Journal of Clinical Medicine

9 pages, 525 KiB

Open AccessArticle

The Relationship between Body Image, Disability and Mental Health in Patients with Multiple Sclerosis

by Viviana Lo Buono, Lilla Bonanno, Francesco Corallo, Davide Cardile, Giangaetano D’Aleo, Carmela Rifici, Edoardo Sessa, Angelo Quartarone and Maria Cristina De Cola

J. Clin. Med. 2023, 12(10), 3606; https://doi.org/10.3390/jcm12103606 - 22 May 2023

Viewed by 1894

Abstract

Background: Multiple sclerosis is a progressive degenerative disorder that frequently involves the development of physical and emotional changes, including loss of limb function or sensitivity, sexual dysfunction, and cognitive and mood alterations. It is likely that these alterations lead to changes in body [...] Read more.

Background: Multiple sclerosis is a progressive degenerative disorder that frequently involves the development of physical and emotional changes, including loss of limb function or sensitivity, sexual dysfunction, and cognitive and mood alterations. It is likely that these alterations lead to changes in body aspects. However, knowledge about body image perception in multiple sclerosis is lacking. Purpose: The present study investigated the relationship between body image perception and its correlation with a disability, neuropsychiatric symptoms, and self-esteem. Methods: A total of 100 outpatients with relapsing-remitting multiple sclerosis underwent neurological assessment using the Expanded Disability Status Scale. Participants also completed the Body Image Scale (BIS), Rosenberg Self-Esteem Scale (RSES), and Symptom Checklist-90-Revised (SCL-90-R). Results: We found a significant positive correlation between body image and disability (r = 0.21; p = 0.03), body image and self-esteem (r = −0.52; p < 0.001), body image and somatization (r = 0.44; p < 0.001), body image and depression (r = 0.57; p < 0.001), and body image and anxiety (r = 0.5; p < 0.001). Conclusions: The body is considered one of the main parts of a person’s identity. Dissatisfaction with one’s own body changes the general evaluation of the “self”. The body image construct has important health outcomes and should be studied more in patients with multiple sclerosis. Full article

(This article belongs to the Section Clinical Neurology)

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14 pages, 458 KiB

Open AccessReview

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

by Christian Calvo-Henriquez, Jaime Viera-Artiles, Miguel Rodriguez-Iglesias, Paula Rodriguez-Rivas, Antonino Maniaci, Miguel Mayo Yáñez, Gabriel Martínez-Capoccioni and Isam Alobid

J. Clin. Med. 2023, 12(10), 3605; https://doi.org/10.3390/jcm12103605 - 22 May 2023

Cited by 7 | Viewed by 2622

Abstract

Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even [...] Read more.

Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

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11 pages, 956 KiB

Open AccessArticle

Plasma Rich in Growth Factors as an Adjuvant Agent in Non-Penetrating Deep Sclerectomy

by Pedro P. Rodríguez-Calvo, Ignacio Rodríguez-Uña, Andrés Fernández-Vega-Cueto, Ronald M. Sánchez-Ávila, Eduardo Anitua and Jesús Merayo-Lloves

J. Clin. Med. 2023, 12(10), 3604; https://doi.org/10.3390/jcm12103604 - 22 May 2023

Viewed by 1247

Abstract

Background: The purpose of this study is to evaluate the utility and safety of plasma rich in growth factors immunosafe eye drops (is-ePRGF) in the postoperative treatment of non-penetrating deep sclerectomy (NPDS). Methods: This is a case–control study in patients with open-angle glaucoma. [...] Read more.

Background: The purpose of this study is to evaluate the utility and safety of plasma rich in growth factors immunosafe eye drops (is-ePRGF) in the postoperative treatment of non-penetrating deep sclerectomy (NPDS). Methods: This is a case–control study in patients with open-angle glaucoma. Group one (control) was not treated with is-ePRGF, while group two (is-ePRGF) was treated (four times a day for four months). Postoperative evaluations were performed at one day, one month, three months and six months. The main outcomes were: intraocular pressure (IOP), microcysts in blebs with AS-OCT and the number of hypotensive eye drops. Results: Preoperatively, group one (n = 48 eyes) and group two (n = 47 eyes) were similar in age (71.5 ± 10.7 vs. 70.9 ± 10.0 years; p = 0.68), IOP (20.6 ± 10.2 vs. 23.0 ± 9.0 mmHg; p = 0.26) and number of hypotensive drugs (2.7 ± 0.8 vs. 2.8 ± 0.9; p = 0.40). The IOP at six months dropped to 15.0 ± 8.0 mmHg (IOP reduction: −27.2%) and 10.9 ± 4.3 mmHg (IOP reduction: −52.6%) for group one and group two, respectively (p < 0.01). At six months, blebs with microcysts were 62.5% (group one) and 76.7% (group two). Postoperative complications were observed in 12 eyes (25%) for group one and in 5 eyes (11%) for group two (p = 0.06). No specific complications related to the use of is-ePRGF were identified. Conclusions: Topical is-ePRGF seems to reduce IOP and the rate of complications in the medium term after NPDS, so it can be considered as a possible safe adjuvant to achieve surgical success. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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9 pages, 258 KiB

Open AccessSystematic Review

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

by Senol Tonyali, Mehmet Yilmaz, Lazaros Tzelves, Esteban Emiliani, Vincent De Coninck, Etienne Xavier Keller and Arkadiusz Miernik

J. Clin. Med. 2023, 12(10), 3603; https://doi.org/10.3390/jcm12103603 - 22 May 2023

Cited by 9 | Viewed by 2596

Abstract

Background: The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as [...] Read more.

Background: The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords “ureteral stone”, “ureteral calculus”, “impacted stone”, “ureteral stenosis”, “ureteroscopic lithotripsy”, “impacted calculus”, and “ureteral strictures” singly or in combination. Results: After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. Conclusion: Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urologic Surgery)

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10 pages, 915 KiB

Open AccessBrief Report

Plasma-Metanephrines in Patients with Autoimmune Addison’s Disease with and without Residual Adrenocortical Function

by Anna-Karin Åkerman, Åse Bjorvatn Sævik, Per Medbøe Thorsby, Paal Methlie, Marcus Quinkler, Anders Palmstrøm Jørgensen, Charlotte Höybye, Aleksandra J. Debowska, Bjørn Gunnar Nedrebø, Anne Lise Dahle, Siri Carlsen, Aneta Tomkowicz, Stina Therese Sollid, Ingrid Nermoen, Kaja Grønning, Per Dahlqvist, Guri Grimnes, Jakob Skov, Trine Finnes, Jeanette Wahlberg, Synnøve Emblem Holte, Katerina Simunkova, Olle Kämpe, Eystein Sverre Husebye, Marianne Øksnes and Sophie Bensing Show full author list Hide full author list

J. Clin. Med. 2023, 12(10), 3602; https://doi.org/10.3390/jcm12103602 - 22 May 2023

Viewed by 1779

Abstract

Purpose: Residual adrenocortical function, RAF, has recently been demonstrated in one-third of patients with autoimmune Addison’s disease (AAD). Here, we set out to explore any influence of RAF on the levels of plasma metanephrines and any changes following stimulation with cosyntropin. Methods: We [...] Read more.

