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Edited by:

Selma Uzunović

Vol. 22, No. 2 (2025):

Published: 25.08.2025.

Medicinski Glasnik

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Abstract

 

Background: Optimal myocardial protection remains challenging in emergency coronary revascularization, especially in patients with severely reduced left ventricular function. Contemporary cardioplegia strategies aim to limit ischemia–reperfusion injury and enhance postoperative ventricular recovery. The aim of this study was to compare operative parameters, early postoperative outcomes, and myocardial functional recovery between single-dose Del Nido cardioplegia and conventional blood cardioplegia in adults with left ventricular ejection fraction (LVEF) ≤40% undergoing emergency isolated coronary artery bypass grafting (CABG).

Methods: This retrospective study included 150 consecutive patients with left ventricular ejection fraction (LVEF) ≤40% who underwent emergency isolated CABG between 2022 and 2024. Patients were assigned to either the Del Nido group (n=80) or the conventional blood cardioplegia group (n=70). Demographics, operative variables, postoperative complications, ventricular function changes, and short-term mortality were analyzed. Myocardial recovery was assessed using ΔEF (postoperative minus preoperative LVEF).  .

Results: The Del Nido group demonstrated significantly shorter aortic cross-clamp and cardiopulmonary bypass times and required less intraoperative defibrillation. The incidence of postoperative atrial fibrillation was lower in the Del Nido group (18%) compared with conventional blood cardioplegia (29%). Improvement in ventricular function was greater with Del Nido (ΔEF +5.8±2.1%) than with blood cardioplegia (+3.2±2.4%). Rates of stroke, perioperative myocardial infarction, and early mortality were comparable between groups.

Conclusion: Single-dose Del Nido cardioplegia provides effective and safe myocardial protection in emergency low-EF CABG, offering improved operative efficiency and superior early ventricular recovery without increasing perioperative complications.

 

27.02.2026. Original article Translational and Clinical Research In the next Issue
An animal model in rat for secondary osteoporosis: the effect of gonadotropin-releasing hormone (GnRH) agonists, low calcium diet, and immobilization on tartrate-resistant acid phosphatase 5b (TRACP-5b) and procollagen type 1 N-terminal propeptide (PINP) levels

By Panji Sananta, Respati Suryanto Dradjat, Istan Irmansyah Irsan, Andhika Yudistira, Aditya Rosid Dwi Anwar

Aim Osteoporosis is a global health concern, characterized by reduced bone density, microarchitectural changes, and an increased risk of fractures. The prevalence of osteoporosis is rising, particularly in developing countries. In Indonesia, the incidence of upper femur fractures due to osteoporosis is notably high. As human studies are limited, animal models are crucial for investigating osteoporosis, with several methods used to induce the condition. This study proposes an alternative model using leuprolide acetate, gonadotropin-releasing hormone (GnRH) agonist, combined with a low-calcium diet and immobilization, to induce secondary osteoporosis in animals.

Methods This experimental study employed a post-test-only control group design with 12 groups of Wistar rats (Rattus norvegicus). Three control groups received no treatment, while nine experimental groups were administered leuprolide acetate along with a low-calcium diet and immobilization. The study measured tartrate-resistant acid phosphatase 5b (TRACP-5b) and procollagen type 1 N-terminal propeptide (PINP) levels in rat bone tissue.

Results Significant increase in TRACP-5b and decrease in PINP levels were observed on days 21, 28, and 35 in the treated groups. Post hoc analysis revealed significant differences between treatment groups.

Conclusion The experimental model successfully demonstrated a reliable and reproducible method for inducing secondary osteoporosis. Elevated TRACP-5b and reduced PINP levels indicate increased osteoclast activity and decreased osteoblast activity resulting from excessive bone remodelling. The combination of leuprolide acetate, a low-calcium diet, and immobilization is an effective and alternative method for inducing secondary osteoporosis in experimental animals.

27.02.2026. Original article Translational and Clinical Research In the next Issue
Effect of vitamin D supplementation on metabolic syndrome and atherosclerosis biomarkers in epilepsy: a randomized controlled trial

By Sri Handayani, Zen Hafy, Fitri Octaviana, Zulkhair Ali, Nita Parisa, Astri Budikayanti, Dessy Agustini, Radiyati Umi Partan

Aim To analyze the effect of vitamin D administration on serum 25(OH)D levels and biomarkers of metabolic syndrome and atherosclerosis (homeostatic model assessment of insulin resistance [HOMA-IR], adiponectin, homocysteine, and high sensitivity C-reactive protein [hs-CRP]) in epilepsy patients receiving enzymatic antiseizure medications (ASMs).

