Medicina

12 pages, 1196 KiB

Open AccessArticle

Functional Magnetic Neuromuscular Stimulation vs. Routine Physiotherapy in the Critically Ill for Prevention of ICU Acquired Muscle Loss: A Randomised Controlled Trial

by Anej Skočir, Alja Jevšnik, Lidija Plaskan and Matej Podbregar

Medicina 2024, 60(10), 1724; https://doi.org/10.3390/medicina60101724 - 21 Oct 2024

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Abstract

Background and Objectives: Muscle loss is a known complication of ICU admission. The aim of the study was to investigate the effect of neuromuscular functional magnetic stimulation (FMS) on quadriceps muscle thickness in critically ill patients. Materials and Methods: Among ICU [...] Read more.

Background and Objectives: Muscle loss is a known complication of ICU admission. The aim of the study was to investigate the effect of neuromuscular functional magnetic stimulation (FMS) on quadriceps muscle thickness in critically ill patients. Materials and Methods: Among ICU patients one quadriceps was randomized to FMS (Tesla Stym, Iskra Medical, Ljubljana, Slovenia) stimulation and the other to control care. Quadriceps thickness was measured by ultrasound (US) in transversal and longitudinal planes at enrolment, Days 3–5, and Days 9–12. The trial stopped early following an interim analysis comparing muscle thickness differences between groups using repeated measures ANOVA. Results: Of 18 patients randomized, 2 died before completing the trial. The final analysis reported included 16 patients (female 38%, age 68 ± 10 years, SOFA 10.8 ± 2.7). Three mild skin thermal injuries were noted initially, which were later avoided with proper positioning of FMS probe. Primary outcome comparison showed that quadriceps thickness in transversal and longitudinal planes decreased in the non-stimulated legs and, but it did not change in FMS legs (−4.1 mm (95%CI: −9.4 to −0.6) vs. −0.7 mm (95%CI: −4.1 to −0.7) (p = 0.03) and −4.4 mm (95%CI: −8.9 to −1.1) vs. −1.5 mm (95%CI: −2.6 to −2.2) (p = 0.02), respectively) (ANOVA difference between groups p = 0.036 and 0.01, respectively). Conclusions: In the critically ill, neuromuscular FMS is feasible and safe with precautions applied to avoid possible skin thermal injury. FMS decreases the loss of quadriceps muscle thickness. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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8 pages, 794 KiB

Open AccessArticle

Unveiling the Intricacies: Exploring Stepwise Initiation of Peritoneal Dialysis in a Single-Center Setting

by Ping-Kun Hsiao, Wei-Je Wong, Su-I Hsieh, Hsiu-Ying Lin, Tzay-Jinn Chen and Chung-Yi Cheng

Medicina 2024, 60(10), 1723; https://doi.org/10.3390/medicina60101723 - 21 Oct 2024

Viewed by 1059

Abstract

Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving [...] Read more.

Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. Materials and Methods: We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, t-test, and negative binomial regression. Results: The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, p = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. Conclusions: Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 1386 KiB

Open AccessArticle

Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study

by Andreea Moga, Radu Bălănescu, Laura Bălănescu, Patricia Cîmpeanu, Mircea Andriescu, Mirela Elena Vasile and Ruxandra Caragata

Medicina 2024, 60(10), 1722; https://doi.org/10.3390/medicina60101722 - 21 Oct 2024

Viewed by 1313

Abstract

Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 [...] Read more.

Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at “Grigore Alexandrescu” Children’s Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors. Full article

(This article belongs to the Section Pediatrics)

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13 pages, 6715 KiB

Open AccessArticle

Accuracy of Cup Placement Angle, Leg Lengthening, and Offset Measurement Using an AR-Based Portable Navigation System: Validation in Supine and Lateral Decubitus Positions for Total Hip Arthroplasty

by Yusuke Ozaki, Takeaki Yamamoto, Satomi Kimura, Toru Kasai, Rintaro Niki and Hisateru Niki

Medicina 2024, 60(10), 1721; https://doi.org/10.3390/medicina60101721 - 21 Oct 2024

Viewed by 1082

Abstract

Background and Objectives: Total hip arthroplasty (THA) requires accurate implant placement to ensure optimal outcomes. In this study, the AR Hip navigation system, an imageless portable navigation tool using augmented reality (AR), was evaluated for measuring radiographic inclination (RI), anteversion (RA), leg [...] Read more.

Background and Objectives: Total hip arthroplasty (THA) requires accurate implant placement to ensure optimal outcomes. In this study, the AR Hip navigation system, an imageless portable navigation tool using augmented reality (AR), was evaluated for measuring radiographic inclination (RI), anteversion (RA), leg lengthening (LL), and offset (OS) changes in supine and lateral decubitus THA. Notably, this is the first report to assess the accuracy of LL and OS measurements using AR technology. Methods: We analyzed 48 hips from primary THA patients: 17 in the supine (S) group and 31 in the lateral (L) group. RI, RA, LL, and OS were measured intraoperatively using AR Hip and postoperatively using Zed Hip 3D software (Version 18.0.0.0). The absolute errors and outlier rates (≥5° for RI/RA and ≥5 mm for LL/OS) were compared between groups. Results: The mean intraoperative RI values with AR Hip were 40.1 ± 0.6° (S), 40.2 ± 1.2° (L), and 40.1 ± 1.0° (total), while the postoperative RI values with Zed Hip were 39.7 ± 2.9° (S), 39.5 ± 2.5° (L), and 39.6 ± 2.6° (total). The absolute errors were 1.8 ± 1.7° (total), with no significant group differences (p = 0.957). For RA, the errors were 2.0 ± 1.2° (total) (p = 0.771). The LL errors were 2.3 ± 2.2 mm (total) (p = 0.271), and the OS errors were 3.5 ± 2.8 mm (total) (p = 0.620). The outlier rates for RI were 11.8% (S) and 3.2% (L); for RA, 0% (S) and 3.2% (L); for LL, 29.4% (S) and 6.5% (L) with a significant difference (p = 0.031); and for OS, 23.5% (S) and 25.8% (L). No significant differences were observed for RI, RA, or OS. Conclusions: AR Hip provided accurate measurements of cup orientation, LL, and OS in both supine and lateral THA. Importantly, this study is the first to report the accuracy of LL and OS measurements using AR technology, demonstrating the potential of AR Hip for improving THA precision. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges: Part II)

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9 pages, 3952 KiB

Open AccessArticle

Effectiveness of Periarticular Pin Tracker Placement Through a Single Main Incision in Robotic-Assisted Total Knee Arthroplasty: Technical Note and Short-Term Results

by Ji-Hoon Baek, Su Chan Lee, Taehyeon Kim, Juneyoung Heo, Dong Nyoung Lee, Hye Sun Ahn and Chang Hyun Nam

Medicina 2024, 60(10), 1720; https://doi.org/10.3390/medicina60101720 - 20 Oct 2024

Viewed by 1383

Abstract

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker–related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through [...] Read more.

