SANAMED journal is international, peer-reviewed, multidisciplinary open-access medical journal, founded in 2006 and is published by the Association of medical doctors Sanamed, a nonprofit organization of physicians and scientists. The journal publishes: original articles, case reports, literature reviews, Systematic review, articles on history of medicine, articles for practitioners, book reviews, comments and letters to editor, and other medical information dedicated to the advancement of medical research, practice, and education, in the field of medicine and related fields. The journal is published both in electronic and print format, three times a year. Immediately after publication, all papers are available online for free, on the journal’s website and other databases. The articles are printed in the English language with an abstract and title both in English and Serbian. Authors accept full responsibility for the accuracy of all content within the manuscript. Editor or Editorial Board of the Sanamed does not accept any responsibility for the statements in the articles. Submission of the manuscript implies that its publication has been approved by the responsible authorities at the institution where the work has been carried out. The publisher will not be held legally responsible should be any claims for compensation. Details of all funding sources for the work should be given.
Association of medical doctors "Sanamed" Novi Pazar
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SURGICAL TREATMENT OF PEDIATRIC SUBPERIOSTEAL ABSCESS SECONDARY TO ACUTE BACTERIAL RHINOSINUSITIS-A CASE REPORT
Introduction: Rhinosinusitis, an inflammation of the mucosal lining of the nasal cavity and paranasal sinuses, can be classified by the European Rhinologic Society as acute or chronic, based on the duration of symptoms and signs. Acute bacterial rhinosinusitis (ABRS), caused by bacterial invasion of the nasal and paranasal sinus mucosa, may lead to severe complications if untreated. Among these, orbital complications are the most common, including pre-septal cellulitis, orbital cellulitis, subperiosteal abscess (SPA), orbital abscess, and cavernous sinus thrombophlebitis. They can be associated with visual impairment and intracranial extension. SPA is a rare but serious complication in children. It arises from infection spreading to the subperiosteal space, often following ABRS involving the ethmoid sinuses, due to developmental, anatomical, and immunological factors. Early diagnosis and intervention are critical to prevent long-term sequelae. Case presentation: A 14-year-old boy presented with complications of ABRS, including progressive right eyelid swelling and impaired ocular mobility. Imaging revealed complete opacification of the right ethmoid and maxillary sinuses with bony erosion of the ethmoidal bony septa and lamina papyracea, but without signs of intracranial extension. Laboratory findings showed elevated white blood cell count, elevated C-reactive protein (CRP), and prior exposure to cytomegalovirus and Epstein-Barr virus, with immunoglobulin G (IgG) levels >500.00 IU/mL. Despite initial antibiotic therapy with amoxicillin-clavulanic acid and metronidazole, clinical deterioration required a change in antimicrobial therapy and surgical intervention. Endoscopic sinus surgery (ESS) was performed, successfully evacuating the purulent collection within the SPA, as well as from the ethmoid and maxillary sinuses. Postoperatively, a combination of broad-spectrum intravenous antibiotics, including vancomycin, meropenem, and clindamycin, guided by bacteriological analysis of the pus sample, was administered to target potentially resistant microorganisms, resulting in near-complete resolution of symptoms. Conclusion: SPA, especially in the pediatric population, requires prompt and aggressive treatment to prevent life-threatening complications. Initial therapy includes intravenous antibiotics, but surgical drainage becomes essential if there is no improvement within 48 hours or if there is impending visual loss. ESS is a safe, minimally invasive technique for managing SPA unresponsive to conservative treatment. Early surgical intervention should be further explored to optimize outcomes and minimize morbidity in pediatric cases.
TREND IN THE PLACEMENT OF PERMANENT AND TEMPORARY CENTRAL VENOUS CATHETERS FOR HEMODIALYSIS
Dear Editor Chronic kidney disease (CKD) is one of the fastest-growing diseases worldwide (1). As the world population ages, the incidence of renal failure is increasing globally, along with the prevalence of people receiving chronic dialysis. There are three renal replacement modalities: peritoneal dialysis (PD), transplantation (Tx), and hemodialysis (HD), HD being the most common form of dialysis, with a worldwide prevalence of 89%, with PD accounting for the remaining 11%. The standard approach for HD is the arteriovenous fistula (AVF), while an alternative vascular access device for HD, still the tunneled central venous catheter (CVC) (1,2), is a salvage vascular access option for HD, but it is still used in approximately one-quarter of prevalent patients worldwide, although it is associated with poor performance and higher risks (2). The literature suggests that CVC remains the most commonly used vascular access option for HD, despite guidelines advising that AVFs should be used whenever possible. The risk of CVC has mostly focused on catheter-related bacteremia and/or has only evaluated tunneled CVCs (TCVKs) (3). CVCs were first used in a patient in 1969. Over time, indications for their use have become more numerous, such as parenteral nutrition, chemotherapy, and situations where peripheral venous access is not possible in patients in intensive care units. CVC placement involves the placement of a catheter in a large-lumen venous system, most commonly the internal jugular, subclavian, or femoral vein. Complications associated with CVC placement occur in 2–26% of cases, so its use is rare and is most often in acute renal failure (4). Globally, almost three-quarters of patients on HD require a CVC (5,6). CVCs provide immediate access to hemodialysis in cases where high nitrogenous wastes, hyperkalemia, and anuria require urgent HD, but the use of a catheter is thought to increase the risk of complications associated with placement and long-term use (7). In patients on HD, CVCs are used when other vascular access options are not available (8–11). Since the introduction of CVCs, catheters have been coated with heparin or antibiotics, and catheter-related complications are less common (12,13). The literature suggests that CVC-associated bloodstream infections in patients on HD are an important cause of hospitalization, morbidity, and mortality. Eliminating bloodstream infections in the hemodialysis setting has been a focus of the Centers for Disease Control and Prevention (CDC) Coalition (14,15,16). General preventive measures, including the use of asepsis and antisepsis, play a key role in the prevention and early detection of CVC-associated infections in patients on HD. Infection control surveillance, together with a team approach to care (doctor–nurse), significantly contributes to the reduction of CVC-related morbidity and mortality (4). Our data from the Nephrology Clinic show that in 2025, out of approximately eighty patients on HD, 14 had a temporary or permanent CVC. Our HD center does not differ significantly from other centers in terms of the trend of CVC placement and the occurrence of complications, which can be explained by the correct placement and monitoring of therapeutic guidelines by anesthesiologists and nephrologists, and the correct maintenance and hygiene of CVCs by educated nurses in the dialysis center, Nephrology Clinic, Clinical Center of Montenegro, and the application of asepsis and antisepsis measures. Continuous evaluation, proper care and hygiene of dialysis catheters, and early detection of patients with end-stage renal disease are recommended in order to initiate HD on time and thereby prevent complications and reduce morbidity and mortality rates, with the aim of extending life expectancy and improving the quality of life of patients on HD.
