Background:Paroxysmal supraventricular tachycardia (PSVT) is a heart rhythm disorder that occurs due to the presence of aberrant cardiac conduction pathways, where the phenomenon of circular conduction of the electrical phenomenon - "reentry" occurs. PSVT presents as: AV nodal tachycardia with reentry, AV reentry tachycardia and focal atrial tachycardia. Objective:The aim of the study was to investigate the causes, age group, gender, place of residence, causative factors, various and cardiac diseases and the role of non-use/use of therapy in the occurrence of PSVT attacks. Methods:In the cross-sectional study, 203 patients were evaluated, of whom 43.35% (88 cases) were male and 56.65% (115) were female. Results:The mean age of the patients included in the study was 40.16±16.13 years. The largest number of patients who sought treatment for PSVT belonged to the group of patients without any diagnosed cardiac condition. The mean age differences reflected in the number of attacks in patients were analyzed and it was concluded that there was a statistically significant difference (p=0.01) in the mean age of patients who had only one attack (37.0±16.1 years) compared to those with three or more attacks (40.2±15.4) years. Conclusion:PSVT is often a heart rhythm disorder with onset ranging from early age to old age. Once present, it tends to recur. Diagnosing and treating PSVT attacks is important for both the quality of life of patients and for the prevention of congestive heart failure.
Background:Diverticula of the gastrointestinal tract are common in older adults, most often affecting the colon. While typically asymptomatic, acute diverticulitis represents the most frequent complication and may lead to severe outcomes, including perforation, abscess formation, and diffuse peritonitis. Duodenal diverticula on the other hand is a rare clinical entity, and is frequently detected incidentally during proximal endoscopy. While most cases are asymptomatic, inflammation of periampullary duodenal diverticula may result in serious complications. Acute pancreatitis secondary to duodenal diverticulitis is exceedingly rare and has been described almost exclusively in isolated case reports. Clinical obesity, particularly increased visceral adiposity, has been associated with more severe inflammatory responses in complicated diverticular disease and may influence disease progression and outcomes. Objective:The aim of this article was to present a case of severe acute pancreatitis with peripancreatic fat necrosis caused by acute duodenal diverticulitis in a patient with clinical obesity. Case presentation:A patient presented with diffuse abdominal pain and was diagnosed with severe acute pancreatitis based on laboratory findings and radiological imaging. Comprehensive diagnostic evaluation, including radiological studies, proximal endoscopy, and endoscopic ultrasound (EUS), excluded common etiology. Further assessment identified a markedly enlarged periampullary duodenal diverticulum as the most likely trigger, associated with peripancreatic visceral fat necrosis and with signs of multiorgan dysfunction. Subsequent anthropometric and body composition assessment confirmed clinical obesity with increased visceral fat area, which was considered a contributing factor to disease severity. Targeted pharmacological therapy combined with individualized nutritional intervention resulted in complete clinical remission. Conclusion:Complicated diverticular disease has been shown to be associated with obesity and increased visceral adipose tissue. Periampullary duodenal diverticulitis complicated by peripancreatic fat necrosis in patients with clinical obesity and increased visceral fat area is rarely described in the literature. Appropriate pharmacological treatment combined with a targeted dietary regimen aimed at reducing visceral adiposity may result in complete remission of severe acute pancreatitis. In patients with acute pancreatitis of unknown etiology and concomitant clinical obesity, duodenal diverticulitis and peripancreatic fat necrosis should be considered as potential underlying causes.
