Journal of Clinical Medicine

11 pages, 11652 KiB

Open AccessArticle

Optical Attenuation Coefficient-Based En Face Optical Coherence Tomography Imaging for the Reliable Assessment of the Ellipsoid Zone

by Hiroaki Sakai, Riku Kuji, Yoshikiyo Moriguchi, Shoko Yamashita, Ayako Takamori, Masato Tamura, Toshihiro Mino, Masahiro Akiba and Hiroshi Enaida

J. Clin. Med. 2024, 13(23), 7140; https://doi.org/10.3390/jcm13237140 - 25 Nov 2024

Abstract

Objective: This study used optical attenuation coefficient (OAC)-based optical coherence tomography (OCT) en face images to assess the ellipsoid zone (EZ) in the foveal region. Methods: This retrospective, observational, cross-sectional study of 41 healthy volunteers and 34 patients with retinal diseases included imaging [...] Read more.

Objective: This study used optical attenuation coefficient (OAC)-based optical coherence tomography (OCT) en face images to assess the ellipsoid zone (EZ) in the foveal region. Methods: This retrospective, observational, cross-sectional study of 41 healthy volunteers and 34 patients with retinal diseases included imaging data acquired using a prototype swept-source OCT system. EZ en face images were generated from OCT raster scan volumes based on OAC, followed by denoising and binarization to quantify the percentage of EZ structural normality or abnormality relative to the total imaging area. We evaluated the reliability of the OAC-based method compared with the OCT signal intensity-based method in healthy and diseased eyes. In addition, the validated program was applied to patients with various retinal conditions. Results: The estimated normal EZ area in healthy eyes was 96.2 ± 5.6% using the OAC-based method versus 89.3 ± 18.8% for the intensity-based method. The OAC-based method effectively mitigated various artifacts caused by retinal blood vessels and other factors in both healthy and diseased eyes. In a pilot study involving six diseased eyes, the area exhibiting EZ structural abnormalities was 27.5–99.6%. Conclusions: The OAC-based EZ assessment robustly suppressed image artifacts and reliably characterized structural abnormalities in the EZ from OCT volumes. Full article

(This article belongs to the Special Issue Latest Advances in the Diagnosis and Management of Vitreo-Retinal Disorders—Second Edition)

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16 pages, 651 KiB

Open AccessFeature PaperReview

Degenerative Cervical Myelopathy: History, Physical Examination, and Diagnosis

by Mariah Balmaceno-Criss, Manjot Singh, Mohammad Daher, Rachelle Buchbinder, Bassel G. Diebo and Alan H. Daniels

J. Clin. Med. 2024, 13(23), 7139; https://doi.org/10.3390/jcm13237139 - 25 Nov 2024

Abstract

Background: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review [...] Read more.

Background: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review aims to provide a repository of up-to-date information regarding pertinent patient history, physical exam findings, and potential alternate diagnoses. Methods: The PubMed database was queried for publications from 1 January 2019 to 19 March 2024. The search terms utilized are as follows: cervical myelopathy”, “cervical spondylotic myelopathy”, “degenerative cervical myelopathy”, “epidemiology”, “prevalence”, “incidence”, “etiology”, “diagnosis”, “differential”, “symptoms’‘, “clinical presentation”, and “atypical symptoms”. The resultant articles were reviewed for relevance and redundancy and are presented within the following categories: Natural History, Epidemiology, Clinical Presentation, Diagnosis, and Management. Results: Myelopathy patients often present with subtle and non-specific symptoms such as sleep disturbances, increased falls, and difficulty driving, which can lead to underdiagnosis and misdiagnosis. Failing to diagnose degenerative cervical myelopathy in a timely manner can result in progressive and irreparable neurological damage. Although many nonoperative treatment modalities are available, surgical decompression is ultimately recommended in most cases to limit further deterioration in neurological function and optimize long-term patient outcomes. Conclusions: A thorough clinical history and physical examination remain the most important diagnostic tools to avoid misdiagnosis and implement early treatment in this patient population. Full article

