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

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.

Background: Thyroid hormones are essential regulators of energy expenditure, thermogenesis, and body composition. Although overt thyroid dysfunction is well known to alter basal metabolic rate (BMR) and body mass, emerging evidence suggests that even hormonal variations within the reference range may exert measurable effects on metabolic and body composition profiles. Women of reproductive age represent a population particularly sensitive to hormonal oscillations due to the interplay between endocrine, reproductive, and cardiometabolic health.

Objective: The study aimed to a) analyze thyroid hormone levels (TSH, FT3, FT4) alongside anthropometric and body composition parameters in women of reproductive age; b) examine thyroid hormone levels, BMR, and body composition parameters across age groups; and c) investigate associations of thyroid hormones with BMR, body composition components, and unfavorable body composition patterns (visceral adiposity, elevated metabolic age, obesity) as well as metabolic indicators..

Methods: A total of 117 women aged 18-45 years were included in this cross-sectional, observational study conducted in Bosnia and Herzegovina between September 2023 and November 2024. Thyroid hormone levels were measured using electrochemiluminescence assays, while body composition was assessed by bioelectrical impedance analysis. Statistical analyses included descriptive methods, Pearson's correlation, and Chi-square testing, with significance set at p<0.05.

Results: TSH showed significant positive associations with fat-free mass, muscle mass, and BMR (p<0.05). FT3 was inversely correlated with metabolic age and visceral fat, while FT4 demonstrated weak negative associations with fat-free mass and metabolic age (p<0.05). Significant age-related differences were observed in fat percentage, fat mass, BMI, visceral fat, and metabolic age, with the most unfavorable profiles in women aged 31-40 years.

Conclusion: Thyroid hormones, even within the reference range, are associated with body composition and metabolic parameters in women of reproductive age. Their role as early indicators of unfavorable metabolic patterns highlights potential implications for reproductive and cardiovascular risk assessment.

Background: Insulin resistance (IR) plays an important role in metabolic dysregulation and adverse outcomes in acute coronary syndrome (ACS). However, assessment of IR during the acute phase of ACS is challenging, as stress-induced hyperglycemia may confound glucose-based surrogate indices.

Objective: This study aimed to evaluate the correlation and diagnostic performance of multiple surrogate indices of IR in comparison with HOMA2-IR in non-diabetic patients with ACS during the acute phase of hospitalization.

Methods: A cross-sectional study was conducted in 116 non-diabetic patients with ACS and 120 healthy control individuals. The healthy control group was used to establish a population-specific cut-off for HOMA2-IR (≥ 1.35). Surrogate indices of IR were calculated from fasting biochemical measurements obtained within 24-48 hours of admission. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC), Spearman's correlation analysis, multivariable logistic regression, and reclassification metrics, including net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Results: The McAuley index demonstrated the highest discriminative ability for IR (AUC = 0.863; 95% CI: 0.794-0.923) and the strongest inverse correlation with HOMA2-IR (ρ = -0.798; p < 0.001). In multivariable analyses adjusted for confounders, the McAuley index remained a strong independent predictor of IR (adjusted OR = 0.302; 95% CI: 0.188-0.485; p < 0.001). TyG-BMI showed an independent association only when BMI was excluded from the covariates, whereas TyG, METS-IR, and lipid ratios showed limited or no diagnostic utility. Reclassification analyses confirmed the superior performance of the McAuley index over non-insulin-based indices (the total NRI ranged from 1.042 to 1.230).

Conclusions: Among non-diabetic patients with acute coronary syndrome during the acute phase, surrogate indices of IR showed variable performance. Glucose-based indices demonstrated limited diagnostic accuracy, whereas the insulin-based McAuley index showed the strongest concordance with HOMA2-IR and the most consistent diagnostic performance among the indices evaluated.

Background: Klebsiella pneumoniae pneumonia is a significant threat to elderly populations, but prospective data from high-prevalence regions like Vietnam are scarce.

Objective: To identify risk factors for multidrug-resistant (MDR) infection and independent predictors of in-hospital mortality in elderly Vietnamese patients.

Methods: A prospective cohort study was conducted at a tertiary geriatric center in Vietnam, enrolling 293 consecutive patients aged ≥60 years with culture-confirmed K. pneumoniae pneumonia. Multivariable logistic regression models were used to identify risk factors for MDR and independent mortality predictors.

Results: The median age was 81 years (IQR 72-87), with in-hospital mortality of 25.3% and MDR prevalence of 38.6%. Multivariable analysis identified ICU admission (AOR 4.29), proton pump inhibitor (PPI) use (AOR 2.15), and COPD (AOR 2.03) as independent MDR risk factors, while appropriate initial antibiotic therapy was strongly protective (AOR 0.15). The strongest independent mortality predictors were invasive mechanical ventilation (AOR 11.07), severe pneumonia (AOR 3.73), and APACHE II score (AOR 1.08). The mortality model demonstrated excellent discrimination (AUC = 0.904, pHosmer-Lemeshow = 0.462).

