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

Background: Diabetic nephropathy is one of the causes of chronic kidney disease with a very complex mechanism, in which oxidative stress plays an important role and bilirubin acts as an effective antioxidant, protecting cells from damage caused by oxidative stress.

Objective: The aim of the study was to investigate the relationship between plasma bilirubin concentration with glomerular filtration rate and creatinine in patients with type 2 diabetes with renal damage.

Methods: Total amount of 60 patients with type 2 diabetes with renal damage. Study design was descriptive.

Results: Mean age 64.1±4.76. The rate of decreased glomerular filtration rate was 86.7% and increased albuminuria accounted for 96.7%. The concentration of total bilirubin in plasma decreased correspondingly to the decrease in glomerular filtration rate. The concentration of total, free and conjugated bilirubin was negatively correlated with creatinine concentration (r=-0.48), (r=-0.37), (r=-0.34) and positively correlated with glomerular filtration rate (r=0.54), (r=0.45), (r=0.41) with p<0.05). The area under the curve (AUC) of total bilirubin concentration was 0.7, lower than the area under the curve (AUC) of creatinine concentration 0.8, uric acid 0.74.

Conclusion: Plasma bilirubin concentration is inversely correlated with creatinine concentration and positively correlated with glomerular filtration rate.

Background: The centrally located portion of the thoracic cavity is called the mediastinum and consists of several essential organs. In the presence of various outcomes and prognostic indicators of mediastinal masses, meticulous diagnosis of these masses is considered crucial.

Objective: In this study, we analyzed all mediastinal masses observed clinically and pathologically at one institution over a period of ten years.

Methods: This is a retrospective, single-institution review of 94 patients with mediastinal masses, drawing on existing data recorded by the hospital. The study was carried out at the King Fahd University Hospital, Khobar, Saudi Arabia. Data was collected from 2009 to 2019. Participants were all patients with malignant or benign mediastinal masses admitted to the hospital, or diagnosed incidentally to have mediastinal masses during investigations for other reasons.

Results: The mean age for developing a mediastinal mass was 33.89 ± 18.91 years of age. Most of the patients (69.1%) were symptomatic at presentation. Overall, (49.23%) of patients who were symptomatic at diagnosis had a malignant mass. Concerning pathologic diagnosis and presentation of the patient (symptomatic versus asymptomatic), there was a significant positive relationship between pathologic diagnosis and symptoms with a P value of 0.020. In our study, only 5.15% of cases experienced recurrence.

Conclusion: This study provides a great understanding of mediastinal tumor biology and the role of both radiotherapy and chemotherapy in increasing the survival rates of patients suffering from similar malignant conditions.

Background: Vitamin D deficiency and insufficiency are considered as major health problems in many countries including Jordan.

Objective: The aim of this study was to assess the knowledge of Jordanian population regarding vitamin D sources, importance, causes and symptoms of vitamin D deficiency as well as their attitude and practices toward vitamin D' sources, supplements and laboratory investigations.

Methods: This is a cross-sectional study among Jordanian population. A survey was designed using Google Forms online platform. The survey included three main sections with 49 questions covering the aims.

Results: The study included a total of 891 participants. The majority were females (75.3%) from the northern of Jordan (66.4%). The participants showed high level of knowledge (80%) regarding sunlight as main source of vitamin D, vitamin D importance for bone health, and the role of limited sunlight exposure as a cause of deficiency. However, they showed moderate (60-79%) or low level of knowledge (<60%) regarding many other aspects. The main sources of knowledge were the social media (52.9%) and the medical staff (46%). Participants showed positive attitude (80%) toward the exposure to sunlight, neutral attitude (60-79%) toward the consumption of dairy products, fortified food, and vitamin D supplements, but negative attitude (<60%) toward many other sources. The main indication for supplements was treatment of deficiency. Vitamin D levels were mainly insufficient (50.43%) or deficient (33.26%) before consumption, but there was an overall improvement upon treatment (normal (60.26%), insufficiency (28.21%), and deficiency (8.55%)).

Conclusion: National health educational programs about vitamin D are highly recommended. This can be driven by the health organizations and health care providers. The production of high-quality medical content on popular social media platforms is expected to improve people' knowledge and attitude. Consumption of vitamin D supplements appears to be driven by many factors including awareness level, healthcare recommendations, and personal health goals.

Background: Polycystic ovary syndrome (PCOS), a significant hormonal disorder that primarily affects young women, has a substantial impact on both their health-related quality of life and their mental well-being.

Objective: To assess the prevalence and patterns of body dysmorphia in polycystic ovary syndrome (PCOS) patients in Kingdom of Bahrain and to reach a consensus regarding the relationship between body dysmorphia and PCOS.

Methods: There were 132 participants involved in the study: 66 were control cases, 66 were PCOS cases. Each was given a survey form. The scoring was based on the Głębocka's self-perception scale and modified Ferriman-Gallwey hirsutism scale were used to assess about own perception to appearance, and pressure to change body shape.

