Medicinski časopis

A brief screening instrument for the early identification of autism spectrum disorders in Serbia: A psychometric study of the Minute for autism (MAUT) instrument

Thu, 05 Jun 2025 22:43:40 +0200

Objective: This study evaluates the psychometric properties of a brief screening tool for autism spectrum disorder (ASD) within a cohort of children with neurodevelopmental disabilities and typically developing children.

Methods: The study involved 306 children (208 boys, representing 68%; mean age 44.6 ± 13.6 months), with data collected from both parents and evaluators (including child psychiatrists, special education teachers, speech therapists, pedagogues, and preschool teachers). The prototype instrument, Minute for Autism (MAUT), consisting of 15 items assessing key ASD symptoms, was tested.

Results: Analysis identified a single factor represented by 7 items in parental assessments (accounting for 53.3% of variance) and 10 items in evaluator assessments (accounting for 53.6% of variance), with primary indicators focusing on measures of social engagement. Four dominant items emerged: "the child looks at you when you speak or play with them," "the child addresses others," "the child talks," and "the child brings objects/toys to show you." These items demonstrated a sensitivity of 72.9% for parental assessments and 84.8% for evaluator assessments. The specificity for detecting ASD, as opposed to typical development, was high (94.1% for parents and 100% for evaluators), although it was lower for differentiating ASD from complex neurodevelopmental disorders (70.8% for parents and 46.2% for evaluators).

Conclusion: The findings suggest that an instrument featuring only four items related to social engagement could be sufficiently effective for rapid and early ASD screening. Evaluators appeared more sensitive to ASD identification than parents, whereas parents were more accurate in distinguishing ASD from other disorders. The primary challenge remains in differentiating ASD from other neurodevelopmental disorders, where the instrument may produce false positives. Future studies should assess the instrument's efficacy in populations of at-risk children.

The Role of the Neutrophil-to-Lymphocyte Ratio in the Development of Heart Failure in Patients with Concomitant Hypertension, Type 2 Diabetes, and Obesity

Tue, 19 Aug 2025 14:53:12 +0200

Objective. Arterial hypertension, type 2 diabetes mellitus (T2DM), and obesity increase cardiovascular risk, including heart failure (HF). The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammation marker, has been linked to adverse cardiovascular outcomes, but its role in HF development remains unclear. This study evaluated NLR as a predictor of HF in these patients.

Methods. A total of 293 patients with essential hypertension, T2DM, and obesity were enrolled in a prospective study. They were categorized into two groups: HF group (n=85) and non-HF group (n=208). NLR was calculated from complete blood count results. HF was diagnosed based on the 2023 ESC guidelines and confirmed via biomarkers (NT-proBNP) or echocardiography. Patients were followed for 24 months.

Results. Patients who developed HF had significantly higher NLR (3.39 ± 1.23 vs. 2.66 ± 1.14, p<0.001). HF patients also had longer T2DM (12.75 ± 5.86 vs. 10.25 ± 4.39 years, p<0.001) and hypertension durations (18.87 ± 8.54 vs. 16.05 ± 7.14 years, p=0.004). A non-dipper blood pressure profile was more frequent in the HF group (36.5% vs. 20.7%, p=0.005). In multivariate regression, NLR (OR 1.383; 95% CI 1.073–2.222; p=0.037), non-dipper BP profile, and disease duration remained independent HF predictors.

Conclusion. NLR is independently associated with HF onset in patients with hypertension, T2DM, and obesity. It may serve as a simple, cost-effective biomarker for HF risk stratification, facilitating early intervention and improved outcomes.

Kawasaki disease - a single centre experience

Nikola Jovanović, Dragana, Karin Vasić, Hristina — Thu, 05 Jun 2025 22:36:03 +0200

Abstract

Objective: To compare clinical symptoms, treatment, and outcomes between typical and atypical forms of Kawasaki disease (KD) in patients treated at our institution.

Methods: A retrospective observational study was conducted at the Pediatric Clinic, University Clinical Center Niš, reviewing medical records of 17 patients diagnosed with KD between September 2017 and February 2024. Clinical characteristics, laboratory results, treatment regimens, and outcomes were compared between typical (n=12) and atypical KD (n=5) groups. Statistical analysis was performed using the R statistical computing environment.