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker–related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA. Full article

(This article belongs to the Section Surgery)

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11 pages, 733 KiB

Open AccessArticle

Rehabilitation for Patients with COVID-19-Associated Acute Respiratory Distress Syndrome During Quarantine: A Single-Center Experience

by Myung Hun Jang, Yong Beom Shin, Ho Jeong Shin, Eunsuk Jeong, Saerom Kim, Wanho Yoo, Hyojin Jang and Kwangha Lee

Medicina 2024, 60(10), 1719; https://doi.org/10.3390/medicina60101719 - 20 Oct 2024

Cited by 1 | Viewed by 1376

Abstract

Background and Objectives: In this study, we evaluated clinical factors associated with implementing a rehabilitation program for patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) during the quarantine period. Materials and Methods: This observational study was conducted [...] Read more.

Background and Objectives: In this study, we evaluated clinical factors associated with implementing a rehabilitation program for patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) during the quarantine period. Materials and Methods: This observational study was conducted in the National Designated Isolated ICU, a dedicated COVID-19 center with 18 beds, from 30 December 2020 to 30 May 2022. One hundred and fifty-four patients (mean age: 67.3 ± 13.4 years; male: 59.7%) were enrolled. The ICU rehabilitation program included early mobilization, chest physiotherapy, and dysphagia treatment. Results: Forty-five patients (29.3%) participated in the rehabilitation program. Multivariate logistic regression identified three significant factors: tracheostomy (odds ratio [OR], 2.796; 95% confidence interval [CI], 1.238–6.316; p = 0.013), body mass index ≥ 25.0 kg/m² (OR, 2.724; 95% CI, 1.276–5.817; p = 0.010), and extracorporeal membrane oxygenation (OR, 2.931; 95% CI, 1.165–7.377; p = 0.022); patients with all three factors were younger (median 44 vs. 70 years, p < 0.001) and had significantly lower Acute Physiology and Chronic Health Evaluation II scores (median 12 vs. 16, p = 0.002) on the MV day. One-year cumulative mortality rates for patients with 0 to 3 factors were 66.7%, 50.8%, 38.9%, and 15.4%, respectively, with a significant difference among them (log-rank, p < 0.001). Conclusions: Three clinical factors associated with implementing a rehabilitation program during the quarantine period for COVID-19-associated ARDS patients were identified. The program was feasible and beneficial, particularly for younger patients with lower illness severity and fewer comorbidities on the day of MV. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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17 pages, 1994 KiB

Open AccessArticle

Machine Learning Algorithm-Aided Determination of Predictors of Mortality from Diabetic Foot Sepsis at a Regional Hospital in South Africa During the COVID-19 Pandemic

by Carlos Matsinhe, Shingirai Brenda Kagodora, Tshifhiwa Mukheli, Tshepo Polly Mokoena, William Khabe Malebati, Maeyane Stephens Moeng and Thifhelimbilu Emmanuel Luvhengo

Medicina 2024, 60(10), 1718; https://doi.org/10.3390/medicina60101718 - 20 Oct 2024

Cited by 1 | Viewed by 1718

Abstract

Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted [...] Read more.

Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Materials and Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis, were collected and analysed. Supervised machine learning algorithms were used to compare their ability to predict mortality due to diabetic foot sepsis. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168 mg/dl, urea 7.8 mmol/L and creatinine 92 µmol/L. The mean potassium level was 4.8 ± 0.9 mmol, and glycosylated haemoglobin 11.2 ± 3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The levels of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective in predicting major amputation and death in patients with DFS. Full article

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13 pages, 319 KiB

Open AccessArticle

Assessment of Paraoxonase 1 and Arylesterase Activities and Lipid Profile in Bodybuilders: A Comparative Study of Physical Activity and Anthropometry on Atherosclerosis

by Hakim Celik, Mehmed Zahid Tuysuz, Yakup Aktas, Mehmet Ali Eren and Recep Demirbag

Medicina 2024, 60(10), 1717; https://doi.org/10.3390/medicina60101717 - 20 Oct 2024

Viewed by 1145

Abstract

Background and Objectives: Atherosclerosis, driven by dyslipidaemia and oxidative stress, is a leading cause of cardiovascular morbidity and mortality. This study evaluates the effects of vigorous-intensity bodybuilding exercise (VIBBE) on atherosclerosis biomarkers—including paraoxonase-1 (PON1) and arylesterase (ARE) activities—and lipid profiles in male [...] Read more.

Background and Objectives: Atherosclerosis, driven by dyslipidaemia and oxidative stress, is a leading cause of cardiovascular morbidity and mortality. This study evaluates the effects of vigorous-intensity bodybuilding exercise (VIBBE) on atherosclerosis biomarkers—including paraoxonase-1 (PON1) and arylesterase (ARE) activities—and lipid profiles in male bodybuilders who do not use anabolic-androgenic steroids. Comparisons were made with individuals engaged in moderate-intensity aerobic exercise (MIAE), as well as overweight/obese sedentary (OOS) and normal-weight sedentary (NWS) individuals. Materials and Methods: A cross-sectional study was conducted involving 122 healthy male participants aged 18–45 years, divided into four groups: VIBBE (n = 31), OOS (n = 30), MIAE (n = 32), and NWS (n = 29). Anthropometric assessments were performed, and fasting blood samples were collected for biochemical analyses, including lipid profiles and PON1 and ARE activities. Statistical analyses compared the groups and evaluated correlations between adiposity measures and atherosclerosis biomarkers. Results: The VIBBE group exhibited significantly lower levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and logarithm of the TG to high-density lipoprotein cholesterol (HDL-C) ratio [log(TG/HDL-C)] compared to the OOS group (p < 0.05 for all), indicating improved lipid profiles. However, these improvements were not significant when compared to the NWS group (p > 0.05), suggesting that VIBBE may not provide additional lipid profile benefits beyond those associated with normal weight status. PON1 and ARE activities were significantly lower in the VIBBE group compared to the MIAE group (p < 0.05 for both), suggesting that VIBBE may not effectively enhance antioxidant defences. Correlation analyses revealed significant inverse relationships between PON1 and ARE activities and adiposity measures, including body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), fat mass index (FMI), and obesity degree (OD) (p < 0.05 for all). Positive correlations were observed between oxLDL and log(TG/HDL-C) and adiposity measures (p < 0.05 for all). Conclusions: Vigorous-intensity bodybuilding exercise improves certain lipid parameters compared to sedentary obese individuals but does not significantly enhance antioxidant enzyme activities or further improve lipid profiles beyond those observed in normal-weight sedentary men. Conversely, moderate-intensity aerobic exercise significantly enhances PON1 and ARE activities and improves lipid profiles, offering superior cardiovascular benefits. These findings underscore the importance of incorporating moderate-intensity aerobic exercise into physical activity guidelines to optimize cardiovascular health by balancing improvements in lipid metabolism with enhanced antioxidant defences. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

9 pages, 666 KiB

Open AccessArticle

Effect of Sarcopenia on Functional Recovery in Acute Stroke Patients Admitted for Standard Rehabilitation Program

by So-Yeong Kim, Woon-Su Cho, Chi-Bok Park and Byeong-Geun Kim

Medicina 2024, 60(10), 1716; https://doi.org/10.3390/medicina60101716 - 20 Oct 2024

Viewed by 1226

Abstract

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted [...] Read more.

