Acta medica academica最新文献

Objectives: The main objective was to assess the relationship between sociodemographic and occupational factors and stress levels among healthcare workers in family medicine in Bosnia and Herzegovina, using the PSS-10-BH scale.

Material and methods: A cross-sectional study was conducted using the PSS-10-BH questionnaire distributed via Google Forms to primary care nurses and physicians between July and August 2022.

Results: The study included 272 participants, with a mean age of 44.7 (±10.55), predominantly women (86.8%) and physicians (58.8%). The mean PSS-10-BH total score for the sample was 21.26 (±6.77) ranging from 3 to 36. The linear regression model indicated male gender and older age showed an association with slightly lower stress levels. Marital status and the number of children showed a slight positive association with stress levels. Occupation (B=-3.068, 95%CI: -5.442 to -0.694, P=0.012) was associated with stress, with physicians tending to report lower stress levels compared to nurses. Years of work experience (B=0.060, 95%CI: -0.190 to 0.309, P=0.636), and patient load (B=0.082, 95%CI: 0.027 to 0.137, P=0.004) were associated with higher stress levels. The results suggest that work-related variables are significant predictors of stress levels as measured by the PSS-10-BH scale in this sample of healthcare workers. The included predictors explain 10% of the variability in the outcome, indicating additional unidentified contributing factors.

Conclusion: Occupational factors, particularly profession, work experience, and daily patient load, significantly influence stress levels in healthcare workers. Further research is needed to explore other potential influences and refine interventions aimed at managing stress in this population.

This review assesses the burden of human papillomavirus (HPV)-related cancers in Bosnia and Herzegovina (BH), aiming to inform strategies for prevention and early detection. Despite the availability of highly effective HPV vaccines and screening programs, HPV-related cancers remain a significant public health burden worldwide. We conducted a comprehensive search of PubMed and GLOBOCAN to identify all available data on HPV prevalence/genotype and HPV-related malignancies in BH, including information on HPV vaccination and cervical cancer screening. A comprehensive literature search revealed limited data on HPV prevalence and HPV-related cancers, as well as the absence of a national HPV vaccination or cervical cancer screening program in BH. In the largest study with available data from BH, HPV prevalence was 43% among women undergoing routine gynecologic exams. HPV-16 was identified as the most common cause of cervical cancer. The HPV prevalence was 50% in head and neck cancer, with HPV-18 being the most prevalent subtype. HPV was detected in 80% of patients with colorectal cancer, and HPV-16 was the most common subtype. Conclusions. HPV-related cancers, particularly cervical cancer, represent a significant public health problem in BH. Implementation of a national HPV vaccination program, along with organized cervical cancer screening is essential to reduce HPV-related morbidity and mortality. Addressing systemic challenges, such as establishing a comprehensive cancer registry, is essential for effective HPV prevention and control. Raising public awareness about HPV infection, its consequences, and the importance of prevention is essential for vaccine acceptance and promoting healthy behaviors. By investing in HPV prevention, BH can significantly improve the health and well-being of its population, particularly women.

Objective: The aim of the present work is to systematically review and present the existing literature on anatomical variations of the appendix.

Methods: Detailed research was conducted in the PubMed medical database, using the terms "Appendix" AND "Anatomical variations", and 74 articles were initially revealed. After the application of the inclusion and exclusion criteria, all the non-related articles were excluded, and thus 40 articles were finally selected.

Discussion: The data analysis suggests that the location and form of the appendix may significantly vary among individuals. Common anatomical variations concerning its location include retrocecal, pelvic, retro-ileal, pre-ileal, prececal and paracecal appendices. The first two variants are the most common, although there is a discrepancy regarding their exact incidence. Rarely, the appendix may be intracecal, intramural, subhepatic or located in the left abdomen; mismatches of the McBurney guide point with the base of the appendix are also recorded. Concerning the appendix's form, several variations in the length, diameter, shape and number of appendages (doubling, tripling) may be present.

Conclusions: As evident from the presentation of the results, the vermiform appendix presents a wide variety and number of anatomical variations. The latter are of particular clinical importance and should be known to doctors - especially surgeons - to avoid complications in clinical practice.

Objective: This study presents the personal experience of a 19-year-old student who fled the war in Ukraine, journeyed across multiple countries, and ultimately enrolled in a university psychology program in Croatia.

Methods: A collaborative autoethnographic approach was employed to explore the student's experience as a war refugee, traversing Europe, and beginning university life in a foreign country. Data were collected through the student's reflective writing. A thematic analysis was conducted to identify key emotional and experiential themes.

Results: The narrative provides a comprehensive account of the student's emotional and physical journey, beginning with the onset of war in Ukraine and progressing through her travels in Romania, Bulgaria, the United Kingdom, and Ireland, before settling in Croatia. Thematic analysis revealed a complex interaction of emotions, family dynamics, community support, and the challenges of adapting to a new environment. Despite numerous obstacles, the student and her family remained hopeful and proactive in seeking a better future. The narrative also underscores the therapeutic impact of sharing personal stories.

Conclusions: The findings highlight storytelling as a powerful medium for personal healing. Moreover, the study emphasizes the collective importance of individual narratives in fostering empathy, understanding, and connection across diverse communities. The narrative underscores the resilience of individuals and the crucial role of compassion and support in times of crisis. This resilience is not just about surviving but finding ways to thrive and contribute meaningfully despite the uncertainties and disruptions caused by the war.

