European Journal of Clinical and Experimental Medicine
<p style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> <p style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">GENERAL INFORMATION <p style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">The European Journal of Clinical and Experimental Medicine (Eur J Clin Exp Med) is an internationally recognized, peer-reviewed, open-access journal published by the Rzeszów University Press. The journal is issued quarterly in an online format and publishes exclusively in English. Submissions are accepted in English only, ensuring accessibility to a global audience. <p class="rtejustify" style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; text-align: justify; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Eur J Clin Exp Med is committed to promoting the dissemination of high-quality research that advances knowledge in clinical and experimental medicine. With its open-access model introduced in 2020, the journal ensures that all published articles are freely available for access, download, and sharing without any subscription barriers. <hr style="box-sizing: content-box; height: 0px; margin-top: 23px; margin-bottom: 23px; border-width: 1px 0px 0px; border-image: initial; font-family: Lato, sans-serif; font-size: 13px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border-color: #eeeeee initial initial initial; border-style: solid initial initial initial;" /> <p style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">THE THEMATIC SCOPE <p class="rtejustify" style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; text-align: justify; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">The European Journal of Clinical and Experimental Medicine publishes original research, reviews, and case studies that contribute to advancements in medical science and practice. The journal covers a broad range of topics within life and health sciences, clinical medicine, experimental medicine, and interdisciplinary research. <p class="rtejustify" style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; text-align: justify; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Eur J Clin Exp Med welcomes submissions that address current challenges and emerging trends in medicine, fostering collaboration and the exchange of knowledge across related disciplines. All published articles are freely accessible, promoting the unrestricted use and application of scientific discoveries worldwide. <hr style="box-sizing: content-box; height: 0px; margin-top: 23px; margin-bottom: 23px; border-width: 1px 0px 0px; border-image: initial; font-family: Lato, sans-serif; font-size: 13px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border-color: #eeeeee initial initial initial; border-style: solid initial initial initial;" /> <p style="box-sizing: border-box; margin: 0px 0px 1em; line-height: 20px; color: #010101; font-size: 14px; font-family: Lato, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">JOURNAL METRICS (2025) <table style="box-sizing: border-box; border-collapse: collapse; border-spacing: 0px; background-color: #ffffff; color: #666666; font-family: Lato, sans-serif; font-size: 13px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: 0.1px; orphans: 2; text-align: start; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; width: 707px;" border="0" cellspacing="1" cellpadding="1"> Rejection rate 68% The average time for initial technical and formal verification of the manuscript by the editor 2 days The average time from submission to the first decision 30 days The average time from submission to the final decision 50 days The average time in which the article is published in the online first version 80 days The average time in which the article is published in the final version (from submission to publication) 250 days
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself. All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
Breast imaging on chest computed tomography after various types of breast surgery
Introduction and aim. The incidence of breast cancer is increasing globally, prompting the development of various surgical and reconstructive techniques for treatment. Chest computed tomography (CT) is frequently performed for multiple clinical indications, including screening, postoperative surveillance, and staging. Therefore, this article aims to review and illustrate the characteristic imaging characteristics of various postoperative breast changes that may be incidentally identified on chest CT. Material and methods. We reviewed the medical records of patients who underwent CT scans at our hospital in the past five years and had changes in the shape of their breasts to confirm diagnosis, surgery, or procedure name, etc. Analysis of the literature. We compared CT findings of patients with surgically confirmed procedures with the surgical tech niques to identify any deformities resulting from surgery. In addition, we investigated the indications and effects of each surgery. Conclusion. Awareness of these characteristic CT appearances can help radiologists avoid misinterpretation, recognize complications or recurrence, and provide clinically relevant information even when breast findings are incidental.
Copyright (c) 2026 European Journal of Clinical and Experimental Medicine https://creativecommons.org/licenses/by/4.0
The role of glutathione peroxidase enzymes in Alzheimer's disease
Introduction and aim. Alzheimer’s disease (AD) is a neurodegenerative disorder that affects mainly the elderly. Among the variety of factors contributing to the pathogenesis of AD, oxidative stress has emerged as a key factor in the initiation and progression of the disease. Glutathione peroxidases (GPxs) are enzymes that are known to play a critical role in maintaining cellular redox balance. To this end, the present narrative review aims to explore the role of GPx enzymes in AD and discuss their contribution to oxidative stress pathways and AD pathogenesis. Literature search. PubMed, Scopus, and Google Scholar were searched for relevant literature. No specific inclusion and exclusion criteria were used due to the narrative nature of the review. Analysis of the literature. Available records suggest a strong association between oxidative stress and the pathological features of AD, including amyloid-β aggregation, tau hyperphosphorylation, and neuroinflammation. The enzyme isoforms GPx1, GPx3, and GPx4 have been implicated in AD pathogenesis. Conclusions: GPx enzymes play an important protective role in AD. Despite promising preclinical evidence, more translational research is required to clarify the therapeutic and biomarker potential of GPxs in AD.
