Polyclinic General Hospital

To provide an ESSKA-ESA formal Consensus to help general practitioners in their daily clinical decisions regarding the diagnosis and treatment of traumatic anterior shoulder instability (TASI) according to age and timing after injury. Part 1 is dedicated to the history-taking, physical examination and imaging studies. Patients were categorised into three age groups: adolescents (<20 years), young adults (20-40 years) and older adults (>40 years). Two clinical scenarios were addressed: first-time and recurrent dislocations. A formal consensus process was followed, including a steering group (15 experts from 9 countries), a rating group (18 experts from 18 countries) and a reader group (28 experts from 13 countries). The steering group formulated 35 clinical questions, 12 of which related to Part 1. Each question was answered with a statement and grade of recommendation (A-D), based on literature and expert opinion. The rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Consensus was reached with high agreement: median (range) 9 (8-9). One question received a grade A recommendation, nine were B, and two were C. Most debated topics included imaging to guide treatment decisions in first-time dislocations, assessment of glenoid bone loss, and soft tissue quality. Each age group presents unique diagnostic considerations: younger patients have higher recurrence risk and activity levels; older patients more often present with associated soft-tissue injuries. While physical exam findings were consistent across ages, associated injuries gain importance with age. The distinction between first-time and recurrent dislocations significantly impacts imaging needs. The ESSKA-ESA Consensus highlights that age and timing (first-time versus recurrent) influence the decision-making when managing TASI. All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. Level II.

Background. The gut microbiota plays a key role in metabolic regulation and is increasingly recognized as a mediator of lifestyle-related health outcomes. Physical activity has emerged as a potential modulator of microbial composition and function. Aim. This narrative review aims to summarize current evidence on the relationship between physical activity and the gut microbiota and to evaluate its implications for metabolic health. Materials and Methods. A PubMed search of English-language studies published over the last 10 years was conducted to assess the effects of physical activity on the gut microbiota and metabolic health. Additional studies were identified through reference screening. Results. Regular moderate physical activity is associated with increased microbial diversity and a higher abundance of beneficial bacteria, including short-chain fatty acid producers. These changes are linked to improved glucose metabolism, reduced inflammation, and enhanced intestinal barrier function. However, excessive or prolonged high-intensity exercise may induce adverse effects, such as increased gut permeability and dysbiosis. The observed effects are strongly influenced by diet and individual factors. Conclusions. The gut microbiota represents an important mediator of exercise-induced metabolic adaptations. Combined lifestyle interventions, particularly physical activity and a fiber-rich diet, may provide synergistic benefits. Further research is needed to develop personalized strategies targeting the gut microbiota in metabolic disease prevention.

Vein grafting may provide a valuable option in microvascular free flap reconstruction for head and neck cancer when direct anastomosis is not feasible. This study assesses indications and outcomes, reappraises prevailing assumptions, and delineates clinical contexts in which the technique could enhance reconstructive reliability and success. This retrospective study evaluates the use of vein grafts in microvascular free flap reconstruction for head and neck malignancies. Among 51 consecutive patients treated at S. Marco Hospital, University of Catania (2021-2024), 11 underwent vein grafting. In 4 cases, grafting was adopted as a secondary measure following anastomotic failure or excessive vessel distance that precluded direct anastomosis; in 7, it was planned from the outset due to anticipated vessel misalignment or insufficient pedicle length. The external jugular vein served as the graft conduit in all cases. Among 11 patients, 5 underwent radial forearm flap, 2 fibular flap, 2 anterolateral thigh (ALT), and 2 latissimus dorsi flap. Four patients underwent radiotherapy, whereas 2 are still awaiting evaluation. Only 1 case resulted in flap necrosis, requiring surgical revision. Complications were minimal, with 1 case of wound dehiscence. No cases of venous thrombosis, arterial insufficiency, or total flap loss occurred beyond the single necrosis case. The overall flap survival rate was 91%. Vein grafting is a safe, effective adjunct for head and neck free flap reconstruction, particularly when pedicle-recipient mismatch or thrombosis precludes direct anastomosis, and can improve outcomes in complex cases.

Amniotic fluid (AF) plays a critical role in fetal development by providing mechanical protection, thermoregulation, and a medium for nutrient exchange [1,2]. Traditionally considered sterile in healthy pregnancies, recent molecular studies have suggested the presence of microbial DNA in AF, although these findings remain controversial due to the challenges of contamination in low-biomass samples [3–8]. In this cross-sectional study, we analyzed 73 AF samples from uncomplicated term pregnancies using a controlled real-time PCR approach targeting common bacterial and fungal taxa. Samples were collected under strict sterile conditions at a private general hospital in Skopje, with informed consent obtained from all participants under ethical approval from the Faculty of Medicine, University in Skopje, North Macedonia. No microbial DNA was detected above negative controls, supporting the notion that AF in healthy term gestations represents a sterile or extremely low-biomass environment [6–20]. Our study is, to our knowledge, the first molecular study of this type conducted in the Republic of North Macedonia, providing original molecular evidence regarding the microbial status of AF. Our results highlight the importance of rigorous contamination-aware methodologies when studing low-biomass intrauterine environments and contribute to understanding the timing of initial microbial colonization and neonatal microbiome establishment [9–11,15,17–20].

