Acta medica academica最新文献

Objective: The presence of cervical ribs, 1st rib anomalies, cervical muscle hypertrophy and repetitive motion are possible aetiologies of subclavian artery (SCA) entrapment and/or compression. Thoracic outlet syndrome of the arterial type may appear with symptoms of hand pain due to the aneurismal part of the compressed SCA. The current cadaveric case describes a hypertrophic right-sided anterior scalene muscle (ASM) and the possible entrapment of the right SCA (RSCA) passing through its fibres. Furthermore, the branching pattern of the entrapped vessel is analysed.

Case report: A hypertrophic ASM was identified in the right infraclavicular area of a male Greek donated cadaver (70 years of age). The RSCA passed through the ASM belly, and some deeply situated fibres extended posteriorly to the RSCA. The ASM compressed the RSCA against the superior part of the 1st rib.

Conclusion: Knowledge of such variants may be important in the diagnosis of upper limb muscle atrophy or neurosensory loss.

Objective: The aim of this review was to present the vascular pattern of the STA, as well as anatomical variations, and to accentuate the areas which should be taken into consideration during manipulations along the course of the artery.

Background: The STA may be encountered during several aesthetic procedures on the face, and iatrogenic trauma could be an incriminating factor of diverse sequelae. The constant increase in demand for facial aesthetic procedures has rendered it imperative to maximize safety and patient satisfaction.

Methods: We conducted a narrative literature review using the electronic databases of PubMed and Google Scholar, retrieving studies concerning the anatomy and variations of the STA. Moreover, we identified registered clinical cases presenting complications which involved the artery.

Discussion: The anatomic morphology of the STA is described and classification systems summarized, on the basis of the studies retrieved. In addition, the STA is related to defined landmarks, and specific danger zones are emphasized. Finally, the clinical significance of the artery is reflected in registered cases of adverse events following specific aesthetic surgeries.

Conclusion: Thorough knowledge of the anatomical variability of the STA, and awareness of the danger zones involved in aesthetic procedures, combined with intraoperative vigilance could increase safety and minimize the advent of relevant sequelae.

Objective: To identify the type of the non-invasive ventilatory treatment for patients diagnosed with chronic obstructive pulmonary disease (COPD), with respiratory status deteriorated by COVID-19 pneumonia, and in need of treatment in the Intensive Care Unit (ICU).

Materials and methods: This cross-sectional study was conducted over a one-year period in the medical intensive care units of two hospitals. As the patients' clinical condition deteriorated and the parameters of the arterial blood gas (ABG) analysis worsened, oxygen support was applied via a high flow nasal cannula (HFNC) or by non-invasive positive pressure ventilation (NPPV). According to the control values of the arterial oxygen saturation (SaO2) and the parameters of ABG, the patients were enabled to be transferred between the two types of non-invasive ventilatory support. The primary outcome was the length of hospital stay, while secondary outcomes were the rate of intubation, the mortality rate, and respiratory supportfree days.

Results: Out of 21 critical patients with COPD and COVID-19, 11 (52.4%) were initially treated with NPPV and 10 (47.6%) with HFNC. The ages (67±9.79 in NPPV group vs. 70.10±10.25 in HFNC group) and severity of illness (SOFA score 5 (3.5) in NPPV group vs. 5 (2.8) in HFNC group) were similar between the two groups. Switching the mode of respiratory support was more common in NPPV (58.3% in survivor group vs. 41.7% in non-survivor group). Patients treated with NPPV compared to HFNC had a nominally longer length of stay (15 (11) vs. 11.5 (4.25)), and higher risk of intubation (66.7% vs. 33.3%) and mortality (66.7% vs. 33.3%), but the comparisons did not reach statistical significance. Survivors had significantly longer Medical Intensive Care Unit and hospital stays, but significantly lower FiO2 (0.60 vs.1) and higher values of PaO2/FiO2 (78(32.4) vs. 56.3(17.8)) than non-survivors. All patients were treated with corticosteroids, and the duration of treatment was similar between groups.

Conclusion: In critically ill patients with COPD and COVID-19, both HFNC and NPPV were commonly used as the initial mode of ventilation. Switching to a different mode and adverse patient outcomes were more frequent in patients initially treated with NPPV. Survivors had higher values of PaO2/FiO2 than non-survivors.

Objective: The objective of this non-interventional post-marketing clinical trial was to analyze the antihypertensive effect and safety of a fixed combination of perindopril and indapamide in the treatment of unregulated essential hypertension.