Relationship between anatomical variations in the aortic arch and risk of aneurysm formation ‒ a systematic review
Introduction and aim. Anatomical variation in the aortic arch has been proposed as an aneurysm risk factor based on changed hemodynamic forces and structural stress in arterial walls. Knowledge of these variations will be valuable in optimizing surgical planning and management of risks for patients to undergo cardiovascular and thoracic procedures. This systematic review summarized existing literature to assess the relation of different variations in the aortic arch with the risk of aneurysm formation by consolidating evidence of clinical relevance and predictive markers of risk. Material and methods. We conducted our searches in seven databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and ProQuest, using Boolean operators and MeSH terms. The ROBINS-I tool was used to assess the risk of bias in studies, including confounding, participant selection, and outcome reporting. GRADE was used to evaluate global certainty of evidence, which also considered consistency, directness, and precision of evidence. Studies were eligible based on strict eligibility criteria and reported findings on specific aortic arch and their potential association with aneurysm formation. Results. The review included 12 studies that varied in terms of sample size and used a mostly retrospective design. According to the findings evaluated, certain forms of the aortic arch, for example, the bovine arch and aberrant right subclavian artery, posed an increased risk of developing proximal versus distal aneurysms. Advanced imaging studies, such as 4D flow MRI and enhanced CT, aided in the selection of at-risk patients, as they described the flow pressure dynamics with detailed assessments. While several authors reported consistent associations of anatomical variation with risk, other authors found no significant correlation and thus suggested variability in clinical relevance. The general review showed both converging and divergent findings of the review about the predictive value of certain types of arch for aneurysm risk. Conclusion. This systematic review highlights the incorporation of knowledge on aortic arch variation as part of the detailed risk assessment required in aneurysmal formation among patients. Although some forms, such as the bovine arch and the aberrant right subclavian artery, did indeed demonstrate the potential to be predictive of complications, study inconsistencies provide reason for continuing research on the topic. Advanced imaging may improve medical decision-making, as patient risk stratification would be feasible with greater information on anatomical variation.
Evaluating the roles of interleukin-17, C3, C4, antinuclear antibody, and antiphospholipid antibody in the pathophysiology of systemic lupus erythematosus
Introduction and aim. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by immune dysregulation, autoantibody (Abs) production, and complement (C) consumption. This study aimed to evaluate the diagnostic and prognostic relevance of antinuclear antibodies (ANA), interleukin (IL)-17A, complement components C3 and C4, and antiphospholipid (APL) Abs in patients to SLE compared with healthy individuals. This study provides an assessment of these biomarkers within a single cohort of an Iraqi population, addressing a regional knowledge gap. Material and methods. A prospective case–control study was conducted in Al-Nasiriyah, Iraq, from July 2024 to July 2025, including 110 patients with SLE and 70 apparently healthy individuals. Serum levels of ANA, IL-17A, complement C3, complement C4 and APL immunoglobulin (Ig) M and G were measured using enzyme-linked immunosorbent assay (ELISA) and nephelometry. Statistical analyzes were included using descriptive statistics, chi-square tests, t-tests, and correlation analyses. Results. Patients with SLE showed significantly higher levels of ANA, IL-17A, and APL Abs, along with significantly lower levels of complement C3 and C4. ANA was positively correlated with IL-17A and APL Abs and negatively with complement components. There were also significant negative correlations of APL-IgM/IgG with C3 and C4, while IL-17A did not show a correlation with C3 or C4. Conclusion. These findings demonstrate coordinated immune activation and complement depletion in SLE and emphasize the value of combined biomarker evaluation within a context of a population of the Middle East specifically.
