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

Background: Relationship between preoperative anemia (PA) and postoperative delirium (POD) is not still completely clear and totally proven for surcigally treated patients. This study tries to unveil that connection in patient surgically treated for colorectal cancer (CRC).

Objective: The aim of this study is to examine relationship between PA and POD in patients surgically treated for CRC and improve preoperative preparation and recognition of critical risk groups of patients for POD.

Methods: Out of 62 patient were analysed in prospective method. All patient have been operated for CRC in Surgical clinic of University clinical centre Tuzla from june until december of 2024. Patients were divided in 2 groups depending on presence of PA. Presence of PA is defined as blood hemoglobin concentration (HGB) lower than 130 g/L (<13 g/dL) or hematocrite (HCT) lower than 39% in grown up men and HGB <120 g/L (<12 g/dL) or HCT<37% in grown up women. Incidence of POD was observed and noted postoperatively. POD was diagnosed and confirmed with CAM test (Confusion Assessment Method), which was done inside first 2 hours after surgery and patient extubation. Noted datas were analysed with descriptive and analytic statistic methods.

Results: POD incidence was 27% (17/62) on the first postoperative day. After analysis statitically significant realtionship was found between PA and POD (ρ=0.324; p<0.05). Realised corellation is on the significance level of 0.05 (95%), it has positive direction and waek intensity. POD occurs 4,5 times more often in patients with PA. (OR= 4,500; 95% IP: 1.355-14.944).

Conclusion: PA is connected with increased number of patients with POD who have been surgically treated for CRC. PA can be defined as one important preoperative risk factor that affect onset of POD . Identification of all preoperative risk factors and its correction represent best way of POD prevention.

Background: Breast hypertrophy is a condition of increased breast volume, occurring at different ages, causing many psychological and physiological problems such as back pain, inflammation of the inframammary folds, and psychological stress1.

Objective: This study aimed to identify the main arterial sources of blood supply to the nipple-areola complex (NAC), which may apply to extensive hypertrophic breast reduction surgeries.

Methods: Describe a cross-sectional, uncontrolled clinical case series to evaluate the most accurate blood supply to the NAC based on angiography for all patients diagnosed with excessive breast enlargement requiring surgery.

Results: 30 female patients were diagnosed with hypertrophic breasts with a minimum volume of 1005cc and a maximum of 2412 cc. Multi-slice computed tomography (MSCT) was indicated preoperatively to determine the blood supplies to the breast; the internal mammary artery (IMA) predominates in 60/60 breasts (100%), and the lateral thoracic artery predominates in 21/60 breasts (35%). Based on the MSCT scan results, the axial flap design carrying the NAC complex has a dominant branch entirely from the IMA: superior medial pedicle in 48/60 breasts (80%), superior pedicle in 11/60 breasts (18.33%) and medial pedicle in 1/60 breasts (1.67%). None of the breasts showed signs of nipple-areola necrosis after surgery, and only two cases (3.3%) of partial NAC necrosis occurred, both in superior flaps.

Conclusion: Preoperative breast MSCT imaging helps select the type of pedicle that supplies blood to the NAC and minimizes the risk of NAC necrosis during breast reduction surgery in cases of significant hypertrophy and severe grades of ptosis.

Background: Primary gastric actinomycosis is a rare infection caused by anaerobic Actinomyces species, normally colonizing the oral and gastrointestinal flora. Often misdiagnosed as malignancy due to atypical presentation and non-specific findings, it typically affects immunocompromised individuals or those with mucosal damage from surgery or trauma.

Objective: The aim of this case report is to explore the diagnostic challenges and the necessity of high clinical suspicion for rare infectious causes of gastrointestinal pathology, especially given its atypical presentation.

