Acta Medica Bulgarica Feed

Comparative Analysis of Anthropometric Parameters and Their Association with Metabolic Health in Patients with Obesity

Mon, 14 Sep 2026 00:00:00 GMT

Background and aim: Body mass index (BMI) is the cornerstone of obesity classification. As the prevalence of obesity as a chronic disease increases, more precise stratification tools are being explored. The aim of this study is to compare established and alternative anthropometric parameters in terms of their association with metabolic health indices in adults with BMI > 25 kg/m2.Materials and methods: Cross-sectional analysis was performed on first-visit assessment data of 401 individuals from an outpatient endocrinology clinic. Weight, height, and waist circumference values were used to calculate the following anthropometrics: waist-to-height ratio (WHtR), Body Shape Index (ABSI), Body Roundness Index (BRI), Conicity Index (CI), Weight-adjusted Waist Index (WWI), and Relative Fat Mass (RFM). The outcomes of interest were metabolic laboratory indices of glycemia (FPG, HbA1c), lipid metabolism (LDL, TG), and hepatic enzymes (ALT, GGT). After log-transformation, they were standardized and combined into glycemic, lipid, hepatic, and overall metabolic burden composite scores. Hierarchical linear regression models adjusted for age and sex were used to measure the association between each anthropometric index and the composite scores. Incremental explained variance (ΔR2) and regression coefficients were compared.Results: The strongest association with the overall metabolic composite was shown by RFM (β = 0.480, 95% Cl = 0.269-0.692; ΔR2 = 0.085), followed by WHtR (ΔR2 = 0.080), BMI (ΔR2 = 0.076), and BRI (ΔR2 = 0.076). ABSI, Cl, and WWI showed no significant incremental contributions. BMI showed the largest ΔR2 for the glycemic composite, whereas RFM ranked highest for lipid and hepatic composites.Conclusion: Waist-based indices – particularly RFM and WHtR – were most consistently associated with composite metabolic laboratory burden in routine outpatient practice.

Geriatric Care in Bulgaria: Current Status, Systemic Challenges and Reform Potential in the Context of Digital Transformation

Mon, 14 Sep 2026 00:00:00 GMT

Geriatric care in Bulgaria is undergoing a complex transformation driven by accelerated ageing of the population, increasing multimorbidity and a growing need for long-term support. The analysis identifies major systemic barriers, including fragmentation between health and social services, the absence of a unified regulatory framework, insufficient development of home and community-based care, workforce shortages, and limited digital infrastructure. The lack of interdisciplinary teams and standardized comprehensive geriatric assessment (CGA) contributes to inefficiency, frequent hospitalizations, and reduced continuity of care. Despite these constraints, Bulgaria demonstrates emerging efforts in active ageing policy, community services, and digital health tools, although their impact remains limited. Diqitalization and artificial intelligence present significant opportunities for improving access, coordination, and quality of services, but their implementation requires strong ethical, legal, and human-centered foundations. A transition towards an integrated care model, expansion of community-based services, professional training, quality regulation, and support for informal caregivers is crucial to ensure equitable, humane, and sustainable geriatric care in Bulgaria.

Comparative Analysis of Bacterial Neuroinfections Before and During The COVID-19 Pandemic

Mon, 14 Sep 2026 00:00:00 GMT

Bacterial meningitis and meningoencephalitis are severe diseases that can be fatal or lead to permanent disability in survivors despite the availability of antibiotic therapy. After the emergence of SARS-CoV-2, changes in morbidity, hospitalizations and etiology have been observed in some countries.Aim: The aim of this analysis was to compare the epidemiological and clinical characteristics of patients with bacterial neuroinfections before and during COVID-19.Materials and methods: The study included 126 patients with bacterial neuroinfections, treated at the Clinic of Infectious Diseases, “Sveti Georgi” Univeristy Hospital in Plovdiv, during two equal periods – from January 2016 to September 2019 (shortly before COVID-19), and from March 2020 to December 2023 (during COVID-19), respectively. Clinical and epidemiological data, laboratory, microbiological, and molecular tests, as well as imaging techniques, were used.Results: 90 patients with bacterial neuroinfections were hospitalized during the pre-COVID-19 period, whereas hospitalizations were only 36 during the COVID-19 period. In addition, seasonal, gender, and age distribution differences were observed. The etiology was similar in both observational periods, with the most common agents being S. pneumoniae, Staphylococcus spp., and L. monocytogenes. Mortality rate was similar (33.3% vs. 37.1%, respectively), but differences in terms of etiology were observed.Conclusion: The significant reduction of bacteria I neuroinfections during the COVID-19 period is probably due to the public prevention and control measures introduced at the beginning of the pandemic. The emergence of new pathogens and the measures that society takes towards fighting them can have an impact on the epidemiology, clinical course, and prognosis of other diseases that are already known to humanity.

