Background Non-ST-elevation myocardial infarction (NSTEMI) is frequently associated with systemic inflammation and metabolic dysregulation. Indices derived from routine laboratory tests that reflect systemic inflammatory and lipid-inflammatory status may offer better prognostic insight. This study aimed to evaluate the association between selected indices and short-term major adverse cardiovascular events (MACE) and all-cause mortality in patients with NSTEMI treated with dual antiplatelet therapy (DAPT) and statin. The selected indices reflect key mechanisms involved in NSTEMI pathophysiology, including insulin resistance, atherogenic dyslipidemia, and inflammation. Materials and methods This prospective observational study included 171 patients with NSTEMI admitted to the Intensive Care Unit of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between February 1, 2022, and January 31, 2023. Blood samples were collected upon admission and 24 hours subsequently. The following indices were calculated: triglyceride-glucose index (TyG), triglyceride-to-high-density lipoprotein ratio (TG/HDL), atherogenic index of plasma (AIP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and pan-immune-inflammation value (PIV). Outcomes were tracked during hospitalization and up to three months post-discharge. MACE was defined as cardiovascular death, reinfarction, stroke, or unplanned revascularization. All patients underwent coronary angiography; revascularization was performed when clinically indicated. Exclusion criteria included active malignancy, infection, or inflammatory disease. Logistic regression was adjusted for age, diabetes, and other clinical variables. Missing data were handled using the pairwise deletion method. Results High levels of TyG at admission were independently associated with MACE (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0-2.8; p = 0.037). All-cause mortality occurred in 14.6% of patients (n = 25), while MACE occurred in 60 patients. Independent predictors of mortality included elevated TyG at admission (OR 2.2; 95% CI 1.1-4.4; p = 0.034), TG/HDL at 24 hours (OR 1.4; 95% CI 1.1-1.7; p = 0.007), AIP at 24 hours (OR 5.7; 95% CI 1.1-28.9; p = 0.035), and NLR at 24 hours (OR 1.1; 95% CI 1.0-1.2; p = 0.002). PLR and PIV at 24 hours were also significantly associated with mortality. Optimal cut-off values were TyG ≥ 8.9, AIP ≥ 0.35, and NLR ≥ 4.5. NLR had the highest estimated area under the curve (AUC ≈ 0.78). Conclusion In NSTEMI patients treated with DAPT and statin, several inflammatory and lipid-inflammatory indices were independently associated with short-term mortality. Indices measured at 24 hours had a stronger prognostic value than baseline values. Serial monitoring may aid early risk stratification. Outcomes were assessed during hospitalization and via structured follow-up up to three months post-discharge.

Background: Primary hypothermia occurs when the body is exposed to extremely low temperatures in an environment with no underlying health conditions. Secondary hypothermia, on the other hand, results from disruptions in thermoregulation due to diseases, trauma, surgery, drugs, alcohol, or infections. Postmortem biochemistry has become a crucial factor in forensic examinations, offering valuable apprehension into tissue of and organ dysfunction associated with the process of dying. Aim: This research aims to explore various biochemical markers and their significance in distinguishing primary from secondary hypothermia. Methods: This study involved 21 Wistar rats, which were separated into three experimental groups: CG (n = 7), which were exposed only to hypothermic conditions; AHG (n = 7); and BHG (n = 7). We tested these parameters in each rat: glucose, urea, creatinine, blood urea nitrogen to creatinine ratio, phosphorus, calcium, sodium, potassium, sodium to potassium ratio, chloride, and calculated osmolality. Results: Distinct biochemical differences were noted between primary and secondary hypothermia. Glucose and creatinine levels exhibited significant variations (p < 0.001). Urea concentrations also manifested notable differences between the groups (p < 0.001). Phosphorus levels demonstrated significant differences (p = 0.004), with post hoc analyses revealing significant contrasts between the AHG and BHG (p = 0.014) and between the BHG and CG (p = 0.014). Potassium levels and the sodium-to-potassium ratio differed significantly (p < 0.001). Osmolality also varied significantly across experimental groups (p < 0.001), with post hoc tests confirming significant differences between the AHG and CG (p = 0.013) and between the BHG and CG (p = 0.002). Conclusion: The calculated osmolality exhibited significant variation among the different groups, indicating a notable impact of the substances on the biochemical profile related to hypothermia. This study focused on the effectiveness of biochemical markers in distinguishing primary hypothermia from secondary hypothermia.