Conclusion: In-hospital mortality for K. pneumoniae pneumonia in elderly Vietnamese patients is high. ICU admission, PPI use, and COPD are key independent risk factors for MDR infection. Invasive mechanical ventilation, severe pneumonia, and a high APACHE II score are the most critical independent determinants of death. The high-performance mortality prediction model developed here may serve as a practical tool for risk stratification.

Background: Umbilical pilonidal sinus (UPS) is a rare condition characterized by the formation of a sinus tract in the umbilical region, often associated with chronic inflammation and hair accumulation. Accordingly, due to its rarity and nonspecific presentation, UPS is frequently underdiagnosed, leading to delays in appropriate management.

Objective: In this article we systematically reviewed all the literature on UPS in Saudi Arabia and worldwide to formulate a clinical picture, a possible management algorithm and report noted outcomes.

Case presentation: This is a 19 years old, male patient, known to have autism spectrum disorder with a prior umbilical hernia repair (when the patient was 6 years old). The patient presented to the out-patient clinic when he was 17 years of age with his parents, complaining of minimal umbilical serous discharges. Upon examination, the area had poor hygiene and villous hair all around the umbilicus. The patient was followed every 3 months with no noted changes, yet after 1 year of follow up, a small umbilical swelling 1x2 cm was noted with 2 pits and hemo-serous discharges with surrounding hair tufts, no hernial recurrence noted. The family was counselled on risks and benefits of conservative versus surgical excision, and they opted for surgical excision. The patient's pre-operative laboratory workup was normal. Post-operatively, the patient was doing well with no complaints (e.g., pain or discharges), however after 2 weeks the patient developed a small hematoma that was aspirated, other than that the follows ups were unremarkable.

Discussion: Clinically, UPS is more common in males with several correlated risk factors (e.g., hirsutism, deep navels, BMI >25 kg/m2, positive family history of pilonidal sinuses) that were derived from the analysis, in which a diagnostic criterion is proposed and a "Step-up" management approach.

Conclusion: The current case report and systematic review highlight the diagnostic challenges of UPS and reviews the spectrum of management options (i.e., conservative vs surgical techniques). As there is a noted international scarcity in UPS-related data, to provide patient-centred and evidence-based care.

Background: Dental caries is a biofilm-mediated, sugar-driven disease in which acids from bacterial fermentation of dietary carbohydrates demineralize tooth structure. While early enamel lesions are reversible, progression into dentin allows rapid bacterial advancement toward the pulp due to the tissue's tubular structure.

Objective: The primary objective of this study is to evaluate the effectiveness of SDF as a minimally invasive approach for arresting dental caries in young children. The secondary objective was to determine whether the alternating SDF+ FV regimen achieves higher caries arrest rates than SDF alone in uncooperative pediatric patients with early to moderate lesions.

Methods: Study Design and Setting: This two-arm, parallel-group randomized controlled trial (RCT) was conducted in two private pediatric dental clinics in Tirana city center, Albania (directed by Dr. Manola Kelmendi and Dr. Enida Petro), both experienced in SDF use. The trial followed CONSORT guidelines, with single-blind outcome assessment, and ran from January 2021 to December 2022.

Results: This randomized trial confirms that semiannual application of SDF is a highly effective and practical method for managing early and moderate caries in primary teeth, particularly in uncooperative children with ECC. Both protocols proved effective over two years. Alternating SDF with FV showed a modest additional benefit, though the difference did not reach statistical significance. Given their ease of application, low cost, and minimal invasiveness, SDF and SDF + FV remain valuable tools. Treatment success was strongly influenced by behavioral and social factors such as oral hygiene, sugar intake, and SES.

Conclusion: This underscores the need for comprehensive caries risk assessment and highlights that SDF-based interventions should be combined with preventive education, dietary counseling, and improved hygiene resources to maximize effectiveness.

Background: Traumatic brain injury (TBI) is one of the leading causes of death and severe neurological sequelae worldwide, profoundly impacting patients' quality of life and imposing a significant economic and social burden. Numerous studies have shown that the mortality and neurological disability rates following TBI remain high, with over 20% of patients either dying or suffering severe disability.

Objective: This study aims to assess the outcomes of decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI) at discharge and 3 months postoperatively, while identifying prognostic factors influencing patient outcomes during this period.