Background:Artificial intelligence (AI) is applied in numerous areas of society and has also led to significant changes in the field of medicine. Medicine is a branch of science of exceptional importance, and it is therefore necessary to ensure a high level of patient protection. The quality of healthcare has significantly improved through the use of artificial intelligence in various stages of the medical process, from the analysis of medical data and diagnostics, through therapy planning, to patient monitoring and the management of healthcare systems. Objective:The aim of this paper is to analyze the civil law aspects of artificial intelligence in medicine, with a particular focus on questions of liability for damage resulting from the use of such systems. Methods:The paper will first present the basic characteristics and areas of application of artificial intelligence in medicine, and then examine potential sources of damage and the legal basis for the liability of various stakeholders, including AI system manufacturers, software developers and data providers, healthcare institutions, and healthcare professionals. Special attention will be given to the challenges of proving causation and allocating liability in situations where decisions are made or supported by autonomous algorithmic systems. Results and Discussion:However, at the same time, numerous legal issues arise, particularly in the field of civil liability in cases where the application of artificial intelligence results in harm to a patient. Given the great importance of medicine and the need to ensure a high level of patient protection, the application of artificial intelligence must be accompanied by appropriate legal protection. The paper gives answers to a number of questions, with particular emphasis on the question of who may be held liable for damage caused by the use of artificial intelligence in medicine, as well as under which regulations and in what manner such liability is determined. Conclusion:Artificial intelligence has the potential to significantly enhance medical practice, its application must be accompanied by appropriate legal mechanisms that ensure patient protection and clearly define the responsibility of all participants in the system. Future legal development in this area will likely focus on further adapting existing civil law institutions to the specificities of artificial intelligence, while simultaneously strengthening preventive risk management mechanisms and transparency of AI systems in medicine.
Background:The integration of Cone Beam Computed Tomography (CBCT) in the dental field has enhanced the capacity to identify remnants of skeletal and decomposing human parts in forensic medicine. Gender classification plays a crucial role in identification, as it can effectively eliminate a significant percentage of possibilities. Objective:The current study aimed to assess the utility of maxillary sinus volumes and dimensions, including ostium positioning, in determining gender among a sample of the Lebanese population. Methods:Data from 140 maxillary sinuses were investigated by means of CBCT images from 70 patients. Three radiologists measured the volume, width, depth, height, and ostium-floor distance of the sinuses using computer software tools. The maxillary sinus volumes with a mean patient age of 58 years were calculated using a mathematically validated formula and compared across left and right sides, genders, dentate and edentulous patients, and various age groups. Results:Statistical analysis of maxillary sinus measurements revealed that both the volume and dimensions of the sinuses were greater in males than in females. Additionally, these measurements tended to decrease with advancing age. Notably, significant differences were observed among patients with natural teeth and those who are edentulous, particularly in the height of the sinuses, which was significantly greater in edentulous individuals, resulting in larger maxillary sinus volumes for both genders. The ostium-floor distance measurements demonstrated high bilateral symmetry, with mean values of 3.54 cm (SD 0.57) for the right side and 3.58 cm (SD 0.52) for the left side, suggesting consistent ostium positioning across the population sample. Conclusion:This retrospective study, which assessed the volume, dimensions, and ostium positioning of the maxillary sinus using CBCT images from 70 patients, revealed that males possess larger maxillary sinuses than females, with a trend towards reduction in size with increasing age. The bilateral symmetry in ostium-floor distance provides additional anatomical reference data for clinical and forensic applications. Thus, the determination of age and gender in forensic medicine utilizing CBCT may prove to be both useful and advantageous.