PATIENT PERCEPTIONS AND EXPERIENCES OF ENDODONTIC TREATMENT IMPLICATIONS FOR ORAL HEALTH CARE
Background: Endodontic treatment is an essential procedure for preserving natural teeth and preventing further oral health complications. However, patients’ perceptions, knowledge, and anxiety related to root canal treatment may influence their willingness to undergo the procedure and their overall satisfaction with dental care. Aim: The aim of this study was to examine the association between demographic characteristics—such as gender, age, and educational level—and patients’ perceptions, attitudes, and expectations regarding endodontic treatment. Materials and Methods: A cross-sectional study was conducted using an anonymous online questionnaire among patients residing in Sarajevo Canton. A total of 171 participants who had previously undergone endodontic treatment completed the questionnaire. The questionnaire collected demographic data and information about patients’ knowledge of endodontic treatment, previous treatment experience, satisfaction with the information provided by the dentist, perceived pain or discomfort, communication with the dentist, and overall treatment experience. Data were analyzed using IBM SPSS Statistics version 22. Descriptive statistics were used to summarize the data, while the independent samples Student’s t-test and one-way analysis of variance (ANOVA) were applied to assess differences between groups. Statistical significance was set at p < 0.05. Results: The majority of participants were female (80.1%), and most had a university degree (60.8%). Male participants reported significantly higher satisfaction with the information provided, the dentist’s professionalism, and comfort during treatment compared to female participants (p < 0.05). Participants aged 41 years and older reported significantly higher satisfaction with communication, information provided, and overall treatment experience than younger age groups. Participants with a lower level of education reported significantly higher levels of pain or discomfort during or after treatment (p < 0.004). Conclusion: Patients generally showed a positive perception of endodontic treatment. Effective communication, adequate patient education, and the dentist’s professionalism play an important role in reducing anxiety and improving patient satisfaction and treatment experience.
PSYCHOTIC MANIFESTATIONS IN PRIMARY SJÖGREN’S SYNDROME: CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGICAL INSIGHTS
Psychotic manifestations in primary Sjögren’s syndrome (SS) represent a rare but clinically meaningful complication of the disease. The aim of this paper was to analyze the clinical characteristics, potential pathophysiological mechanisms, therapeutic approaches, and outcomes of psychotic symptoms in patients with SS. A narrative review of the available literature was conducted, with particular focus on case reports and small case series describing psychosis in the context of SS. Psychotic manifestations in SS may arise from central nervous system involvement, immune-inflammatory mechanisms, cytokine dysregulation, and neurotransmitter alterations, as well as from corticosteroid therapy. Pro-inflammatory cytokines, particularly interleukin-6, have been linked to dopaminergic dysfunction and the emergence of positive psychotic symptoms. Corticosteroids may induce psychotic episodes depending on dose and duration of treatment. Chronic somatic symptoms, including ocular and oral dryness, pain, and fatigue, may be vulnerable to delusional misinterpretation. In several reported cases, psychotic symptoms improved following immunosuppressive therapy, supporting a potential immune-mediated subtype of psychosis in this population. Psychosis in primary Sjögren’s syndrome likely has a multifactorial etiology. Early recognition of a possible autoimmune basis is essential, as treatment strategies may require immunomodulatory therapy in addition to standard psychiatric management.
ERGONOMIC RISK AND MUSCULOSKELETAL PAIN IN DENTAL PRACTICE
Objective: Ergonomics in dental practice plays a crucial role in maintaining professional health, as prolonged static postures and repetitive movements significantly increase the risk of work-related musculoskeletal disorders among dental professionals. Understanding ergonomic risk factors and their impact on musculoskeletal health is essential for identifying vulnerable groups and developing effective preventive strategies in dental practice. Aim: The aim of this study was to assess the occurrence of musculoskeletal pain as a manifestation of work-related musculoskeletal disorders among dentists and to analyze its association with demographic characteristics, work habits, and dental specialization. Materials and Methods: This cross-sectional study included 130 dentists from various dental specialties. Data were collected using a structured questionnaire addressing demographic variables, work habits, ergonomic conditions, and the presence of musculoskeletal pain. Descriptive statistical methods were applied, and chi-square tests were used to analyze associations between categorical variables, with statistical significance set at p < 0.05. Results: The results indicated that the majority of participants experienced work-related musculoskeletal disorders, with prevalence increasing with age and length of professional experience. Occupational factors such as prolonged sitting or standing, improper working posture, lack of ergonomic chairs, and insufficient physical activity were significantly associated with the occurrence of work-related musculoskeletal disorders (p < 0.05). A statistically significant association was also observed between dental specialty and the presence of work-related musculoskeletal disorders (χ²(9) = 25.83; p < 0.01). The highest prevalence was reported among specialists in prosthodontics, pediatric dentistry, orthodontics, and endodontics, while lower prevalence was observed among oral surgeons, general dental practitioners, and periodontists. Conclusion: These findings emphasize the importance of implementing ergonomic interventions, regular physical activity, and preventive strategies in dental practice to reduce the occupational risk of work-related musculoskeletal disorders.
ASSOCIATION OF THE TP53 PIN3 16-BP DUPLICATION POLYMORPHISM WITH ORAL SQUAMOUS CELL CARCINOMA RISK AND PROGNOSIS
Background/Aim: Oral squamous cell carcinoma (OSCC) is associated with multiple risk factors, including genetic variations such as the TP53 PIN3 16-bp duplication polymorphism. This study aimed to assess the association between this polymorphism and susceptibility to OSCC in the Montenegrin population and to evaluate its influence on OSCC prognosis and progression. Materials and Methods: Genomic DNA extracted from 60 patients with OSCC and 71 cancer-free controls was analyzed using the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) technique to identify TP53 PIN3 genotypes and allele frequencies. Clinical and pathological data, along with three-year follow-up outcomes, were also analyzed. Results: During the follow-up period, 12 patients (20%) experienced local recurrence of disease and 6 patients (10%) developed regional metastases, with no distant metastases detected. No significant associations were observed between the PIN3 16-bp duplication polymorphism and patient age, tumor site, grade, disease recurrence, or metastasis (p > 0.05). A significant association between TP53 genotypes and advanced stage of disease was found (p = 0.006). There were no significant differences in disease-free survival among genotypes: A1A1 (28.26 ± 1.70 months), A1A2 (35.00 ± 0.94 months), and A2A2 (30.00 ± 5.20 months) (p = 0.38). Additionally, no significant differences in allele or genotype frequencies between patients and controls were observed (p > 0.05). Conclusion. The TP53 PIN3 16-bp duplication polymorphism cannot be considered a risk factor for OSCC development in the Montenegrin population. Furthermore, this polymorphism does not modulate susceptibility to OSCC progression.
