Folia medica最新文献

{"title":"Non-invasive mechanical ventilation in children: a four-year retrospective review.","authors":"Lilia Bozadzhieva, Lyubomila Ilarionova, Tania Teneva, Blagomir Zdravkov, Guergana Petrova","doi":"10.3897/folmed.68.e183527","DOIUrl":"10.3897/folmed.68.e183527","url":null,"abstract":"<p><p>Introduction: Non-invasive ventilation (NIV) is becoming more common in the treatment of respiratory failure in children, but its effectiveness varies with the severity of the underlying disease.\u0000\u0000Aim: The study’s objective was to assess, over a four-year period, the indications, physiological effects, and clinical outcomes of NIV in children admitted to a pediatric intensive care unit (PICU) with acute or chronic respiratory failure.\u0000\u0000Materials and methods: This retrospective, single-center study included 25 children who received NIV between 2021 and 2025. Demographic data, underlying diagnoses, type of respiratory failure, inflammatory markers, radiological findings, NIV interface, gas exchange parameters before and after NIV, and clinical outcomes were analyzed.\u0000\u0000Results: The median age was 3.9 years (range 0–17), with 68% being male. Neuromuscular disorders were the leading indication (55%), followed by primary pulmonary disease (37%). Spinal muscular atrophy type 1 was the most common specific diagnosis. Interface use was age-dependent: infants predominantly received nasal masks/prongs, while older children used oronasal or full-face masks. NIV produced significant improvements in gas exchange (p<0.05), indicating effective correction of respiratory acidosis and hypoxemia. Radiology and inflammatory markers distinguished two clinical phenotypes. Children with primary respiratory disease, genetic syndromes, or systemic comorbidities frequently showed pneumonic infiltrates and markedly elevated CRP/PCT, indicating infection-driven respiratory failure. In contrast, neuromuscular patients demonstrated minimal inflammatory elevation and chronic or atelectatic radiographic patterns, consistent with ventilatory pump failure. The S/F ratio at initiation strongly predicted outcome: all children with an S/F ratio <150 experienced NIV failure or death, whereas those with an S/F ratio >250 showed successful recovery. NIV duration was longest in neuromuscular disorders (mean 48 days), reflecting chronic ventilatory insufficiency.\u0000\u0000Conclusion: NIV is effective in improving gas exchange in both acute and chronic respiratory failure in children. Clinical outcome depends on underlying diagnoses, inflammatory activity, radiologic pattern, and initial oxygenation status. The S/F ratio is a reliable predictor of NIV success.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achalasia in a 15-year-old child with recurrent respiratory infections: a case report.","authors":"Norin Khan, Albena I Spasova, Yordan I Trifonov, Svetlana A Velizarova, Petar I Trifonov, Edmond V Rangelov, Nikola K Kartulev, Zdravka Antonova, Velichka D Oparanova, Nadezhda Tolekova, Hristo Shivachev, Natalia Gabrovska","doi":"10.3897/folmed.68.e166816","DOIUrl":"10.3897/folmed.68.e166816","url":null,"abstract":"<p><p>Achalasia is a rare childhood disease. We report a case of a 15-year-old child with recurrent respiratory infections over the past 5 years. Due to positive household contacts with relatives with positive sputum pulmonary tuberculosis, he was referred to our pulmonology clinic. The child exhibited symptoms of failure to thrive, fatigue, intermittent fever, and chronic dry cough. A detailed medical history revealed that the child vomited almost after every meal and had regurgitation and odynophagia. On physical examination, the child was in a poor general condition, with an intoxicated appearance, febrile (38.5°C), with asthenic habitus, and with evidence of respiratory failure. The chest X-ray shows a strongly enlarged paratracheal shadow and infiltrative changes in the left lower lung lobe, which indicated various conditions affecting the trachea, mediastinum, or pleura. A CT scan of the lungs revealed severe long-term esophageal achalasia with an extremely dilated lumen measuring 69×58 mm in axial size. The bird’s beak sign in the esophagus was seen on a barium swallow. An esophagoscopy was performed in a surgery clinic, during which a large amount of food material was removed. Three dilations of the esophagus were performed, followed by a one-month period of nutritional support. A laparoscopic Heller myotomy was performed, followed by four balloon dilations of the cardia under endoscopic control using pneumatic and hydrostatic dilators over a period of one year with significant clinical improvement.