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted with acute stroke patients admitted within 90 days of onset to the rehabilitation hospital. Participants were divided into a stroke with sarcopenia group and a stroke without sarcopenia group. Evaluations were conducted at baseline, 4 weeks, and 8 weeks, including the following assessments: manual muscle testing (MMT), Berg Balance Scale (BBS), functional ambulation category (FAC), and Modified Barthel Index (MBI). Both groups received an identical rehabilitation program for 8 weeks. Results: Significant within-group improvements were observed in both groups across all measures (p < 0.05). However, the stroke with sarcopenia group showed significantly less improvement in MMT, BBS, FAC, and MBI compared to the stroke without sarcopenia group at both 4 and 8 weeks (p < 0.05). Conclusions: These results underscore the significant impact of sarcopenia on functional recovery in stroke patients, despite both groups receiving identical rehabilitation programs. The presence of sarcopenia was a critical predictor of poorer outcomes in muscle strength, balance, ambulation, and activities of daily living. Given these findings, specific rehabilitation strategies targeting sarcopenia are needed to improve recovery in stroke patients. Future research should include larger sample sizes, longer follow-ups, and sarcopenic patient-specific rehabilitation programs. Full article

(This article belongs to the Special Issue New Advances in Acute Stroke Rehabilitation)

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11 pages, 3215 KiB

Open AccessArticle

Napabucasin Inhibits Proliferation and Migration of Glioblastoma Cells (U87) by Regulating JAK2/STAT3 Signaling Pathway

by İlker Ünlü, İlhan Özdemir and Mehmet Cudi Tuncer

Medicina 2024, 60(10), 1715; https://doi.org/10.3390/medicina60101715 - 19 Oct 2024

Viewed by 1264

Abstract

Background and Objectives: Napabucasin (NP) was discovered as a natural compound that suppresses cancer stemness by inhibiting the signal transducer and activator of the transcription 3 (STAT3) signaling pathway. In this study, the anti-proliferative and apoptotic effects of NP and the chemotherapy [...] Read more.

Background and Objectives: Napabucasin (NP) was discovered as a natural compound that suppresses cancer stemness by inhibiting the signal transducer and activator of the transcription 3 (STAT3) signaling pathway. In this study, the anti-proliferative and apoptotic effects of NP and the chemotherapy agent doxorubicin (DX), a natural compound, on glioblastoma cells (U87) were investigated. Materials and Methods: In this study, the effects of NP and DX on cell viability on the glioblastoma U87 cell line were determined by MTT test. Expressions of Jak2/Stat3 genes were examined by qRT-PCR. Apoptosis was evaluated by Hoescht 33258 staining. Moreover, NP, its antagonistic–synergistic effects and IC50 doses of the combined treatment of DX were determined. Results: Napabucacin and doxorubicin were found to inhibit glioblastoma U87 cell proliferation. It was determined that NP applied in the range of 0.3–1 µM and its combination with DX killed almost all of the glioblastoma cells in 48 h of application. Additionally, it was observed that Jak2/Stat3 expressions downregulated. Conclusions: These results show that NP suppresses the proliferation of glioblastoma cells. It was shown that the combination of NP and DX can prevent invasion of the U87 cell line due to its Jak2/Stat3 inhibitory effect. Since it can suppress Jak2/Stat3, an important cancer cell proliferation pathway in glioblastoma, the combination of NP and DX can be used as an alternative treatment agent. But no synergistic effect of NP and DX on the U87 cells of the glioblastoma cell line was observed. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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13 pages, 1504 KiB

Open AccessArticle

Real-World Data Mining for Signal Detection of Antipsychotics-Associated Adverse Events Using the Korea Adverse Event Reporting System (KAERS) Database

by Suhyeon Moon, Minjung Ko, Yeo-Jin Choi and Sooyoung Shin

Medicina 2024, 60(10), 1714; https://doi.org/10.3390/medicina60101714 - 18 Oct 2024

Viewed by 996

Abstract

Background and Objectives: Recent studies suggest that the binary categorization of first-generation antipsychotics (FGAs) as being primarily responsible for extrapyramidal symptoms (EPSs) and second-generation antipsychotics (SGAs) for cardiometabolic abnormalities is an oversimplification. SGAs also demonstrate antagonistic affinity for D2 receptors, indicating their potential [...] Read more.

Background and Objectives: Recent studies suggest that the binary categorization of first-generation antipsychotics (FGAs) as being primarily responsible for extrapyramidal symptoms (EPSs) and second-generation antipsychotics (SGAs) for cardiometabolic abnormalities is an oversimplification. SGAs also demonstrate antagonistic affinity for D2 receptors, indicating their potential to induce EPSs. This study utilized the Korea Adverse Event Reporting System (KAERS) database to explore adverse drug event (ADE) signals related to both FGAs and SGAs. Materials and Methods: Relevant ADE reports from January 2013 to December 2022 were extracted from the KAERS database and analyzed using disproportionality analysis, employing the proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC) with its 95% lower confidence interval (LCI) indices. Results: Of the initial dataset of 2,890,702 ADE reports, those with insufficient data and duplicates were removed, resulting in a final dataset of 5249 reports for analysis. Aripiprazole, an SGA, showed signals for movement disorders, including EPSs (PRR 4.7, ROR 4.8, IC 2.2), tremors (PRR 5.3, ROR 5.4, IC 2.4), and akathisia (PRR 18.6, ROR 19.3, IC 3.5). Notably, for quetiapine, cardiovascular signals were detected, including increased blood pressure (PRR 2.1, ROR 2.3, IC 0.5), and tachyarrhythmia (PRR 13.9, ROR 14.1, IC 1.8), along with peripheral edema (PRR 2.5, ROR 2.5, IC 0.2). Metabolic abnormalities, such as weight gain and increased appetite, were identified for four SGAs: aripiprazole, olanzapine, quetiapine, and risperidone. Safety signals related to movement disorders were not detectable for FGAs, likely due to the limited number of ADE reports available for analysis. Conclusions: Our study findings support that the distribution of ADEs between FGAs and SGAs is not strictly binary. Aripiprazole, despite being an SGA, showed signals for extrapyramidal movement disorders. Four SGAs (aripiprazole, olanzapine, quetiapine, and risperidone) were linked to metabolic side effects, while quetiapine was associated with cardiovascular safety signals. Full article

(This article belongs to the Section Pharmacology)

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9 pages, 7417 KiB

Open AccessArticle

Saccharomyces boulardii Mitigates Fructose-Induced Non-Alcoholic Fatty Liver in Rats

by Mehmet Ulusan, Mumin Alper Erdogan, Ozkan Simsek, Vehbi Gunes and Oytun Erbas

Medicina 2024, 60(10), 1713; https://doi.org/10.3390/medicina60101713 - 18 Oct 2024

Viewed by 1201

Abstract

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern closely linked to metabolic disorders, including obesity, insulin resistance, and dyslipidemia. Emerging evidence suggests that the gut–liver axis plays a critical role in the pathogenesis of NAFLD, with recent [...] Read more.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern closely linked to metabolic disorders, including obesity, insulin resistance, and dyslipidemia. Emerging evidence suggests that the gut–liver axis plays a critical role in the pathogenesis of NAFLD, with recent research highlighting the influence of gut microbiota, including fungal species such as Saccharomyces boulardii (S. boulardii). This study aimed to evaluate the effects of S. boulardii on lipid metabolism and oxidative stress in a rat model of fructose-induced NAFLD. Materials and Methods: Thirty Wistar rats were divided into three groups: a control group, a fatty liver group induced by 35% fructose supplementation, and a treatment group receiving S. boulardii (100 mg/kg/day) after fructose induction. Results: Biochemical analyses revealed that the treatment group exhibited significantly lower plasma levels of malondialdehyde (MDA), alanine aminotransferase (ALT), total triglycerides, and cholesterol compared to the untreated fatty liver group (p < 0.05). Furthermore, liver tissue analysis showed a marked reduction in lipid accumulation and fatty infiltration in the treatment group, with no visible lipid vacuoles in hepatocytes. The expression of aquaporin-8 (AQP8) and sirtuin-1 (SIRT1), key markers associated with hepatocyte function and lipid metabolism, was significantly higher in the S. boulardii group compared to the fatty liver group (p < 0.001). Conclusions: These findings indicate that S. boulardii supplementation mitigates the metabolic and oxidative stress-related alterations associated with fructose-induced NAFLD. In conclusion, our study suggests that S. boulardii exerts protective effects on the liver by reducing lipid accumulation and oxidative stress, highlighting its potential as a therapeutic intervention for NAFLD. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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14 pages, 885 KiB