POST-LAPAROSCOPIC SHOULDER PAIN: A NARRATIVE REVIEW OF A FREQUENT POSTOPERATIVE SEQUELA
While the adoption of laparoscopic surgery has enhanced patient safety, comfort, and satisfaction, a considerable number of patients experience post-laparoscopic shoulder pain (PLSP), which can slow recovery. The English-language literature was reviewed after searching major academic databases and engines, including PubMed, Google Scholar, ResearchGate, and Web of Science, to summarize the current understanding of the etiopathogenesis, associated risk factors, and management strategies for post-laparoscopic shoulder pain. The precise etiology remains undefined, and several theories have been proposed to explain PLSP. The most widely accepted theory suggests that PLSP is a form of referred pain caused by diaphragmatic irritation due to stretching from pneumoperitoneum or the presence of residual gases and fluids. Currently, there are no universally accepted protocols for either the prevention or treatment of PLSP; consequently, a wide range of modalities are applied based on the surgeon’s expertise and preference. There is a clear need to improve awareness of this condition to enable the standardization of management options, thereby optimizing patient outcomes.
HÜRTHLE-CELL CARCINOMA OF THE THYROID: CLINICOPATHOLOGIC FEATURES AND SURGICAL OUTCOMES AT A SINGLE INSTITUTION
Background: Hürthle cell carcinoma (HCC) is a rare differentiated thyroid malignancy with variable biological behavior. This study evaluates clinicopathologic features, treatment patterns, and long-term outcomes in patients managed at a single tertiary institution. Methods: We retrospectively reviewed medical records of patients with histologically confirmed HCC between January 2005 and December 2020. Demographics, tumor characteristics, surgical treatment, adjuvant radioactive iodine (RAI) therapy, recurrence, and survival were analyzed. Outcomes were compared with reported retrospective series and discussed in the context of current ATA guidelines. Results: Forty-eight patients were identified (mean age, 58.7 ± 11.4 years; female-to-male ratio, 2.2:1). Mean tumor size was 38.5 ± 14.2 mm. Minimally invasive disease was present in 29 patients (60.4%), and widely invasive disease in 19 (39.6%). Total thyroidectomy was performed in 36 patients (75%), and lobectomy in 12 (25%). RAI therapy was administered to 30 patients (62.5%), predominantly in widely invasive cases. Median follow-up was 104 months (range, 24–192 months). Recurrence occurred in 8 patients (16.7%), with a median time to relapse of 78 months. Five- and ten-year overall survival (OS) rates were 91.3% and 81.5%, respectively. Disease-specific survival (DSS) was 95.6% at 5 years and 90.2% at 10 years. Ten-year disease-free survival (DFS) was 82.1%. Conclusions: Our results support existing evidence that minimally invasive HCC carries an excellent prognosis, while widely invasive tumors have a higher risk of recurrence. Long-term follow-up is essential, given the potential for late recurrence. These findings are consistent with current ATA guidelines recommending risk-tailored treatment and surveillance strategies.
RISK FACTORS FOR POTENTIAL DRUG-DRUG INTERACTIONS OF ANALGESICS IN HOSPITALIZED UROLOGICAL PATIENTS
Objective: To evaluate potential drug–drug interactions (pDDIs) involving analgesics in hospitalized urological patients and identify risk factors influencing their number. Methods: This study involved a post hoc analysis based on data obtained from a retrospective observational cohort clinical study conducted at the Clinic of Urology, University Clinical Centre Kragujevac, Serbia. Of the original 220 patients, 191 who received analgesics were included. Daily pharmacotherapy data, along with demographic and clinical characteristics, were collected, while pDDIs were identified and classified using the Lexicomp Interaction Checker. Descriptive statistics were used to summarize the data. Multiple linear regression with backward elimination was used to identify independent predictors of the number of pDDIs. Results: Analgesic-related pDDIs were detected in 175 patients (91.6%). Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed to 173 patients (90.6%), opioids to 53 (27.7%), and paracetamol to 54 (28.3%). The mean number of pDDIs per patient was 5.5 ± 5.5 (range 0–30). Category X interactions most frequently included NSAID combinations (diclofenac + ketorolac, ketorolac + metamizole), while category D interactions frequently involved enoxaparin + ketorolac and opioid–benzodiazepine pairs. Category C interactions were dominated by NSAID + potassium chloride and tramadol + ondansetron or atropine combinations. Multiple regression analysis identified diabetes, a higher number of prescribed drugs, and the use of NSAIDs or opioids as positive predictors of the number of pDDIs, whereas a cancer diagnosis was associated with a lower number. Conclusion: Analgesic-related pDDIs affect the majority of hospitalized urological patients. Avoiding high-risk combinations, close monitoring, and multidisciplinary medication review in patients with risk factors may help reduce preventable harm.
BRIDGING PRIMARY CARE AND SURGERY: THE ROLE OF GENERAL PHYSICIANS AND ANESTHESIOLOGISTS IN PERIOPERATIVE OPTIMIZATION
The transition of a patient from primary or internal medicine care to the operating room represents a critical juncture in perioperative management. Surgical patients requiring anesthesia must undergo thorough, multidisciplinary preparation involving family physicians, internists, hospitalists, anesthesiologists, surgeons, and physiotherapists. This multidimensional approach helps ensure a safe and seamless transition to anesthesia and surgery, thereby optimizing procedural outcomes. Key challenges during this phase include accurate assessment of physical status, risk stratification, optimization of comorbidities, and management of chronic medications. Adequate preoperative preparation minimizes the risk of surgical delays and enhances patient safety. This paper aims to highlight critical issues that can be addressed collaboratively by general physicians and anesthesiologists, fostering improved communication, shared knowledge, and clinical expertise.
