Acta medica academica最新文献

Objective: This study presents the personal experience of a 19-year-old student who fled the war in Ukraine, journeyed across multiple countries, and ultimately enrolled in a university psychology program in Croatia.

Methods: A collaborative autoethnographic approach was employed to explore the student's experience as a war refugee, traversing Europe, and beginning university life in a foreign country. Data were collected through the student's reflective writing. A thematic analysis was conducted to identify key emotional and experiential themes.

Results: The narrative provides a comprehensive account of the student's emotional and physical journey, beginning with the onset of war in Ukraine and progressing through her travels in Romania, Bulgaria, the United Kingdom, and Ireland, before settling in Croatia. Thematic analysis revealed a complex interaction of emotions, family dynamics, community support, and the challenges of adapting to a new environment. Despite numerous obstacles, the student and her family remained hopeful and proactive in seeking a better future. The narrative also underscores the therapeutic impact of sharing personal stories.

Conclusions: The findings highlight storytelling as a powerful medium for personal healing. Moreover, the study emphasizes the collective importance of individual narratives in fostering empathy, understanding, and connection across diverse communities. The narrative underscores the resilience of individuals and the crucial role of compassion and support in times of crisis. This resilience is not just about surviving but finding ways to thrive and contribute meaningfully despite the uncertainties and disruptions caused by the war.

This paper presents a comprehensive and updated overview of inborn errors of immunity (IEIs), focusing on the optimal treatment strategies. IEIs or primary immunodeficiencies (PIDs) are a heterogeneous group of approximately 500 disorders, classified into ten categories according to the affected component of the immune system. The clinical presentation varies, based on the type of the disorder and the patient's age. Early diagnosis is essential to prevent recurrent severe infections and potential organ damage. Treatment strategies, including hematopoietic stem cell transplantation, enzyme replacement therapy, thymus trans-plantation, or gene therapy, primarily focus to restore immune function. Emerging therapeutic approaches aiming to modify the immune response comprise small molecule inhibitors, biological therapies, and adoptive transfer of virus-specific T-cells. Given the complexity and diversity of PIDs, as well as evolving novel therapies, continuous education of the physicians on timely diagnosis and effective intervention, significantly improves patients' management and outcomes. CONCLUSION: Early diagnosis and individualized treatment plans are crucial for effectively managing IEIs. As treatment options evolve, ongoing education and the integration of new approaches are key to improving patient outcomes and quality of life.

Objective: The aim of the present work is to systematically review and present the existing literature on anatomical variations of the appendix.

Methods: Detailed research was conducted in the PubMed medical database, using the terms "Appendix" AND "Anatomical variations", and 74 articles were initially revealed. After the application of the inclusion and exclusion criteria, all the non-related articles were excluded, and thus 40 articles were finally selected.

Discussion: The data analysis suggests that the location and form of the appendix may significantly vary among individuals. Common anatomical variations concerning its location include retrocecal, pelvic, retro-ileal, pre-ileal, prececal and paracecal appendices. The first two variants are the most common, although there is a discrepancy regarding their exact incidence. Rarely, the appendix may be intracecal, intramural, subhepatic or located in the left abdomen; mismatches of the McBurney guide point with the base of the appendix are also recorded. Concerning the appendix's form, several variations in the length, diameter, shape and number of appendages (doubling, tripling) may be present.

Conclusions: As evident from the presentation of the results, the vermiform appendix presents a wide variety and number of anatomical variations. The latter are of particular clinical importance and should be known to doctors - especially surgeons - to avoid complications in clinical practice.

Objective: The goal of this research was to examine the morphological characteristics and exact anatomical positioning of the greater palatine foramen (GPF), with reference to nearby anatomical landmarks.

Material and method: The research was performed on dry human skulls belonging to the Bosnian and Herzegovina population, using digital vernier calipers. The study began by noting the GPF's position relative to the maxillary molars, then measuring its distance from the median palatine suture (MPS), the incisive fossa (IF), the posterior border of the hard palate (PBHP), and the posterior nasal spine (PNS). Measurements were conducted bilaterally, and afterwards the data were analyzed using Student's t-test and Chi-squared test. A statistical significance was set at P<0.05.