Open AccessArticle

Bleeding Events Associated with Rivaroxaban Therapy in Naive Patients with Nonvalvular Atrial Fibrillation: A Longitudinal Study from a Genetic Perspective with INR Follow-Up

by Nur Ul Ain, Niaz Ali, Abid Ullah, Shakir Ullah and Shujaat Ahmad

Medicina 2024, 60(10), 1712; https://doi.org/10.3390/medicina60101712 - 18 Oct 2024

Viewed by 1165

Abstract

Background and Objectives: Rivaroxaban is a direct-acting anticoagulant used to prevent stroke in patients with atrial fibrillation. Rivaroxaban is a substrate for P-glycoprotein, which is encoded by the ABCB1 gene. Rivaroxaban is also metabolized by the CYP3A5 gene. Therefore, the current study [...] Read more.

Background and Objectives: Rivaroxaban is a direct-acting anticoagulant used to prevent stroke in patients with atrial fibrillation. Rivaroxaban is a substrate for P-glycoprotein, which is encoded by the ABCB1 gene. Rivaroxaban is also metabolized by the CYP3A5 gene. Therefore, the current study is carried out to study the effects of polymorphisms in the ABCB1 and CYP3A5 genes, which may affect the plasma levels of rivaroxaban, with subsequent clinical outcomes (bleeding events) associated with the therapy. Materials and Methods: The study was conducted on 66 naive patients with atrial fibrillation treated with rivaroxaban. Blood samples of rivaroxaban were taken at 3 h and after 1 month following the administration of the drug to measure plasma levels. The blood level of rivaroxaban was measured with an HPLC-UV detector. Sanger sequencing was used to find polymorphisms in the targeted genes. Coagulation parameters were measured at 3 h and after 1 month of administration of rivaroxaban. Frequencies of bleeding events were recorded throughout the one-month course of drug therapy. Results: The heterozygous and homozygous mutant genotypes of ABCB1 (rs2032582, rs1045642, rs1128503, and rs4148738) and CYP3A5 (rs776746) showed lower plasma concentrations as compared to the wild-type genotype. ABCB1 (rs2032582, rs1045642, rs1128503, and rs4148738) and CYP3A5 (rs776746) gene polymorphisms had a statistically significant impact on the plasma concentration of rivaroxaban among the heterozygous and homozygous mutant genotypes compared to the wild-type genotype. The heterozygous variant of ABCB1 and homozygous variant of CYP3A5 suffered more events of bleeding. Conclusions: It was concluded that ABCB1 (rs2032582, rs1045642, rs1128503, and rs4148738) and CYP3A5 (rs776746) gene polymorphisms had a significant impact on the plasma levels of rivaroxaban in patients treated for atrial fibrillation on day three as well as after one month of the therapy. The lowest plasma levels were observed in patients with a homozygous variant of ABCB1 (rs2032582, rs1045642, or rs4148738) along with the CYP3A5*1/*3 allele. The heterozygous variant of ABCB1 SNPs and homozygous variant of CYP3A5 SNPs suffered more events of bleeding. Full article

(This article belongs to the Section Pharmacology)

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10 pages, 317 KiB

Open AccessArticle

Association of Age at Menarche with General and Abdominal Obesity in Young Women

by Rada Rakic, Tatjana Pavlica, Jelena Havrljenko and Jelena Bjelanovic

Medicina 2024, 60(10), 1711; https://doi.org/10.3390/medicina60101711 - 18 Oct 2024

Cited by 1 | Viewed by 1126

Abstract

Background and Objectives: Age at menarche is related to various biological and socioeconomic factors in childhood. The aim of the study was to examine the association of age at menarche with general and abdominal obesity in young women. Materials and Methods: [...] Read more.

Background and Objectives: Age at menarche is related to various biological and socioeconomic factors in childhood. The aim of the study was to examine the association of age at menarche with general and abdominal obesity in young women. Materials and Methods: A transversal anthropometric survey was conducted with 102 females from 21 to 25 years of age. The surveyed traits included height, weight, waist circumference (WC) and hip circumference (HC). General obesity was assessed using the body mass index (BMI) and abdominal obesity by WC, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). A retrospective method was used for collecting age at menarche data. Results: The average age at menarche is 12.80 years. Early menarcheal age (<12 years) is detected in 25.5% of young females, while late onset of menarche (>14 years) is recorded for 20.6% of subjects. Early menarche age subjects exhibit significantly higher BMI, WC and WHtR in comparison with their late menarche age peers. There is a significant negative correlation between BMI, WC and WHtR values and menarcheal age. Late age at menarche is associated with higher probability of underweight status (BMI < 18.5 and/or WHtR < 0.4). Conclusions: Age at menarche has a negative correlation with general and abdominal obesity. Young women with early age at menarche show statistically higher values of BMI, WC and WHtR, while those with late menarcheal age show greater susceptibility to becoming underweight. Full article

(This article belongs to the Section Endocrinology)

10 pages, 885 KiB

Open AccessArticle

A Comparative Analysis of Pain Assessment Methods in the Initial Postoperative Phase Following Different Pilonidal Cyst Surgeries

by Edvinas Dainius, Julija Garnyte, Egle Juskeviciute, Audrius Parseliunas, Tadas Latkauskas, Guoda Burzinskiene, Donatas Venskutonis and Algimantas Tamelis

Medicina 2024, 60(10), 1710; https://doi.org/10.3390/medicina60101710 - 18 Oct 2024

Viewed by 835

Abstract

Background and Objectives: In this study, we aimed to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale and to explore potential correlations between these methods. Materials and Methods: A total of [...] Read more.