Chromium picolinate modulates nitric oxide pathways but enhances myocardial peroxynitrite formation in a rat heart during metabolic syndrome modeling
Introduction and aim. Metabolic syndrome (MetS) is a global non-communicable health burden. Chromium picolinate (CRPIC) as modulator of p38 MAPK cascade may have a potential therapeutic effect on MetS. The objective of the present study is to evaluate the effects of CRPIC administration on nitric oxide generation and myocardial levels of nitric oxide metabolites in rats under conditions of metabolic syndrome. Material and methods. The experiment was performed on 24 Wistar rats, which were randomly allocated into four groups (n=6 per group): Group I, the control group; Group II, the metabolic syndrome (MetS) group, in which MetS was induced by providing a 20% fructose solution as the sole source of drinking water for 60 days; Group III, the CRPIC-treated group, receiving CRPIC at a dose of 80 µg/kg; and Group IV, the CRPIC+MetS group, in which CRPIC administration was carried out under conditions of experimentally induced metabolic syndrome. The following biochemical parameters were evaluated: total nitric oxide synthase (NOS) activity, inducible NOS (iNOS) and constitutive NOS (cNOS) activities, arginase activity, nitrite reductase and nitrate reductase activities, as well as the concentrations of nitrites, peroxynitrites, nitrosothiols, and hydrogen sulfide. Results. Administration of CRPIC under MetS conditions resulted in a 38.2% reduction in NOS activity and a 40.2% decrease in iNOS activity, accompanied by a 48.9% increase in cNOS activity compared with the MetS group. CRPIC treatment also reduced arginase activity by 13.2%. While the activity of nitrate reductase remained unchanged, nitrite reductase activity decreased by 37.0%. Furthermore, CRPIC increased nitrite levels by 95.2% and peroxynitrite concentrations by 35.2%, while the content of nitrosothiols was reduced by 49.1%. H2S levels also decreased by 16.8%. Conclusion. Administration of CRPIC on the background of metabolic syndrome modeling alleviates enhanced nitric oxide production from the L-arginine-dependent and L-arginine-independent pathways, but increases peroxynitrite compared to the metabolic syndrome group.
Association of vitamin D deficiency with inflammatory cytokines and disease severity in chronic heart failure
Introduction and aim. Vitamin D deficiency has been associated with impaired cardiovascular dysfunction and adverse outcomes in chronic heart failure (CHF); yet the connection between inflammatory and cardiac biomarkers in different disease severities remains incompletely understood. Therefore, this study aimed to investigate the role of vitamin D and related biochemical parameters in the etiopathophysiology and severity of chronic heart failure. Material and methods. A total of 219 people diagnosed with chronic heart failure, aged 30 and 89 years, were enrolled and stratified according to the functional class (I–II, n=123; III–IV, n=96). An age and sex-matched control group of 51 apparently healthy individuals was included. Serum levels of vitamin D, natriuretic peptide (BNP), N-terminal pro–brain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor-alpha (TNF-α), galectin-3 and fibroblast growth factor-23 (FGF-23) were quantified using validated immunoassays. Comparisons between groups were performed using nonparametric statistical tests. Associations between variables were evaluated using Spearman’s correlation analysis. The diagnostic utility of the selected biomarkers for different levels of severity of CHF was evaluated using receiver operating characteristic (ROC) curve analysis. Results. Vitamin D deficiency was associated with CHF severity. Across increasing NYHA functional classes, serum levels of IL-6, IL-18, TNF-α, BNP, NT-proBNP, galectin-3, and FGF-23 differed significantly (p<0.001). Vitamin D concentrations were positively associated with left ventricular ejection fraction and inversely related to BNP, NT-proBNP, IL-6, IL-18, TNF-α, galectin-3, and FGF-23. ROC analysis indicated that IL-6 (AUC 0.799, sensitivity 75%, specificity 78%) and galectin-3 (AUC 0.791, sensitivity 72%, specificity 80%) were the most discriminative biomarkers in patients with CHF with vitamin D deficiency, supporting their clinical utility for risk stratification and disease monitoring. Conclusion. This study provides novel evidence by integrating inflammatory cytokines, galectin-3, FGF-23, and natriuretic peptides in patients with vitamin D-deficient CHF, identifying IL-6 and galectin-3 as the most discriminative biomarkers of disease severity in this clinical setting.
