Dario Leskur

In this review we present a comprehensive overview of the published literature related to the use of Hybrid Cooperative Complexes (HCCs) of low- and high-molecular-weight hyaluronic acid in aesthetic medicine. HCCs have been developed to overcome the shortcomings of traditional hyaluronic based dermal fillers. Specifically, HCCs deliver both high- and low-molecular-weight hyaluronic acid (HA), maximizing their complementary effects. They are biocompatible and formulated without the addition of foreign agents. Cooperative hydrogen bonds extend their durability and make them more resistant to hyaluronidase compared to high-molecular-weight HA. The rheological properties of HCC formulations allow for easy exertion through the needle and diffusion in the tissue compared to high-molecular-weight HA alone. In vitro studies have shown that HCCs improve vitality of fibroblasts, keratinocytes and adipocytes, and stimulate production of collagen and elastin. Studies on scratched co-cultures of immortalized human keratinocytes and human dermal fibroblasts demonstrated that HCCs accelerate wound closure. Furthermore, HCCs delayed senescence of mesenchymal stromal cells to a greater extent than high-molecular-weight HA or low-molecular-weight HA alone. Clinical studies show a reduction in wrinkle severity, improvement in skin roughness profile and reduction of skin laxity with pronounced improvement in superficial skin hydration lasting up to 6 months. The formulation intended for restoration of fat compartments demonstrated reduction in cheek volume loss and improvement in skin thickness. Subjects report moderate-to-high satisfaction and are likely to recommend the treatment. Limitations of the published studies are also addressed, as well as reported adverse events and published safety data.

Background: Clinical experience with semaglutide in patients with type 2 diabetes mellitus shows that its benefits extend far beyond glucose regulation. This study examines whether this drug is indeed popular among the Croatian population and explores whether factors such as gender or proximity to the healthcare sector influence its potential use, attitudes toward weight loss, and knowledge regarding its application and possible adverse effects. Methods: This was a cross-sectional population study. In this study we focused on the brand name Ozempic^® for semaglutide as it is the most commonly searched term for semaglutide. Results: The study included 290 participants, most of who were women (N = 243, 83.8%). As many as 214 (73.8%) people stated they had heard of Ozempic^®; however, there was no significant difference in whether people had heard of Ozempic^® if they had type 2 diabetes mellitus (p = 0.415). In total, 23.4% of people stated they knew someone who took Ozempic^®. Women were significantly more likely to feel pressure about their appearance than men, with 51.1% of men reporting no pressure at all compared to only 39.9% of women (p = 0.015). A majority of participants agreed that social media strongly affects perception on the use of medications for weight loss (73.8%). Individuals with a family member in the healthcare field were significantly more informed about the possible adverse reactions of semaglutide compared to those without such a connection. Among participants without a healthcare professional in the family, 75.0% reported being unaware of potential adverse effects, compared to 47.9% of those with a family member in healthcare. Moreover, participants with a healthcare professional in the family were more likely to know the correct route of administration for Ozempic^® (68.1% vs. 54.6%, p = 0.025); Conclusions: The results of this study show that three-quarters of people had heard of Ozempic^®, regardless of whether they had an indication for its use or not. In addition, the results indicate that although both men and women share satisfaction with their bodies, women feel more pressured by societal expectations related to their appearance.

Down syndrome (DS), the most common survivable autosomal aneuploidy, is associated with a high prevalence of congenital anomalies of the kidney and urinary tract (CAKUT), significantly increasing the risk of chronic kidney disease (CKD). This review examines the diversity of CAKUT phenotypes reported in individuals with DS, focusing on anomalies affecting the kidney, ureter, bladder, and urethra. According to available literature, hydronephrosis is the most common renal anomaly, often secondary to other CAKUT phenotypes, followed by renal hypoplasia and glomerulocystic disease. Furthermore, obstructive uropathies are also frequent but usually lack detailed characterization in the literature. Key features of CAKUT in DS, including reduced kidney size, renal cystic diseases, acquired glomerulopathies, reduced nephron number, and immature glomeruli heighten the risk of CKD. Also, early detection of lower urinary tract dysfunction (LUTD) is critical to prevent progressive upper urinary tract damage and CKD. Despite the prevalence of CAKUT in DS, reported between 0.22% and 21.16%, there is a lack of standardized diagnostic criteria, consistent terminology, and extended follow-up studies. Systematic screening from infancy, including regular renal monitoring via urinalysis and ultrasound, plays a critical role in the timely diagnosis and intervention of CAKUT. To further enhance diagnostic accuracy and develop effective therapeutic strategies, increased awareness and focused research into the genetic factors underlying these anomalies are essential. Moreover, a multidisciplinary approach is indispensable for managing CAKUT and its associated complications, ultimately ensuring better long-term outcomes and an improved quality of life for individuals with DS.

