six weeks postpartum did not differ between groups (median 38 (inter-quartile range (IQR) 20-74) in the ferric carboxymaltose, median 34 (IQR 20-70) in the ferric derisomaltose, and median 36 (IQR 20-72) in the ferrous sulphate group; p=0.26). Participants receiving oral iron had lower levels of hemoglobin (135 (119-150) vs 134 (113-157) vs 131 (125-137) g/L; p=0.008), ferritin (273 (198-377) vs 187 (155-246) vs 24 (17-37) µg/L; p<0.001) and transferrin saturation (34 (28–38) vs 30 (23–37) vs 24 (17-37) %; p<0.001) than those receiving ferric carboxymaltose or ferric derisomaltose. Conclusions: Intravenous ferric carboxymaltose, intravenous ferric derisomaltose and oral ferrous sulphate had similar impact on maternal fatigue at six weeks postpartum despite improved hematological laboratory parameters in the intravenous iron groups.

Eritrocitoza je stanje povečane skupne mase eritrocitov, ki se pojavi zaradi zelo heterogenih vzrokov. Bolniki so lahko brez simptomov ali pa imajo simptome in znake povečane viskoznosti krvi. Pri obravnavi bolnika z eritrocitozo uporabljamo diagnostični algoritem, ki omogoča opredelitev vzroka eritrocitoze in ustreznega zdravljenja. V prvem koraku potrjujemo absolutno eritrocitozo s koncentracijo hemoglobina (Hb) > 185 g/L in/ali hematokritom (Ht) > 0,52 za moške ter s Hb > 165 g/L in/ali Ht > 0,48 za ženske. V drugem koraku hkrati izključujemo pravo policitemijo in iščemo sekundarne pridobljene vzroke eritrocitoze, kot so bolezni pljuč, srca, ledvic, tumorji z neustreznim izločanjem eritropoetina. Omeniti velja, da je po smernicah Svetovne zdravstvene organizacije (SZO) diagnosticiranje prave policitemije ob ustrezni klinični sliki določeno že pri nižjih vrednostih, natančneje ob Hb > 165 g/L ali Ht > 0,49 za moške ter Hb > 160 g/L ali Ht > 0,48 za ženske. V tretjem koraku bolnike, ki nam jih ni uspelo opredeliti kljub natančnim diagnostičnim preiskavam, napotimo na genetsko testiranje za opredelitev prirojene eritrocitoze. Ko izključimo pravo policitemijo, sekundarno pridobljeno in prirojeno eritrocitozo, ostane skupina oseb s t. i. idiopatsko eritrocitozo. Priporočeno zdravljenje je odvisno od vzroka eritrocitoze, najpogosteje pa vključuje jemanje acetilsalicilne kisline in ustrezno zniževanje hematokrita z venepunkcijami ob rednih kontrolah krvne slike.

Prophylactic treatment with emicizumab has become an important and effective bleeding prevention for people with hemophilia A (PwHA). Perioperative management of PwHA using emicizumab prophylaxis is still challenging due to a lack of experience. Medical records of perioperative management and outcomes were reviewed, and data were collected for adult PwHA receiving emicizumab and undergoing surgical procedures between August 2019 and July 2022 at the University Medical Center Ljubljana. Twelve surgical procedures were performed in eight PwHA (one with FVIII inhibitors) while on emicizumab prophylaxis. Three minor procedures included cataract surgery, cystoscopic lithotripsy, and percutaneous coronary intervention. Nine major surgeries included four osteosyntheses, necrectomy of chronic osteomyelitis with new ankle arthrodesis, two below-knee amputations, total knee replacement, and placement of ventriculostomy after a spontaneous intraventricular hemorrhage. No major bleeds, thrombotic events or deaths, or new inhibitors appeared. Our real-world experience demonstrates that minor and major surgeries can be performed safely in PwHA on emicizumab prophylaxis. Additional data are needed to optimize dosing/duration of additional hemostatic agents in diverse invasive procedures and complex clinical situations.

INTRODUCTION:Hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) is complement-mediated due to the lack of complement inhibitors in the hemopoietic cell membranes, making complement inhibition the best approach to manage PNH. Three complement inhibitors are approved by the European Medicines Agency as targeted therapy for PNH: eculizumab and ravulizumab, two humanized monoclonal antibodies targeting the same complement 5 (C5) epitope, approved in 2007 and 2019, respectively, and the more recently approved cyclic peptide, the complement 3 (C3) inhibitor pegcetacoplan. Although national and international PNH treatment guidelines exist, they do not take into consideration the latest clinical trial evidence. Given the lack of evidence-based data for some clinical situations encountered in real life, we identified specific populations of patients who may benefit from switching to proximal C3 from terminal C5 inhibition. METHODS:The expert recommendations presented here were created using a Delphi-like process by a group of expert PNH specialists across Central Europe. Based on an initial advisory board meeting discussion, recommendations were prepared and reviewed as part of a Delphi survey to test agreement. RESULTS:Using a systematic approach, literature databases were searched for relevant studies, and 50 articles were reviewed by the experts and included as supporting evidence. CONCLUSION:Implementation of these recommendations uniformly across healthcare institutions will promote the best use of complement inhibition in managing PNH, and has the potential to positively impact patient outcomes in Central Europe and worldwide.