Ultrasonographic features of pediatric umbilical hernias ‒ associations with age, sex, and hernial orifice width
Introduction and aim. Given the limited data on standardized ultrasound evaluation of hernial defect morphology in pediatric umbilical hernias, this study aimed to evaluate the ultrasonographic features of primary umbilical hernias in pediatric patients, with a particular focus on the width of the hernial orifice, the contents of the hernial sac and their potential correlation with age and sex. Material and methods. A retrospective analysis of medical records of pediatric patients with primary umbilical hernia who presented to the pediatric surgery outpatient clinic and had ultrasonographic measurements performed using a standardized protocol between 01.01.2024 and 31.07.2025. Results. Analysis of ultrasound measurements of the width of the hernial orifice width demonstrated a significant association between the width of the hernial orifice and the contents of the hernial sac. Children with intestinal loops present in the hernial sac were significantly younger than those with preperitoneal fat (p=0.016), and the width of the hernial orifice was greater in cases containing intestinal loops (p=0.028). In particular, among children with a hernial orifice larger than 14 mm, intestinal loops were observed more frequently than among those with an orifice width of 14 mm or less (58.82% vs 15.38%; p=0.026). Furthermore, the analysis revealed that the umbilical orifice was wider in boys than in girls (mean±SD: 15.44±1.64mm vs. 13.08±2.43mm; p=0.043).There was a difference between the width of the hernial orifice in children under 1 year of age and older. Conclusion. Ultrasonographic evaluation of pediatric umbilical hernias provides clinically relevant information on the morphology of hernial defects. In particular, the width of the hernial orifice is associated with the presence of intestinal loops in the hernial sac, especially in younger children, with a threshold value of >14 mm identifying patients at higher likelihood of intestinal content. These findings suggest that ultrasonography may contribute to risk stratification and support clinical decision-making in the management and follow-up of pediatric umbilical hernias.
Evaluation of serum and follicular fluid progranulin in relevance to BMI, oocyte, and embryo quality in Iraqi women with polycystic ovary syndrome undergoing intracytoplasmic sperm injection
Introduction and aim. Polycystic ovarian syndrome (PCOS) is a common endocrine-metabolic disease often associated with obesity, persistent low-grade inflammation, and suboptimal results of assisted reproductive technology (ART). The aim was to evaluate the relevance of serum and follicular progranulin (PGRN) levels in relation to intracytoplasmic sperm injection outcomes among normal and overweight/obese body mass index (BMI) women with PCOS. Material and methods. This prospective comparative study included women diagnosed with PCOS undergoing intracytoplasmic sperm injection (ICSI) between the first of October 2024 and the first of April 2025. Baseline serum markers were measured on cycle days 2‒3. Participants were categorized as having a normal BMI, group 1 (n=30), or being overweight/obese, group 2 (n=37). Fasting serum and follicular fluid progranulin (PGRN) levels were assessed on oocyte retrieval day. Results. Women with normal BMI were younger and had significantly lower BMI and shorter infertility duration compared with overweight/obese women (p≤0.05). No statistically significant differences were observed between BMI groups in the number of retrieved oocytes, MII oocytes, fertilized oocytes, embryo grades, blastocysts, or biochemical pregnancy rate (p>0.05). Numerically, normal-BMI women showed slightly higher retrieved and MII oocyte counts, whereas overweight/obese women demonstrated higher numbers of fertilized oocytes, total embryos, grade I embryos, blastocysts, and biochemical pregnancy rates; however, these differences did not reach statistical significance. Serum and follicular fluid PGRN levels were comparable between groups (p>0.05), with only limited correlations observed between follicular fluid PGRN and total oocyte count. Conclusion. Serum and follicular fluid PGRN levels were comparable across BMI categories in women with PCOS undergoing ICSI. Although numerical variations in oocyte and embryo parameters were observed between BMI groups, most differences were not statistically significant. The findings suggest that follicular fluid PGRN may be associated with certain ovarian response parameters; however, its independent clinical relevance in predicting ART outcomes remains uncertain. Larger studies incorporating clinical pregnancy and live birth outcomes are required to clarify the potential role of follicular fluid PGRN in PCOS-related infertility.