This year the journal "Medical Archives" celebrates 80th anniversary of the establishiment (1947-2026). With the name "Medicinski Arhiv" this journal was founded in the year 1947 as official journal of the Society of physicians of Bosnia and Herzegovina (B&H). The first Editorial board was consisted of professors of the Faculty of Medicine of the University in Sarajevo opened in November 16th 1947: Vladimir Čavka, Blagoje Kovačević, Bogdan Zimonjić and Ibro Brkić. "Medical Archives" journal was a key milestone that helped in education of all academic and professional staff that became the foundation of Bosnian and Herzegovinian medicine, as a science and health care as a profession. The oldest medical journal in B&H was "Jahrbuch des Bosnisch-Herzegowinischen Landesspitales in Sarajevo" ("Annual of the National Hospital in Sarajevo") which was established in 1897 and printed in German language in the period from 1897 until 1900. From the year 1950 "Medicinski Arhiv" was included in the most influential and important index database MEDLINE, as one of oldest medical journals in Souut-Eastern Europe. The first aim of journal was to give a opportunity to young researchers from B&H to present their scientific and research work to wider community. The tradition of publishing of "Medical Archives" as the most recognizable journal in B&H, was kept by Editor of Professor Izet Masic in 1993 who in extraordinary and difficult occasions (during wartime in BiH from 1992 until 1995) re-established journal and continued printing of the war issues. Hopefully the MEDLINE did not stop to continue receiving "Medicinski arhiv" journal and did not stop accept of published articles of "Medicinski Arhiv" in Medline/PubMed, SCOPUS, EMBASE, HINARI, EBSCO, and a lot of other indexed databases. From the year 2013 articles published in "Medical Archives" were included in PubMed Central with full papers (in extenso). Today "Medical Archives" belong to the most cited journals in former Yugoslavia countries with h-Index 38 in SCImago rank, it means 38 published papers in "Medical Archives" were cited 38 times in other indexed scientific journals worldwide, with SJR 0.33 and Q3 in the year 2024.
Background:Severely malnourished patients undergoing major gastrointestinal surgery are at high risk of postoperative complications, increasing costs and length of hospital stay. Objective:This study aimed to evaluate the impact of perioperative nutritional support on nutritional and surgical outcomes in these patients. Methods:This was a prospective before-after study. Perioperative nutritional support in severely malnourished patients based on at least one of the following criteria: SGA.C, weight loss > 10% within 6 months, BMI < 18 kg/m2, serum albumin < 30 g/l. Once the patients were nourished achieving target energy continuously for at least 7 days and improved nutritional conditions, they were operated. Postoperative nutritional support lasted until hospital discharge. The preoperative and postoperative target energy intake was 30 and 25 kcal/kg, respectively. Enteral and parenteral feeding was combined perioperatively. Results:A total of 53 patients underwent perioperative nutritional support combining one-stage surgery. Preoperative nutritional conditions improved. Postoperative catabolism was inevitable but patients early restored anabolism before hospital discharge. Overall and malnutrition-related postoperative complication rates were 11.3% and 7.5%, respectively, with no mortality or anastomotic leakage. The postoperative and perioperative average durations were 9 and 17.3 days, respectively. Nutritional and hospitalization costs were not high. Conclusion:Perioperative nutritional support for severely malnourished patients undergoing major gastrointestinal surgery improved preoperative nutritional conditions, early restored anabolism postoperatively, provided positive surgical outcomes on postoperative complications, costs and length of hospitalization.
Background: Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, and abrupt discontinuation can lead to severe neuropsychiatric destabilization, including withdrawal catatonia. High-potency dopamine D2 receptor antagonists may further precipitate neuroleptic malignant syndrome (NMS), a condition with substantial clinical overlap with malignant catatonia. Objective: This report follows CARE guidelines to provide a structured and transparent description of a complex case involving abrupt clozapine withdrawal and rapid antipsychotic transition. Case presentation: This report describes a male patient with schizophrenia who developed malignant catatonia with overlapping NMS features following abrupt clozapine withdrawal and initiation of fluphenazine. Conclusion: The case underscores the importance of cautious antipsychotic transitions and early recognition of catatonia and NMS.