Expression of Human Endogenous Retroviruses (HERVs) in Breast Cancer: A Transcriptomic Study

Mon, 14 Sep 2026 00:00:00 GMT

Background: Human endogenous retroviruses (HERVs) are ancient viral elements integrated into the human genome. HERVs, especially HERV-K (HML-2), play a significant role in the onset and advancement of breast cancer. This study examined the expression of endogenous retroviruses in human breast tissues to reveal potential associations between retroviruses and breast cancer.Materials and methods: RNA-Seq datasets from breast cancer tissues (ductal carcinoma and triple-negative subtypes) and normal breast tissues were retrieved from the NCBI Sequence Read Archive (SRA). Bio-informatics analysis included read mapping against the human genome (hg19) and a custom pseudogenome containing HERVsequences. Normalized expression of HERV-human junctions was calculated, and statistical comparisons were performed using independent samples t-tests and Mann-Whitney testsResults: Breast cancer tissues exhibited significantly higher normalized coverage of HERV integration sites compared to healthy controls (p = 0.009). Among breast cancer cases, patients who had undergone treatment showed significantly lower HERV expression than untreated patients (p = 0.023). Visualization via IGV confirmed increased read accumulation at HERV loci in cancer samples.Conclusion: HERVs were overexpressed in breast cancer cell lines compared to healthy breast tissue samples, with expression levels influenced by therapeutic interventions. These findings support the potential role of HERVs as biomarkers for breast cancer diagnosis, prognosis, and therapeutic monitoring.

Serum Levels of Lipocalin-2/NGAL, Kidney Injury Molecule 1 (KIM-1), and Interleukin-18 Are Not Related to Risk Predictions for Cardiovascular and Renal Events in Type 2 Diabetes

Mon, 14 Sep 2026 00:00:00 GMT

Type 2 diabetes is currently one of the leading causes of cardiovascular and renal morbidity and mortality. The quest for reliable biologic markers for future cardiovascular and renal events is still ongoing.Objective. This study was designed to explore serum levels of Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1), and Interleukin-18 (IL-18) in type 2 diabetes patients and to describe their relationship with computer-based predictions for future cardiovascular (CV) and renal events.Materials and methods. This was a cross-sectional observational study. One hundred sixty-five patients with type 2 diabetes participated: 1) group A – non-insulin hypoglycemic treatment (84 patients); 2) group B on insulin treatment (with or without added oral agents, 81 patients). The glycemic and metabolic parameters were assessed by routine methods: glycated hemoglobin A1c in % and mmol/mol, lipid profiles (mmol/l), serum creatinine in μmol/l urinary albumin/creatinine ratio (ACR in ma/mmol/l and μa/mg). and estimated glomerular filtration rate (eGFR in ml/min/1.72 m2) using the MDRD formula, Interieukin-18 and Lipocalin-2/NGAL were measured by ELISA (BioVendor), while Human KIM-1 was measured using the FineTest Kit (Wuhan Fine Biotech Co.). Cardiovascular risks were calculated using the UKPDS version 2.0 and the ADVANCE risk engines. In addition, the ADVANCE risk engine allowed predictions about future renal events. All statistical analyses were performed on an IBM SPSS 19.0 for Windows platform (SPSS Corp., Chicago, IL).Results. The three markers did not differ between patients treated with insulin or non-insulin drugs. We found minor differences in levels of NGAL and IL-18 in patients with CKD grade 4 only, as well as of KIM-1 in CKD grade 1. No intergroup differences based on the presence/grade of albuminuria were detected. No differences in the three kidney markers were detected among the three risk groups for coronary artery disease based on the ADVANCE and UKPDS formulas. No differences were found in the three ADVANCE-based risk groups for renal events or new-onset albuminuria except for the levels of KIM. The correlation analyses were unable to find a relationship between the renal markers and the calculated risk for CV or renal events.Conclusion. Our results show an almost complete lack of relationship between the three markers for kidney damage (IL-18, NGAL, and KIM- 1) and the calculations of long-term CV- and renal risks. The presence/absence of CKD and/or albuminuria did not affect the mean levels of the three markers. Therefore, those markers should be regarded as indicators for acute kidney damage only without any direct relationship to the actual renal or CV-conditions or calculated future risks.

