Lumbar radicular pain is a major public health and economic problem. It is among the most common reasons for professional disability. The most common cause of lumbar radicular pain is intervertebral disc herniation, which results from degenerative disc changes. The dominant pain mechanisms are direct pressure of the hernia on the nerve root and the local inflammatory process triggered by intervertebral disc herniation. Treatment of lumbar radicular pain includes conservative, minimally invasive, and surgical treatment. The number of minimally invasive procedures is constantly increasing, and among these methods is epidural administration of steroids and local anesthetic through a transforaminal approach (ESI TF). The aim of this research was to examine the effectiveness of ESI TF as measured by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), depending on whether there is contact between the herniated intervertebral disc and the nerve root. In both groups of participants, there was a significant reduction in pain intensity, but there was no significant difference between the groups. In the group with disc herniation and nerve root contact, the only significant reduction was in pain intensity (p < 0.001). There were no significant differences in measurements in other domains of the ODI. In the group without disc herniation and nerve contact, there was a significant difference in all domains except weight lifting. In the group without contact, there was significant improvement after 1 month (p = 0.001) and 3 months (p < 0.001) according to the ODI, while there was no significant improvement in the group with contact. In addition, there were no significant differences in the distribution of participants based on the ODI and whether disc herniation and nerve contact was present. The results suggest that transforaminal epidural administration of steroids is a clinically effective method for treating lumbar radicular pain caused by intervertebral disc herniation in people with and without nerve root contact, without significant differences.

Introduction: Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients.Material and methods: A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days.Results: Patients with gram(–) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(–) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692–0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541–0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(–) BC. Age and high serum CRP levels were significant predictors of poor outcomes.Conclusions: PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.

Lumbar radicular pain is defined as pain in the lumbar spine with propagation to the lower extremities. It is a major public health, social and economic problem in the modern society, and is one of the most common reasons for visits to the doctor. Lumbar radicular pain is often the reason for absenteeism and occupational disabilities. It is estimated that about 70-85% of the world’s population have experienced lumbar spine pain once in their lifetime. There are numerous modalities for the treatment of lumbar radicular pain, ranging from pharmacotherapy to surgery. In order to avoid systemic side effects of analgesics, anaesthesia and long-term and extensive surgery, minimally invasive procedures are increasingly used for treating lumbar radicular pain. Percutaneous laser disc decompression (PLDD) is one such procedure, first performed by Dr Choy and Dr Ascher in 1986. PLDD is an outpatient surgery performed under local anaesthesia, its success rate is high and the complication rate is low. This method therefore certainly attracts the attention of clinicians dealing with this issue.

Objective: To examine physicians’ attitudes on initiating and terminating cardiopulmonary resuscitation (CPR) in terminally ill patients and to explore how these attitudes vary by demographic and professional characteristics. Methods: This cross-sectional study included 129 medical specialists from 14 departments of the University Hospital Centre Osijek, Croatia (2021). Data were collected using a 31- item questionnaire covering demographics, professional experience, attitudes toward CPR, knowledge of survival outcomes, and responses to six clinical scenarios. Results: More than half of respondents (55.1% and 69.8%, respectively) supported withholding or early termination of CPR in patients with incurable illness, primarily citing false hope, prolonged suffering, and resource overuse. Despite these views, over half indicated they would initiate CPR in all six hypothetical scenarios, including patients with advanced malignancy and multiple comorbidities. ICU admission following successful CPR was favoured by 52% of respondents, even in terminal cases, although knowledge of outcomes and resources was limited: only 45% correctly identified survival rates after in-hospital cardiac arrest, and fewer than 40% knew ICU bed capacity. Surgeons were less likely than non-surgeons to regard CPR in terminal patients as futile (P<0.05). Conclusion: Our findings indicate that structured ethics education and clear institutional guidelines are essential to improve decision-making in end-of-life care in Croatia.

