Medical Research" is a peer-reviewed scientific journal of the Faculty of Medicine of the University of Belgrade, which was first published in 1971, that is, half a century ago. The journal "Medical Research" is primarily dedicated to publishing the results of the scientific research work of teachers and associates of the Faculty of Medicine, as well as other scientists in the field of biomedical research. The journal "Medical Research" publishes scientific papers in English with an abstract in Serbian and has an open access policy. It is published three times a year, while the fourth volume also publishes summaries of the presentations at the "Aspirations and Innovations in Medicine" symposium. Original and previously unpublished works are published in the journal "Medical Research": a. original works in which the results of own research are published for the first time; b. review papers (Review), critically and originally presented (with self-citations); c. presentations of patients and cases (Case report). The works published in the journal "Medical Research" belong to the fields of: basic biomedical research, clinical research and preventive medicine. For the purpose of expert review of submitted papers, the Editorial Board of the journal is divided into three sections: basic, clinical and preventive sciences, and their work is coordinated by the Section Editors. The section for statistical data analysis will be involved in the evaluation of the statistical data of the submitted works.
Medicinski fakultet Univerzitet u Beogradu
Evolution of the SYNTAX score (I, II and II 2020): development, application and limitations in everyday clinical practice
Surgical myocardial revascularization is the gold standard for myocardial revascularization in chronic coronary syndrome (CCS). The first randomized trials comparing bare metal stent (BMS) implantation and aorto-coronary bypass graft surgery (CABG) resulted in similar mortality and myocardial infarction rate, and lower rate of repeat revascularization after CABG compared to BMS implantation, directed the development of drug eluting stents (DES) with the lower rate of clinical restenoses. Over the years, there was a need for objective assessment and calculation of risk and benefit of both surgical and percutaneous myocardial revascularization, and giving an advantage to one of these two methods, or equipoise for a specific patient. SYNTAX score I was used for the quantitative assessment of coronary stenoses complexity in a patient with CCS. However, two major flaws of the SYNTAX score I, (1) absence of the assessment of functional significance of coronary stenosis, and (2) absence of clinical variables that may influence perioperative mortality rate, were partially overcome with development of SYNTAX score II including clinical variables that showed the greatest association with mortality (age, creatinine clearance, left ventricular ejection fraction, unprotected left main coronary artery disease, female gender, peripheral vascular disease and chronic obstructive pulmonary disease) and SYNTAX score II 2020 predicting 10-year mortality rate. The SYNTAX score II and II 2020 potentially can change the recommendation for myocardial revascularization based on SYNTAX score I alone. This review focuses on development of these scores, their accuracy, predicitve value and limitations in practical applications in an individual patient with CCS.
Unilateral genu recurvatum: A case report
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction: Genu recurvatum is characterized by knee hyperextension, gait instability, and pain. It is rarely encountered in routine orthopedic practice, and evidence regarding optimal treatment strategies remains limited. In this case, the absence of trauma, associated varus malalignment, and the unilateral presentation further increased the complexity, with progressive worsening observed over a three-year follow-up period. This report presents a rare case of unilateral genu recurvatum of unknown etiology, treated with corrective proximal tibial osteotomy and posterior tibial slope adjustment, along with postoperative outcomes and a brief review of the literature. Case Presentation: A 32-year-old male patient presented with unilateral genu recurvatum and an intact posterior cruciate ligament (PCL), confirmed by MRI and arthroscopy. Preoperative planning was based on MSCT analysis. An open-wedge proximal tibial corrective osteotomy with plate fixation was performed. Under C-arm–guided fluoroscopy, the planned correction and posterior tibial slope were achieved. The posterior tibial tilt increased from 94° to 101°, improving knee stability and correcting the deformity. Conclusion: Corrective proximal tibial osteotomy with posterior slope adjustment represents an effective treatment option for unilateral genu recurvatum of unknown etiology. This technique provides reliable mechanical axis correction, joint stabilization, and favorable clinical outcomes with relatively rapid postoperative recovery.
Ovarian Hyperstimulation Syndrome: Contemporary Approach to Pathophysiology, Risk Stratification, Prevention and Management
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<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Ovarian hyperstimulation syndrome (OHSS) is a potentially serious iatrogenic complication of controlled ovarian stimulation in assisted reproductive technology procedures. Despite substantial progress in stimulation protocols and preventive strategies, OHSS remains an important clinical and safety concern in contemporary IVF practice. The purpose of this narrative review is to summarize and critically analyze current knowledge regarding the pathophysiology, risk factors, clinical presentation, prevention, and management of OHSS. Relevant literature was identified through searches of the PubMed/MEDLINE, Scopus, and Web of Science databases, including clinical studies, cohort analyses, systematic reviews, and professional society guidelines published between 2019 and 2026, with selective inclusion of earlier landmark studies essential for understanding the basic mechanisms of the syndrome. Current evidence indicates that the key pathophysiological mechanism of OHSS is increased vascular permeability mediated by vascular endothelial growth factor (VEGF), most commonly triggered by exposure to human chorionic gonadotropin. Identification of high-risk patients using ovarian reserve biomarkers, individualized gonadotropin dosing, the use of GnRH antagonist protocols and GnRH agonist trigger, as well as freeze-all embryo strategies, have substantially reduced the incidence of moderate and severe forms of the syndrome. Contemporary management of OHSS is therefore primarily based on prevention and individualized stimulation strategies aimed at optimizing reproductive outcomes while ensuring maximal patient safety.