Background and Objectives: In this study, we aimed to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale and to explore potential correlations between these methods. Materials and Methods: A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study. The patients were divided into two groups based on the type of surgery assigned to each patient at the pre-hospital consultation: pit-picking surgery (n = 39) and radical excision (n = 39). The pain levels at the surgical site were assessed and compared using the visual analog scale (VAS) and pressure algometry the morning before surgery and the day after the operation. Results: There was no statistically significant difference (p > 0.05) in VAS measurement results between surgical groups when comparing pain intensity experienced by patients before, during, and after surgery. Notably, specific pressure algometry variables (pressure pain tolerance left 2.05 ± 1.46 compared to 1.42 ± 0.73 kg/cm², p = 0.02; maximum pressure pain tolerance left 2.91 ± 1.33 compared to 2.32 ± 1.14 kg/cm², p = 0.04; maximum pressure pain tolerance center 2.51 ± 1.07 compared to 1.91 ± 0.91 kg/cm², p = 0.01; interval of pressure pain tolerance center 0.98 ± 0.62 compared to 0.59 ± 0.39 kg/cm², p = 0.00) on the first postoperative day were significantly lower in the “pit-picking” group compared to the excision group. Furthermore, no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day. Conclusions: In the early postoperative period following pilonidal disease surgery of varying extents, pain measured with the VAS does not differ. In contrast, the pressure algometry method showed greater pain in the minimally invasive surgery cohort on the first postoperative day. However, further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement. Full article

(This article belongs to the Section Surgery)

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16 pages, 589 KiB

Open AccessSystematic Review

Evaluation of the Accuracy of Electronic Apex Locators in Modern Endodontics: An Umbrella Review

by Massimo Pisano, Giuseppe Sangiovanni, Eugenio Frucci, Michela Scorziello, Giuseppina De Benedetto and Alfredo Iandolo

Medicina 2024, 60(10), 1709; https://doi.org/10.3390/medicina60101709 - 18 Oct 2024

Viewed by 1905

Abstract

Background and Objectives: To achieve success in endodontic treatment, it is essential to properly perform the steps of shaping, cleansing and obturation. Determining the working length of the canal is, therefore, a process that must be precise and accurate. Electronic apex locators are [...] Read more.

Background and Objectives: To achieve success in endodontic treatment, it is essential to properly perform the steps of shaping, cleansing and obturation. Determining the working length of the canal is, therefore, a process that must be precise and accurate. Electronic apex locators are a useful tool for the clinician to best perform this step of endodontic treatment. Materials and Methods: The purpose of the following umbrella review is to evaluate, through data in the literature, the degree of accuracy of apex locators. Results: Seven systematic reviews were included in the following umbrella review. Five compare the accuracy of apex locators versus radiographic techniques, two compare different types of electronic apex locators, and two analyze the determination of working length in primary teeth. Conclusions: From the results obtained from the following umbrella review, albeit at low levels of evidence, the methods for determining working length using electronic apex locators and other methods, particularly using radiographic evaluation, are equally valid. Full article

(This article belongs to the Special Issue Modern Therapeutic Approaches in Endodontics and Restorative Dentistry)

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13 pages, 837 KiB

Open AccessArticle

Investigating the Impact of the Number of Medication Use on Depression Among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey Database

by Fahad T. Alsulami, Atiah H. Almalki, Majed A. Algarni, Mohammad S. Alzahrani and Yousef Saeed Alqarni

Medicina 2024, 60(10), 1708; https://doi.org/10.3390/medicina60101708 - 18 Oct 2024

Viewed by 1161

Abstract

Background and Objective: Hypertension is a prevalent chronic condition often treated with multiple medications, leading to polypharmacy, which can heighten the risk of adverse drug reactions and contribute to psychological issues like depression. This study aimed to investigate the relationship between polypharmacy and [...] Read more.

Background and Objective: Hypertension is a prevalent chronic condition often treated with multiple medications, leading to polypharmacy, which can heighten the risk of adverse drug reactions and contribute to psychological issues like depression. This study aimed to investigate the relationship between polypharmacy and depressive symptoms in hypertensive patients using data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Materials and Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2017 and March 2020. Results: Among 2543 hypertensive participants, 12.3% met the criteria for depression. The findings revealed that patients using 11 or more medications were ten times more likely to experience depressive symptoms compared to those taking 1 to 2 medications (OR = 10.06, p < 0.001). Additionally, younger age (18 to 45 years), female gender, and lower educational attainment were significantly associated with higher rates of depressive symptoms. Specifically, females were 1.47 times more likely to experience depression compared to males (p = 0.032). Conclusions: This research highlights the substantial impact of medication burden on mental health among hypertensive patients, emphasizing the need for tailored clinical interventions for this vulnerable population. Full article

(This article belongs to the Section Epidemiology & Public Health)

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10 pages, 7934 KiB

Open AccessArticle

The Effect of CKD-495, Eupacidin, and Their Marker Compounds on Altered Permeability in a Postoperative Ileus Animal Model

by Min-Jae Kim, Zahid Hussain, Young Ju Lee and Hyojin Park

Medicina 2024, 60(10), 1707; https://doi.org/10.3390/medicina60101707 - 18 Oct 2024

Viewed by 866

Abstract

Background and Objectives: Postoperative ileus (POI) is a delay in gastrointestinal transit following surgery that leads to various complications. There is limited understanding of its effective treatment options. CKD-495 and eupacidin are natural products licensed for treating mucosal lesions in acute and chronic [...] Read more.

Background and Objectives: Postoperative ileus (POI) is a delay in gastrointestinal transit following surgery that leads to various complications. There is limited understanding of its effective treatment options. CKD-495 and eupacidin are natural products licensed for treating mucosal lesions in acute and chronic gastritis; however, little is known about their effects on intestinal permeability. This study evaluated the effects of CKD-495, eupacidin, and its components (eupatilin and cinnamic acid) on intestinal permeability in an animal model of POI. Materials and Methods: Guinea pigs underwent surgical procedures and were randomly assigned to different treatment groups. Drugs were administered orally prior to surgery. Intestinal permeability, leukocyte count, and the expression of calprotectin and tight junction proteins were measured in the harvested ileum tissue. Results: The intestinal permeability and leukocyte count were higher in the POI group than in the control group. The pre-administration of CKD-495, cinnamic acid, eupacidin, and eupatilin effectively prevented these changes in the POI model. No significant differences were observed in the expression of tight junction proteins. Conclusions: CKD-495, cinnamic acid, eupacidin, and eupatilin exerted protective effects against increased intestinal permeability and inflammation in an animal model of POI. These natural products have potential as therapeutic options for the treatment of POI. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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11 pages, 269 KiB

Open AccessArticle

Protective Effect of Exercise Against Depression, Anxiety, and Stress Among University Students Based on Their Level of Academic Performance

by Ibrahim M. Gosadi

Medicina 2024, 60(10), 1706; https://doi.org/10.3390/medicina60101706 - 17 Oct 2024

Viewed by 2430

Abstract

Background and Objectives: Certain lifestyle behaviors can act as either buffering or aggravating factors influencing the mental well-being of university students. The current investigation assessed the association between academic performance and the risk of anxiety, depression, and stress among university students and how [...] Read more.

