Introduction Vascular access (VA) dysfunction is a major determinant of inadequate dialysis delivery and clinical complications in hemodialysis (HD) patients. Mean platelet volume (MPV), a marker of platelet activation, has emerged as a potential discriminatory marker for thrombotic events and VA complications. The aim of this study was to evaluate the association and discriminatory performance of platelet indices, particularly MPV, in identifying VA dysfunction in patients undergoing chronic HD. Secondary objectives included exploring the relationship of platelet parameters with dialysis adequacy and selected hematologic parameters. By evaluating the discriminatory performance of these routinely available platelet indices, this study also explored their potential clinical relevance as accessible biomarkers that may help identify VA dysfunction in HD patients. Materials and methods This retrospective study analyzed 104 HD patients treated between 2017 and 2021. Patients were grouped by VA: arteriovenous fistula (AVF, n=51) or permanent catheter (PC, n=53). MPV and platelet count (PLT) were evaluated against access dysfunction (Qb<250 mL/min), dialysis adequacy indices (single pool (spKt/V), urea reduction ratio (URR%)), and anemia control parameters (hemoglobin (Hgb) levels; erythropoiesis-stimulating agents (ESAs) doses used). Correlation and comparative analyses, effect size estimation, and receiver operating characteristic (ROC) curve analysis were performed. MPV was higher in PC patients (11.34±1.09 fL) than AVF patients (10.11±1.33 fL; p<0.00001). Higher MPV correlated with lower spKt/V, lower Qb, higher ESA requirements, and lower Hgb in both groups (p<0.001). ROC analysis showed excellent discriminatory performance of MPV for identifying VA dysfunction with an AUC of 0.96 (95% CI: 0.904-1.00, p<0.0001) in AVF and an AUC of 0.956 (95% CI: 0.884-1.00; p< 0.001) in PC, with optimal cut-off values >10.27 fL and >11.5 fL, respectively. PLT showed a statistically significant inverse discriminatory ability AUC of 0.053 (95% CI: 0.010-0.096; p<0.001) in AVF and AUC of 0.086 (95% CI: 0.05-0.167; p<0.001) in PC with poor diagnostic performance. Discussion MPV was strongly associated with VA dysfunction in patients undergoing HD. Higher MPV values were linked to reduced dialysis blood flow, lower dialysis adequacy, higher ESA requirements, and lower hemoglobin levels. ROC analysis demonstrated strong discriminatory performance (AUC≈0.96) with clearly identifiable cutoff values across VA types. Although PLT showed a statistical association with VA dysfunction, its inverse discriminatory pattern and lack of a clinically useful threshold limit its practical applicability. The consistent inverse relationship between MPV and PLT supports the potential relevance of platelet activation, rather than platelet quantity, in the pathophysiology of VA dysfunction. Conclusion MPV may represent a readily available laboratory parameter associated with VA dysfunction and dialysis performance in HD patients. Given its routine availability as part of the CBC, MPV may have potential clinical relevance for identifying patients with VA impairment. Prospective studies are needed to validate these findings and to clarify the potential role of platelet indices in VA monitoring.
Introduction. Tuberculous (TB) lymphadenitis is the most frequent extrapulmonary manifestation of Mycobacterium tuberculosis infection, with predominant involvement of the cervical lymph nodes (LN). Bilateral LN enlargement in elderly patients, especially in the presence of a thyroid nodule, may closely mimic malignant disease. This case highlights the diagnostic challenge of distinguishing TB from metastatic thyroid carcinoma and contributes to literature by emphasizing the role of minimally invasive and molecular techniques in diagnosis. Case report. An 83-year-old female was admitted with progressive bilateral cervical swelling, pain, and systemic symptoms, including weight loss, fatigue, and night sweats. Physical examination revealed bilateral cervical lymphadenopathy and a palpable thyroid nodule. Laboratory studies showed microcytic anemia, leukopenia, and subclinical hypothyroidism. Computed tomography demonstrated bilateral cervical and mesenteric lymphadenopathy, right pleural effusion with pulmonary consolidation, and splenomegaly. Fine-needle aspiration (FNA) of a cervical LN revealed granulomatous inflammation, while polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis. Cytological evaluation of the thyroid nodule was benign. A final diagnosis of disseminated extrapulmonary TB (EPTB) with LNs, pleural, and probable thyroid involvement was established. The patient was referred to a specialized tuberculosis clinic for further management, but follow-up data were not available. Conclusion. This case illustrates the diagnostic complexity of EPTB, particularly when concurrent thyroid pathology is present. In such patients, TB may be clinically and radiologically indistinguishable from metastatic malignancy. FNA combined with molecular testing significantly enhances diagnostic accuracy, reducing the need for excisional biopsy.