IMAGING OF VASCULAR ANOMALIES OF THE AORTA AND VESSELS OF THE HEAD AND NECK- REVIEW ARTICLE
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Locked="false" Priority="21" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> This review article aims to present the most common vascular anomalies of the head and neck arteries, detailing their clinical presentations, the diagnostic advantages of current imaging modalities, and the selection of appropriate therapeutic interventions. Vascular malformations result from localized errors in the development of blood and lymphatic vessels, leading to the formation of abnormal structures prior to birth. They typically grow proportionally with the child, though they may occasionally undergo rapid expansion. Vascular malformations are classified based on their hemodynamic characteristics into two major categories: slow-flow anomalies (comprising capillary, lymphatic, and venous malformations) and fast-flow anomalies (arteriovenous and arterial malformations). The incidence of arteriovenous malformations (AVMs) is increasing; many remain clinically asymptomatic, though approximately 12% are symptomatic. In cases involving hemorrhage, the mortality rate is 10–15%, with morbidity ranging from 30% to 50%. There is no gender predilection. Computed Tomographic Angiography (CTA) and Magnetic Resonance Imiging (MRI) are essential for therapeutic planning and risk assessment across surgical, endovascular, and radiological interventions. These modalities allow for the visualization of complications such as hemorrhage, stroke, and cerebral atrophy. Furthermore, magnetic resonance imaging is critical for assessing the reduction of the nidus size, the extent of post-therapeutic edema, and the presence of radiation necrosis within the treatment field. While surgery remains the primary definitive treatment, embolization has become a significant therapeutic component in recent years.
PERIOPERATIVE ACUTE KIDNEY INJURY AFTER MAJOR NON-CARDIAC SURGERY: RISK FACTORS, CLINICAL OUTCOMES, AND PREDICTIVE PERFORMANCE OF PERIOPERATIVE SCORING SYSTEMS
Background: Perioperative acute kidney injury (AKI) is a serious complication after major non-cardiac surgery, associated with increased mortality, prolonged ICU stay, and the need for renal replacement therapy (RRT). Objective: To assess the impact of AKI severity and associated risk factors on clinical outcomes after major abdominal surgery and to evaluate the prognostic performance of SPARK, APACHE II, and SOFA scores, including sepsis-associated AKI. Materials and Methods: This prospective cohort study was conducted in the Surgical ICU of University Hospital Center Bežanijska Kosa (Belgrade) from January to June 2024. Thirty adult patients who developed perioperative AKI after major abdominal surgery were analyzed. AKI was defined according to KDIGO criteria and sepsis according to Sepsis-3. Disease severity was assessed using APACHE II and SOFA, and preoperative AKI risk using the SPARK index. Results: AKI occurred in 30 operated patients. KDIGO stages were: stage 1 in 26.7%, stage 2 in 30.0%, and stage 3 in 43.3%. In-hospital mortality was 30.0% and occurred exclusively in patients older than 60 years. Mortality was significantly higher in KDIGO stage 3 (61.5% vs. 5.9%, p=0.0016). KDIGO stage 3 and age >60 years were strongly associated with death. SPARK showed good discrimination for severe AKI (AUC≈0.78), while APACHE II demonstrated excellent performance for severe AKI and mortality (AUC≈0.97). RRT use was more frequent in advanced AKI stages. Conclusions: Perioperative AKI was infrequent but severe, with high mortality driven by KDIGO stage 3 and advanced age. SPARK and particularly APACHE II were useful for risk stratification.
Sphenoid sinus pneumatization · Vidian canal · Anterior clinoid process · Pterygoid process · Multidetector computed tomography.
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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline 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SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 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Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException 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<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 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Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Background: Multidetector computed tomography of the sphenoid sinus is the most accurate method for visualizing sinus pneumatization and all anatomical variations. Objective: To characterize the patterns of pneumatization of the sphenoid sinus and assess the association with variations in the bony structures of the sinus in relation to gender and age groups. Methods: Retrospective CT analysis of 127 patients (43 men and 84 women). Pneumatization patterns, skull base extensions, and Vidian canal types were classified. Results: Bilateral increased sphenoid sinus pneumatization shows a very strong age association (p = 0.001), with clustering in middle-aged (40–52) and elderly (≥ 66) groups. Right-sided preserved sphenoid sinus pneumatization shows a statistically significant association with gender (χ² = 3.90, p = 0.048), with a higher proportion of males than females. Bilateral pneumatization (BPP) showed a statistically significant association with age (p = 0.019); individuals with BPP were significantly younger. Sellar type predominated (67.7%), with frequent posterior and lateral extensions. The dorsal sphenoid sinus configuration is the only variant showing a statistically significant association with age (χ² = 8.17, p = 0.043). Complete sellar type shows a strong, consistent positive association with both anterior clinoid and pterygoid process pneumatization on all sides (p ≤ 0.015, often < 0.001). Type III Vidian canal occurred in ~ 40%. Vidian canal Type I is strongly associated with pterygoid process pneumatization, especially bilaterally (p < 0.001 in all cases). Conclusions: The cohort exhibits a highly pneumatized, surgically relevant sphenoid sinus phenotype, primarily developmental rather than symptom-driven.
PREDICTORS OF CARDIAC ARREST IN CHILDREN
The incidence of cardiac arrest (CA) in pediatric patients is lower than in the adult population. The unique anatomical and physiological characteristics of children contribute to differences in the etiology of CA and the outcomes of resuscitation. Key factors for surviving a life-threatening event include the rapid recognition of CA and the prompt initiation of effective resuscitation. Therefore, identifying predictors of CA is crucial, as they indicate the potential for such an event and help differentiate affected patients from others. It is possible to prevent the occurrence of CA by appropriate treatment in these situations. Moreover, there are significant differences in the approach, implementation of resuscitation procedures, treatment, outcomes, and education regarding CA events that occur in children, whether they take place in-hospital or out-of-hospital.
