Medical archives (Sarajevo, Bosnia and Herzegovina)最新文献

Background: Hirschsprung's disease (HD) is a congenital condition marked by the absence of ganglion cells in the distal bowel, leading to chronic functional obstruction. Surgical management involves resection of the aganglionic segment and reconstruction using ganglionated bowel. Among the commonly performed procedures - Duhamel, Soave, and transanal endorectal pull-through (TAEP) - complications such as obstruction, enterocolitis, and stricture can lead to reoperation. Objective: This study aims to compare postoperative complications requiring reoperation following Duhamel, Soave, and TAEP procedures in patients with HD treated at Pirngadi General Hospital between 2014 and 2022.

Methods: A retrospective review was conducted of 58 pediatric patients diagnosed with HD who underwent definitive pull-through procedures. Clinical data were extracted from electronic medical records, focusing on demographics, surgical technique, complications, and need for reintervention. Patients requiring a second surgery due to severe constipation or obstruction were further evaluated. Results: Of the 58 patients (64% male, 36% female), 30 underwent Duhamel (51.8%), 16 Soave (27.5%), and 12 TAEP (20.6%). Eight patients (13.7%) required reoperation: 2 (25%) from the Duhamel group, 5 (62.5%) from Soave, and 1 (12.5%) from TAEP. The mean age at initial surgery was 10.25 ± 7.59 months. Stricture (75%) and enterocolitis (37.5%) were the most frequent complications. Management included dilatation, septum resection, colostomy, and revision pull-through procedures.

Conclusion: The Soave procedure was associated with a higher rate of reoperation. Tailored surgical selection and close postoperative monitoring are essential to improve long-term outcomes in HD.

Background: The type of anesthesia and intensity of pain experienced during surgery are linked to the body's stress response, as reflected in preoperative and postoperative glucose levels.

Objective: This comparative study aims to assess the hyperglycemic stress response to cesarean sections performed under different types of anesthesia.

Methods: This prospective study included 302 participants, divided into two groups: a general anesthesia group and a spinal anesthesia group. Our primary objective was to investigate the effects of general versus spinal anesthesia on pregnant women undergoing cesarean section. Secondarily, we aimed to assess the impact of other factors on the maternal and neonatal stress response during surgery.

Results: Both groups exhibited a significant proportional increase in mean blood glucose levels after surgery. However, this increase was more pronounced in the general anesthesia group than in the spinal anesthesia group. Therefore, spinal anesthesia had a greater effect in attenuating the hyperglycemic response to surgery during cesarean section compared to general anesthesia. Maternal blood glucose levels were significantly associated with steroid injection, type of anesthesia, and gestational age. In contrast, neonatal blood glucose was significantly associated with gestational age, APGAR score, maternal steroid injection, type of anesthesia, maternal age, and both preoperative and postoperative maternal blood glucose levels.

Conclusion: Spinal anesthesia was superior to general anesthesia in attenuating both maternal and neonatal hyperglycemic responses during the cesarean section. This highlights the significant impact of anesthesia type on maternal and neonatal well-being.

Background: Embryo quality is a crucial factor in the success of in vitro fertilization (IVF). Morphokinetics, which refers to the timing and sequence of embryonic cell division and development, has gained attention as a potential indicator of embryo viability and genetic competence.

Objective: This study evaluates the relationship between abnormal embryonic morphokinetics and genetic analysis results, and their impact on clinical outcomes in assisted reproductive technology (ART).

Methods: Conducted at Duc Phuc Hospital with Hanoi Medical University from January to December 2023, the prospective study included 152 patients undergoing in-vitro fertilization (IVF). A total of 968 blastocysts were analyzed using preimplantation genetic testing for aneuploidy (PGT-A). Time-lapse monitoring assessed cell division milestones and abnormal morphokinetic patterns, including direct cleavage, reverse cleavage, multinucleation, and vacuole. Patients received a single euploid embryo transfer. Clinical outcomes were tracked to the live birth stage, analyzed using SPSS 20.0, with p-values < 0.05 considered significant.

