Vojnosanitetski pregled

Insight into the management of patients with melanoma in times of the COVID-19 pandemic – a single-center experience

Fri, 26 Apr 2024 09:47:21 +0200

Background/Aim. Despite all innovations in medicine, melanoma still has a rising incidence and high mortality and thus represents a significant challenge for the healthcare system. The pandemic of the coronavirus dis-ease 2019 (COVID-19), spanning three years, redirected healthcare resources, suspended preventive programs, and strained the healthcare system, significantly impacting melanoma management. The aim of this study was to as-sess the influence of the COVID-19 pandemic on the treatment of melanoma patients. Methods. This retro-spective study analyzed melanoma patients treated at a single tertiary care center over two distinct three-year peri-ods: pre-COVID period (2017–2020) and the COVID-19 pandemic period (2020–2022). The following data were collected and compared: patient demographics, melanoma characteristics, time intervals from biopsy to surgery, and the share of thin and thick melanoma. Results. During the COVID-19 pandemic period, there was a 30% reduc-tion in melanoma patients compared to the pre-COVID-19 period. The decline was most pronounced in 2020 when the state of emergency was introduced in the coun-try. Thin melanoma percentage as a measurement of suc-cessful screening programs decreased significantly during the COVID-19 pandemic (11.57% vs. 24.01%), while me-dian Breslow thickness remained stable. The distribution of different histological types was consistent across both periods. The average time from biopsy to surgery re-mained similar between the two periods, around 40 days. Conclusion. Despite challenges posed by the COVID-19 pandemic, melanoma remains a critical healthcare issue. This study emphasized the significance of prioritizing mel-anoma care in emergencies, ensuring patient identification and timely treatment in order to optimize survival and minimize treatment costs.

Higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance in women with unsuccessful weight loss

Fri, 26 Apr 2024 09:48:01 +0200

Background/Aim. Obesity is a chronic and relapsing condition, and since recently, it has been considered a global epidemic. Current guidelines for tripartite treatment of obesity emphasize a program of lifestyle modifications such as medical nutrition therapy, aerobic exercise, and behavioral intervention. The aim of the study was to evaluate whether specific psychological factors (general attitudes and beliefs and frustration tolerance) could be predictors of successful weight loss, i.e., factors that can be further addressed as part of the integrated therapy approach. Methods. A total of 84 consecutive overweight and obese female participants who were apparently healthy and homogeneous in age, level of education, and marital or employment status were prescribed the same medical nutrition therapy protocol as a single six-month therapeutic intervention. Prior to starting the therapy, the General Attitude and Belief Scale (GABS) and the Frustration Discomfort Scale (FDS) were administered. The participants were divided into two groups: successful (group A) and unsuccessful (group B). Group A, or the successful group [with the mean body mass index (BMI) ± standard deviation (SD) of 24.1 ± 5.81 kg/m²], consisted of 40 participants who have reached the corresponding loss, i.e., they lost ≥ 10% of the starting body weight (BW). Group B, or the unsuccessful group (with the mean BMI ± SD of 28.51 ± 2.74 kg/m²), consisted of 44 participants who have not reached the corresponding loss, i.e., they lost < 10% of the starting BW. Results. Participants in group B had significantly higher scores (p < 0.05) on the GABS subscales for the Need for Approval, Need for Comfort, and Other Downing. A statistically significant difference between groups (p < 0.05) was shown for FDS subscales of Emotional Intolerance, Entitlement, and Achievement Frustration. Conclusion. Results of our study showed that participants who were unsuccessful in medical nutrition therapy had a higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance when compared to successful participants. The recommendation, based on our results, would be to include psychotherapeutic techniques in the integrative obesity treatment, aimed at cognitive changes and increasing frustration tolerance.