Case presentation: A 63-year-old woman presented with hematemesis, melena, and epigastric pain. Laboratory tests revealed severe anaemia, hypoalbuminemia, and elevated cancer antigen 19-9 (CA 19-9). Gastroscopy revealed oesophageal erosions and a gastric ulcer with a wide, black-coloured base on a polypoid lesion, along with small erosions. Histopathological findings showed filamentous and rod-like bacteria, consistent with Actinomyces, in gastroscopic biopsies. The patient was then treated with high-dose intravenous penicillin G. Conclusion: This case highlights the diagnostic challenges of gastric actinomycosis, which can be mistaken for peptic ulcers or malignancy. Clinicians should consider gastric actinomycosis, especially in immunocompromised patients, when imaging or endoscopy reveals a submucosal lesion or ulcer.

Background: Trachoma is a specific type of keratoconjunctivitis caused by bacteria Chlamydia trachomatis and characterized by conjunctival follicular and papillary hyperplasia, followed by conjunctival scarring, entropion, trichiasis and corneal ulcerations.

Objective: The aim of this article is to describe the successful epidemiological programs and actions which led to eradication of trachoma in Croatia.

Methods: Online literature search conducted with the purpose of identifying studies describing epidemiological methods of eradicating trachoma in Croatia.

Results: In an effort to eradicate trachoma in Croatia, many medical and epidemiological actions were taken in the middle of the 20th century. At the time, throughout infected areas antitrachoma stations were founded, in form of an outpatient clinic office with a trained ophthalmologist and a nurse who would continuously treat and monitor trachoma patients. Special attention was given to screening and treatment of school-aged children and special programs were developed for their treatment. Many adults were treated in form of an intermittent treatment. Epidemiologists and ophthalmologists also organized regular screenings of the whole population in the infected areas. These screenings were conducted jointly with educational activities which consisted of simplified informative posters, brochures, flyers, and films.

Conclusion: Success of trachoma treatment in Croatia in the middle of the 20th century was a result of a combination of a well-organized epidemiological programs and actions throughout the infected areas, which included educational programs, adequate treatment of local population and improvement of hygiene and living conditions. We hope that this historical review could help in planning and implementing the eradication of the most common infectious cause of blindness in low to mid income countries still nowadays.

Background: Elderly-onset rheumatoid arthritis (EORA) is a distinct clinical entity of Rheumatoid Arthritis (RA), which begins after the age of 60 years, and which is distinguished by its clinical features from young-onset rheumatoid arthritis (YORA).

Objective: This case report aims to highlight the importance of increased vigilance, because in many cases EORA can begin with pulmonary, cardiological, dermatological, but also locomotor lesions.

Case presentation: We present an excellent case of a 68-year-old male patient, a heavy and long-term tobacco user, with arterial hypertension, dyslipidemia, with a rapid onset of the disease. Pleurisy, pericarditis, rheumatoid joints, pannus and later synovitis were its explosive clinical picture. Due to the presence of pleurisy and pericarditis, but also high nonspecific inflammatory parameters, the clinical situation was an acute case and rapid diagnosis was a clinical challenge. Based on the clinical picture, inflammatory, serological and radiological parameters, the patient was diagnosed with EORA. The treatment started with DMARDs, glucocorticoids, antihypertensives and antilipemics and there was a good response with regression of the clinical picture.

Result: Although the patient was old, with chronic diseases and with a weakened immunity due to external factors, treatment with Methotrexate, Glucocorticoids in small doses and antihypertensives for 10 days. This treatment achieved a great improvement in the clinical picture and a decrease in the inflammatory activity of EORA.

Conclusion: The onset of a disease with pleurisy, pericarditis and delayed appearance of synovitis, associated with high inflammatory parameters is one of the variants of the presentation of EORA.

Background: The number of oocytes retrieved is a key determinant of in-vitro fertilization (IVF) success, positively associated with fertilization rate, blastocyst formation, and cumulative live birth outcomes. Optimal results are observed in cycles retrieving 16-20 oocytes, with no decline in cumulative live birth rate at higher yields.

Objective: This study aimed to compare embryological outcomes between vitrified and fresh oocytes in the same patients with diminished ovarian reserve.