AN UNUSUAL PRESENTATION OF TYPE I KOUNIS SYNDROME: HIGH TROPONIN WITHOUT CHEST PAIN AFTER ANAPHYLAXIS
Introduction: Kounis syndrome is defined as the simultaneous occurrence of acute coronary syndrome and an allergic or anaphylactic reaction. It primarily affects men between 40 and 70 years of age and is often associated with chest pain. Owing to limited awareness, this syndrome is frequently under-recognized and under-diagnosed in clinical practice. Case presentation: We report a case of type I Kounis syndrome in a young woman without chest pain. The patient, who had allergic asthma since childhood, developed anaphylactic shock during the administration of bronchodilators, corticosteroids, and an antibiotic in an emergency outpatient setting, followed by cardiac arrest. Subsequent laboratory testing confirmed acute coronary syndrome. Conclusion: Although Kounis syndrome is uncommon, particularly in young women, clinicians should consider the possibility of acute coronary syndrome in severe allergic reactions. In this case, myocardial injury was documented by electrocardiographic changes and later by cardiac biomarkers consistent with coronary syndrome.
ANTIMICROBIAL STEWARDSHIP ACROSS THE SURGICAL PATHWAY
Antimicrobial stewardship programs (ASPs) help ensure antibiotics are used effectively to treat infections, reduce side effects, and slow the spread of antibiotic resistance. Improving collaboration among healthcare professionals is the most important way to strengthen ASPs in hospitals. So far, most ASPs have focused on medical specialities and applied the same approach to all hospital settings. In surgery, it is essential to understand the local cultural and contextual factors that shape prescribing habits so targeted strategies can be developed. Antibiotic stewardship in surgery must be integrated with strict infection prevention and source control, as all three work together to improve patient care. Effective ASPs usually combine persuasive strategies, which educate and influence prescribers, with restrictive ones, which limit certain practices. While clinical guidelines turn evidence into practice and improve the quality of care, they do not always fit local realities. Adapting them into locally relevant tools, such as protocols, bundles, checklists, and posters, can boost acceptance and adherence. Actively involving prescribers in developing these tools increases the likelihood of meaningful change. Clearly defining responsibilities for specific actions within these protocols helps ensure they are followed.
THE LIFE AND LEGACY OF ERNEST AMORY CODMAN: A PIONEER OF OUTCOMES AND A FORERUNNER OF MODERN QUALITY MEASUREMENT SYSTEMS IN HEALTHCARE
Ernest Amory Codman (1869–1940) was an American surgeon, reformer, and visionary whose work marked the beginnings of systematic quality measurement in medicine. The first part of this paper traces his life and career: his education at Harvard Medical School, his work at Massachusetts General Hospital, his conflicts with colleagues over his insistence on public reporting of outcomes, his founding of a private hospital, and the establishment of the Bone Sarcoma Registry—one of the first disease-specific registries in history. The second part of the paper analyzes his philosophy of the “End Result System” through a comparative table in which its core principles—patient monitoring, complication tracking, transparency, continuous improvement, and accountability—are compared with their modern equivalents, such as outcome indicators, national registries, public reporting systems, quality improvement (QI) methodologies, and health information systems. The paper concludes that Codman’s work represents both the biographical story of a persistent reformer and a conceptual foundation for modern quality measurement systems in healthcare.
AORTIC AND SUPERIOR MESENTERIC ARTERY THROMBOSIS IN ANTITHROMBIN III DEFICIENCY-DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN CONSERVATIVE MANAGEMENT
Introduction: Thrombosis of large arterial vessels, such as the abdominal aorta and superior mesenteric artery, is a rare but serious condition that requires timely diagnosis and appropriate management. One of the risk factors is antithrombin III (AT III) deficiency, a rare coagulation disorder that increases the likelihood of thrombosis. While arterial thromboses are less common than venous ones, they can have significant clinical consequences. Case report: We present the case of a 39-year-old woman hospitalized due to sudden abdominal pain. Diagnostic imaging, including a contrast-enhanced CT scan of the abdomen and pelvis and CT angiography, revealed thrombosis of the distal abdominal aorta and superior mesenteric artery. Laboratory testing confirmed low AT III levels, while tests for hereditary thrombophilias were negative, suggesting a likely acquired deficiency. The patient was treated conservatively with AT III concentrate, low-molecular-weight heparin, and oral anticoagulation, alongside regular INR monitoring. Therapy was complemented with cardioprotective and gastroprotective medications, as well as physical rehabilitation. During hospitalization, the patient remained hemodynamically stable, and symptoms gradually resolved. Follow-up imaging after several months demonstrated complete recanalization of the affected vessels. Long-term monitoring over two years confirmed stable clinical status and absence of recurrent thrombosis. Conclusion: This case highlights the importance of early diagnosis, identification of the underlying cause, and carefully implemented conservative management in patients with AT III deficiency. It demonstrates that even in extensive arterial thrombosis, conservative management can preserve organ function and achieve a favorable outcome without the need for surgical intervention.
AVULSION FRACTURES OF THE ANTERIOR ILIAC SPINE IN CHILDREN AND ADOLESCENTS: CLINICAL OUTCOMES OF NON-OPERATIVE TREATMENT
Objective: Avulsion fractures of the anterior iliac spine are injuries typically seen in physically active children and adolescents. There is no clear consensus regarding the optimal treatment, particularly concerning the degree of fragment displacement that warrants surgical intervention. Aim: The aim of this study was to analyze the clinical outcomes of non-operative treatment of pelvic avulsion fractures in adolescents and to examine the relationship between patient age and rehabilitation duration. Patients and Methods: A retrospective study was conducted on 12 adolescent patients with radiographically confirmed pelvic avulsion fractures. Data on age, fracture location, injury mechanism, treatment, and rehabilitation duration were collected and analyzed. All patients underwent non-operative management consisting of rest, analgesics, and crutch-assisted ambulation, followed by physical therapy. Results: All patients were male, with a mean age of 12 years. The most common fracture site was the anterior inferior iliac spine (66.6%). All fractures healed without complications. Rehabilitation duration tended to be shorter in younger patients. Functional outcomes were excellent, with all patients returning to their pre-injury activity levels. Conclusion: Non-operative treatment is an effective and safe approach for managing pelvic avulsion fractures in adolescents, even in cases with fragment displacement up to 15 mm. It provides excellent functional recovery without complications, supporting its use as the first-line treatment in this population.