Results: Of 583 blastocysts, 294 (50.4%) showed abnormal cleavage patterns. The aneuploidy rate was higher in embryos with reverse cleavage (56.1%) and multinucleation (50%), while direct cleavage and vacuolization showed no significant correlation. Early blastocyst formation (≥100 hours) was linked to a higher aneuploidy rate (60.8%). Nonetheless, clinical outcomes, such as β-hCG positivity and live birth rates, were similar between abnormal and normal cleavage groups when euploid embryos were transferred.

Conclusion: Abnormal morphokinetic patterns are linked to higher aneuploidy rates, but do not significantly affect clinical outcomes when euploid embryos are selected. Integrating genetic testing with morphokinetic assessment can optimize ART success rates.

Background: The global HIV/AIDS epidemic, with its significant presence in Vietnam by the early 2000s, often linked to injecting drug use, prompted concern at the National Otorhinolaryngology Hospital due to a rising prevalence of HIV among ENT patients. This highlighted a need to understand their specific clinical and laboratory profiles.

Objective: This study aimed to systematically evaluate selected biochemical, hematological, and immunological parameters in these HIV-positive ENT patients to characterize their infection and identify significant laboratory alterations.

Methods: This retrospective-prospective cohort study included 104 HIV-positive ENT patients from January 2010 to August 2014. HIV diagnoses were confirmed via a multi-test approach. Demographic, risk behavior, and ENT diagnosis data were collected from medical records. Biochemical, hematological, and immunological (CD4, CD8, CD4/CD8 ratio) parameters were analyzed.

Results: The cohort was predominantly young adult males (85.55%), with injecting drug use as the main risk factor (79.04%). Over half (53.60%) had HIV-related ENT conditions; 46.40% were incidentally diagnosed. Biochemical analysis showed significantly elevated total protein/globulin and reduced albumin/A/G ratio (p < 0.05). Hematologically, leukopenia (7.4% males) and mild/moderate anemia (20.4% males, 33.3% females) were observed. Immunological profiling revealed significantly decreased CD4 counts (264±89.57 cells/mm³) and CD4/CD8 ratios, alongside increased CD8 counts (all p < 0.05).

Conclusion: HIV-positive ENT patients in Vietnam exhibit typical demographic/risk profiles and frequent HIV-related ENT manifestations. Significant biochemical, hematological, and profound immunological abnormalities underscore HIV's systemic impact. ENT clinics are crucial for early HIV detection, necessitating comprehensive laboratory monitoring for effective disease management.

Background: Chronic rhinitis, including the specific condition of inferior turbinate hypertrophy, represents a significant challenge within the field of otolaryngology. This condition, characterized by the hyperplastic enlargement of the turbinates, severely impacts nasal airflow and overall quality of life.

Objective: This study aims to address this gap by evaluating the effectiveness of endoscopic inferior turbinectomy using a microdebrider in treating chronic rhinitis in a Vietnamese hospital setting.

Methods: This prospective case series was conducted at Viet-Tiep Hospital, involving 31 patients with chronic rhinitis and inferior turbinate hypertrophy who underwent endoscopic inferior turbinectomy using a microdebrider from 2017 to 2019. Preoperative, intraoperative, and postoperative variables were analyzed, including nasal airflow, surgical duration, and symptom improvement. Key outcomes, such as pain, nasal crusting, and airflow changes, were assessed using the Visual Analog Scale and Glatzel scale, alongside endoscopic findings and CT imaging for turbinate morphology.

Results: This study included 31 patients (mean age: 42 years, 64.5% male) undergoing endoscopic inferior turbinectomy using a microdebrider. All patients had nasal congestion, with 83.9% experiencing bilateral symptoms. Preoperatively, 80.6% had severe nasal obstruction, and 87.1% showed no response to vasoconstrictors. Common symptoms included rhinorrhea (64.5%), snoring (67.7%), and headache (71%). Postoperative outcomes were favorable, with 90.3% reporting good results. Mild nasal obstruction persisted in 12.9% after one month. Nasal crusting was minimal in 51.6%, and 93.3% showed turbinate reduction. Mild postoperative bleeding occurred in 6.5%, and pain levels were mostly mild.

Conclusion: Endoscopic inferior turbinectomy with a microdebrider is an effective, minimally invasive option for chronic rhinitis, offering significant symptom relief and low complication rates. Its short operative time and minimal postoperative pain support its broader adoption.

