Medicinski Glasnik最新文献

Aim: Diabetes type 2 (DT2) is a metabolic disease characterized by high blood sugar caused by insulin resistance and/or insufficient insulin production. The pathogenesis of DT2 is complicated by both genetic predisposition and environmental and lifestyle variables. At least 150 genetic variants have been linked to the probability of having DT2. The aim of this study was to determine the expression of PLD6, CHRAC1, and PDCD5 genes in type 2 diabetic patients.

Methods: Information on 12 DT2 patients was obtained from the Gene Expression Omnibus (GEO) using the series identification (ID) (GSE34008). The analysis tools GEO2R, String Utils (STRING), University of Alabama at Birmingham Cancer data analysis (UAL-CAN), and the Cancer Genome Atlas (TCGA) were used. The human protein atlas provided details on gene cancer.

Results: Only ten genes with expression differences ranging from low to high were selected. PLD6, CHRAC1, and PDCD5 were detected to have higher expression in patients compared to controls. The number of patients with primary pancreatic adenocarcinoma for SLC16A4, DERK2, and CHRAC1 was greater than that of healthy controls. Concerning the severity of cancer, all chosen genes demonstrated a greater proportion of affected individuals compared to the control group.

Conclusion: There are multiple genes whose increased expression is linked to type 2 diabetes.

Aim: Acetabular fractures are complex articular fractures with a big challenge for orthopaedic surgeons. Surgically managed displaced fractures carry favourable outcomes, especially if the articular surface is reduced accurately. This study aims to assess the clinical outcomes of surgically fixed displaced acetabular fractures with central dislocation using combined anterior and medial plating.

Methods: We have retrospectively evaluated sixteen patients, who had surgically managed displaced acetabular fractures with central dislocation at our institute. All patients underwent open reduction and internal fixation using combined anterior and medial plating via the Kocher-Langenbeck, the ilioinguinal, or the Stoppa approach. The functional outcome was assessed using the Harris Hip score.

Results: Our study includes sixteen patients (12 males, 4 females) with a mean age of 35 years (range: 15-53 years). The mean follow-up was 7.8 years (range: 5-13 years). Functional outcomes were good to excellent in 12 (80%) patients and fair in 3 (20%) patients. At the final follow-up, the solid union had been achieved in all fractures, the mean HHS was 88.84 ± 7.61.

Conclusion: Early reduction and surgical fixation of displaced acetabular fractures with central dislocation using combined anterior and medial plates appear to have good clinical outcomes.

Aim: A rare and diverse set of abnormalities formed by spinal blood arteries known as spinal arteriovenous malformations (AVMs) has a higher risk of hemorrhage and morbidity, causing the shunting of blood from veins with an aberrant capillary bed to arteries. Knowledge of the vascular anatomy of spinal AVMs and the spinal cord's vascular supply is crucial to its therapy. The aim of this study was to report a case of SAVM healing after surgical excision, highlighting the importance of surgical excision in treating these rare lesions.

Methods: A 56-year-old male with progressive bilateral lower extremity weakness and numbness was diagnosed with spinal cord arteriovenous malformation (SAVM). A thoracolumbar spine MRI was performed, and a vascular lesion was found. The feeding artery was coagulated and incised, and the surrounding hematoma was removed. Spinal cord arteriovenous malformation was diagnosed postoperatively. The Oswestry Disability Index (ODI) and the SF-36 questionnaires assessed functional outcomes and physical functioning in individuals with acute or chronic low back pain.

Results: In the reported case, the aneurysm showed spontaneous regression at follow-up after surgical removal of the AVM. Post-surgery rehabilitation improved his motor function. After seven months, he showed 90% physical functioning, 75% emotional well-being, 75% social functioning, 87.5% pain, and 55% general health. He could walk with a walking aid and perform daily activities.

Conclusion: Treatment strategies for AVM-related spinal aneurysms should be carefully considered. Surgical treatment in several conditions has advantages and is reported to have good outcomes.

Aim: To evaluate the clinical impact of corticosteroids (CS) overuse in inflammatory bowel disease (IBD) patients. Excessive use of CS could delay more efficacious treatment and may indicate poor quality of care.

Method: This is a two-phase study that used Steroid Assessment Tool (SAT) to measure corticosteroid exposure in IBD patients. In the first phase, data from 211 consecutive ambulatory patients with IBD (91 with ulcerative colitis, 115 with Crohn's disease, and five with unclassified inflammatory bowel disease) were analysed by SAT. In the second phase, one year after data entry, clinical outcome of patients with corticosteroids overuse was analysed.