RETINAL VASCULAR CHANGES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
INTRODUCTION/AIM Chronic obstructive pulmonary disease (COPD) is a progressive and inflammatory disease of the airways that often leads to cardiovascular and microvascular changes. This study aimed to analyze retinal microcirculation in patients with COPD using optical coherence tomography angiography (OCTA) MATERIALS AND METHODS Cross-sectional study. A total of 44 subjects were analyzed, including 28 with COPD and 16 healthy controls. Inclusion criteria were subjects older than 18 years with a confirmed COPD diagnosis based on spirometric parameters RESULTS The statistically significant differences were observed between the groups for the following parameters: deep capillary plexus macular (p = 0.009), parafoveal (p = 0.026), and perifoveal region (p = 0.034). A significant negative correlation was observed between the ratio of residual volume to total lung capacity (RV/TLC) and the vessel density in the macular and perifoveal superficial capillary plexus regions (p<0.05). The choriocapillaris Flow also demonstrates a significant inverse relationship with the RV/TLC ratio. Regarding the deeper retinal layers, our analysis revealed a significant negative correlation between outer retina Flow and forced vital capacity (FVC). CONCLUSION Monitoring changes in the OCTA parameters, particularly in relation to lung volume parameters like RV/TLC and FVC, we conclude that OCTA may provide valuable insights into systemic vascular progression and overall severity of the disease in COPD patients
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Ischemic heart disease (IHD), or coronary artery disease, ranks as the primary global cause of mortality and disability. This narrative review summarizes the epidemiology of IHD, focusing on global distribution, risk factors, and prevention. A literature search was conducted using PubMed, Scopus, and Google Scholar databases to identify relevant studies from the past decade. In 2019, IHD affected 197.2 million individuals, resulting in 9.1 million deaths, and 182.0 million disability-adjusted life years (DALYs) worldwide. While age-standardized mortality rates, DALYs, and prevalence have declined, the number of reported cases continues to rise. The highest prevalence was reported in Central and Eastern Europe and Central Asia, while the lowest was in South Asia. Modifiable and non-modifiable risk factors influence IHD. The main causal risk factors, such as hypertension, dyslipidemia, diabetes, smoking, and age, are independently associated with IHD development. Environmental factors (air pollution, noise exposure, and climate change) further increase the risk of IHD. The emerging concept of the exposome emphasizes that the cumulative and combined influence of environmental risk factors plays a crucial role in the development of IHD. IHD can be prevented from developing through primordial (targeting social determinants like urbanization, poverty, illiteracy, living conditions) and primary prevention (management of risk factors through lifestyle interventions, pharmacotherapies). IHD is a growing global health and economic challenge, disproportionately affecting low-income regions, as a result of population aging, limited access to healthcare, and the presence of numerous risk factors that require appropriate prevention and treatment.
EFFECTS OF NMDA RECEPTOR ANTAGONISTS ON ACUTE POSTOPERATIVE PAIN
Introduction/Aim of the paper: Pain represents a multifactorial process with detrimental effects on the entire organism. This randomized, open-label pilot study investigated the effect of preemptive administration of ketamine and magnesium-sulfate on the intensity of postoperative pain after laparoscopic colon tumor resection. Methods: Sixty patients were randomized into the ketamine-magnesium (KM) and the control (C) groups. After the introduction to anesthesia, patients in the KM group received an i.v. bolus dose of 0.5 mg/kg ketamine, followed by a continuous infusion of 0.6 mg/kg/h lasting until the end of surgery. After a bolus dose of ketamine, they received magnesium-sulfate 20 mg/kg in an intravenous infusion (5-10 minutes). Group C received only 0.9% NaCl infusion. After the patients were awakened (0h), the pain intensity was compared (0- 46h) between the two groups. Results: The Mann-Whitney test implied significantly (p<0.05) lower visual analog scale (VAS) scores, in KM group at 0, 1, 2, 10, 22 and 30 hours after the surgery, and no statistical significance (p>0.05) for VAS scores after 6, 14, 18, 38 and 46 hours, compared to C group. Ketamine and magnesium-sulfate significantly (p<0.05) reduced the postoperative consumption of analgesics, increased the sedation level at 0h postoperatively, and increased the overall patient satisfaction with the treatment. Conclusion: Preemptive administration of ketamine and magnesium-sulfate combination has beneficial effect on postoperative pain after laparoscopic colon tumor resection.
SURGICAL SIGNIFICANCE OF ANATOMICAL VARIATIONS OF THE PARATHYROID GLANDS
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope return"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="footnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="line number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="page number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="table of authorities"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="macro"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="toa heading"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 5"/> <w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Closing"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Signature"/> <w:LsdException Locked="false" Priority="1" SemiHidden="true" UnhideWhenUsed="true" Name="Default Paragraph Font"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent"/> <w:LsdException 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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline 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SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 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UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 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Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 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Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" 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2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> A solid understanding of the surgical anatomy of the parathyroid glands is based on a thorough knowledge of their embryonic development. Anatomical variations in the number, morphology, vascularization, and localization of the parathyroid glands present a challenge during surgical exploration of the neck, both in the treatment of hyperparathyroidism (HPT) and in thyroid surgery. In about 2.3% of patients undergoing thyroidectomy, incidental parathyroidectomy occurs. Our review aims to highlight the incidence of anatomical variations in the localization, number, morphology, and vascularization of the parathyroid glands, as well as their significance in the surgical treatment of parathyroid gland functional disorders. A good understanding of embryologic development and neck anatomy is essential for parathyroid surgery. Contemporary imaging diagnostic modalities used in parathyroid surgery do not have the same sensitivity and specificity as in other surgical fields, and they significantly increase treatment costs. The success of surgical treatment largely depends on the surgeon's knowledge and experience. If parathyroid glands are not found in their usual locations, an extensive bilateral neck exploration must be performed. Meanwhile, parathyroid adenomas located in the mediastinum below the aortic arch require a specialized diagnostic and surgical approach. Measurement of intraoperative PTH (ioPTH) levels increases the success rate of surgical interventions.