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calf and mid-upper arm circumference as screening tools for sarcopenia in elderly diabetics: evidence from primary healthcare centers.","authors":"Alif Adlan Zulizar, Nabil Hajar, Lukman Faishal Fatharani, Gita Nurtaningtyas Aini, Tsaqifatul A'izza, Mickhael Sandyka, Muhamad Zidan Akmal Hisani, Bagas Iqbal Pahlevi, Thoha Ibnu Muwaffaq","doi":"10.3897/folmed.68.e184141","DOIUrl":"10.3897/folmed.68.e184141","url":null,"abstract":"<p><p>Introduction: The bidirectional relationship between sarcopenia and type 2 diabetes mellitus (T2DM) in the elderly creates a detrimental metabolic cycle where insulin resistance accelerates muscle wasting. In resource-limited primary care settings, the lack of advanced diagnostic imaging necessitates the validation of accessible, non-invasive screening tools, such as anthropometric parameters, muscle strength, physical performance, and glycemic control, as surrogate markers for identifying muscle mass depletion.\u0000\u0000Aim: To evaluate correlations between anthropometric parameters, muscle strength, physical performance, and glycemic control with skeletal muscle mass (SMM) in elderly patients with T2DM.\u0000\u0000Methods: A cross-sectional study was conducted with 203 elderly T2DM patients at a primary healthcare center. Anthropometric measurements included mid-upper arm circumference (MUAC) and calf circumference (CC). The skeletal muscle mass was measured via bioelectrical impedance analysis, muscle strength via handgrip dynamometry, and physical performance via the timed up and go test (TUGT). Glycemic control data (HbA1c and fasting blood glucose) were retrieved from medical records. Data were analyzed using Pearson and Spearman correlation tests and multiple linear regression.\u0000\u0000Results: The prevalence of sarcopenia was 41.4%. Multiple linear regression identified CC as the strongest independent predictor of SMM (β=0.370, p=0.000), followed by BMI (β=0.327) and MUAC (β=0.193), with the model explaining 49.6% of SMM variance (R2=0.496).\u0000\u0000Conclusion: CC and MUAC are valid, low-cost screening alternatives for SMM assessment in resource-limited settings. CC, in particular, serves as a robust indicator for early sarcopenia detection.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromodulation with pulsed radiofrequency of the sphenopalatine ganglion in selected forms of chronic headache.","authors":"Todor Shamov, Georgi Krasimirov Georgiev, Demetrio Atanasov","doi":"10.3897/folmed.68.e179522","DOIUrl":"10.3897/folmed.68.e179522","url":null,"abstract":"<p><strong>Introduction: </strong>The article examines the role of the sphenopalatine ganglion (SPG) in the pathogenesis of various pain syndromes involving the head and neck, particularly in trigeminal autonomic cephalalgias.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of postintubation tracheal stenosis: a clinical case.","authors":"Boyko Yavorov, Vladimir Aleksiev, Hristo Stoev, Martin Karlyukov, Filip Shterev, Stanislav Kartev, Zaprin Vazhev","doi":"10.3897/folmed.68.e156282","DOIUrl":"10.3897/folmed.68.e156282","url":null,"abstract":"<p><p>Postintubation tracheal stenosis, a complication of prolonged mechanical ventilation via orotracheal intubation, often presents with stridor and dyspnea due to tracheal fibrosis and scarring, typically distal to the cricoid cartilage. Its complex nature necessitates a multidisciplinary approach and expertise in tracheal, thyroid, mediastinal, and neurovascular surgical techniques. This case report details the clinical management of postintubation tracheal stenosis, highlighting a successful tracheal resection and anastomosis procedure.