Acta medica academica最新文献

Objective: This study aimed to investigate which of the two vitamin K antagonists, warfarin or acenocoumarol, provides more stable anticoagulation control in patients with mechanical heart valves and atrial fibrillation.

Patients and methods: This was a prospective, one-year clinical cohort study. In total, 73 outpatients with mechanical heart valves and atrial fibrillation who were already treated with warfarin or acenocoumarol were recruited from the Blood Transfusion Institute of the Federation of Bosnia and Herzegovina. The prothrombin time target values, expressed as the international normalized ratio (INR), were 2.0-3.0/4.0. Numerical data between the treatment groups were summarized descriptively.

Results: Patients in the warfarin (N=35) and acenocoumarol (N=38) treatment groups were similar in terms of sex, age, body mass index, body surface area, and number of concomitant drugs known to interact with vitamin K antagonists. The number of INR measurements per patient, number of INR measurements within the therapeutic range per patient, mean time interval between successive INR measurements, and mean INR values across consecutive measurements were similar in both groups. However, compared to acenocoumarol, warfarin treatment seemed to be associated with more stable anticoagulation, i.e., with a higher mean time in the therapeutic range (TTR) (76.1±24.2 vs. 69.1±21.5%) and a smaller proportion of patients below all predefined TTR thresholds (<60%, <65%, and <70%).

Conclusion: Our unadjusted descriptive results suggested that warfarin, compared to acenocoumarol, may provide more stable and therefore safer anticoagulation control in patients with mechanical heart valves and atrial fibrillation. To confirm this, larger prospective clinical studies are needed in patients with mechanical heart valves with or without atrial fibrillation.

Objective: HPV infection is a key etiological factor in cervical epithelial alterations and neoplasia. Its prevalence and cytological impact vary with age, co-infections, and screening practices. This study investigated the association between HPV infection, age, and cervical cytological findings in women from North Macedonia.

Materials and methods: This cross-sectional study included 300 women aged 26-66 years, who were screened over a 13-month period (June 2023-July 2024). The participants were divided into two age groups (26-36 and 37-66 years). All participants underwent Pap testing, HPV screening, and microbiological evaluation. Ordinal regression analysis was used to examine the associations between age, microbial factors, and HPV positivity.

Results: HPV prevalence was higher in the 37-66 group (12.33%) than in the 26-36 group (6.0%). However, younger age showed a stronger statistical association with HPV positivity (OR=2.10; P<0.1). Cytological abnormalities, particularly LSIL/CIN I, were more prevalent in HPV-positive participants. The use of conventional Pap smears was associated with lower HPV detection (OR=0.16; P<0.05). Co-infection with Candida spp. and atrophic inflammation were inversely associated with HPV positivity.

Conclusion: This study confirmed the association between HPV infection and cytological changes, particularly in younger age groups. These results highlight the importance of age-tailored screening approaches and support the continued use of conventional Pap smears as cost-effective tools. Integrating virological and microbiological assessments may further refine cervical cancer prevention strategies, particularly in transitional healthcare systems across the Western Balkans.

Objective: This study aimed to assess selected sociodemographic characteristics of patients with schizophrenia and compare them with those of a healthy control group, as well as within the group of patients with schizophrenia.

Patients and methods: A retrospective observational study was conducted involving 400 patients with schizophrenia and 200 healthy controls from the Herzegovina-Neretva Canton. The diagnosis of schizophrenia was made according to ICD-10 criteria, and sociodemographic data were obtained through structured interviews.

Results: Individuals with schizophrenia are more likely to be older, less educated, unemployed, single, and smokers compared to healthy controls. Among patients with schizophrenia, analyses controlling for age showed that gender was significantly associated with both age of onset and duration of illness, with significant gender-by-age interactions. Marital status was significantly related to age at onset and demonstrated a significant interaction with age in relation to illness duration. Education level was associated with age at onset but not with illness duration. No significant differences in illness onset were found across employment groups.

Conclusion: Sociodemographic characteristics are closely associated with key clinical features of schizophrenia, including age at onset and illness duration. These findings highlight the importance of considering gender, marital status, and educational background when interpreting illness trajectories. The results further underscore the need for early intervention strategies, psychoeducation, and integrated social and healthcare support aimed at improving functional outcomes and quality of life for individuals with schizophrenia and their caregivers.