Methods This double-blind, randomized, placebo-controlled trial randomized 40 adult epilepsy patients treated with enzymatic ASMs to receive vitamin D3 (2,000 IU/day) or placebo for 12 weeks. The primary outcome was the change in serum 25-hydroxyvitamin D (25[OH]D) levels. Secondary outcomes included changes in HOMA-IR, adiponectin, homocysteine, and hs-CRP. Data were analyzed using a per-protocol approach.

Results Thirty-four patients completed the study. Vitamin D supplementation yielded a significantly greater increase in serum 25(OH)D (10.67 ± 8.16 vs. –1.29 ± 3.96 ng/mL; p < 0.001) and adiponectin (1.38 ± 3.05 vs. 0.34 ± 1.89 µg/mL; p = 0.045), as well as a significantly greater reduction in hs-CRP (–6.74 ± 14.65 vs. 1.81 ± 7.75 mg/L; p = 0.041) compared with placebo. Conversely, no significant differences were observed between groups regarding the changes in HOMA-IR (–0.24 ± 3.71 vs. –0.14 ± 3.38; p = 0.940) or homocysteine (7.90 ± 1.79 vs. 8.15 ± 2.70 µmol/L; p = 0.290).

Conclusion Vitamin D supplementation (2,000 IU/day) effectively restores 25(OH)D levels and improves adiponectin and hs-CRP in epilepsy patients on enzymatic ASMs, suggesting a potential benefit for cardiovascular risk reduction. However, vitamin D alone did not prevent the rise in homocysteine, likely due to the concurrent cessation of B-vitamin supplementation.

27.02.2026. Original article Biochemistry In the next Issue
Evaluation of brain injury biomarkers in mild traumatic brain injury with and without computed tomography findings

By Alma Osmić-Husni, Radivoj Jadrić, Svetlana Jović- Lacković, Aida Žabić, Sabina Čamdžić-Smajić

27.02.2026. Original article New and Emerging Methods In the next Issue
Knowledge of general medicine students from the medical faculties in Tuzla and Zenica about lung cancer prevention

By Amar Terzimehić, Elma Kuduzović, Nino Hasanica, Muhamed Skomorac, Erna Terzić, Iman Kovač

27.02.2026. Original article Biochemistry In the next Issue
Comparative evaluation of HbA1c in point-of-care testing (POCT) devices: enzymatic and immunoassay methods compared to ion-exchange high-performance liquid chromatography (IE-HPLC)

By Windradini Rahvian Aridama, Ferdy Royland Marpaung, Yessy Puspitasari

27.02.2026. Original article New and Emerging Medical Entities In the next Issue
Risk factors for red blood cell alloimmunization in polytransfused patients

By Svetlana Jović Lacković, Almira Ćosićkić

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Aim
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The results of our survey have suggested that the reasons for decreased compliance with hand washing protocols may be related to forgetting to wash the hands or not being acquainted with hand washing protocols at all. The strategies focused only on one aspect of hand hygiene are, according to scientific literature, ineffective in the long term.

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Aim
Accumulated evidence suggests that vitamin A and D agonists can alleviate the development of atherosclerosis. Therefore, the aim of this study was to determine the effect of vitamin A and D combination supplement on interleukin-1β (IL-1β) and clinical outcome in ischemic stroke.
Methods
A single-blind, randomized controlled trial was conducted on ischemic stroke patients at Adam Malik Hospital between March 2018 to February 2019. The patients were randomized into 4 groups of the treatment consisting of supplementation using vitamin A or D only, combination of vitamin A and D, and placebo group, all given for 12 weeks. Clinical outcome was determined using the National Institute of Health Stroke Scale (NIHSS). At the time of admission and after the treatment was completed, all patients were measured for vitamin A, vitamin D, and IL-1β serum level, and NIHSS score.
Results
From the total of 120 patients, in the combination group there were significant increments on both vitamin A (p=0.04) and vitamin D (p=0.01) serum level after 12 weeks of the treatment, compared to the other groups. In conjunction, IL-1β serum level showed a significant decrement in the combination group (p<0.001). Lastly, the biggest improvement of NIHSS could be seen in the combination group, which was marked by the highest decrement of NIHSS score (p<0.001).
Conclusion
Administration of combination of vitamin A and D supplementation can significantly increase vitamin A and D serum level, decrease IL-1β serum level, and ultimately improve clinical outcome in ischemic stroke patients.

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