Materia socio-medica最新文献

Background: Lymphadenopathy is a common finding in clinical practice. The cause of enlarged nodes on clinical examination alone is challenging and there may be multiple reasons for this enlargement. It may become enlarged due to stimulation by infectious agents or the involvement of metastasis or malignant diseases, such as lymphoma.

Objective: The aim of the study was to investigate the diagnostic role of fine needle aspiration cytology of lymph nodes in metastatic cancer and lymphoma.

Methods: A total of 48 FNAC lymph nodes suspicious for malignancy were sampled with follow-up biopsy in Clinical Center of University of Sarajevo from 2017 to 2023. Lymph nodes were aspirated using 20-22 G needle with minimally 2 passes, spread on slides, air-dried, stained with May-Grünwald-Giemsa or Papanikolaou and residual material sent for cytoblock.

Results: Out of 48 cytological samples, 30 (62.5%) revealed metastatic epithelial cells and 12 (25%) lymphoproliferative neoplasm. Three samples were suspected for malignancies, one sample was unrepresentative, one inconclusive and one falsely negative. Histopathological confirmation had 35 patients, while others were confirmed based on clinical presentation and radiological techniques. Compared to histopathological diagnosis, cytology had a sensitivity of 89.47%, specificity of 93.33%, positive predictive value (PPV) 95.04% and negative predictive values (NPV) 86.13% for epithelial metastatic cancer. The overall diagnostic test accuracy was 91.06%. For lymphoproliferative neoplasms cytology in comparison to histopathology had sensitivity 85.71%, specificity 91.18%, PPV 76.4% and NPV 95.04%. The overall diagnostic test accuracy was 89.81%. In both ways cytology is showing significant possibility to be used as a primary tool in detecting cancers.

Conclusion: FNAC is a fast, reliable, and efficient method for diagnosing malignant lymphadenopathy. The cytological diagnosis can sometimes be accepted as the definitive diagnosis without further correlation with histopathology, especially in advanced malignancies and known primary malignancies.

Background: Infection causes cirrhosis to decompensate, affecting liver function and resulting in several complications, including esophageal variceal hemorrhage, hepatic encephalopathy, and hepatorenal syndrome. Objective: This study aimed to identify the prevalence, essential features, and related factors of bacterial infection among patients with cirrhosis in Vietnam.

Methods: This retrospective study included 317 patients diagnosed with cirrhosis, who were divided into two groups: group 1 including 125 patients with bacterial infection and group 2 including 192 patients without bacterial infection. Infection was diagnosed on the basis of its localization.

Results: Spontaneous bacterial peritonitis (SBP; 31.2%) and pneumonia (28.8%) were the most common infections identified. The procalcitonin (PCT) level had a strong diagnostic value with an area under the curve value of 0.868. The most common type of gram-negative bacteria was Escherichia coli, while the gram-positive bacteria seen were Staphylococcus, Enterococcus, and Streptococcus among the patients with infection. In the logistic regression analysis, Child-Pugh class B and C (p<0.001, OR=4.14, CI=1.90-9.03; OR=4.76, CI=2.03-11.16, respectively) and the presence of acute kidney injury (p=0.009, OR=2.57, CI=1.27-5.22) and gastrointestinal hemorrhage (p=0.035, OR=0.39, CI=0.16-0.94) significantly differed between the groups.

Conclusion: The most prevalent type of bacterial infection in patients with cirrhosis is SBP, with gram-negative bacteria being the most common cause. The PCT level is useful in identifying infection in patients with cirrhosis. Decompensated cirrhosis is linked to a higher risk of infection.

Background: Workplace health and safety are critical concerns for healthcare professionals, who are often exposed to various occupational hazards.

Objective: The aim of the study was to analyze the effectiveness and impact of law enforcement mechanisms in ensuring occupational health and safety for healthcare professionals in Kosovo.

Methods: Consist in conduct research on the role of law enforcement mechanisms in ensuring the occupational health and safety of healthcare professionals in Kosovo, using a qualitative methodology with questionnaires targeting the Health Inspectorate and Labor Inspectorate.