Performance and territorial governance assessment of the National Breast Cancer Screening Program in Taza Province, Morocco (2022–2024)
Introduction​‍​‌‍​‍‌ and aim. Breast cancer is one of the leading causes of cancer-related mortality among women in Morocco. This study assessed the performance of the National Breast Cancer Screening Program (NBCSP) in Taza Province from 2022 to 2024. focusing on screening coverage, participation, detection indicators, and territorial equity. Material and methods. We analyzed Health Information System data from 74,269 women aged 40–69 years eligible for screening. Temporal trends and rural–urban differences in screening participation and diagnostic completion were assessed using appropriate statistical models. Results. Screening participation among the women contacted was between 54.8% and 82.0%, while overall coverage remained around 50% of the eligible population. The breast cancer detection rate was raised from 1.35 to 2.12 per 1,000 women screened. Clinical breast examination positivity was almost unchanged and low (≈2.4%). After adjustment, rural residence was associated with lower odds to participate in the screening, to complete referral and biopsy, and to get timely diagnosis within 60 days. Conclusion. While positive changes were made in screening activities and detection indicators, there are still gaps in program quality and equity. The absence of systematic stage-at-diagnosis data limits interpretation of clinical impact and underscores the need for integrated data systems to improve breast cancer screening evaluation in ​‍​‌‍​‍‌Morocco.
Analysis of the effects of a continuous magnetic field on the heart and diaphragm of elderly Wistar rats
Introduction and aim. The aim was to investigate the histomorphometric effects of applying a static magnetic field (MF) of different intensities to the diaphragm muscle and heart of aging rats. Material and methods. Continuous MF of three different intensities were applied for five consecutive days (10 hours in total). Morphological and histological variables in the diaphragm and heart were assessed, including capillary density, cardiomyocyte diameters, histopathological index, and the presence of regenerative changes. Results. In the diaphragm, there was a significant reduction in the number of capillaries in the treated groups (p<0.05), with no changes in the other morphological variables (p>0.05). In the heart, there were no differences in cardiac mass or in the heart weight/body weight ratio (p>0.05), indicating no macroscopic hypertrophy. However, the intensity of 2500 G led to an increase in the area of the cardiomyocytes and their nuclei (p<0.05), suggesting an adaptive response to the overload. There were no significant changes in the histopathological index or in muscle degeneration characteristics (p>0.05). Conclusion. Exposure to MF influenced the microcirculation of the diaphragm and promoted cellular changes in the heart, especially at higher intensities, without causing apparent damage to the tissue.
Clinical profile and predictors of mortality in upper gastrointestinal bleeding presenting to the emergency department of a tertiary care center ‒ a prospective observational study
Introduction and aim. Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening emergency associated with significant morbidity and mortality. Prospective emergency department (ED)-based data from India on factors associated with in-hospital mortality remain limited, and comparative evidence between bleeding-specific scores such as the Glasgow-Blatchford Score (GBS) and triage systems like the Emergency Severity Index (ESI) is scarce. This study aimed to describe the clinical profile of patients presenting with UGIB and to evaluate predictors of in-hospital mortality, with a focus on comparing the prognostic performance of GBS and ESI. Material and methods. This single-center prospective observational cohort study was conducted in the ED of a tertiary care center in North India from January 2024 to January 2025. Adult patients with clinically suspected or endoscopically confirmed UGIB were enrolled. Clinical, laboratory, and management data were recorded using a standardized form. GBS and ESI were assigned at presentation by trained clinicians prior to outcome assessment. The primary outcome was in-hospital mortality. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Results. Eighty-three patients with UGIB were included; 55.4% had a GBS >2. Patients with higher GBS demonstrated greater physiological derangement, increased transfusion requirements, higher incidence of shock, and significantly higher mortality (39.1% vs. 0%, p<0.001). All non-survivors were triaged as high acuity by ESI and had qSOFA ≥2 at presentation. GBS showed good discriminative ability for predicting mortality (AUROC=0.785), outperforming ESI (AUROC=0.723). Conclusion. GBS showed good performance in predicting in-hospital mortality and may aid early ED risk stratification. However, findings should be interpreted cautiously given the single-center design and small sample size.
