Southeastern European Medical Journal

Cervical Lymph Node Metastases from Unknown Primary Tumor

Vladimir Milosev — 2025-02-13

Introduction: Metastases of the lymph nodes of the neck originating from cancers of an unknown primary site represent a diagnostic and therapeutic challenge. Metastatic carcinomas of unknown primary site (CUPS) account for about 3-5% of all malignant disease diagnoses. Planocellular carcinomas account for 90% of cancers of unknown site, while the remaining 10% are poorly differentiated and adenocarcinomas.

Materials and methods: This paper presents three case reports of patients with surgical treatment at the Department of Maxillofacial Surgery, Clinical Hospital, Stip, who had metastases of the lymph nodes of the neck with the unknown primary tumor site.

Results: We fallow diagnostic protocols which include a detailed clinical examination, radiological diagnostics, fine needle biopsy (FNAB) of the tumor change in the neck, esophagogastroduodenoscopy, detailed examination of the naso, oro and hypo pharynx, evaluation of the laryngeal structures. In all patients, after the clinical evaluation, ultrasonography, otorhinolaryngological examination, neck CT and fine needle biopsy were performed. FNAB findings showed metastatic deposits from squamous cell carcinomas. The therapy of metastases from CUPS includes surgical treatment (neck dissection) and the use of radiotherapy (RT), and some authors also recommend chemoradiotherapy, in cases with advanced regional disease.

Conclusion: Significant advances in diagnostic and operative techniques have increased the probability of identifying the primary tumor, as well as its regional and systemic spread. If CT or MRI does not identify a primary site, PET/CT scans should be performed before surgical biopsy. Although high-quality data on treatment protocols are lacking, patients with more advanced stages of regional disease require combined treatment that includes neck dissection, and postoperative radiotherapy with or without chemotherapy.

KEYWORDS : Carcinoma, unknown primary origin site (CUPS), metastases, lymph nodes, neck

Prognostic Value of Hemoglobin to Red Cell Distribution Width Ratio for Patients with Multiple Myeloma

Nikol Marošević — 2025-02-13

Aim: Multiple myeloma (MM) is a malignant hematological disorder characterized by clonal plasma cell proliferation and is often associated with renal impairment, anemia, and increased mortality. This study aims to determine whether the hemoglobin-to-red cell distribution width ratio (HRR) at the time of diagnosis acts as an independent prognostic factor for overall survival (OS).

Subjects and methods: This study included patients diagnosed with MM between 2017 and 2023 at the University Hospital Center Osijek. Data were obtained from medical records, and statistical analysis was conducted using SPSS 23 and MedCalc Statistical Software version 22.018 with significance set at α= 0.05.

Results: A total of 56 patients with MM were included in the study, consisting of 29 (52%) males and 27 (48%) females. Male patients demonstrated significantly higher HRR values (P = 0.04), with notable variations related to the International Staging System (ISS). Patients with elevated HRR (HR = 0.63) had significantly longer survival rates. The cut-off HRR value for predicting mortality was ≤ 5.09. Receiver operating characteristic (ROC) analysis revealed that 42 patients (75%) had HRR values above 5.09, while 14 (25%) had values ≤ 5.09. Patients with HRR values above 5.09 demonstrated significantly better survival outcomes.

Conclusion: There is a statistically significant difference in HRR values based on sex, ISS, and outcome, in male patients, patients in ISS stage I and survivors exhibiting higher HRR levels. Reduced HRR is associated with poorer outcomes and OS in MM patients, establishing HRR as a straightforward and valuable prognostic indicator for long-term survival in MM.

Key words: hemoglobine, multiple myeloma, prognostic factor

Cognitive Reactivity to Sad Mood as a Risk Factor for Depressive Recurrence

Dijana Miloseva — 2025-02-13

According to cognitive theories of depression, vulnerability for onset and recurrence lies in some kind of cognitive dysfunction, or maladaptive cognitive information processing. This literary review paper aims to clarify the role of cognitive reactivity to sad mood as a risk factor to depressive recurrence, mechanism and measurement in order to provide tailor treatment and prevention for depression. Comprehensive searches of PsycInfo, PubMed and Web of Science were conducted. Teasdale’s differential activation hypothesis suggests that the initial depressive episode establishes specific dysfunctional patterns of processing that lie latent after recovery but that can be reactivated by depressed mood. This activation would in turn strengthen the dysfunctional processing patterns and thereby create a vicious loop of depression recurrence. Teasdale calls this concept cognitive reactivity. Cognitive Reactivity (CR) is the extent to which an individual experiences a negative shift in cognitive content and processes during a sad mood. Finding from our review suggests that CR can be conceptualized as a risk factor that is present in vulnerable individuals before depression-onset, that distinguishes between vulnerable and non-vulnerable groups even when in remission, and that predicts depression relapse.There also research evidence that the duration of the first depressive episode, regardless of its intensity, is of crucial importance in the formation of cognitive reactivity to sad mood.Based on findings from different countries we conclude that Index for Depression sensitivity, LEIDS-R is a promising test for measuring cognitive reactivity to sad mood (CR). The results obtained from previous research indicate the importance of an interactive approach when examining the factors that contribute to the recurrent course of depression.