Background and Objectives: Certain lifestyle behaviors can act as either buffering or aggravating factors influencing the mental well-being of university students. The current investigation assessed the association between academic performance and the risk of anxiety, depression, and stress among university students and how physical activity might buffer the levels of these conditions. Materials and Methods: A cross-sectional design was utilized to reach a sample of university students from Saudi Arabia. Data about the demographics of the students, GPA, exercise regularity, and levels of anxiety, depression, and stress were collected. Logistic regression was performed to investigate the influence of exercise regularity on the presence of anxiety, depression, and stress, dividing the sample according to the GPA category. Result: A total of 506 students were recruited. The mean age of the students was 22 years, and 53% of the students were men. An assessment of the levels of depression, anxiety, and stress indicated that 60%, 57%, and 40% have abnormal levels of these conditions, respectively. Students with a GPA of “good” or lower exhibited higher levels of stress. Exercising regularly was associated with a protective effect against depression and stress (p < 0.05). However, the buffering effect of exercise was more apparent among students with a GPA of “very good” or above compared to students with lower academic achievement. Conclusions: The lack of a statistically significant association between physical activity regularity and mental well-being among students classified as low academic achievers may indicate the need for additional psychological support in addition to the promotion of a physically active lifestyle. Full article

(This article belongs to the Section Psychiatry)

16 pages, 989 KiB

Open AccessArticle

A Prospective Study of the Medication Regimen Complexity Index and Hospitalization Due to Adverse Drug Reactions Among People Living with HIV

by Basavaraj Poojar, Ashwin Kamath, Sathish B. Rao, Sheetal Dinkar Ullal, John Ramapuram, Muralidhar B. Yadiyal and Ashok K. Shenoy

Medicina 2024, 60(10), 1705; https://doi.org/10.3390/medicina60101705 - 17 Oct 2024

Viewed by 835

Abstract

Background and Objective: The complexity of antiretroviral therapy (ART) regimens in people living with HIV (PLHIV) poses significant challenges for medication management, impacting adherence and overall health outcomes. The Medication Regimen Complexity Index (MRCI) is a tool that quantifies regimen complexity, yet [...] Read more.

Background and Objective: The complexity of antiretroviral therapy (ART) regimens in people living with HIV (PLHIV) poses significant challenges for medication management, impacting adherence and overall health outcomes. The Medication Regimen Complexity Index (MRCI) is a tool that quantifies regimen complexity, yet its correlation with hospitalization rates and adverse drug reactions (ADRs) in PLHIV remains underexplored. Materials and Methods: This prospective study, which was conducted at a government-funded antiretroviral treatment center, investigated the relationships among MRCI scores, hospitalization due to ADRs, and the ADR rates in 285 PLHIV participants over 18 months. Results: The study revealed a significant association between higher baseline MRCI scores and hospitalization due to ADRs, with a threshold MRCI score of 8 indicating increased risk. There was no significant association between average MRCI scores and overall ADR rates or non-ADR-related hospitalizations. Conclusions: These findings emphasize the importance of monitoring medication regimen complexity in PLHIV, particularly in the context of preventing hospitalizations related to ADRs. Further research is needed to understand the multifactorial influences on ADR occurrence and to optimize ART regimens for better patient outcomes. Full article

(This article belongs to the Section Pharmacology)

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16 pages, 3895 KiB

Open AccessArticle

Computational Fluid Dynamics (CFD) in Arteriovenous (AV) Graft Implantation Through End-to-Side Anastomosis with Varying Tube Diameters Across Different Vascular Access Locations for Dialysis Treatment

by Roland Jayson Panganiban, Reniela Redem Lictaoa, Martin Lance Mesia, Jordan Angelo Amorado and Heherson Cabrera

Medicina 2024, 60(10), 1704; https://doi.org/10.3390/medicina60101704 - 17 Oct 2024

Viewed by 1183

Abstract

Background/Objectives: Arteriovenous (AV) graft is a procedure for hemodialysis performed in the arm. Optimizing AV graft design is vital to enhance haemodialytic efficiency in patients with kidney disease. Despite being a standard procedure, making it work optimally is still difficult due to various [...] Read more.

Background/Objectives: Arteriovenous (AV) graft is a procedure for hemodialysis performed in the arm. Optimizing AV graft design is vital to enhance haemodialytic efficiency in patients with kidney disease. Despite being a standard procedure, making it work optimally is still difficult due to various graft diameters and anastomosis configurations, which have limited studies. This research aims to find the ideal AV graft tube diameter on blood flow and pressure gradients and the ideal body site for AV graft implantation and to study their angles for dialysate flow. Methods: Nine models were designed in Autodesk Fusion 360 with 40°, 50°, and 60° angles each having 2 mm, 5.1 mm, and 14.5 mm diameters, all following specific equations on continuity, momentum (Navier-Stokes Equation)), and the Reynolds Stress Model (RSM). The CFD simulation of these models was performed in ANSYS Fluent with an established parameter of 0.3 m/s inlet velocity and stiff/no-slip graft and artery wall boundary condition. Results: As a result, the design with a diameter of 14.5 mm and a 40° angle was overall the most ideal in terms of minimal wall shear stress and turbulence. Conclusions: Thus the brachiocephalic area or the forearm is calculated to be the most optimal implantation site. Additionally, varying angles do affect dialysate flow, as smaller values cause less stress. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 1404 KiB

Open AccessCase Report

An Uncommon Overlap Syndrome Between Ankylosing Spondylitis and Amyotrophic Lateral Sclerosis—Case Report

by Christian Banciu, Sorin Chiriac, Cristina Pojoga, Loredana Marian, Antonio Fabian, Armand Gogulescu, Mihaela Simu, Ramona Parvanescu, Alexandra Mioc, Roxana Racoviceanu and Andreea Munteanu

Medicina 2024, 60(10), 1703; https://doi.org/10.3390/medicina60101703 - 17 Oct 2024

Viewed by 1559

Abstract

This case report describes an uncommon overlap syndrome between ankylosing spondylitis (AS) and amyotrophic lateral sclerosis (ALS). Initially, the patient was diagnosed with AS, for which he received various specific treatments, including TNF-α inhibitors. After five years of treatment with TNF-α inhibitor etanercept, [...] Read more.

This case report describes an uncommon overlap syndrome between ankylosing spondylitis (AS) and amyotrophic lateral sclerosis (ALS). Initially, the patient was diagnosed with AS, for which he received various specific treatments, including TNF-α inhibitors. After five years of treatment with TNF-α inhibitor etanercept, the patient was referred for a full neurological assessment after he reported balance disturbances, postural instability, muscle weakness, and other neurological symptoms that indicated the presence of a neurological disorder. After a thorough investigation, the patient was diagnosed with ALS. This case report aims to contribute to the limited literature by providing a detailed case study regarding the crosstalk between AS and ALS while also exploring the potential underlying mechanisms and the possible link between TNF-α inhibitors therapy and ALS. Full article

(This article belongs to the Section Neurology)

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16 pages, 770 KiB

Open AccessArticle

Exploring the Role of Hemogram-Derived Ratios and Liver Fibrosis Scores in Pulmonary Fibrosis

by Vera Ciornolutchii, Victoria Maria Ruta, Adina Milena Man, Nicoleta Stefania Motoc, Stefan-Lucian Popa, Dan L. Dumitrascu, Abdulrahman Ismaiel and Daniel-Corneliu Leucuta

Medicina 2024, 60(10), 1702; https://doi.org/10.3390/medicina60101702 - 16 Oct 2024

Viewed by 1211

Abstract

Background and Objectives: Pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF) and secondary pulmonary fibrosis (SPF), is a progressive lung disease that significantly impairs respiratory function. Accurate differentiation between IPF and SPF is crucial for effective management. This study explores the association between pulmonary [...] Read more.

