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

Background: Plastic bronchitis (PB) is a rare airway-obstructive disease characterized by the formation of tenacious casts resembling bronchial airway architecture which can progress to extensive bronchial blockage, leading to pulmonary ventilation dysfunction and life-threatening respiratory failure.

Objective: The aim of this article was to desribe a very rare case of plastic bronchitis caused by group C streptococcus (GCS) as a pathogen causing PB.

Case presentation: A 5-year-old girl with no known underlying chronic diseases presented in October 2022 with a moderate-grade fever, dyspnea, and a productive cough of 3-months' duration On physical examination, she was slightly tachypneic with an oxygen saturation of 98%, but there were no other significant findings. Initial imaging studies, including a chest X-ray (CXR) and a two-dimensional echocardiogram, were normal. Most cases of PB result from procedures to repair congenital heart diseases, although other etiologies have been identified, including infections, inflammatory processes, and acute chest syndrome of sickle cell disease. The incidence of pulmonary infection associated with PB has increased over the years, primarily due to adenovirus, influenza viruses, Mycoplasma pneumoniae, and Haemophilus influen zae. To the authors' knowledge, this is the first case report describing group C streptococ cus (GCS) as a pathogen causing PB.

Conclusion: To the authors' knowledge, this is the irst case report describing group C streptococcus (GCS) as a pathogen causing PB.

Background: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, increasing morbidity, ICU stay, dialysis need, hospitalization length, and costs. Despite prophylactic strategies, POAF incidence remains high, especially in moderate and high risk patients.

Objective: To assess the effect of amiodarone on POAF incidence and onset timing in moderate and high risk patients.

Methods: This prospective observational study included 454 patients undergoing elective coronary artery bypass grafting (CABG). Risk stratification of patients was based on the McSPI AFRisk Index, compared with the POAF Score and CHA2DS2-VASc Score. Moderate and high risk patients received amiodarone in combination with beta blockers (Amiodarone group), while low risk patients received beta blockers only. The primary outcome was POAF incidence, analyzed via Kaplan-Meier and Cox regression. Secondary analysis compared POAF rates between groups using the χ2 test.

Results: POAF occurred in 5.95% of the Amiodarone group versus 9.25% in the beta blocker group (overall incidence: 15.2%). The relative risk reduction was 27% (RR = 0.27, 95% CI = 0.105-0.689, p = 0.006). POAF incidence was significantly lower in the Amiodarone group (p = 0.008, χ2 test). Kaplan-Meier analysis showed delayed POAF onset in the Amiodarone group (median: 48h vs. 33h, p = 0.0007). Cox regression confirmed a 73% lower risk of early POAF (HR = 0.27, 95% CI = 0.105-0.689, p = 0.006).

Conclusion: Amiodarone combined with beta blockers reduces POAF incidence and delays its onset after CABG. Keywords: POAF, CABG, amiodarone, risk stratification. Keywords: Body Dysmorphia, PCOS patients, prevalence.

Background: Vinculin is a cytoplasmic protein that binds to actin and is involved in cell adhesion. The presence of anti-vinculin autoantibodies in irritable bowel syndrome (IBS) is consistent with prior studies which have implicated vinculin as an important regulator of the enteric nervous system.

Objective: Therefore, in this study, we developed a testing protocol and optimized it before evaluating the value of the Anti-Vinculin quantitative test in the diagnosis of IBD and IBS.

Methods: To establish the procedure for quantification of anti-vinculin antibody (ATV) in serum by indirect ELISA and to investigate value of anti-vinculin testing in diagnosing irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

Results: After optimizing the procedure for ATV quantitative ELISA, we conducted the tests to determine the concentration of ATV in serum specimens. In this research, we use ATV results from 215 patients with IBS, 71 patients with IBD and 31 healthy subjects and assessed utility of ATV as a diagnostic test for IBS and to differentiate between IBS and IBD. On testing for ATV in patients with IBS and IBD, we found that it has potential for diagnosing patients with IBS, with an area under the curve (AUC) of 0.76, p <0.001With a cut-off of ATV concentration at 510.59 ng/mL, sensitivity of test was 48.8%, and specificity was 96.8%.

Conclusion: The model of using ATVs to differentiate between IBD and IBS had not given optimal results. Further research is needed with larger sample sizes and uniformity among groups to come up with an effective model.

Background: The role and influence of a positive psychotherapeutic relationship on the outcome of psychotherapy has been widely documented. Ruptures in the psychotherapeutic relationship are defined as a deterioration in the collaborative relationship between the psychotherapist and the client.

