Balkan Medical Journal最新文献

Anaphylaxis is a severe, rapidly developing systemic hypersensitivity reaction that can be life-threatening if not promptly identified and treated. Its global incidence is on the rise, especially among children, though fatal outcomes remain uncommon. This review summarizes the current understanding of anaphylaxis, covering its epidemiology, triggers, acute management, and strategies for long-term prevention, with emphasis on cases caused by food, medications, and insect stings.The estimated lifetime prevalence of anaphylaxis ranges from 0.05% to 2%. In children, food is the primary trigger, whereas in adults, medications are the most commonly responsible. The main culprits for food-related anaphylaxis differ by region: in Western countries, peanuts and tree nuts predominate; in East Asia, hen’s eggs and cow’s milk are most frequent; and in Southeast Asia, seafood is the leading cause. Drug-induced anaphylaxis-often the main cause of anaphylaxis-related deaths worldwide-is increasing due to the growing use of chemotherapies and biologic agents. Insect stings cause about 10% of all cases and remain the most common cause of fatal anaphylaxis.Intramuscular adrenaline continues to be the primary treatment, yet its administration is often delayed or insufficiently used. Patients should be prescribed adrenaline autoinjectors following an initial reaction, but availability and usage rates differ widely across countries. Education for patients and caregivers and the creation of clear action plans are essential. New alternatives, such as intranasal and sublingual adrenaline devices, are being developed to improve access and minimize hesitation in treatment. For prevention, VIT is well established and highly effective, preventing systemic reactions in over 90% of cases. Drug desensitization enables safe administration of necessary medications despite confirmed allergies, and this approach is suitable for all ages, including children. Oral immunotherapy for food allergens can increase tolerance levels and lower the chance of accidental exposure in selected patients, though safety concerns limit its widespread use.Biologic therapies like omalizumab present new treatment avenues for patients with multiple food or drug allergies. Recent studies have shown that omalizumab can raise the threshold for reactions to peanuts and other allergens in children. Case reports also indicate it may improve safety during drug desensitization, including for chemotherapy.Ongoing progress in diagnosis, emergency readiness, immunotherapies, and biologics continue to broaden the range of options for managinganaphylaxis. Nonetheless, gaps in access, awareness, and supportingevidence-particularly for children and older adults-underscore the needfor additional research and health system investment.

Postoperative pulmonary complications (PPCs) continue to be a major cause of illness and death among surgical patients, affecting recovery and increasing healthcare expenses. This in-depth review examines the wide range of PPCs, covering infectious, inflammatory, mechanical, airway, vascular, lymphatic, and transplant-related issues. It highlights the vital function of imaging-especially computed tomography-in promptly identifying, correctly diagnosing, and managing these problems. Frequent complications like pneumonia, empyema, acute respiratory distress syndrome, atelectasis, and pulmonary embolism are covered, as well as rarer but serious conditions such as lung torsion, bronchopleural fistulas, and pseudoaneurysms. The review describes clinic signs and matches them with imaging characteristics to support diagnosis and treatment planning. It also underscores the value of a team-based approach involving surgeons, radiologists, and critical care experts to enable timely care and better patient results.

Background: The effects of dietary copper and magnesium intake, the geriatric nutritional risk index (GNRI), and the systemic inflammation response index (SIRI) on stroke risk in the elderly remain unclear.

Aims: To examine the relationships between dietary copper and magnesium intake, GNRI, SIRI, and stroke risk in the elderly.

Study design: Cross-sectional study.

Methods: Data from 7,157 elderly participants in National Health and Nutrition Examination Survey 2007-2016 were analyzed using multifactorial logistic regression, subgroup analysis, smooth curve fitting, threshold effect analysis, mediation analysis, and sensitivity analysis.

Results: Higher dietary copper and magnesium intake were significantly and linearly associated with lower stroke risk. SIRI was positively associated with stroke risk, while GNRI had a stable protective effect. In fully adjusted models, medium- and high-level copper and magnesium intake were positively associated with GNRI and negatively associated with SIRI. GNRI mediated 4.4% and 5.5% of the associations between copper and magnesium intake and stroke risk, respectively; SIRI mediated 3.4% and 2.9%, respectively.

Conclusion: Higher dietary copper and magnesium intake are associated with reduced stroke risk in the elderly, with GNRI and SIRI exerting modest mediating effects.