Platelet Parameters as Indicators of Arteriovenous Fistula Thrombosis in Hemodialysis Patients

Mon, 14 Sep 2026 00:00:00 GMT

Background: The total number of platelets (PLT), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) are utilized as markers of platelet activation in assessing thrombotic vascular events. Given the critical importance of maintaining adequate vascular access, i.e., arteriovenous (AV) fistula, for the survival of hemodialysis (HD) patients, the question arises: Is it possible to detect changes in platelet parameters that indicate a connection to occurrences of thrombotic complications with AV fistula?Materials and methods: The study involved 100 patients diagnosed with end-stace renal disease, admitted to the Clinic of Hemodialysis at the University Clinical Center Sarajevo (UCCS). All patients underwent standard bicarbonate HD three times a week, utilizing a native AV fistula for access. The study group was divided into two subgroups: patients without confirmed AV fistula thmmbosis (AVF-nonT; n = 66) and patients with confirmed AV fistula thrombosis (AVF-T; n = 34). Anamnestic data and platelet parameter values were collected during the surveyed period.Results: The average value of the PLT was significantly lower (p = 0.001), while the average value of the MPV was significantly higher (p = 0.0001) in patients of the AVF-T group in relation to the patients in the AVF-nonT group. In differentiating patients of the AVF-T group and patients of the AVF-nonT group, PLT in peripheral blood had a moderately good diagnostic accuracy (AUC = 0.704; p = 0.001), and MPV had an excellent diagnostic accuracy (AUC = 0.991; p < 0.001).Conclusion: PLT and MPV can be used as effective biomarkers ofAV fistula thrombosis in patients undergoing chronic HD treatment.

Significance and Applicability of Some Inflammatory Markers in Patients Undergoing Hemodialysis

Mon, 14 Sep 2026 00:00:00 GMT

Introduction: Patients with end-stage renal disease treated with hemodialysis are increasing worldwide, and the main reasons for their shortened survival are cardiovascular and infectious events.Aim: The aim of our study was to monitor the levels of the most commonly used inflammatory markers in practice and to clarify their applicability in this subgroup of patients.Materials and methods: We studied the values of C-reactive protein, interleukin-6, procalcitonin, ferritin, and uric acid in 69 patients treated with hemodialysis for more than 90 days. Those who had clinical evidence of infection or active neoplasm were excluded from the study. We compared the data with sex, age, main diagnosis, and vascular access. By age, patients were divided into those under and over 65 years of age. The data were processed with Statistical Package for Social Sciences (SPSS), version 20.0 (IBM Corp., Armonk, NY). Statgraphics Plus, version 2.1, and EXCEL for Windows.Results: We found that the data for procalcitonin. interleukin-6. ferritin. and uric acid were significantly higher than the reference values for healthy individuals. The only indicator that showed comparable values with healthy individuals was CRP. At the same time, the results for CRP and IL-6 were significantly higher in the groups over 65 years of age (0.025 and 0. 006, respectively).Conclusion: According to our results, the only well-correlated and significant indicator in patients on hemodialysis treatment is CRP. Other markers should be used primarily to monitor the effect of the treatment.

Unraveling the Genetic Background of Cachexia in COPD: A Perspective Overview

Mon, 14 Sep 2026 00:00:00 GMT

Chronic obstructive pulmonary disease (COPD) is a multifactorial disorder influenced not only by environmental exposure but also by genetic susceptibility Recent advances in molecular genetics have enabled the identification of many candidate genes and genome-wide associations contributing to COPD development and its systemic manifestations. Cachexia in COPD is a syndrome that is associated with increased protein catabolism, severe weight loss, and reduction of muscle and adipose mass. The imbalance between protein synthesis and degradation, impaired skeletal muscle regeneration, and inflammatory activation are central mechanisms in its pathogenesis. The loss of muscle mass can be affected by mechanisms that participate in the balance between protein synthesis and protein breakdown. Thus, the impaired ability to regenerate skeletal muscle mass might contribute to the reduction of muscle mass in COPD and cachexia. Cachexia in these patients drastically increases treatment cost. Several genetic factors have demonstrated a significant association with both COPD and cachexia. Subjects with alpha- 1-antitrypsin deficiency (SERPINA1) are at increased risk of developing both conditions. Early candidate gene studies have implicated ACE, bradykinin receptor, vitamin D receptor, secretory phospholipase A2, and inflammatory cytokines (IL-1 /3, IL-6, TNF) in muscle loss and systemic inflammation. More recent GWAS and transcriptomic analyses have identified associations with EFNA2, BAIAP2, FTO, NEB, TPM1, and TPM2, highlighting molecular pathways involved in muscle remodeling, regeneration, and hypoxia response. The aim of this review is to summarize current evidence on the genetic factors contributing to cachexia in COPD, integrating findings from candidate gene studies and genome-wide analyses, and to discuss their potential biological and clinical implications.