EVALUATION OF HEMODYNAMIC AND BIOMARKER CHANGES IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT
Background: Aortic stenosis (AS) is a systemic disease characterized by valvular obstruction, ventricular remodeling, and perioperative vulnerability to oxygen supply–demand imbalance. This study evaluated perioperative metabolic and biomarker dynamics and early postoperative outcomes in patients undergoing surgical aortic valve replacement (AVR). Patients and Methods: A prospective observational study was conducted on 60 consecutive adults with severe AS who underwent surgical AVR at a single center. Demographics, anthropometric data, intraoperative variables, complications, and pre- and postoperative hemodynamic and laboratory parameters were evaluated. Postoperatively, the following were assessed at 6 and 24 hours: mean arterial pressure (MAP), arterial oxygen saturation (SaO₂), partial pressure of oxygen (PaO₂), pH, partial pressure of carbon dioxide (PaCO₂), hemoglobin (Hb), lactate, and creatine kinase–MB isoenzyme (CK-MB). Continuous data are presented as mean ± standard deviation (SD) or median (interquartile range, IQR). Paired t-tests were used to compare values between 6 and 24 hours. Results: The mean age was 69.9 ± 7.3 years; 58.3% were male. Mean anesthesia and operation times were 151.5 ± 21.8 and 126.8 ± 20.6 minutes, respectively; mean cardiopulmonary bypass (CPB) and cross-clamp times were 78.3 ± 17.6 and 58.5 ± 16.7 minutes. Nearly half of the patients (46.7%) had no postoperative complications; others experienced bleeding (16.7%), arrhythmias requiring therapy (6.7%), permanent pacemaker implantation (8.3%), re-exploration (6.7%), infection (8.3%), respiratory failure (3.3%), or renal failure (3.3%). From 6 to 24 hours postoperatively, lactate decreased (2.34 ± 0.96 →1.87 ± 0.98 mmol/L; p = 0.006) and CK-MB declined (52.5 ± 34.2 →39.0 ± 30.8 U/L; p = 0.001), while Hb increased (103.5 ± 10.1 →120.1 ± 22.9 g/L; p < 0.001). pH decreased modestly (7.396 ± 0.057 →7.365 ± 0.065; p = 0.015). MAP, SaO₂, PaO₂, and PaCO₂ showed no significant changes. The median hospital stay was 7 days (IQR 6–8). Conclusions: In patients undergoing surgical AVR for AS, early postoperative trends demonstrated an improving metabolic profile (lower lactate) and biomarker normalization (CK-MB) with stable oxygenation, alongside low-to-moderate complication rates and a consistent 7-day median stay. Integrating perioperative oxygen-balance markers and cardiac biomarkers with imaging and left ventricular hypertrophy (LVH) assessment may refine timing and risk stratification for intervention. Prospective studies with standardized imaging and longer follow-up are warranted to link early metabolic recovery with ventricular remodeling and clinical outcomes.
RISK FACTOR STRATIFICATION AND EARLY DETECTION OF INCISIONAL HERNIAS AFTER CESAREAN AND OPEN GYNECOLOGIC PROCEDURES: A PROSPECTIVE OBSERVATIONAL STUDY
Background: Incisional hernia is a major complication of abdominal surgery, leading to pain, functional impairment, and increased healthcare costs. This study aimed to identify and rank risk factors for incisional hernia in patients undergoing Cesarean section or open gynecologic surgery, and to evaluate strategies for early detection. Methods: From January 2023 to June 2025, a prospective observational study enrolled 200 women, each followed for 12 months. Half of the women underwent Cesarean section (n=100) and the other half underwent open gynecologic surgery (n=100). Data were collected on patient demographics, body mass index, comorbidities, surgical details, and complications. The primary outcome was the incidence of incisional hernia within one year, assessed by clinical examinations at 6 weeks, 6 months, and 12 months. Results: The overall incidence of incisional hernia was 8.0% (16/200), with 6.0% (6/100) after Cesarean section and 10.0% (10/100) after open gynecologic procedures. Multivariable analysis identified independent risk factors: higher body mass index (adjusted odds ratio 1.12 per unit, 95% confidence interval 1.05–1.19, p<0.001), vertical incision (odds ratio 4.10, 95% CI 1.75–9.60, p=0.001), postoperative wound infection (odds ratio 5.22, 95% CI 2.15–12.67, p<0.001), and history of two or more prior Cesarean sections (odds ratio 3.85, 95% CI 1.42–10.45, p=0.008). Continuous fascial closure was protective (odds ratio 0.42, 95% CI 0.20–0.88, p=0.022). Early patient-reported symptoms preceding diagnosis included a palpable bulge (75%), persistent pain (62.5%), and discomfort during activity (50%). Conclusion: Higher body mass index, vertical incisions, wound infection, and multiple prior Cesarean sections are significant risk factors for incisional hernia. Using transverse incisions and continuous fascial closure, when possible, together with vigilant wound care and patient education on self-examination for early symptoms, can help reduce risk and enable early detection in high-risk patients.
REASSESING RIBONUCLEIC ACID ISOLATION FROM HUMAN MONONUCLEAR CELL CULTURE WITH MAGNETIC BEADS PRE-ENRICHMENT FOR MOLECULAR ANALYSIS
Dear Editor, It is with considerable interest that I have perused the recently published contribution by Bhatia, entitled “Ribonucleic Acid Isolation from Human Mononuclear Cell Culture with Magnetic Beads Pre-enrichment for Molecular Analysis,” set forth within Sanamed, volume 19(1). The author addresses a conundrum of pronounced import for those engaged in molecular analyses and the development of immunotherapies. As such, the established difficulty of extracting ribonucleic acid (RNA), particularly from mononuclear cell (MNC) cultures exceeding a few months in age, is well documented within the author’s own laboratory experience, having persisted, as stated, for over two years of consistent failure. The developed methodology, centered upon the pre-enrichment of the cultured MNCs utilizing Cluster of Differentiation 45 (CD45)-specific magnetic beads antecedent to the customary mini column isolation, proves efficacious where previous attempts faltered. The successful isolation of RNA from cultures exceeding six months in duration—confirmed through spectrophotometric yield measurements and subsequent conventional and real-time Polymerase Chain Reaction (PCR) assays for the beta-actin housekeeping gene—is indeed a notable technical advancement. The assertion that this study constitutes the inaugural demonstration of isolating RNA from aged human MNC cultures via specific magnetic beads is, moreover, a claim that warrants careful consideration. Notwithstanding the demonstrated success of this technique, one might cast an inquiring gaze upon certain aspects of the execution and presentation. Firstly, the affiliation of the esteemed author with Genekam Biotechnology AG, which entity serves as the sole source for the crucial magnetic beads, the mini column isolation kit, the PCR kits, and the specialized magnetic rack, invites circumspection. Whilst proprietary methods often feature in novel protocols, the near-total reliance upon reagents and apparatus supplied by the author’s own commercial interest renders the protocol less immediately accessible or generalizable for laboratories not possessed of the aforementioned instruments and supplies. The efficacy of the method, therefore, appears for the present to be closely associated with this particular commercial supply chain. Secondly, whilst the author reports that the initial method failed consistently over two years, and that isolation without magnetic beads was not achieved, the results presented lack detailed quantitative metrics comparing the failed isolations to the successes. The presentation of “failure” in Table 1 illustrates the necessity of the pre-enrichment step, yet does not afford the readership an optimal means to gauge the precise extent of nucleic acid degradation or inhibition encountered previously—data which would further illuminate the magnitude of the technical challenge overcome. Finally, the discussion alludes to further consequential applications of the isolated RNA—namely, its conversion to complementary DNA (cDNA) and subsequent use for other purposes—yet these vital data are deferred for “future publications.” Herewith, a more comprehensive elucidation of the robustness of the isolated material might have been advantageously reserved for this singular publication, ensuring that the full scope of the methodology’s utility is presented forthwith (1). In essence, whilst the developed magnetic bead pre-enrichment methodology provides a much-needed solution for obtaining RNA from refractory MNC cultures, it is sincerely hoped that future work will include more extensive comparative data and endeavor to ascertain the protocol's viability utilizing reagents sourced from diverse suppliers, thereby further affirming its widespread applicability in molecular diagnostics and therapeutic development. This issue merits further investigation. We thank Bhatia et al. (1) for their valuable study on RNA isolation from human MNC culture with molecular analysis.