Accidental hypothermia (AH) in hospitalized adults is an under-recognized condition associated with increased morbidity, mortality, and prolonged hospital stays. Unlike primary AH caused by environmental exposure, inpatient hypothermia is often secondary to acute illness, comorbidities, iatrogenic factors, or medications that impair thermoregulation. We systematically reviewed studies reporting risk factors, management strategies, and clinical outcomes of AH in adults (≥18 years). Five studies, including 1,698 patients, met the inclusion criteria. Common risk factors were advanced age, male sex, alcohol use, reduced functional status, sepsis, endocrine or neurological disorders, and hospital-related exposures such as cool environments or unwarmed intravenous fluids. Management strategies comprised passive external, active external, and active internal rewarming, with ICU monitoring for moderate-to-severe cases. In-hospital mortality ranged from 13% to 26%, with complications including arrhythmias, coagulopathy, infection, and prolonged length of stay; trauma-specific populations had significantly higher mortality (OR ~5.18). These findings highlight the need for early recognition, targeted rewarming, and preventive measures in high-risk inpatients. Future multicenter prospective studies with standardized definitions and predictive models are required to optimize detection, management, and outcomes of AH in hospitalized adults.

Dental caries is a disease that can damage the tooth structure, leading to cavities. However, the symptoms of decay are often unnoticed until a toothache develops, which can lead to cavities. Severe cases of dental caries, which cause cavities, require direct inspection. With early diagnosis of decay, preventive measures and treatment steps can be taken sooner. This helps prevent further development of tooth damage and reduces the need for more invasive restorative treatments. Therefore, this study develops a classification model for dental caries using Convolutional Neural Network architectures, namely Residual Network (ResNet)-50, EfficientNet B4, and MobileNet V2, where images are classified into two classes: decayed and normal teeth. The dataset comprises 700 dental images. Model evaluation includes accuracy, precision, recall, and F1-score. Experimental results indicate that the EfficientNet B4 model outperforms MobileNet V2 and Residual Network (ResNet)-50 architectures in classifying dental caries. Specifically, EfficientNet B4, trained on the lower occlusal dataset with a learning rate of 10⁻⁵, batch size of 16, and 200 epochs, achieves an accuracy of 77%, precision of 78%, recall of 77%, and F1-score of 77%. When the model is trained using a learning rate of 10⁻⁴, it achieves a better accuracy of 81%. The superiorperformance of EfficientNet B4 comes from its depthwise separable convolutions and squeeze-and-excitation (SE) blocks, which improve how features are extracted. These results show the promise of deep learning models in identifying dental cavities, leading to better diagnostics for oral health. However, an expanding dataset diversity is needed in further research for model generalization enhancement, aiming to ensure model’s robustness to apply in clinical settings.

Aim . To analyze the incidence of osteosarcopenic obesity (OSO) using various fat depot indices in patients with multivessel coronary artery disease. Material and methods . A total of 800 patients were included, with in­dices assessed after 12 months. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older Peop­le (EWGSOP, 2019), and osteopenic syndrome was diagnosed according to World Health Organization (WHO, 2008) guidelines. Sarcopenia was screened using the SARC-F questionnaire, handgrip test, multislice computed tomography (CT) of muscle tissue, and dual-energy X-ray absorptiometry. Body mass index (BMI) was assessed. Bioimpedance analysis, computed tomography, and adipose tissue ultrasound were performed. Statistical significance was considered at p≤0,05. Results . A BMI &gt;30 kg/m 2 was more common at baseline in women (50,9%) compared to men (38,6%) (p=0,002), and in the prospective phase — 59,2% and 40,0%, respectively (p=0,001). Visceral fat values based on CT were higher in men, consistent with bioimpedance analysis and ultrasound findings. Subcutaneous fat thickness in women was higher than in men. Given the CT limitations and the inability to assess the musculoskeletal component using ultrasound, bioimpedance analysis can be used as an alternative diagnostic method for OSO. Conclusion . The incidence of obesity depended on the diagnostic method and ranged from 38,7% to 81,2% in men and 31,0% to 91,2% in women. An analysis of the detection rate of visceral adipose tissue components revealed sex differences and variations in the studied indicator depending on the diagnostic method (from 2,0% for BMI to 16,4% for intraabdominal fat thickness).

Holodiastolic flow reversal in the descending aorta can complicate acute myocarditis, indicating decreased cardiac output and possible aortitis. This pathology is related to the disappearance of the 'Windkessel' phenomenon, normally enabling the aortic walls to store potential energy during systole, which is released to the thoracic aorta blood flow during diastole. Furthermore, severe low-output syndrome or distributive shock can render the aortic walls incapable of exploiting their elasticity, which usually enhances the power of aortic blood flow. Moreover, the increased release of catecholamines, or their large-scale administration, causes vasoconstriction, mainly in the abdominal aorta and iliac-femoral branches. This increases peripheral resistance, but to a lesser extent in the supra-aortic branches, whose network becomes competitive and remains supplied with a sufficient amount of blood. From a pathological point of view, aortitis can be caused by an increase in the release of inflammatory cytokines, enhanced by ischemia resulting from a decrease in blood supply from the vasa vasorum, a consequence of shock. This pathology, easily detected by Echocardiography, must be considered an important sign of shock and is worthy of further investigation using 4D MRI aortic angiography.