Serum ATP1A1 and epinephrine as potential biomarkers for essential hypertension ‒ a case-control study
Introduction and aim. Essential hypertension is a leading cause of global morbidity driven by complex genetic and physiological interactions. The roles of the Na+/K+-ATPase pump, sympathetic nervous system, and electrolyte balance are critical, yet their simultaneous interaction remains unexplored. This study aimed to investigate the serum levels of Na+/K+-ATPase alpha-1 subunit (ATP1A1), epinephrine, and key electrolytes (sodium, potassium, chloride, and calcium) in hypertensive patients, providing a novel multi-marker approach to evaluate their potential as diagnostic biomarkers. Material and methods. We enrolled 80 hypertensive patients and 40 normotensive controls in this cross-sectional study. Serum ATP1A1 and epinephrine levels were measured by ELISA, and electrolytes were analyzed using an ion-selective electrode analyzer. Results. Hypertensive patients exhibited significantly higher serum levels of ATP1A1 (430±190 vs. 161±71.16 ng/L), epinephrine (339±188 vs. 116.5±38.6 ng/L), sodium, chloride, and calcium, with significantly lower potassium (all p<0.001 ROC analysis demonstrated a promising discriminatory ability for ATP1A1 (AUC=0.92) and epinephrine (AUC=0.94). Multiple regression analysis identified ATP1A1, epinephrine, and chloride levels as significant independent predictors of systolic blood pressure. Conclusion. Patients with essential hypertension display a distinct biochemical signature of elevated serum ATP1A1 and epinephrine levels coupled with significant electrolyte disturbances. These preliminary findings suggest potential value as biomarkers for essential hypertension, although extensive validation in larger, independent cohorts is required before clinical application can be considered.
Longitudinal hormonal dynamics during minipuberty and exploratory associations with vitamin D status in healthy term male infants
Introduction and aim. Minipuberty, the transient postnatal reactivation of the hypothalamic-pituitary-gonadal axis, is a critical window for male reproductive maturation. The study prospectively characterized hormonal dynamics during minipuberty and explored associations between 25-hydroxyvitamin D [25(OH)D] and gonadal hormones, adrenal corticosterone, and genital growth parameters. Material and methods. Sixty healthy term male babies were enrolled; 52 completed follow-up. Testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), corticosterone, and 25(OH)D were measured on day 3 and at 3 months by LC-MS/MS and chemiluminescence immunoassay. Penile length and testicular volume were recorded at both visits. Results. Testosterone increased from 47.18 to 142.62 ng/dL, LH from 1.31 to 2.46 mIU/mL, and FSH from 1.22 to 2.10 mIU/L (all p<0.001), while corticosterone decreased from 211.19 to 86.25 ng/dL (p<0.001). Several nominal associations were observed before multiple comparison correction; however, after Bonferroni correction, only the inverse association between 25(OH)D and corticosterone at 3 months (r=−0.576, p<0.001) remained statistically significant. All other associations should be considered exploratory. Conclusion. Only the inverse association between vitamin D and corticosterone remained statistically significant after correction, while other associations were exploratory and require confirmation in larger studies.
Molecular detection of isoniazid and rifampin-resistant Mycobacterium tuberculosis strains from southwest of Iran
Introduction and aim. The study of molecular mechanisms of resistance to first-line antibiotics for the treatment of tuberculosis is of great importance. Investigating these mechanisms provides valuable information to treatment policy makers. Therefore, this study aimed to identify mutations associated with resistance to rifampin (RIF) and isoniazid (INH) among drug-resistant Mycobacterium tuberculosis (MTB) isolates from a TB reference center in southwest Iran. Material and methods. In this cross-sectional study (September 2014-February 2018), a total of 772 MTB isolates were confirmed by culture on Löwenstein-Jensen (LJ) medium and standard biochemical tests. Drug susceptibility testing of RIF and INH was determined by the proportion method on LJ medium. Mutations conferring resistance to INH and RIF were determined by polymerase chain reaction analysis and sequencing. Results. In this study, 772 (22.68%) MTB strains were isolated from 3,404 TB-suspected patients, of whom 26.6% were women and 73.8% male. Of the 772 clinical strains, 8 (1.03%) were MDR (resistant to INH and RIF), 15 (1.94%) were resistant to RIF and 4 (0.5%) were resistant to INH. Of the 12 identified isolates identified (including both 4 isolates resistant to INH and 8 isolates resistant to MDR), 2 (16.6%) had a mutation at codon 315 of katG, 1 (8.33%) had a mutation at (-15) of inhA, and 9 (75%) did not show a detectable mutation. Regarding rifampin, the frequency of mutations in the rpoB gene was the following: codons 531 (n=7, 30.4%), 533 (n=5, 21.7%), 526 (n = 2, 8.69%) and 511 (n=1, 4.3%). Furthermore, no mutations were detected in 8 (34.7%) isolates. Conclusion. The most prevalent mutation in INH resistant isolates was at codon 315 of katG. In RIF-resiatant isolates, the most prevalent mutation was at codon 531 of the rpoB gene. In a considerable number of isolates, no mutations in katG, inhA, and rpoB were found compared with deposited sequences available from NCBI GenBank.