NEURODEVELOPMENTAL DISORDERS IN CHILDREN WITH 22q11.2 DELETION SYNDROME AND RECOMMENDATIONS FOR PEDIATRIC FOLLOW UP
Summary Neurodevelopmental disorders are the most prevalent chronic diagnoses in pediatric primary care, with rising incidence and significant impact on cognitive, motor, social, and communication functioning. 22q11.2 deletion syndrome (22q11.2 DS)—the most common human microdeletion syndrome—presents with a broad spectrum of somatic and neurodevelopmental abnormalities. Nearly all individuals with 22q11.2 DS show neurodevelopmental difficulties, including delays in motor and speech milestones, cognitive impairments, and behavioral challenges. The disorder affects approximately 1 in 2,500 newborns and is also associated with congenital heart defects, palatal anomalies, hypocalcemia, and immunodeficiency. Neurodevelopmental manifestations typically begin in infancy with delayed motor and speech development and progress into school age with difficulties in learning, attention, and peer interaction. Intellectual disabilities are common, with a distribution skewed toward lower IQ scores. Children often exhibit a verbal-performance IQ discrepancy and may experience further cognitive decline in adolescence or adulthood. Over 40% of affected individuals meet criteria for autism spectrum disorder, attention-deficit/hyperactivity disorder, or both. They also have increased risks for psychiatric conditions such as anxiety, depression, and schizophrenia. Pediatricians, as primary care providers, play a critical role in early identification and long-term monitoring. Recommendations include routine developmental assessments, early interventions (e.g., speech and occupational therapy), and regular IQ and adaptive functioning evaluations, especially during educational transitions. Early diagnosis and individualized, multidisciplinary approaches are essential to improve developmental outcomes and quality of life in children with 22q11.2 DS. Keywords: 22q11.2 deletion syndrome, DiGeorge syndrome, neurodevelopmental disorders
CASE REPORT OF SEVERE CYTOMEGALOVIRUS INFECTION IN PREGNANCY: PREVENTION AND TREATMENT OPTIONS
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction: Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. It can be the cause of serious clinical manifestations, leading to permanent disability in infected children. Unlike most other TORCH infections, both primary and non-primary CMV infection can affect fetus. Patient Review: We present a case of congenital CMV infection that was diagnosed after the onset of severe fetal anomalies in the third trimester. The patient was referred to our hospital in 35. weeks of pregnancy complicated by severe intrauterine growth restriction and fetal brain anomalies seen on the ultrasound and magnetic resonance imaging (MRI): simplified gyration and a highly suspected band heterotopia (differential diagnosis: lissencephaly), dilated temporal and occipital horns of lateral ventricles with intraventricular septations, vermian hypoplasia, zones of t2 hyperintense lesions. Serology testing revealed positive results for CMV-specific IgM antibodies and a positive result for CMV-specific IgG antibodies with high avidity (91,7%). After performing the amniocentesis (PCR), we got positive result for CMV. The patient was informed about the poor prognosis of the congenital CMV infection with those findings on the fetal brain. She opted for the termination of pregnancy. Conclusion: Given that this is the most common congenital infection, it is necessary to continually raise awareness among pregnant women about primary prevention methods. In the meantime, efforts should focus on research aimed at timely detection and treatment, to prevent severe forms of congenital infection.
PROGNOSTIC SIGNIFICANCE OF INDEXED STROKE VOLUME IN ASYMPTOMATIC PATIENTS WITH MODERATE TO SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Introduction and aim: Whether and when to intervene in asymptomatic patients with moderate to severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) has not yet been determined. In patients with AS, low flow through the aortic valve is defined as indexed stroke volume (SVi) ≤35ml/m2. The aim of our work was to determine the relationship between SVi and all-cause mortality, as well as the prognostic significance of low SVi in asymptomatic patients with moderate to severe AS, high mean gradient across (Pmean) the aortic valve and preserved LVEF. Methods: The study included 121 asymptomatic patients (69 men, mean age 66±11 years) with moderate-to-severe AS (aortic valve area ≤1.5cm2), high Pmean across the aortic valve and preserved LVEF. The median follow-up was 38 months (IQR 35-42 months). Results: Ten patients (8%) died during the follow-up. All-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m2 compared with those with SVi >35ml/m2 (15% vs. 4%, p<0.045). The cumulative incidence of all-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m2 compared with those with SVi >35ml/m2 (log-rank p-value 0.035). After adjustment for outcome predictors, SVi was found to be the most significant predictor of all-cause mortality in the mid-term follow-up (adjusted-HR: 0.870; 95%CI: 0.801–0.945; p=0.001). Conclusion: The left ventricular SVi is an important predictor of all-cause mortality in asymptomatic patients with moderate-to-severe AS, high Pmean across the aortic valve, and preserved LVEF.
SCAPHOCEPHALY: A RETROSPECTIVE SERIES EXAMINING TREATMENT STRATEGIES AND LONG-TERM FOLLOW-UP
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2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction Scaphocephaly, the most common form of craniosynostosis, is caused by the premature fusion of the sagittal suture, resulting in an elongated skull shape and constrained cranial growth. Material and methods This retrospective study included all consecutive patients with sagittal synostosis who were operated on at the Clinic of Neurosurgery, UCCS, in the 20-year period. Detailed patient data were obtained from medical records and neuroradiological diagnostics. The follow-up period for these patients ranged from 6 to 20 years. The acquired data were thoroughly statistically analyzed. Results There were 93 children with a clear male preponderance. In the majority of children, there were no perinatal complications, and the majority of mothers didn’t have any chronic illnesses. Three types of surgical treatment were used, with an almost equal distribution. The mean blood loss during surgery varied across the three operative techniques, with the lowest blood loss observed using the TSEO technique. Successful treatment was observed in only 57.1% patients who underwent strip-suturectomy, 96.6% patients treated with the π procedure, and all patients treated with the TSEO technique. Statistical analysis revealed a significantly higher success rate of the TSEO and π procedure compared to strip-suturectomy. Cranial index remained dolichocephalic in 6/28 children treated with strip-suturectomy alone, while in all cases treated with TSEO and π procedure, cranial index normalized. The majority of operated children had no complications. Conclusion Successful treatment of scaphocephaly requires a case-specific approach that extends beyond the surgical procedure itself. This series emphasizes the need for individualized treatment plans and a multidisciplinary approach throughout the surgical process.