Background: Perspectives and views on addiction have changed throughout history, from moralistic interpretations to pharmacological, medical, social and cultural approaches. Research and thinking about the connection between social development and the use of psychoactive substances has broadened the perspective. Personal factors that contribute to the development of a tendency towards addiction are extremely important for understanding addictive behavior, but they are less the focus of researchers. This is one of the key reasons why the underlying causes of this disease are still under-researched.

Objective: To discover how psychological profiles differ between those who have successfully completed treatment and those who have not, thereby providing deeper insight into traits that may be key to successful rehabilitation of addicts.

Methods: The study involved drug addicts (N=368) who were undergoing residential treatment for a year at the Therapeutic Community Institution, Campus of Canton Sarajevo. The study used the MMPI 2 - Minnesota Multiphasic Personality Inventory, a broad-ranging test designed to identify a number of major personality and emotional disorders, and a standardized questionnaire with basic data on addicts in the treatment program, the Pompidou questionnaire, which is used in many European countries to determine: the prevalence of substance abuse, the modality of their use, and the associated harmful consequences. After the psychological profiles were formed, we investigated whether there was a difference between the groups of addicts who completed treatment and those who did not. The IBM SPSS (v23.0) software for statistical analysis was used to process the collected data.

Results: AGE - statistically significant differences/borderline differences were found on the scale Psychopathic Deviation (F=7.501 p=0.001), Paranoia (F=3.025, p=0.056), Psychoasthenia (F=3.144, p=0.051) and Schizophrenia (F=4.383, p=0.017). Status of previous treatment - statistically significant differences were found on the scales Psychopathic Deviation (F=6.047 p=0.017) and Masculinity-Femininity (F=5.086, p=0.028).

Conclusion: Understanding the personality psychological profiles, sociodemographic characteristics, history of the disease of addiction can improve the understanding of the personality of the addict and help to be more successful in the treatment. Previous research in this area shows that addicts have additional psychological difficulties that should be addressed and treated during addiction treatment.

Background: Sepsis is a state of immune response imbalance in an attempt to eliminate infection. Currently, the hypoxic conditioned medium (HPO-CM) secretome from mesenchymal stem cells (MSCs) has been considered as a therapeutic approach with their immunomodulatory capabilities.

Objective: The aim of this article was to study the effect of HPO-CM secretome on the levels of IL-6 and IL-4 in the rat model of sepsis.

Methods: Forty-eight male Rattus norvegicus rats aged 10-12 weeks were divided into four groups: sham (no sepsis induction and treatment), control (sepsis induction without treatment), T1 (sepsis induction and treated with 150 µL of HPO-CM secretome), and T2 (sepsis induction and treated with 300 µL of HPO-CM secretome). Sepsis was induced with procedures based on previous studies. Forty-eight hours after sepsis induction, we sacrificed the rats and collected the blood from the rat orbitals to examine the serum IL-6 and IL-4 levels.

Results: A significant decrease in IL-6 levels was found in rats given 150 µL and 300 µL of HPO-CM secretome. Meanwhile, a significant increase in IL-4 levels was found in rats given 300 µL of HPO-CM secretome.

Conclusion: HPO-CM secretome can alleviate immune dysregulation in sepsis by reducing serum IL-6 levels and increasing serum IL-4 levels.

Background: Nodular thyroid disease is increasingly prevalent, largely due to advances in imaging techniques. Key risk factors include female sex and older age. Thyroid nodules are clinically significant because they can cause thyroid dysfunction, lead to compressive symptoms if large, which can adversely affect patients' quality of life and, most importantly, pose a risk of malignancy. The malignancy rate in thyroid nodules ranges from 5% to 15%.

Objective: This study aimed to investigate the association between thyroid nodules with clinical characteristics, imaging features, and FNAC accuracy. It also explored the relationship between nodule size, malignancy and outcome predictors.

