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Background: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) and atrial fibrillation (AF), yet data on the clinical outcomes and management of AF in RA patients remain limited.

Objective: This study aimed to evaluate the impact of RA on AF-related outcomes and treatment strategies.

Methods: We conducted a retrospective cohort study using the TriNetX US collaborative network database, including adult patients diagnosed with AF between 2015 and 2025. Patients were divided into two cohorts based on the presence or absence of RA. Propensity score matching was performed to balance baseline characteristics.

Results: A total of 33,922 RA-AF patients and 33,922 non-RA AF patients were analyzed after matching. RA-AF patients exhibited a significantly higher risk of all-cause mortality (24.5% vs. 21.0%, OR: 1.216, p<0.001) and hospitalization or emergency department visits (72.2% vs. 69.2%, OR: 1.153, p<0.001). Additionally, RA-AF patients had a higher incidence of ischemic stroke or transient ischemic attack (13.2% vs. 11.4%, OR: 1.180, p<0.001) and composite hemorrhagic events (14.4% vs. 10.6%, OR: 1.411, p<0.001). Notably, AF with rapid ventricular response (RVR) was more common in RA-AF patients (36.1% vs. 33.5%, OR: 1.122, p<0.001). Despite the elevated thromboembolic risk, RA-AF patients demonstrated lower utilization of anticoagulation (46.9% vs. 49.4%, OR: 0.905, p<0.001) and a preference for rate control over rhythm control strategies.

Conclusion: RA-AF patients experience higher mortality, increased stroke and hemorrhagic risk, and more frequent hospitalizations compared to non-RA AF patients. Despite these risks, anticoagulation underutilization remains a concern.

Background: Obesity and Type 2 diabetes mellitus (T2DM) are growing public health concerns in Southeast Asia, including Indonesia. Obesity promotes insulin resistance and metabolic irregularities, increasing the risk for T2DM. CTLA-4, an immune checkpoint receptor, plays a role in immune regulation, but its involvement in obesity, dyslipidemia, and T2DM remains unclear.

Objective: The aim of this study was to evaluate the association between CTLA-4 levels and obesity, dyslipidemia, and T2DM.

Methods: A cross-sectional study was conducted at Universitas Sumatera Utara Hospital and affiliated hospitals, including 100 adult participants from the endocrine clinic. Participants with coronary heart disease, kidney issues, heart problems, and cancers were excluded. Fasting blood glucose, A1C levels, LDL cholesterol, triglycerides, and CTLA-4 expression were measured. BMI was calculated from age, gender, height, and weight data. Statistical analysis was performed using SPSS 26.0, applying the Mann-Whitney U-test and Spearman correlation for variable relationships. Statistical significance was set at p < 0.05. Result: Among 100 participants, 36% were obese, 42% had dyslipidemia, and 31% had T2DM. The median CTLA-4 serum level was 93.3 pg/mL (range 36-264). CTLA-4 levels were significantly lower in obese individuals (67.2 pg/mL) compared to non-obese individuals (106.8 pg/mL, p = 0.019). No significant differences in CTLA-4 levels were found for dyslipidemia (p = 0.839) or T2DM (p = 0.351). A significant negative correlation was found between CTLA-4 levels and BMI (r = -0.329, p = 0.001).

Conclusion: CTLA-4 levels negatively correlate with BMI, indicating its potential involvement in obesity-related metabolic changes. No significant link was found with dyslipidemia or T2DM, warranting further research.

Background: Hydrocephalus is the accumulation of cerebrospinal fluid in the ventricles of the brain. Ventriculoperitoneal shunt placement is one of the most commonly performed neurosurgical procedures and is necessary for the treatment of most forms of hydrocephalus.

Objective: The aim of the study was to determine demographic indicators, comorbidities, complications and outcome of patients with hydrocephalus after ventriculoperitoneal shunt implantation.

