Acta medica academica最新文献

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.

Objective: This study aimed to identify the factors affecting the quality of life (QoL) of children with transfusion-dependent thalassemia.

Materials and methods: A cross-sectional study was conducted on 38 hospitalized pediatric patients with thalassemia at two regional hospitals in Indonesia. We used demographic and anthropometric data, as well as the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL), to collect the data.

Results: The median age of the participants was 11 years (range, 2-18), with a median age at diagnosis of 12.5 months (2 - 84). The average hemoglobin (Hb) level was 8.47 g/dl, and 34% of the patients had blood type O. The interval between blood transfusions was 23.74 days, with a median number of transfusions of 200.5 (range, 22 - 405). The median current weight was 25 kg (range, 9.5 - 50 kg). More than half of the fathers (52.6%) and mothers (50%) of the children with thalassemia had completed only elementary school. The mean total QoL score reported by children was 82.69±13.38, and by parents, 82.6±11.27. Among the PedsQL domains, the children reported the highest scores in social functioning (89.86±15.48) and the lowest in school functioning (74.21±18.06). Similarly, parents reported the highest score in social functioning (91.05±12.95) and the lowest in school functioning (78.42±13.9). Multivariable analysis showed that Hb level and current weight were significantly associated with QoL in children with thalassemia.

Conclusions: The QoL of children with thalassemia is generally good and is influenced by their current body weight and Hb levels.

Objective: This study aimed to precisely identify the location of the adductor canal to assist knee surgeons during procedures.

Materials and methods: We utilized twenty formalin-fixed cadavers to measure the length of the lower limb from the midinguinal point (MIP) to the base of the patella and divided the measured length into three parts: the proximal, middle, and distal. After dissecting the adductor canal, we measured the distance between the MIP and the proximal foramen and the distal foramen (adductor hiatus), the distance between the distal foramen and the base of the patella, and the length of the adductor canal. We also measured the location of the proximal and distal foramina concerning the upper and lower limits of the middle third of the thigh.

Results: The mean lengths of the thigh and adductor canal were 39.59±3.6 cm and 15.24±2.26 cm, respectively. The average distances between the MIP and the proximal and distal foramina and between the distal foramen and the base of the patella were 14.39±1.98 cm, 29.56±2.22 cm, and 10.28±1.87 cm, respectively. In 75% of lower limbs, the proximal foramen was below the upper limit of the mid-third of the thigh, with an average distance of 1.74 cm, whereas in 85% of cases, the distal foramen was below the lower limit of the mid-third of the thigh, with an average distance of 3.3 cm.

Conclusion: This study suggests that the ideal adductor canal block approach is within the middle third of the thigh.

This review explores how virtual and augmented reality technologies are transforming medical education and clinical practice, particularly in anatomy instruction. Virtual and augmented reality technologies are reshaping our perception and interaction with anatomical structures. Their integration into medical practice has introduced opportunities in diagnostics, surgical training, rehabilitation, and patient education. With the increasing number of U.S. Food and Drug Administration approvals, these technologies offer a transformative shift in the teaching and practice of medicine. Virtual environments facilitate detailed anatomical visualization, offering students and trainees immersive and interactive experiences. This paper highlights the role of these technologies in enhancing educational methods, improving knowledge retention, and overcoming traditional limitations, such as the scarcity of cadavers. CONCLUSION: Virtual and augmented reality offer novel educational tools in the health sciences, providing cost-effective, accessible, and innovative approaches to anatomy education and clinical application. Further research is required to elucidate the benefits of these technologies in the education and training of medical students.

Objective: We present a rare case of primary retroperitoneal cavernous hemangioma, highlighting its clinical, imaging, and histological parameters.

Case report: A 54-year-old patient presented with chronic abdominal pain that had been experienced for the past six months. No notable findings were identified in the patient's medical history, clinical examination, or laboratory tests. Full imaging was performed using magnetic resonance imaging and abdominal computed tomography (CT). A mass was found in the retroperitoneal area, located posterior to the stomach and close to the splenic portal, the left lobe of the liver, and the left hemidiaphragm. CT-guided fine-needle aspiration confirmed the presence of a benign tumor, which was surgically excised. Histological and immunohistochemical investigations confirmed the presence of a retroperitoneal cavernous hemangioma with extrahepatic tissue.

Conclusion: Primary retroperitoneal cavernous hemangiomas are rare retroperitoneal tumors with nonspecific clinical and radiological characteristics, making diagnosis difficult. This case demonstrates the occurrence of extrahepatic tissue involvement, a feature that has been reported only exceptionally in the literature. Surgical resection is the primary treatment for symptomatic patients with a favorable prognosis, and histological examination of the surgical specimen confirms the diagnosis.

Objective: This study aimed to explore the influence of sociodemographic characteristics and lifestyle on the occurrence of anxiety and depression, and the interrelationship between metabolic syndrome (MS) and anxiety and depression.

Methods: A total of 685 adults were divided into two groups (with and without MS) using the International Diabetes Federation's definition of MS. In both groups, we used the Beck Inventory for Anxiety and Depression. The influence of sociodemographic and other characteristics on the occurrence of MS, anxiety, and depression was observed. The multivariate logistic regression model was appropriate for determining which variables (especially anxiety and depression) affected the presence of MS in the participants.

Results: MS was observed in 37.5% of participants. Women with mild and severe anxiety were statistically significantly more represented in the group with MS than in the group without MS (26.2% : 12.0%, P=0.001; 16.7% : 4.8%, P=<0.001), as well as women with severe depression (6.3% : 1.9%, P=0.038), while there was no significant difference in men. Sociodemographic characteristics such as female gender, older age, employment status (retirees and homemakers), lower level of education, marital status (divorced and widowed), and more children affected the occurrence of anxiety and depression in participants. Physical inactivity during leisure time, high-risk drinking, and a higher level of cardiovascular risk showed significant influence on the presence of anxiety and depression, while smoking was inversely associated with the presence of depression but not with anxiety.

Conclusion: The association between MS and anxiety and depression was confirmed. Women with MS were at a higher risk of anxiety and depression symptoms, whereas this was not confirmed in men.

Objective: This study aimed to investigate long-term trends in the prevalence of behavioral risk factors among adolescents in Kazakhstan and highlight a successful preventive intervention, specifically the establishment of a health school.

Materials and methods: The authors analyzed publications from the past 10 years to monitor behavioral risk factors, existing trends among adolescents in Kazakhstan and abroad, and recommendations and guidelines from global health authorities.

Results: Alongside a decline in tobacco and alcohol consumption, there has been an observed increase in obesity, vaping, depression, use of digital devices, and engagement with TikTok. A model is proposed based on implementing a Preventive Program by establishing a Health School, guided by international best practices and recommendations.

Conclusion: In recent years, there has been a noticeable shift in public health behavior in Kazakhstan. While tobacco use and alcohol abuse have declined, new challenges are emerging, such as increasing rates of obesity among adolescents and excessive engagement with online games, gadgets, and social media. Simultaneously, physical activity levels have significantly decreased. To promote healthy lifestyle habits, a Health School was established at the Republican Sanatorium "Alatau" under the Ministry of Health of the Republic of Kazakhstan.