\u0000\u0000A patient, S.A., presented at the Thoracic Surgery Department, UMHAT Kaspela, Plovdiv, with respiratory distress, including stridor and dyspnea, following 10 days of mechanical ventilation for aspiration pneumonia. The diagnostic workup included thoracic computed tomography (CT), video bronchoscopy, echocardiography, and pulmonary function tests. Surgical intervention involved Kocher’s cervicotomy, tracheal mobilization, circular resection of the stenotic segment, and termino-terminal anastomosis. Intraoperative video bronchoscopy confirmed stenosis location and post-anastomosis tracheal integrity. The patient recovered uneventfully and was discharged in satisfactory condition.\u0000\u0000Surgical management of postintubation tracheal stenosis, when guided by early diagnosis, precise imaging, and a multidisciplinary approach, yields favorable outcomes. This case underscores the importance of surgical expertise and meticulous planning in achieving successful results.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of NGAL, eGFR, and tubular injury markers for early detection of chemotherapy-induced nephrotoxicity in pediatric oncology patients.","authors":"Petya Markova, Antoniya Yaneva, Mariya Spasova, Stoyan Markov, Kostadin Kostadinov","doi":"10.3897/folmed.68.e184913","DOIUrl":"10.3897/folmed.68.e184913","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury is a common complication in children with oncological diseases. Its etiology is multifactorial, with key risk factors including drug-induced nephrotoxicity, tumor lysis syndrome, and infection-including sepsis during periods of aplasia. The classical diagnostic criteria for AKI rely on monitoring serum creatinine levels and detecting oliguria. In the context of drug-induced nephrotoxicity, the predominant pathophysiological mechanism is tubular injury, which is typically non-oliguric and may not cause changes in serum creatinine, even in cases of severe damage.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotator cuff tear arthropathy and reverse total shoulder arthroplasty: biomechanics and contemporary designs.","authors":"Nikolay Cherkezov, Daniela Kovacheva-Predovska, Nikolay Dimitrov","doi":"10.3897/folmed.68.e183236","DOIUrl":"10.3897/folmed.68.e183236","url":null,"abstract":"<p><p>Rotator cuff tear arthropathy (RCTA) is a complex condition characterized by rotator cuff insufficiency, altered shoulder kinematics, and progressive joint degeneration. In advanced stages, it results in pain, loss of active elevation, and significant functional impairment. Reverse shoulder arthroplasty (RSA) is now the best surgical option for advanced RCTA because it restores shoulder elevation by changing how the joint works and making the rotator cuff less important.\u0000\u0000The original RSA concept focused on medialization and distalization of the center of rotation to increase the deltoid moment arm, improve joint stability, and allow active elevation in the absence of a functional rotator cuff. Although this design provided clinical improvement, it also revealed biomechanical limitations, including scapular notching and restricted rotational range of motion, among others.\u0000\u0000In response, contemporary RSA systems have evolved design modifications, such as lateralization and glenosphere eccentricity, inferior tilt, variable humeral neck-shaft angles, and modular humeral socket configurations. These strategies aim to optimize deltoid efficiency, minimize impingement, and improve range of motion. Despite the availability of numerous implant designs, no consensus exists regarding the optimal combination of components or positioning parameters. A comprehensive understanding of RSA biomechanics associated with modern designs is essential for implant selection and surgical planning in patients with RCTA.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic fractures of the proximal femur: Can we rely on the Vancouver classification as a prognostic tool?","authors":"Federico Falcinelli, Sara Barderi, Belinda Misso, Luca Fabbri, Giuseppe Digrandi, Edoardo Ipponi, Stefano Marchietti, Paolo Domenico Parchi","doi":"10.3897/folmed.68.e185237","DOIUrl":"10.3897/folmed.68.e185237","url":null,"abstract":"<p><p>Introduction: Periprosthetic fractures’ incidence is increasing, leading to growing concerns on their impact on patients’ clinical conditions and healthcare systems budgets.