Background:The MEESSI-AHF score is widely recommended for 30-day risk stratification in acute heart failure (AHF), but its ability to predict in-hospital mortality - an endpoint with immediate implications for triage and resource allocation - has not been evaluated in Vietnam. Objective:This study externally validated MEESSI-AHF for in-hospital mortality in Vietnamese patients hospitalized with AHF, assessing both discrimination and calibration. Methods:A prospective cohort of adults hospitalized with AHF (Sep 2024 - Mar 2025; n = 241) was analyzed. The endpoint was in-hospital mortality; performance was assessed by AUC and calibration (CITL, slope, Brier, HL g=6, plots), with minimal recalibration (intercept/slope) if needed. Results:In-hospital mortality was 10.8% (26/241). MEESSI-AHF scores were higher in non-survivors than survivors (median 0.49 vs - 2.17; p<0.001) and showed excellent discrimination (AUC 0.886, 95% CI 0.832 - 0.940). Observed mortality increased stepwise across six pre-specified strata (p for trend < 0.001). Overall calibration suggested over-prediction (CITL -1.201, 95% CI -1.665 to -0.737; slope 1.118, 95% CI 0.734 - 1.502), with Brier score 0.092 (Brier skill 0.042) and poor HL fit (g=6: χ²=28.44, p < 0.001), mainly in the highest-risk stratum. Relative to low-intermediate risk, mortality was higher in high-risk (OR 17.55, 95% CI 1.89 - 162.51) and very-high-risk groups (OR 57.12, 95% CI 7.49 - 435.83). Conclusion:In Vietnamese patients hospitalized with AHF, MEESSI-AHF shows excellent discrimination for in-hospital mortality but systematically overpredicts risk; minimal recalibration corrects this and supports its use for bedside triage with local adjustment.
Background:Upper eyelid hollowing is a common manifestation of periorbital aging caused by soft-tissue atrophy and loss of orbital fat volume. Although various corrective techniques have been described, outcome assessment remains largely subjective. High-resolution ultrasonography may provide an objective and quantitative method for evaluating postoperative soft-tissue changes. Objective:The present study aimed to evaluate the effectiveness and stability of combined orbital fat repositioning and microfragmented autologous fat grafting for the correction of moderate upper eyelid hollowing, using high-resolution ultrasonography as an objective assessment tool. Methods:A prospective study was conducted in 35 female patients (70 upper eyelids), aged 40-65 years, with moderate upper eyelid hollowing (Park grade II). All patients underwent combined orbital fat pad repositioning with supplemental microfragmented autologous fat grafting. High-resolution ultrasonography was performed preoperatively and at 1, 3, and 6 months postoperatively to measure the space anterior to the upper eyelid skin (D1) and upper eyelid thickness (D2). Clinical outcomes and patient satisfaction were also evaluated. Results:he mean preoperative hollowing depth was 5.88 ± 0.85 mm, and the mean grafted fat volume was 1.09 ± 0.29 mL. Postoperative ultrasonography demonstrated a significant decrease in D1 and a significant increase in D2 at all postoperative time points compared with baseline (all p < 0.05). No statistically significant differences were observed between the 3- and 6-month follow-up periods (p > 0.05), indicating stabilization of outcomes after 3 months. Overall patient satisfaction was 97.14%. No major complications were observed. Conclusion:Combined orbital fat repositioning and microfragmented autologous fat grafting is a safe and effective technique for correcting moderate upper eyelid hollowing. High-resolution ultrasonography provides an objective, reproducible, and clinically applicable method for postoperative outcome assessment.
Background:Three dimensional (3D) models have shown promise in enhancing medical education across various specialties. However, the application of 3D-silicone skin models in dermatology education remains underexplored, particularly in Saudi Arabia. To our knowledge, this is the first study in Saudi Arabia to evaluate 3D skin models as a teaching tool for undergraduate medical students. Objective:To evaluate the effectiveness of 3D-silicone skin models as a teaching tool in dermatology education for undergraduate medical students. Methods:This quasi-experimental study was conducted at Imam Abdulrahman Bin Faisal University (2024-2025) and included 97 fourth year medical students, of whom 75 completed both pre- and post-intervention surveys. Following a dermatology lecture, students completed diagnostic assessments using two-dimensional (2D) photographs and subsequently 3D silicone models (Simu-Skin™, Mater Transformation). Outcomes included diagnostic accuracy, satisfaction, confidence, and perceived realism. Statistical analyses were performed using IBM SPSS v26.0 employing McNemar's test, t-tests, Chi-square tests, Cohen's kappa, and effect size calculations. Results:A total of 97 participants (53 females and 44 males) were included, with the majority reporting previous exposure to dermatology. No significant differences were found based on gender or prior dermatology experience (p > 0.05). Diagnostic accuracy using 2D models was initially high, with over 90% correct lesion and category identifications. Although diagnostic accuracy improved after exposure to the 3D models, the change was not statistically significant (p > 0.05). The 3D models were highly rated for satisfaction (mean 4.60-4.88/5), confidence in clinical application (mean 4.68-4.81), and perceived realism. Conclusion:3D-silicone based models produced modest but consistent improvements in diagnostic accuracy and were highly rated for satisfaction and realism. These findings support the integration of tactile simulation into dermatology education and underscore the need for further validation through larger, more diverse cohorts.