Methods: This retrospective study included 114 women with diminished ovarian reserve (DOR) who underwent oocyte accumulation using both vitrified and fresh oocytes between June 2021 and January 2025. A total of 400 vitrified and 291 fresh oocytes were analyzed. The survival rate, fertilization rate, cleavage rate, and day-2 embryo quality were compared. Subgroup analysis was performed according to POSEIDON groups 3 (<35 years) and 4 (≥35 years). Pregnancy outcomes were preliminarily evaluated in 52 patients who underwent frozen embryo transfer using embryos derived from both oocyte types.

Results: The mean survival rate was 93.1% ± 14.6%. No significant differences were observed between vitrified and fresh oocytes in fertilization rate (79.7% vs. 86.0%, p = 0.41), cleavage rate (90.8% vs. 93.9%, p = 0.31), or day-2 embryo quality (p > 0.05). Embryological outcomes were comparable in both POSEIDON 3 and 4 groups. In group 4, the proportion of grade 3 embryos was higher in the vitrified oocyte group than in the fresh group (16.0% vs. 9.5%), but this difference was not statistically significant. The overall pregnancy and clinical pregnancy rates were 51.9% and 36.5%, respectively.

Conclusion: Oocyte vitrification is a feasible and effective strategy for oocyte accumulation in women with DOR, yielding comparable embryological outcomes to fresh oocytes. This approach may offer a valuable option for improving reproductive outcomes in low-prognosis patients.

Background: Triangular fibrocartilage complex (TFCC) injuries commonly cause ulnar-sided wrist pain, yet reports on arthroscopic management outcomes in Asian populations remain limited.

Objective: This study evaluates clinical outcomes following arthroscopic treatment of TFCC injuries in Vietnamese patients.

Methods: This prospective study included 40 patients (60% female, mean age 32.6±8.6 years) with TFCC injuries treated arthroscopically between January 2021 and December 2022. Preoperative assessment included Visual Analog Scale (VAS) pain evaluation, Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) scores, physical examination, and MRI. Surgical techniques included debridement (17.5%), capsular repair (57.5%), and transosseous repair (25.0%). Patients were evaluated at 1, 3, and 6 months postoperatively.

Results: Type 1B tears (62.5%) were most common. MRI diagnosis matched intraoperative findings in only 42.5% of cases. Mean VAS pain scores improved from 6.90±1.57 preoperatively to 1.03±1.44 at 6 months (p<0.001). MMWS scores improved from 51.50±12.57 to 88.38±10.15, with 87.5% of patients achieving good or excellent results. DASH scores decreased from 38.73±15.93 to 9.23±8.62 (p<0.001). Complications occurred in 15% of patients, primarily transient ulnar nerve symptoms. No significant outcome differences were observed between surgical techniques. Patient satisfaction was high (92.5%).

Conclusion: Arthroscopic management of TFCC injuries in Vietnamese patients demonstrates excellent short-term outcomes regardless of surgical technique. The discrepancy between MRI and arthroscopic findings highlights the importance of thorough arthroscopic evaluation.

Background: Date palm fruits (Phoenix dactylifera L.) are a widely available product that contains numerous macronutrients including a high sugar content. Research has shown that date fruit extracts possess antibacterial and antifungal properties, as well as antimutagenic and antiatherogenic effects. Date fruit can also have a beneficial effect on the female reproductive system. Several studies have examined the impact of date consumption during pregnancy on the outcome of labor, providing useful results.

Objective: This study aims to determine the effects of date fruit consumption on the onset and progression of labor.

Methods: The study included 120 pregnant women who were pregnant at GAK Sarajevo, in the period from 01.01. 2020 to 31.12. 2020. The patients were divided into two groups, the first group of 60 patients who consumed 6 dates during the last four weeks of pregnancy, and the second group of 60 patients who did not consume dates during pregnancy.