Results: The statistical analysis revealed that: the distance of the greater palatine foramen (GPF) from the midline is approximately 15.80±1.28 mm on the right side and 15.86±1.19 mm on the left side. The distance of the GPF from the incisive fossa measures about 40.12±2.19 mm on the right side and 40.34±2.08 mm on the left side. The GPF is positioned around 4.00±1.07 mm on the right side and 4.35±1.34 mm on the left side from the posterior border of the hard palate. Lastly, the distance from the GPF to the posterior nasal spine means 17.55±1.99 mm on the right side and 17.61±1.81 mm on the left side in the entire study population. The highest percentage of skulls (73.05%) showed the GPF positioned at the level of the third molar.

Conclusion: The findings of this study further emphasize the variations in the location of the greater palatine foramen and underline the importance of thorough preoperative assessment in patients undergoing maxillofacial surgeries and regional block anesthesia.

This review assesses the burden of human papillomavirus (HPV)-related cancers in Bosnia and Herzegovina (BH), aiming to inform strategies for prevention and early detection. Despite the availability of highly effective HPV vaccines and screening programs, HPV-related cancers remain a significant public health burden worldwide. We conducted a comprehensive search of PubMed and GLOBOCAN to identify all available data on HPV prevalence/genotype and HPV-related malignancies in BH, including information on HPV vaccination and cervical cancer screening. A comprehensive literature search revealed limited data on HPV prevalence and HPV-related cancers, as well as the absence of a national HPV vaccination or cervical cancer screening program in BH. In the largest study with available data from BH, HPV prevalence was 43% among women undergoing routine gynecologic exams. HPV-16 was identified as the most common cause of cervical cancer. The HPV prevalence was 50% in head and neck cancer, with HPV-18 being the most prevalent subtype. HPV was detected in 80% of patients with colorectal cancer, and HPV-16 was the most common subtype. Conclusions. HPV-related cancers, particularly cervical cancer, represent a significant public health problem in BH. Implementation of a national HPV vaccination program, along with organized cervical cancer screening is essential to reduce HPV-related morbidity and mortality. Addressing systemic challenges, such as establishing a comprehensive cancer registry, is essential for effective HPV prevention and control. Raising public awareness about HPV infection, its consequences, and the importance of prevention is essential for vaccine acceptance and promoting healthy behaviors. By investing in HPV prevention, BH can significantly improve the health and well-being of its population, particularly women.

Background: This study characterizes lymphomas presenting as palpable head and neck masses and evaluates the role of fine needle aspiration (FNA) and flow cytometry (FC) in diagnosis.

Design: A 5-year retrospective review of FNAs performed by pathologists in an ENT clinic identified cases with a predominant lymphoid population that lacked an epithelial component. Cytology, FC, and subsequent surgical pathology diagnoses were correlated.

Results: Of 821 FNAs, 154 (19%) met selection criteria. Reactive lymph nodes accounted for 43% (67/154), with most diagnosed as 'negative for malignancy,' except one 'atypical' (ATY) case. Lymphoma was confirmed in 57% (87/154) of cases, categorized as ATY (55%), suspicious for lymphoma (SFM) (36%), or positive for lymphoma (PFM) (9%). Lymphoma patients were older (median 66 vs. 46 years). Thyroid and salivary gland lymphomas typically indicated systemic involvement, except for two cases of marginal zone lymphoma (MZL) in patients with Sjögren syndrome. FC alone had a sensitivity of 67.5% for detecting lymphoma, but when combined with cytology, the sensitivity increased to 100%. The combined approach maintained a specificity of 98%. More abnormal clonal cells were identified by FC in PFM cases compared to SFM or ATY cases (P=0.004). Cytologic atypia with negative FC occurred in 29% of lymphomas, including Hodgkin and diffuse large B-cell lymphoma (DLBCL).

Conclusion: Lymphomas presenting as neck masses are diverse, with FNA playing a key diagnostic role. Cytologic atypia and FC complement each other, as some cases show minimal atypia but positive FC, while others show significant atypia with negative FC.

Objective: A wide range of lesions, including a mesothelial cyst of the uterine round ligament, are included in the differential diagnosis of a groin mass. Our study emphasizes the rarity of this ailment and the significance of correct preoperative diagnosis in guiding our treatment approach.

Case report: A 43-year-old female patient, presented to our hospital with a five-year history of swelling and slight discomfort in the right groin. A nonreducible inguinal mass with greater projection during a Valsalva maneuver was found. An abdominal CT scan revealed a well-defined lesion located near the right horn of the uterus and extending through the inguinal canal. The patient was brought to the operating room with the clinical suspicion of an inguinal hernia. A soft mass measuring 4.5×2×1.8cm was discovered in the right round ligament, and it was surgically removed. Histopathological examination confirmed a mesothelial cystic lesion. The patient's condition, after a period of 12 months, continues to be satisfactory.