Background and Objectives: Simultaneous bilateral scapular fractures are exceptionally rare injuries and are most commonly associated with high-energy trauma, convulsions, or electrical injury. Their occurrence following low-energy trauma is extremely uncommon. This study aimed to conduct a scoping review of the literature on simultaneous bilateral scapular fractures, with emphasis on demographic characteristics, mechanisms of injury, fracture patterns, treatment strategies, and clinical outcomes. To provide clinical context, the findings are illustrated by a case of a 43-year-old previously healthy recreational athlete who sustained simultaneous bilateral scapular fractures after a low-energy fall directly onto the back. Materials and Methods: A scoping review of the literature was conducted in accordance with PRISMA-ScR guidelines using the PubMed/MEDLINE and Scopus databases. Studies reporting simultaneous bilateral scapular fractures were identified and analyzed with respect to demographic characteristics, mechanisms of injury, fracture patterns, treatment modalities, and outcomes. Results: Thirty-seven studies published between 1946 and 2025 were included, comprising a total of 43 patients. Most cases resulted from high-energy trauma (41.9%), convulsions (25.6%), or electrical injury (16.3%). Low-energy trauma and spontaneous fractures were rare. The scapular body was the most commonly involved anatomical region. Conservative treatment predominated and was generally associated with favorable functional outcomes, while surgical intervention was reserved for displaced or intra-articular fractures. The illustrative case involved bilateral comminuted extra-articular fractures of the scapular bodies and spines without associated injuries and was managed conservatively, resulting in complete fracture healing and full, painless shoulder range of motion. Conclusions: The findings of this scoping review, illustrated by the representative clinical case, indicate that simultaneous bilateral scapular fractures may occur even after low-energy trauma in otherwise healthy individuals. Bilaterality alone should not be interpreted as an independent indication for surgical treatment when fractures are stable and minimally displaced. A high index of clinical suspicion and appropriate radiological evaluation are therefore warranted, particularly in emergency and trauma settings, in order to avoid missed or delayed diagnosis, even in cases with seemingly benign mechanisms of injury.

Background: Debridement, antibiotics, and implant retention (DAIR) is an established treatment for early periprosthetic joint infection (PJI) following hip arthroplasty; however, reported success rates remain highly variable, particularly in patients with significant comorbidities, fracture-related arthroplasty, or resistant microorganisms. Augmentation of standard DAIR with structured local antimicrobial strategies may improve infection control but remains insufficiently standardized and evaluated. Methods: This retrospective single-center case series evaluated outcomes of a standardized multimodal DAIR-based strategy, the Mursa protocol, in 16 consecutive patients treated for early hip PJI between 2022 and 2025. PJI was diagnosed according to European Bone and Joint Infection Society criteria. The treatment included radical surgical debridement and exchange of mobile components with sequential intraoperative antiseptic microdebridement using povidone–iodine and hypochlorous/hypochlorite solution, followed by postoperative drain-based local antimicrobial irrigation and systemic antibiotic therapy. Treatment success was defined as sustained infection eradication with implant retention, absence of clinical and radiological signs of infection, no requirement for long-term suppressive antibiotics, and no infection-related mortality at a minimum one-year follow-up. Results: The cohort was clinically complex, with a predominance of arthroplasty procedures performed for fracture-related indications (11/16), a high comorbidity burden (median Charlson Comorbidity Index 5), revision arthroplasty in four patients, and a high rate of resistant or polymicrobial infections. At final follow-up, 15 of 16 patients (93.8%) achieved treatment success. One patient required implant removal due to persistent polymicrobial infection. No irrigation-related complications, wound-healing problems, or clinically relevant systemic toxicity were observed. Conclusions: In this high-risk cohort, a structured multimodal DAIR protocol incorporating sequential antiseptic microdebridement and postoperative local antimicrobial irrigation was feasible, safe, and associated with encouraging infection control. However, these findings should be interpreted as hypothesis-generating, and further prospective comparative studies are required to validate the protocol.