Patients and methods: The prospective clinical trial included patients aged 20 to 75 years with essential hypertension and blood pressure values ≥ 140/90 mmHg at baseline. On the basis of the investigator's decision, patients received 2 mg perindopril + 0.625 mg indapamide (group 2+0.625) or 4 mg perindopril + 1.25 mg indapamide (group 4+1.25).

Results: The study included 1173 patients (426 patients in group 2+0.625 and 747 patients in group 4+1.25) at 27 investigational centers in Bosnia and Herzegovina. Mean blood pressure values at baseline and visits after nine months were significantly higher in the 4+1.25 group compared to the 2+0.625 group. There was a significant drop in systolic and diastolic blood pressure in both groups. The target values of systolic and diastolic blood pressure, according to the European Society of Cardiology (2018), were reached after nine months of therapy by more than 80% of patients in the 2+0.625 group, and this number was significantly higher compared to the 4+1.25 group where more than 60% of patients reached target values. Newly diagnosed patients had a better response to therapy. The percentage of patients receiving additional antihypertensive therapy decreased by the end of the study. Age, gender and the existence of diabetes mellitus were identified as negative predictors of target blood pressure achievement. The therapy showed a good safety profile.

Conclusion: A fixed combination of perindopril and indapamide was effective and safe in the treatment of unregulated essential hypertension.

Objective: The aim of this study was to carry out the cultural adaptation and validation of the Assessment of Chronic Illness Care questionnaire (ACIC) in the Republika Srpska, Bosnia and Herzegovina.

Methods: A validation study was conducted in two randomly selected primary health care centers in the Republika Srpska, Bosnia and Herzegovina, during March and April 2016. The study participants were all physicians working in family medicine departments during the study. Translation of the ACIC questionnaire version 3.5 was performed following the guidelines of the World Health Organization. The validity and reliability of the questionnaire were tested with face validity, construct validity, and internal consistency.

Results: The questionnaire was distributed to 66 family physicians. Missing values were negligible, therefore the criteria for factor analysis were met. Exploratory factor analysis confirmed that the questionnaire measured one factor. The Cronbach alpha coefficient (0.970) showed the excellent level of internal consistency of the questionnaire. The intraclass correlation coefficient (0.802) confirmed the good reliability of the questionnaire.

Conclusion: The ACIC questionnaire can be used to assess the quality of chronic care in family medicine practice in Bosnia and Herzegovina. Further research is needed to explore how changes in healthcare care delivery impact changes in the Chronic Care Model domain.

Objective: To describe the anatomy of the lacrimal sac in relation to the lateral nasal wall by cadaver dissection, and to measure the distances of surgically important landmarks from relevant structures for safer and more efficient surgery.

Method: A total of 12 endoscopic dacryocystorhinostomy (DCR) were performed on both sides (right and left) of 6 fresh-frozen cadavers. The distances of the lacrimal sac to the posterior edge of the uncinate process, the frontal process of the maxilla, the maxillary ostium, the nasal vestibule, the middle turbinate attachment and the inferior turbinate were measured. In addition, the width and length of the lacrimal sac were measured.

Results: The mean width and length of the lacrimal sac were 5.6 mm and 11.1 mm, respectively. The lacrimal sac was located at 15.2 mm from the posterior edge of the uncinate process, at 35.5 mm from the nasal vestibule, at 13.5 mm from the maxillary ostium, at 12.2 mm from the frontal process of the maxilla, at 8.7 mm from the middle turbinate attachment, and at 7.3 mm from the inferior turbinate.

Conclusion: This study provides additional measurements regarding the lacrimal sac and its relationships with nearby landmarks for use in endoscopic dacryocystorhinostomy. The distances of the lacrimal sac to the nasal vestibule, the uncinate process and the frontal process of the maxilla are not as reliable as the middle turbinate attachment for predicting the anatomic localization of the lacrimal sac during DCR.