THE ROLE OF THE MUCINOUS COMPONENT AS AN INDEPENDENT PREDICTIVE FACTOR IN COLORECTAL ADENOCARCINOMA THERAPY-THE POTENTIAL OF ARTIFICIAL INTELLIGENCE AS AN ADJUNCT TOOL TO IMPROVE TREATMENT OUTCOMES
Mucinous adenocarcinoma of the colon (MAC) is a distinct histological subtype of colorectal cancer (CRC), defined by the presence of ≥50% extracellular mucin. This CRC subtype exhibits unique clinical and molecular characteristics, including more frequent localization in the right colon, higher prevalence among younger patients, and associations with microsatellite instability-high (MSI-H) and BRAF gene mutations. Evidence suggests that MAC demonstrates a poorer response to conventional therapies; however, the independent prognostic value of the mucinous component remains unclear. This narrative review aims to evaluate the prognostic significance of the mucinous component in CRC. Twenty relevant studies published between 2018 and 2025 were analyzed. Results indicate that MAC is more often detected at advanced stages and shows a weaker response to fluorouracil-based regimens and neoadjuvant chemoradiotherapy in rectal tumors. Nonetheless, several studies reported no significant difference in overall survival between mucinous and non-mucinous carcinomas. Additionally, immune-related factors such as tumor-infiltrating lymphocytes (TILs) and desmoplasia are gaining importance and may have greater prognostic value than mucinous differentiation itself. MAC also frequently exhibits marked molecular heterogeneity, complicating prognosis and treatment decisions. Consequently, careful patient monitoring and timely molecular profiling are essential for optimizing therapy. Novel artificial intelligence–based models that integrate histological images, molecular biomarkers, and clinical data show promise for personalizing treatment in MAC. In conclusion, although MAC is currently treated according to standard CRC guidelines, its distinct features underscore the need for individualized therapeutic approaches and further clinical research.
DIABETES MELLITUS TYPE 2 - THE IMPORTANCE OF HEALTH EDUCATION OF PATIENTS: A REVIEW
Diabetes mellitus (DM) represents a significant public health problem, and Type 2 Diabetes Mellitus (DM2) is the most common form of this disease, accounting for about 90% of all DM cases worldwide. The prevalence of DM2 has reached pandemic proportions, especially in developed countries. Studies have shown that a low level of health literacy among patients with DM2 can be a significant predictor of premature death, disability, and increased healthcare costs. It is important to emphasize patient education to reduce mortality and improve the quality of life for DM2 patients. This review is based on a search of scientific literature, focusing on original research articles and meta-analyses found in scientific databases such as PubMed, SCOPUS, MEDLINE, and SCI Index, all published within the last ten years. The search focused on topics related to the public health issue of DM2 and the health literacy of affected individuals. Key terms used in the search included diabetes mellitus, Type 2 diabetes mellitus, prevention, health education, public health, risk factors, and others. Studies have shown that a low level of health literacy among DM2 patients can significantly increase the risk of premature death and disability, as well as healthcare costs. It is crucial to emphasize patient education to reduce mortality and improve the quality of life for DM2 patients.
FACIAL NERVE PARALYSIS AS A COMPLICATION OF ACUTE OTITIS MEDIA IN CHILDREN: A CASE REPORT AND LITERATURE REVIEW
Introduction: The facial nerve controls facial expression, and its dysfunction causes facial asymmetry and reduced mimic function. Facial nerve paralysis is significantly less common in children compared to adults. Children under the age of 10 are estimated to have an incidence rate of approximately 3 per 100,000 per year. The leading cause of facial paralysis in the pediatric population is idiopathic (Bell’s palsy), similar to that in adults. In cases where the cause is not idiopathic, infections accompanied by trauma and congenital anomalies are the most frequent etiological factors of facial nerve paralysis in children. This condition is most often attributed to nerve edema and subsequent compression within the bony fallopian canal. Case Report: This report presents a case of peripheral facial nerve paralysis as an extracranial complication of acute otitis media in a 2-year-old child. It also includes a literature review focusing on recent diagnostic protocols, evaluation, and therapeutic approaches. Conclusion: As demonstrated in our case, the prognosis for facial nerve paralysis associated with acute otitis media (AOM) was generally good after appropriate therapy. Recovery from facial paralysis usually occurs within three months. This report delineates a rare complication of AOM in children. Timely recognition and appropriate therapy are crucial to achieve good outcomes.
A CHALLENGING “SILENT DEPTH” CLINICAL SCENARIO IN NORTH MACEDONIA: UNMASKING A RARE CASE OF AMELANOTIC MELANOMA WITH TRAPEZIUS MUSCLE INVASION AND METASTATIC DISEASE
Introduction: Amelanotic melanoma is a subtype of melanoma that exhibits little or no pigment on visual or histological examination. Approximately 1–8% of all melanomas are amelanotic. It can mimic various benign or malignant melanocytic and non-melanocytic skin tumors, thereby presenting a significant diagnostic challenge. Primary amelanotic melanoma with muscle involvement is an extremely rare entity. A review of the literature revealed no series or case reports. Case Report: We present the case of a 62-year-old female patient with primary amelanotic melanoma infiltrating the trapezius muscle. The tumor was excised together with a clinically positive lymph node on the right side of the neck. Computed tomography (CT) angiography of the lungs, abdomen, and pelvis demonstrated bilateral diffuse nodular changes, a mediastinal pretracheal lymph node, and multiple diffuse liver lesions, consistent with secondary deposits. Molecular pathology revealed positivity for the BRAF V600E2/K/R/D mutation, and the patient began first-line targeted therapy with BRAF/MEK inhibition in accordance with protocols for BRAF-positive metastatic melanoma. Three months later, a follow-up CT scan demonstrated complete remission of the previously observed metastatic changes. Conclusion: Primary amelanotic melanoma with muscle involvement is exceptionally rare, with no published series or case reports identified. This case highlights the importance of early detection and treatment in suspected melanoma and underscores the need to consider melanoma in all clinically unclear cases.