Results: The study found that while laws and regulations for workplace safety in healthcare exist in Kosovo, their enforcement is inconsistent and often inadequate.

Conclusion: The study concludes that the enforcement of workplace health and safety laws in Kosovo's healthcare sector is inadequate, leading to unsafe working conditions for healthcare professionals.

Background: Occupational health and safety (OHS) in healthcare institutions are crucial for the well-being of healthcare workers who are exposed to numerous risks in their working environment. In Kosovo, where healthcare institutions operate under resource constraints, understanding the challenges of OHS management challenges is vital for developing effective strategies.

Objective: This study aims to explore the challenges of OHS management in Kosovo's healthcare system, focusing on three levels of healthcare provision in both the public and private sectors. The study aims to identify gaps in policies, practices, and infrastructure that affect the safety of healthcare workers and propose actionable recommendations.

Methods: A qualitative research design was used, involving 191 healthcare professionals from primary, secondary, and tertiary levels of healthcare. Participants were randomly selected from public and private institutions. Data collection methods included semi-structured interviews and focus group discussions, ensuring a comprehensive understanding of OHS practices, perceptions, and barriers. Thematic analysis was used to identify key patterns and findings.

Results: The findings revealed significant challenges in OHS management, including inadequate infrastructure, lack of personal protective equipment, insufficient training, and weak enforcement of regulations. Healthcare professionals reported high exposure to biological, chemical, and physical hazards, compounded by limited institutional support. Private sector facilities demonstrated slightly better resource availability but faced similar regulatory gaps.

Conclusion: The study highlights critical deficiencies in OHS management in Kosovo's health system, posing risks to health professionals and the overall service quality. Addressing these challenges requires a multifaceted approach, including policy reforms, enhanced enforcement mechanisms, capacity-building initiatives, and improved resource allocation. Strengthening OHS management is essential for safeguarding the health workforce and ensuring sustainable healthcare delivery in Kosovo.

Background: The incidence of HF following ACS remains unacceptably high at discharge and several identified risk factors contribute to the development of HF in this context.

Objective: This study investigated the prevalence and clinical significance of HF in patients admitted to the Clinic for Heart, Blood Vessels, and Rheumatic Diseases at the Clinical Center of the University of Sarajevo following ACS.

Methods: This retrospective observational study was conducted at the Clinic for Heart, Blood Vessels, and Rheumatic Diseases of the Clinical Center of the University of Sarajevo between February 1^st and April 1^st, 2023, involving patients who were admitted because of ACS.

Results: Patients with HFrEF were significantly (p=0.034) older (70.0 (62.0;76.0) vs 67.0 (57.5;75.0)), had (p=0.046) higher median score of LDH (321.5 (222.3; 501.5) vs. 256.0 (200.0; 420.0)), fibrinogen (p=0.047) (4.5 (3.2; 5.1) vs 3.6 (2.8; 5.0)), and NT-proBNP (p<0.001) (3705.0 (2500.0; 12559.5) vs. 500.0 (275.0; 333.0)), had enlarged left atrium diameter (3.9 (3.4; 4.4) vs 3.6 (3.1; 4.1)), enlarged left ventricular diameter both in diastole (5.1 (4.5; 5.8) vs 4.6 (4.1; 5.1)) and systole (3.7 (3.2; 4.1) vs 3.5 (3.1; 3.7)), thinner interventricular septum diameter both in diastole (1.1 (1.0; 1.2) vs 1.2 (1.1; 1.3)) and systole (1.3 (1.2; 1.5) vs. 1.4 (1.3; 1.5)) and elevated right ventricular systolic pressure (37.0 (30.0; 47.5) vs. 35.0 (28.0; 40.0 )) compared to patients without HFrEF. Severe mitral regurgitation was more observed in group of patients with HFrEF (p<0.001).