At the beginning of the COVID-19 (SARS-CoV-2) pandemic, it was not clear which patients would be most at risk, although it was soon realised that older age was a major risk factor and that there was a high incidence of coagulation disorders and thrombosis associated with COVID-19 infection.1 For clinicians managing PWH, and for the patients themselves, it was not known whether this would reduce, increase or have no impact in PWH. It soon became apparent that the risk of infection and severe disease in the general population was greater in older adults. Adults > 65 years of age represented 80% of hospitalizations and had a 23-fold greater risk of death than those < 65 years old.2 Published data regarding the incidence of COVID-19 infection in populations of people with haemophilia (PWH) is sparse (non-existent for populations of PWH B) and has only provided information for short time spans within the pandemic.3–5 Having suffered greatly from past viral infections (such as HIV and hepatitis C transmitted throughblood andbloodproducts), itwas speculated that the haemophilia community might be better prepared and willing to shield during the pandemic. The Age-related DeVelopments ANd Comorbidities in haemophilia (ADVANCE) Working Group is a European collaboration of over 20 Haemophilia Treatment Centres (HTCs) that focuses on the management of PWH aged ≥40 years. We conducted a survey within the ADVANCE HTC network that aimed to clarify the incidenceof serious adverseoutcomesofCOVID-19 inPWH aged≥40 years. A COVID-19 specific survey instrument was developed to record COVID-19 adverse outcomes (hospitalization, ICU admission and death) in PWH aged ≥40 years with haemophilia A or B at ADVANCE HTCs in Europe throughout the pandemic over a 24-month period (until 30April 2022). Patient numberswere recorded for themost serious outcome atmonth/year of first occurrence; for example, if patients died after being admitted the ICU, they were only included in the number of those who died from COVID-19. Information collected included date of hospital/ICU admission or death, age range, haemophilia type and severity, haemophilia treatment and major comorbidities linked to adverse COVID-19 outcomes. Aggregated data was provided by participating HTCs and therefore did not require Ethical Committee approval. Twenty ADVANCE HTCs participated in the study, comprising a total population of 3379 PWHA and 671 PWHB. Of the overall haemophilia A and B population, .9% (36/4050) suffered a serious outcome as a result of COVID-19 infection; .64% (27/4166) required hospital admission, .1% (5/4050) were admitted to the ICU and .1% (4/4050) died. Eleven of the participating 20 centres registered PWHAwith serious outcomes; serious outcomes for PWHBwere only reported in five centres. Overall, 22 (.6%) PWHA out of a total of 3379 PWHA treated at the ADVANCE HTCs required hospital admission for COVID-19; .1% (n = 5) required admission to the ICU; and < .1% (n=3) died due toCOVID-19, see Table 1.Of the 671PWHB treated at the ADVANCEHTCs, 5 (7.4%) required hospital admission, no patients were admitted to the ICU and one patient died. Of the patients with HA, 11 of the 22 who were hospitalised had ≥1 comorbidity associated with worse outcomes (eight patients had hypertension, two of whomalsohadobesity).Nearly all patientswithHAwhowereadmitted to the ICU or died had ≥1 comorbidity associated with worse outcomes; 4/5 patients admitted to the ICU and two of three patients who died had diabetes (Table 1). Most of the cases in people with either haemophilia A or B occurred early in the pandemic with no clear distinction according to haemophilia severity, age or geography (Table 2). The four reported deaths from a total population of 4050 patients cared for at the 20 participating HTCs (3/3379 for haemophilia A; 1/671 for haemophilia B) is low when compared with the total impact of the pandemic on the total population. Although there are not direct comparisons, in 2020, the WHO reported .6 million recorded deaths from COVID-19 (all ages) in Europe in 2020, resulting in a mortality rate of .13%.6,7 However, this is likely to be higher in the age group studies; US data to May 2020 showed an increase in the COVID-19 death rate from .4% in the 40–49 age group to 8.0% in the 70–79 age group.8 This is in accordance with a comprehensive review in which haemophilia was not identified as a condition presenting a high-risk for developing severe COVID-19.9 The World Federation of Hemophilia (WFH) concluded that there is no evidence to suggest that PWH, including those on prophylaxis with traditional replacement therapy or those with haemophilia A receiving emicizumab, are at increased risk for infection with COVID-19 or for more severe disease unless they have additional well-described comorbidities such as older age (> 65 years), pulmonary or cardiovascular disease, hypertension, obesity or diabetesmellitus.10 Whether the low rates of seriousCOVID-19 infection are due to some inherent degree of protection in PWH due to their coagulation state is beyond the remit of this study. However, the close interaction between PWH, their HTCs and organisations such as the WFH, the European Haemophilia Consortium (EHC), the

florio HAEMO is a new hemophilia treatment monitoring application consisting of a patient smartphone application (app) and a web‐based dashboard for healthcare professionals, providing several novel features, including activity tracking, wearable connectivity, kids and caregiver mode, and real‐time pharmacokinetic factor level estimation.