Conclusion: Few cases of uterine round ligament mesothelial cysts have been reported worldwide. Their cause is unknown, and preoperative diagnosis is unreliable. Resection relieves symptoms, and histological examination of the surgical specimen confirms the diagnosis. Additional clinical cases are needed to create a systematic clinical approach.

Objective: The goal of this review was to determine the effectiveness of different types of monobloc and bibloc mandibular advancement device (MAD) devices in the treatment of all forms of obstructive sleep apnea (OSA), by reviewing the available literature.

Methods: A systematic literature search was performed in PubMed, ResearchGate, NCBI and Google Scholar databases. The search included articles in English, published in the inclusive time period from 2000 to 2024.

Results: A total of 13 studies were analyzed that directly compared the effectiveness of monobloc and bibloc devices. The studies were published in the period from 2000 to 2024, and included crossover and parallel randomized controlled trials, as well as cross and parallel cohort studies. Out of the 13 studies, four were classified as RCT parallel studies, six were RCT crossover studies, two cohort parallel studies, and one cohort crossover study. The duration of the studies was variable, ranging from four weeks to one year, with six studies having a so-called "washout period" between the use of monobloc and bibloc MAD devices.

Conclusion: Both monobloc and bibloc devices show significant success rates in the treatment of mild to moderate OSA.

Background: Paraneoplastic Neurological Syndromes (PNS) constitute a heterogeneous cluster of disease manifestations related to various cancers. Small Cell Lung Cancer (SCLC) is strongly related to PNS. This narrative review conducted a survey in the available PubMed literature to highlight the appearance of PNSs in SCLC cases and discuss published research highlights on the subject so that general practitioners can be acquainted with the medical phenomenon present in SCLC patients.

Method: A narrative review of the medical literature was conducted as documentary informative research in the PubMed medical database, combined with a survey of the online e-library Google Books. The key words used were: "Paraneoplastic Neurological Syndromes" and "Small Cell Lung Cancer".

Results: Paraneoplastic syndromes are related to the presence of a malignancy and are not secondary to treatment. Paradoxally, both a malignancy and its therapeutic approach may cause a series of PNSs. Paraneoplastic cerebellar degeneration, motor neuron disorders, peripheral neuropathies, hyponatremia, and syndromes such as myasthenic Lambert-Eaton, ectopic Cushing's, Stiffman, and Opsoclonus-myoclonus syndrome may also appear in SCLC cases. Diagnosis follows specific criteria, and they are caused by tumor-directed antibodies known as onconeural antibodies. Immunosuppressants, intravenous immunoglobulins, plasma exchange, rituximab, cyclophosphamide, azathioprine, and tocilizumab could be considered as treatment agents.

Conclusions: Most patients demonstrate poor PNS treatment results with common relapse. The time for beginning treatment of PNS is discussed. A multidisciplinary team is needed for potentially earlier diagnosis and PNS improvement, better prognosis, and increased overall survival and quality of life.

Objective: This study aims to develop and create a specialized acute kidney injury (AKI) predictor score for the intensive care unit (ICU) patients in Padang, Indonesia.

Patients and methods: This study was a prospective observational study on 352 ICU patients at three specialized hospitals in Padang City; Dr. M. Djamil General Hospital, Dr. Rasidin General Hospital, and Siti Rahmah Islamic Hospital. Data regarding demographics, clinical characteristics, laboratory results, and outcomes related to AKI were gathered. The factors that predict AKI were identified using multivariate logistic regression analysis to determine independent factors. The predictor scores were created using regression coefficients and then internally confirmed.

Results: Out of a total of 352 patients, 128 individuals (36.4%) suffered from AKI. Factors that independently predict the occurrence of AKI include age over 60 years old, having a history of chronic kidney disease, having sepsis, need for vasopressors, and having creatinine level 1.3 mg/dL (IQR 1.0-1.8) upon admission to ICU. An area under the curve (AUC) of 0.85 (95% CI 0.80-0.90) indicated the strong performance of the constructed predictor score.

Conclusion: The constructed AKI predictor score a scale factor of 10, resulting in a range of 0-10 for the AKI predictor score. It demonstrates a good level of accuracy in predicting AKI in ICU patients in Padang. This score can be used by healthcare professionals to quickly identify and categorize individuals based on their risk level, facilitating timely intervention and personalized treatment.