Background and Objectives: Pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF) and secondary pulmonary fibrosis (SPF), is a progressive lung disease that significantly impairs respiratory function. Accurate differentiation between IPF and SPF is crucial for effective management. This study explores the association between pulmonary fibrosis and hepatic conditions, evaluating the utility of various hemogram-derived ratios and hepatic fibrosis scores in distinguishing between IPF and SPF. Materials and Methods: We conducted a retrospective study involving patients diagnosed with IPF or SPF at the “Leon Daniello” Clinical Hospital of Pneumology in Cluj-Napoca, Romania. Pulmonary fibrosis was confirmed via imaging techniques, and hepatic steatosis and fibrosis were assessed using non-invasive scores. We analyzed clinical, laboratory, and pulmonary function data, focusing on hemogram-derived ratios and hepatic scores. Statistical analyses, including ROC curves, were used to evaluate the effectiveness of these biomarkers in differentiating IPF from SPF. Results: We included a total of 38 patients with IPF and 28 patients with SPF. Our findings revealed that IPF patients had a significantly higher FIB-4 score compared to SPF patients, suggesting increased hepatic fibrosis risk in IPF, as well as an increased RDW/PLT ratio. Conversely, SPF patients exhibited elevated PLR, PNR, and SII, reflecting a more pronounced inflammatory profile. PLR and PNR demonstrated the highest discriminatory ability between IPF and SPF, while traditional hepatic fibrosis scores showed limited differentiation capabilities. No significant differences in pulmonary function tests were observed across hepatic fibrosis risk categories. Conclusions: The study highlights the value of biomarkers like PLR and PNR in differentiating between IPF and SPF, offering additional diagnostic insights beyond traditional imaging. Integrating hepatic assessments into the management of pulmonary fibrosis could improve diagnostic accuracy and patient care. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)

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15 pages, 2051 KiB

Open AccessArticle

Factors Influencing the Clinical Course of Bullous Pemphigoid among Geriatric Patients: A Pilot Study

by Paula Mazan, Aleksandra Lesiak, Igor Bednarski, Dorota Sobolewska-Sztychny, Marcin Noweta and Joanna Narbutt

Medicina 2024, 60(10), 1701; https://doi.org/10.3390/medicina60101701 - 16 Oct 2024

Viewed by 1057

Abstract

Background and Objectives: Bullous pemphigoid (BP) is the most common autoimmune blistering disease affecting mainly elderly patients. Still, little is known about the pathogenesis of pruritus in BP or the factors that affect the clinical course of the disease. This study aimed [...] Read more.

Background and Objectives: Bullous pemphigoid (BP) is the most common autoimmune blistering disease affecting mainly elderly patients. Still, little is known about the pathogenesis of pruritus in BP or the factors that affect the clinical course of the disease. This study aimed to evaluate the factors influencing the clinical course of BP among older patients. Materials and Methods: A retrospective analysis of medical records of 55 patients with BP hospitalized in the dermatology department in 2015–2021 was conducted. The study focused on preliminary diagnosis, medical history, clinical examination (characteristics and location of cutaneous changes), laboratory investigation, and direct and indirect immunofluorescence. Results: Analysis of laboratory results in combination with the clinical course of BP showed that red blood cell count, hemoglobin, and hematocrit values were negatively associated with a risk of erosions and erythema, while MCHC values were positively correlated with a risk of associated pruritus. A correlation was found between neurological diseases and an increased risk of erosions. Conclusions: We have shown that age and neurological conditions, including stroke, affect the clinical course of BP. Further studies on a larger group of patients should be conducted to investigate the different factors affecting the clinical aspect of BP and to understand the relationship between them. Full article

(This article belongs to the Section Dermatology)

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11 pages, 565 KiB

Open AccessReview

Early-Stage and Locally Advanced Cervical Cancer during Pregnancy: Clinical Presentation, Diagnosis and Treatment

by Hanna Mruzek, Joanna Kacperczyk-Bartnik, Anna Dańska-Bidzińska, Michał Ciebiera, Laretta Grabowska-Derlatka and Paweł Derlatka

Medicina 2024, 60(10), 1700; https://doi.org/10.3390/medicina60101700 - 16 Oct 2024

Viewed by 1898

Abstract

In this comprehensive review supported by clinical examples, the authors explore the topic of cervical cancer in pregnancy, with emphasis on potential pre-cancer progression, the possibility of coexisting preinvasive and invasive disease, and neoadjuvant chemotherapy. This manuscript addresses the challenges of managing cervical [...] Read more.

In this comprehensive review supported by clinical examples, the authors explore the topic of cervical cancer in pregnancy, with emphasis on potential pre-cancer progression, the possibility of coexisting preinvasive and invasive disease, and neoadjuvant chemotherapy. This manuscript addresses the challenges of managing cervical cancer in pregnant women with a pregnancy-preserving approach, including the importance of screening, the timing of surgery, and the impact of pregnancy on the course of the disease. The first case study illustrates the potential for a benign cervical lesion to transform into a malignant one during pregnancy and the possible coexistence of preinvasive lesions together with early-stage cervical cancer. It also questions the rationale behind the non-treatment of pregnant patients initially diagnosed with CIN 2/3 during pregnancy. The second presented clinical example shows the histologically confirmed response to neoadjuvant chemotherapy, resulting in a radiologically diagnosed FIGO stage IIA1 being downgraded to adenocarcinoma in situ in the histology report after surgery performed six weeks postpartum. The treatment of cervical cancer, which is becoming increasingly prevalent among pregnant women, and the necessity for an individualized diagnostic and therapeutic approach represent significant challenges for contemporary medicine. Discrepancies in therapeutic options proposed among centers within the same region lead to the conclusion that there is a need for centralization and unification of evidence-based management in referral centers with both high-level oncological and perinatal care. Full article

(This article belongs to the Special Issue Advances in Cancer Therapy from Research to Clinical Practice—Surgical, Molecular or Systemic Management of Cancer: 2nd Edition)

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20 pages, 1242 KiB

Open AccessReview

The Hidden Heart: Exploring Cardiac Damage Post-Stroke: A Narrative Review

by Marian Mitrică, Lorenzo Lorusso, Alexandru-Andrei Badea, Carmen-Adella Sîrbu, Andreea Pleșa, Ana-Maria Alexandra Stănescu, Florentina Cristina Pleșa, Octavian Mihai Sîrbu and Alice Elena Munteanu

Medicina 2024, 60(10), 1699; https://doi.org/10.3390/medicina60101699 - 16 Oct 2024

Cited by 2 | Viewed by 1680

Abstract

Stroke–heart syndrome (SHS), a critical yet underrecognized condition, encompasses a range of cardiac complications that arise following an ischemic stroke. This narrative review explores the pathophysiology, clinical manifestations, and implications of SHS, focusing on the complex interplay between the brain and the heart. [...] Read more.

Stroke–heart syndrome (SHS), a critical yet underrecognized condition, encompasses a range of cardiac complications that arise following an ischemic stroke. This narrative review explores the pathophysiology, clinical manifestations, and implications of SHS, focusing on the complex interplay between the brain and the heart. Acute ischemic stroke (AIS) triggers autonomic dysfunction, leading to a surge in catecholamines and subsequent myocardial injury. Our review highlights the five cardinal manifestations of SHS: elevated cardiac troponin (cTn) levels, acute myocardial infarction, left ventricular dysfunction, arrhythmias, and sudden cardiac death. Despite the significant impact of these complications on patient outcomes, there is a notable absence of specific guidelines for their management. Through a comprehensive literature search, we synthesized findings from recent studies to elucidate the mechanisms underlying SHS and identified gaps in the current understanding. Our findings underscore the importance of early detection and multidisciplinary management of cardiac complications post-stroke. Future research should focus on establishing evidence-based protocols to improve clinical outcomes for stroke patients with SHS. Addressing this unmet need will enhance the care of stroke survivors and reduce mortality rates associated with cardiac complications. Full article

(This article belongs to the Special Issue Recent Advances in Stroke Screening)

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15 pages, 1253 KiB

Open AccessArticle

Post-Lunch Napping as a Strategy to Enhance Physiological Performance and Cognitive Function in Elite Volleyball Players

by Özgür Eken, Oguzhan Bozkurt, Musa Türkmen, Ahmet Kurtoglu, Madawi H. Alotaibi and Safaa M. Elkholi

Medicina 2024, 60(10), 1698; https://doi.org/10.3390/medicina60101698 - 16 Oct 2024

Cited by 1 | Viewed by 3672

Abstract

Background and Objectives: Volleyball demands high levels of anaerobic strength, flexibility, agility, and mental focus. Adequate sleep has been shown to enhance athletic performance and cognitive function. This study investigates the impact of post-lunch naps of varying durations (25 and 45 min) [...] Read more.