(This article belongs to the Section Orthopedics)

7 pages, 437 KiB

Open AccessTechnical Note

Proximal Fibula Resection for Tumors—Case Series and Technical Note

by Reinhard Hofer, Marisa Valentini, Maria Anna Smolle, Andreas Leithner and Marko Bergovec

J. Clin. Med. 2024, 13(23), 7138; https://doi.org/10.3390/jcm13237138 - 25 Nov 2024

Abstract

Background: The resection of tumors of the proximal fibula includes the removal of the lateral collateral ligament (LCL) and biceps femoris tendon (BFT) attachment. The aim was to describe and evaluate a surgical reconstruction technique in terms of functional outcome and knee [...] Read more.

Background: The resection of tumors of the proximal fibula includes the removal of the lateral collateral ligament (LCL) and biceps femoris tendon (BFT) attachment. The aim was to describe and evaluate a surgical reconstruction technique in terms of functional outcome and knee joint stability. Methods: We analyzed the outcome of six patients, treated by a proximal fibula resection. The reconstruction of the attachments of the LCL and BFT was performed with two suture anchors, fixed onto the tibia at the level of the proximal tibiofibular joint (PTFJ). The postoperative knee flexion strength as well as the lateral knee joint stability were compared to the contralateral side using a digital scale and stress x-ray. Patient-reported outcome measures and postoperative complications were documented. Results: No lateral instability and no significant loss of knee flexion strength could be observed (p = 0.075). One persistent postoperative peroneus paresis was reported. High functional outcome was achieved with a mean MSTS score of 92.2%. Conclusions: The resection of the proximal fibula with the reinsertion of the LCL and the BFT using bone anchors in the PTFJ seems to provide a good functional outcome, with a low level of associated comorbidities. Full article

(This article belongs to the Section Orthopedics)

10 pages, 933 KiB

Open AccessArticle

Fibrinogen and Prothrombin Complex Concentrate: The Importance of the Temporal Sequence—A Post-Hoc Analysis of Two Randomized Controlled Trials

by Marco Ranucci, Tommaso Aloisio, Umberto Di Dedda, Martina Anguissola, Alessandro Barbaria and Ekaterina Baryshnikova

J. Clin. Med. 2024, 13(23), 7137; https://doi.org/10.3390/jcm13237137 - 25 Nov 2024

Abstract

Background/Objectives: A low level of soluble coagulation factors after cardiac surgery may cause excessive bleeding and trigger clinical correction using prothrombin complex concentrate (PCC). According to the current guidelines, the trigger values for PCC administration are not defined. In the published algorithms, [...] Read more.

Background/Objectives: A low level of soluble coagulation factors after cardiac surgery may cause excessive bleeding and trigger clinical correction using prothrombin complex concentrate (PCC). According to the current guidelines, the trigger values for PCC administration are not defined. In the published algorithms, when driven by ROTEM^®, the triggers vary from 80 s to >100 s of coagulation time (CT) during an EXTEM test. Two randomized controlled trials on fibrinogen (FC) supplementation after cardiac surgery previously pointed out that the patients receiving FC supplementation had a significant decrease in their EXTEM CT. This study investigates the hypothesis that after increasing the availability of a substrate (fibrinogen), thrombin generation induces fibrin network formation faster, and that, before considering PCC administration, the normalization of fibrinogen levels should be sought. Methods: A retrospective study based on a post-hoc analysis of the data collected in two previous RCTs involving 85 patients, all of whom received FC supplementation. Results: The results of this post-hoc analysis demonstrate that there is a significant negative association between FIBTEM maximum clot firmness (MCF) and the EXTEM CTs before and after FC supplementation; FC supplementation decreases the EXTEM CTs both in patients with a low FIBTEM MCF and a normal FIBTEM MCF. After FC supplementation, 45 (53%) of the patients had an EXTEM CT of > 80 s, 22 (26%) had an EXTEM CT of > 90 s, and 8 (9%) had an EXTEM CT of > 100 s. Conclusions: Our study confirms and quantifies the effects of reducing EXTEM CTs through FC supplementation. A stepwise strategy of factors correction with FC supplementation should be used before considering PCC administration as it might reduce the need for PCC. Full article