\u0000\u0000Aim: Evaluation of the clinical impact of periprosthetic fractures and their treatment on patients’ functionality and quality of life\u0000\u0000Materials and methods: We reviewed all hip periprosthetic fractures treated surgically between 2018 and 2024. Fractures were classified with the Vancouver classification. Surgical delay, surgical times, and postoperative hospitalization (days) were recorded. The number of blood units administered was counted. We also assessed whether cases could walk and bear weight on the treated limb after our treatments.\u0000\u0000Results: Ninety-four cases with proximal femur periprosthetic fractures were included. (4 type A, 36 type B1, 30 type B2, 5 type B3, and 19 type C). Patients’ mean hospitalization was 10.6 days (5–27). Vancouver classes did not represent prognostic factors in our cohort. Seventy-eight cases experienced postoperative anemia and required transfusion. In our cohort, longer surgical delays led to longer postoperative hospitalizations. The complication rate was 11.7%. Nine percent of our cases died within six months after the fracture. During their follow-up, 65% of our patients had their preoperative walking ability restored; those who had complications were most likely to have reduced postoperative mobility.\u0000\u0000Conclusion: The Vancouver classification is a useful tool for surgical planning, but does not represent a prognostic factor. Periprosthetic hip fractures can reduce patients’ walking ability, especially in case of complications, and even put at risk the survival of the most fragile patients.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary exercise testing in children: application and interpretation challenges.","authors":"Aglika Byandova, Blagoy Marinov","doi":"10.3897/folmed.68.e192711","DOIUrl":"10.3897/folmed.68.e192711","url":null,"abstract":"<p><p></p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for permanent stoma after low anterior resection.","authors":"Gancho Kostov, Mladen Doykov, Rossen Dimov, Bozhidar Hristov, Daniel Doykov, Katya Doykova, Lyubomir Chervenkov, Lyuboslav Dimov, Georgi Amaliev, Valentin Ivanov","doi":"10.3897/folmed.68.e167932","DOIUrl":"10.3897/folmed.68.e167932","url":null,"abstract":"<p><p>Introduction: Postoperative anastomotic leakage is a serious complication in rectal surgery that affects quality of life, increases morbidity and mortality rates, and worsens oncologic outcomes. One of the methods that can minimize septic complications is a diverting ostomy. Although intended as temporary, approximately 20% of diverting stomas become permanent or are converted to end colostomies. Factors significantly increasing the risk of permanent stomas include advanced age, local recurrence, stoma-related complications, and impaired anal sphincter function caused by denervation during surgery or due to neo-adjuvant or adjuvant radiotherapy.\u0000\u0000Aim: This study aimed to identify the risk factors that increase the possibility of temporary stoma becoming permanent after low anterior resection.\u0000\u0000Materials and methods: For the described period, we reviewed a total of 418 histologically confirmed rectal cancer patients who underwent low anterior resection with temporary diverting ileostomy.\u0000\u0000Results: Our study included 348 patients, of whom 324 (93.1%) had their stomas reversed. After a median follow-up of 50.4 months (range 6-106 months), 324 (93.1%) patients had temporary stomas and 24 (6.9%) had permanent ones. Of the 24 permanent stoma patients, there were 12 ileostomies (50.0%), 6 colostomies (25.0%), six patients with abdominoperineal resections (25.0%) due to total dehiscence of the anastomosis.\u0000\u0000Conclusion: Neo-adjuvant or adjuvant chemo and/or radiation therapy, local recurrence, and anastomotic leakage could be important risk factors for the stoma’s nonclosure or re-creation after primary closure in low rectal cancer patients. Surgeons should be more alert in the stoma closure of these risk patients.</p>","PeriodicalId":12415,"journal":{"name":"Folia medica","volume":"68 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}