In the present review, we briefly discuss the breakthrough advances in precision medicine using a tumor-agnostic approach and focus on BRAF treatment modalities, the mechanisms of resistance and the diagnostic approach in cancers with BRAF mutations. Tumor-type agnostic drug therapies work across cancer types and present a significant novel shift in precision cancer medicine. They are the consequence of carefully designed clinical trials that showed the value of tumor biomarkers, not just in diagnosis but in therapy guidance. Six tumor-agnostic drugs (with seven indications) have been approved through October 2022 by FDA. The first tumor-agnostic treatment modality was pembrolizumab for MSI-H/dMMR solid tumors, approved in 2017. This was followed by approvals of larotrectinib and entrectinib for cancers with NTRK fusions without a known acquired resistance mutation. In 2020, pembrolizumab was approved for all TMB-high solid cancers, while a PD-L1 inhibitor dostarlimab-gxly was approved for dMMR solid cancers in 2021. A combination of BRAF/MEK inhibitors (dabrafenib/trametinib) was approved as a tumor-agnostic therapy in June 2022 for all histologic types of solid metastatic cancers harboring BRAFV600E mutations. In September 2022, RET inhibitor selpercatinib was approved for solid cancers with RET gene fusions. CONCLUSION: Precision cancer medicine has substantially improved cancer diagnostics and treatment. Tissue type-agnostic drug therapies present a novel shift in precision cancer medicine. This approach rapidly expands to provide treatments for patients with different cancers harboring the same molecular alteration.

Objective: The current study records the prevalence of the accessory foramen, located posterior to the transverse foramen (TF), the so-called the retrotransverse foramen (RTF), its morphometry, exact location, and coexistence with ossified posterior bridges. Additionally, factors associated with the length of the RTF are investigated.

Materials: One-hundred and forty-one dried atlas vertebrae were examined.

Results: Thirty-seven out of the 141 vertebrae (26.2%) had at least one RTF. The RTF was unilateral in 67.6% and bilateral in 32.4%. The mean RTF anteroposterior diameter (length) was 4.2±1.4 mm on the right and 3.8±1.0 mm on the left side. The mean RTF laterolateral diameter (width) was 2.6±1.2 mm on the right and 2.5±0.8 mm on the left side. Both dimensions were symmetrical. The RTF was symmetrically located from the TF, at a mean distance of 4.6±1.1 mm on the right and of 4.5±0.9 mm on the left side. For the given TF-RTF distance, laterality, and presence of posterior bridges, each mm increase in the RTF width was associated with a 0.74 mm increase in the relevant length.

Conclusion: The estimated prevalence was higher than most of those reported in other studies. However, the between-studies prevalence varies to a significant degree. Hence, a systematic review and meta-analysis should be performed to identify a more precise estimate due to the clinical importance of the RTF.

Objective: The objective of the current study was to describe the anatomical variations of vessels observed in patients with Meckel's Diverticulum.

Methods: A narrative review of the literature was undertaken by means of the PubMed database, using the terms: "Meckel's Diverticulum AND vessels", "Meckel's Diverticulum AND anatomical variation" and "Meckel's Diverticulum variation". Classical anatomical textbooks were also used for normal anatomy. Additional articles provided useful information in relation to the aim of this review. Hence, the articles that met the inclusion criteria were included in this review, and the collected data were categorized into a single table.

Results: The majority of studies indicated the presence of an abnormal vitelline artery. Other angiographic findings concerned variations of the ileal and the iliac arteries. However, the literature revealed the presence of vascular variations without the existence of Meckel's Diverticulum, whereas a remnant of the vitelline vein may be present, but it is very rare.

Conclusion: The detection of vascular variations accompanying Meckel's Diverticulum is not always easy and requires the correct choice of imaging method to prevent misdiagnosis.

Objective: The aim of the work was to show a Cutaneous Ciliated Cyst (CCC) in an unusual location in a 16-month-old girl.

Case report: We present the case of a 16-month otherwise healthy girl presented to our hospital, with a report of a palpable mass in the left suprascapular region. Physical examination revealed a soft-textured, fluctuating, mobile and painless entity, with no further indications of local inflammation. The mass was totally excised, under general anesthesia, for both diagnostic and therapeutic purposes. According to the histopathological findings, the cystic lesion was covered by a pseudostratified ciliary epithelium, resembling the epithelium of a normal fallopian tube, surrounded by a smooth muscle layer. Immunohistochemical studies identified the cyst epithelium as having cytokeratin (CKAE1/AE3) expression, despite the negative immunostaining findings on Estrogen and Progesterone Receptors.

Conclusion: Our case report concerns a CCC in an unusual position, in the suprascapular area. After a thorough review of the international literature, we concluded that this is the second published case regarding this specific location. To our knowledge our patient is the youngest ever diagnosed with CCC.