Results: There was a significant positive effect of consuming date fruits on maternal outcomes in the first and third stages of labor. The group of pregnant women who consumed dates had a shortened latent phase of labor, which meant that their cervix reached maximum dilation (10 cm) faster. Pregnant women in this group gave birth 8.5 hours faster than pregnant women who did not consume dates, in whom labor lasted about 15 hours. Of the 60 pregnant women in the first group, 60% had a spontaneous natural birth, and only 40% of the patients received oxytocin, because dates enhance the effect of oxytocin, which is responsible for uterine contractions.

Conclusion: This study showed a promising effect of consuming date fruits on the duration of the stages of labor. Saturated and unsaturated fatty acids found in dates stimulate the production of prostaglandins, which are necessary for labor. Dates are also rich in folic acid, vitamin K, iron, potassium, and magnesium.

Background: Chronic hepatitis B (CHB) remains a significant health concern, especially in low- and middle-income countries. Some CHB patients with normal or mildly elevated ALT may have advanced liver fibrosis, which often goes undetected.

Objective: The aim of this study was to assess the prevalence of significant fibrosis and the diagnostic accuracy of serum markers in CHB patients with ALT <2× ULN in Vietnam.

Methods: A cross-sectional study was conducted at 175 Military Hospital between October 2019 and December 2021. A total of 144 CHB patients with ALT <2× ULN were assessed for liver fibrosis using FibroScan (METAVIR criteria). The diagnostic accuracy of APRI and FIB-4 was evaluated using receiver operating characteristic (ROC) curves.

Results: Among 144 participants, 26.4% exhibited advanced fibrosis (F≥2), including 9% with cirrhosis. Advanced fibrosis correlated with older age (50 vs. 42 years, p=0.012), male sex (p=0.024), higher AST, ALT, and GGT levels (p<0.05), and lower platelet counts (PLT) (p<0.001). APRI and PLT demonstrated the highest diagnostic accuracy (AUC=0.802 and 0.805, respectively). APRI achieved 84.2% sensitivity and 92.5%, negative predictive value (NPV), while PLT had the highest specificity (81.1%). FIB-4 (AUC=0.716), ALT (AUC=0.676), and prothrombin time (PT) (AUC=0.646), had moderate performance. Combining APRI and PLT significantly improved diagnostic accuracy (p<0.05).

Conclusion: Significant fibrosis was present in 26.4% of CHB patients with normal or mildly elevated ALT levels. APRI and PLT are reliable and cost-effective to detect early fibrosis in re-source-limited settings. These findings underscore the need to revise Vietnam's CHB management strategies for earlier fibrosis diagnosis and treatment.

Background: Gentamicin is a potent, broad-spectrum aminoglycoside antibiotic used in the treatment of many infections. Gentamicin can induce hepatotoxicity through oxidative stress and apoptosis. Since melatonin has antioxidant properties, its protective effects on liver tissue damage were evaluated in this study.

Objective: The aim of this study was to conduct our investigation to assess the hepatoprotective effects of melatonin in rats treated with gentamicin.

Methods: Forty eight adult male Wistar rats were used. The animals were randomly distributed into six groups of equal size. During the period of 11 days, three control groups of rats were daily injected i.p. with the vehicle or with melatonin at a dose of 5 or 10 mg/kg. The gentamicin group was injected with gentamicin at a dose of 80 mg/kg during 8 days and vehicle for 11 days. The other two experimental groups were administered gentamicin (80 mg/kg during) 8 days and melatonin (doses of 5 and 10 mg/kg) 3 days before and 8 days concomitantly with melatonin. Obtained liver sections were analyzed using qualitative, semi-quantitative, and stereological analysis.

Results: Gentamicin expressed hepatotoxic effects inducing congestion of lobular blood vessels, hydropic degeneration of periportal hepatocytes and mononuclear infiltration in the portal tract. Treatment with gentamicin resulted in an increase in the Vv of blood vessels, a decrease in the Vv of hepatocytes, and a decrease in the glycogen content in all three lobular zones. Melatonin administration reduced the liver alterations induced by gentamicin; the higher dose had a more potent protective effect.

Conclusion: Melatonin has a beneficial effect on gentamicin-induced liver damage and the effect is dose-dependent.