Vojnosanitetski pregled

Challenges and considerations in the management of acute pulmonary embolism: a critical analysis of European Society of Cardiology guidelines

Slobodan Obradović, Boris Džudović, Tamara Simpson — Wed, 27 Nov 2024 12:21:04 +0100

Analysis of the vascular patterns of 52 amelanotic cutaneous melanoma metastases: a prospective descriptive study

Wed, 27 Nov 2024 12:28:03 +0100

Background/Aim. Early diagnosis of amelanotic cutaneous melanoma metastases (ACMM) represents a great challenge and is essential for determining the stage, treatment, and prognosis of the disease. The aim of the study was to evaluate the vascular structures and their arrangement and frequency in ACMM. Methods. The study was conducted as a prospective, descriptive, multicenter study of pathohistologically confirmed ACMM. Results. The study included a total of 52 ACMM from 17 patients (8 men and 9 women, with an age range of 32–91 years, median 63.12 years) with a previous history of primary melanoma. The most prevalent were elevated ACMM – 39 (75.0%) lesions, while 13 (25.0%) ACMM were flat. Linear irregular blood vessels were statistically significantly more often associated with elevated ACMM, compared to flat ACMM (92.3% vs. 50.0%, p < 0.001). Dotted blood vessels were statistically significantly more frequent in flat ACMM, compared to elevated ACMM (76.9% vs. 28.2%, p = 0.003). Diffuse distribution of blood vessels was the most prevalent, with 92.3% of flat ACMM and 76.9% of elevated ACMM (p = 0.416). Peripheral arrangement of blood vessels was detected in 15.4% of elevated ACMM and 7.7% of flat ACMM (p = 0.815). The central arrangement of blood vessels was seen in 2.6%, while the cluster (segmental) schedule was present in 5.1% of elevated ACMM. The monomorphic vascular pattern was the predominant pattern in 84.6% of flat ACMM and 61.5% of elevated ACMM (p = 0.232). Conclusion. Our study supports the finding that linear irregular blood vessels are more commonly associated with elevated ACMM, while the dotted ones are dominant in flat ACMM.

Value of real-time tissue elastography diffusion quantitative analysis combined with tumor markers for differential diagnosis of benign and malignant breast nodules

Ling Zhu, Lina Mei, Xuekui Pan — Fri, 29 Nov 2024 08:40:53 +0100

Background/Aim. Serum tumor markers (TMs) are commonly combined with imaging examinations to differentiate benign and malignant breast nodules (BNs), but there are still limitations. The aim of the study was to determine the value of real-time tissue elastography (RTE) diffusion quantitative analysis combined with serum TMs for the differential diagnosis of benign and malignant BNs. Methods. A total of 149 patients with BNs were included in this study. They were assigned to the benign BN group (n = 87) and malignant BN group (n = 62). All patients were examined using RTE diffusion quantitative analysis. Venous blood was collected to detect the levels of TMs carcinoembryonic antigen-CAE, cancer antigen (CA) 153, and CA 199. The value of RTE diffusion quantitative analysis parameters, TMs, and their combination for the differentiation of benign and malignant BNs was analyzed using the receiver operating characteristic-ROC curve. Results. Among all the above indicators, the area ratio of the blue region (AREA%) had the highest differential value, with an area under the curve (AUC) of 0.916 [95% confidence interval (CI): 0.812–0.967], while sensitivity and specificity were 88.90% and 86.79%, respectively (p < 0.05). Compared to RTE diffusion quantitative analysis parameters or TMs alone, the combination of the two showed the highest value for the differentiation of benign and malignant BNs, with an AUC of 0.957 (95% CI: 0.834–0.982), while sensitivity and specificity were 95.50% and 94.33%, respectively (p < 0.05). Conclusion. RTE diffusion quantitative analysis combined with TMs has a high value for the differentiation of benign and malignant BNs.

Clinical outcome in patients monitored by the NIHSS after mechanical thrombectomy in relation to time and cerebrovascular risk factors

Valentina Mileusnić, Irena Grkić, Aleksandra Zečević — Wed, 27 Nov 2024 12:34:35 +0100

Background/Aim. Mechanical thrombectomy (MT) is an endovascular treatment that involves the extraction of thrombotic masses in the first hours of acute ischemic stroke (AIS) from the large blood vessels of the head and/or neck. The aim of the study was to determine the role of predictors (time and vascular risk factors) of the clinical outcome of patients with AIS monitored by the National Institute of Health Stroke Scale (NIHSS). Methods. The study included 134 patients diagnosed with occlusion of a blood vessel of the head and/or neck with a clinical picture of AIS who met the criteria for MT and in whom, upon admission to the hospital, existing vascular risk factors were observed. In relation to the time parameter from the onset of the clinical picture of AIS to the start of MT, the patients were divided into two groups. The first, the examined group, consisted of 85 (63.4%) patients in whom recanalization was initiated within the first four hours from the onset of symptoms, and the second, the control group, consisted of 49 (36.6%) patients in whom recanalization was initiated after the fourth hour. The results were monitored by the change of the NIHSS score at the time of discharge of the patient, on the 30th and 90th day, in relation to the NIHSS score on admission. Results. There was no statistically significant difference between the groups except for the variables endovascular treatment (EVT) and previous vascular event [cardiovascular disease (CVD)] (p < 0.05). A statistically significant correlation was found between improvement and the time when EVT was performed in relation to the onset of complaints (χ²(1) = 4.756; p < 0.05). A statistically significant correlation was also found between improvement and CVD (χ²(1) = 4.756; p < 0.05). Conclusion. The results of our study support MT as a promising stand-alone therapy for AIS. Clinical outcome monitored by the NIHSS after MT in relation to time and cerebrovascular risk factors shows that patients in whom EVT was performed in the first four hours have an improvement more often than patients in whom EVT was performed four hrs after the onset of symptoms. Likewise, patients without CVD were more likely to show improvement than patients with CVD.