Pharmacists have been recognized as the most accessible healthcare professionals, and research has been carried out on expanded pharmacy services they could provide. Additional pharmacy services are a cost-effective way to prevent medication errors, reduce the number of drug-related problems, and prevent chronic disease progression. Therefore, this study aims to evaluate pharmacy service users’ views of expanded pharmacy services in Croatia. This study included 745 participants. Patients who have a healthcare professional in their family more frequently knew of the existence of e-health records and the option to share it with their pharmacists (134, 56.3% vs. 229, 45.2%, p = 0.005), while persons that have chronic illness more frequently visit the same pharmacy (176, 77.9% vs. 178, 34.3%, p < 0.001). Participants are confident that pharmacists can provide screening services and education on inhaler usage; however, only around 60% agreed that pharmacists can independently lead therapy adjustment, medication substitution, or monitor therapy based on test results. Our findings should be supported with projects evaluating the cost-effectiveness of such services as they would be accepted by a greater number of pharmacy service users if covered by the national health insurer.

Despite technological advancements, healthcare professionals must actively prioritize patient safety. Reporting adverse drug reactions is a critical aspect of this responsibility, and the most accessible healthcare providers, community pharmacists, and pharmacy technicians play a key role. Therefore, this study assessed their knowledge and practices regarding adverse drug reaction reporting in Croatia. A total of 180 participants were included. Pharmacists demonstrated significantly better knowledge than technicians (94.78 vs. 73.97, p = 0.024). Chronic medication users also showed greater understanding compared to non-users (104.96 vs. 85.39, p = 0.021). Knowledge improved with the number of adverse drug reactions reported, and most participants (72.78%) had reported adverse drug reactions. Pharmacists were 83.60% more likely to report adverse drug reactions than technicians (p < 0.001). These findings reveal a gap in pharmacy technicians’ integration into pharmacovigilance, underscoring a need to strengthen their role in adverse drug reaction reporting and patient safety.

Background/Objectives: Schizophrenia is a chronic psychiatric disorder usually managed with antipsychotics, which can cause adverse drug reactions (ADRs) that may impact patients’ attitudes toward their treatment, as well as treatment adherence. This study aimed to assess the influence of ADRs and other factors on treatment attitudes among female patients with schizophrenia. Methods: A cross-sectional study was conducted at the Vrapče Psychiatry Clinic with 109 female schizophrenia patients. The DAI-10 (Drug Attitude Inventory) questionnaire was used to assess attitudes toward treatment. Data on their demographic details, pharmacotherapy, ADR occurrence and ADR reporting rates were collected. Multiple regression analyses were used to identify predictors of DAI-10 scores. Results: Patients using more medications and those experiencing ADRs had lower DAI-10 scores, indicating less favorable attitudes (F (2, 106) = 7.364, p = 0.001, R² = 0.105). ADRs, primarily extrapyramidal symptoms and weight gain, were reported by 43.1% of patients; however, only one patient formally reported them. First-generation antipsychotics were associated with a higher prevalence of ADRs (χ² = 4.969, df = 1, p = 0.022). Conclusion: Negative experiences with ADRs significantly impact patients’ attitudes and adherence. Low ADR reporting rates highlight the need for better pharmacovigilance education. Enhancing patient awareness may foster more positive attitudes and adherence, potentially improving patient outcomes.