Background:Clinical artificial intelligence (Clinical AI) is now a commonplace tool being used for administrative, diagnostic and therapeutic purposes. However, it gives rise to novel and complex liability questions that will involve multiple actors including physicians, hospitals, suppliers, vendors and more. Objective:The paper compares the relevant laws in nine jurisdictions in the MENA region - including the United Arab Emirates (UAE) and the other GCC states alongside Algeria, Egypt, and Morocco - to understand how evolving legislation, regulation and ethical codes impact fault and damages. Methods:The Clinical AI ecosystem roles are defined, and core legal duties related to consent, data protection, patient rights and safety oversight mapped. The text critiqued (i) the hospital's selection, governance, training, and ongoing post-deployment monitoring responsibilities; (ii) the accountability of clinicians in mixed "decision-support" workflows, including disclosure of the use of AI to patients and standard-of-care implications of accepting or override AI output; and (iii) supplier/vendor exposure through product liability, performance warranties, cybersecurity obligations, licensing/clearance and ongoing post-market updates and supervision. Results:The comparative section shows significant differences between MENA liability models. It also highlights the need for facility-wide incident response proper process that encompasses model drift, cyber events and data-quality failures, which more often cause the harm than algorithm malfunction. Conclusion:In conclusion, improved risk allocation through governance, documentation, contracting and incident reporting, can aid in reducing uncertainty, enhancing patient safety, and facilitating more scalable cross-border deployment of Clinical AI in the region.
Background:Depression ranks among the five leading disability causes. The research associations with depression include many demographic, lifestyle and health-related measures. These factors and depression probably interact with each other. Objectives:The objectives of the study are to describe the characteristics of the participants, to examine the bivariate association between a proxy of depression and the study variables, to identify independent predictors with the help of a logistic regression model, and to evaluate a neural network classification model. Methods:A cross-sectional secondary analysis of a publicly available dataset N = 50000 was conducted. Depression indicator (Yes/No) is outcome variable. A neural network of the multilayer perceptron type (15 inputs, a hidden layer with. Results:Depression indicator in 40.7% of participants. In bivariable analyses, physical activity, alcohol consumption, dietary habits, family history of depression, and chronic medical conditions showed statistically significant but small differences. Income (p = 0.239) and number of children (p = 0.078) did not differ between groups. Conclusion:There was a modest association with depression index and poor discrimination by neural networks. In performing a classification relating to depression using machine learning one must use assessments with validated outcomes and employ class-sensitive performance assessment.
Background: The COVID-19 pandemic has significantly impacted many aspects of healthcare, particularly pediatric visits to primary healthcare (PHC). Difficulties associated with PHC in this delicate age group can result in substantial complications. Objective: This study aims to determine the impact of the COVID-19 pandemic on pediatric primary care delivery by examining patient characteristics, the number and types of visits, and their relationships both before and after the pandemic. Methods: This comparative cross-sectional study (pre-COVID-19 and COVID-19) utilized register-based data of children aged ≤14 years old, including both Saudi and non-Saudi females and males. Data collection spanned from 2016 to 2021. Sampling was conducted using a stratified random sampling method based on age groups, followed by a simple random sampling technique with proportional allocation to each age group. Results: A total of 1,439 pediatric visits were included in this study, with males accounting for 52.2% of the sample. The most highly represented age group was toddlers, and 60% of the sample were Saudis. Vaccination was the most common reason for visits, accounting for 32% of the cases, followed by general and well-baby checkups, constituting 25.4%. During the COVID-19 pandemic, there was an increase in visits related to general and well-baby checkups, vaccinations, and psychiatry compared to the pre-COVID-19 period. Conversely, visits for fever, dermatology, ENT (ear, nose, and throat), gastrointestinal (GI), and respiratory conditions decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. Moreover, there was a statistically significant increase in referrals to the ophthalmology department in contrast to a decrease in referrals to the emergency department (ED) compared to the pre-COVID-19 period. Conclusion: The COVID-19 pandemic resulted in a significant impact on pediatric visits to PHC. Awareness of families regarding the well-baby clinic and vaccination visits reflects a positive attitude, emphasizing the importance of this during and after the pandemic will contribute to the overall wellbeing of the pediatric population. In addition, greater effort should be made to provide mental health PHC visits to protect and support this age group in future pandemics.