(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)

14 pages, 434 KiB

Open AccessArticle

The Impact of the Coronary Artery Calcium Score on the Clinical Outcomes in Patients with Acute Myocardial Infarction

by Hisashi Sato, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masashi Hatori, Taku Kasahara, Yusuke Watanabe, Shun Ishibashi, Masaru Seguchi and Hideo Fujita

J. Clin. Med. 2024, 13(23), 7136; https://doi.org/10.3390/jcm13237136 - 25 Nov 2024

Abstract

Background: It is essential to identify the risk factors for poor clinical outcomes in patients with acute myocardial infarction (AMI). The coronary artery calcium score (CACS) is gathering attention as a predictor for future cardiovascular events. This study aimed to (1) measure [...] Read more.

Background: It is essential to identify the risk factors for poor clinical outcomes in patients with acute myocardial infarction (AMI). The coronary artery calcium score (CACS) is gathering attention as a predictor for future cardiovascular events. This study aimed to (1) measure CACSs in patients with AMI by non-ECG-gated computed tomography (CT), (2) compare clinical outcomes between patients with a high CACS and a low–intermediate CACS and (3) to elucidate the association between high CACS and clinical outcomes. Methods: We defined the high CACS group as the highest quantile of CACS (Q4) and defined the low–intermediate CACS group as the other quantiles of CACS (Q1–Q3). The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, non-fatal MI and target vessel revascularization. We included 548 patients with AMI who underwent non-ECG-gated CT and divided them into the high CACS group (CACS ≥ 5346.5, n = 137) and the low–intermediate CACS group (CACS ≤ 5329.3, n = 411). Results: During the median follow-up duration of 535 days, 150 MACE were observed. The Kaplan–Meier curves showed that MACE occurred more frequently in the high CACS group than in the low–intermediate CACS group (p < 0.001). Multivariable Cox hazard analysis revealed that a high CACS was significantly associated with MACE (hazard ratio 1.597, 95% confidence interval 1.081–2.358, p = 0.019) after controlling for multiple confounding factors. Conclusions: Clinical outcomes were worse in AMI patients with a high CACS than in those with a low–intermediate CACS. A high CACS was significantly associated with MACE in multivariate analysis. Full article

(This article belongs to the Section Cardiovascular Medicine)

9 pages, 416 KiB

Open AccessSystematic Review

The Role of the Endometrial Microbiota in Endometrial Cancer: A Systematic Review of the Literature

by Guglielmo Stabile, Alessandra Doria, Matteo Bruno, Marco D’Indinosante, Valerio Gallotta, Francesco Fanfani, Giovanni Scambia, Stefano Restaino, Giuseppe Vizzielli, Stefania Carlucci and Luigi Nappi

J. Clin. Med. 2024, 13(23), 7135; https://doi.org/10.3390/jcm13237135 - 25 Nov 2024

Abstract

Background: Endometrial cancer is currently the sixth most frequent cancer in women, and scientific research is focusing on the search for particular features of the endometrium that may explain a further predisposition to the onset of endometrial cancer, aimed at improving knowledge [...] Read more.