The literature describes niacinamide, but also postbiotics and peptides, as ingredients that improve skin barrier function, but also affect melanin and sebum levels in individuals. However, the combined effects of these ingredients in a single cosmetic serum have not been sufficiently investigated. Therefore, the aim of this randomized controlled study, conducted at the University of Split School of Medicine (Croatia), was to evaluate the effects of cosmetic products containing these active ingredients. This study was registered with ClinicalTrials.gov (NCT06189105) and has been completed. Primary outcomes were the levels of trans epidermal water loss, skin hydration, erythema, melanin, and sebum, all measured in 25 healthy Caucasian participants. Significant differences between hydration levels were observed at week 4 (61.0 ± 11.2 vs. 68.6 ± 13.3 AU, control and intervention). Moreover, a significant decrease in erythema values from the first to last measurement in the intervention group was observed, (379.9 ± 106.8 vs. 333.6 ± 73.5 AU, baseline values and week 4, intervention group). Interestingly, both the increase in skin hydration levels and the decrease in skin erythema after niacinamide serum application were significant in study participants who did not use sun protection products. It is well known that ultraviolet radiation has detrimental effects on human skin, and our results suggest that niacinamide could help counteract these effects.

Food–drug interactions (FDIs) are pharmacokinetic or pharmacodynamic changes in drug effects caused by the presence of specific foods. To identify and prevent FDIs, pharmacists, alongside other healthcare professionals, should possess a certain level of knowledge. This study aimed to assess knowledge of FDIs among Croatian pharmacists. A total of 206 participants were included in this cross-sectional study. The median knowledge score among Croatian pharmacists was 69.44%, with an interquartile range of 19.44. Croatian pharmacists most commonly recognized FDIs involving theophylline, warfarin, and tetracycline, while the lowest rate of correct answers was observed with digoxin interactions. Future studies should evaluate pharmacists’ clinical practice concerning FDIs. Additionally, more research is needed to develop educational programs on this topic, either at the university level or for continuing education.

With the rapid development of the pharmaceutical industry and constant growth of drug usage, ecopharmacovigilance (EPV) has emerged as a way of coping with and minimizing the effects that drugs have on the environment. EPV concerns and describes unwanted effects that the use of a specific drug could have on the environment. The US, EU and Cananda are the improving position of EPV, both in legislation and practice. EPV requires further development as previous studies have shown that neither the general population nor healthcare professionals have enough knowledge about the subject. Improving awareness and knowledge about this topic is a key task for the future of EPV. The main objective was to determine students’ level of knowledge about ecopharmacovigilance and to examine ways of storing and disposing of unused and expired drugs. Students’ knowledge and habits were examined by a previously published survey. The survey contains twenty questions divided into three parts and the possibility of writing an additional note. There was no difference in the level of knowledge between the students of different studies. Also, students who had a family member working as healthcare professional did not show a higher level of knowledge compared to the others. Pharmacy students had a greater intention to educate their environment about EPV when compared to students of the other studies. This is in the line with a previous study which showed that the general public expects that pharmacists and physicians educate them about EPV. Medicine and dental medicine students will become prescribers after finishing their studies, and as such, they should be informed about eco-directed sustainable prescribing (EDSP) as part of an EPV strategy. More than half of the participants reported good adherence to prescribers’ instruction, which decreased the amount of unused drugs. Most of the students found that the drug expiration date was legible, but they did not check it often. In comparison with similar studies, Croatian students had more knowledge and better practices concerning EPV and drug disposal. Structured learning strategies and curriculum implementation for EPV are much needed for further raising awareness about the subject among healthcare professionals and the public.

Contact dermatitis is a common inflammatory skin disease that often requires prescription therapy and is associated with adverse reactions. Omega fatty acids have been recognized for their anti-inflammatory effect and could serve as a safer option in contact dermatitis treatment. Therefore, the aim of this randomized controlled study, conducted at the University of Split School of Medicine, was to evaluate the efficacy and safety of omega fatty acids containing topical products in an experimental model of irritant contact dermatitis. This study was registered with ClinicalTrials (NCT06189144) and is closed. The primary outcomes were levels of transepidermal water loss, skin hydration, and skin erythema, all measured using an MPA6 device in 25 healthy participants. A significant difference was observed between the hydration values of the intervention (45.7 ± 12.4) and control groups (31.6 ± 12.3) (p < 0.05) on final measurements (day 10). Moreover, higher erythema levels were observed in participants who were smokers, compared to non-smokers. No adverse drug reactions were observed during the study period. In conclusion, omega fatty acids topical product use shows promise in the treatment of irritant contact dermatitis, and further studies are needed to evaluate efficacy in a larger sample of patients.