Background:Lyme borreliosis/European borreliosis (LB/EB) is a multisystemic infection caused by the bacterium Borrelia burgdorferi, which is transmitted to humans by the bite of ticks and other hematophagous insects. Transmitted borrelia can occupy any organ where it causes a silent inflammation, which in sensitive persons is intermittently repeated chronically. Objective:The aim of this paper was to determine how much Borrelia burgdorferii participates in the occurrence of chronic urticaria in children and adults. Methods:In the 13-year period from January 1, 2013 to December 31, 2025, a study of all manifestations of Lyme borreliosis was conducted on a sample of 1,059 patients, treated and monitored in the Private practice of an infectious disease specialist. The research was retrospective-prospective, descriptive, clinical and analytical. It was carried out in three phases: the first retrospective phase and the second two prospective phases. The diagnosis of LB was established on the basis of anamnestic-epidemiological data, clinical picture, clinical findings of new borreliosis markers and performed examinations. Serological confirmation of borreliosis was done using ELISA, WB and Immunoblot methods, as well as the ex-yuvantibus method, and in the last six months of 2025, additionally, the finding of bacteria Borreliosis in a dark field with a light microscope. Results:The results showed that 92.1% of the patients in the study group had intermittent migratory redness with itching. In the majority of patients, redness was without exudation or with little or no exudation. In 4.8% of patients, typical urticarial changes were found that occurred occasionally or daily. In all subjects, we serologically confirmed the presence of Borrelia burgdorferi. All patients had intermittent itching of the skin, which lasted for years. Conclusion:Based on the results, it can be concluded that Borrelia burgdorfrii is one of the most important factors in the development of chronic urticaria in monitored patients with 96.9%. Due to its persistence in the macroorganism, it causes reduced tolerance to food. Only 3.1% of cases of urticaria are caused by some other factors. In all cases of chronic urticaria, new clinical markers should be sought on the patients' skin. Serologically look for antibodies to Borrelia protein sequences in an immunoblot. In the active phase, look for Borrelia with a light microscope in the dark field. Administer antibiotic therapy together with antihistamines. Exclude food to which the intolerance test confirmed hypersensitivity greater than "2".
Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary disease affecting small vessels in the brain caused by mutations in the NOTCH3 gene. It has a wide palette of clinical manifestations, usually starting with cognitive decline, migraine and headaches. Therefore, it is frequently misdiagnosed as a transitory ischaemic attack (TIA), ischaemic stroke, or migraine. As advances in genetic testing enable the detection of patients with CADASIL, its incidence is rising. However, CADASIL is still rarely diagnosed, especially in countries with scarce socio-economic resources in healthcare, such as genetic testing that is mandatory to diagnosticate CADASIL. However, it should be considered in everyday clinical practice as a differential diagnosis, especially in younger patients with positive family history. To our knowledge, there has not been a CADASIL case reported in Bosnia and Herzegovina. Objective: This case report aims to present rare confirmed case of CADASIL in a 56-year-old man that presented with rapid cognitive decline. Case presentation: A 56-year-old man was admitted to the Department of Neurology accompanied by his wife, who gave heteroanamnestic information. The patient works abroad and in the past month, during a telephone conversation, the wife noticed that the patient forgets what he has just said to her. The test results showed the presence of heterozygote mutation (c.401G>A) on the NOTCH3 gene, which confirmed the CADASIL diagnosis in this patient. He was further prescribed dual antiplatelet therapy and advised to do a follow-up exam in one month. Genetic advisory and testing of other family members was recommended, but it has not yet been conducted. He can still perform all activities of daily living. The importance of exome sequencing that enables the detection of a genetic mutations causing this rare disease is highlighted. Conclusion: Family members should also be advised to do genetic testing, as this enables the detection of CADASIL before the onset of symptoms. In addition, more aggressive preventive methods, life-style changes and symptomatic treatment can be included on-time, which will increase patient’s quality of life and decrease the development of various neurological complications.