Methods: A prospective descriptive study was conducted on all patients with severe TBI indicated for DC from March to December 2024 at Viet Duc University Hospital. CT scan characteristics were evaluated using the Rotterdam and Helsinki scoring systems. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at discharge and 3 months post-injury. Prognostic factors were analyzed through multivariate logistic regression and receiver operating characteristic (ROC) curve analysis.

Results: Among 150 patients with severe TBI who underwent DC, 71.33% had poor outcomes (GOS 1-2-3) at discharge. This proportion decreased to 40.85% after 3 months, indicating notable recovery. Poor outcomes at discharge were significantly associated with advanced age, high Helsinki score on admission, and presence of hemiparesis. These factors also demonstrated stronger predictive power at the 3-month follow-up. The Rotterdam score correlated with discharge outcomes and was valuable for early risk stratification, whereas the Helsinki score was predictive at both discharge and follow-up time points.

Conclusion: Decompressive craniectomy is an effective life-saving procedure in patients with severe TBI. However, surgical decision-making should be guided by comprehensive prognostic evaluation, including age, neurological status at admission, and radiological scoring systems. Such multifactorial assessment enhances the likelihood of survival, meaningful functional recovery, and long-term quality of life.

Background: Temporomandibular joint disorder (TMD) encompasses structural and functional disturbances within the temporomandibular joint (TMJ), the masticatory muscles, and adjacent craniofacial soft tissues. Internal derangement (ID) of the TMJ, which represents approximately 80% of TMD cases, refers to abnormalities in the spatial relationship between the articular disc, condyle, mandibular fossa, and articular eminence.

Objective: This study aims to evaluate the correlation between magnetic resonance imaging (MRI) findings and clicking sound symptoms in patients with temporomandibular joint internal derangement (TMJID).

Methods: This was a prospective descriptive study conducted at Hanoi Medical University Hospital from August 2023 to August 2024, including 178 patients with a total of 267 TMJs clinically diagnosed with TMJID. All patients were assessed for clicking sounds, followed by MRI examination of the temporomandibular joint. MRI features, including disc position, condylar morphology, disc morphology, and joint effusion, were analyzed for correlations with the presence of clicking sounds.

Results: The study demonstrated a statistically significant correlation between clicking sounds and both disc displacement and disc deformities on MRI (p<0.05). In contrast, no significant correlation was found between clicking sounds and condylar damage or joint effusion (p>0.05).

Conclusion: Disc displacement and morphological abnormalities on MRI are closely associated with clicking sound symptoms in patients with TMJID.

Background: Infective endocarditis (IE) is a severe disease associated with high in-hospital mortality. Prognostic factors and the independent role of cardiac surgery remain unclear in clinical practice in Vietnam.

Objective: To identify factors associated with in-hospital mortality in IE patients and evaluate the independent role of cardiac surgery.

Methods: This retrospective descriptive-analytical study included 129 patients diagnosed with IE at the University Medical Center Ho Chi Minh City from January 2019 to April 2024. Clinical, laboratory, treatment, and outcome data were collected. Logistic regression analyses were performed to identify mortality predictors.

Results: The in-hospital mortality rate was 16.3%. Univariate analysis identified hepatic failure, septic shock, ventilator-associated pneumonia, disseminated intravascular coagulation (DIC), and absence of surgery as associated factors. In multivariate analysis, septic shock (OR = 22.0; 95% CI: 7.1-68.5) and not undergoing cardiac surgery (OR = 0.07; 95% CI: 0.01-0.43) were independent predictors.

Conclusion: In-hospital mortality in IE remains high. Early identification of high-risk patients and improved access to indicated cardiac surgery may enhance prognosis.

Background: Complications of breastfeeding occured mostly due to improper breastfeeding tecniques and poor education of mothers. These are reversible and can be prevented with proper education of mothers and medical personnel.

Objective: This research aimed to examine, through anonymous questionnaires, breastfeeding complications in the maternity unit, but also later during breastfeeding in the area covered by the district nurses of the Zagreb-West Health Center.

Methods: Out of 200 mothers participated and the research was conducted from January 2020 until May 2021.

Results: Most of the pregnant women were beetwen 31-40 years old. 67.2% of them had vaginal birth. Most common complications during breastfeeding were engorged breasts (33.6%) while the rarest were mental disorders (3.1%) and nipple vasospasm (1.6%). Mothers used different kinds of solutions for these complications: silicone nipple shields, correction of position and proper breast grip, warm and cold compresses, breast pumping, massage and stimulation of breasts. As many as 46.9% of respondents had difficulties breastfeeding in the maternity unit, and the majority were primiparas (62.0%).

Conclusion: Complications of breastfeeding are more common with first-time mothers then with mothers who gave birth to multiple children. Primary solution for prevention, recognition of complications on time and managing complications is a continuous education of mothers and sensitization of overall public about advantages of breastfeeding.