Background and Objectives: Volleyball demands high levels of anaerobic strength, flexibility, agility, and mental focus. Adequate sleep has been shown to enhance athletic performance and cognitive function. This study investigates the impact of post-lunch naps of varying durations (25 and 45 min) on the physiological performance and cognitive focus of elite volleyball players. Materials and Methods: Sixteen elite volleyball players (8 male, 8 female) with at least 7 years of competitive experience participated in a randomized crossover study. They underwent three experimental conditions: no nap (No-Nap), a 25-min nap (N25), and a 45-min nap (N45). Physical performance was measured through counter-movement jumps (CMJ) and volleyball agility tests, while cognitive function was assessed using the D2 attention test. Statistical analysis included repeated measures ANOVA to examine the differences between nap conditions and gender-specific responses. Results: Significant improvements in both physical performance and cognitive focus were observed in the N25 and N45 conditions compared to the No-Nap condition (indicating the effectiveness of short naps in enhancing both physical and mental performance). Males outperformed females in most physical metrics, while females scored higher on the D2 attention test (suggesting possible gender-specific responses to napping). The 25-min nap showed slightly better results in terms of sleep quality and subsequent performance (confirming that shorter naps may be more beneficial). Conclusions: Post-lunch naps, especially of 25 or 45 min, enhance both physiological and cognitive performance in elite volleyball players. These findings suggest that integrating short naps into athletes’ training regimens can improve performance and focus, with potential gender-specific benefits. Further research is needed to explore long-term effects and variations across other sports. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

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12 pages, 833 KiB

Open AccessArticle

Handgrip Strength and Cognitive Recovery in Older Stroke Survivors: A Prospective Study

by Young-Ah Choi

Medicina 2024, 60(10), 1697; https://doi.org/10.3390/medicina60101697 - 16 Oct 2024

Viewed by 1225

Abstract

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in [...] Read more.

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation. Full article

(This article belongs to the Section Neurology)

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11 pages, 967 KiB

Open AccessArticle

Analysis of Complications of a Neglected Disease: 13 Years of Experience with Liver Hydatid Cysts in a High-Volume Hospital

by Mustafa Azizoğlu, Bahattin Aydogdu, Tahsin Onat Kamci, Serkan Arslan, Erol Basuguy, Salim Bilici and Mehmet Hanifi Okur

Medicina 2024, 60(10), 1696; https://doi.org/10.3390/medicina60101696 - 15 Oct 2024

Cited by 1 | Viewed by 965

Abstract

Background and Objectives: The aim of this study was to evaluate the clinical presentation, treatment outcomes, and complications associated with hepatic hydatid cysts in a pediatric population. Materials and Methods: This retrospective study analyzed 214 pediatric patients with liver hydatid cysts, [...] Read more.

Background and Objectives: The aim of this study was to evaluate the clinical presentation, treatment outcomes, and complications associated with hepatic hydatid cysts in a pediatric population. Materials and Methods: This retrospective study analyzed 214 pediatric patients with liver hydatid cysts, focusing on clinical presentation, treatment outcomes, and associated complications. Patients were classified based on treatment modality, including non-operative management with albendazole, PAIR, and surgical intervention. This study compared cyst characteristics, recurrence rates, and complications such as cysto-biliary fistulas. Results: Among the patients, 68% (n = 145) had a single cyst and 86% (n = 184) were found to have isolated liver cysts. No significant statistical difference was observed between Group 1 and Group 2 in terms of age, gender, and basic laboratory values and general characteristics of the cysts, such as the lobe where the cyst was located, involvement of multiple organs, number of cysts, the state of cyst rupture, and recurrence; no statistically significant difference was found between the groups (p > 0.05 for each comparison). Cyst rupture incidence was 6%, and the average incidence of recurrence was 2%, with a surgical recurrence incidence of 3%. A total of 37 patients had a laparotomy, while 7 had laparoscopic surgery. In total, capitonnage was performed in 68 patients, omentopexy in 4, and cystostomy in 6. Consequently, among the treated patients (PAIR + surgery), the incidence of cysto-biliary fistula was 11%, anaphylaxis was 2%, surgical recurrence was 3%, and the incidence of reoperation (Clavien–Dindo ≥ 3) was 6%. The average follow-up period was 72 months, during which no mortality was observed. Conclusions: We identified key clinical outcomes related to both non-surgical treatments (cyst rupture and recurrence) and surgical groups (cysto-biliary fistulas, anaphylaxis, the need for reoperation, rupture, and recurrence). Full article

(This article belongs to the Section Pediatrics)

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12 pages, 1207 KiB

Open AccessReview

Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management

by Marzia Varanese, Marco Spadaccini, Antonio Facciorusso, Gianluca Franchellucci, Matteo Colombo, Marta Andreozzi, Daryl Ramai, Davide Massimi, Roberto De Sire, Ludovico Alfarone, Antonio Capogreco, Roberta Maselli, Cesare Hassan, Alessandro Fugazza, Alessandro Repici and Silvia Carrara

Medicina 2024, 60(10), 1695; https://doi.org/10.3390/medicina60101695 - 15 Oct 2024

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Abstract

Background and objectives: Subepithelial lesions (SELs) of the gastrointestinal (GI) tract present a diagnostic challenge due to their heterogeneous nature and varied clinical manifestations. Usually, SELs are small and asymptomatic; generally discovered during routine endoscopy or radiological examinations. Currently, endoscopic ultrasound (EUS) [...] Read more.

Background and objectives: Subepithelial lesions (SELs) of the gastrointestinal (GI) tract present a diagnostic challenge due to their heterogeneous nature and varied clinical manifestations. Usually, SELs are small and asymptomatic; generally discovered during routine endoscopy or radiological examinations. Currently, endoscopic ultrasound (EUS) is the best tool to characterize gastric SELs. Materials and methods: For this review, the research and the study selection were conducted using the PubMed database. Articles in English language were reviewed from August 2019 to July 2024. Results: This review aims to summarize the international literature to examine and illustrate the progress in the last five years of endosonographic diagnostics and treatment of gastric SELs. Conclusions: Endoscopic ultrasound is the preferred option for the diagnosis of sub-epithelial lesions. In most of the cases, EUS-guided tissue sampling is mandatory; however, ancillary techniques (elastography, CEH-EUS, AI) may help in both diagnosis and prognostic assessment. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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Medicina, Volume 60, Issue 10 (October 2024) – 166 articles

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