Background: Endometrial cancer is currently the sixth most frequent cancer in women, and scientific research is focusing on the search for particular features of the endometrium that may explain a further predisposition to the onset of endometrial cancer, aimed at improving knowledge of the pathogenetic factors of this disease. The aim of our review is to analyze in detail the results of the literature on the endometrial microbiota in patients with endometrial cancer and to investigate its role. Methods: We performed our research on the Pubmed, Web of Science, and Scopus databases. We searched up to December 2023 and considered manuscripts published from 2000. Only articles in English were included in the search. We excluded studies in which the endometrial microbiota were collected through the vagina or cervical canal. Results: We included in our review a total of five manuscripts at the end of the screening process, and the total number of patients involved was 190. Four studies considered only post-menopausal patients, while one study considered both pre- and post-menopausal patients. In all studies, the microbiota analysis was derived from a post-hysterectomy biopsy. From our review, it emerged that Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria are the most represented bacteria in patients with endometrial cancer. These are both Gram-positive and Gram-negative, but predominantly anaerobic bacteria. Conclusions: The reduced microbial diversity and the presence of specific bacteria is often associated with endometrial cancer. Further work on larger population samples, and on healthy women and those affected by endometrial carcinoma, is needed to understand how the endometrial microbiota changes and influences the development of the tumor and whether intervening in the changes in the microbiota will have a therapeutic impact on endometrial carcinoma Full article

(This article belongs to the Section Obstetrics & Gynecology)

20 pages, 934 KiB

Open AccessReview

What Is New in Morphea—Narrative Review on Molecular Aspects and New Targeted Therapies

by Tomasz Stein, Paulina Cieplewicz-Guźla, Katarzyna Iżykowska, Monika Pieniawska, Ryszard Żaba, Aleksandra Dańczak-Pazdrowska and Adriana Polańska

J. Clin. Med. 2024, 13(23), 7134; https://doi.org/10.3390/jcm13237134 - 25 Nov 2024

Abstract

Morphea, also known as localized scleroderma, is an autoimmune chronic connective tissue disease. It is characterized by excessive collagen deposition in the dermis and/or subcutaneous tissue. The etiopathogenesis of this disease is not fully understood, with endothelial cell damage, immunological disorders, extracellular matrix [...] Read more.

Morphea, also known as localized scleroderma, is an autoimmune chronic connective tissue disease. It is characterized by excessive collagen deposition in the dermis and/or subcutaneous tissue. The etiopathogenesis of this disease is not fully understood, with endothelial cell damage, immunological disorders, extracellular matrix disorders and factors such as infection, trauma and other autoimmune diseases being considered. As medicine advances, there is increasing evidence that genetic factors play a significant role in disease risk and progression. In addition to environmental factors and genetic predisposition, epigenetic factors may be potential triggers for morphea. Epigenetics studies changes that affect gene expression without altering the DNA sequence, such as microRNAs, long non-coding RNAs or DNA methylation. Understanding the pathogenesis of this disease is key to identifying potential new treatments. There are anecdotal reports of good therapeutic effects following the use of biological drugs such as tocilizumab, a humanized IgG monoclonal antibody; abatacept, a recombinant soluble fusion protein; JAK inhibitors, such as tofacitinib and baricitinib; and a drug used successfully in cancer treatment, imatinib, a tyrosine kinase receptor inhibitor. In this article, we aim to review up-to-date knowledge on the pathogenesis of morphea, with particular emphasis on genetic and epigenetic factors. In addition, we present the new options of morphea treatment based on several case series treated with new drugs that are potential targets for the development of therapies for this disease. Full article

(This article belongs to the Section Immunology)

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12 pages, 270 KiB

Open AccessArticle

Assessing Cardiovascular Risk in Geriatric Patients Without Atherosclerotic Cardiovascular Disease

by Witold Żurański, Justyna Nowak, Aleksander Danikiewicz, Barbara Zubelewicz-Szkodzińska and Bartosz Hudzik

J. Clin. Med. 2024, 13(23), 7133; https://doi.org/10.3390/jcm13237133 - 25 Nov 2024

Abstract

Introduction: Age is a major risk factor that affects the likelihood of developing atherosclerotic cardiovascular disease (ASCVD). The anticipated 10-year ASCVD risk for nearly all individuals aged 70 years and older surpasses conventional risk thresholds. When considering treatment for risk factors, it is [...] Read more.