Clinical and Mutagenic Spectrum of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4B: A Narrative Review

Mon, 14 Sep 2026 00:00:00 GMT

Avian influenza A(H5N1) is a highly pathogenic virus causing significant out-breaks in birds and sporadic human infections since 1997. The virus is classified into various clades based on genetic characteristics, and recently, concerns have been raised over the risk ofclade 2.3.4.4b becoming widespread and infecting humans. Since 1997, more than 1,000 infections with highly pathogenic avian influenza A(H5N1) virus among humans have been reported globally. Given ongoing A(H5N1) outbreaks in animals, understanding the frequency of A(H5N 1) virus infections ‘among asymptomatic persons can inform public health risk assessments and infection prevention guidance. We performed a literature search focusing on reported infections amona humans with Highly Pathogenic Avian Influenza (HPAI). This study was conceived as a narrative review focusing on clade 2.3.4.4b H5N1, but was expanded to all reported H5Nx and other zoonotic subtypes (H5N6, H6N1, H7N9, H10N3) when clade-specific data were sparse. Although not a formal systematic review, the search, screening, and appraisal followed the PRISMA 2020 Checklist for search reporting where applicable.

Synchronous Primary Atypical Pulmonary Carcinoid and Cecal Adenocarcinoma: A Case Report

Mon, 14 Sep 2026 00:00:00 GMT

Pulmonary carcinoid tumors are a rare subgroup of neuroendocrine lung neo-plasms, accounting for approximately 1-2% of all primary lung cancers. The occurrence of synchronous primary malignancies involving pulmonary carcinoid and colorectal adeno-carcinoma is exceptionally uncommon. We report a 78-year-old woman initially diagnosed with an endobronchial atypical carcinoid tumor of the left lower lobe. After initial refusal of surgical treatment by the patient and following endoscopic management, a left lower lobectomy with systematic lymphadenectomy was performed. Histopathology confirmed a G2 atypical carcinoid (pTIcNORO, stage I). One month later, the patient developed symptomatic anemia and abdominal pain. Colonoscopy revealed a stenosing adenocarcinoma of the cecum. A right hemicolectomy with en bloc resection of infiltrated adjacent structures was performed. Final staging demonstrated moderately differentiated adenocarcinoma (pT3N0R0, stage IIA). The postoperative course after both procedures was uneventful, and the patient was referred for adjuvant oncologic evaluation. Synchronous primary atypical pulmonary carcinoid and colorectal adenocarcinoma is rare. This case underscores the importance of distinguishing metastatic disease from synchronous independent primaries in elderly patients with newly diagnosed malignancies and highlights the role of multidisciplinary staged surgical management in achieving favorable outcomes.

Cardiac Resynchronization Therapy in a Patient with Total Correction of Tetralogy of Fallot and Right Ventricular Lead Dysfunction

Mon, 14 Sep 2026 00:00:00 GMT

Adults with congenital heart lesions constitute a rapidly growing group of patients with cardiovascular disease, with patients with surgically corrected Tetralogy of Fallot forming one of the most complex groups in terms of long-term therapeutic management. Although it can be surgically repaired, Tetralogy of Fallot remains a progressive condition in which heart failure becomes the main determinant of long-term clinical outcomes and mortality. Cardiac resynchronization therapy has a well-established role in the treatment of left ventricular systolic dysfunction with interventricular dyssynchrony, either due to left bundle branch block or due to chronic right ventricular pacing. Here, we present a case of a 52-year-old male patient with Tetralogy of Fallot who underwent radical surgical correction. The patient experienced the typical progression of conduction abnormalities associated with this defect, requiring permanent pacemaker implantation. Because of confirmed septal dyskinesia and bordedine left ventricular function (Left Ventricular Ejection Fraction of 45%), the patient was referred for cardiac resynchronization therapy pacemaker. Precise anatomical assessment of the new pacing system and postoperative status was assessed by multislice cardiac computed tomography. This case illustrates the critical transition from conventional pacing to cardiac resynchronization therapy pacemaker. During the 8-month follow-up, achieving electromechanical synchrony in both the left ventricle and right ventricle was confirmed, resulting in significant clinical improvement.