Objective: The aim of the research is to shed light on the issue of subjective experiences of psychotherapists regarding the perception of the meaning and interpretation of rupture, to discover the unique ways in which psychotherapists work to identify, manage and overcome them during the psychotherapy relationship, and to discover the psychotherapist's strategies for dealing with successful or unsuccessful processes of resolving the process of rupture in the psychotherapy process.

Methods: The sample of respondents consisted of a total of 6 qualified psychotherapists with different psychotherapy orientations, who have completed accredited psychotherapy training programs with at least two years of psychotherapy experience, and are actively conducting psychotherapy sessions. The research was conducted according to the Theoretical Domains Framework (TDF) methodology of qualitative studies. Semi-structured interview questionnaire - When conducting research in focus groups, a semi-structured interview questionnaire was used, which contains the domains provided by the Theoretical Domains Framework and open-ended questions related to the research objective.

Results: The role of the therapeutic relationship in working with clients is assessed as the most important component without which there is no psychotherapy treatment, and a good therapeutic relationship as a predictor of psychotherapy success. The following indicators are crucial in the identification of psychotherapy rupture according to therapists: lack of mutual respect, feeling of being let down, presence of conscious or unconscious transference or countertransference, failure to meet expectations and compliance. On the emotional level, in the identification of psychotherapy rupture, the feeling of fatigue and anger, helplessness is identified.

Conclusion: The results of the theoretical review and data analysis indicate the existence of several unique points for creating an integrative approach to the resolution of a psychotherapeutic rupture: Identification of the rupture, open discussion about the situation and relationship that has arisen, negotiation, and establishment of a new relationship. Further studies in this direction are needed.

Background: Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that is usually found in the thorax. Herein, we report a very unusual presentation in the kidney.

Objective: The aim of this article was to present a unique rare case of the largest kidney SFT that was reported in the literature.

Case presentation: A 65 year-old-male patient who is known to have chronic kidney disease (CKD) and type 2 Diabetes mellitus (T2DM) presenting with a huge SFT in the kidney that was managed with open radical nephrectomy and diagnosis was confirmed using immunohistochemistry.

Conclusion: Awareness of this rare entity can aid in accurate diagnosis and management; Further research and additional case reports are warranted.

Background: The incidence of chemotherapy-resistant colorectal cancer (CRC) is increasing. Location of CRC is important in determining CRC progression. The location itself is associated with the presence of cancer stem cell.

Objective: The aim of this study is to determine association between GRP94 expression, a cancer stem cell marker, and location of CRC.

Methods: This cross-sectional study was conducted in Adam Malik Hospital and it's sister hospitals. Inclusion criteria were patients who underwent colonoscopy or biopsy or operation due to CRC, Indonesian and willing to provide familial medical history regarding CRC and other malignancies up to third degree relatives. CRC tissue was obtained from each subject as specimen and undergone immunohistochemistry examination to determine GRP94 expression. Data was analyzed using statistical software.

Results: A total of 118 subjects were involved and divided into proximal (32 subjects), distal (43 subjects), and rectal (43 subjects) CRC. Mean age of subjects was 57.30 (SD 12.99) years with 69 (58.5%) subjects were males. The percentage of high level GRP94 expression was found in subjects with distal CRC, folllowed by proximal and rectal CRC. There was a significant association between GRP94 expression and location of CRC (p=0.007). No relationship was observed between GRP94 expression with gender, age, body mass index, hemoglobin level, leukocyte count, platelet count, and histopathology grade of CRC.

Conclusion: GRP94C expression is associated with the location of CRC. Higher GRP94 expression is observed in distal CRC.

Background: Hydroxychloroquine (HCQ) is an anti-malarial, antirheumatic disease-modifying medication. Besides the familiar adverse effects, HCQ has been associated with cutaneous manifestations like hyperpigmentation, vitiligo, and pruritus.

Objective: This case report aims to describe the clinical features and outcome of hydroxychloroquine-induced skin hyperpigmentation in a patient with SLE.

Case presentation: In this case report, we present a 32-year-old man with a history of Systemic lupus erythematosus who was treated with hydroxychloroquine. One year after treatment, the patient complained of diffused discoloration and melanonychia. Furthermore, punch biopsy from the involved sites showed pigment incontinence. To our knowledge, this is the only case reported with biopsy and photographic evidence from our geographical area.

