Acta medica academica最新文献

Objective: The objective of this paper is to present and document a specific case of breast reconstruction using an adapted Type IV Keystone Flap technique, with a droplet-shaped design with a reduced flap ratio, and to identify the qualities of this method.

Case report: A 41-year-old woman, with a history of myocardial infarction and low ejection fraction, underwent a lumpectomy, resulting in a lower medial quadrant deficit in her left breast. After she developed skin and tissue necrosis and infection, implementing the Type IV Keystone Flap effectively addressed the deficit, ensuring sufficient coverage. The flap extended dropwise beneath the deficit, progressing anteriorly towards the upper rectus abdominis, with a ratio of 2.5:1. The flap's novel droplet shape allowed for the utilization of fewer perforators, while ensuring adequate blood supply and tissue coverage, leading to improved perfusion and aesthetic outcome.

Conclusion: The application of the adapted Type IV Keystone Flap highlights its capacity as a versatile and effective method for breast reconstruction post-lumpectomy. With the advantages of a short learning curve, easy execution, and acceptable risk profile, it offers a valuable alternative for patients who may not be suitable for more complex surgeries. Further research is recommended to confirm its broader applicability and to conduct a comparative analysis with other techniques.

Objective: The aim was to design accessible, simple, inexpensive protection for teeth and soft tissues during ETI, compare damage occurrence with and without protection, and investigate post-ETI orofacial pain symptoms.

Materials and methods: The selection procedure for adequate protection was carried out after which a reduced elastomer mouthguard was selected. Fifty patients were divided into 2 groups. In the first group, ETI was carried out using a mouthguard, while in the second group it was performed without it. The mouthguard was fabricated by anesthesiologists. After the ETI procedure, the patients and anesthesiologists were asked to complete a survey.

Results: No difference in intubation severity and time required for intubation between the two groups was present. Seven patients from the non-mouthguard group suffered injuries during the ETI procedure. No injuries were present in the mouthguard group. In 92% of cases anesthesiologists agreed that mouthguards should be used during ETI. However, most of them (96% of cases) agree that the mouthguard should be used only when there is an increased risk of tooth loss and/or tooth damage. There was a significant ETI effect on the emergence of new orofacial pain cases.

Conclusion: The mouthguard adequately protected dental and soft tissues and did not affect the work of the anesthesiologist. A significantly higher number of patients experiencing temporomandibular joint and masticatory muscles pain after surgery indicates that ETI might be a risk factor for orofacial pain.

Objective: The objective of this study was to identify when family physicians decide to prescribe oral corticosteroids (OCS) to treat asthma, to establish the factors affecting their decision, and how familiar family physicians are with the side effects of OCS.

Materials and methods: A cross-sectional observational study was conducted among physicians that are members of the Slovenian Family Medicine Society.

Results: The study included 122 family physicians from all 12 Slovenian regions. The great majority (86.9%) reported they had previously prescribed OCS to asthma patients. The largest share of these (45.1%) tended to prescribe a limited number of tablets, although many (42.6%) also prescribed the entire pack. Regarding the adverse effects associated with OCS, the physicians listed a range of potential problems, highlighting hyperglycemia and exacerbated diabetes, the impact on bone density, a suppressed immune system and increased risk of infection as the most common.

Conclusion: In the future, it is vital to improve family physicians' awareness of when OCS may be prescribed to treat severe asthma, and to define the clinical pathway for severe asthma, which should also involve interdisciplinary collaboration.

Objective: This study aims to illustrate a rare case of retroperitoneal schwannoma by presenting the clinical, imaging, and histological parameters.

Case report: A 36-year-old patient visited the outpatient clinic because of back pain experienced over the previous two months. There were no complaints regarding the nervous system or urinary system. Thorough imaging evaluation, including magnetic resonance for the lumbar spine, abdominal computed tomography, and positron emission tomography was conducted. An encapsulated mass was found in the retroperitoneal area, positioned in front of the O4 vertebra and in close proximity to the left psoas muscle, the left common iliac artery, and the left ureter. The lesion exhibited FDG radioisotope uptake, and a CT-guided biopsy confirmed a benign peripheral nerve tumor. The patient underwent laparotomy surgery, where the tumor was removed. The histological investigation, along with immunohistochemistry, confirmed the presence of a retroperitoneal schwannoma.

Conclusion: Schwannoma is a rare type of retroperitoneal tumor, with nonspecific clinical and radiological characteristics that make diagnosis difficult. Surgical resection is the primary treatment for symptomatic patients, with a favorable prognosis. Long-term follow-up is advised to reduce the chance of late recurrence.

Objective: This cohort study aimed to examine the impact of the FLT3-ITD mutation on the downstream signaling pathway of PI3K/AKT pathway, the percentage of leukemia stem cells, and the survival of patients receiving D3A7 induction therapy.