Results: Most of the PCOS patients in the Kingdom of Bahrain who are above 30 years old experienced body dysmorphia along with other physical changes in appearance and psychological disorders such as social anxiety and depression. About 86% of them have hirsutism which significantly affects their self-esteem and self-confidence within themselves. However, the average hair distribution volume ranges only from 1.82 to 2.53 in the different parts of the body.

Conclusion: Body dysmorphia is prevalent in patients diagnosed with PCOS. It is important to understand that these manifestations of PCOS in women significantly impact their quality of life..

Background: Timely reperfusion is crucial in patients with ST-segment elevation myocardial infarction (STEMI), with door-to-balloon time often considered a key metric for assessing quality of care. However, the impact of door-to-balloon time on clinical outcomes during off-hours remains uncertain.

Objective: To compare clinical outcome and door-to-balloon time of patients with STEMI in off-hours versus on-hours in King Fahad Uni-versity Hospital (KFHU).

Methods: A mixed-method, qualitative and quantitative retrospective cohort study was conducted at KFUH in Al Khobar, Saudi Arabia, including adults diagnosed with STEMI and managed with primary percutaneous coronary intervention (PCI) between May 2023 to February 2024. The sample was divided into two groups based on-duty hours. The first group comprised patients presenting during duty hours, including weekdays (Sunday to Thursday, 8 a.m. - 4 p.m.), while the second group included patients presenting during off-duty hours, which consisted of weekdays (Sunday to Thursday, 4:01 pm to 7:59 am), weekends (Friday to Saturday), national holidays, and Eid holidays.

Results: The study included 79 patients (57 off-hours and 22 in-hours) diagnosed with STEMI who underwent primary PCI. The mean age of the participants was 55.0 years (±10.8), 89.9% were males, 36.7% were Saudi, and 41.8% were smokers. Off-hours presentation did not significantly impact mortality rates or complications compared to on-hours presentation (p > 0.05), Similarly, no significant association was found between door-to-balloon time and 48-hour or 30-day mortality rates (p > 0.05). The mean time was statistically significant across the on- and off-duty time groups (65.2±18.0 vs 107.4±44.5, p<0.0001). Hypotension was the only complication signifi-cantly associated with mortality at 30 days (p < 0.001).

Conclusion: Our results revealed that neither door-to-balloon time nor off-hours presentation significantly affected mortality rates or complications in pa-tients with STEMI undergoing Primary PCI, with the exception of hypotension being significantly associat-ed with 30-day mortality. Further research is warranted to explore other factors that may influence STEMI outcomes beyond door-to-balloon time and presentation hours. Additionally, investigating the specific rela-tionship between hypotension and 30-day mortality could lead to improved risk stratification and manage-ment strategies for STEMI patients.

Background: The presentation of Pott's has a wide variation and an insidious onset, which makes timely accurate diagnosis quite challenging.

Objective: To review Pott's cases to enhance the disease management and fill the literature gap regarding the approach to Pott's disease.

Methods: A descriptive observational retrospective hospital-based study conducted from 2007 to 2022 at KFHU. 346 patients who were diagnosed with TB were reviewed thoroughly. Only 13 cases were labeled as Pott's disease based on imaging or microbiology testing and hence were included in this study, and other TB pulmonary and extrapulmonary cases were excluded.

Results: In our analysis of 13 cases of Pott's disease, we observed a significant male predominance (69.23%) and diverse symptoms, with back pain (69.2%) being most prevalent among our patients. Lumbar involvement was the most frequently observed site (38.4%), and diagnoses were made through microbiology (69.2%) or clinical/radiological means (30.8%). Acid-fast bacilli (AFB) culture testing exhibited a positivity rate of 61.5%, while TB-PCR showed positive results in 57.1%. Imaging studies revealed vertebral lesions (90.9% CT, 81.8% MRI), abscesses (54.5% CT, 81.8% MRI), and spondylodiscitis (18.2% CT, 54.5% MRI). Treatment, administered in 92.3% of cases, involved the use of Isoniazid, Rifampicin, and Ethambutol. Surgical interventions, though less frequent, encompassed various procedures. Outcomes demonstrated a notable high cure rate of 84.9%, with a 15.4% incidence of cases experiencing loss of follow-up.

Conclusion: The high cure rate of 84.9% accentuates the effectiveness of early diagnosis and comprehensive treatment strategies that combine medical and surgical interventions when necessary.

Background: Effective and equitable oral healthcare delivery relies on robust institutional capacity and good governance. In transitional health systems such as Kosovo's, the voices of managerial personnel are often overlooked in health system evaluations, particularly in the oral health sector.

Objective: This study aims to assess the institutional and governance capacities of oral healthcare facilities in Kosovo by analyzing insights from facility managers across public and private sectors..