HYPERTHERMIC INTRATHORACIC CHEMOTHERAPY (HITHOC) - A TERTIARY ONCOLOGICAL CENTER EXPERIENCE
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6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction: This study aimed to present our experience with HITHOC in the field of multimodality treatment of heterogeneous, potentially resectable, chemotherapy-sensitive pleural malignancies—primary and metastatic—limited to the unilateral thoracic inlet. Methods: The research included all patients who underwent a HITHOC procedure with CRS at the Institute for Oncology and Radiology of Serbia from January 2018 to December 2024. The indications for procedure were: resectable chemo-sensitive primary or residual/recurrent thoracic malignancies confined to one side of the thorax, and various metastatic diseases restricted to the unilateral thoracic inlet with achieved local disease control. HITHOC was performed with cisplatin (100 mg/m2 in 1000 ml of 5 % glucose, gradually heated to 42 °C) perfusion lasting 90 minutes. Results: Eleven patients were included in the study, with a mean age of 48.27 ± 18.37 years. The most common tumor pathology was thymoma, followed by malignant pleural tumors. Other tumor pathologies included ovarian cancer, Ewing's sarcoma, alveolar rhabdomyosarcoma, and lung cancer. Average follow-up was 41,73 (median: 35; range: 2-72) months. The overall survival rate was 64%. Conclusion: HITHOC procedure can be regarded as a safe, feasible, and effective approach for well-selected patients. It could be beneficial not only for its current indications, but also for chemosensitive pleural malignancies, both primary and metastatic, limited to the unilateral thoracic inlet.
Computed tomography (CT) perfusion is CT examination modality that enables visualization and non-invasive quantitative assessment of tissue perfusion. Application of CT perfusion in oncology enables non-invasive detection and quantification of neo-angiogenesis (i. e. pathological vascularization) of various malignant tumors. Based on value of CT perfusion parameters, it is possible to distinguish neoplasm from healthy tissue, malignant from benign tumors, high-aggressive from low-aggressive tumors, and good from poor tumor response to oncological therapy. Basic principle of performing the low-dose CT perfusion implies repeated scanning of selected region where tumor is located, using reduced tube voltage and current, in short time intervals after intravenous administration of small bolus of iodine contrast by automatic injector with a high flow rate. Using different kinetic-mathematical models, several software for CT perfusion analysis have been developed, by which it is possible to measure following tissue perfusion parameters: blood flow (BF), circulating blood volume (BV), mean transit time (MTT) and vascular permeability (PS or K trans). Results obtained by different CT perfusion software are not comparable. Standardized perfusion value (SPV) is a universal semi-quantitative indicator of tissue perfusion, which is independent of the CT perfusion algorithm and can be simply calculated in the absence of commercial CT perfusion software. Values of BF, BV and PS are significantly higher, and MTT is shorter in the majority of high-grade malignant tumors compared to low-grade, benign tumors and healthy tissue. Significant decline of CT perfusion parameter values is a marker of good response of neoplasm to the oncological therapy.
DEFENSIVE INJURIES IN HOMICIDE VICTIMS: A TEN-YEAR RETROSPECTIVE AUTOPSY STUDY
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope return"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="footnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="line number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="page number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="table of authorities"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="macro"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="toa heading"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Bullet 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 5"/> <w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Closing"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Signature"/> <w:LsdException Locked="false" Priority="1" SemiHidden="true" UnhideWhenUsed="true" Name="Default Paragraph Font"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent"/> <w:LsdException 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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline 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SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 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UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 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Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 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Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Background: Defensive injuries represent a key forensic indicator of a victim’s attempt to resist an assault and hold substantial value in distinguishing homicide from suicide. This study aimed to analyze the frequency, forensic and other characteristics of defensive injuries in homicide victims and to assess their relationship with demographic factors, injury mechanisms, and weapon types. Methods: A retrospective cross-sectional analysis was conducted on 161 homicide autopsies performed between 2014 and 2023 at the Institute of Forensic Medicine in Belgrade, Serbia. Data on demographics, weapon type, and injury patterns were statistically evaluated, including descriptive and analytical statistic methods, with significance set at p < 0.05. Results: Defensive injuries were identified in 56 cases (34.8%), most commonly bilateral and polymorphic, localized in the upper third or diffusely along the forearms. They occurred significantly more often in sharp- and blunt-force homicides (p < 0.001) and nearly absent in firearm-related deaths. Male and elderly victims exhibited higher rates of defensive injuries. Discussion: Defensive injuries are typically located on the upper limbs. The distribution of defensive injuries depends on multiple factors, including the weapon used, attack’s direction, the assailant’s approach, and the relative body positions of both individuals. Numerous, widely distributed defensive injuries, present in large numbers, may point to a prolonged and dynamic struggle. Conclusion: The recognition and interpretation of defensive injuries provide valuable insight into the dynamics of homicide, enabling accurate forensic reconstruction and contributing to the legal classification of homicide cases.
