Acta medica academica最新文献

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.

Objective: Childhood obesity is a growing public health concern influenced by social and familial determinants. This study examines the associations between caregiver education, family structure, social risk factors, and familial obesity with childhood obesity in a Portuguese pediatric population to inform targeted interventions.

Materials and methods: A retrospective case-control study was conducted at a Portuguese secondary hospital, including 78 children with obesity and 326 controls. Controls were selected using a time-matched, hospital-based approach from the same ward and calendar years as the cases. Socioeconomic data were extracted from the hospital records. Social risk was defined based on documented indicators of socioeconomic vulnerability, such as financial hardship, suspicion of neglect, and housing instability, identified through multidisciplinary records. Logistic regression models were used to assess the risk of obesity while adjusting for age and sex.

Resulst: Caregiver education and familial obesity were the strongest predictors of childhood obesity. Children whose caregivers had not completed compulsory education had a significantly higher risk of obesity, whereas familial obesity showed an even stronger association. Social risk factors were linked to obesity in univariate analyses but lost significance in adjusted models. An exploratory interaction between caregiver education and social risk suggested higher odds when both disadvantages co-occurred. Family structure did not independently predict obesity.

Conclusion: This study highlights the need for targeted public health interventions addressing caregiver education, economic support for at-risk families, and family-wide lifestyle changes. A multi-sectoral approach integrating healthcare, education, and community programs is crucial for reducing childhood obesity and promoting long-term health equity.

Immunoglobulin A (IgA) vasculitis (IgAV) is the most prevalent systemic vasculitis in children. Although the condition is typically self-limiting with spontaneous recovery within a few weeks, both acute and long-term complications can arise, with renal involvement being the most significant. In recent years, considerable attention has been directed toward unraveling the genetic basis of IgAV. Studies have identified associations between disease susceptibility and specific human leukocyte antigen (HLA) polymorphisms. In addition, variants in genes encoding cytokines, chemokines, and other biologically important proteins - particularly those involved in the abnormal glycosylation of IgA1 - have been linked to both increased risk of developing IgAV and more severe disease manifestations. Notably, polymorphisms in the interleukin-1 receptor antagonist (IL1RN) and IL8 genes have been correlated with an increased risk of glomerular injury. Other gene polymorphisms have also been associated with specific clinical phenotypes, such as HMGB1 and RAGE, whereas polymorphisms in genes involved in mucosal immune defense have not demonstrated any significant correlations to date. Ongoing research is essential to clarify these findings further and determine their implications for clinical practice.

Objective: To report two additional cases of glycogen-rich clear cell carcinoma (GRCC) of the breast - detailing their clinicopathologic features, immunophenotypes, and follow-up - and to provide an updated literature review since 2020.

Case reports: Two patients (66 and 52 years old) had GRCC confirmed morphologically and histochemically. Case 1 was ER-positive/HER2- positive (luminal B/HER2-positive) and was managed with surgery, followed by adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy (trastuzumab). Case 2 was triple-negative and received neoadjuvant chemoimmunotherapy (pembrolizumab- based) with marked pathologic tumor regression at resection. Both patients were disease-free at one and 12 months, respectively.

Conclusions: GRCC is heterogeneous and should not be regarded as a single clinicopathologic entity within invasive breast carcinoma of no special type or assumed to have a uniform prognosis. Management should be biomarker-guided, as illustrated by these cases. The role of targeted and immune therapies in GRCC warrants multi-institutional studies.

Objective: This case report describes the capability of a smartphone-based electrocardiogram (ECG) in detecting multivessel coronary artery disease (CAD), with initial findings suggestive of double-vessel involvement, which was later confirmed as triple-vessel disease (TVD) by coronary angiography.

Case report: In this case report, we describe a 51-year-old woman with a known medical history of CAD, hypertension, TVD, and a prior episode of acute coronary syndrome who presented to Swami Rama Himalayan University, Dehradun, with complaints of chest pain. She had previously undergone percutaneous coronary intervention with stent placement. Conventional 12-lead ECG (Philips PageWriter ECG) indicated myocardial ischemia. Follow-up smartphone-based ECG (Spandan Pro) revealed inferolateral ischemia possibly affecting the left anterior descending artery (LAD) and left circumflex artery (LCX), with a possible diagnosis of double-vessel disease (DVD). Coronary angiography later confirmed the diagnosis of TVD with significant stenosis of the LAD, LCX, and right coronary artery, along with additional involvement of the left main coronary artery. Post-angiography, the patient was recommended for coronary artery bypass grafting as the first option and percutaneous transluminal coronary angioplasty as an alternative.

Conclusion: This case illustrates the clinical efficacy of the smartphone-based ECG device in detecting inferolateral ischemia suggestive of DVD in patients with suspected or known CAD and highlights its diagnostic concordance with standard investigations, particularly coronary angiography.