Keywords: cognitive reactivity; sad mood; risk factor; depressive recurrence

The Connection between Sleeping Disorders Among Students and Academic Success

Adel El Mourtada — 2025-02-13

Aim of the study: Objective of this research was to examine whether sleep disturbances affect the academic success of students of the Faculty of Medicine in Osijek.

Methods: The respondents conducted a self-assessment using a sociodemographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI).

Results: It is observed that there is no significant correlation between age, overall academic success and months of work (if the respondents were employed) with the sleep quality index. Respondents from lower years of studies have a higher sleep quality index, therefore worse sleep quality compared to higher years respondents, whereas daily average studying time has proportional values to the PSQI sleep quality index. In other words, the more hours they spend studying, the higher the sleep quality index. Therefore, the quality of sleep is lower. There are no significant differences in the PSQI sleep quality index in relation to the general characteristics, except in the case of treatment by a psychiatrist. Subjects who were treated by a psychiatrist had significantly worse sleep quality compared to other subjects.

Conclusion: There is no significant correlation between sleep disorders and academic success among students. Subjects from lower years of study had higher values of the PSQI and their sleep quality was inversely proportional to the time they spent studying. Subjects who had a psychiatric diagnosis had worse quality of sleep.

Keywords: academic success; correlation; sleep disorders

The Effect of Continuous Positive Airway Pressure on Middle Ear Pressure

Mirjana Grebenar Čerkez — 2025-02-13

Aim of the study: The study investigated the effects of continuous positive airway pressure (CPAP) on middle ear pressure.

Methods: Forty-two patients with obstructive sleep apnea (OSA) were assigned to the study group. The patients underwent standard tympanometry before starting CPAP therapy and six months after regular CPAP therapy.

Results: The average pressure range of the CPAP device (cm H2O) was 4,80 – 13,50. Middle ear pressure (MEP) was between -146,00 and 64,00 daPa before therapy and between -103,00 and 40,00 daPa after treatment. The results showed that the subjects experienced an increase in middle ear pressure after the CPAP therapy.

Conclusion: This study demonstrated that the appropriate use of CPAP therapy leads to a statistically significant increase in pressure in the middle ear.

Keywords: OSA, middle ear pressure, tympanometry, CPAP

Viral Infection in Glioblastoma: Immunohistochemistry in Detection of Cytomegalovirus, Epstein-Barr and Herpes Simplex – 1 Virus

Nenad Koruga — 2025-02-13

Introduction: Glioblastoma (GB) is the most aggressive glial tumor of the brain with a dismal prognosis. Studies conducted during the last two decades highlighted neurotropic viruses as a risk factors involved in development of glioblastoma. Authors present an immunohistological study conducted in a single center on sixty-three archive paraffin-embedded samples of GB.

Patients and methods: The tissues were tested using immunohistochemistry in a homogenous group of sixty-three glioblastoma paraffin-embedded tissues for the presence of Cytomegalovirus (CMV), Epstein-Barr virus (EBV) and herpes simplex virus type 1 (HSV-1).

Results: Three species of herpes viruses were tested: HSV-1, Epstein-Barr virus (EBV) and Cytomegalovirus using the standard automatized immunohistochemistry. According to the IRS score, there were six samples of HSV-1 regarded as IRS 2 and five IRS 1 samples of the same virus. EBV and CMV were negative.

Conclusion: The result of our study identified HSV-1 as the most prominent neurotropic virus among population surgically treated of GB. Further studies are necessary to confirm its possible oncomodulatory role.

Keywords: cytomegalovirus; Epstein-Barr virus; Herpes simplex virus; glioblastoma; neurotropic viruses; oncogenic viruses

Vitamin D Deficiency as a Risk Factor for Colorectal Cancer

Angjel Stojanovski — 2025-02-13

Introduction: Colorectal cancer is the third most common diagnosis and cause of death in both sexes in highly developed countries. It is assumed that environmental factors are involved in the development of the disease, with strong evidence favoring lifestyle as well as the influence of diet. There are also many studies that indicate that low vitamin D levels are a significant risk factor for the occurrence of colorectal cancer.

Objective: To evaluate and compare serum concentrations of 25-hydroxyvitamin D (25(OH)D) between people diagnosed with colorectal cancer and a control group of healthy subjects.

Materials and methods: A total of 30 people with colorectal cancer and a control group of 30 healthy subjects were analyzed in the study.

Results: The comparison of the colorectal cancer group and control group in terms of serum vitamin D concentration showed that lower values were measured in the group with colorectal cancer. The mean vitamin D concentration in the colorectal cancer group was 16.6 ± 7.8, while in the control group it was 28.7 ± 10.3; the difference of 12.1 was statistically significant, for p=0.001.

Conclusion: The results of the presented study indicate significantly lower serum concentrations of 25(OH)D in individuals with colorectal cancer compared to the control group.

Keywords: colorectal cancer, cancer, vitamin D