Context: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic marker in several types of malignant tumors. The prognostic value of HALP score in diffuse large B-cell lymphoma (DLBCL) remains unknown. Aim: We aimed to determine the prognostic value of baseline HALP score in DLBCL patients. Subjects and Methods: We retrospectively analyzed data from 153 newly diagnosed DLBCL patients treated with R-CHOP or R-CHOP-like regimens at our university hospital center. We evaluated the significance of HALP score as a predictor of response to treatment, overall survival (OS), and event-free survival (EFS). Results: The median follow-up time for all patients was 40 months. Lower HALP score was found in patients with advanced stages of disease (P = 0.005) and in those with poor response to therapy (P = 0.004). Patients with a HALP score ≤20.8 had significantly worse 5-year OS (47.3% vs. 79.5%, P < 0.001) and 5-year EFS (40.6% vs. 76.7%, P < 0.001). These observations remained statistically significant in the multivariate Cox regression models independently of International Prognostic Index (IPI) and age. Conclusion: Lower HALP is associated with unfavorable clinicopathological characteristics of DLBCL and seems to be an IPI independent negative prognostic factor. HALP score can be easily and inexpensively applied to timely recognize DLBCL patients under higher risk of unwanted outcomes in everyday clinical practice.

Background Following the increased internet use due to the COVID-19 pandemic there have been concerns regarding an elevated risk of developing internet addiction (IA). University students are especially prone to develop IA and risk factors for its development in this population during pandemics are not fully investigated nor understood. This study aimed to identify possible risk factors of IA in the studied population during the ongoing pandemic and to compare it with risk factors in pre-pandemic time. Methods In April 2016 and April 2022 a validated, anonymous questionnaire that contained questions regarding demographic data, as well as Young's Internet Addiction Test, was self-administered to a cross-faculty representative student sample of the University of Osijek, Croatia. Results The study included 1602 university students median age of 21 years (interquartile range 20-22), 34.5% males, and 65.5% females. There was no statistically significant difference in the median age between the two student samples (p = 0.234). The main reason for internet use (social networking and entertainment and online gaming) was considered the significant risk factor for IA in a studied population in pre-pandemic time (the year 2016) and pandemic time (the year 2022) (p &lt; 0.001). In pre-pandemic time the IA was more frequent in males (p = 0.046) while the difference in IA prevalence between sexes did not exist during pandemics (p = 0.160). During pandemics, the students who did not work during their study had higher proportions of IA (p = 0.021) while there was no difference in IA prevalence among students regarding their working status during the study in pre-pandemic time (p = 0.251). Conclusions During the COVID-19 pandemic working status of students has been recognized as the new risk factor for IA in the Croatian university students population. Further studies are needed to identify other possible risk factors for IA in the studied population during pandemics. Key messages

Background Excessive caffeine intake combined with increasing numbers and availability of caffeine-containing products in modern societies are causes for concern. University students may be at increased risk of excessive caffeine consumption due to seeking caffeinated products with well-known wakefulness effects and cognitive benefits. This study aimed to highlight the characteristics of caffeine consumption among Croatian university students. Methods This cross-sectional questionnaire study was conducted from May 2020 to April 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data about caffeine consumption habits, and its sources was self-administered via an online link to a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. Results The study sample included 1197 subjects with, median age of 22 years (interquartile range 21-24), 24.1% males, and 75.9% females. The median caffeine intake was 512.0 mg/day (interquartile range 228.0-972.0). The higher caffeine intake was observed in part-time students (p = 0.026), students who were preparing for exams during the participation in this study (p = 0.010), and students who smoked cigarettes (p &lt; 0.001). There was a poor positive correlation between the amount of caffeine intake and academic success connected with caffeine consumption (rs = 0.225; p &lt; 0.001). There were fair positive correlations between the amount of caffeine intake and caffeine consumption because of the avoidance of the withdrawal symptoms (rs = 0.490; p &lt; 0.001) and between the amount of caffeine intake and knowledge of the impact of caffeine consumption on the occurrence of social conflicts (rs = 0.349; p &lt; 0.001). Conclusions The study revealed high caffeine intake among Croatian university students. The implementation of specific preventive measures directed toward the protection of students’ health from adverse health effects related to caffeine is needed. Key messages • Croatian university students have displayed high caffeine intake in their everyday life. • There is a need for the implementation of specific preventive measures directed toward the protection of students’ health from adverse health effects related to caffeine consumption.

This is the first report on a case of perindopril/amlodipine-induced thrombotic microangiopathy (TMA) syndrome. A 48-year-old female was admitted complaining of nettle rash all over the body, bloody urine, and weakness shortly after starting antihypertensive therapy with perindopril/amlodipine. Shortly thereafter, she developed pronounced hemiparesis, somnolence, and sensorimotor aphasia. Laboratory findings were compatible with microangiopathic hemolytic anemia and thrombocytopenia. She was diagnosed with TMA. Cessation of perindopril/amlodipine therapy and treatment with plasma exchange and systemic corticosteroids resulted in full recovery. Very seldom perindopril/amlodipine may cause hematologic abnormalities, probably through an immunological mechanism, but there were no reports of causing TMA so far. In our case, the symptoms began shortly after the start of perindopril/amlodipine use. The clinical course of TMA in the case was compatible with TMA related to an acute, immune-mediated drug reaction. The most important thing is to promptly recognize TMA and its induction by a drug because distinctive treatment and cessation of the suspected drug can prevent severe outcome, as it was avoided in our patient.

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