Coronary artery anomalies (CAAs) are rare congenital abnormalities with variable reported prevalence. Data from Eastern Europe remain limited. This study assessed the prevalence and characteristics of CAAs in a large Bulgarian angiographic cohort. We retrospectively analyzed 9 567 consecutive patients who underwent diagnostic coronary angiography between January 2014 and July 2025 at a single tertiary center. CAAs were classified according to the Angelini system into anomalies of origin and course, intrinsic anomalies and anomalies of termination. Prevalence was calculated both including and excluding myocardial bridges and commonly considered benign anatomical variants. Overall, 530 anomalies were identified (5.5
Abstract Background Heart failure (HF) is a complex clinical syndrome characterized by progressive functional impairment and systemic congestion. Soluble CD146 (sCD146) has been proposed as a biomarker related to endothelial dysfunction and volume overload; however, its clinical significance in relation to functional status and established biomarkers remains incompletely defined. Purpose The present study aimed to investigate the association of sCD146 with functional severity, clinical congestion, and NT-proBNP in patients with heart failure. Methods 60 patients with HF, encompassing left ventricular, right ventricular, and combined phenotypes, were prospectively investigated. Demographic characteristics, clinical symptoms, and physical findings were systematically recorded. All participants underwent comprehensive transthoracic echocardiography. Functional status was assessed using the New York Heart Association (NYHA) functional classification and the 6-minute walk test. Laboratory evaluation included NT-proBNP, sCD146, and standard biochemical parameters. Correlation analyses and multivariable linear regression were performed; sCD146 and NT-proBNP were logarithmically transformed. Results The mean age was 65.7 ± 12.7 years; 65% were male, and 50% had combined HF. Mean left ventricular ejection fraction (LVEF) was 42.2 ± 14.9%. Median sCD146 concentration was 460. sCD146 levels were significantly higher in patients with advanced functional limitation NYHA class IV vs III: 576 vs 418, p=0.001) Fig.1 and in those with clinical signs of systemic congestion, including ascites (510 vs 454.9, p=0.008). sCD146 demonstrated statistically significant positive association with NT-proBNP (Spearman’s ρ=0.44, p=0.017) Fig.2 . In contrast, no significant differences in sCD146 levels were observed according to LVEF or HF phenotype. Multivariable analysis identified NYHA class and NT-proBNP as independent predictors of increased sCD146 levels. Conclusion sCD146 is closely associated with functional severity and hemodynamic burden in HF, supporting its potential role as a complementary biomarker of disease severity.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.
Myelodysplastic syndromes (MDSs) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and their diagnosis remains challenging, requiring integration of clinical, morphological, and genetic data. MicroRNAs (miRNAs) have emerged as potential biomarkers in MDS, offering insights into disease mechanisms and patient stratification. This study aimed to evaluate the diagnostic and prognostic significance of five plasma microRNAs (miR-22-3p, miR-144-3p, miR-16-5p, let-7a-5p, and miR-451a) in 40 patients with MDS, diagnosed according to WHO 2016 criteria and stratified by R-IPSS, and ten healthy controls. Plasma miRNA levels were measured by RT-qPCR. Expression profiles were compared between patients and controls, and further assessed in relation to disease subtypes, risk categories, and clinicopathological features. Expression analysis showed that miR-144-3p, miR-16-5p, let-7a-5p, and miR-451a were significantly lower in MDS patients compared to controls. MiR-451a demonstrated the highest diagnostic predictive value (p = 0.0022), followed by miR-16-5p (p = 0.0055), miR-144-3p (p = 0.0074), and let-7a-5p (p = 0.0092). Let-7a-5p was higher in MDS with excess blasts and both let-7a-5p and miR-451a were lower in the low-risk R-IPSS group. Strong correlations between miR-16-5p, miR-144-3p, and miR-451a were observed, probably reflecting their function in erythropoiesis. None of the investigated microRNAs showed independent prognostic significance for overall survival. In conclusion, circulating microRNAs, particularly miR-451a and let-7a-5p, show promise as supportive biomarkers that may complement existing diagnostic and risk assessment tools in MDS. Further studies are needed to validate their clinical applicability.