Results: Patients presented with high fever (>38.5 °C) at admission. Diagnosis was delayed in atypical KD cases compared to typical cases (9.6 ± 2.3 days vs. 7.92 ± 2.81 days, respectively). Echocardiographic abnormalities were present in 35% of all cases, including mild left ventricular dysfunction (n=2) and pericardial effusion (n=4). Treatment with intravenous immunoglobulins (IVIg) and aspirin led to significant clinical improvement in most patients. However, corticosteroids were added in 12% (n=2) of cases due to prolonged fever despite initial therapy. One atypical KD patient, diagnosed late, was treated with aspirin alone. Laboratory markers showed notable improvements post-treatment, particularly CRP reduction in typical KD from 77.33 ± 55.92 mg/L to 9.43 ± 7.04 mg/L.

Conclusion: Both typical and atypical KD patients showed good short- and medium-term prognoses, with no significant complications noted during follow-up. However, delays in diagnosis, particularly among atypical cases, highlight the need for improved communication across healthcare levels. A larger, multicenter study is recommended to enhance patient management and outcomes.

Keywords: vasculitis, pediatric, treatment, laboratory

PSYCHODERMATOLOGY – FOCUS ON PSYCHIATRIC OUTCOMES OF THERMAL SKIN INJURIES

Marko Simic, Uros Velickovic — Mon, 07 Jul 2025 21:56:44 +0200

Psychodermatology represents the discipline that explores the complex interaction between the central nervous system and the skin and offers a lot of confirmations for bidirectional interconnection between the pathological alterations that affect both the skin and nervous system. Psychodermatological disorders can be classified into three principal groups: Psychophysiological disorders, Psychiatric disorders with dermatological symptoms, and Dermatological disorders with psychiatric symptoms, while other entities that appear in clinical practice are classified as Miscellaneous. Thermal skin injuries are classified in the category of dermatitis artefacta. It has been confirmed that burns do not affect somatic health components only, but also have a deep impact on the patient’s mental health and overall quality of life. Severe thermal skin injuries have been shown to also exert a significant systemic response that is finally accompanied by a visible impact on mental health. The major groups of markers that show the common type of alterations that connect cutaneous events (typical for thermal injury) and mental outcomes accompanied by burns are oxidative stress and inflammation markers, neurotransmitters, and neurotrophin system elements. The aim of this literature overview was to summarize some specific clinical entities for psychiatric/dermatological disorders that share the same underlying pathophysiological mechanisms, especially from the rarely evaluated direction (“skin to brain”) – psychiatric outcomes of thermal skin injuries.

CALCITONIN NEGATIVE MEDULLARY THYROID CARCINOMA

Marijana C Jandrić-Kočić — Thu, 05 Jun 2025 22:51:50 +0200

Medullary thyroid cancer (MTC) is a neuroendocrine neoplasm that arises from parafollicular C cells. Basal and stimulated calcitonin are used in screening, differential diagnosis, assessment of response to treatment and monitoring of MTC. Calcitonin-negative MTC (MTC with normal values of basal and stimulated calcitonin) is extremely rare (49 cases described in the literature). In the absence of appropriate disease predictors, the diagnosis of calcitonin-negative MTC is not easy and is often delayed.

A patient with a nodule in the thyroid gland and diskettely elevated calcitonin values is shown. Calcium gluconate stimulation test and carcinoembryonic antigen were normal, and the existence of MTC was ruled out. After a year, the patient notices pain in the lower part of the spinal column. He is referred to rehabilitation treatment, which does not give significant results. Laboratory work-up determines elevated values of parathyroid hormone, scintigraphy shows an enlarged hyperactive lower left parathyroid gland, and thyroidectomy and lower left parathyroidectomy with lymphadenectomy are performed. Pathohistological examination revealed MTC pT1aNxMx. Immunohistochemical analysis was negative for calcitonin and thyroglobulin, positive for chromogranin A and thyroid transcription factor 1 (Thyroid transcription factor-1.

Further randomized clinical trials are needed to identify appropriate predictors of calcitonin-negative MTC. Until then, it is necessary to keep in mind the existence of calcitonin-negative MTC that cannot be identified by basal and stimulated calcitonin and carcinoembryonic antigen.