Introduction: Age is a major risk factor that affects the likelihood of developing atherosclerotic cardiovascular disease (ASCVD). The anticipated 10-year ASCVD risk for nearly all individuals aged 70 years and older surpasses conventional risk thresholds. When considering treatment for risk factors, it is important to take into account ASCVD risk modifiers, such as malnutrition, polypharmacy, and comorbidities. Objectives: The aim of this study was to estimate ASCVD risk in apparently healthy (without established ASCVD) elderly persons. We also evaluated several biochemical and clinical indicators to better characterize the studied population. Patients and methods: A total of 253 elderly individuals aged 70 years and older, who were apparently healthy and did not have established atherosclerotic cardiovascular disease (ASCVD), were enrolled in the study. The Systemic Coronary Risk Estimation 2-Older Persons (SCORE2-OP) model was utilized to assess their 10-year risk of developing ASCVD. Results: Among the 253 participants, 41 (16.2%) were classified as high risk, while 212 (83.8%) were categorized as very high risk. No individuals had a low ASCVD risk (defined as less than 7.5%). The median 10-year risk of developing ASCVD for the study group was 23% (ranging from 17% to 32%). The number of individuals identified as very high risk increased significantly with age, with nearly all participants aged 75 years and older being considered very high risk. An age of 75 years or older is associated with a very high risk for ASCVD, supported by a C-statistic of 0.92, which reflects a positive predictive value (PPV) of 99% and a negative predictive value (NPV) of 52% (p < 0.001). Conclusions: Elderly individuals without established ASCVD constitute a varied group. The majority were identified as being at very high risk for ASCVD. Age and hypertension were the primary factors contributing to this risk. Furthermore, modifiers of ASCVD risk, including malnutrition, polypharmacy, and multimorbidity, were commonly observed. Full article

(This article belongs to the Section Cardiovascular Medicine)

11 pages, 425 KiB

Open AccessArticle

Use of Sport Supplements and Doping Substances by Athletes: Prevalence and Relationships

by Philip Hurst, Maria Kavussanu, Rachael Davies, Neil Dallaway and Christopher Ring

J. Clin. Med. 2024, 13(23), 7132; https://doi.org/10.3390/jcm13237132 - 25 Nov 2024

Abstract

Background: The use of sport supplements may represent a risk factor for the use of doping in sports. To explore this putative risk, the current study examined the frequency of sport supplement use and associations between the use of sport supplements and [...] Read more.

Background: The use of sport supplements may represent a risk factor for the use of doping in sports. To explore this putative risk, the current study examined the frequency of sport supplement use and associations between the use of sport supplements and the use of doping substances and methods in athletes. Methods: The participants (n = 345; 56% male, 22 ± 5 years, 18–43 years) completed measures of sport supplement use, sport supplement beliefs, doping likelihood, and doping use. Based on the Australian Institute of Sport’s “Sports Supplement Framework”, the participants were asked whether they used 23 sport supplements from four categories (sport foods, medical supplements, performance supplements, other). They were also asked whether they used six classes of doping substances and methods (alphabodies, stimulants, steroids, erythropoietin, growth hormone, blood doping). Results: Sport supplements were used by 96% of the athletes, whereas doping substances were used by 4% of the athletes. Moreover, athletes who used more sport supplements also used more doping substances. The use of sport supplements was related to the use of doping substances both directly and indirectly via sport supplement beliefs and doping likelihood. Conclusions: Consumption of sport supplements is common, whereas doping is rare, and, moreover, the belief that sport supplements help optimize performance in competitive sport confers an increased risk for doping. Full article

(This article belongs to the Section Sports Medicine)

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35 pages, 3758 KiB

Open AccessReview

Role of Proteins in Oncology: Advances in Cancer Diagnosis, Prognosis, and Targeted Therapy—A Narrative Review

by Magdalena Kędzierska and Magdalena Bańkosz

J. Clin. Med. 2024, 13(23), 7131; https://doi.org/10.3390/jcm13237131 - 25 Nov 2024

Abstract

Modern oncology increasingly relies on the role of proteins as key components in cancer diagnosis, prognosis, and targeted therapy. This review examines advancements in protein biomarkers across several cancer types, including breast cancer, lung cancer, ovarian cancer, and hepatocellular carcinoma. These biomarkers have [...] Read more.