Diagnostic performance of serum oncostatin M and MMP-9 in differentiating disease activity in Crohn's disease and ulcerative colitis
Introduction and aim. Inflammatory bowel disease (IBD) requires reliable noninvasive biomarkers for diagnosis and disease activity monitoring. Oncostatin M (OSM) and matrix metalloproteinase-9 (MMP-9) are implicated in intestinal inflammation and tissue remodeling, yet their combined diagnostic utility in IBD remains underexplored. The aim was to evaluate serum OSM and MMP-9 levels in Crohn's disease (CD) and ulcerative colitis (UC) patients compared to healthy controls, and to assess their correlation with disease activity and diagnostic performance. Material and methods. This cross-sectional study included 105 participants (35 CD, 35 UC, 35 controls). Serum OSM and MMP-9 were measured by ELISA. Disease activity was evaluated using CDAI and the Total Mayo Score. ROC curve analysis evaluated diagnostic accuracy. Results Both OSM and MMP-9 were significantly elevated in CD and UC compared to controls (p=0.016 and p=0.006, respectively), with progressive increases paralleling disease severity (p<0.001). For differentiating active from inactive CD, OSM demonstrated a high AUC of 0.951 (95% CI: 0.882–1.000) with 100% specificity (95% CI: 71.5%–100.0%). For active UC, MMP-9 achieved an AUC of 0.85 (95% CI: 0.724–0.976) with 95.4% sensitivity (95% CI: 78.9%–99.9%). Conclusion. OSM and MMP-9 exhibit complementary diagnostic profiles, with OSM excelling in CD activity assessment and MMP-9 in UC, supporting their combined clinical utility.
Serum Bruton's tyrosine kinase and NF-κB in Hashimoto's thyroiditis ‒ a case-control study of potential diagnostic biomarkers
Introduction and aim. Hashimoto's thyroiditis (HT) is the leading cause of hypothyroidism, yet its diagnosis relies on markers with known limitations. Bruton's tyrosine kinase (Btk) and nuclear factor kappa B (NF-κB) are implicated in B-cell-mediated autoimmunity. This study aimed to explore the serum levels and preliminary diagnostic potential of Btk and NF-κB in Iraqi patients with HT. Material and methods. In this case-control study, 30 HT patients, 30 non-autoimmune hypothyroidism patients, and 60 healthy controls were enrolled from three centers in Karbala, Iraq. HT was defined by elevated TSH (>4.2 µIU/mL), reduced fT4 (<0.93 ng/dL), and positive anti-TPO and/or anti-Tg, whereas non-autoimmune hypothyroidism was defined by elevated TSH and low fT4 with negative thyroid autoantibodies. Serum Btk and NF-κB were measured by enzyme-linked immunosorbent assay. Thyroid hormones and autoantibodies were determined by electrochemiluminescence immunoassay. Receiver operating characteristic (ROC) analysis was performed to assess preliminary diagnostic accuracy for distinguishing HT from non-autoimmune hypothyroidism and healthy controls. Results. Serum Btk and NF-κB levels were significantly elevated in HT patients compared to both control groups (Btk: 7.81±0.98 vs. 7.00±0.77 vs. 6.10±1.60 ng/mL; NF-κB: 1.90±0.71 vs. 0.91±0.21 vs. 0.84±0.39 ng/mL, p<0.001). In ROC analysis, NF-κB showed an area under the curve (AUC) of 0.95 (95% CI: 0.89–0.99) for discriminating HT from non-autoimmune hypothyroidism. Both biomarkers correlated positively with anti-TPO, anti-Tg, and TSH, and negatively with fT4. Conclusion. Serum Btk and NF-κB were elevated in HT and showed preliminary associations with autoimmune activity. NF-κB, in particular, demonstrated promising initial diagnostic performance. These exploratory findings require validation in larger, independent cohorts.