Conclusion: HFrEF patients showed a 40% incidence of post-ACS, had elevated LDH, fibrinogen, and NT-proBNP levels, along with distinct echocardiographic differences, including enlarged heart chambers and higher mitral regurgitation rates following ACS. Early HF risk factor management is crucial for optimizing outcomes in ACS patients.

Background: Hypothetically, PPE played an estimated influential role in preventing SARS-CoV-2 transmission among HCWs before immune-prophylaxis by vaccination in BH. Objective: This research aims to determine the relationship between PPE use and the serological response to SARS-COV-2 among HCWs.

Methods: The sample contained 127 COVID-19 outpatients with an average age of 43.5 ± 10.8, 66% women, and 80 (63%) health workers as the study group (37% non-medical workers as a control subjects). The created questionnaire collected sociodemographic data on comorbidity or not, application of PPE, and severity of the clinical picture of COVID-19 infection.

Results: All subjects were monitored for the dynamics of antibodies, separately for IgM- and Ig-G three times, repeated every 3 months (only three before immuno-prophylaxis by vaccinations). A serological investigation of subjects' blood was collected by trained medical staff in vacutainers with a clotting activator to obtain the subjects' serum centrifuged, separated, and tested on the AFIAS 6 COVID-19 apparatus. Healthcare workers who did not wear goggles had significantly higher IgM antibody levels than HCWs who use them [F=9.359 (1, 102), p=.003, partial η2=.084]. Also, HCWs who did not use a visor had significantly higher IgM nucleocapsid antibody titer than those who used it daily or occasionally [F=4.790 (1, 102), p=.031, partial η2=.045]. Increase SARAS-COV-2 IgM titer three, six, or nine months after past COVID-19 infection and before vaccination.

Conclusion: It presents a new acute or recent asymptomatic infection in our HCWs and unrecognized COVID-19. This implies considerable source and unrecognized risk of transmission of the SARS-COV-2 virus, and among HCWs, COVID-19 is an infectious disease with a high prevalence rate.

Background: Autoimmune diseases encompass a diverse array of disorders that disturb the optimal functioning of the immune system, which is to eliminate the 'foreign or/and dangerous' to mistakenly target the body's own tissues.

Objective: The aim of this research is to evaluate the most effective approach to managing autoimmune diseases within the framework of pregnancy.

Methods: The exact causes and etiologies of these diseases are multifactorial and mostly still unclear. Ro/SSA autoantibodies and La/SSB, could be found in Sjögren's disease (SJ), systemic lupus (SLE) and other autoimmune disorders. Smoking, stress, UV exposure, vitamin D deficiency, and other genetic and environmental factors have been identified as risk factors for rheumatic diseases.

Results: Over the years, an ever-increasing incidence of these diseases has been observed in the general population, with the female sex being at increased risk for their occurrence. This fact raises the question of what should be the management of these pathological entities during pregnancy. Taking into account the very significant impact on the quality of paitients'daily life and the seemingly augmented prevalence of autoimmune diseases, as well as their preference in the female population, the reasonable question arises as to what should be the optimal management of these diseases in the context of pregnancy.

Conclusion: Given the limited data of the global medical community regarding the etiological factors and mechanisms that trigger the onset of rheumatic diseases, the management of pregnant women is a complex conundrum that health professionals are challenged to face and solve.

Background: Thyroid dysfunction includes hyper- and hypofunction of the thyroid gland (hyperthyroidism and hypothyroidism). The spectrum encompasses both subclinical and clinical disease presentation. The etiology is vast and varied, as are the risk factors and simptoms.

Objective: The main aim of the research is to indicate the leading symptom for initial thyroid hormone status evaluation, as well as to identify the distribution of positive and negative test results, and specific disorders according to sex and age groups.

Methods: The research is designed as a retrospective, clinical, descriptive study. There were 500 participants included, 355 female and 145 male. Patients were referred to the Department of endocrinology by their primary care physicians. The data was collected through patient documentation.

