Acta medica academica最新文献

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.

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.

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.

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.

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: 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 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.