DEPRESSION IN PATIENTS WITH AND WITHOUT POST-STROKE EPILEPSY
Introduction: Depression is the most common neuropsychological complication of stroke. It affects quality of life, prolongs hospitalization, and leads to more frequent doctor visits. The incidence of depression after stroke ranges from 18% to 33%. About 6–15% of patients develop epilepsy following stroke. Patients with post-stroke epilepsy tend to experience depression more frequently. Objective: The aim of this study was to compare the incidence of depression during the first year after stroke in patients who developed epilepsy versus those who did not. Patients and Method: We tested patients during the first year after stroke, treated at the Department of Neurology, General Hospital Nikšić, Montenegro. Two groups of 60 patients each were assessed: one group with post-stroke epilepsy and the other without epilepsy. Depression was measured using the Hamilton Depression Scale. Statistical analysis included mean values, t-test, and Chi-square test (χ²). A significance level of p < 0.05 was used for all tests. Results: The incidence of depression after stroke was high among our patients. Depression prevalence in the post-stroke epilepsy group was 55%, while it was 26.7% in the group without epilepsy. Conclusion: Patients with epilepsy have almost twice the incidence of depression compared to those without epilepsy after stroke (p < 0.05). These patients require special monitoring and more frequent follow-ups. Early detection of epilepsy and timely initiation of treatment with appropriate antiepileptic drugs, along with early management of depression, are important to prevent suicide and mortality and to improve quality of life.
CLINICAL UTILITY OF RETICULOCYTE INDICES IN THE DIAGNOSIS AND MANAGEMENT OF PAEDIATRIC SICKLE CELL DISEASE PATIENTS IN PORT HARCOURT, NIGERIA
Introduction:Sickle cell anemia (SCA) is a hereditary blood disorder resulting from a point mutation in the β-globin gene, leading to the production of abnormal hemoglobin S that distorts red blood cell morphology and impairs their function. Reticulocyte indices, which measure immature red blood cells in circulation, are key indicators of bone marrow response and erythropoietic activity in SCA patients. Materials and Methods: This cross-sectional study examined reticulocyte indices in individuals with sickle cell anemia. It involved 45 children aged 2 to 19 at the Rivers State University Teaching Hospital. Blood samples were collected from each patient and placed in EDTA bottles. Reticulocyte counts were performed using the New Methylene Blue staining method and counted under a light microscope. Hemoglobin (Hb) and packed cell volume (PCV) were measured with a Veri-Q RED Hemoglobin meter. Reticulocyte indices, including absolute reticulocyte count (ARC), reticulocyte index (RI), and reticulocyte production index (RPI), were calculated using MDCalc. Results: The mean reticulocyte count was 1.33 ± 0.22%, while the mean reticulocyte production index was 0.40 ± 0.09. Reticulocyte production index (RPI) showed a positive and significant correlation with Hb and PCV in both crisis and steady states (r = 0.820, p = 0.02). Additionally, RPI and RC were significantly correlated in patients on and off hydroxyurea (p < 0.01). Only 2 (4.4%) SCA patients demonstrated appropriate bone marrow response, while the remaining 43 (95.6%) SCA patients were hypoproliferative. Conclusion: This study found derangements in the reticulocyte parameters indicating hypoproliferative anaemia. There is a need to monitor the patients closely by periodic reticulocyte counts for overall improved patient outcomes and quality of life in SCA patients.
IMPACT OF MATERNAL ANAEMIA ON NEONATAL OUTCOMES: A SINGLE-CENTRE EXPERIENCE
Background: Maternal anaemia is one of the most common complications of pregnancy and is associated with adverse outcomes such as preterm delivery, impaired fetal development, and increased risks of morbidity and mortality in the perinatal period. The high prevalence of anaemia in pregnancy and its impact on fetal development represents a significant public health issue. The aim of this study was to analyze the influence of maternal anaemia on neonatal outcomes. Patients and Methods: In a two-year prospective study conducted at the Clinic of Gynecology and Obstetrics and the Clinic of Children's Diseases of the University Clinical Center Tuzla, 177 newborns and their mothers were analyzed—127 in the experimental group (mothers with anaemia) and 50 in the control group (without anaemia). Sociodemographic and clinical data of the mothers and newborns were collected. Data were processed using conventional statistical techniques. Ethical approval was obtained from the relevant institutional review board. Results: Of the 120 (70.58%) mothers with anaemia included in the study, 106 (88.3%) were between 18 and <35 years of age. Working mothers had lower odds of anaemia (p = 0.025), while mothers who did not use supplements during pregnancy had higher odds (p = 0.001). Maternal anaemia was significantly associated with smoking or tobacco use (p = 0.015). Mothers living outside of marriage were more likely to be anaemic. A higher percentage of vaginal bleeding (p = 0.0001), uncontrolled pregnancies (p = 0.011), and caesarean section as the mode of delivery (p = 0.000) were recorded among anaemic mothers. Babies born to anaemic mothers had lower birth weight compared to those born to non-anaemic mothers (p = 0.004). Maternal anaemia significantly affected gestational age (p = 0.024) and Apgar scores in the 1st (p = 0.006) and 5th minutes (p = 0.0031). In this study, maternal anaemia during pregnancy had a statistically significant impact on perinatal outcomes including perinatal asphyxia, respiratory distress syndrome, neonatal infections, icterus neonatorum, intracranial hemorrhage, and hypoxic-ischemic encephalopathy. Conclusion: In developing countries, current strategies for the prevention of anaemia in pregnancy have had limited success. Programs for careful monitoring and management of anaemia during pregnancy need to be developed in order to prevent poor perinatal outcomes.
EARLY DETECTION OF TRAUMA PATIENTS REQUIRING INTENSIVE CARE IN THE EMERGENCY DEPARTMENT: A NEXT-GENERATION RISK SCORE MODEL
Background: Trauma remains a leading cause of death worldwide; therefore, it is important to identify patients who need intensive care unit (ICU) admission in the emergency department (ED). Current trauma scoring systems such as the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) are not very efficient at predicting ICU need. The application of machine learning (ML)-based predictive models is a novel approach to enhance the triage process. Objective: The primary objective of this study was to develop and validate a risk scoring model based on machine learning for early identification of trauma patients requiring ICU admission from the emergency department. The study also aimed to assess the predictive ability of the ML model compared to traditional scoring systems such as the GCS, RTS, and ISS. Methods: A retrospective, observational cohort study was conducted at Esenyurt Necmi Kadıoğlu State Hospital, collecting trauma patient data from January 1, 2024, to August 31, 2024. A total of 1,500 trauma patients aged ≥18 years with complete clinical, laboratory, and imaging data were included. Predictive variables consisted of demographics, trauma mechanism, vital signs, laboratory results, imaging findings, and existing trauma scores. The area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were used to train and evaluate ML algorithms (Logistic Regression, Random Forest, Support Vector Machines, XGBoost, and LightGBM). The model was compared to traditional scoring systems using the DeLong test. Results: Of the 1,500 patients, 50.73% (n=761) required ICU admission. The developed ML model had an AUC of 0.999, with sensitivity of 99.22%, specificity of 99.69%, and accuracy of 99.56%, far outperforming traditional scoring systems. The strongest predictors of ICU admission were age, lactate level, RTS, systolic blood pressure, respiratory rate, and oxygen saturation. No significant difference in ICU admission rates was observed between blunt and penetrating trauma groups, indicating that trauma mechanism alone should not be used as a predictor. Conclusion: The machine learning-based risk scoring model demonstrated better predictive performance than traditional trauma scoring systems in identifying trauma patients requiring ICU admission. Integration of this model into ED workflows may improve triage and patient care. However, validation in multicenter prospective studies is needed before clinical implementation.
CARDIOLOGICAL DIAGNOSTIC APPROACH TO CHILDREN WITH CONSCIOUSNESS DISORDERS
Introduction:Syncope is one of the most common reasons for seeking medical attention in the pediatric population. The underlying etiology ranges from benign causes to potentially life-threatening conditions. Objective:This cross-sectional retrospective study aimed to cardiologically evaluate children presenting with syncope and identify potential predictive parameters for cardiogenic syncope, the most dangerous type of syncope. Patients and Methods: Data from 100 children aged 6 to 18 years who presented with syncope were retrospectively collected from medical records at the Pediatric Clinic of the Clinical Center of the University of Sarajevo between January 1, 2021, and December 31, 2022. Binary logistic regression was used to examine the predictive significance of the studied parameters. Results: Of the 100 children with documented syncope, 71.0% were girls, with the peak incidence of syncope episodes occurring at age 15. There were no statistically significant differences in height, weight, or BMI between boys and girls. The most common cardiac diagnosis was sinus arrhythmia, while headache was the most frequent non-cardiac symptom. Seventy-three percent of patients experienced more than one syncope episode, with the highest percentage occurring at school. Prodromal symptoms were present in 87% of cases, whereas palpitations and chest pain prior to syncope were reported in 10% and 12% of cases, respectively. Among the 49 patients with abnormal ECG findings, 29% had sinus arrhythmia and 25% had incomplete right bundle branch block. The most common echocardiographic finding was mild pulmonary valve regurgitation, which is considered a normal variant. Of all studied parameters, only EEG demonstrated significant predictive value for cardiogenic syncope (p = 0.035, EXP(B) = 2.99). Conclusion:EEG findings have predictive significance for cardiogenic syncope in children. A borderline EEG increases the odds of cardiogenic syncope by approximately threefold.
REVISITING A COMPARATIVE STUDY OF MELATONIN WITH PLACEBO IN ATTENUATION OF HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION
No abstract available
ARE WE TRAINING MEDICAL STUDENTS TO MANAGE AUTONOMIC DYSREFLEXIA IN SPINAL CORD INJURY? A STUDY
Background: Autonomic dysreflexia (AD) is a potentially life-threatening complication of spinal cord injury (SCI), characterized by sudden, paroxysmal episodes of hypertension. Healthcare professionals and family members caring for individuals with SCI must be able to recognize and manage AD promptly and appropriately. This study aimed to assess the level of knowledge about AD among final-year medical students, evaluate their preparedness to manage AD, and highlight the importance of educating families of SCI patients on its recognition and management. Methods: A questionnaire-based, descriptive cross-sectional study was conducted among final-year (MD-4) medical students at the College of Medicine, Qassim University. Data were collected, cleaned, and analyzed using Microsoft Excel 2021. Students were then categorized into three groups based on their knowledge level: poor, fair, and good. Results: Significant gaps were identified in students’ knowledge of AD. Out of 68 students initially surveyed, 24 (35.3%) had not heard of AD and were excluded. Among the 44 participants included in the final analysis, scores ranged from 4 to 12 out of a maximum of 21, with a mean score of 7.02 (33.4%). A total of 27 students (61%) were classified as having poor knowledge, and 17 (39%) as fair. None of the students qualified for the “good” knowledge category. Conclusions: The findings underscore the need for incorporating autonomic dysreflexia into the undergraduate medical curriculum. Early education would ensure that medical graduates are better prepared to manage AD and can help prevent complications by educating patients’ families.
COMPARATIVE ANALYSIS OF SURGICAL OUTCOMES IN AO-OTA 31-A2 FRACTURES: TWO-HOLE VS. FOUR-HOLE DYNAMIC HIP SCREW
Background: The choice of implant for the treatment of multifragmentary pertrochanteric fractures AO-OTA 31-A2 is complex, and the dynamic hip screw (DHS) can be used as a biomechanically safe and cost-effective option. Surgeons typically choose between DHS plates with two or four holes. The primary aim of this study was to determine whether there is a difference in surgery time, hospital stay, intraoperative blood loss, and incision length in patients with AO-OTA 31-A2 fractures treated with two-hole or four-hole DHS. The secondary aim was to compare the rate of complications, including fracture nonunion, implant breakage (DHS plate, sliding screw, compression screw, or cortical screws), cut-out, fracture collapse, and avascular necrosis. Methods: This retrospective study included 94 patients with AO-OTA 31-A2 fractures treated with DHS implants containing either two or four holes. Patients were divided into two groups: Group A, which included 60 patients treated with a two-hole DHS plate, and Group B, which included 34 patients treated with a four-hole DHS plate. Results: Group A had a significantly shorter surgery time (44.80± 8.01 minutes) compared to Group B (48.12 ± 5.43 minutes; p<0.05). Group A also had a significantly smaller incision (p<0.05). There were no significant differences between the two groups in terms of the remaining outcomes. Conclusion: The absence of significant differences in complication rates supports the conclusion that both DHS types are viable options for the treatment of AO-OTA 31-A2 fractures.