Results: Of the 211 IBD patients, 132 (62%) were not on corticosteroids, 45 (22%) were corticosteroid-dependent, and 34 (16%) used corticosteroids appropriately, according to the European Crohn's and Colitis Organization guidelines. In the group of patients with ulcerative colitis, 57 (63%) were not on corticosteroids, 18 (20%) were corticosteroid-dependent, and 16 (16%) used corticosteroids appropriately; in the group of patients with Crohn's disease 70 (61%), 27 (23%) and 18 (16%), respectively. Overall, 24 (out of 45; 53%) patients with IBD could avoid the overuse of corticosteroids if they had a timely change of the treatment, surgery, or entered a clinical trial.

Conclusion: An excessive corticosteroid use can be recognized on time using the SAT. We have proven that excessive corticosteroid use could be avoided in almost half of cases and thus the overuse of CS may indicate poor quality of care in those patients.

Aim: Congenital pseudarthrosis of the tibia (CPT) is a rare, dysplastic condition causing significant disability in the lower limbs. A treatment aims to achieve long-lasting union, prevent limb length discrepancies, and prevent soft tissue lesions. Traditional surgery often yields satisfactory results, but amputation may be proposed in failed cases. This report presents a congenital pseudarthrosis of the tibia and fibula, treated with the Paley cross-union protocol.

Methods: A 15-month-old girl presented with a crooked right lower leg at the age of two months, history of a right lower leg fracture at the age of eight months, and pain when moving her leg. She had undergone an initial surgical procedure to maintain tibia alignment with K-Wire insertion and was cast at a private hospital.

Results: The patient's physical examination showed a cast causing limited range of motion, but no tenderness or distal neurovascular issues. The Paley cross-union protocol was performed, involving anterior approach, curettage, and insertion of a titanium intramedullary elastic nail into the tibia. The fracture site area was covered with a meshed periosteum layer and filled with synthetic bone grafts. A long leg cast was performed after the procedure. An imaging examination post-cross-union protocol showed a good result.

Conclusion: Cross-union for CPT represents a paradigm shift in the treatment of this horrible child disease. Given the promising result, the cross-union approach has to be regarded as a fresh criterion for treating CPT.

Aim: To determine the effect of body mass index (BMI) and waist-hip ratio (WHR) on the concentration of circulating sex hormone-binding globulin (SHBG) throughout the menopausal transition.

Methods: This cross-sectional study included 150 women divided into three groups: premenopausal (n=50), perimenopausal (n=50), and postmenopausal (n=50). The processing of the test women consisted of three phases: interview, blood sampling and determination of BMI and WHR. The SHBG concentration was determined from the blood, and BMI and WHR were measured.

Results: The BMI and WHR of the postmenopausal women were significantly higher comparing to the other two groups, while the postmenopausal SHBG was significantly lower compared to the premenopausal concentration. In all three groups, a significant negative correlation was found between SHBG and BMI (Rho= -0.385; p<0.05), and between SHBG and WHR (Rho= -0.411; p<0.05). By the univariate regression analysis model, it was determined that BMI (β= -0.594; p<0.001) and WHR (β= -0.407; p=0.003) were independently negative predictors of SHBG in postmenopausal women, while in the multivariate regression analysis model only BMI as an independently negative predictor of SHBG in postmenopausal women was found (β= -0.263; p=0.024).

Conclusion: The value of SHBG during the menopausal transition decreases and women with higher BMI and WHR have lower values of SHBG regardless of the duration of menopause. Considering the connection between SHBG and anthropometric parameters, and the drop in its values upon entering and passing through the menopausal transition as such it can be used as a predictor for an increased risk of cardiovascular diseases and metabolic syndrome in a selected group of women.

Aim: To determine the normative range of ultrasound dimensions for the liver, spleen and kidneys in healthy children according to gender, age, body measurements, body surface area (BSA), and the influence of ethnicity on organ size.

Methods: The prospective study included children, ranging from full-term neonates to children aged 15, with normal ultrasonographic (US) findings of the liver, spleen and kidney and no clinical evidence of a disease. Gender, age, as well as body measurements and BSA, were determined for each child along with US measurements, and normative ranges were established.