Objective: This retrospective case series study aims to assess the clinical role of surgical re-resection for isolated local recurrence of pancreatic cancer, integrating detailed case presentations with current evidence to clarify patient selection criteria, operative feasibility, and oncologic outcomes.

Case presentations: We present three patients with locally recurrent pancreatic cancer who underwent repeat pancreatic resection. Patient 1, who previously underwent distal pancreatectomy for an Intraductal Papillary Mucinous Neoplasm (IPMN)-associated adenocarcinoma, developed a new pancreatic head lesion three years later and underwent pylorus-preserving pancreaticoduodenectomy; histopathology confirmed a small invasive IPMN, and the patient remains alive 8 years after the initial diagnosis and 5 years after the reoperation. Patient 2, who had previously undergone Pylorus-Preserving Pancreaticoduodenectomy for distal bile duct adenocarcinoma, developed recurrent disease in the pancreatic body and tail three years later. He underwent distal pancreatectomy but developed liver recurrence due to hematogenous metastasis one month postoperatively and succumbed 6 months later from generalized widespread disease. Patient 3, who previously underwent a Whipple procedure for IPMN-associated adenocarcinoma, developed a recurrent mass at the pancreatojejunostomy five years later and underwent distal pancreatectomy, with an uneventful recovery.

Conclusion: Our findings suggest that repeat pancreatic resection may be feasible in carefully selected patients with isolated local recurrence, potentially offering a survival benefit. Strict selection criteria, including the absence of distant metastases, good performance status, and technically resectable disease, appear essential to optimize outcomes, supporting the consideration of surgical re-resection as an option within a multidisciplinary management framework.

Objective: This review examines the existing literature on the structural and functional changes in the anatomy of the prefrontal cortex (PFC) associated with autism spectrum disorder (ASD), focusing on the roles of molecular signaling disruptions and trace element imbalances.

Methods: A literature review was performed through a structured search of academic publications from 2010 to 2025.

Discussion: Anatomic variations and structural and functional abnormalities within the PFC, including disruptions in neural connectivity, synaptic plasticity, and neurochemical balance, significantly contribute to the cognitive, social, and emotional deficits observed in ASD. The interplay between brain-derived neurotrophic factor dysregulation, oxidative stress, and trace element imbalances further exacerbates these dysfunctions.

Conclusion: According to our findings, the anatomy of the PFC appears to play a crucial role in the pathophysiology of ASD, given its involvement in executive function, emotional processing, and social cognition, suggesting a multifactorial pathophysiology that demands a multidimensional research approach.

Objective: This article aims to emphasize the importance of considering invasive thymoma in the differential diagnosis of mediastinal masses and highlights the critical role of timely surgical and oncological management in improving patient outcomes.

Case report: We present the case of a 70-year-old woman who presented with signs of superior vena cava syndrome, including dyspnea, facial swelling, and fatigue. Advanced imaging and intraoperative findings revealed a large anterior mediastinal mass infiltrating the left brachiocephalic vein and superior vena cava, extending into both the right atrium and right ventricle. Surgical intervention was performed, and histopathological analysis confirmed B2 thymoma with a high Ki-67 proliferation index. Despite surgical intervention, the patient's condition deteriorated, and she ultimately succumbed to the disease.

Conclusion: To the best of our knowledge, this is the first reported Bosnian case of B2 thymoma invading the brachiocephalic vein and superior vena cava and infiltrating both the right atrium and ventricle, causing superior vena cava syndrome. Despite their rarity, thymomas should always be considered in patients presenting with an enlarged mediastinum.

This review summarises the current knowledge of the interactions between Histoplasma capsulatum (Hc) and the human immune system, with particular emphasis on host immune responses and fungal immune evasion mechanisms that modulate disease pathogenesis and clinical outcomes. Histoplasmosis is a disease caused by Hc, a fungus found worldwide. Upon inhalation, complex interactions occur between the pathogen and the human immune system, primarily involving the recognition of fungal cell wall components. Both innate and adaptive immune responses are orchestrated to eliminate the fungus through a tightly regulated balance. However, Hc has evolved multiple strategies to evade host defences and establish infection. The clinical spectrum of histoplasmosis varies, ranging from isolated pulmonary involvement to disseminated disease, depending on host factors and pathogen characteristics. CONCLUSION: Overall, host-pathogen interactions between Hc and the human immune system play a central role in determining disease outcomes and represent key targets for improving preventive, diagnostic, and treatment strategies.

