Balkan Medical Journal最新文献

{"title":"Bilateral Pulmonary Arterial Involvement in Takayasu Arteritis.","authors":"Yuta Inoue, Michihito Kono, Tatsuya Atsumi","doi":"10.4274/balkanmedj.galenos.2026.2026-7-13","DOIUrl":"https://doi.org/10.4274/balkanmedj.galenos.2026.2026-7-13","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Locally Destructive Mandibular Dentinogenic Ghost Cell Tumor Mimicking Ameloblastoma.","authors":"Cong Zhao, Yufeng Wu, Ziqiao Zhuang, Fengyuan Ma, Weiwei Liu","doi":"10.4274/balkanmedj.galenos.2026.2026-7-17","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-7-17","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"534-535"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Leech Inhabiting the Nasal Cavity.","authors":"Chuxiong Zeng, Fuping Li, Fu Guan","doi":"10.4274/balkanmedj.galenos.2026.2026-6-30","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-6-30","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"532-533"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-OJ Antisynthetase Syndrome with Dermatomyositis-Pattern Skin Lesions and Interstitial Lung Disease.","authors":"Jobson Lopes de Oliveira, Igor Albuquerque Nogueira, Diana Arrais de Souza Rangel, Guilherme Ferreira Maciel da Silva, Leonardo de Oliveira Cavalcante","doi":"10.4274/balkanmedj.galenos.2026.2026-6-13","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-6-13","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"540-542"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Traditional Risk Factors: The MAINER Approach to Atherosclerotic Cardiovascular Disease.","authors":"Çağlar Kaya, Fatih Kardaş, Müge Tezer","doi":"10.4274/balkanmedj.galenos.2026.2026-7-19","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-7-19","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"536-537"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Driven Atrial Fibrillation Management: From Signal to Strategy.","authors":"Vedat Cicek, Mert Ilker Hayiroglu, Vanshali Sharma, Amir Rahsepar, Michael Markl, Ulas Bagci, Rod S Passman","doi":"10.4274/balkanmedj.galenos.2026.2026-6-21","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-6-21","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and is associated with substantial morbidity, including ischemic stroke, heart failure, and cognitive decline. Despite established diagnostic and therapeutic strategies, AF remains frequently underdiagnosed and suboptimally managed, particularly in asymptomatic or paroxysmal cases, in which the episodic nature of the arrhythmia may make it difficult to detect using standard electrocardiography. Artificial intelligence (AI), including machine learning and deep learning, has emerged as a transformative technology across multiple aspects of AF care. AI-based electrocardiographic analysis and wearable technologies have demonstrated promising performance in detecting subclinical AF and facilitating scalable population screening. Multimodal models integrating clinical, imaging, and electrophysiological data have demonstrated improved accuracy in stroke prediction, recurrence risk estimation, and therapeutic planning. AI-assisted imaging has advanced atrial segmentation, fibrosis characterization, and ablation planning, whereas AI-driven mapping systems may enhance procedural efficiency and improve patient selection. Nevertheless, significant challenges remain, including limited external validation, data heterogeneity, concerns regarding interpretability, integration into clinical workflows, and ethical and regulatory considerations. Future efforts should prioritize explainable, clinically validated, and human-centered AI systems that are integrated into real-world clinical workflows. This review provides a comprehensive overview of current AI applications in AF management, including early detection, risk stratification, cardiovascular imaging, clinical decision support, and interventional electrophysiology.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"489-502"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>ATM</i> Variants and Breast Cancer Risk in North Macedonia: Focus on the Regionally Enriched <i>p.(Leu2492Arg)</i> Variant.","authors":"Ivana Maleva Kostovska, Sanja Kiprijanovska, Predrag Noveski, Marija Vujovikj, Marija Terzic, Dijana Plaseska-Karanfilska","doi":"10.4274/balkanmedj.galenos.2026.2026-1-289","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-1-289","url":null,"abstract":"<p><strong>Background: </strong>Germline pathogenic variants (PVs) in the ataxia-telangiectasia mutated (<i>ATM</i>) gene are established moderate-risk factors for breast cancer (BC), however, population-specific variant spectra and the clinical significance of many missense variants remain incompletely characterized.</p><p><strong>Aims: </strong>To evaluate the prevalence of <i>ATM</i> variants in a large cohort of patients with BC from North Macedonia and compare it with that in the general population, with a particular focus on the frequency of the p.(Leu2492Arg) variant and its distribution relative to global genomic datasets.</p><p><strong>Study design: </strong>Retrospective case–control study.</p><p><strong>Methods: </strong><i>ATM</i> variants were analyzed in 1,211 patients with BC from North Macedonia using a targeted hereditary cancer gene panel. These findings were compared with those from 1,303 population-based controls analyzed by clinical exome or whole-exome sequencing.</p><p><strong>Results: </strong>Pathogenic <i>ATM</i> variants were identified in 1.9% of BC cases and 0.4% of controls, indicating a significantly increased risk of BC [odds ratio (OR) = 5.02, <i>p</i> = 0.0006]. Most PVs were protein-truncating, with six recurrent variants accounting for over 70% of detections, suggesting regional enrichment. Carriers showed a significantly higher prevalence of human epidermal growth factor receptor 2-positive tumors (OR = 2.92, <i>p</i> = 0.0189). Variants of uncertain significance were observed at comparable frequencies in cases and controls. The p.(Leu2492Arg) missense variant was more frequently detected in cases than in controls (1.9% vs. 1.1%; OR = 1.78, <i>p</i> = 0.086) and exhibited a markedly higher allele frequency in this population than in global databases.</p><p><strong>Conclusion: </strong>These findings confirm <i>ATM</i> as a clinically relevant BC susceptibility gene in North Macedonia and highlight the population-specific enrichment of both PVs and the p.(Leu2492Arg) missense variant. The results emphasize the importance of using population-matched controls and regional genomic data for accurate risk assessment and variant interpretation.