Association between arterial stiffness and autonomic recovery following graded aerobic exercise in healthy young adults ‒ an exploratory pilot study
Introduction and aim. Arterial stiffness reflects vascular properties that can influence blood pressure (BP) and heart rate (HR) responses to exercise, but its association with post-exercise autonomic recovery in healthy young adults remains unclear. This exploratory pilot study investigated the relationship between baseline aortic stiffness and post-exercise hemodynamic and autonomic recovery following graded submaximal aerobic exercise. Material and methods. Thirty healthy young adults (17 women, 13 males; mean age 22.7±2.5 years) underwent baseline evaluation of carotid–femoral pulse wave velocity (cf-PWV), central BP, and pulse wave analysis. Participants completed a graded submaximal cycling protocol from 20 to 80% of the maximum oxygen uptake in 3-minute stages, followed by 5 minutes of seated recovery. HR was continuously recorded and BP measured at 1, 3, and 5 minutes of recovery. Autonomic recovery was assessed using heart rate recovery (HRR) and heart rate variability (HRV) indices. Associations were analyzed using correlation and multivariate linear regression adjusted for age, sex, and body mass index. Results. Higher baseline cf-PWV was associated with higher peak HR and systolic BP during exercise (p<0.01), and slower HRR at 1 min (r=-0.517, p=0.002). Cf-PWV independently predicted early HRR after adjustment. Conclusion. In this pilot sample of healthy young adults, greater aortic stiffness was associated with higher BP responses during exercise and slower early autonomic recovery. These findings suggest an association between vascular properties and early postexercise recovery, which should be confirmed in larger studies.
Should oophoropexy be a standard procedure after ovarian torsion in premenarchal patients? A case-based review of fixation indications and techniques
Introduction and aim. Ovarian torsion is a rare but significant cause of acute abdomen in children. Diagnosis is challenging due to nonspecific symptoms. While Doppler ultrasound is essential, it is not definitive. Laparoscopy with detorsion remains the diagnostic and therapeutic standard. For recurrent and high-risk cases, oophoropexy is considered, but there is no consensus on its indications or optimal technique. We analyze the diagnostic process, reasons for recurrence, and outcomes of different oophoropexy techniques. Description of the case. A premenarchal girl experienced three episodes of ipsilateral ovarian torsion. After the second recurrence, she underwent laparoscopic oophoropexy via fixation posterior to the uterus to the ovarian fossa with absorbable sutures, which failed. Following a third torsion, a laparotomy with a subsequent oophoropexy to the round ligament using non-absorbable sutures achieved a long-term recurrence-free period. Conclusion. Retorsion remains a significant risk. This case provides a unique intrapatient comparison, demonstrating that the technical approach influences the outcomes. Fixation to the abdominal wall with non-absorbable sutures proved to be superior in this scenario, preventing further recurrence. The patient's age and torsion etiology are critical in selecting a fixation method. This report highlights the potential for oophoropexy failure and offers vital technical insights, underscoring the need for further studies to standardize practices for fertility preservation.
Antiphospholipid syndrome in an adolescent with refractory immune thrombocytopenia and massive central venous thrombosis
Introduction and aim. Immune thrombocytopenia (ITP) and antiphospholipid syndrome (APS) may coexist, creating a clinical paradox of simultaneous bleeding risk and thrombophilia. In children and adolescents, APS may remain unrecognised for years when thrombocytopenia dominates the early course. The thrombotic risk associated with thrombopoietin receptor agonists (TPO-RAs) in this setting remains uncertain. Description of the case. A 17-year-old boy with refractory ITP during romiplostim therapy developed massive upper-extremity and central venous thrombosis with near-complete superior vena cava obstruction. Persistent lupus anticoagulant, anticardi olipin, and anti-β2-glycoprotein I antibody positivity established APS. He was treated with heparin, alteplase, and long-term warfarin plus low-dose aspirin, while romiplostim was continued to support safe anticoagulation. No recurrent thrombosis or major bleeding was observed during 20 months of follow-up. Conclusion. Thrombocytopenia does not protect against thrombosis in APS. In adolescents with chronic or refractory ITP, especial ly when vascular symptoms, unexplained prolonged aPTT, or other autoimmune red flags are present, targeted antiphospholipid antibody testing should be considered. Management of combined ITP and APS requires individualized balancing of anticoagula tion and platelet support, with vitamin K antagonists remaining the preferred long-term anticoagulant strategy in high-risk APS.