Cardiorenal syndrome type 1 in the cardiology intensive care unit
The kidneys and the heart are closely connected, and the dysfunction or failure of one organ often leads to the dysfunction or failure of the other. This condition is known as cardiorenal syndrome. There are five types of cardiorenal syndrome (CRS), categorized by the primarily failing organ (the kidneys or the heart) and whether the failure is acute or chronic. CRS type 1 (CRS-1) is defined as acute kidney injury (AKI) caused by acute heart failure (AHF). CRS-1 develops in more than 30% of patients hospitalized in the cardiology intensive care unit (CICU). The aim of this narrative review is to present the pathophysiological mechanisms, therapeutic implications and prognostic significance of CRS-1 in patients hospitalized in the CICU. The mechanisms of CRS-1 development are complex. They include low cardiac output and venous congestion with subsequent neurohumoral activation and inflammation. Since the hallmark of CRS-1 is diuretic resistance, the development of CRS-1 complicates the treatment strategy in acutely decompensated patients, and strongly and negatively affects patients’ short- and long-term outcomes. For clinicians, early identification of patients at risk of developing CRS-1 is essential, along with timely adjustment of the therapeutic approach to achieve optimal decongestion, prevent CRS-1 progression, and improve both short- and long-term prognosis.
Revealing Hidden Neuroanatomical Patterns of the Brain for Diagnosis and Personalized Therapy Using Artificial Intelligence and Neuroimaging
The integration of artificial intelligence (AI) with advanced neuroimaging techniques represents one of the most important developments in contemporary neuroscience and clinical neuroanatomy. The aim of this narrative review is to summarize how machine learning and deep learning methods may be applied to neuroimaging data in order to reveal hidden anatomical and functional patterns of the brain with direct clinical relevance. Neuroanatomy plays a central role in this process, providing the structural framework for interpreting functional, metabolic and electrophysiological signals. AI-based analysis enables the detection of subtle alterations in gray and white matter, identification of disrupted brain networks, and integration of multimodal imaging data beyond the limits of human perception and conventional statistical approaches. These capabilities contribute to earlier and more accurate diagnosis, improved disease differentiation, identification of neurobiological subtypes, and more reliable prognostic assessment. In addition to diagnostic applications, AI supports the development of personalized therapeutic strategies, including targeted neuromodulation, neuroimaging-guided surgery, adaptive brain–computer interfaces, and individualized neurofeedback. Despite existing challenges related to data heterogeneity, model interpretability, and ethical regulation, the synergy between AI and neuroimaging represents a critical step toward precision medicine. By leveraging detailed neuroanatomical information, AI-driven approaches enable therapies tailored to the unique brain structure and network organization of each individual.
SNAKE BITE WITH A FATAL OUTCOME IN WESTERN SERBIA – A RARE CASE REPORT
Introduction: Snakebites can lead to a wide range of clinical manifestations, from local tissue effects to systemic complications, including rhabdomyolysis, coagulopathy, acute kidney injury, neurological, and cardiac events. Although snakebites in Western Serbia are generally not a major public health issue, severe cases may occur, with potentially fatal outcomes. Patient review: We report the case of a 71-year-old man bitten by Vipera ammodytes in ####, Western Serbia. He presented with fatigue, vomiting, and swelling of the left hand one hour after the bite. His past medical history included diabetes mellitus, ischemic stroke, and cerebral aneurysm repair. On admission, he was hypotensive and dehydrated, with a local hematoma and thrombocytopenia. He received antivenom, corticosteroids, dopamine, antibiotics, and supportive care. Despite initial stabilization, the patient developed acute respiratory distress, acute kidney injury, hypotension, and peripheral cyanosis, requiring mechanical ventilation and dual inotropic support. Laboratory findings indicated coagulopathy and rising markers of organ injury. Despite intensive management, the patient succumbed to complications. Conclusion: This represents the first reported fatal snakebite in Western Serbia in the past 30 years. The primary pathogenic mechanism was likely disseminated intravascular coagulation triggered by the venom. This case highlights the importance of prolonged clinical and laboratory monitoring, timely supportive therapy, and awareness of severe systemic complications following snakebites, even in regions with historically low incidence.
DIAGNOSIS AND TREATMENT OF VARICEAL BLEEDING
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Portal hypertension is defined as an increase in the hepatic venous pressure gradient, most commonly resulting from liver cirrhosis and leading to the development of portosystemic collaterals, particularly esophageal varices. At the time of cirrhosis diagnosis, approximately 50% of patients have esophageal varices, and variceal bleeding represents one of the most severe and life-threatening complications in gastroenterology. Esophagogastroduodenoscopy is the cornerstone for both diagnosis and treatment of acute variceal bleeding. Therapeutic options include endoscopic hemostasis, pharmacological therapy, balloon tamponade, interventional radiology procedures, and surgical interventions. Endoscopic band ligation is the preferred first-line endoscopic treatment, while sclerotherapy, involving intravariceal or paravariceal injection of sclerosant agents, is now used less frequently. Pharmacological management includes splanchnic vasoconstrictors such as octreotide, terlipressin, vapreotide, and somatostatin analogues, along with supportive measures including fluid resuscitation, blood product transfusion, and correction of coagulopathy. Prophylactic antibiotic therapy, most commonly with fluoroquinolones or cephalosporins, is mandatory in cirrhotic patients with variceal bleeding. Balloon tamponade using devices such as Sengstaken–Blakemore, Minnesota, or Linton–Nachlas tubes serves as a temporary rescue therapy. In cases refractory to standard treatment, transjugular intrahepatic portosystemic shunt (TIPS) or surgical management may be considered in carefully selected patients. Management of variceal bleeding requires intensive care and a multidisciplinary approach.
