Acta medica academica最新文献

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.

Objective: This article reviews the literature on the anatomy, incidence, and clinical significance of the corona mortis, especially in minimally invasive surgery, where inadvertent surgical complications are more likely to occur.

Methods: A systematic search was performed using the PubMed, Google Scholar, and ScienceDirect databases. Studies with the term "corona mortis" in the title and/or abstract published between 2000 and 2025 that were relevant to the aim of this study were included in this review. Studies published in languages other than English were excluded. The studies were analyzed using narrative data synthesis.

Results: This study reviews the relevant literature and provides a thorough overview of the anatomy of the corona mortis vessels, including different classifications, incidence, location, and size of the vessels. There was a significant discrepancy in the reported prevalence of the corona mortis between studies, especially cadaveric and intraoperative studies. Both arterial and venous 'corona mortis' vessels have been reported, with a greater frequency of venous vessels, which are present in approximately 20% and 40% of hemipelvises, respectively. A number of case reports were evaluated regarding injury to the corona mortis vessels during minimally invasive procedures. These case reports highlight that current surgical practices and techniques seem to adequately prevent damage to these structures.

Conclusion: While there is a relative scarcity of reports showcasing adverse events due to the corona mortis, the moderately high incidence of this variable vessel in approximately half of the hemipelvises necessitates detailed anatomical knowledge and consideration when planning a minimally invasive procedure in the retropubic pelvic space.

Objective: This paper aims to present the perioperative anesthetic challenges in an infant with Lodder-Merla syndrome.

Case report: We present a case report of a 7-month-old infant with Lodder-Merla syndrome, a pacemaker, epileptic spasms, and severe reflux, who was scheduled for open gastrostomy and gastrojejunal tube insertion. Such an intervention would constitute a second consecutive procedure under general anesthesia, shortly after pacemaker implantation. Perioperatively, emphasis was given to maintaining respiratory and cardiac stability, avoiding drugs with parasympathomimetic effects, preventing aspiration, optimizing ventilation, and controlling seizures.

Conclusion: Since Lodder-Merla syndrome affects many organs, perioperative multidisciplinary collaboration and optimization of the affected systems are fundamental.

Objective: This narrative review aimed to investigate the potential differences in antenatal care provision, perinatal outcomes, and administration of obstetric neuraxial analgesia between migrant women and their native counterparts in high-income countries.

Methods: Between March and July 2024, we searched four electronic databases through Ovid and PubMed: Medline, Embase, Global Health, and Maternity and Infant Care. The search terms used included "migrant", "refugee", "asylum seeker", "perinatal", "antenatal", "pregnancy", "neonate", "obstetric anaesthesia", "neuraxial analgesia", and "outcome". We included peer-reviewed articles published in English that presented data on the provision of antenatal and perinatal care, as well as the administration of obstetric neuraxial analgesia to refugee mothers who migrated to high-income countries.

Results: Among the 795 screened records, 41 studies met the inclusion criteria. Of these, ten focused on obstetric neuraxial analgesia administration, while the remaining studies highlighted the differences in antenatal care and perinatal outcomes.

Conclusion: Access to antenatal care, utilisation of neuraxial analgesia, and perinatal and neonatal outcomes for migrant women differ from those of their native counterparts, reflecting the significant challenges encountered during the perinatal period.

Objective: Locally advanced pancreatic cancer (LAPC) represents a significant subset of pancreatic cancers and is characterized by a poor prognosis and limited treatment options. Conventional therapies, including chemoradiotherapy, have demonstrated limited success, prompting interest in innovative strategies, such as immunotherapy. This review evaluates the role of immunotherapy in LAPC.

Materials and methods: For this review, a comprehensive search of the PubMed database was conducted in August 2024. After applying the exclusion criteria, 26 studies were included in the analysis.