This paper presents a comprehensive and updated overview of inborn errors of immunity (IEIs), focusing on the optimal treatment strategies. IEIs or primary immunodeficiencies (PIDs) are a heterogeneous group of approximately 500 disorders, classified into ten categories according to the affected component of the immune system. The clinical presentation varies, based on the type of the disorder and the patient's age. Early diagnosis is essential to prevent recurrent severe infections and potential organ damage. Treatment strategies, including hematopoietic stem cell transplantation, enzyme replacement therapy, thymus trans-plantation, or gene therapy, primarily focus to restore immune function. Emerging therapeutic approaches aiming to modify the immune response comprise small molecule inhibitors, biological therapies, and adoptive transfer of virus-specific T-cells. Given the complexity and diversity of PIDs, as well as evolving novel therapies, continuous education of the physicians on timely diagnosis and effective intervention, significantly improves patients' management and outcomes. CONCLUSION: Early diagnosis and individualized treatment plans are crucial for effectively managing IEIs. As treatment options evolve, ongoing education and the integration of new approaches are key to improving patient outcomes and quality of life.

Objective: The goal of this research was to examine the morphological characteristics and exact anatomical positioning of the greater palatine foramen (GPF), with reference to nearby anatomical landmarks.

Material and method: The research was performed on dry human skulls belonging to the Bosnian and Herzegovina population, using digital vernier calipers. The study began by noting the GPF's position relative to the maxillary molars, then measuring its distance from the median palatine suture (MPS), the incisive fossa (IF), the posterior border of the hard palate (PBHP), and the posterior nasal spine (PNS). Measurements were conducted bilaterally, and afterwards the data were analyzed using Student's t-test and Chi-squared test. A statistical significance was set at P<0.05.

Results: The statistical analysis revealed that: the distance of the greater palatine foramen (GPF) from the midline is approximately 15.80±1.28 mm on the right side and 15.86±1.19 mm on the left side. The distance of the GPF from the incisive fossa measures about 40.12±2.19 mm on the right side and 40.34±2.08 mm on the left side. The GPF is positioned around 4.00±1.07 mm on the right side and 4.35±1.34 mm on the left side from the posterior border of the hard palate. Lastly, the distance from the GPF to the posterior nasal spine means 17.55±1.99 mm on the right side and 17.61±1.81 mm on the left side in the entire study population. The highest percentage of skulls (73.05%) showed the GPF positioned at the level of the third molar.

Conclusion: The findings of this study further emphasize the variations in the location of the greater palatine foramen and underline the importance of thorough preoperative assessment in patients undergoing maxillofacial surgeries and regional block anesthesia.

Background: Paraneoplastic Neurological Syndromes (PNS) constitute a heterogeneous cluster of disease manifestations related to various cancers. Small Cell Lung Cancer (SCLC) is strongly related to PNS. This narrative review conducted a survey in the available PubMed literature to highlight the appearance of PNSs in SCLC cases and discuss published research highlights on the subject so that general practitioners can be acquainted with the medical phenomenon present in SCLC patients.

Method: A narrative review of the medical literature was conducted as documentary informative research in the PubMed medical database, combined with a survey of the online e-library Google Books. The key words used were: "Paraneoplastic Neurological Syndromes" and "Small Cell Lung Cancer".

Results: Paraneoplastic syndromes are related to the presence of a malignancy and are not secondary to treatment. Paradoxally, both a malignancy and its therapeutic approach may cause a series of PNSs. Paraneoplastic cerebellar degeneration, motor neuron disorders, peripheral neuropathies, hyponatremia, and syndromes such as myasthenic Lambert-Eaton, ectopic Cushing's, Stiffman, and Opsoclonus-myoclonus syndrome may also appear in SCLC cases. Diagnosis follows specific criteria, and they are caused by tumor-directed antibodies known as onconeural antibodies. Immunosuppressants, intravenous immunoglobulins, plasma exchange, rituximab, cyclophosphamide, azathioprine, and tocilizumab could be considered as treatment agents.

Conclusions: Most patients demonstrate poor PNS treatment results with common relapse. The time for beginning treatment of PNS is discussed. A multidisciplinary team is needed for potentially earlier diagnosis and PNS improvement, better prognosis, and increased overall survival and quality of life.

Objective: This study aims to develop and create a specialized acute kidney injury (AKI) predictor score for the intensive care unit (ICU) patients in Padang, Indonesia.

Patients and methods: This study was a prospective observational study on 352 ICU patients at three specialized hospitals in Padang City; Dr. M. Djamil General Hospital, Dr. Rasidin General Hospital, and Siti Rahmah Islamic Hospital. Data regarding demographics, clinical characteristics, laboratory results, and outcomes related to AKI were gathered. The factors that predict AKI were identified using multivariate logistic regression analysis to determine independent factors. The predictor scores were created using regression coefficients and then internally confirmed.

Results: Out of a total of 352 patients, 128 individuals (36.4%) suffered from AKI. Factors that independently predict the occurrence of AKI include age over 60 years old, having a history of chronic kidney disease, having sepsis, need for vasopressors, and having creatinine level 1.3 mg/dL (IQR 1.0-1.8) upon admission to ICU. An area under the curve (AUC) of 0.85 (95% CI 0.80-0.90) indicated the strong performance of the constructed predictor score.

Conclusion: The constructed AKI predictor score a scale factor of 10, resulting in a range of 0-10 for the AKI predictor score. It demonstrates a good level of accuracy in predicting AKI in ICU patients in Padang. This score can be used by healthcare professionals to quickly identify and categorize individuals based on their risk level, facilitating timely intervention and personalized treatment.

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.