Chronic diseases and self-assessment of health as predictors of unmet health needs of the elderly population in the Republic of Serbia: national health survey

Fri, 29 Nov 2024 08:42:23 +0100

Introduction/Aim. Unmet health needs are the difference between the health services considered necessary to solve a particular health problem and the health services that were actually received. Unmet health needs in the elderly population with chronic diseases can lead to deterioration of the health condition and complications. The aim of the study was to analyze the connection between the presence of chronic diseases and self-assessment of health with the unmet health needs of the elderly population. Methods. The study was part of the latest National Population Health Survey of the Republic of Serbia, conducted as a cross-sectional study on a representative stratified two-stage sample. Data from 3,450 respondents aged 65 and above were used for the purposes of the research. The research was conducted according to the European population health research methodology. Univariate and multivariate logistic regression were used to assess predictors of unmet health needs. Results. Every third respondent with a chronic disease did not receive the necessary form of health care (36.3%). Dominant predictors of unmet health needs were self-assessment of health [odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.58–0.68] along with chronic diseases (OR = 2.29; 95% CI = 1.87–2.81) and depression (OR = 2.12; 95% CI = 1.71–2.64). Respondents with a chronic health disorder were 2.2 times more likely to fail in the realization of the necessary health service compared to respondents who did not have long-term illnesses. Respondents who assess their own health as poor/very poor report unfulfilled health needs two times more often than respondents in good health. Conclusion. Unmet health needs in the elderly population are associated with self-reported health and the presence of chronic diseases. The results of such research can be the basis for a better organization of health care and the creation of health policies in order to improve the health of this population group.

Strengthening psychological resilience: the effectiveness of autogenic training of community pharmacists

Dragana Jocić — Wed, 27 Nov 2024 00:00:00 +0100

Background/Aim. Psychological resilience is essential for healthcare professionals like community pharmacists. It enables them to navigate daily challenges effectively. Autogenic training (AT) has emerged as a promising psychological technique for enhancing resilience and reducing stress in this population. The aim of this study was to investigate the impact of AT on resilience among community pharmacists. Methods. The study recruited licensed pharmacists from community pharmacies. Participants received information about the aims and procedures of the research. Resilience was assessed using a scale that measured five domains: Confidence, Agility, Coping with Stress, Interpersonal Relationships, and Developmental Thinking. Using a controlled trial design, participants were randomly divided into two experimental groups, which underwent AT, and a control group, which did not undergo AT. Statistical analyses, including the Kruskal-Wallis and Wilcoxon rank-sum tests, were conducted to analyze the data. Results. Participants who underwent AT showed statistically significant improvements in resilience compared to the control group, particularly in the domains of Confidence, Coping with Stress, and Interpersonal Relationships. Furthermore, a notable shift towards higher resilience categories was observed in the experimental groups after the intervention. Conclusion. AT appears promising as an intervention to enhance resilience and reduce stress among community pharmacists. Integrating AT into pharmacist education and practice guidelines could significantly affect pharmacist welfare and patient care outcomes.

Operative treatment of calcified thoracic disc herniation: a case report on natural fusion method following spinal canal decompression

Wed, 27 Nov 2024 00:00:00 +0100

Introduction. The literature describes several ways to approach the thoracic spinal segment, but there are still many dilemmas regarding what is best to do after a complete discectomy, regardless of the surgical approach chosen. The incidence of postoperative kyphosis is higher if a posterior surgical approach to the spine is performed, and there are no clearly defined indications for the application of intervertebral fusion (IF) after an anterior ap-proach. The aim of the paper was to highlight the low morbidity of the transthoracic multidisciplinary approach, as well as a potential solution for a good, natural IF of the adjacent vertebrae without expanding and prolonging the duration of the surgical procedure itself. Case report. A 44-year-old woman presented with severe anterior compressive myelopathy caused by a calcified thoracic disc herniation in the space between the T10-11 vertebrae. A minimally invasive, open, transthoracic approach was performed with decompression of the spinal canal at the specified level and IF was achieved with an autologous rib graft during the same procedure. Despite the relatively low incidence of postoperative spinal instability, one should not overlook a good chance to achieve IF and prevent long-term complications. A control examination of the thoracolumbar segment using the magnetic resonance imaging showed that there is no more compression of the spinal cord and also showed a good IF without an increase in the level of kyphosis. Conclusion. Significant thoracic disc herniation is a rare and challenging surgical lesion. The anterior mini-open transthoracic approach provides good exposure to the relevant structures and is considered minimally invasive. The benefits of subsequent IF after the transthoracic surgical approach should always be taken into account for each individual patient, thus minimalizing the postoperative morbidity.

Bicentennial of keratoplasty: Thus spoke the pioneers

Ljubisa B Nikolić — Wed, 27 Nov 2024 12:52:52 +0100