Background and Objectives: Tibial tuberosity avulsion fractures are rare injuries in pediatric athletes, with limited data on the potential role of an elevated body mass index (BMI) as a risk factor. Previous studies have primarily focused on age, sex, and sport type, but the association between BMI and these injuries remains underexplored. Tibial tuberosity avulsion fractures are rare injuries predominantly affecting adolescent boys during sports activities involving strong quadriceps contractions. This pilot study aimed to analyze the epidemiological and anthropometric characteristics of patients with these fractures, including the distribution of injury mechanisms and the fracture types, to test whether the prevalence of overweight/obesity among cases exceeded national population benchmarks, and to describe the associated clinical outcomes. Materials and Methods: A retrospective analysis was conducted on medical records and radiographs of patients under the age of 18 treated between 2017 and 2024. The data collected included demographic and anthropometric characteristics, injury mechanisms, fracture classification, treatment methods, complications, and outcomes. The patients were categorized as normal weight (<85th percentile) or overweight/obese (≥85th percentile). The primary outcome was whether the prevalence of overweight/obesity among the cases exceeded national pediatric benchmarks. Formal sample size and power analyses were performed to guide future research. Results: Twenty-one patients met the inclusion criteria, with a mean age of 13.7 years; 95.2% were male. Soccer was the most common injury mechanism (52.4%), followed by athletics and running. The predominant fracture type was Ogden IVb (38.1%). Overweight/obesity was present in 52.4% of the patients, significantly higher than the national benchmarks. An open reduction and internal fixation was performed in 90.5% of the cases, with a mean follow-up of 14.6 months (range: 6–36). Complications occurred in 14.3% overall, all within the overweight/obese group (27.3%). Conclusions: This pilot retrospective study suggests a potential link between an elevated BMI and tibial tuberosity avulsion fractures, with overweight/obesity being significantly more prevalent in affected patients than in the general pediatric population. These exploratory findings warrant confirmation in larger, adequately powered studies, and emphasize the importance of weight management and tailored sports activities as potential preventive strategies. An early diagnosis, timely surgical intervention, and adequate rehabilitation are critical for achieving optimal functional recovery.

Background: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Guidelines favor direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs), but real-world Croatian data are scarce. Methods: A prospective dual-center registry included 773 patients discharged with acute PE between 2013 and 2024. Clinical, laboratory, and socioeconomic data were collected. The primary outcome was all-cause mortality; secondary outcomes were recurrent venous thromboembolism (VTE) and major bleeding. Results: DOAC users were younger, with higher education and income, than VKA or heparin patients. Median follow-up was 1106 days. Mortality reached 60.3% with VKA, 26.0% with DOAC, and 84.1% with heparin (p < 0.001). VTE recurrence did not differ significantly. Major bleeding occurred in 9.3% of VKA versus 2.9% of DOAC patients (p = 0.003). Adjusted analysis showed a lower mortality risk with DOAC versus VKA (HR 0.62, 95% CI 0.48–0.80, p < 0.001), while heparin predicted higher mortality (HR 3.63, 95% CI 2.54–5.21, p < 0.001). Higher PESI class independently increased mortality and recurrence. Conclusion: In the first Croatian PE cohort, DOACs were linked to reduced mortality and bleeding risk compared with VKAs, with similar recurrence. Clinical, socioeconomic, and policy factors strongly influenced prescribing patterns and outcomes.

To investigate the incidence, type, severity and time of occurence of various postoperative complications in NICU patients undergoing surgery under general anesthesia and to determinate the preoperative, intraoperative and postoperative risk factors which can predicte their appearance. We retrospectively analyzed the postoperative complications which occurred in neonatal/preterm patients with congenital or acquired surgical condition and whose surgery under general anesthesia was performed during hospitalisation in tertiary level NICU centre Osijek during five years period from January 2015 to December 2019. Patients with congenital diaphragmatic hernia, esophageal atresia and congenital hearth disease were excluded because they were for treatment transported in higher, level IV NICU Centre, Zagreb. Complications were recorded until the 30 th postoperative day. Minor complications, defined as any deviations from normal postoperative course with or without administration of pharmacological treatment, are the most common ( infections, metabolic, hematological disturbances ). About a quarter of patients had severe complications, defined with uni or multiorgan dysfunction, need for reoperation and death, which is still high. Predictor factors for severe postoperative complications were very low birth weight ( BW<1500 g), GA < 32 weeks and abdominal operations. This single centre retrospective analyses show that very low gestation age, very low birth weight and abdominal surgery present risk factors for severe postoperative complications in our NICU patients.

Background/Objectives: Overweight and obesity in early childhood is a serious public health problem as in most cases it persists into adulthood and significantly affects the quality of life. The aim of this study was to investigate the mechanisms that trigger extracellular matrix (ECM) remodeling in the subcutaneous (SAT) and visceral (VAT) adipose tissue of male children in relation to their body weight. Methods: During elective abdominal surgery, SAT and VAT were acquired from 75 male subjects undergoing hernia repair (inguinal herniorrhaphy by Ferguson) or orchidopexy. Based on their Z-score, subjects were separated into two groups. The morphometry of both adipose tissue compartments was assessed after hematoxylin and eosin histological staining, immunohistochemistry to quantify CD163⁺ cells and the number of crown-like structures (CLSs), and real-time polymerase chain reaction to assess the relative gene expression for collagen VI subtype alpha 3 (COL6α3). Results: Obese and overweight individuals were found to have higher numbers of CD163⁺ cells, greater numbers of CLSs in VAT and SAT, and a higher expression of COL6α3 in both compartments. Conclusions: Obesity in childhood may lead to increased COL6α3 gene expression and promote the activation of macrophage polarization, compromise the structural integrity of the ECM, and thus influence the development of inflammatory processes.