Methods: This is a retrospective study. Data on the subjects' age, gender, symptoms, degree of disability, complications, comorbidities and outcome after ventriculoperitoneal shunt implantation were recorded. All patients were clinically examined by neurologists and neurosurgeons and diagnosed through unified and standardized algorithms according to established guidelines for hydrocephalus. Cognitive functionality was assessed according to the Mini Mental State Test. Urinary incontinence was assessed based on patients' subjective feelings. Data on comorbidities and complications were collected from the patients' medical records. The degree of disability was assessed using the modified Rankin scale.

Results: The average age of the subjects was 58.7 years, and the highest frequency of subjects was in the age group over 61 years (62.2%). There was no statistically significant difference in age in men (X=54.69, SD=18.77), or women (X=60.88, SD=19.96); t (35)=0.8, p=0.3. A statistically significant number of patients with hydrocephalus had a lower degree of disability after ventriculoperitoneal shunt implantation (p<0.05). Hypertension was the most common comorbidity with hydrocephalus (35.1%). Pneumonia was the most common general complication in patients with hydrocephalus (8.1%). Females had a statistically significantly worse survival (p=0.01). There was no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation (p>0.05).

Conclusion: Patients with hydrocephalus after ventriculoperitoneal shunt implantation have a lower degree of disability, and female patients have statistically significantly worse survival. Hypertension is the most common comorbidity, and pneumonia the most common complication in patients with hydrocephalus. There is no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation.

Background: Chronic rhinosinusitis (CRS) is a prevalent and debilitating condition among industrial workers exposed to occupational hazards such as dust and chemical irritants. Despite its significant impact on quality of life and productivity, evidence-based interventions for occupational CRS remain limited.

Objective: This study evaluates the effectiveness of combined health education and nasal irrigation in reducing CRS symptoms among direct labor workers at the Hai Phong Cement Plant, Vietnam.

Methods: A randomized controlled trial was conducted from 2014 to 2015, involving 90 workers diagnosed with CRS. Participants were randomly assigned to an intervention group (n=45), receiving nasal irrigation kits and training, or a control group (n=45), receiving health education only. Health education sessions focused on improving knowledge, attitudes, and practices (KAP) related to CRS prevention. Nasal irrigation involved twice-daily rinsing with 0.9% saline solution. Outcomes were assessed using structured questionnaires, clinical examinations, and the Intervention Effectiveness Index (HQCT).

Results: The health education intervention significantly improved KAP scores, with a 2967% increase in positive attitudes and an 847% improvement in understanding preventive measures. Nasal irrigation demonstrated substantial efficacy, reducing moderate nasal discharge by 58% and nasal congestion by 1600%. Objective findings revealed a 1657% increase in workers reporting no nasal cavity discharge and a 158% improvement in nasal mucosal health. After six months, 60% of the nasal irrigation group reported "good" improvement, compared to 11.1% in the control group (p < 0.05).

Conclusions: This study highlights the synergistic potential of health education and nasal irrigation in managing occupational CRS. Nasal irrigation, in particular, emerged as a highly effective, low-cost intervention for alleviating CRS symptoms in high-risk industrial settings. These findings underscore the importance of integrating non-pharmacological approaches into occupational health programs to safeguard respiratory health among workers exposed to environmental hazards.

Background: Depressive disorder is characterized by a persistent low mood (sadness, irritability, or emptiness) or a loss of pleasure, accompanied by other cognitive, behavioral, or neurovegetative symptoms that significantly impair a person's ability to function. Anxiety and fear-related disorders are marked by excessive anxiety and fear, which lead to behavioral disturbances and cause significant distress or impair personal, family, social, educational, occupational, or other key areas of functioning.

Objective: The aim of this study was to analyze whether there are differences in the development of depressive symptoms between COVID-19 patients and patients with symptoms of the flu or common cold.

Methods: This is a prospective study that included sixty participants: thirty with COVID-19 and thirty without COVID-19. Data were collected from the ambulatory observational records of participants, documenting their symptoms. We analyzed the relationship between variables such as age, sex, education, and the level of potential depression. The participants were divided into two groups: one consisting of individuals with COVID-19 and the other of individuals without COVID-19. All participants were male and female, aged between 40 and 65 years, and had no previous history of depressive disorder. The first group consisted of patients with COVID-19 who were treated at home but were examined at our outpatient clinic and subsequently sent home.