Modern oncology increasingly relies on the role of proteins as key components in cancer diagnosis, prognosis, and targeted therapy. This review examines advancements in protein biomarkers across several cancer types, including breast cancer, lung cancer, ovarian cancer, and hepatocellular carcinoma. These biomarkers have proven critical for early detection, treatment response monitoring, and tailoring personalized therapeutic strategies. The article highlights the utility of targeted therapies, such as tyrosine kinase inhibitors and monoclonal antibodies, in improving treatment efficacy while minimizing systemic toxicity. Despite these advancements, challenges like tumor resistance, variability in protein expression, and diagnostic heterogeneity persist, complicating universal application. The review underscores future directions, including the integration of artificial intelligence, advanced protein analysis technologies, and the development of combination therapies to overcome these barriers and refine personalized cancer treatment. Full article

(This article belongs to the Section Oncology)

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8 pages, 509 KiB

Open AccessArticle

The Glasgow Benefit Inventory—Assessment of Patients Who Underwent Laser-Assisted Dacryocystorhinostomy (LDCR)

by Radosław Różycki, Katarzyna Ulaszewska and Łukasz Skrzypiec

J. Clin. Med. 2024, 13(23), 7130; https://doi.org/10.3390/jcm13237130 - 25 Nov 2024

Abstract

Background/Objectives: Disruptions in lacrimal function can lead to various conditions, including chronic nasolacrimal duct obstruction and dacryocystitis, which may cause symptoms like excessive tearing, pain, and recurrent infections. In cases where pharmacological treatments are insufficient, surgical intervention becomes essential, which is widely used [...] Read more.

Background/Objectives: Disruptions in lacrimal function can lead to various conditions, including chronic nasolacrimal duct obstruction and dacryocystitis, which may cause symptoms like excessive tearing, pain, and recurrent infections. In cases where pharmacological treatments are insufficient, surgical intervention becomes essential, which is widely used to restore effective tear drainage. Methods: This study evaluated postoperative outcomes of laser-assisted dacryocystorhinostomy (LDCR) in 48 patients, totaling 56 treated eyes, over a follow-up period of 6 months to 3.5 years. During the follow-up examination, patients completed the Glasgow Benefit Inventory questionnaire. Results: The outcomes demonstrated significant improvements, particularly in the GBI total score (+35.07) and general subscale (+44.36), with minimal effects on social support and physical health subscales. Conclusions: LDCR proves to be an effective, minimally invasive alternative to traditional dacryocystorhinostomy, offering significant patient satisfaction, faster recovery, and reduced complications in treating nasolacrimal duct obstruction. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 560 KiB

Open AccessSystematic Review

The Efficacy and Acceptability of Flash Glucose Monitoring in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review

by Franciszek Ługowski, Julia Babińska, Zofia Awiżeń-Panufnik, Ewelina Litwińska-Korcz, Magdalena Litwińska, Artur Ludwin and Paweł Jan Stanirowski

J. Clin. Med. 2024, 13(23), 7129; https://doi.org/10.3390/jcm13237129 - 25 Nov 2024

Abstract

Background: Gestational diabetes mellitus (GDM) occurs in approximately 9% of pregnancies, and proper glycemic control is of utmost importance in the prevention of GDM-associated obstetric complications. Flash glucose monitoring (FGM), a subtype of continuous glucose monitoring (CGM), offers intermittent blood glucose scanning and [...] Read more.