Association Between Serum Vitamin D, Insulin Resistance (HOMA-IR), and Gestational Diabetes Mellitus

Mon, 14 Sep 2026 00:00:00 GMT

Aim. To investigate whether early pregnancy serum vitamin D levels and insulin resistance (HOMA-IR) are associated with the development of gestational diabetes mellitus (GDM).Materials and methods. This prospective cohort study was conducted between 2023 and 2025 and included 850 pregnant women enrolled during early gestation. Baseline serum Vitamin D concentrations were measured. Fasting plasma glucose and fasting insulin were determined, and HOMA-IR was calculated. Participants were followed until 24–28 weeks of gestation, when GDM was diagnosed using a standardized 75 g oral glucose tolerance test. Correlation analysis and multivariate logistic regression were performed to determine associations and predictive relationships.Results. Women who developed GDM had significantly higher pre-pregnancy BMI (M = 29.8, SD = 5.1) compared to non-GDM women (M = 26.4, SD = 4.7), t(848) = 7.5, p < .001. Similarly, HOMA-IR was significantly elevated in the GDM group (M = 4.3, SD = 1.5) compared to the non-GDM group (M = 3.1, SD = 1.1), t(848) = 9.8, p <0.001. Fasting plasma glucose and fasting insulin were also higher among women with GDM (glucose: M = 5.2, SD = 0.5 vs. M = 4.9, SD = 0.4, t(848) = 5.8, p < .001; insulin: M = 18.5, SD = 5.6 vs. M = 14.3, SD = 4.8, t(848) = 9.2, p < 0.001). There were no statistically significant differences in maternal age (t(848) = 1.8, p = 0.07) or serum vitamin D levels (M = 23.6, SD = 7.2 vs. M = 24.1, SD = 6.8, t(848) = 0.9, p = 0.36) between the groups.Conclusions. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was independently associated with increased risk of gestational diabetes mellitus, while serum vitamin D levels showed no significant relationship, and HOMA-IR demonstrated excellent predictive accuracy for GDM.

Half a Century of Kingella Kingae: A Literature Review from a Pediatric Rheumatology Perspective

Mon, 14 Sep 2026 00:00:00 GMT

ObjectiveTo review the current knowledge on Kingella kingae infections in children from a pediatric rheumatology perspective, focusing on epidemiology pathogenesis, clinical features, diagnostic methods, and treatment strategies.Materials and methodsA literature search was conducted using PubMed and Google Scholar (2010–2025) with keywords including “Kingella kingae”, “pediatric rheumatology”, “osteomyelitis”, “septic arthritis”, “spondylodiscitis”, and “diagnostic techniques”. Studies were selected based on clinical relevance, methodological quality and contribution to understanding pediatric Kingella kingae infections, prioritizing recent reviews, original research, clinical guidelines, and seminal historical studies.ResultsKingella kingae has become a leading cause of osteoarticular infections in children under four years, often presenting with mild or afebrile symptoms and modest inflammatory markers. It can cause septic arthritis, osteomyelitis, spondylodiscitis, and tenosynovitis. Advances in nucleic acid amplification assays have improved detection over traditional culture methods. The RtxA toxin and outer membrane vesicles play key roles in pathogenicity, β-lactam antibiotics are highly effective, with short-course regimens increasingly favored. Remaining challenges include diagnostic delays, limited access to molecular testing, and a lack of standardized treatment guidelines.ConclusionEarly recognition of Kingella kingae infections is essential to prevent morbidity Pediatric rheumatologists and orthopedics should maintain a high index of suspicion in children aged 6-48 months with subtle musculoskeletal symptoms. Further research is needed to refine diagnostic algorithms, optimize antibiotic regimens, and understand regional epidemiological variations.

