<p><strong>Introduction.</strong> Ruptured abdominal aortic aneurysm (RAAA) is a life-threatening emergency with high mortality. While conventional risk factors are well recognized, emerging evidence suggests environmental temperature may also influence rupture risk. This relationship has not been studied in Bosnia and Herzegovina. The aim of this study is to investigate the association between ambient temperature and RAAA incidence.</p> <p><strong>Methods:</strong> A retrospective observational study was conducted at the Clinical Center of the University of Sarajevo between January 2021 and February 2025. Data from 105 RAAA patients were analyzed using demographic, clinical, and temperature data, with time series analysis assessing patterns around rupture events.</p> <p><strong>Results:</strong> The mean patient age was 71.5 ± 7.6 years; 86.7% were male. The average aneurysm diameter was 85.1 ± 17.7 mm. Hypertension (68.6%), smoking (55.2%), and diabetes (37.7%) were the most prevalent comorbidities. The mortality rate was 38.7%. Most ruptures occurred during colder months, with a peak in January (16.1%) and a low in August, March, and February (each 4.7%). The mean ambient temperature during the 10 days before rupture was 11.41 ± 6.16 °C, not significantly different from the temperature on the rupture day (p = 0.991). However, minimum daily temperature was significantly lower than the mean daily temperature on rupture days (6.48 ± 5.92 °C vs. 11.42 ± 17.61 °C; p < 0.001).</p> <p><strong>Conclusion:</strong> A seasonal RAAA pattern with winter clustering was observed, but no consistent short-term link to ambient temperature was found, warranting further study with advanced models.</p>
Background/Objectives. Ebstein’s anomaly (EA), which accounts for fewer than 1% of congenital heart diseases, and atrioventricular canal defect (AVCD), present in approximately 4–5% of cases, exceptionally coexist, with this combination observed in fewer than 0.5% of patients with AVCD. We aim to report the oldest documented case of a 45-year-old female with the exceptionally rare combination of complete AVCD, EA, and right ventricular hypoplasia and to provide a concise review of these anomalies. Case presentation. Diagnosed in early childhood with a complete AVCD, pulmonary stenosis, and right ventricular (RV) hypoplasia, the patient underwent palliative surgical intervention with a modified Blalock–Taussig shunt at the age of 10 but did not receive subsequent regular follow-up. Over the ensuing 35 years, she remained largely untreated until presentation at 45 years of age with progressive exertional dyspnea, central cyanosis, and palpitations, corresponding to NYHA class III. Comprehensive multimodal imaging, including transthoracic echocardiography and cardiac magnetic resonance, revealed a complete AVCD with moderate-to-severe mitral regurgitation secondary to an anterior mitral leaflet cleft, severe tricuspid regurgitation, RV hypoplasia, and hallmark features of EA. Given the complex cardiac anatomy and the elevated surgical risk, the patient was considered inoperable, and a strategy of conservative management with multidisciplinary follow-up was implemented. Conclusions. This case highlights the exceptional longevity of a patient with the rare coexistence of complete AVCD, EA, and RV hypoplasia, surviving 45 years from diagnosis despite limited early intervention. It underscores the importance of lifelong follow-up in complex congenital heart disease and illustrates the role of multimodal imaging in assessing anatomy and guiding management when surgical options are high-risk or not feasible.
Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm2, and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA.
Background and Objectives: Resilience and perceived social support are crucial factors influencing psychological well-being among breast cancer survivors. Understanding their levels and interrelations can inform psychosocial interventions aimed at improving survivorship outcomes. This study aimed to examine the relationship between resilience and perceived social support, to evaluate the psychometric properties of the applied scales, and to explore their associations with key sociodemographic factors among breast cancer survivors. Materials and Methods: A total of 193 women in clinical remission, at least six months post-primary treatment, were recruited from the General Hospital Sombor. Participants completed sociodemographic and clinical questionnaires, the Connor–Davidson Resilience Scale (CD-RISC-25), and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, Pearson’s correlations, and group comparisons (t-tests and ANOVA) were conducted to assess the relationships among study variables and sociodemographic factors. Results: Participants demonstrated moderate resilience (57 ± 18), with Coping and Hardiness as the strongest domains and Optimism the lowest. Perceived social support was also moderate (4.65–4.82) across all domains, highest for family and significant others. Resilience and perceived social support were positively correlated (r = 0.616, p < 0.001), with Hardiness most strongly associated with overall resilience (r = 0.899). Support from a significant other was particularly linked to adaptability (r = 0.617). Participants living in urban areas and those with higher income reported significantly higher resilience and social support, though with low effect sizes. No other sociodemographic associations were observed. Conclusions: Breast cancer survivors in this Serbian cohort reported moderate resilience and social support, with a strong interrelationship between the two. These findings underscore the importance of strengthening social support networks as a potential pathway to enhance resilience and psychological well-being in cancer survivorship care.
Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary anomaly with an estimated incidence of 1 in 300,000 live births. While commonly diagnosed in infancy, adult presentations are exceedingly rare and pose significant diagnostic challenges. Delayed diagnosis may result in progressive myocardial ischemia, heart failure, arrhythmias, or sudden cardiac death. Surgical correction is the definitive treatment, with the goal of restoring a dual coronary artery system and preventing irreversible myocardial damage. We present the case of a 30-year-old male with a prior history of non–ST-elevation myocardial infarction who was referred for evaluation of exertional angina and symptoms of heart failure. Transthoracic echocardiography revealed a dilated left ventricle with an ejection fraction (LVEF) of 35%. Coronary angiography and cardiac MDCT identified an anomalous origin of the left circumflex artery (LCx) from the right pulmonary artery (RPA) and a coronary–pulmonary artery fistula involving the LAD. The patient underwent successful surgical correction with reimplantation of the LCx into the ascending aorta. Postoperative recovery was uneventful. At 3-month follow-up the patient was symptom-free, though echocardiography revealed persistent LV dilation and reduced LVEF, necessitating continued pharmacologic therapy and monitoring. This case highlights the importance of maintaining a high index of suspicion for ALCAPA in adult patients with unexplained cardiomyopathy or ischemic symptoms. Early diagnosis and surgical intervention remain crucial for improving long-term outcomes and preventing life-threatening complications.
The journal retracts the article titled "Resilience and Perceived Social Support in Cancer Survivors: Validity, Levels, and Sociodemographic Correlates of CD-RISC-25 and MSPSS Scales" [...].
Background and Objectives: Resilience and perceived social support are crucial factors influencing the psychological well-being among breast cancer survivors. Understanding their levels and interrelations can inform psychosocial interventions aimed at improving survivorship outcomes. This study aimed to examine the relationship between resilience and perceived social support, evaluate the psychometric properties, and explore their associations with key sociodemographic factors among breast cancer survivors. Materials and Methods: A total of 253 women in clinical remission, at least six months post-primary treatment, were recruited from the University Clinical Center of Vojvodina. Participants completed sociodemographic and clinical questionnaires, the Connor–Davidson Resilience Scale (CD-RISC-25), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Participants reported moderate levels of resilience (Mdn = 75, IQR = 19). Among resilience domains, Hardiness (Mdn = 22, IQR = 7) and Coping (Mdn = 14, IQR = 4) scored highest, while Optimism (Mdn = 6, IQR = 3) was the lowest. A significant positive correlation was found between resilience and fertility-related quality of life (ρ = 0.454, p < 0.01), while a negative correlation was observed between resilience and fertility-related stress (ρ = −0.275, p < 0.01). Adaptive coping strategies, particularly from the Practical Management Branch of the CIQ, were positively associated with resilience and quality of life, while avoidance coping was linked to higher stress and lower well-being. Conclusions: Breast cancer survivors in this Serbian cohort reported moderate resilience and social support, with a strong interrelationship between the two. These findings underscore the importance of strengthening social support networks as a potential pathway to enhance resilience and psychological well-being in cancer survivorship care.
BACKGROUND Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care. AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes. METHODS A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated. RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker. CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patient had a history of colon cancer and active tuberculosis, complicating the clinical management. He reported chest pain, shortness of breath, and palpitations, with atrial fibrillation observed on a 24 h Holter ECG. Coronary angiography revealed robust collateral circulation and a suspected anomalous origin of the right coronary artery, confirmed by CT imaging. The patient’s stress MRI showed mildly reduced left and right ventricular ejection fractions and perfusion deficits in the apical segments (2/17) of the septal and inferior walls. Given the patient’s comorbidities, including active tuberculosis, the Heart team decided on a non-operative management approach, focusing on careful monitoring and pharmacological management rather than immediate surgery. This case emphasizes the complexity of managing ARCAPA in the context of significant comorbidities, highlighting the importance of individualized, multidisciplinary treatment strategies. Early diagnosis using advanced imaging techniques is crucial, and a non-operative approach can be considered in patients with preserved left ventricular function and no significant ischemia, as demonstrated in this case.
Background/Objectives: Congenital heart disease (CHD), affecting approximately 1% of live births, has transitioned to a chronic condition due to advances in diagnostics and surgery, resulting in an increasing adult congenital heart disease (ACHD) population. This study characterizes the clinical and demographic profiles of ACHD patients in Serbia, focusing on congenital anomalies, mortality rates, and key clinical factors to identify opportunities for improving care and outcomes. Methods: This observational single-center study was conducted at the Cardiovascular Institute “Dedinje” in Belgrade, Serbia, involving patients diagnosed or treated for CHD between 2006 and 2022. Results: A total of 1532 patients were included in the study, with common diagnoses including atrial septal defects (ASD) (47.65%) and ventricular septal defects (VSD) (13.19%). The mean patient age was 48.31 years, with a slight predominance of females (57.21%). The complexity of CHD was categorized as mild (54.6%), moderate (36.5%), and severe (6.3%). The mortality rate was 4.2%, with higher rates observed in conditions like Ebstein anomaly (17.78%) and congenital aortic stenosis (11.76%). Conclusions: This study provides a comprehensive overview of the current state of ACHD management in Serbia, highlighting the high prevalence of ASD and VSD among patients, the challenges associated with moderate and severe CHD, and the notable mortality rates for certain conditions. The findings underscore the importance of improving early detection, individualized treatment plans, and multidisciplinary care to enhance patient outcomes in this growing population.
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