AIM Moderate to severe asthma patients with sufficient and insufficient vitamin D serum level, respectively, were assessed with quality of life questionnaires before and after treatment with vitamin D added to their standard asthma treatment. METHODS Patients with moderate to severe asthma have been divided into two groups based on a serum level of vitamin D as sufficient or insufficient level of vitamin D, respectively. During 12 months, a total of 120 patients with sufficient level of vitamin D as well as 120 patients with insufficient level were given treatment with 2000 IU vitamin D for a three-month period. Quality of life of all patients was assessed by Asthma Control Test (ACT), Asthma Quality of Life (AQOL) and the physician's assessment expressed through the Global Evaluation of Treatment Effectiveness (GETE), which were performed before and after the treatment with Vitamin D. RESULTS Values of ACT and AQOL were higher after the treatment with vitamin D in both groups of patients. Values of GETE were lower after the treatment with vitamin D in both groups. All assessed components, psychological, physical, as well as the subjective feeling of control of the disease assessed by treating physicians, showed improvement after treatment. CONCLUSION Adding vitamin D in the treatment regimen of moderate to severe asthma patients improves quality of life and general asthma treatment effectiveness.

Background: Posterior pericardiotomy has been proposed as a preventive strategy against postoperative pericardial effusion and cardiac tamponade in patients undergoing coronary artery bypass grafting (CABG). However, data regarding its clinical outcomes and potential associations with postoperative complications remain limited. Objective. To evaluate intraoperative and postoperative outcomes in patients undergoing off-pump CABG with concomitant posterior pericardiotomy, and to assess potential associations between perioperative variables and the development of common postoperative complications. Methods. This retrospective study included 38 patients who underwent off-pump CABG with posterior pericardiotomy. Demographic and clinical characteristics, procedural details, postoperative complications, and outcomes were analyzed. Associations between operative time, comorbidities (sex, diabetes mellitus, smoking), and postoperative complications such as atrial fibrillation, pleural and pericardial effusions, and drainage volume were statistically evaluated using chi-square and correlation analysis. Results. The study cohort had a mean age of 66.64 ± 7.28 years, with 68.1% male patients. Arterial hypertension was present in all patients, diabetes mellitus in 44.7%, and prior myocardial infarction in 65.7%. The mean left ventricular ejection fraction was 42.86 ± 10.21%, and triple-vessel disease was observed in 63.2% of patients. All patients underwent off-pump CABG. The mean operative time was 254.31 ± 59.04 minutes. Postoperative complications included new-onset atrial fibrillation in 15.7% of patients, pleural effusion in 42.1%, and pericardial effusion in 10.5%. No cases of cardiac tamponade were reported. A significant association was found between smoking and new-onset atrial fibrillation (p = 0.050), while no significant associations were observed between sex or diabetes and postoperative complications. Operative time was not significantly associated with pericardial or pleural effusion, nor with drainage volume. Complete recovery was observed in all 100.0% of patients. Conclusion. Posterior pericardiotomy performed during off-pump CABG was associated with a low incidence of pericardial effusion and no occurrence of cardiac tamponade. The procedure appears to be safe and may contribute to favorable postoperative outcomes. Smoking may be a risk factor for new-onset atrial fibrillation, warranting further investigation.

Background: Aortic stenosis (AS) is the most common form of valvular disease in the elderly population, with degenerative calcified valves remaining the primary cause of this condition. Due to the progressive nature of the disease, a significant reduction in aortic valve area leads to increased left ventricular (LV) pressure overload, resulting in adaptive but ultimately maladaptive concentric hypertrophy and progressive myocardial remodeling. Objective: The main objectives of the study were to assess the regression of left ventricular (LV) hypertrophy, Methods: This retrospective study included 150 patients who underwent surgical aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis and the St. Jude Regent (STJ) mechanical valve. Patients were divided into three groups based on follow-up duration: six months, one year, and two years. changes in transvalvular gradient, perioperative outcomes, and survival rates. Results: The results showed a significant reduction in the transvalvular gradient for both valves (p < 0.0001), with a more pronounced decrease in patients with the SFS valve. The thickness of the interventricular septum (IVS) continuously decreased in SFS patients across all groups, whereas a significant reduction was observed only in Group 2 for STJ valves. Left ventricular ejection fraction (LVEF) showed a significantly greater increase in patients with the SFS valve (p < 0.024), particularly in Group 2. Overall mortality was 5.30% for STJ valves and 6.66% for SFS valves, with no statistically significant differences in Kaplan–Meier survival analysis (p > 0.05). Conclusion: The SFS valve demonstrated superior hemodynamic performance and more pronounced LV hypertrophy regression, making it a suitable option for high-risk patients. The STJ valve ensures stable long-term function and remains the preferred choice for younger patients with acceptable operative risk. These findings highlight the importance of a personalized approach in selecting valvular prostheses.