Phenylketonuria: importance of neonatal screening, insights into genotype-phenotype correlations, and novel therapeutic approaches
Phenylketonuria (PKU) is the most common inborn error of metabolism (IEM) affecting amino acid metabolism among individuals of Caucasian origin, with an incidence ranging from 1:10,000 to 1:20,000 live births. It is inherited in an autosomal recessive manner and results from reduced activity of the enzyme phenylalanine hydroxylase (PAH), leading to the accumulation of phenylalanine and a deficiency of tyrosine. In untreated patients, the clinical phenotype is primarily a consequence of neurotoxicity and includes developmental delay, intellectual disability, and epilepsy. To date, more than 1,100 pathogenic variants of the PAH gene have been identified. The most frequent pathogenic variant reported in Serbia is p.Leu48Ser. Numerous studies have focused on elucidating genotype-phenotype correlations in PKU. Early detection through newborn screening (NBS) programs, based on the identification of elevated phenylalanine concentrations, and prompt initiation of treatment, remains the only effective strategy to prevent intellectual disability and epilepsy and to enable normal neurodevelopment. The introduction of tandem mass spectrometry has significantly expanded the number of IEMs detected by NBS programs across Europe and worldwide. PKU treatment continues on a phenylalanine-restricted diet, which is highly effective but demanding for patients and their families. Adjunct therapeutic approaches include the use of the PAH cofactor tetrahydrobiopterin and enzyme substitution therapy with pegvaliase, aiming to liberalize diet. However, a major limitation of tetrahydrobiopterin therapy is the lack of response in patients with severe phenotypes. The introduction of BH2 (sepiapterin) offers promising prospects for increasing residual PAH activity across different phenotypic groups.
The Use of Hybrid Systems in Neurorehabilitation: A Narrative Review
The use of hybrid systems in neurorehabilitation represents a significant advancement in the field, integrating multiple technological and therapeutic approaches to enhance recovery outcomes for patients with neurological impairments. Recent technological advancements have given rise to hybrid neurorehabilitation systems—integrative platforms that combine biological signals and artificial technologies to drive more effective and personalized rehabilitation This multifaceted approach addresses the complex nature of neural damage and plasticity, offering personalized and adaptive rehabilitation protocols. Hybrid systems in neurorehabilitation commonly integrate modalities such as brain-computer interfaces, robotics, functional electrical stimulation and virtual reality. These systems leverage multimodal sensory feedback and advanced control algorithms to promote neuroplasticity, functional reorganization, and motor relearning by actively involving the patient’s neural and muscular activity in real-time therapeutic interventions. Clinical studies have demonstrated that hybrid systems can improve motor functions in stroke survivors, spinal cord injury patients, and individuals with neurodegenerative diseases more effectively than conventional rehabilitation alone. These systems offer quantifiable performance metrics, allowing clinicians to tailor interventions and monitor progress objectively. Furthermore, the technology enables intensive, repetitive, and task-specific practice, which are critical factors in neural recovery. Overall, hybrid systems in neurorehabilitation exemplify the convergence of neuroscience, engineering, and clinical therapy, resulting in innovative solutions that maximize functional recovery. Future developments will likely focus on increasing system accessibility, optimizing user interfaces, and integrating machine learning algorithms to refine adaptive rehabilitation strategies further
THE CONCEPT OF TRAUMATIC CHILDBIRTH AND PSYCHOPATHOLOGICAL CONSEQUENCES
Childbirth is expected to be a predictable and positive experience in a woman's life. Nevertheless, traumatic experiences related to childbirth have been described for years, which in the most severe cases can result in the onset of postpartum post-traumatic stress disorder. According to current evidence, about 4.7% of women after delivery will meet the criteria for Childbirth-Related Post-Traumatic Stress Disorder (CB-PTSD) diagnosis. Unfortunately, little is known about the aspects of traumatic childbirth, the risk factors for the occurrence of this disorder are insufficiently known, and if it progresses to a clinical diagnosis of post-traumatic stress disorder, it is rarely diagnosed and even less often treated. Viewing childbirth as a traumatic experience can have numerous consequences in the form of avoiding subsequent pregnancies, sexual relations or gynecological examinations, avoiding obligations regarding the newborn, breastfeeding, making attachment with the baby difficult, and the relationship between partners can become dysfunctional. Given this, it is extremely important to increase professional and general awareness of this mental disorder, getting to know the risk factors for its occurrence and possibilities for its diagnosis and treatment.
The Association of Physical Activity with the Severity of Carotid Disease
Introduction: Regular physical activity reduces the risk of cardiovascular diseases (CVD). The aim of this study was to examine the association of physical activity with the severity of carotid disease. Materials and methods: This cross-sectional study involved 506 patients from the Vascular Surgery Clinic at the Institute for Cardiovascular Diseases „Dedinje“, who underwent carotid endarterectomy from 2012 - 2017. The severity of carotid disease was assessed based on the degree of carotid stenosis, the type of plaque, and the patients’ symptomatic status before surgery. Patient physical activity data were collected using the standardized Baecke questionnaire. Univariate and multivariate logistic regressions were performed to examine the association between physical activity and the severity of carotid disease. Results: According to the univariate analysis, there was no significant association of any form of physical activity (occupational, sports or recreational) with the degree of carotid stenosis, nor with other characteristics. Also, physical activity was not associated with complicated carotid plaque. The only characteristic associated with complicated carotid plaque was the use of OACs in therapy (OR=2.91; 95% CI=1.12-7.52; p=0.028). The relationship between physical activity and symptomatic carotid disease was not observed, but according to multivariate analysis, the following factors were associated with symptomatic status: age (OR=0.97; 95% CI 0.94-0.99; p=0.016), gender (OR=0.64; 95% CI 0.44-0.99; p=0.028), family history of CVD (OR=0.63; 95%CI 0.43-0.94; p=0.022), use of clopidogrel (OR 1.79; 95% CI 1.18-2.71; p=0.006) and ACEIs in therapy (OR=1.60; 95% CI 1.02-2.53; p=0.041). Conclusion: Physical activity was not associated with the severity of carotid disease.