Background: Childhood bronchiectasis (BE) is a chronic lung condition that remains under recognized, marked by irreversible widening of the bronchi, frequent respiratory infections, a persistent wet cough, and progressive lung damage, often leading to significant health burdens.

Aims: To evaluate children with cystic fibrosis (CF) and non-CF BE and to examine the association between clinical presentation and radiological severity of BE using the Bhalla scoring system.

Study design: Retrospective observational study.

Methods: Children aged 0-18 years with a CT-confirmed diagnosis of BE were enrolled. Data on demographics, clinical characteristics, and imaging results were collected retrospectively from medical records. The Bhalla score was used to assess BE severity. Patients were categorized into CF-related and non-CF BE groups. The two groups were compared with respect to clinical features, growth z-scores, hospitalization frequency, and pulmonary function test outcomes.

Results: A total of 157 patients were analyzed. Among them, CF accounted for 23.6% of cases, and while the leading causes in the non-CF group were post-infectious BE (28%), immunodeficiency (19.8%), and primary ciliary dyskinesia (12.8%). The CF group presented at an earlier age, had a longer follow-up period, and experienced more frequent hospitalizations (p < 0.001). In the CF group, weight, height, and body mass index z-scores significantly improved from the initial to the final assessment (p = 0.010, p = 0.006, and p = 0.026, respectively), whereas no such improvement was observed in the non-CF group. Severe Bhalla scores were more frequently observed in the CF group (p < 0.001). Among CF patients, Bhalla scores showed a strong correlation with forced expiratory volume in one second (FEV₁) in univariate analysis (r = 0.846, p < 0.001), though this was not significant in multivariable analysis (p = 0.434). In the non-CF group, there was no correlation between Bhalla scores and final FEV₁ values (p = 0.148, r = 0.212).

Conclusion: The results underscore distinct clinical trajectories between CF and non-CF BE in children. Improvements in CF patients suggest the effectiveness of structured clinical management, whereas inconsistent outcomes in non-CF patients point to the need for standardized follow-up protocols. While the Bhalla score may indicate the extent of structural lung disease in CF, it does not independently predict lung function, and therefore should be used as a supplementary, not solitary, measure of disease severity.

Background: Inhibition of the Hedgehog and phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathways has been shown to suppress tumor proliferation and stem cell activity. However, the precise role of these pathways in vasculogenic mimicry (VM) of ovarian cancer stem cells (OCSCs) remains unclear.

Aims: To investigate the roles of the PI3K/AKT and Hedgehog signaling pathways in VM formation and the underlying mechanisms in OCSCs.

Study design: In vitro and in vivo experimental model.

Methods: OCSCs were induced through serum-free culture of SK-OV-3. Hypoxia-inducible factor-1α (HIF-1α) knockdown was achieved by transfection with sh-HIF-1α. Cells were treated with the PI3K agonist 740 Y-P, the PI3K inhibitor LY294002, the Hedgehog agonist purmorphamine, and the Hedgehog inhibitor cyclopamine under hypoxic conditions. Expression of HIF-1α, epithelial-to-endothelial transition (EET) markers, and components of the PI3K and Hedgehog pathways was analyzed using immunofluorescence and Western blotting. VM capacity was assessed using a Matrigel three-dimensional (3D) culture assay. Cell proliferation and invasion were evaluated by MTS, EdU, and Transwell assays. VM formation was further examined in an OCSC xenograft model.

Results: OCSCs accounted for more than 85% of seventh-generation SK-OV-3 cells cultured under serum-free conditions. Hypoxia markedly increased HIF-1α expression, which activated the PI3K and Hedgehog signaling pathways. HIF-1α knockdown suppressed activation of these pathways. Treatment with LY294002 and cyclopamine, as well as HIF-1α knockdown, inhibited hypoxia-induced upregulation of N-cadherin and VE-cadherin, as well as the formation of branching points and 3D channels. Moreover, both LY294002 and cyclopamine significantly reduced cell proliferation, invasion, and VM formation in vitro and in xenografted OCSCs.

Conclusion: HIF-1α knockdown inhibits activation of the PI3K and Hedgehog signaling pathways, thereby reducing EET and VM formation in hypoxia-induced OCSCs.