Errata

Tue, 16 Jun 2026 00:00:00 GMT

Role of Calcium Signaling in the Pathogenesis of Neurodegenerative Diseases

Tue, 16 Jun 2026 00:00:00 GMT

Calcium (Ca²+) is a central intracellular second messenger regulating cellular homeostasis through tightly controlled signaling. Intracellular Ca²+ dynamics depend on coordinated interactions between the endoplasmic reticulum (ER), mitochondria, and plasma membrane channels, including SERCA (Sarcoplasmic/Endoplasmic Reticulum Ca²+- ATPase, which is a calcium pump located in the sarcoplasmic and endoplasmic reticulum (SR and ER) pumps, inositol 1,4,5-trisphosphate receptors (IP3Rs), ryanodine receptors (RyRs), transient receptor potential (TRP) channels, and store-operated calcium entry (SOCE). ER–mitochondria contact sites integrate calcium signaling with mitochondrial energetics, oxidative stress responses, autophagy, and apoptosis. Changes in calcium signaling play a key role as a risk factor in the pathogenesis of neurodegenerative diseases, with calcium influx pathways, including store-operated calcium entry (SOCE), critically implicated in their pathophysiology. Despite ongoing research, these diseases remain incurable, and current therapies provide only symptomatic relief. Restoration of calcium signaling homeostasis is proposed as a potential therapeutic target for the treatment of neurodegenerative disorders. Proper functioning of calcium signaling pathways is critical for neuronal function. It has been clearly demonstrated that dysregulation of calcium signaling is a common feature of neurodegenerative diseases. Abnormal Ca²+ signaling leads to mitochondrial dysfunction and synaptic instability, and restoration of normal calcium homeostasis is a potential strategy for treating these diseases. SOCE impairment is observed in Alzheimer’s disease (AD), Huntington‘s disease (HD), and Parkinson‘s disease (PD). This review summarizes mechanistic insights into calcium signaling alterations involved in neurodegeneration, focusing on ER calcium storage, SERCA function, SOCE regulation, and calcium-dependent signaling pathways. Emerging neuroprotective strategies targeting calcium homeostasis, including pharmacological agents and natural bioactive compounds, are discussed. Restoration of intracellular Ca²+ balance represents a promising therapeutic approach to reduce calcium-mediated cytotoxicity and slow neurodegenerative progression.

Unicompartmental Knee Arthroplasty: Current Surgical Approaches, Indications, Outcomes, and Future Perspectives

Tue, 16 Jun 2026 00:00:00 GMT

Background. Unicompartmental knee arthroplasty (UKA) is increasingly recognized as a suitable alternative to total knee arthroplasty (TKA) for patients with osteoarthritis limited to a single tibiofemoral compartment. Once considered appropriate only for older, less physically active individuals, its use has broadened to include younger and more active patients, supported by advances in implant design and refinement of surgical methods. This review aims to outline the current indications, operative techniques, clinical results, and complications of UKA, while addressing emerging evidence and evolving practices.Materials and methods. A narrative literature review was conducted using PubMed, Scopus, and Web of Science, covering publications from 2000 to 2025. Key historical studies were included to provide context on UKA development. Studies were selected based on methodological quality and relevance to clinical decision-making.Results. Studies indicate that UKA can achieve excellent survivorship and often allows quicker rehabilitation and more natural knee motion than TKA, particularly in carefully selected patients. Bone preservation and minimally invasive approaches facilitate future revision if necessary. Results still depend on the careful patient selection and surgeon experience. The main complications reported include bearing dislocation, infections, polyethylene wear, and component loosening.Conclusion. Unicompartmental knee arthroplasty represents a reliable surgical solution for isolated compartment osteoarthritis when performed in carefully selected patients. The growing use of robotic assistance and newer implant designs, along with broader indications, may further strengthen the role of UKA in managing knee arthritis. Although long-term evidence is still emerging, recent studies show promising results.

Incidental Splenic Lesions in a Complex Surgical Patient: A Diagnosis and Management Dilemma

Tue, 16 Jun 2026 00:00:00 GMT

Introduction: Incidental splenic lesions discovered during unrelated imaging often require additional radiological workup for defining differential diagnosis. This conventional framework may be inadequate for suspicious splenic capsule lesions encountered during unrelated surgery, which pose a diagnostic and management challenge.Case presentation: A 41-year-old female was found to have papular capsular splenic lesions during robotic bilateral salpingo-oophorectomy that was not addressed during the procedure. The patient subsequently underwent a robotic partial splenectomy due to concern for malignancy. Histopathology report revealed benign splenic parenchyma with capsular adhesions.Discussion: Capsular splenic lesions are rare findings during abdominal surgeries and thus may pose diagnostic and management dilemma. In such cases, laparoscopic or robotic-assisted partial splenectomy can provide a safe and effective diagnostic tool while preserving splenic function.Conclusion: This case highlights the importance of including splenic adhesions in the differential for atypical splenic lesions.