Results: Immune checkpoint inhibitors have produced inconsistent clinical outcomes, with modest improvements in progression-free survival and significant side effects. Cancer vaccines, particularly GVAX in combination regimens, have demonstrated potential, as have fibroblast activation protein (FAP) and mKRAS-specific amphiphile vaccines in preclinical and clinical settings. Chimeric antigen receptor (CAR) T-cell therapies targeting various antigens have yielded encouraging outcomes but have faced safety and efficacy challenges. Emerging approaches, including Toll-like receptor agonists, tumor-associated macrophage targeting, and radioimmunotherapy, have also shown preclinical promise but require further study. Despite numerous investigations, the overall impact of immunotherapy on LAPC remains limited. Some combination therapies involving checkpoint inhibitors, vaccines, and CAR T cells have shown positive outcomes; however, many are hindered by the immunosuppressive environment and toxicity of tumors. Recent studies emphasize the need for further research to refine these strategies and improve treatment options.

Conclusion: LAPC remains one of the deadliest malignancies, with immunotherapy offering potential but constrained by limited survival benefits and adverse effects. Further studies focusing on novel agents, refined combinations, and overcoming tumor resistance mechanisms are critical to improve outcomes for this challenging disease.

Objective: We describe a rare case of satisfactory renal allograft function without immunosuppressive therapy following allogeneic hematopoietic stem cell transplantation (alloHSCT).

Case report: The patient was a 64-year-old male who had undergone a kidney transplant from a sibling donor in 2007. After 16 years, he required alloHSCT for acute myeloid leukemia (AML), with the same sibling serving as the donor for both transplants. HLA was a 50% match. Post-alloHSCT, immunosuppressive therapy was discontinued, and the renal allograft function remained stable. The patient later developed severe complications and succumbed to infection. Insights into the precise tolerance mechanisms were limited because laboratory evaluation for chimerism was not performed.

Conclusion: There is potential for immunosuppressive-free renal allograft function after alloHSCT. This case underscores the significant risk of infection-related mortality. To achieve the best outcome, rigorous patient selection, tailored conditioning regimens, robust infection prevention strategies, and the possibility of combined transplantation for carefully selected patients are needed.

Objective: This study aimed to thoroughly assess and evaluate recent studies comparing radiofrequency ablation (RFA) and surgical resection in older patients with hepatocellular carcinoma (HCC).

Methods: We searched the databases PubMed, Scopus, and Cochrane for articles published up to 31 October 2024. This review included studies comparing RFA and surgical resection in individuals with HCC aged 65 years or older. The exclusion criteria were non-human research, case reports, editorials, and studies involving patients with liver metastases or cholangiocarcinoma.

Results: We found four retrospective cohort studies. The derived data showed no difference in one-year survival rates. However, the RFA group exhibited a better disease-free survival rate and a lower mortality rate than the surgical resection group.

Conclusion: RFA outperformed surgical resection in terms of overall and disease-free survival rates while showing no appreciable variation in the occurrence of complications. However, this study underscores the need for more extensive research utilizing larger sample sizes, particularly in low- and middle-income countries.

Objective: This case report describes a young female who developed agranulocytosis with blast cells in peripheral blood following prolonged metamizole use after ankle surgery.

Case report: A 17-year-old female patient was admitted to the Department of Infectious Diseases due to high fever and sore throat. Initial diagnostics revealed agranulocytosis, followed by occurrence of blast cells and left shifted neutrophils in the peripheral blood, in subsequent days. Extensive further diagnostics were performed due to suspicion of leukaemia, which was excluded after flow cytometry and cytogenetic analysis of bone marrow aspirate. After all tests were completed, the patient disclosed that she had been using metamizole for four months following ankle surgery.

Conclusion: In cases of agranulocytosis, involving a prolonged history of metamizole use accompanied by the presence of blast cells and granulocyte precursors in peripheral blood, we would recommend an initial diagnostic approach that includes a complete blood count with differential and flow cytometry of peripheral blood. Bone marrow aspiration may be postponed or deemed unnecessary if peripheral blood flow cytometry shows no aberrant populations and there are no other signs of leukaemia.