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:Sepsis is a state of immune response imbalance in an attempt to eliminate infection. Currently, the hypoxic conditioned medium (HPO-CM) secretome from mesenchymal stem cells (MSCs) has been considered as a therapeutic approach with their immunomodulatory capabilities. Objective:The aim of this article was to study the effect of HPO-CM secretome on the levels of IL-6 and IL-4 in the rat model of sepsis. Methods:Forty-eight male Rattus norvegicus rats aged 10-12 weeks were divided into four groups: sham (no sepsis induction and treatment), control (sepsis induction without treatment), T1 (sepsis induction and treated with 150 µL of HPO-CM secretome), and T2 (sepsis induction and treated with 300 µL of HPO-CM secretome). Sepsis was induced with procedures based on previous studies. Forty-eight hours after sepsis induction, we sacrificed the rats and collected the blood from the rat orbitals to examine the serum IL-6 and IL-4 levels. Results:A significant decrease in IL-6 levels was found in rats given 150 µL and 300 µL of HPO-CM secretome. Meanwhile, a significant increase in IL-4 levels was found in rats given 300 µL of HPO-CM secretome. Conclusion:HPO-CM secretome can alleviate immune dysregulation in sepsis by reducing serum IL-6 levels and increasing serum IL-4 levels.
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:Nodular thyroid disease is increasingly prevalent, largely due to advances in imaging techniques. Key risk factors include female sex and older age. Thyroid nodules are clinically significant because they can cause thyroid dysfunction, lead to compressive symptoms if large, which can adversely affect patients' quality of life and, most importantly, pose a risk of malignancy. The malignancy rate in thyroid nodules ranges from 5% to 15%. Objective:This study aimed to investigate the association between thyroid nodules with clinical characteristics, imaging features, and FNAC accuracy. It also explored the relationship between nodule size, malignancy and outcome predictors. Methods:We retrospectively reviewed 733 thyroid nodules from 679 patients who underwent thyroid surgery between 2016 and 2022 at four healthcare institutions in Saudi Arabia's Eastern Province. Nodule sizes were categorised using ultrasound and histopathology. Malignancy risk, FNAC accuracy, and false-negative rates were compared. Statistical comparisons were made between nodules <4.0 cm and ≥4.0 cm, with multivariate analysis to identify independent predictors. Results:Nodules ≥4.0 cm were independently associated with benign pathology (OR 0.59, p = 0.004) but showed increased rates of extrathyroidal extension, follicular thyroid carcinoma, and rare malignancies. Multivariate analysis revealed higher odds of intermediate (OR 2.39, p = 0.003) and high (OR 5.33, p < 0.001) recurrence risk. Suspicious ultrasound features and Bethesda V-VI cytology were predictive of malignancy. FNAC performance in nodules ≥4.0 cm showed higher false-negative rates (40.0% vs. 25.9%), lower sensitivity (60.0% vs. 74.1%), and reduced accuracy (66.7% vs. 75.4%). Conclusion:Nodule size ≥4.0 cm is benign as well as associated with distinct diagnostic profiles and greater recurrence risk. Importantly, larger nodules are aggressive and demonstrate a substantially higher FNAC false-negative rate. Therefore, a careful evaluation by ultrasound risk stratification and consideration of diagnostic lobectomy are advisable, even with benign cytology, particularly when suspicious ultrasound features are present.