Conclusion: Hydroxychloroquine-induced pigmentation is not a rare adverse effect of HCQ. Biopsy revealed pigment incontinence. Additionally, our patient had no history of ecchymoses or anticoagulant therapy.

Background: The foot arch is an important structural characteristic that plays a key role in supporting weight and facilitating movement. Flat foot might result in difficulties due to changes in biomechanics and muscular imbalances.

Objective: The aim of this study was to determine the differences of isometric strength, range of motion, ankle mobility in participants with normal medial longitudinal arch and flat foot.

Methods: A Comparison cum correlation cross-sectional study was conducted with twenty-eight normal medial longitudinal arch and twenty-eight with flat foot participants were randomly selected for this study. The navicular drop test was employed to identify foot arch. Handheld dynamometer, ankle joint range of motion, and Dorsiflexion Lunge Test were used to assess isometric strength, goniometer, and ankle mobility, respectively. An independent t-test was used to compare between the two independent groups. Pearson correlation coefficient was used to find the relationship between variables.

Results: The findings of this study indicated that there were statistically significant differences between participants' arch height, ankle mobility, muscular strength, and range of motion at dorsiflexion and plantar flexion. There were statistically significant relationships among all variables except calf muscle circumference with foot arch (r=.100,p=.463), and isometric muscular strength at dorsiflexion (r=.190,p=1.61). Arch height with range of motion at dorsiflexion (r=.190,p=.160), range of motion at dorsiflexion with range of motion at plantar flexion (r=.095,p=.486) for participants with normal medial longitudinal arch and participants with flat foot.

Conclusion: Findings indicate that normal medial longitudinal arch group had greater scores for all variables than flat foot group. Positive significant correlations between all variables except ankle mobility were found. The relationship between range of motion and isometric strength was less pronounced, indicating that these variables may be influenced by other biomechanical factors.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions marked by extensive epidermal necrolysis and skin sloughing.

Objective: The study aimed to assess the serum levels of specific proinflammatory interleukins (IL-18, -21, 22, -23, -27, and -31) and their relationship with the severity of SJS/TEN within the Vietnamese population.

Methods: This descriptive cross-sectional study was conducted from 2018 to 2020. Serum levels of IL-18, -21, -22, -23, -27, and -31 were measured using the fluorescence covalent microbead immunosorbent assay.

Results: The study included 61 patients (29 males and 32 females; 21 with SJS and 40 with TEN), with a median age of 51 years (interquartile range: 37-58), and 20 healthy controls. The median lesional area covered 45% of the body surface area (interquartile range: 8-70%). The most frequently identified medications were traditional medicine (19 patients; 31.15%), allopurinol (9 patients; 14.75%), and carbamazepine (8 patients; 13.11%). In the TEN group, the serum level of IL-18 was significantly elevated compared to the healthy control group. A correlation was found between serum levels of IL-18 and IL-27 and the lesional area in SJS/TEN patients, as well as between serum levels of IL-18 and IL-31 and the lesional area in TEN patients.

Conclusion: Serum levels of IL-18 were increased in TEN group. Additionally, serum concentrations of IL-18, IL-27, and IL-31 were associated with disease severity as indicated by the lesional area. These interleukins may play an important role in the pathogenesis of SJS/TEN.

Background: Pain-free and relief are one of the anesthesiologist's most important concerns during the operation. General aim is always to effectively control pain but while simultaneously reducing opioid requirements to reduce opioid related side effects and mortality. Patients undergoing orthopedic operations tend to have high pain scores and analgesic requirements.

Objective: In this study, we aim to investigate the effect of adding nefopam on reducing the postoperative pain scores and the need for opioids.

Methods: This double-blind placebo-controlled prospective study aims to determine the effectiveness of nefopam in relieving the pain resulting from the operation in addition to the pain resulting from tourniquet. The unlabeled drug solution was administered one at the beginning of surgery. A 10 mL solution containing nefopam 20 mg or placebo diluted with normal saline was infused over 20 min. 11-point visual analogue scale was utilized to assess the pain score.

Results: Forty-nine participants enrolled in the study, 24 received nefopam. The mean age was 40.45 years. Participants received nefopam achieved better postoperative surgical site pain score, less intraoperative and postoperative opioids use. Nefopam utilization was the single independent factor affecting the postoperative pain score.

Conclusions: Compared with placebo, opioid requirement was decreased, the pain resulting from operation and tourniquet pain were decreased.