BACKGROUND Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation. AIM To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS. METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics. RESULTS The Simplified Acute Physiology Score II score (P = 0.029), dobutamine (P = 0.003) and epinephrine requirement (P = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (P = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (P = 0.047), neutrophilia (P = 0.038), lymphopenia (P = 0.013) and lactatemia (P = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (P = 0.017) and T1 (P = 0.007), as well as mean arterial pressure at T0 (P = 0.037) and T2 (P = 0.033) was higher for the low T3 group. CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.

Background: Autoimmune limbic encephalitis (ALE) is an inflammatory brain process involving a group of diseases with antibodies against neuronal synaptic and cellular antigens. Diagnosis is based on clinical examination, neurological functional tests, cerebrospinal fluid analysis, immunological testing, and radiological findings. Objective: This case report aims to present the case of a 68-year-old patient initially hospitalized for intermittent neurological deficits in the form of cognitive disorders of consciousness, which was initially declared as dementia without physical neurological deficit. Case presentation: Initial brain MRI (SIEMENS Magnetom Avanto, 1.5 T, Erlangen, Germany) showed changes differentially diagnosed characterised as glial neoplasm of mixed-grade astrocytoma or inflammatory process of unilateral autoimmune encephalitis. Since the neurosurgical opinion suggested a higher-grade glioma with proposed surgical treatment, the patient was referred for repeated MRI with MR spectroscopy in order to exhaust all diagnostic possibilities before surgery. MRI with MR spectroscopy (SIEMENS Magnetom Lumina, 3 T, Erlangen, Germany) revealed radiologically altered findings, in the right hippocampus and parahippocampal gyrus, which primarily corresponded to changes due to unilateral autoimmune encephalitis,due to its morphology characteristics and spectroscopy profile, making the primary glial neoplasm of lower grade less likely. Since the neurological mosaic IIFT result showed a positive LGI1 antibody finding, therapy for autoimmune encephalitis was initiated, leading to significant improvement in cognitive functions and the return of short-term memory. Conclusion: Although the detection of antibodies against onconeural, cellular, and synaptic proteins represents a significant advancement in diagnosing autoimmune limbic encephalitis, the role of conventional diagnostic tools such as MRI, EEG, and cerebrospinal fluid analysis should not be overlooked, where the application of new functional imaging techniques such as MR spectroscopy can be beneficial and should be considered.

Case report : Severe mitral regurgitation due to rupture of the chordae tendineae and mitral valve pro-lapse (Barlow’s disease), with a left atrial volume of 37.6 mL/m 2 was verified in 43-year old patient. He was admitted for an examination due to frequent palpitations and fast and irregular heartbeats. In the anamnestic data, thrombosis of the veins of the right leg was verified (thrombosis of popliteal, posterior tibial and great saphenous vein during previous years). He carries mutations: heterozygote of factor V Leiden, with MTHFR C677T heterozygote (CT), PAI- 1 heterozygote (4G⁄5G) and MTHFR A1298C heterozygote. The surgical treatment was done, and mechanical valve was implanted. In the follow-ing months, the patient complained on frequent dizziness, with crises of consciousness, and a short-ness of breath. He was not suitable for beta-blocker therapy, as well as propafenone and amiodarone, which had been prescribed in therapy in the meantime. The 24-hour ECG Holter monitoring described various arrhythmias, most of the time AV block of the first degree with PQ interval up to 320 msec, oc-casionally second-degree atrioventricular block Mobitz II, polymorphic ventricular extrasystoles and one attack of non-sustained ventricular tachycardia (6 ventricular extrasystoles in row), with intermit-tent nodal rhythm, junctional tachycardia and atrial flutter with AV ratio 2:1. An electrophysiological study was performed, and the cavotricuspid isthmus (CTI) dependent atrial flutter was verified, and radiofrequent ablation was done. After the procedure patient was in sinus rhythm. During the next follow up visits, the patient was in sinus rhythm, on therapy with a low dose of nebivolol (inability to tolerate beta blockers) and ivabradine, along with vitamin K antagonists. Conclusion