Methods: We retrospectively reviewed 733 thyroid nodules from 679 patients who underwent thyroid surgery between 2016 and 2022 at four healthcare institutions in Saudi Arabia's Eastern Province. Nodule sizes were categorised using ultrasound and histopathology. Malignancy risk, FNAC accuracy, and false-negative rates were compared. Statistical comparisons were made between nodules <4.0 cm and ≥4.0 cm, with multivariate analysis to identify independent predictors.

Results: Nodules ≥4.0 cm were independently associated with benign pathology (OR 0.59, p = 0.004) but showed increased rates of extrathyroidal extension, follicular thyroid carcinoma, and rare malignancies. Multivariate analysis revealed higher odds of intermediate (OR 2.39, p = 0.003) and high (OR 5.33, p < 0.001) recurrence risk. Suspicious ultrasound features and Bethesda V-VI cytology were predictive of malignancy. FNAC performance in nodules ≥4.0 cm showed higher false-negative rates (40.0% vs. 25.9%), lower sensitivity (60.0% vs. 74.1%), and reduced accuracy (66.7% vs. 75.4%).

Conclusion: Nodule size ≥4.0 cm is benign as well as associated with distinct diagnostic profiles and greater recurrence risk. Importantly, larger nodules are aggressive and demonstrate a substantially higher FNAC false-negative rate. Therefore, a careful evaluation by ultrasound risk stratification and consideration of diagnostic lobectomy are advisable, even with benign cytology, particularly when suspicious ultrasound features are present.

Background: Leber's hereditary optic neuropathy (LHON) is the most common maternally inherited disease linked to mitochondrial DNA (mtDNA). The patients present with subacute asymmetric bilateral vision loss. It is a rare disease that typically affects young adults-men more than women-and is a relatively common cause of blindness. The majority (more than 95%) of patients have one of three mtDNA point mutations: m.14484T→C, m.3460G→A, or m.11778G→ A.The hallmark of hereditary optic neuropathies determined by mitochondrial dysfunction is the vulnerability and degeneration of retinal ganglion cells (RGC). Due to its low prevalence in the population (1:50,000), this diagnosis is often overlooked, misdiagnosed, and mismanaged, which may exacerbate symptoms.

Objective: The aim of the paper is to present the complexity and challenge of making the correct diagnosis in patients with progressive vision loss.

Case report: A 42-year-old patient, female, complains of a bilateral decrease in visual acuity after surgery performed under general anaesthesia. The visual acuity value at the first ophthalmological examination was 0.8 bilaterally and could not be corrected. The OCT finding was within the ''reference values'', while the visual field finding showed non-specific changes. Further examinations by a neurologist and psychiatrist do not lead to a correct diagnosis. After a long time, genetic testing reveals a genetic mutation and a diagnosis of LHON is made.

Conclusion: Although still uncommon, the presentation of LHON in middle-aged women is possible and should be considered as one of the differential diagnoses in a patient when painless vision loss occurs.

Background: Children's drawings are considered an important tool for detecting emotions and experiences that a child may be unable or unwilling to express verbally.

Objective: This study aimed to assess the emotional state, psychological development, and adjustment mechanisms of children with chronic diseases using projective drawing tests, and to compare their responses with those of healthy children.

Methods: A cross-sectional design was implemented in one region of Greece, involving 100 children aged 6-12 years. The sample included 50 children with chronic diseases (25 with type 1 diabetes and 25 with cystic fibrosis) and 50 healthy children serving as a control group, selected from pediatric clinics and schools. Data collection took place between January and June 2023. Participants completed three projective tests: the Kinetic Family Drawing Test (KFD), Tree Drawing Test, and House Drawing Test, which assessed emotional expression and psychological functioning.

Results: Children with chronic diseases expressed emotions differently compared to healthy peers. In the KFD, they depicted fewer smiling faces, indicating higher emotional distress and a more negative perception of their family environment. In the tree drawings, symbolic elements such as birds-representing freedom or hope - were more common among children with chronic diseases, while healthy children more often drew roots, suggesting emotional stability. The House Drawing Test revealed no significant differences between the two groups.

Conclusion: Projective tests such as the KFD and Tree Drawing Test appear to be effective in identifying emotional issues in children with chronic illnesses, unlike the House Drawing Test. These findings support the integration of such tools into psychological assessments and therapeutic interventions for pediatric chronic disease populations.