Results: The study included 500 participants, 71% of diagnostic requests made were for women. 80% of subjects had normal thyroid hormone status, p<0.001. Most requests were made for the 41-60 age group, p<0.001. Women had similar number of positive and negative test outcomes, as well as men. When it comes to the age groups, outcomes were similar in all of them, 15-23% positive and 77-85% negative. There were significant differences in the type of symptom expressed in both men and women, as well as all the age groups. Men reported high blood pressure as the most common symptom (30.3%), while women reported weight gain (22.3%). In the 18-25 and 26-40 age groups most common symptom belongs to the category of other. Age group of 41-60 reported weight gain as the most common symptom, while in participants older than 60, high blood pressure is proven to be the most common. Hypothyroidism is the most common disorder in both men and women, as well as in all age groups.

Conclusion: It is statistically proven that there were more requests made for women, and older age groups. Leading symptom for initial thyroid hormone status evaluation is high blood pressure. There is no statistically significant difference in distribution of thyroid disorders according to sex or age groups.

Background: The rate of multi-drug antibiotic resistance in nosocomial bloodstream infections in elderly patients is increasing. This study examined the data for bloodstream infections to gain a better understanding of bacterial antibiotic resistance.

Methods: This was a retrospective study of 817 patients with the first positive blood culture between January 1, 2016 and December 31, 2019.

Results: Moyen's age was 77.4 ± 9.8 years, male (52.4%) and SOFA 5.0 ± 4. ESBL(+) rate was 78/817 (9.5%). ESBL(+) rate for Escherichia coli and Klebsiella pneumoniae was 69/141 (48.9%) and 9/52 (17.3%), respectively. The most common isolates were Escherichia coli (17.3%), Stenotrophomonas maltophilia (13.7%), and Staphylococcus species (23.1%). The rate of septic shock and mortality accounted for 22.3% and 28.9%, respectively. Escherichia coli is highly sensitive to carbapenem, and resistant (>50%) with quinolone and aminoside. Klebsiella pneumoniae and Pseudomonas aeruginosa were highly sensitive to carbapenem. Acinetobacter baumannii was resistant to meropenem (75%). Stenotrophomonas maltophilia was sensitive to quinolone (13.8 %), and highly resistant to remaining antibiotics. Methicillin-resistant Staphylococcus aureus had a low resistance rate for vancomycin, teicoplanin, and linezolid. Multivariate analysis showed that the significant factors associated with mortality were age >75; SOFA >7; respiratory infection; intensive care unit treatment and presentation with septic shock.

Conclusion: The mortality rate was still high, especially for antibiotic-resistant agents.

Background: This study examines the employability and career trajectories of International Hellenic University's (IHU) midwifery students who graduated between 2016 to 2021, with a focus on undergraduate curriculum changes.

Objective: To comprehensively examine the post-graduation journey of recent IHU Midwifery graduates. This includes shedding light on their employment trajectories, satisfaction levels, and the practical application of academic knowledge. Through this exploration, the study seeks to inform educational strategies to ensure alignment with the evolving needs of midwifery professionals in Greece.

Methods: Online questionnaires that explored post-graduation experiences, perspectives on the study program, and future plans. The questionnaires consisted of a mix of open and closed-ended questions and were completed by 273 recipients. The study was conducted from May to September 2023, with participant anonymity maintained. Statistical analysis was performed using SPSS. Results: This study revealed differences between graduates of the 'old' and 'new' midwifery undergraduate curriculum. There were notable variations in the perceived impact of the six-month internship on employment. The study also highlighted the impact of the COVID-19 pandemic on educational experiences, emphasizing the nuanced challenges faced during clinical practice, practical training, and simulation training. Finally, the self-employed professionals and those employed in the public sector expressed higher satisfaction with the alignment of their employment with their undergraduate studies, than their counterparts in the private sector (p=0.038).

Conclusions: Our study offers valuable insights into job placement, knowledge sufficiency, and the impact of the pandemic on midwifery undergraduate education. These findings can guide tailored strategies for improved education and holistic professional development, ultimately enhancing maternal and neonatal care.