Methods: A mixed-methods design was employed. Quantitative and qualitative data were gathered through semi-structured interviews with 40 managers of oral health institutions. Participants were purposively sampled to ensure geographical and institutional diversity across the Kosovo's seven regions. Survey topics included organizational communication, workforce issues, and policy coordination. Interview discussions explored institutional strategies, infrastructure challenges, and leadership dynamics. Quantitative data were analyzed using descriptive statistics, and qualitative data were examined through thematic analysis.

Results: Managers identified inadequate infrastructure, constrained financial flexibility, and unclear governance structures as major impediments to institutional effectiveness. Responses underscored disparities between urban and rural services and the absence of a coherent national oral health strategy. Concerns were also raised regarding fragmented responsibilities between central and municipal health authorities.

Conclusion: Kosovo's oral health institutions face considerable governance and infrastructure limitations that hinder effective service delivery. Addressing these structural and managerial deficiencies is essential for strengthening institutional capacity, enhancing strategic planning, and improving resource allocation. These findings offer relevant lessons for other transitional health systems aiming to build sustainable and responsive oral healthcare frameworks.

Background: Secondary hematuria due to benign prostatic hyperplasia (BPH) is especially challenging to treat in elderly, high-risk patients. It can be very difficult to manage with conventional therapies.

Objective: This case report illustrates the successful use of PAE to treat refractory hematuria in a 98-year-old male with advanced BPH. Case presentation: In this report, we present a 98-year-old male who had recurrent hematuria and was successfully treated with prostate artery embolization (PAE). The patient underwent bilateral prostate artery. PAE, which led to resolution of the hematuria without complication.

Conclusion: This case demonstrates the effectiveness of PAE as a minimally invasive surgical technique in attempting to resolve complex clinical problems.

Background: Progressive systemic sclerosis (PSS) is an inflammatory disease of connective tissue, with onset as edema that continues with fibrosis, induration, and skin atrophy. The gastrointestinal tract is affected in about 90% of those diagnosed with PSS, often with several organs in this system being affected simultaneously.

Objective: This study aimed to investigate the gastrointestinal tract in patients diagnosed with PSS.

Methods: In this prospective, descriptive and analytical study conducted at the University Clinical Center of Kosovo, a total of 75 patients were included.

Results: The mean age of the female participants was 55.6±8.7 years. Clinical findings in the patients were: dysphagia was the most prevalent symptom, affecting 24 individuals (32%), followed by nausea in 15 patients (20%), heartburn in 13 patients (17.3%) and vomiting in 11 patients (14.7%). In the lower gastrointestinal tract, the predominant symptom was constipation, reported by 38 patients, while anal pain was observed in 13 cases; rectal bleeding and diarrhea were observed less frequently. The primary endoscopic pathologies identified in the esophagus included gastroesophageal reflux disease (GERD) and hiatal hernia. In the stomach, the most prominent conditions were gastritis and gastric ulcers. In the colon, colitis and diverticular disease were identified.

Conclusion: The investigation of clinical and endoscopic findings is of fundamental importance for pharmacological and sometimes surgical treatment, but also for the prognosis of life and its quality.

Background: Understanding the aging process has become one of the global concerns as the world faces the new challenges of an aging population. Central to this phenomenon is cellular senescence, marked by an irreversible growth arrest due to cellular damage. Gut microbiome is a dynamic community of microorganisms influenced by diet, environmental exposures, and aging.

Objective: This research highlights the significant impact of gut microbiota composition on overall health, particularly in older adults, where deterioration in microbial diversity can lead to adverse health outcomes. Kombucha, a fermented tea beverage, has emerged as a potential gut microbiota modulator, offering antioxidant properties and digestive support. Specifically, Kombucha derived from Areca catechu shows promise in modulating inflammatory markers and gut microbiota composition.

Methods: This review synthesizes current literature on the relationship between aging, frailty, and gut health, with a particular focus on gut microbiota composition and chronic inflammation, referred to as "inflammaging." We specifically investigate the potential of Kombucha, a fermented tea beverage, to modulate gut microbiota and inflammatory markers.

Results: Kombucha, a fermented tea beverage, has emerged as a potential gut microbiota modulator, offering antioxidant properties and digestive support. Specifically, Kombucha derived from Areca catechu shows promise in modulating inflammatory markers and gut microbiota composition. This review synthesizes current literature on the interplay between aging, frailty, and gut health-focusing on the role of gut microbiota and chronic inflammation ("inflammaging")-to elucidate the therapeutic potential of Kombucha in promoting gut health and mitigating age-related decline, thereby contributing to a deeper understanding of its role in the aging process.

Discussion: This research elucidates the therapeutic potential of Kombucha in promoting gut health and mitigating age-related decline, contributing to a deeper understanding of its role in the aging process. The interplay between gut microbiota and chronic inflammation highlights the importance of dietary interventions in managing health in aging populations.

Conclusion: Kombucha presents a viable strategy for modulating gut health and addressing the challenges of aging, emphasizing the need for further exploration of its benefits in older adults.