The influence of psychological factors on the frequency and perception of post-endodontic pain

Marija Mijailovic, Veljko Kolak — Fri, 26 Apr 2024 09:48:36 +0200

Background/Aim. Post-endodontic pain (PEP) is associated with the presence of any uncomfortable feeling or sensitivity that occurs within a few hours or a few days after the endodontic treatment. The aim of this study was to evaluate the possible association between psychological factors and the frequency and perception of PEP. Methods. The study sample consisted of 140 patients with incisors, canines, or premolars indicated for root canal treatment (RCT) without periapical pathology. A single experienced endodontist was involved in the procedure, and the same clinical protocol was used for all the patients. Participants psychometric evaluation was done using the Depression Anxiety Stress Scale 21 (DASS-21). PEP levels were assessed using a Visual Analog Scale at different intervals (24, 48, and 72-hour intervals and after a week). Results. The presence of postoperative pain was reported in 63.6% of the respondents. The vast majority rated the pain intensity as mild, and the pain significantly decreased over evaluated time intervals. Participants who exhibited higher scores for depression, anxiety, and stress reported significantly higher pain intensity. The multivariate logistic regression analysis showed that tooth type (p = 0.001) and high anxiety score (p = 0.035) were directly associated with the occurrence of pain after therapy. Conclusion. Psychological factors, such as depression, stress, and anxiety, influenced pain perception after RCT treatment, and a high anxiety score was directly associated with the frequency of post-obturation pain.

Hospital professional staff awareness of hospital plans for the provision of teams for medical support in case of disasters

Fri, 26 Apr 2024 10:41:09 +0200

Background/Aim. Resuscitation and surgical medical aid are the most important medical procedures in disaster relief operations. The limited time frame available for life-saving activities in such circumstances demands that resuscitation and surgical medical teams be established and trained for timely reaction and disaster medical support prior to disaster occurrence. The aim of the study was to analyze the awareness among the hospital medical staff in the Plovdiv Region of the hospital response plan in case of disaster, which concerns surgical and resuscitation team composition and tasks for disaster medical support. Methods. An anonymous survey, consisting of 55 questions about hospital staff awareness of the medical activities described in the hospital disaster medical support plan, was conducted between July and September 2019 among 295 hospital medical professionals in the Plovdiv Region, Bulgaria. Descriptive statistics and Pearson’s χ² test were used in the statistical analysis of results. Results. The survey showed that the majority of medical staff demonstrated complete ignorance regarding the presence, number, and tasks of the specialized medical teams planned for hospital disaster response. Employees of multidisciplinary hospitals for active treatment were more familiar with the aforementioned plans than their colleagues from the university multidisciplinary hospitals. Conclusion. Insufficient awareness about human resources foreseen for disaster medical support negatively impacts the hospital surge capacity, leading to inadequate medical assistance in such cases. Hospital tactical disaster preparedness must be ameliorated by conducting a more rigorous training program among medical staff related to the planned hospital activities in case of disastrous events, especially for those working in emergency departments, intensive care units, and surgical departments.

Comparison of DECAF score and DECAF+Lactate score in the prediction of mortality in patients with acute exacerbation of COPD

Fri, 26 Apr 2024 09:49:17 +0200

Background/Aim. Chronic obstructive pulmonary disease (COPD) is a chronic process that progresses with exacerbations. Various studies are carried out to predict mortality. Among the routine tests used to monitor and treat disease in the emergency department, special efforts are made to find those that are meaningful and diagnostic. The aim of the study was to compare the DECAF score and DECAF+Lactate score and examine the significance of the DECAF+Lactate score in predicting mortality in critically ill patients presenting with COPD exacerbation. Methods. This prospective multicentric study included 435 patients recruited from two centers. Patients who presented to the emergency department with acute COPD exacerbation and fit the definition of critically ill according to the quick Sequential Organ Failure Assessment (qSOFA) were included in the study. The prognostic values of the scores were compared using the receiver operating characteristic (ROC) curve analysis. The efficiency of scoring 28-day mortality was compared with logistic regression analysis. Results. For 435 patients, sensitivity, specificity, and area under the curve (AUC) were calculated for lactate, DECAF score, and DECAF+Lactate score, which were statistically significant in the ROC curve analysis for predicting mortality: 50%, 90.2%, 0.711, odds ratio (OR): 0.622 [95% confidence interval (CI): 1.573–2.203]; 57.6%, 64.3%, 0.654, OR: 0.618 (95%CI: 1.501–2.291); 60.1%, 75.4%, 0.744, OR: 0.790 (95%CI: 1.826–2.659), respectively. Each unit increase in the DECAF+Lactate score increased the risk of mortality by 2.203. Conclusion. As a result of our study, we believe that the DECAF+Lactate score is a more effective scoring system than the DECAF score as a predictor of mortality in critically ill patients with COPD exacerbation.