Objective: This study analyzed PhD theses defended in Croatia between 1992 and 2023, with the aim of examining national trends, institutional contributions, disciplinary patterns, and data-related challenges.

Methods: This retrospective time-trend study utilized the administrative data obtained from the Croatian Bureau of Statistics. Data on the number of defended PhD theses were collected by year, university, and school/department. Linear regression models were applied to assess temporal trends at both the national and institutional levels.

Results: A total of 17,578 PhD theses were defended in Croatia between 1992 and 2023. The national output increased substantially, reaching a peak of 1,338 theses in 2012, followed by a subsequent decline and a gradual recovery. The University of Zagreb accounted for 74.8% of all defended theses, followed by the Universities of Osijek, Rijeka, and Split. Across institutions, the medical, economic, and engineering faculties were the most productive. Linear regression analyses demonstrated statistically significant upward trends at both the national level and across all major public universities. Collectively, medical schools produced 18% of all theses, with newer institutions, particularly those in Split and Osijek, exhibiting later but consistent growth. However, notable data inconsistencies were observed, including non-standardized institutional nomenclature, variable data granularity, and discrepancies among official reports.

Conclusion: Croatia's PhD output expanded markedly after 2000, reflecting the maturation and expansion of its higher education system. Regional universities and medical schools substantially increased their contributions, indicating national academic growth. Sustained institutional support will be essential to sustain progress and foster disciplinary development.

Objective: This study aimed to conduct a thorough literature review regarding the ansa pancreatica as a potential risk factor for recurrent acute pancreatitis, exploring its pathophysiological mechanisms and possible complications during the surgical management of pancreatic conditions.

Methods: A comprehensive search was performed in the PubMed and Scopus databases using the keyword 'Ansa Pancreatica', yielding a total of 80 articles (PubMed: 34, Scopus: 46, with 52 unique articles). After applying strict inclusion and exclusion criteria, unrelated and duplicate articles were removed, resulting in the selection of 38 relevant studies.

Results: Ansa pancreatica was found to be a statistically significant independent risk factor for recurrent acute pancreatitis in the majority of the literature reviewed. The suggested pathophysiological mechanism involves anatomical obstruction and subsequent pre-activation of the pancreatic enzymes, causing an inflammatory cascade. Diagnosis can be established using Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Cholangiopancreatography, or Endoscopic Ultrasonography, while treatment options are either conservative or surgical, with the invasive procedures being associated with a significant risk of complications. Furthermore, some studies have indicated a correlation between ansa pancreatica and intraductal mucinous neoplasms.

Conclusion: The findings clearly show that Ansa Pancreatica is a rare anatomical variant with significant clinical and surgical implications, underscoring the necessity for clinicians to be aware of it to mitigate complications and effectively manage pancreatic diseases.

Objective: To highlight the diagnostic and therapeutic challenges of Spitzoid melanoma in childhood, with a focus on its potential genetic predisposition.

Case report: A 7-year-old female patient presented with a growing nodular lesion on her upper leg. Excision was performed, and histopathological analysis confirmed a diagnosis of Spitzoid melanoma, classified as pT2a. Following a multidisciplinary review, wide local re-excision and sentinel lymph node biopsy (SLNB) were recommended. No residual tumor was found, and the SLNB was negative. A comprehensive diagnostic evaluation ruled out systemic disease, and no additional treatment was required. Germline genetic testing identified a pathogenic CHEK2 variant (c.444+1G>A), prompting recommendations for genetic counseling and close follow-up.

Conclusion: This case report contributes to the limited body of knowledge on pediatric Spitzoid melanomas and underscores the importance of genetic insights in guiding both diagnostic and treatment decisions. The detection of a CHEK2 mutation underscores the importance of genetic profiling in family counseling.