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"524-531"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Steroid Associated Neurological Worsening in Spinal Dural Arteriovenous Fistula with Conus Medullaris Syndrome and \"H-sign\".","authors":"Sabina Amiraslanova, Merve Bahar Ercan, Belgin Kocer, Murat Ucar","doi":"10.4274/balkanmedj.galenos.2026.2026-6-23","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-6-23","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"538-539"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal Hypoxemia and Incident Coronary Artery Disease in Obstructive Sleep Apnea: Results from the Sleep Apnea Patients in Skaraborg Study.","authors":"Yüksel Peker, Henrik Holtstrand Hjälm, Helena Glantz, Aylin Pıhtılı, Erik Thunström","doi":"10.4274/balkanmedj.galenos.2026.2026-3-213","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-3-213","url":null,"abstract":"<p><strong>Background: </strong>The relationship between obstructive sleep apnea (OSA) and coronary artery disease (CAD) remains controversial. Although observational studies have suggested that OSA is associated with an increased risk of coronary events, substantial confounding and neutral findings from treatment trials have raised uncertainty regarding which aspects of OSA are most strongly linked to CAD risk.</p><p><strong>Aims: </strong>This study aimed to examine the association between nocturnal hypoxemia, assessed using the oxygen desaturation index (ODI), and incident CAD.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Methods: </strong>Adults referred for evaluation of suspected OSA within the sleep apnea patients in Skaraborg study were prospectively followed for the occurrence of incident CAD. Associations between nocturnal hypoxemia, measured using the ODI, and incident CAD were investigated. Apneahypopnea index (AHI) categories were also analyzed for comparison. Multivariable Cox proportional hazards regression models were constructed, including models that evaluated AHI and ODI separately as well as simultaneously to determine their independent associations with CAD risk.</p><p><strong>Results: </strong>The analytic cohort included 2,902 adults (1,012 women and 1,890 men) with a median follow-up duration of 8.7 years, during which 111 incident CAD events were identified. In fully adjusted Cox regression analyses, participants in the highest ODI category (≥ 30 events/h) had a significantly greater risk of incident CAD than those in the lowest category (hazard ratio, 1.99; 95% confidence interval, 1.08-3.65). In contrast, AHI categories were not independently associated with incident CAD. Moreover, when AHI and ODI were simultaneously included in the same model, ODI remained independently associated with incident CAD. In analyses restricted to adults with OSA, the association between ODI and CAD was attenuated and did not reach statistical significance, although the direction and magnitude of the association remained generally consistent with those observed in the primary analysis.</p><p><strong>Conclusion: </strong>Among adults referred for OSA evaluation, nocturnal hypoxemia assessed using ODI, rather than event-based OSA severity, was associated with incident CAD. However, the absence of independent associations when both ODI and AHI were considered simultaneously suggests substantial overlap between these OSA severity metrics. These findings suggest that hypoxemia-related parameters may provide additional value for coronary risk stratification.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"503-512"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission-Based Machine-Learning Models for Predicting Mechanical Ventilation and Mortality in Fibrotic Interstitial Lung Disease: A Multicenter Cohort Study with External Validation.","authors":"Jibo Sun, Xirui Chen, Xiangpeng Wang, Xing He, Lu Guo, Dajun Li, Lian Wang, Guanping Liu, Xiang Tong, Hong Fan","doi":"10.4274/balkanmedj.galenos.2026.2026-4-269","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-4-269","url":null,"abstract":"<p><strong>Background: </strong>Admission-based risk stratification tools are limited for hospitalized patients with fibrotic interstitial lung disease (F-ILD).</p><p><strong>Aims: </strong>To develop and externally validate admission-based machine-learning models for predicting mechanical ventilation (MV), 30-day and 3-month mortality, and long-term all-cause and cause-specific mortality in hospitalized patients with F-ILD.</p><p><strong>Study design: </strong>Multicenter retrospective cohort study.</p><p><strong>Methods: </strong>This study included hospitalized adults with F-ILD from two tertiary hospitals in China. Clinical characteristics and laboratory test results obtained within 24 hours of admission were used as candidate predictors. Machine-learning models were developed to predict MV, 30-day and 3-month mortality, and long-term all-cause and cause-specific mortality, with internal testing and independent external validation. Model performance, clinical utility, and interpretability were evaluated.</p><p><strong>Results: </strong>A total of 1,272 patients were included (derivation cohort, n = 1,006; external validation cohort, n = 266). In the external validation cohort, the models demonstrated robust discrimination for MV [area under the curve (AUC), 0.913], 30-day mortality (AUC, 0.926), and 3-month mortality (AUC, 0.813). For long-term all-cause mortality, the final model achieved a C-index of 0.768, with time-dependent AUCs of 0.811 at 12 months and 0.768 at 24 months. The corresponding values for cause-specific mortality were 0.768, 0.815, and 0.761, respectively. Lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) emerged as key predictors of MV and short-term mortality, whereas long-term mortality risk was additionally associated with older age, male sex, smoking history, an idiopathic pulmonary fibrosis phenotype, and lower albumin-to-globulin ratio and platelet-to-white blood cell ratio.</p><p><strong>Conclusion: </strong>Admission-based models demonstrated strong discriminatory performance for predicting MV and mortality in hospitalized patients with F-ILD. Elevated LDH and NLR levels, together with lower PNI, characterized a high-risk profile for acute deterioration and death. Local recalibration may be necessary before implementation in new clinical settings.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"513-523"},"PeriodicalIF":4.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}