The expression of renin-angiotensin system components in human carotid plaque

Fri, 26 Apr 2024 00:00:00 +0200

Background/Aim. The renin-angiotensin system (RAS) is linked to the development of atherosclerosis (As), including its initiation and progression. Besides the well-known angiotensin-converting enzyme (ACE), two newer RAS family members are related to vascular remodeling – ACE2 as a homolog of ACE and collectrin [transmembrane protein 27 (TMEM27)] as a homolog of ACE2. Up to now, a limited number of studies have examined the expression of these RAS components in advanced carotid plaque (CP) tissue based on the sex of the patients and plaque phenotypes (PPs). There are two ultrasonographically defined PPs – the hypoechogenic plaque (HoP) and the hyperechogenic plaque (HerP) phenotype. The aim of the study was to investigate whether there was a correlation between the expression of RAS components in the CP and the sex and PPs of patients. Methods. We examined 74 patients with advanced CP who underwent carotid endarterectomy. The intraplaque expression of RAS components was determined with the real-time polymerase chain reaction, using the TaqMan^® gene expression assays and Western blot. A two-way ANOVA followed by a post-hoc Tukey test was performed for the statistical analysis of results. Results. No interaction was recorded between the sex of the patients and PPs in influencing the relative expression of ACE and TMEM27 messenger RNA (mRNA) (p > 0.05). In 56.06% of plaque samples, no expression of ACE2 mRNA was detected. Among the plaques where ACE2 mRNA expression was detected, its expression level was higher in females with the HoP phenotype compared to females with the HerP phenotype (p < 0.001). In patients with the HoP phenotype, females had higher expression of ACE2 mRNA than males (p < 0.05). In the male study group, ACE protein levels were significantly lower in the HoP phenotype compared to the HerP phenotype (p < 0.001). Females with the HoP phenotype had significantly higher ACE protein levels than males with the HoP phenotype (p < 0.0001). Conclusion. Our results revealed alterations in the expression levels of ACE and ACE2, at the mRNA and protein levels, in advanced carotid As. These alterations are impacted by sex and PP and may indicate a switch from the balanced RAS/ACE/ACE2 axis in the healthy blood vessel to the unbalanced axis in vascular remodeling due to As.

Solitary basaloid follicular hamartoma: a report of two cases and a brief review of the literature

Fri, 26 Apr 2024 10:11:26 +0200

Introduction. Basaloid follicular hamartoma (BFH) is a rare benign follicular malformation often clinically misdiagnosed. Patients with BFH demonstrate a variety of clinical manifestations and associated abnormalities. BFH may be a familial, congenital, or acquired condition with a localized or generalized distribution. Several clinical variants of generalized BFH are recognized, which may be associated with a diverse spectrum of abnormalities. Case report. We present two cases of solitary BFH in pediatric patients. The first patient was a 16-year-old boy with a history of autism spectrum disorder, admitted to our department for consultation due to a harmless dermal nevus on his face. The second patient was a six-year-old girl presented with a ten-month history of an asymptomatic, skin-colored papule located on the right nasolabial fold that gradually increased in size over time. Both cases were documented dermoscopically, and they were presented with a brief overview of the current literature. Conclusion. Considering the overlapping clinical, histological, and dermoscopic features of BFH with other benign and malignant lesions, its incidence in pediatric patients is probably higher than what is reported in the current literature.

The use of psychoactive substances in the Kingdom of Serbs, Croats, and Slovenes (1918–1929) and the Kingdom of Yugoslavia (1929–1941)

Aleksandar Medarević, Kristina Djordjić — Fri, 26 Apr 2024 00:00:00 +0200