Current Therapeutic Approaches to Cerebral Metastases in Melanoma Patients

Tue, 16 Jun 2026 00:00:00 GMT

Brain metastases from melanoma (MBMs) present significant treatment challenges due to their aggressive nature and the complexity of managing both intracranial and extracranial disease. Advances in systemic therapies, including immune checkpoint inhibitors (ICIs) and targeted agents, such as BRAF and MEK inhibitors, have improved outcomes for MBM patients, particularly those with asymptomatic disease. Combination therapies, especially nivolumab plus ipilimumab, have shown higher intracranial response rates and durable control compared to monotherapies. Local treatments, including stereotactic radiosurgery (SRS) and surgical resection, remain vital for managing symptomatic or large lesions and may enhance systemic therapy efficacy when integrated appropriately. Recent evidence suggests synergy between ICIs and radiation, leading to improved tumor control and survival, though risks of radiation necrosis require further study. Despite the decline in whole-brain radiotherapy (WBRT) due to limited survival benefits and cognitive side effects, its role as adjuvant therapy after SRS or surgery continues to be explored. Multidisciplinary approaches tailored to individual patient characteristics are essential to optimize outcomes. Ongoing clinical trials will further clarify the safety and efficacy of combined systemic and local treatment modalities in MBM management.

Pharmacological, Optical, and Combined Approaches to Myopia Control in Bulgarian Children: A Longitudinal Study

Tue, 16 Jun 2026 00:00:00 GMT

This study presents different treatments, including both medication and glasses, that affect the progression of myopia in children over time. A total of 250 children aged 6 to 16 were evaluated for a period of 36 months. For the purpose of the study, four groups were formed: one group of pediatric patients receiving low-dose atropine (0.01%), another group wearing defocus-modifying glasses, a third group receiving both treatments, and a control group with no treatment. Key biometric indicators, such as axial length, spherical equivalent, and best-corrected visual acuity, were measured at the start of the study and after that every six months. Non-parametric statistical methods were used to compare changes within each group over time and to identify differences between groups. The protocol achieved high data completeness and showed significant changes within the groups (p<0.001). Clear differences between groups appeared after 12 months. The results suggest that combining atropine and defocus lenses is most effective in slowing myopia progression while maintaining good vision.

Febrile Maculopapular Exanthem Associated with Influenza a Subtype H3N2 Viral Infection: A Rare Manifestation and a Review of the Literature

Tue, 16 Jun 2026 00:00:00 GMT

Background: Influenza A-associated cutaneous manifestations are rare in adults and are poorly characterized, especially in infections, due to seasonal H3N2 strains. Awareness of influenza-related exanthems is clinically important because misdiagnosis may delay antiviral therapy and broaden unnecessary investigations.Case presentation: We report a case of a previously healthy 21-year-old man presenting with high-grade fever, pharyngitis, non-pruritic maculopapular rash, and pronounced lymphopenia. An influenza A/H3N2 infection was identified by rapid antigen testing and multiplex respiratory PCR. Further investigation ruled out other viral and bacterial infections, as well as medications, as a cause of the exanthem. He had a rapid clinical improvement with oseltamivir therapy, with complete resolution of fever and significant regression of rash by day 5.Discussion: Adult-onset maculopapular exanthems associated with influenza A infection are rare and might closely resemble other viral exanthems, hypersensitivity reactions, or streptococcal diseases. This case broadens the dermatologic spectrum of influenza A/H3N2 and highlights the need to consider influenza as a cause of febrile rash syndromes during epidemic seasons. Review of the literature shows limited, but consistent, documentation of similar presentations, mainly attributed to H1N1 strains.Conclusion: Influenza A/H3N2 infection should be considered in the differential diagnosis of acute febrile maculopapular rash in adults. Early antiviral therapy may promote rapid clinical improvement and avoid unnecessary procedures. This case underscores the need for greater recognition of dermatologic manifestations related to influenza infection in order to enhance diagnostic precision and patient care.