Results: Statistical data processing was performed using the Excel program and the R statistical data processing program. Percentages are calculated in relation to 30 respondents in each group.There was no statistically significant correlation between the level of education in Group 1 and the development of depression(Spearman ro=0.007, P=0.972). In Group 1 (Covid ) there is a statistically significant correlation between the age of the subjects and the development of depression (Spearman ro=0.44, P=0.015). A positive value of the Spearman correlation coefficient means that the score increases with the age of the respondent. Three questions with the highest score in group 1 were: Question 2=71, Questions 15 and 16=66, Question 14=65; three questions with the highest score in group 2 were: Question 2=74, Question 1 =50, Question 18=46.

Conclusion: COVID-19 can contribute to the development of depression. In our study, 16.7% of patients with COVID-19 showed signs of depression, with 10% experiencing mild depression and 6.7% experiencing moderate depression. Patients in the first group, particularly those of older age, were more likely to develop mild or moderate depression associated with COVID-19. Additionally, no statistically significant correlation was found between the level of education in Group 1 and the development of depression.

Background: Vascular ultrasound evaluation of the abdominal aorta is a simple and efficient technique for assessing the morphology and size of the abdominal aorta, as well as for identifying infrarenal aortic aneurysms, a potential condition with significant mortality.

Objective: This study aims to evaluate the diameter and morphology of abdominal aorta in a community-based population using vascular ultrasound and to determine the prevalence of infrarenal aortic aneurysms.

Methods: A randomized sample of individuals aged 60 years and above was recruited from several provinces. Abdominal aortic diameters were measured using vascular ultrasound according to established international guidelines.

Results: 810 individuals were enrolled in the study, of whom 40.2% were male, with a mean age of 70.9 ± 7.56 years. The mean infrarenal abdominal aortic diameter was 18.2 ± 2.93 mm in men and 16.3 ± 1.87 mm in women (p < 0.001). A significant increase in aortic diameter was observed with advancing age. Age, male sex, body surface area, and current smoking status were significant predictors of infrarenal aortic diameter.

Conclusion: In this population-based survey, the mean infrarenal abdominal aortic diameter was 18.2 ± 2.93 mm in men and 16.3 ± 1.87 mm in women, with an infrarenal aortic aneurysm prevalence of 0.12%. Further population-based studies with a bigger sample and extended follow-up are necessary to investigate further the aortic morphologies predisposing to later aneurysm.

Background: Malnutrition is a frequent yet often overlooked comorbidity in patients undergoing surgery for colorectal cancer. It is associated with adverse postoperative outcomes, including increased complications, prolonged hospital stay, and elevated mortality.

Objective: This study aimed to assess the clinical impact of short-term preoperative enteral nutrition in malnourished patients undergoing elective colorectal cancer surgery.

Methods: A prospective cohort study was conducted involving 68 malnourished patients with histologically confirmed stage I-III colorectal cancer. Patients were divided into three groups: Group A (14-day enteral nutrition), Group B (7-day enteral nutrition), and Group C (no supplementation). Nutritional status, laboratory parameters, postoperative complications, transfusion needs, and hospitalization metrics were compared among groups.

Results: Group A demonstrated the most favorable outcomes, including significantly fewer postoperative complications such as anastomotic leakage (5.0% vs. 17.9%, p = 0.030), reduced transfusion and albumin requirements, and shorter ICU and hospital stays (1.6 ± 0.7 and 7.1 ± 2.4 days, respectively). Group C showed the highest complication and mortality rates. Improvements in biochemical markers were observed in both intervention groups, supporting the efficacy of enteral supplementation.

Conclusion: Short-term preoperative enteral nutrition significantly improves clinical outcomes in malnourished colorectal cancer patients undergoing elective surgery. These findings support the integration of nutritional screening and intervention as standard components of perioperative care in oncologic surgery.

Background: Immediate implant-retained surgery on the fibula using the traditional method is a technical challenge in mandibular reconstruction and can worsen the following prosthetic process. A digital workflow with multiple surgical guidance tools can help ensure accuracy and even immediate temporary prosthesis placement in mandibular reconstruction using fibula flaps.