Distant Metastasis–Free Interval and Overall Survival in Breast Sarcoma: A Single-Institution Retrospective Study
Background: Breast sarcomas (BS) are rare malignant tumors with aggressive behavior and limited evidence guiding outcome assessment. Data on distant metastasis–free interval (DMFI) in this population are scarce. This study aimed to describe oncologic outcomes and to explore clinicopathologic factors associated with DMFI and overall survival (OS) in patients with BS treated with curative intent. Methods: Patients with primary or secondary breast sarcoma treated at a single tertiary cancer center between 2013 and 2025 were retrospectively analyzed. Patients with metastatic disease at diagnosis were excluded. DMFI was the primary endpoint and OS was secondary. Survival was estimated using Kaplan–Meier methods and compared with log-rank tests. Exploratory receiver operating characteristic analyses were performed for descriptive stratification. Results: Twenty-six patients met inclusion criteria. Angiosarcoma was the most common histologic subtype, predominantly occurring as secondary disease after prior breast radiotherapy. Median DMFI was not reached during follow-up, with 71.5% of patients remaining metastasis free at 3 years, whereas median OS was 31 months with a 3-year OS of 46.9%. Shorter DMFI was associated with higher pathological T stage, larger tumors, tumor necrosis, younger age, and narrower resection margins. Overall survival was significantly associated only with resection margins, which was the sole variable related to both DMFI and OS. Exploratory Cox regression analyses were inconclusive because of limited event numbers. Conclusions: Tumor burden–related factors, tumor necrosis, and surgical margin width were associated with metastasis-related outcomes and survival in breast sarcoma. Adequate surgical resection remains critical in this rare and heterogeneous disease.
Psychedelic-Assisted Psychotherapy: Clarifying the Role of the ‘Psychotherapy’
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Name="List Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Psychedelic-assisted psychotherapy (PAP) is emerging as a novel intervention for major psychiatric disorders, most notably major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). While psychotherapy is widely regarded as a core element of PAP its precise role remains poorly defined. This narrative review traces the development of PAP within contemporary Western psychiatry, outlines the therapeutic framework of preparation, dosing, and integration, and synthesizes findings from recent high-impact randomized controlled trials with psilocybin and MDMA. The primary purpose of this review is to clarify the role of psychotherapy in PAP. Despite methodological rigor, studies differ substantially in their therapeutic orientation, degree of manualization, and therapist involvement, yet all report significant clinical benefit. Some evidence points to the fact that treatment outcomes may not depend on the number of psychotherapy hours, raising questions about whether psychotherapy functions as an active ingredient, a facilitative context, or a safeguard. In light of these inconsistencies, we discuss novel phenomenological accounts of change in PAP, which propose that psychedelics exert therapeutic effects by altering “existential feelings,” with psychotherapy primarily serving to stabilize and integrate these shifts. Current evidence highlights both the promise of PAP and the unresolved uncertainty regarding its psychotherapeutic components. Clarifying these issues will require trials that explicitly address psychotherapeutic variables, as well as the establishment of standardized protocols, ethical safeguards, and licensure pathways for practitioners.
CAPILLAROSCOPY IN HEALTHY SUBJECTS OF DIFFERENT AGE
Introduction: Capillaroscopy is a non-invasive diagnostic tool used to detect morphological abnormalities in the microcirculation. The assessment of capillaroscopic findings in healthy subjects is likely the area where controversies are most difficult to resolve. This review focuses on capillary architecture in healthy individuals across different age groups. Methods: A search was conducted in PubMed, MEDLINE, and Scopus using the following terms: capillaroscopy, healthy subjects, Raynaud’s phenomenon, microcirculation, and microvascular abnormalities. A total of 10 relevant articles were identified. Results: The shape of capillaries and the architecture of the nailfold microvascular network can vary significantly among healthy individuals. The most commonly observed abnormalities in this population include tortuosity, crossovers, homogeneously enlarged loops, neoangiogenic capillaries, and microbleeding. Less frequently, more unusual patterns, such as ramified, bushy, or glomerular loops, may be observed. These atypical features require careful evaluation to avoid missing a potential underlying disease. Conclusion: This review critically examines capillaroscopy findings in healthy individuals, taking into account typical nail care practices and age-related changes. These insights may assist clinicians in distinguishing physiological variations from early signs of microvascular damage.
Copyright (c) 2025 Medical Investigations
Turner disease: a contemporary clinical approach
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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline 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Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException 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<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Turner syndrome (TS) is a rare genetic disorder in females caused by partial or complete loss of one X chromosome. It presents with multisystem clinical manifestations that require lifelong multidisciplinary care and monitoring. Phenotypically, TS is characterized by short stature, short neck with lateral skin folds (pterygium colli), low-set ears, and a low posterior hairline. Clinically, it is associated with cardiovascular diseases (CVD) and primary hypogonadism. The diagnosis of TS is based on clinical presentation and genetic analysis, with early prenatal detection possible. In newborns, TS should be suspected in the presence of oedema of the hands and feet. Short stature becomes evident in early childhood, while delayed puberty and primary amenorrhea are common later findings. CVDs may be congenital or acquired; coarctation of the aorta is a key diagnostic sign, whereas aortic dissection and rupture of an aortic aneurysm are life-threatening complications. Most women with TS have primary hypogonadism and high infertility rates. Spontaneous pregnancies are rare, and fertility preservation options, such as oocyte or embryo cryopreservation, should be considered early. Associated autoimmune diseases, kidney anomalies, liver disorders, and hearing loss are also common. Hormone replacement therapy is essential for pubertal induction, maintenance of general health, and prevention of long-term complications of untreated hypogonadism. Due to numerous comorbidities and variable phenotypes, an individualized multidisciplinary approach is required. With early diagnosis, appropriate management, and psychosocial support, individuals with TS can lead a good quality of life despite ongoing health risks.