Purpose: Residual adrenocortical function, RAF, has recently been demonstrated in one-third of patients with autoimmune Addison’s disease (AAD). Here, we set out to explore any influence of RAF on the levels of plasma metanephrines and any changes following stimulation with cosyntropin. Methods: We included 50 patients with verified RAF and 20 patients without RAF who served as controls upon cosyntropin stimulation testing. The patients had abstained from glucocorticoid and fludrocortisone replacement > 18 and 24 h, respectively, prior to morning blood sampling. The samples were obtained before and 30 and 60 min after cosyntropin stimulation and analyzed for serum cortisol, plasma metanephrine (MN), and normetanephrine (NMN) by liquid-chromatography tandem-mass pectrometry (LC-MS/MS). Results: Among the 70 patients with AAD, MN was detectable in 33%, 25%, and 26% at baseline, 30 min, and 60 min after cosyntropin stimulation, respectively. Patients with RAF were more likely to have detectable MN at baseline (p = 0.035) and at the time of 60 min (p = 0.048) compared to patients without RAF. There was a positive correlation between detectable MN and the level of cortisol at all time points (p = 0.02, p = 0.04, p < 0.001). No difference was noted for NMN levels, which remained within the normal reference ranges. Conclusion: Even very small amounts of endogenous cortisol production affect MN levels in patients with AAD. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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16 pages, 2836 KiB

Open AccessArticle

Ileocolonic Healing after Small Ileocecal Resection in Mice: NOD2 Deficiency Impairs Anastomotic Healing by Local Mechanisms

by Maria B. Witte, Johannes Saupe, Johannes Reiner, Karen Bannert, Clemens Schafmayer, Georg Lamprecht and Peggy Berlin

J. Clin. Med. 2023, 12(10), 3601; https://doi.org/10.3390/jcm12103601 - 22 May 2023

Viewed by 1402

Abstract

Ileocecal resection (ICR) is frequently performed in Crohn’s disease (CD). NOD2 mutations are risk factors for CD. Nod2 knockout (ko) mice show impaired anastomotic healing after extended ICR. We further investigated the role of NOD2 after limited ICR. C57B16/J (wt) and Nod2 ko [...] Read more.

Ileocecal resection (ICR) is frequently performed in Crohn’s disease (CD). NOD2 mutations are risk factors for CD. Nod2 knockout (ko) mice show impaired anastomotic healing after extended ICR. We further investigated the role of NOD2 after limited ICR. C57B16/J (wt) and Nod2 ko littermates underwent limited ICR including 1–2 cm terminal ileum and were randomly assigned to vehicle or MDP treatment. Bursting pressure was measured on POD 5, and the anastomosis was analyzed for matrix turn-over and granulation tissue. Wound fibroblasts from subcutaneously implanted sponges were used for comparison. The M1/M2 macrophage plasma cytokines were analyzed. Mortality was not different between groups. Bursting pressure was significantly decreased in ko mice. This was associated with less granulation tissue but was not affected by MDP. However, anastomotic leak (AL) rate tended to be lower in MDP-treated ko mice (29% vs. 11%, p = 0.07). mRNA expression of collagen-1α (col1 α), collagen-3α (col3 α), matrix metalloproteinase (mmp)2 and mmp9 was increased in ko mice, indicating increased matrix turn-over, specifically in the anastomosis. Systemic TNF-α expression was significantly lower in ko mice. Ileocolonic healing is impaired in Nod2 ko mice after limited ICR by local mechanisms maybe including local dysbiosis. Full article

(This article belongs to the Special Issue Surgery for Inflammatory Bowel Disease: State of the Art and Future Perspectives)

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14 pages, 2263 KiB

Open AccessFeature PaperArticle

Knee Arthrodesis with a Modular Silver-Coated Endoprosthesis for Infected Total Knee Arthroplasty with Extensive Bone Loss: A Retrospective Case-Series Study

by Olga D. Savvidou, Angelos Kaspiris, Stavros Goumenos, Ioannis Trikoupis, Dimitra Melissaridou, Athanasios Kalogeropoulos, Dimitris Serenidis, Jim-Dimitris Georgoulis, Ioanna Lianou, Panagiotis Koulouvaris and Panayiotis J. Papagelopoulos

J. Clin. Med. 2023, 12(10), 3600; https://doi.org/10.3390/jcm12103600 - 22 May 2023

Cited by 3 | Viewed by 1931

Abstract

Introduction: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. Methods: [...] Read more.

Introduction: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. Methods: Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. Results: The median follow up was 32 months (range 24–59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. Conclusions: The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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14 pages, 2009 KiB

Open AccessArticle

Supporting the Diagnosis of Fabry Disease Using a Natural Language Processing-Based Approach

by Adrian A. Michalski, Karol Lis, Joanna Stankiewicz, Sylwester M. Kloska, Arkadiusz Sycz, Marek Dudziński, Katarzyna Muras-Szwedziak, Michał Nowicki, Stanisława Bazan-Socha, Michal J. Dabrowski and Grzegorz W. Basak

J. Clin. Med. 2023, 12(10), 3599; https://doi.org/10.3390/jcm12103599 - 22 May 2023

Cited by 7 | Viewed by 2982

Abstract

In clinical practice, the consideration of non-specific symptoms of rare diseases in order to make a correct and timely diagnosis is often challenging. To support physicians, we developed a decision-support scoring system on the basis of retrospective research. Based on the literature and [...] Read more.

In clinical practice, the consideration of non-specific symptoms of rare diseases in order to make a correct and timely diagnosis is often challenging. To support physicians, we developed a decision-support scoring system on the basis of retrospective research. Based on the literature and expert knowledge, we identified clinical features typical for Fabry disease (FD). Natural language processing (NLP) was used to evaluate patients’ electronic health records (EHRs) to obtain detailed information about FD-specific patient characteristics. The NLP-determined elements, laboratory test results, and ICD-10 codes were transformed and grouped into pre-defined FD-specific clinical features that were scored in the context of their significance in the FD signs. The sum of clinical feature scores constituted the FD risk score. Then, medical records of patients with the highest FD risk score were reviewed by physicians who decided whether to refer a patient for additional tests or not. One patient who obtained a high-FD risk score was referred for DBS assay and confirmed to have FD. The presented NLP-based, decision-support scoring system achieved AUC of 0.998, which demonstrates that the applied approach enables for accurate identification of FD-suspected patients, with a high discrimination power. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Rare Diseases)

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12 pages, 1040 KiB

Open AccessArticle

Characteristics of Chemosensory Perception in Long COVID and COVID Reinfection

by Mikki Jaramillo, Thankam P. Thyvalikakath, George Eckert and Mythily Srinivasan

J. Clin. Med. 2023, 12(10), 3598; https://doi.org/10.3390/jcm12103598 - 22 May 2023

Cited by 1 | Viewed by 1640

Abstract

Emerging data suggest an increasing prevalence of persistent symptoms in individuals affected by coronavirus disease-19 (COVID-19). The objective of this study was to determine the relative frequency of altered taste and smell in COVID reinfection (multiple COVID positive tests) and long COVID (one [...] Read more.

Emerging data suggest an increasing prevalence of persistent symptoms in individuals affected by coronavirus disease-19 (COVID-19). The objective of this study was to determine the relative frequency of altered taste and smell in COVID reinfection (multiple COVID positive tests) and long COVID (one COVID positive test). We sent an electronic survey to patients in the Indiana University Health COVID registry with positive COVID test results, querying if they were experiencing symptoms consistent with long COVID including altered chemosensory perceptions. Among the 225 respondents, a greater long COVID burden and COVID reinfection was observed in women. Joint pain was reported as the most common symptom experienced by 18% of individuals in the long COVID cohort. In the COVID reinfection cohort >20% of individuals reported headache, joint pain, and cough. Taste perception worse than pre-COVID was reported by 29% and 42% of individuals in the long COVID and COVID reinfection cohorts, respectively. Smell perception worse than pre-COVID was reported by 37% and 46% of individuals in long COVID and COVID reinfection cohorts, respectively. Further, Chi-square test suggested significant association between pre-COVID severity of taste/smell perception and headache in both cohorts. Our findings highlight the prevalence of persistent chemosensory dysfunction for two years and longer in long COVID and COVID reinfection. Full article

(This article belongs to the Special Issue COVID-19: Clinical Advances and Challenges)

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13 pages, 948 KiB

Open AccessArticle

Improvement in Fertility and Pain after Endometriosis Resection and Adhesion Prevention with 4DryField^® PH: Follow-up of a Randomized Controlled Clinical Trial

by Bernhard Krämer, Jürgen Andress, Felix Neis, Sascha Hoffmann, Sara Brucker, Stefan Kommoss and Alice Höller

J. Clin. Med. 2023, 12(10), 3597; https://doi.org/10.3390/jcm12103597 - 22 May 2023

Cited by 7 | Viewed by 2817

Abstract

Background: Adhesions after endometriosis resection are frequent and the most common causes for chronic pain and secondary infertility. Primary results of our randomized controlled trial (RCT) on adhesion prevention after deep infiltrating endometriosis (DIE) resection using the gel barrier 4DryField^® PH showed [...] Read more.

Background: Adhesions after endometriosis resection are frequent and the most common causes for chronic pain and secondary infertility. Primary results of our randomized controlled trial (RCT) on adhesion prevention after deep infiltrating endometriosis (DIE) resection using the gel barrier 4DryField^® PH showed 85% adhesion reduction in second-look surgeries. Secondary endpoint data on fertility and pain development were collected during 12-month follow-ups. Methods: This RCT comprised 50 patients. Preoperatively and after 1, 6 and 12 months, pain scores for cycle-independent pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as the number of pregnancies, were recorded,. Results: The pregnancy rate in the intervention group was significantly higher (p < 0.05). Pain development was also improved: after 12 months, all 5 subscores were lower in the intervention group and improvements were more pronounced, most prominently concerning cycle-independent pelvic pain and dysmenorrhea, the two subcategories with the highest preoperative scores and, therefore, the highest relevance for the patients. Cycle-independent pelvic pain even recurred in the control group, while barrier application prevented this. Conclusions: Considering the known causal link between adhesions and pain, it is apparent that the favourable outcomes in the intervention group are linked to effective adhesion prevention. The significant increase in pregnancies is remarkable. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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11 pages, 1100 KiB

Open AccessFeature PaperArticle

Triticum vulgare Extract and Polyhexanide (Fitostimoline^® Hydrogel/Fitostimoline^® Plus Gauze) versus Saline Gauze Dressing in Patients with Diabetic Foot Ulcers: Results of a Randomized Controlled Trial

by Giuseppe Della Pepa, Gianluca Lombardi, Salvatore Gianfrancesco, Roberto Piccolo, Giovanni Chirico, Micaela Pellegrino, Luigi Santella, Nicola Tecce, Anastasia Volpicelli, Elena Sollo, Lutgarda Bozzetto, Maria Masulli, Gabriele Riccardi, Angela Albarosa Rivellese and Gennaro Saldalamacchia

J. Clin. Med. 2023, 12(10), 3596; https://doi.org/10.3390/jcm12103596 - 22 May 2023

Cited by 4 | Viewed by 2127

Abstract

Background: The use of dressings is an essential component of the standard of care for diabetic foot ulcers (DFUs); however, despite the wide variety of dressings available, there is a lack of evidence from head-to-head randomized controlled trials. We evaluated the efficacy and [...] Read more.

Background: The use of dressings is an essential component of the standard of care for diabetic foot ulcers (DFUs); however, despite the wide variety of dressings available, there is a lack of evidence from head-to-head randomized controlled trials. We evaluated the efficacy and safety of Triticum vulgare extract and polyhexanide (Fitostimoline^® hydrogel/Fitostimoline^® Plus gauze) versus saline gauze dressings in patients with DFUs. Methods: This study involved a monocentric, two-arm, open-label, controlled trial in patients with DFUs (Grades I or II, Stage A or C, based on the Texas classification) randomized to 12 weeks of dressing with Fitostimoline^® hydrogel/Fitostimoline^® Plus gauze or saline gauze. The number of patients with complete healing, the reduction in DFU size, and the presence of local signs and symptoms of the wound and perilesional skin were evaluated every two weeks and at the end of treatment. Results: A total of 40 adult patients were recruited (20 patients in each treatment group). The proportion of patients with complete healing was similar between the two groups (61% vs. 74%, p = 0.495, Fitostimoline^® hydrogel/Fitostimoline^® Plus gauze vs. saline gauze, respectively), without significant differences, as well as the reduction in DFU size. A significant improvement in local signs and symptoms of the wound and signs of perilesional skin in the Fitostimoline^® hydrogel/Fitostimoline^® Plus gauze compared with the saline gauze group was observed. Conclusions: In a clinical setting, the use of Fitostimoline^® hydrogel/Fitostimoline^® Plus gauze dressing in patients with DFUs significantly improves signs and symptoms of the wound and signs of perilesional skin compared with saline gauze dressing with a similar efficacy in terms of wound healing. Full article

(This article belongs to the Section Dermatology)

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12 pages, 1293 KiB

Open AccessArticle

Impact of Hyperkalemia in Heart Failure and Reduced Ejection Fraction: A Retrospective Study

by Andrea Lopez-López, Raúl Franco-Gutiérrez, Alberto José Pérez-Pérez, Margarita Regueiro-Abel, Juliana Elices-Teja, Charigan Abou-Jokh-Casas and Carlos González-Juanatey

J. Clin. Med. 2023, 12(10), 3595; https://doi.org/10.3390/jcm12103595 - 22 May 2023

Cited by 1 | Viewed by 2052

Abstract

(1) Background: Hyperkalemia is a common finding in patients with heart failure and reduced ejection fraction (HFrEF), though its prognostic significance is controversial. There is no consensus on optimal potassium levels in these patients. The primary endpoint of this study was to determine [...] Read more.

(1) Background: Hyperkalemia is a common finding in patients with heart failure and reduced ejection fraction (HFrEF), though its prognostic significance is controversial. There is no consensus on optimal potassium levels in these patients. The primary endpoint of this study was to determine the 5-year incidence of hyperkalemia in a cohort of patients with HFrEF. Secondary endpoints were to determine predictors of hyperkalemia and its impact on overall 5-year mortality; (2) Methods: retrospective, longitudinal, single-center observational study of patients with HFrEF followed-up in a specialized unit between 2011 and 2019. Hyperkalemia was considered as potassium concentration > 5.5 mEq/L; (3) Results: Hyperkalemia was observed in 170 (16.8%) of the 1013 patients. The 5-year hyperkalemia-free survival rate was 82.1%. Hyperkalemia was more frequent at the beginning of follow-up. Factors associated with hyperkalemia in the multivariate analysis were baseline potassium (HR 3.13, 95%CI 2.15–4.60; p < 0.001), creatinine clearance (HR 0.99, 95%CI 0.98–0.99; p = 0.013), right ventricular function (HR 0.95, 95%CI 0.91–0.99; p = 0.016) and diabetes mellitus (HR 1.40, 95%CI 1.01–1.96; p = 0.047). The overall survival rate at 5 years was 76.4%. Normal–high potassium levels (5–5.5 mEq/L) were inversely associated with mortality (HR 0.60, 95%CI 0.38–0.94; p = 0.025); (4) Conclusions: Hyperkalemia is a common finding in patients with HFrEF with an impact on the optimization of neurohormonal treatment. In our retrospective study, potassium levels in the normal–high range seem to be safe and are not associated with increased mortality. Full article

(This article belongs to the Section Cardiology)

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6 pages, 841 KiB

Open AccessCase Report

Successful Bilateral Sperm Retrieval in a Hypogonadal Patient with Non-Obstructive Azoospermia Showing Normal Serum 17-Hydroxyprogesterone Levels Suggestive of Normal Intratesticular Testosterone Production: A Case Report

by Ettore Caroppo and Giovanni M. Colpi

J. Clin. Med. 2023, 12(10), 3594; https://doi.org/10.3390/jcm12103594 - 22 May 2023

Viewed by 1374

Abstract

The impact of hypogonadism on the probability of retrieving testicular sperm from patients with non-obstructive azoospermia (NOA) is still a matter of debate. Conflicting evidence in this field may be justified by the striking differences between serum and intratesticular testosterone (ITT) levels found [...] Read more.

The impact of hypogonadism on the probability of retrieving testicular sperm from patients with non-obstructive azoospermia (NOA) is still a matter of debate. Conflicting evidence in this field may be justified by the striking differences between serum and intratesticular testosterone (ITT) levels found in men with severe spermatogenic dysfunction, so that normal ITT levels may coexist with low serum testosterone levels. Here we report the case of a patient with NOA with a steadily reduced serum testosterone level irresponsive to hormonal stimulation with human chorionic gonadotropin. Supported by his normal serum 17-hydroxyprogesterone (17 OHP) levels, previously suggested to be marker of ITT levels, microdissection testicular sperm extraction was performed for both testes on two separate occasions, resulting in the retrieval of enough sperm for ICSI. Three ICSI cycles were then performed, one blastocyst was transferred, and five were cryopreserved. This case report suggests that normal serum 17 OHP levels, being suggestive of normal ITT levels, may support the decision to proceed with surgical sperm retrieval in hypogonadal patients with NOA, even for those irresponsive to hormonal treatment. Full article

(This article belongs to the Section Reproductive Medicine & Andrology)

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7 pages, 252 KiB

Open AccessCommunication

Predictors of ICU Admission in Children with COVID-19: Analysis of a Large Mexican Population Dataset

by Martha I. Cárdenas-Rojas, José Guzmán-Esquivel and Efrén Murillo-Zamora

J. Clin. Med. 2023, 12(10), 3593; https://doi.org/10.3390/jcm12103593 - 22 May 2023

Viewed by 1110

Abstract

Children, although mostly affected mildly or asymptomatically, have also developed severe coronavirus disease 2019 (COVID-19). This study aims to assess potential predictors of intensive care unit (ICU) admission in a large population (n = 21,121) of children aged 0–9 years with laboratory-confirmed [...] Read more.

Children, although mostly affected mildly or asymptomatically, have also developed severe coronavirus disease 2019 (COVID-19). This study aims to assess potential predictors of intensive care unit (ICU) admission in a large population (n = 21,121) of children aged 0–9 years with laboratory-confirmed disease. We performed a cross-sectional analysis of a publicly available dataset derived from the normative epidemiological surveillance of COVID-19 in Mexico. The primary binary outcome of interest was admission to the ICU due to respiratory failure. Results showed that immunosuppressed children and those with a personal history of cardiovascular disease had a higher likelihood of being admitted to the ICU, while increasing age and the pandemic duration were associated with a lower likelihood of admission. The study’s results have the potential to inform clinical decision-making and enhance management and outcomes for children affected by COVID-19 in Mexico. Full article

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

12 pages, 551 KiB

Open AccessArticle

The Effectiveness of Pyruvic Acid Peeling in Improving the Quality of Life of Patients with Acne Vulgaris

by Beata Jankowska and Małgorzata Elżbieta Zujko

J. Clin. Med. 2023, 12(10), 3592; https://doi.org/10.3390/jcm12103592 - 22 May 2023

Cited by 2 | Viewed by 2391

Abstract

Improving the quality of life (QoL) of patients with various chronic diseases has become a challenge and priority of contemporary medicine. The aim of this study was to assess the impact of pyruvic acid peeling on the QoL of patients with acne vulgaris. [...] Read more.

Improving the quality of life (QoL) of patients with various chronic diseases has become a challenge and priority of contemporary medicine. The aim of this study was to assess the impact of pyruvic acid peeling on the QoL of patients with acne vulgaris. The study group consisted of 200 young patients (mean age 23.04 ± 4.71) with acne vulgaris of mainly mild or moderate severity. Basic data about the patient were collected using a self-reported questionnaire. The assessment of QoL was carried out using standardized questionnaires: CADI (Cardiff Acne Disability Index), DLQI (Dermatology Life Quality Index), SWLS (Satisfaction With Life Scale), and BDI (Beck Depression Inventory). The cosmetic intervention consisted of chemical peeling with 35% pyruvic acid for acne lesions on the body and included four series repeated at 7-day intervals. This study demonstrated that acne vulgaris impairs the quality of life of young people. There were no significant differences between the severity of acne and the lifestyles of the subjects. The applied cosmetic procedure significantly decreased the severity of the acne and improved the quality of life of the patients. Full article

(This article belongs to the Special Issue Medical Cosmetic Skin Diseases: Starting from Acne and Facial Dermatitis)

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9 pages, 243 KiB

Open AccessArticle

Role of Ureteroscopy (URS) and Stone Treatment in Patients with Recurrent UTIs: Outcomes over a 10-Year Period

by Francesco Ripa, Virginia Massella, Andrea Ong, Mriganka Mani Sinha, Amelia Pietropaolo and Bhaskar K. Somani

J. Clin. Med. 2023, 12(10), 3591; https://doi.org/10.3390/jcm12103591 - 22 May 2023

Cited by 2 | Viewed by 1506

Abstract

Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, [...] Read more.

Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. Results. Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7–17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, p = 0.005). Conclusions. SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS. Full article

(This article belongs to the Section Nephrology & Urology)

10 pages, 1426 KiB

Open AccessArticle

Comparison of Two Types of Guidewires for Malignant Hilar Biliary Obstruction by Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial

by Sung Yong Han, Jung Wan Choe, Dong Uk Kim, Jong Jin Hyun, Joung-Ho Han, Hoonsub So, Sung Jo Bang, Dong Hee Koh and Seok Jeong

J. Clin. Med. 2023, 12(10), 3590; https://doi.org/10.3390/jcm12103590 - 22 May 2023

Cited by 1 | Viewed by 1783

Abstract

Background: There is insufficient information regarding the optimal guidewire for managing malignant hilar biliary obstruction (MHBO). Therefore, a newly designed 0.025-inch guidewire was compared with the conventional 0.035-inch guidewire for selective cannulation of both intrahepatic ducts (IHDs) in patients with MHBO. Methods: Patients [...] Read more.

Background: There is insufficient information regarding the optimal guidewire for managing malignant hilar biliary obstruction (MHBO). Therefore, a newly designed 0.025-inch guidewire was compared with the conventional 0.035-inch guidewire for selective cannulation of both intrahepatic ducts (IHDs) in patients with MHBO. Methods: Patients were randomly enrolled into the curved type newly designed 0.025-inch guidewire group (0.025 group) or the curved type conventional 0.035-inch guidewire group (0.035 group). The primary outcome was the selective cannulation rate of IHD. If the assigned guidewire failed to pass the stricture within 5 min, the crossover guidewire was selected. If the crossover guidewire failed to cross the stricture within the next 5 min, it was judged as a failed selective cannulation of both IHDs. Results: A total of 90 patients were enrolled (0.025 group, n = 47; 0.035 group, n = 43). There was no significant difference in baseline characteristics between the groups regarding sex, age, BMI, obstruction level, and clinical presentation. Four patients (8.5%) in the 0.025 group the cannulation of the IHD failed and the conventional 0.035-inch guidewire was substituted in a second attempt; the 0.035-inch guidewire failed to cross the stricture in all four patients. In the 0.035 group, eleven patients (25.6%) failed to achieve selective cannulation of IHD, and the 0.025-inch guidewire was substituted; the newly designed 0.025-inch guidewire crossed the stricture in ten of these (10/11, 90.9%). The selective cannulation rate of IHD was significantly higher in the 0.025 group (95.1% vs. 85.5%, p = 0.043). Conclusions: The 0.025 group exhibited a higher success rate for selective cannulation of both IHDs in MHBO than did the 0.035 group. Full article

(This article belongs to the Special Issue Endoscopic Management of Pancreaticobiliary Disease)

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15 pages, 1625 KiB

Open AccessArticle

Association between Cerebrospinal Fluid Soluble TREM2, Alzheimer’s Disease and Other Neurodegenerative Diseases

by Wenchuan Zhou, Yutong Zhou and Jing Li

J. Clin. Med. 2023, 12(10), 3589; https://doi.org/10.3390/jcm12103589 - 22 May 2023

Cited by 5 | Viewed by 2272

Abstract

Background: Cerebrospinal fluid (CSF) soluble triggering receptor expressed on myeloid cells 2 (sTREM2) is a potential biomarker and therapy target for neurodegenerative diseases (NDDs). The purpose of this meta-analysis was to investigate the association between CSF sTREM2 level and NDDs, [...] Read more.

Background: Cerebrospinal fluid (CSF) soluble triggering receptor expressed on myeloid cells 2 (sTREM2) is a potential biomarker and therapy target for neurodegenerative diseases (NDDs). The purpose of this meta-analysis was to investigate the association between CSF sTREM2 level and NDDs, and to reveal the dynamic changes in CSF sTREM2 level in Alzheimer’s disease (AD) continuum. Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases for observational studies, which compared the levels of CSF sTREM2 between NDDs and controls. Sources of heterogeneity were analyzed using sensitivity analysis, subgroup analysis and meta-regression. We assessed pooled data using a random-effects model. Results: Twenty-two observational studies which included 5716 participates were identified. Compared with the controls, the whole AD continuum group showed a significant increase in CSF sTREM2 level (standardized mean difference [SMD]: 0.41, 95% confidence intervals [CI]: 0.24, 0.58, p < 0.001). The mild cognitive impairment (MCI) group displayed the largest effect size (SMD, 0.49 [95% CI: 0.10, 0.88], p = 0.014), followed by the AD cohort (SMD, 0.40 [95% CI: 0.18, 0.63], p < 0.001). The increase in sTREM2 in the preclinical stage of AD (pre-AD) group was the lowest (SMD, 0.29 [95% CI: 0.03, 0.55], p = 0.031). Other NDDs also showed an increase in the CSF sTREM2 levels compared with control groups (SMD, 0.77 [95% CI: 0.37, 1.16], p < 0.001). Conclusions: The pooled data confirmed that NDDs are associated with increased CSF sTREM2 level, thereby suggesting the CSF sTREM2 as a potential dynamic biomarker and therapy target for NDDs. Full article

(This article belongs to the Special Issue Oxidative Stress in Neurodegenerative Diseases: Molecular and Cellular Mechanisms, Therapeutic Targets and Neuroprotective Strategies)

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9 pages, 795 KiB

Open AccessArticle

Enhanced Monofocal Intraocular Lenses: A Retrospective, Comparative Study between Three Different Models

by Rita Mencucci, Alberto Morelli, Michela Cennamo, Anna Maria Roszkowska and Eleonora Favuzza

J. Clin. Med. 2023, 12(10), 3588; https://doi.org/10.3390/jcm12103588 - 21 May 2023

Cited by 11 | Viewed by 4244

Abstract

The purpose of this study was to compare the visual performance and optical quality between three new enhanced monofocal intraocular lenses (IOLs). This retrospective study included patients affected by cataracts with corneal astigmatism less than 0.75 D and no ocular comorbidities who underwent [...] Read more.

The purpose of this study was to compare the visual performance and optical quality between three new enhanced monofocal intraocular lenses (IOLs). This retrospective study included patients affected by cataracts with corneal astigmatism less than 0.75 D and no ocular comorbidities who underwent cataract surgery with bilateral implantation of Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc., Jacksonville, FL, USA), Vivinex Impress XY1-EM (Hoya Surgical Optics, Singapore) or IsoPure 123 (PhysIOL, Liege, Belgium) IOLs. Three months postoperatively, monocular and binocular uncorrected and corrected distant, and intermediate and near visual acuities were measured. Binocular defocus curve, photopic contrast sensitivity, Point Spread Function (PSF), low order aberrations (LOAs), high order aberrations (HOAs), objective scatter index (OSI), halo and glare perception were also evaluated. This study included a total of 72 eyes from 36 patients. Visual acuity outcomes, PSF, LOAs, HOAs and OSI were similar between groups. There were no statistically significant differences in terms of photopic contrast sensitivity, halo or glare perception. In patients without ocular comorbidities, the Eyhance ICB00 IOL, the Vivinex Impress IOL and the Isopure IOL—even though based on different optical properties—provided similar results in terms of visual acuity, contrast sensitivity and intraocular aberrations, with no influence on photic phenomena. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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18 pages, 1092 KiB

Open AccessArticle

A Global Review of Publicly Available Datasets Containing Fundus Images: Characteristics, Barriers to Access, Usability, and Generalizability

by Tomasz Krzywicki, Piotr Brona, Agnieszka M. Zbrzezny and Andrzej E. Grzybowski

J. Clin. Med. 2023, 12(10), 3587; https://doi.org/10.3390/jcm12103587 - 21 May 2023

Cited by 9 | Viewed by 3182

Abstract

This article provides a comprehensive and up-to-date overview of the repositories that contain color fundus images. We analyzed them regarding availability and legality, presented the datasets’ characteristics, and identified labeled and unlabeled image sets. This study aimed to complete all publicly available color [...] Read more.

This article provides a comprehensive and up-to-date overview of the repositories that contain color fundus images. We analyzed them regarding availability and legality, presented the datasets’ characteristics, and identified labeled and unlabeled image sets. This study aimed to complete all publicly available color fundus image datasets to create a central catalog of available color fundus image datasets. Full article

(This article belongs to the Special Issue Advances in Ophthalmic Imaging)

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17 pages, 994 KiB

Open AccessReview

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

by Paolo Severino, Andrea D’Amato, Silvia Prosperi, Vincenzo Myftari, Lorenzo Colombo, Elisa Tomarelli, Alice Piccialuti, Gianluca Di Pietro, Lucia Ilaria Birtolo, Viviana Maestrini, Roberto Badagliacca, Gennaro Sardella, Francesco Fedele, Carmine Dario Vizza and Massimo Mancone

J. Clin. Med. 2023, 12(10), 3586; https://doi.org/10.3390/jcm12103586 - 21 May 2023

Cited by 12 | Viewed by 4649

Abstract

Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease [...] Read more.

Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasingly recognized. Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor for the pathophysiology and prognosis of patients with MINOCA. Genetic susceptibility may have a role in primum movens in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential in order to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction. Progress in research would allow early identification of high-risk patients and the development of pharmacological, patient-tailored strategies. The aim of this review is to revise the pathophysiology and underlying mechanisms of MINOCA, focusing on CMD and actual knowledge about genetic predisposition to it. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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16 pages, 4838 KiB

Open AccessArticle

Erenumab and Possible CGRP Effect on Chronotype in Chronic Migraine: A Real-Life Study of 12 Months Treatment

by Laura Pilati, Angelo Torrente, Salvatore Di Marco, Salvatore Ferlisi, Giulia Notaro, Marika Romano, Paolo Alonge, Lavinia Vassallo, Ludovica Ferraù, Massimo Autunno, Rosario Grugno, Cecilia Camarda and Filippo Brighina

J. Clin. Med. 2023, 12(10), 3585; https://doi.org/10.3390/jcm12103585 - 21 May 2023

Cited by 9 | Viewed by 1954

Abstract

The introduction of monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP), or its receptor (CGRPr), revolutionized migraine management due to their high efficacy and few side effects. Data suggest that the CGRP may even be implicated in circadian rhythm, but studies [...] Read more.

The introduction of monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP), or its receptor (CGRPr), revolutionized migraine management due to their high efficacy and few side effects. Data suggest that the CGRP may even be implicated in circadian rhythm, but studies about the effect of anti-CGRP treatments on sleep are still lacking. The aim of the present study was to assess the effect of erenumab (70 and 140 mg per month), a human mAb directed against CGRPr, on chronotype in chronic migraineurs; secondly, we assessed its efficacy, safety, and the effects on anxiety and depression. Sleep was evaluated using self-administrable questionnaires investigating chronotype, sleep quality, and daytime sleepiness. Migraine diaries and several self-administrable questionnaires regarding headache impact and psychological correlates were evaluated every 3 months during 12 months of treatment. Eighty-eight patients were included; most of them showed a significant reduction in headache frequency and an improvement in psychological symptoms. Moreover, an initial change in chronotype was observed at the three-month assessment from a morning chronotype to an intermediate one; a similar trend remained in the other evaluations, even if it did not reach a statistical significance. Lastly, patients who responded to the treatment showed a progressive sleep efficiency reduction. The present real-life study hypothesized the influence of erenumab on chronotype, representing a link between circadian rhythm, CGRP, and migraine. Full article

(This article belongs to the Special Issue Clinical Management of Migraine)

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11 pages, 2400 KiB

Open AccessArticle

Comparative Study of Anticipatory Postural Adjustments between Normal and Cervical Myelopathy Patients

by Haruki Funao, Tatsuya Igawa, Masaru Matsuzawa, Norihiro Isogai and Ken Ishii

J. Clin. Med. 2023, 12(10), 3584; https://doi.org/10.3390/jcm12103584 - 21 May 2023

Viewed by 1385

Abstract

Patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament have been considered to be prone to falls due to lower extremity dysfunction and gait instability. Anticipatory postural adjustments (APAs) are unconscious muscular activities to counterbalance perturbation. To date, there are [...] Read more.

Patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament have been considered to be prone to falls due to lower extremity dysfunction and gait instability. Anticipatory postural adjustments (APAs) are unconscious muscular activities to counterbalance perturbation. To date, there are no reports on APAs in cervical myelopathy patients, and quantification of postural control remains difficult. Thirty participants were enrolled, of which 15 were cervical myelopathy patients and 15 were normal age- and sex-matched controls. A three-dimensional motion capture system with force plates was used, and the APA phase was defined as the time between start of movement at the center of pressure and heel-off of the step leg. The APA phase (0.47 vs. 0.39 s, p < 0.05) and turning time (2.27 vs. 1.83 s, p < 0.01) were significantly longer, whereas step length tended to be shorter (305.18 vs. 361.04 mm, p = 0.06) in cervical myelopathy patients. There was a significant correlation between Japanese Orthopaedic Association lower extremity motor dysfunction scores and step length (p < 0.01). Cervical myelopathy patients are prone to falls due to longer APA phases with shorter step lengths. Analysis of the APA phase aids the visualization and quantification of postural control during initial gait in cervical myelopathy patients. Full article

(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)

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9 pages, 570 KiB

Open AccessArticle

Patients with Achilles Tendon Rupture Are Prone to Develop Ventricular Arrhythmia

by Volkan Gür, Furkan Yapici, Uğur Küçük, İzzet Özay Subaşi, Mehmet Burak Gökgöz, Reşit Karaköse and Nizamettin Koçkara

J. Clin. Med. 2023, 12(10), 3583; https://doi.org/10.3390/jcm12103583 - 21 May 2023

Cited by 1 | Viewed by 1481

Abstract

Background and Objectives: This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. Materials and Methods: Between June 2014 and July 2020, a [...] Read more.

Background and Objectives: This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. Materials and Methods: Between June 2014 and July 2020, a total of 29 patients (28 males, 1 female; mean age: 40 ± 9.78 years; range, 21–66 years) who presented to the emergency department within the first three weeks of injury, and were diagnosed with acute spontaneous ATRs and treated with an open Krackow suture technique, were retrospectively analyzed. Fifty-two healthy individuals (47 males, 5 females; mean age: 39 ± 11.45 years; range, 21–66 years) were recruited as a control group from the cardiology outpatient clinic. Clinical data (demographic features and laboratory parameters (serum glucose, creatinine, hemoglobin, white blood cell count, and lipid profile)) and electrocardiograms (ECGs) were collected from medical records. ECGs were evaluated for heart rate and VR parameters of QRS width, QTc interval, cQTd interval, Tp-e interval, and Tp-e/QT ratio. The clinical data and these ECG parameters were compared between groups. Results: There was no statistically significant difference between groups, regarding clinical data (all p < 0.05). Among ECG parameters, heart rate, QRS width, QTc interval, and cQTd interval were similar between groups (all p < 0.05). There were two important statistically significant findings of this research: The mean Tp-e interval was longer (ATR group: 72.4 ± 24.7, control group: 58.8 ± 14.5, p: 0.01), and the Tp-e/QT ratio was higher (ATR group: 0.2 ± 0.1, control group: 0.16 ± 0.4, p: 0.027) in the ATR group. Conclusions: According to the ventricular repolarization disturbances found in this study, patients with ATR may be at a higher risk of ventricular arrhythmia than healthy people. As a result, ATR patients should be assessed for ventricular arrhythmia risk by an expert cardiologist. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 5915 KiB

Open AccessArticle

The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning—A k-Means Cluster Analysis

by Thomas Stamm, Moritz Kanemeier, Dieter Dirksen, Claudius Middelberg, Ariane Hohoff, Johannes Kleinheinz and Jonas Q. Schmid

J. Clin. Med. 2023, 12(10), 3582; https://doi.org/10.3390/jcm12103582 - 21 May 2023

Cited by 2 | Viewed by 1567

Abstract

The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients [...] Read more.

The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle

α

between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and

α = 8^{\circ}

, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and

α = 11^{\circ}

, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and

α = 2^{\circ}

, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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28 pages, 1281 KiB

Open AccessReview

Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews

by Janny Mathieu, Mégane Pasquier, Martin Descarreaux and Andrée-Anne Marchand

J. Clin. Med. 2023, 12(10), 3581; https://doi.org/10.3390/jcm12103581 - 21 May 2023

Cited by 3 | Viewed by 3292

Abstract

Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination [...] Read more.

Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination findings can inform management strategies. The aim of this study was to summarize evidence investigating the diagnostic value of patient evaluation components applicable in primary care settings for the diagnosis of low back pain. To this end, peer-reviewed systematic reviews were searched in MEDLINE, CINAHL, PsycINFO and Cochrane databases from 1 January 2000 to 10 April 2023. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Of the 2077 articles identified, 27 met the inclusion criteria, focusing on the diagnosis of lumbar spinal stenosis, radicular syndrome, non- specific low back pain and specific low back pain. Most patient evaluation components lack diagnostic accuracy for the diagnosis of low back pain when considered in isolation. Further research is needed to develop evidence-based and standardized evaluation procedures, especially for primary care settings where evidence is still scarce. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

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9 pages, 918 KiB

Open AccessReview

Pseudoexfoliation Syndrome—Clinical Characteristics of Most Common Cause of Secondary Glaucoma

by Martyna Tomczyk-Socha, Wojciech Tomczak, Weronika Winkler-Lach and Anna Turno-Kręcicka

J. Clin. Med. 2023, 12(10), 3580; https://doi.org/10.3390/jcm12103580 - 21 May 2023

Cited by 6 | Viewed by 3916

Abstract

Pseudoexfoliation syndrome (XFS) is a condition in which excess material builds up not only in the structures of the anterior chamber but also throughout the body. The frequency of the syndrome varies significantly (0.3–18%) depending on the region and the method of examination. [...] Read more.

Pseudoexfoliation syndrome (XFS) is a condition in which excess material builds up not only in the structures of the anterior chamber but also throughout the body. The frequency of the syndrome varies significantly (0.3–18%) depending on the region and the method of examination. Environmental risk factors for XFS include a large number of sunny days, proximity to the equator, dietary factors such as higher consumption of coffee and tea, long-term alcohol consumption, exposure to UV, and outdoor work. The pathognomonic sign of XFS is the presence of white material on the lens capsule and other anterior chamber components. In addition, a characteristic Sampaolesi line can be observed during gonioscopy. Systemic alterations indicative of XFS have been observed in the extracellular matrix of the eyelid skin, the heart, lungs, liver, kidneys, gallbladder, meninges, and endothelium of the blood vessels. XFS is the most common cause of secondary open-angle glaucoma, which is called pseudoexfoliative glaucoma and is more severe than primary open-angle glaucoma. It is plausible that a combination of environmental factors and genetic alterations promotes the onset of pseudoexfoliation syndrome, which requires additional research. Full article

(This article belongs to the Topic An Update on the Diagnosis and Management Options of Glaucoma)

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13 pages, 1329 KiB

Open AccessSystematic Review

Edge-to-Edge Transcatheter Mitral Valve Repair Using PASCAL vs. MitraClip: A Systematic Review and Meta-Analysis

by Kaveh Hosseini, Hamidreza Soleimani, Amir Nasrollahizadeh, Yaser Jenab, Angelos Karlas, Dimitrios V. Avgerinos, Alexandros Briasoulis, Toshiki Kuno, Ilias Doulamis and Polydoros N. Kampaktsis

J. Clin. Med. 2023, 12(10), 3579; https://doi.org/10.3390/jcm12103579 - 20 May 2023

Cited by 3 | Viewed by 3906

Abstract

Background: Transcatheter edge-to-edge repair (TEER) of the mitral valve (MV) can be performed using the PASCAL or MitraClip devices. Few studies offer a head-to-head outcome comparison of these two devices. Material and Methods: PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and WHO’s International Clinical Trials [...] Read more.

Background: Transcatheter edge-to-edge repair (TEER) of the mitral valve (MV) can be performed using the PASCAL or MitraClip devices. Few studies offer a head-to-head outcome comparison of these two devices. Material and Methods: PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and WHO’s International Clinical Trials Registry Platform, from 1 January 2000 until 1 March 2023, were searched. Study protocol details were registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42023405400). Randomized Controlled Trials and observational studies reporting head-to-head clinical comparison of PASCAL and MitraClip devices were eligible for selection. Patients with severe functional or degenerative mitral regurgitation (MR) who had undergone TEER of the MV with either PASCAL or MitraClip devices were included in the meta-analysis. Data from six studies (five observational and one randomized clinical trial) were extracted and analyzed. The main outcomes were a reduction in MR to 2+ or less, improvement of New York Heart Association (NYHA) and 30-day all-cause mortality. Peri-procedural mortality, success rate and adverse events were also compared. Results: Data from 785 and 796 patients that underwent TEER using PASCAL and MitraClip, respectively, were analyzed. Thirty-day all-cause mortality (Risk ratio [RR] = 1.51, 95% CI 0.79–2.89), MR reduction to maximum 2+ (RR = 1.00, 95% CI 0.98–1.02) and NYHA improvement (RR = 0.98, 95% CI 0.84–1.15) were similar in both device groups. Both devices had high and similar success rates (96.9% and 96.7% for the PASCAL and MitraClip group, respectively, p value = 0.91). MR reduction to 1+ or less at discharge was similar in both device groups (RR = 1.06, 95% CI 0.95–1.19). Composite peri-procedural and in-hospital mortality was 0.64% and 1.66% in the PASCAL and MitraClip groups, respectively (p value = 0.094). Rates of peri-procedural cerebrovascular accidents were 0.26% in PASCAL and 1.01% in MitraClip (p value = 0.108). Conclusions: Both PASCAL and MitraClip devices have high success and low complication rates for TEER of the MV. PASCAL was not inferior to MitraClip in reducing the MR level at discharge. Full article

(This article belongs to the Special Issue Heart Valve Surgery: Repair or Replacement?)

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9 pages, 1270 KiB

Open AccessArticle

Condition “Vasa Vasorum” in Patients with Thoracic Aortic Aneurysm

by Petr V. Chumachenko, Alexandra G. Ivanova, Mariam Bagheri Ekta, Andrey V. Omelchenko, Vasily N. Sukhorukov, Alexander M. Markin, Yuliya V. Markina and Anton Y. Postnov

J. Clin. Med. 2023, 12(10), 3578; https://doi.org/10.3390/jcm12103578 - 20 May 2023

Cited by 2 | Viewed by 1629

Abstract

It is known that vasa vasorum contributes substantially to the blood supply and nutrition of one-third of the wall of the ascending thoracic aorta. Therefore, we focused on studying the relationship between inflammatory cells and vasa vasorum vessels in patients with aortic aneurysm. [...] Read more.

It is known that vasa vasorum contributes substantially to the blood supply and nutrition of one-third of the wall of the ascending thoracic aorta. Therefore, we focused on studying the relationship between inflammatory cells and vasa vasorum vessels in patients with aortic aneurysm. The material for the study was biopsies of thoracic aortic aneurysms taken from patients during an aneurysmectomy (34 men, 14 women, aged 33 to 79 years). The biopsies belonged to patients with non-hereditary thoracic aortic aneurysm. An immunohistochemical study was carried out using antibodies to antigens of T cells (CD3, CD4, CD8); macrophages (CD68); B cells (CD20); endothelium (CD31, CD34, von Willebrand factor (vWF)); and smooth muscle cells (alpha actin). Samples without inflammatory infiltrates contained less vasa vasorum in the tunica adventitia than samples with inflammatory infiltrates, and this difference was statistically significant p < 0.05. T cell infiltrates in the adventitia of aortic aneurysms were found in 28 of 48 patients. In the vessels of the vasa vasorum, surrounded by inflammatory infiltrates, T cells that adhered to the endothelium were found. The same cells were also localized in the subendothelial area. The number of adherent T cells in patients with inflammatory infiltrates in the aortic wall dominated the number of these cells in patients without inflammation of the aortic wall. This difference was statistically significant, p < 0.0006. Hypertrophy and sclerosis of the arteries of the vasa vasorum system, the narrowing of their lumen, and, as a result, impaired blood supply to the aortic wall, were found in 34 patients with hypertension. In 18 patients (both in patients with hypertension and in patients without hypertension), T cells that adhered to the vasa vasorum endothelium were found. In nine cases, massive infiltrates of T cells and macrophages were found, which surrounded and squeezed the vasa vasorum, preventing blood circulation. In six patients, parietal and obturating blood clots were found in the vasa vasorum vessels, which disrupted the normal blood supply to the aortic wall. We believe that this indicates the importance of the state of the vessels of the vasa vasorum in the development of an aortic aneurysm. In addition, pathological changes in these vessels may not always play a primary role, but always a very important role, in the pathogenesis of this disease. Full article

(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)

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Open AccessFeature PaperReview

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

by David de la Rosa-Carrillo, Guillermo Suárez-Cuartín, Oriol Sibila, Rafael Golpe, Rosa-María Girón and Miguel-Ángel Martínez-García

J. Clin. Med. 2023, 12(10), 3577; https://doi.org/10.3390/jcm12103577 - 20 May 2023

Cited by 5 | Viewed by 2631

Abstract

The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic [...] Read more.

The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics. Full article

(This article belongs to the Section Pulmonology)

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J. Clin. Med., Volume 12, Issue 10 (May-2 2023) – 257 articles

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