Objective: In this article, we present a digital workflow for dental implant placement in the fibula flap using a 3D-printed surgical guide before the vascularization of the flap and temporary prosthesis immediately during surgery.

Case presentation: This procedure includes resection of the mandibular lesion, immediate reconstruction with a fibula flap, immediate implant placement, and provisional prosthesis placement. Our patient received both mandibular reconstruction and dental implant prosthesis completed in a single day at the tumor resection stage, which enormously shortens the recovery time without teeth to zero. Regarding the implant position on the fibula, the results were awe-inspiring. We measured and compared with the assumed plan; the neck deviation was about 1.47mm, the average change in implant height was 1.06mm, and the average implant deviation angle was 9.17 degrees. The above results helped the process of trying on temporary restorations and grinding the occlusion completely smoothly, even with the permanent restoration process later.

Conclusion: We report two cases utilizing the fully digital "Jaw in a Day" workflow. VSP and surgical guidance are essential in the precise cutting and shaping of the fibula flap and the prosthetic restoration with dental implants.

Background: Cardiometabolic risk (CMR), encompassing metabolic syndrome, type 2 diabetes mellitus, hypertension, and dyslipidemia, represents a major public health challenge in Bosnia and Herzegovina, where overweight and obesity prevalence is high.

Objective: The study aimed to: a) examine the prevalence of three or more metabolic risk factors in relation to age; b) analyze biochemical parameters, lipid indices, and body composition indices in association with cardiometabolic risk (QRISK3); and c) identify age-specific thresholds for elevated risk.

Methods: A cross-sectional, observational, descriptive-analytical study included 203 working-age participants (≤49, 50-54, 55-59, ≥60 years). The research instruments included: laboratory analysis, anthropometric and body composition parameters, and the Q3 risk calculator.

Results: The prevalence of three or more metabolic risk factors increased with age, from <49 years to ≥60 years. Younger participants exhibited lower HDL and higher visceral fat, whereas older groups showed elevated glucose, ALT, and AST (p<0.05). The Q3 risk score increased significantly across age groups (median 8.15 to 24.80; p<0.001). Visceral fat, BMI, and body fat percentage emerged as strong predictors of risk in younger and middle-aged adults.

Conclusion: Cardiometabolic risk develops already in early adulthood. Age-specific thresholds for visceral fat and biochemical markers may improve risk stratification, highlighting the importance of early screening and preventive interventions.

Background: Stroke is the second leading cause of global mortality and the major contributor to morbidity. 2D speckle-tracking echocardiography (STE) is a sensitive method for evaluating myocardial function, but its parameters and prognostic value in stroke patients remain limited.

Objective: The aim of this study was to evaluate the prognostic performance of left atrial and left ventricular function through the correlation of STE and tissue Doppler imaging (TDI) parameters.

Methods: We conducted a prospective case-control study on 67 ischemic stroke patients who met inclusion criteria and underwent clinical evaluations, 2D echocardiography, TDI, and STE. We employed multivariate and univariate analyses to assess relationships, the area under the curve (AUC) and the receiver operating characteristic (ROC) curve to assess the prognostic performance of STE parameters.

Results: In 67 stroke patients (55% men, 58 ± 10.1 years old) and 40 control patients (77.5% men, 43.75 ± 5.3 years old), correlation assessment regarding STE parameters, GLS and LAVmax in the two groups significantly declined from -18.6 ± 2.6 to -20.6 ± 1.3, 29.6 ± 8.5 to 24.6 ± 7.5, respectively. ROC curve analysis demonstrated high performance with AUC = 0.89, cut-off = 35.5%, sensitivity = 94.1% and specificity = 52%. Regarding multivariate logistic regression analysis, LAS indicated a significant relationship with severe stroke events (OR: 0.69, 95% CI 0.56 - 0.88, p = 0.001).

Conclusion: The AUC of ROC showed STE parameters as a highly significant prognostic factor. After eliminating insignificant factors via a uni-multivariable logistic model, STE parameters remained a key factor in prognostic stroke progression.