INTRODUCTION:As people with haemophilia (PWH) receive better treatment and live longer they are more likely to encounter cardiovascular disease (CVD) and other comorbidities. ESC guidelines for the acute management of patients presenting with acute coronary syndrome (ACS) are based on the non-haemophilia population.AIM:To review the guidelines and propose relevant adaptations for PWHA without inhibitors who are treated with prophylaxis and present with ACS.METHODS:As part of the ADVANCE Group, 20 European haemophilia experts used a modified Delphi approach to develop and gain consensus on proposed adaptations of the ESC guidelines for PWHA without inhibitors.RESULTS:Of the 32 Class I recommendations across both guidelines, adaptions were considered necessary and proposed for 15. The adaptions highlight the need to provide sufficient FVIII trough levels at the time of antithrombotic treatment in people with haemophilia A (HA) without inhibitors. Patients receiving emicizumab prophylaxis and requiring oral anticoagulation therapy or combined single antiplatelet plus oral anticoagulation therapy will require additional FVIII replacement therapy.CONCLUSION:In the absence of high-quality clinical evidence, the combined expert opinion used to develop these adaptions to the current ESC guidelines may help to guide clinicians in their treatment decisions when a PWHA presents with ACS.

Introduction The sixth angstrom land Islands Conference on von Willebrand disease (VWD) on the angstrom land Islands, Finland, was held from 20 to 22 September 2018. Aim The meeting brought together experts in the field of VWD from around the world to share the latest advances and knowledge in VWD. Results and discussion The topics covered both clinical aspects of disease management, and biochemical and laboratory insights into the disease. The clinical topics discussed included epidemiology, diagnosis and treatment of VWD in different countries, management of children with VWD, bleeding control during surgery, specific considerations for the management of type 3 VWD and bleeding control in women with VWD. Current approaches to the management of acquired von Willebrand syndrome were also discussed. Despite significant advances in the understanding and therapeutic options for VWD, there remain many challenges to be overcome in order to optimise patient care. In comparison with haemophilia A, there are very few registries of VWD patients, which would be a valuable source of data on the condition and its management. VWD is still underdiagnosed, and many patients suffer recurrent or severe bleeding that could be prevented. Awareness of VWD among healthcare practitioners, including non-haematologists, should be improved to allow timely diagnosis and intervention. Diagnosis remains challenging, and the development of fast, simple assays may help to facilitate accurate and rapid diagnosis of VWD.

Prophylaxis with factor VIII (FVIII) concentrates is the mainstay of treatment for haemophilia A; however, patients’ perceptions of treatment can negatively affect compliance and treatment outcomes. The aim of this study was to explore treatment limitations and satisfaction in haemophilia A from the patient’s perspective, with a focus on product storage characteristics. Patients with haemophilia A in Slovenia completed a survey focussing on treatment satisfaction and understanding of FVIII product storage conditions. Patient satisfaction with product storage was analysed using the Kano model. There were 63 survey respondents in total (note: not all patients answered all questions). Most patients were aged > 18 years (93.6

The next frontier in hemophilia A management has arrived. However, questions remain regarding the broader applicability of new and emerging hemophilia A therapies, such as the long-term safety and efficacy of non-factor therapies and optimal regimens for individual patients. With an ever-evolving clinical landscape, it is imperative for physicians to understand how available and future hemophilia A therapies could potentially be integrated into real-life clinical practice to improve patient outcomes. Against this background, nine hemophilia experts from Central European countries participated in a pre-advisory board meeting survey. The survey comprised 11 multiple-choice questions about current treatment practices and future factor and non-factor replacement therapies. The survey questions were developed to reflect current unmet needs in hemophilia management reflected in the literature. The experts also took part in a follow-up advisory board meeting to discuss the most important unmet needs for hemophilia management as well as the pre-meeting survey results. All experts highlighted the challenge of maintaining optimal trough levels with prophylaxis as their most pressing concern. Targeting trough levels of ≥30–50 IU/L or even higher to achieve less bleeding was highlighted as their preferred strategy. However, the experts had an equal opinion on how this could be achieved (i.e., more efficacious non-factor therapies or factor therapy offering broader personalization possibilities such as targeting trough levels to individual pharmacokinetic data). In summary, our study favors personalized prophylaxis to individual pharmacokinetic data rather than a "one-size-fits-all" approach to hemophilia A management to maintain optimal trough levels for individual patients.

Ana Butković1 , Martina Bago2 , Irena Preloznik Zupan3,4, Barbara Faganel Kotnik3 , Ivana Prga Borojević2 , Vesna Bačić Vrca5,6, Silva Zupančić Šalek7,8 1 Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia 2 Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia 3 University Medical Center Ljubljana, Ljubljana, Slovenia 4 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia 5 Clinical Hospital Dubrava, Zagreb, Croatia 6 Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia 7 University Hospital Centre Zagreb, Zagreb, Croatia 8 Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia