Acta Medica Academica

Difficulties in Accessing the List and Full Text of the Defended PhD Theses from Medical Schools: a Retrospective Case Study from Croatia

Tue, 09 Apr 2024 00:00:00 +0000

Objective. To conduct scientometric studies on PhD (“Doctor of Philosophy”) theses (i.e., doctoral theses), researchers should be able to access the theses. We aimed to explore how to obtain a list and full text of the defended PhD theses from medical schools in Croatia over 30 years (from the beginning of 1992 to the end of 2021).

Methods. We tried to obtain information from the Croa- tian Bureau of Statistics, the National and University Library in Zagreb (NSK), universities, medical schools and online reposito- ries.

Results. We could not find a single list (source) of all PhD theses. Based on 4 different sources (website of the University of Zagreb and Medical School in Rijeka; school administrator from Split; library catalog from Osijek), we gathered information that from the beginning of 1992 to the end of 2021, there were 2955 PhD theses defended at medical schools in Croatia – 357 in Osijek, 550 in Rijeka, 337 in Split and 1711 in Zagreb. In May 2022, the online Croatian Digital Dissertations Repository contained 631 (22%) of full-text theses in Portable Document Format (PDF). University of Zagreb School of Medicine has its own repository that holds the full text of 834 (49%) of their PhD theses. One of the three PhD programs of the University of Split School of Medicine, namely Translational Research in Biomedicine (TRIBE), published full texts of all PhD theses defended at that program on its website. NSK held 2650 (90%) of the theses in a printed version.

Conclusion. It was extremely challenging to access the list and full texts of doctoral theses defended in Croatia. Making PhD theses publicly available would ensure transparency and enable analyses that should improve scientific policy.

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis

Tue, 30 Apr 2024 00:00:00 +0000

Objective. To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective.

Materials and Methods. After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups accord- ing to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables.

Results. According to the variability of two parameters, Stroke Volume Variation and Pulse Pressure Variation, patients were classified as stable or unstable. Unstable patients showed a significant alteration in several hemodynamic indices, in comparison to stable ones. According to the intraoperative monitoring, eight high risk patients could have been sent to an ordinary ward due to their stability, with a reduction in the improper use of CSDU and, consequently, in costs.

Conclusions. Hemodynamic monitoring with PRAM can be useful in these patients, both for intraoperative management and for the choice of the more appropriate postoperative setting, possibly reducing the improper use of CSDU for hemodynami- cally stable patients who are judged to be at high risk preoperatively, and re-evaluating low surgical risk patients with an unstable intraoperative pattern, with a possible reduction in costs.

Autonomic Dysfunction in Amyotrophic Lateral Sclerosis – A Case-Control Study

Tue, 30 Apr 2024 00:00:00 +0000

Introduction. This study aimed to explore autonomic nervous system involvement in amyotrophic lateral sclerosis (ALS) pa- tients by evaluating sympathetic skin response (SSR).

Materials and Methods. The study included 35 sporadic (ALS) patients (cases), and 35 healthy age and sex-matched participants (controls) aged <60 years. SSR was recorded in the electrophysiology lab of the Neurology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients with diseases associated with peripheral or autonomic neuropathy were excluded. Prolonged latency (delayed SSR) or an ab- sent response was considered abnormal SSR.

Results. SSR was found to be abnormal in 17 (48.6 %) ALS cases, with an absent response in the upper limbs of six cases (17.1%). Abnormal SSR was more prevalent in the lower limbs, with 33 (94.3%) and 20 (57.1%) cases having a delayed or absent response, respectively. In comparison, SSR was normal in all control participants (P-value <0.05). Abnormal SSR was significantly more common in the lower limbs of ALS cases with bulbar palsy than those without bulbar palsy (P-value=0.04). There was no association of SSR with disease severity and duration.

Conclusion. ALS is significantly associated with abnormal SSR, indicating autonomic nervous system involvement. There could also be an associa- tion between bulbar palsy and abnormal SSR among ALS patients. Further studies should be carried out to determine the as- sociation of abnormal SSR with disease severity, duration, and type.

Prejudice and Fear as Influences in Relation to a Successful Organ Donation – Experiences of Immigrants Living in Sweden

Tue, 30 Apr 2024 00:00:00 +0000

Objectives. The purpose of this study was to determine whether fear and prejudice in relation to organ donation and the transplantation of organs may influence the decision to become an organ donor.

Materials and Methods. Data were collected through four group interviews using open-ended questions and qualitative content analysis. Forty participants, 16 males and 24 females from seven countries, participated in the focus group interviews.

Results. The analysis resulted in three main categories, and nine subcategories. Fears and prejudice caused by tradition and customs, approval of organ donation by family members, perception of the body as a gift from parents, the influence of religious leaders, knowledge about the religious understanding of organ donation, influence of social ambience on respondents, knowledge of the donation process in the healthcare system, including knowing about life after eventual organ donation, were some of predictors in the decision to agree to organ donation.

Conclusion. More education on the factors that influence organ donation, more information in schools, health institutions and through the media, as well as more research with the aim of “dispelling” fears and prejudice about organ donation would significantly improve the current situation and result in a larger number of potential organ donors.

An Efficacy and Safety Comparison of Regorafenib and Nivolumab in Unresectable Hepatocellular Cancer Patients: A Systematic Review

Darmadi Darmadi, Taufik Sungkar, Cennikon Pakpahan, Sem Samuel Surja — Tue, 30 Apr 2024 00:00:00 +0000

Objective. This systematic review aimed to compare the efficacy and safety of regorafenib and nivolumab, two FDA-approved second-line treatments for unresectable Hepatocellular Carcinoma (HCC).

Methods. Literature comparing the efficacy and safety of regorafenib and nivolumab in unresectable HCC patients was systematically searched across seven databases, including: PubMed, SCOPUS, Cochrane Database of Systematic Reviews, ScienceDirect, EBSCOhost, EMBASE, and ProQuest, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was done on April 2nd, 2023. Study quality and risk of bias were assessed using the Agency for Healthcare Research and Quality (AHRQ) and ROBINS-1 tools. The selected studies were included in the qualitative data synthesis.

Results. Three trials found that HCC patients taking nivolumab had statistically insignificantly longer OS, TTP, and progression-free survival than those on regorafenib. Nivolumab increased ORR, with largely partial responses, and mixed DCR, with little statistical significance. All three studies showed that nivolumab had fewer side effects and improved tolerance.

Discussion. Three retrospective cohort studies with a total of 383 regorafenib-receiving cohorts and 230 nivolumab-receiving cohorts were included in the qualitative analysis. Nivolumab was found to be superior in regards of longer overall survival, longer time to progression, higher objective response rate, and lower adverse event occurrence. However, statistical significance was not achieved in most of the parameters.

Conclusions. The use of nivolumab is preferable as the second-line systemic therapy for unresectable HCC. More high-quality studies are urgently needed to generate quantitative analysis, and to encourage the formation of guidelines for second-line systemic therapy.

Late Adverse Effects after Treatment for Childhood Acute Leukemia

Tue, 30 Apr 2024 00:00:00 +0000

The aim of this review is to raise awareness and knowledge among healthcare professionals and policymakers about late adverse effects in survivors of childhood leukemia. With contemporary treatment, over 90% of children with acute lymphoblastic leukemia (ALL) and over 60% with acute myeloid leukemia (AML) are cured. Large cohort studies demonstrate that 20% of ALL and most AML survivors have at least one chronic health condition by 20-25 years after diagnosis. These are life-changing or threatening in some survivors and contribute to increased premature mortality. We describe the frequency, causes, clinical features, and natural history of the most frequent and severe late adverse effects in childhood leukemia survivors, including subsequent malignant neoplasms, metabolic toxicity, gonadotoxicity and impaired fertility, endocrinopathy and growth disturbances, bone toxicity, central and peripheral neurotoxicity, cardiotoxicity, psychosocial late effects, accelerated ageing and late mortality. The wide range of late effects in survivors of haemopoietic stem cell transplant is highlighted. Recent developments informing the approach to long-term survivorship care are discussed, including electronic personalized patient-specific treatment summaries and care plans such as the Survivor Passport (SurPass), surveillance guidelines and models of care. The importance of ongoing vigilance is stressed given the increasing use of novel targeted drugs with limited experience of long-term outcomes.

Conclusion. It is vital to raise awareness of the existence and severity of late effects of childhood leukemia therapy among parents, patients, health professionals, and policymakers. Structured long-term surveillance recommendations are necessary to standardize follow-up care.

Establishment of a Unified Register of Donor Sexual Gametes in the Republic of Kazakhstan

Mon, 08 Apr 2024 00:00:00 +0000

Objective. The purpose of this narrative review paper was to review the state and development of the field of donor gametes in Kazakhstan, compare its legislative and technical capabilities with other countries and identify key steps towards the establishment of a unified register of donor gametes in the Republic.

Materials and Methods. The narrative review paper conducted an analysis of scientific publications and legal documents to examine the implementation of Assisted Reproductive Technologies (ART), focusing on Donor Sexual Gametes (DSG), globally. It utilized medical publications from 2019 to 2023, legal acts, and recommendations from global health organizations to analyze eligibility criteria, legal regulations, and the social aspects of ART across different regions.

Results. In Kazakhstan, ART is regulated by legislation, with DSG procedures governed by age limits, medical screening, and restrictions on the number of children born from donated gametes. Worldwide, practices vary, but there is growing interest in establishing a unified register of reproductive donor material to enhance transparency and accountability. However, legal gaps and ethical considerations must be addressed.

Conclusion. The study identifies gaps in Kazakhstan’s legisla- tion compared to Western countries, emphasizing the necessity for enhanced legal rights for donors and recipients, including options for anonymity. Ethical concerns highlight the importance of confidentiality and data security in accessing the donor registry. Overall, implementing such a register promises to enhance transparency, safety, and accountability in reproductive medicine.

Spontaneous Bleeding in Vestibular Schwannoma in Patients on Oral Anticoagulant Therapy: Report of Two Cases and Review of Literature

Mirza Pojskić, Domagoj Gajski, Alisa Arnautović, Kenan I. Arnautović — Fri, 29 Dec 2023 00:00:00 +0000

Objective. Anticoagulant therapy is a risk factor for repeated intratumoral hemorrhage and acute enlargement of a vestibular schwannoma (VS) with neurological deficits. Therefore, we describe two cases of patients on oral anticoagulant therapy with intratumoral hemorrhage in which anticoagulant therapy prior to surgical resection was discontinued. We also discuss other similar cases from the literature since this is a rare event.

Case Reports. We described the two cases of intratumoral hemorrhage in acoustic neurinoma and conducted a literature review of similar cases of patients with intratumoral hemorrhage in acoustic neurinoma who were also on oral anticoagulants. Both patients presented with CN-VII palsy prior to surgery; both also fully re- covered after surgery except for hearing loss on the tumor side. Our literature review found 50 cases of VS (reported as vestibular schwannomas in the literature) with intratumoral hemorrhage. From this total, 11 patients used oral anticoagulant therapy with reported poor outcomes and high mortality; 9 of these 11 cases were reported in the past 20 years. The incidence is expected to rise due to increased use of anticoagulant therapy due to onset of atrial fibrillation, atherosclerosis, and thromboembolism from longer human lifespan.

Conclusion. Anticoagulant therapy represents a risk factor for intratumoral hemorrhage and acute enlargement of VS tumor mass with neurological deficits.

An X across the Chest: A Rare Case of a Criss-crossed Sternalis Muscle

Fri, 29 Dec 2023 00:00:00 +0000

Objective. The present case study aims at drawing attention to a very rare presentation of the sternalis muscle noticed during routine dissection, and is intended to highlight the clinical significance and usefulness of this unique muscle in reconstructive surgeries, especially of the breast.

Case Report. Though many morphological variants of the muscle have been reported, we came across a unique bilateral sternalis muscle during routine dissection for undergraduate medical teaching, in an 80-year-old male cadaver. The muscle originates on both sides from the external oblique aponeurosis from the fleshy belly, and after becom- ing tendinous, converges in the midline to form a common tendon at the level of the sternal angle, and then splits again into two tendons which become continuous with the ipsilateral sternocleidomastoid.

Conclusion. Notwithstanding the fact that the presence of a sternalis can be misdiagnosed as a wide range of anterior chest wall lesions and tumors, especially with misdiag- nosis of breast masses in routine mammograms, it has great use as a muscular flap for reconstructive surgeries of the anterior chest wall, head, neck and breast.

George Sclavunos (1869-1954): Anatomical Insights and his contribution into the “Magenstrasse of Waldeyer”

Mon, 11 Mar 2024 00:00:00 +0000

The purpose of this article is to present a well-known physician and highlight his contribution into an essential, but neglected anatomical feature. George Sclavunos (1869-1954) was a 20th century Greek physician, whose scientific work was a significant milestone in global medical knowledge. In 1899 he became Professor of Anatomy and Head Director of the Department of Anatomy. In 1906 Sclavunos G. published the first volume of the three volume book “Human Anatomy” (1906-1926), which is characterized by its unparalleled illustrations. For more than a century it was the most important book of medical literature in Greece. In 1926 he became a Full Member of the Academy of Athens and was named Life Partner of the International Anatomi- cal Society. His interests included Anatomy, Physiology, Histology, as well as Osteology and Syndesmology. In his book “Human Anatomy”, he described for first time the “Sialine Groove of the Stomach”, which was described by Waldeyer-Hartz almost at the same time as the “Magenstrasse”, a German word that means “stomach road”. It is a ribbon-like path that extends along the lesser curvature of the stomach from the gastric cardia to the antrum and releases the gastric content directly into the small intestine. Its importance is confirmed by its association not only with drug delivery, but also with anti-obesity surgical techniques. The old German term has come back into common medical usage in view of the commonly performed Magenstrasse and Mill pro- cedure, a form of bariatric surgery.

Conclusion: Sclavunos G. managed to observe an anatomical structure that has remained of great importance until today.

The Genesis of Multidisciplinary Health Professionals Teams for Pain Management. A History from the Hellenic Antiquity to Modern Palliative Medicine

Heleni Karassava, Loukas Agorgianitis, Evaggelos Mavrommatis — Tue, 30 Apr 2024 00:00:00 +0000

No abstract available.

Response to Letter to the Editor by Josef Finsterer, MD, PhD: “The More Intensive the Diagnostic Workup, the More Likely It Is That the Cause of Coccygodynia Can Be Clarified”

Spyridon P. Galanakos, Nikolaos D. Karakousis, George Bablekos, Sophia Fontara — Mon, 11 Mar 2024 00:00:00 +0000

No anstract available.