Results: US images of the liver and spleen from 372 children and 366 US images of kidneys of 366 children were included. US measurements of the liver, spleen and kidney correlated well with gender, age, body weight and height, and often differed to a greater or lesser extent from the normal range of measurements (5th to 95th percentile) reported in other studies.

Conclusion: Our results differed slightly from other reports conducted in Europe, but larger differences compared to measurements performed on children on other continents were found. Thus, our study confirmed that ethnically appropriate and modern tables of normal ultrasound dimensions for the liver, spleen and kidneys should be used, and that the national nomogram is justified.

Aim: During the pandemic of severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2), many countries reported a significant decrease in the prevalence of influenza virus cases. The study aimed to characterize the flu seasons from 2018 to 2023 in Sarajevo Canton, Bosnia and Herzegovina (B&H), and to assess the possible impact of the SARS-CoV-2 pandemic on the influenza A and B virus circulation.

Methods: The CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panels were used for the detection of influenza virus A and B, and subtyping of influenza virus A (H1pdm09 virus and H3). The data for this registry-based retrospective study were collected at the Clinical Centre of the University of Sarajevo, Unit for Clinical Microbiology (the laboratory that acts as a referral for the detection and characterization of influenza virus and SARS-CoV-2 in Federation B&H).

Results: In the 2018/2019 and 2019/2020, an equal percentage of positive cases was recorded (148/410; 36%, and 182/504; 36%, respectively). The absence of the influenza virus was observed in 2020/2021. During 2021/2022, influenza virus was detected among 19/104 (18%) patients and slightly increased in 2022/2023 (45/269; 17%). The switch of the influenza B virus lineage was observed.

Conclusion: The SARS-CoV-2 virus had an impact on the prevalence of influenza virus infection among the population of the Sarajevo Canton, B&H. Since the interactions between these two viruses are not entirely clear, awareness of a possible threat to public health is crucial.

Aim: To compare the need for intubation and mechanical ventilation after surfactant delivery between less invasive surfactant administration (LISA)-treated and intubation-surfactant-extubation (IN-SURE)-treated premature infants with respiratory distress syndrome (RDS).

Methods: Retrospective registry-based cohort study enrolled 36 newborns admitted to the Neonatal Intensive Care Unit of the "Santa Maria" Hospital of Terni between 2016 and 2023. As a primary outcome, the need for intubation and mechanical ventilation within 72 hours of life was followed, and major neonatal morbidities and death before discharge as the secondary outcome.

Results: The LISA group and the IN-SURE group included 13 and 23 newborns, respectively. Demographic features showed no significant differences between the two groups. The need for mechanical ventilation in the first 72 hours of life was similar in both groups (p>0.99). There were no significant differences in morbidities.

Conclusion: LISA and INSURE are equally effective modalities for surfactant administration for the treatment of RDS in preterm infants.

Aim: To investigate out-of-hospital cardiac arrest (OHCA) trend, provided advanced life support (ALS) measures, automated external defibrillator (AEDs) utilization and bystanders' involvement in cardiopulmonary resuscitation (CPR) during OHCA incidents.

Methods: This cross-sectional study encompassed data pertaining to all OHCA incidents attended to by the Emergency Medical Service of Canton Sarajevo, Bosnia and Herzegovina, covering the period from January 2018 to December 2022.

Results: Among a total of 1131 OHCA events, 236 (20.8 %) patients achieved return of spontaneous circulation (ROSC); there were 175 (74.1%) males and 61 (25.9%) females. The OHCA incidence was 54/100,000 inhabitants per year. After a 30-day period post-ROSC, 146 (61.9%) patients fully recovered, while 90 (38.1%) did not survive during this timeframe. Younger age (p<0.05), initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (p<0.05), and faster emergency medical team (EMT) response time (p<0.05) were significantly associated with obtaining ROSC. Only 38 (3.3%) OHCA events were assisted by bystanders, who were mostly medical professionals, 25 (65.7%), followed by close family members, 13 (34.3%). There was no report of AED usage.

Conclusion: This follow-up study showed less ROSC achievement, similar bystanders' involvement, similar factors associated with achieving ROSC (age, EMT response time), and a decline in OHCA events (especially in year 2021 and 2022) compared to our previous study (2015-2019). There was an extremely low rate of bystander engagement and no AEDs usage. Governments and health organizations must swiftly improve public awareness, promote better practice (basic life support), and actively encourage bystander participation.