Method: Bone marrow mononuclear cells were collected from 20 adult AML patients who had completed D3A7 induction therapy at Cipto Mangunkusumo National General Hospital and Dharmais Cancer Hospital. FLT3-ITD gene mutation was examined by the PCR-sequencing method. Expression of phosphorylated PI3K and AKT was detected using the sandwich ELISA method. Flow cytometry was used for detecting the number of apoptosis and proliferation cells, and biomarkers of leukemia stem cells.

Result: The expression levels of PI3K and AKT proteins were higher in FLT3-ITD, both in the mutant group compared to the non-mutation group, and in the patient group with treatment failure outcomes compared to the patient group with treatment response. The percentage of the leukemia stem cell population did not differ significantly between the FLT3-ITD mutation group and the wild type group, and between the treatment failure outcome group and the response outcome group.

Conclusion: This study presents the important role of FLT3-ITD mutation via its downstream signaling (PI3K/AKT) in the outcome of D3A7 induction therapy. The FLT3-ITD mutation plays an important role in the 12-month survival of AML patients after D3A7 therapy. However, the outcome of D3A7 therapy and FLT3-ITD mutation were not associated with leukemia stem cells.

The aim of this historical review is to present the beliefs of the ancient Greeks related to lyssa and how the mythology surrounding this disease was created. In Greek antiquity Lyssa was a secondary goddess, a personification of a zoonotic disease which could be transmitted after an animal bite. Also named hydrophobia, the illness lyssa presented with an acute loss of mental stability, offensive frenzy and madness, and fear of water in the patient, who was seen to be possessed by a daemon as a divine punishment. In the Trojan War, lyssa was seen as a drug to Greek warriors, to demonstrate unreal power during battle. Homer was the first to refer to the hound of Orion, who was the greatest ancient Greek hunter. The hound, named Sirius, as a carrier of lyssa, was used as a bio-weapon to inflict death among the Trojans. Soranus of Ephesus and Galen gave descriptions of the disease, and proposed a sponge soaked with various herbal drugs as a therapeutic measure. The Greco-Roman physician Caelius Aurelianus noted that ancient Greeks knew about lyssa, and was the first to suggest that this was a neuro-disease. Lyssa was a figure in Greek Tragedy, depicted as a young female with a dog-like crown, related to Erinyes and Maniae. CONCLUSION: Lyssa was noted as a disease in Hellenic literature more than 2500 years ago. It was used as a bio-weapon to inflict madness. This vignette reveals Lyssa within a historical framework for the reader to understand the disease's origins.

Background: The deadliest, most dangerous subtype of breast cancer is triple-negative, which lacks treatment targets and accounts for 30% of all breast cancer-related deaths worldwide. TNBC is characterized by the expression of no estrogen, progesterone, or human epidermal growth factor 2 receptors. This suggests that new treatment modalities with fewer adverse effects are required.

Objective: The aim of the present study was to investigate the therapeutic potential of selenium compounds as an adjuvant therapy for Triple Negative Breast Cancer (TNBC), either on their own or in conjunction with nutritional supplements and chemotherapy medications.

Methods: Using the keywords "selenium" and "triple negative breast cancer", a thorough search was conducted in the PubMed database, yielding 23 articles. The following factors were taken into consideration for inclusion: studies using TNBC cell culture lines or in vivo tumors/specimens; full-text articles from the PubMed database; studies published in the English language; experiments with statistically significant results; and selenium used alone or in combination with other antioxidants or chemotherapy. This led to the evaluation of 13 articles in this review.

Results: The results show that selenium therapy increased the anti-cancer drug's effects and produced tumor cytotoxicity, while reducing the cellular features of the cancer (hyperproliferation, growth, and metastasis).

Discussion: This study evaluated the various selenium compounds tested, the cell lines and model organisms used, the assays performed, and the cellular pathways affected.

Conclusion: Examining the possible benefits of selenium in TNBC treatment highlights the need for more studies to confirm selenium compounds as viable co-therapeutic agents.

Objective: This study aimed to determine which pedagogic method, online workshops or live medical education, was the better way to teach about self-medication for middle school students.

Methods: The following groups were formed: group O (students receiving online education), group L (students participating in live medical education animated by a medical practitioner and a science teacher) and group C (students without any medical learning). To compare them, the students answered three multiple choice questions before and after the educational intervention. The students in group L were evaluated immediately after the live medical training and group O immediately after the online workshops (t1). Group C was only evaluated at t0.

Results: Group C N=195), group L (N=219) and group O (N=200, but 101 students who participated in the online workshops students dropped out before the end) were equivalent in terms of gender, but their ages and school grades were statistically different (P<0.001). A post-hoc test revealed that students in group O were older and in a higher grade than those in the other two groups (P<0.001) but the mean ages and school grades were equivalent in group L and group C. At t0, the results obtained were equivalent in the 3 groups. At t1, school students obtained better results in both groups (P<0.001) but these same results were significantly better in group L than those obtained in group O (P<0.001). Age, gender, school grade and school level had no effect on the students' results.

Conclusion: The study's findings suggest that live medical education is a superior approach for imparting self-medication knowledge to middle school students.