Background: Gestational diabetes mellitus (GDM) occurs in approximately 9% of pregnancies, and proper glycemic control is of utmost importance in the prevention of GDM-associated obstetric complications. Flash glucose monitoring (FGM), a subtype of continuous glucose monitoring (CGM), offers intermittent blood glucose scanning and is considered a propitious alternative to the standard method of self-monitoring of blood glucose (SMBG). Aim: The aim of this review was to systematically assess the efficacy and acceptability of FGM in in pregnancies complicated by GDM. Methods: A systematic literature search was performed in the PubMed, MEDLINE, Scopus, and Cochrane databases. The review was conducted following the PRISMA guidelines, and the study protocol has been registered in the PROSPERO database with the registration number CRD42024545874. Results: A total of 872 articles were initially identified, 141 publications underwent an in-depth full-text analysis, resulting in 133 studies being excluded from further assessment. Eventually, eight studies were included in the analysis. Conclusions: The analysis revealed that FGM is a safe and efficient method of glycemic control in GDM. The majority of the studies consider its accuracy comparable to SMBG. Furthermore, FGM is well accepted by patients with numerous advantages in user-friendliness over SMBG. Full article

(This article belongs to the Special Issue Clinical Updates on Maternal Fetal Medicine)

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7 pages, 211 KiB

Open AccessOpinion

The Challenges in Treating Inflammatory Bowel Diseases During the COVID-19 Pandemic: An Opinion

by Jonatan Vukovic, Ivana Jukic and Ante Tonkic

J. Clin. Med. 2024, 13(23), 7128; https://doi.org/10.3390/jcm13237128 - 25 Nov 2024

Abstract

The COVID-19 pandemic posed significant challenges in the treatment of chronic diseases, particularly inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis. These challenges are multifaceted, encompassing difficulties in maintaining routine care, concerns about the safety of immunosuppressive therapies, disruptions in [...] Read more.

The COVID-19 pandemic posed significant challenges in the treatment of chronic diseases, particularly inflammatory bowel diseases (IBDs) such as Crohn’s disease and ulcerative colitis. These challenges are multifaceted, encompassing difficulties in maintaining routine care, concerns about the safety of immunosuppressive therapies, disruptions in healthcare delivery, and the complexities of managing IBD in patients who contract COVID-19. This article explores the various obstacles faced in the treatment of IBD during the pandemic and discusses potential strategies to overcome these challenges. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

12 pages, 936 KiB

Open AccessArticle

Whole Gut Motility Patterns in Patients with Chronic Nausea and Vomiting

by Mette W. Klinge, Anne Mette Haase, Nanna Sutter Rolighed, Klaus Krogh, Mark Scott, Vincent Schlageter, Esben Bolvig Mark, Gursharan Kaur Nandhra, Asbjørn Mohr Drewes and Anders Bergh Loedrup

J. Clin. Med. 2024, 13(23), 7127; https://doi.org/10.3390/jcm13237127 - 25 Nov 2024

Abstract

Background/Objectives: Chronic nausea and vomiting (N/V) disorders are common in clinical practice. Our primary aim was to compare total and segmental gastrointestinal transit times as well as gastric contraction patterns in patients with chronic N/V syndrome to those of healthy volunteers (HVs). In [...] Read more.

Background/Objectives: Chronic nausea and vomiting (N/V) disorders are common in clinical practice. Our primary aim was to compare total and segmental gastrointestinal transit times as well as gastric contraction patterns in patients with chronic N/V syndrome to those of healthy volunteers (HVs). In the patient group, our secondary aim was to explore how symptoms and motility patterns were affected by a serotonin HT₄ receptor agonist (Prucalopride). Methods: Patients with chronic N/V syndrome and HVs underwent baseline assessment of regional gastrointestinal (GI) motility/transit using the Motilis 3D-Transit system. Patients were then treated with Prucalopride 2 mg daily for 28 days, with the 3D-transit examination repeated within 10–20 days after treatment onset. Two self-administered questionnaires (the Gastrointestinal Symptom Rating Scale [GSRS] and Gastroparesis Cardinal Symptom Index [GCSI]) were used to assess patients’ symptoms. Results: A total of 19 patients (13 F; median age 25 years (IQR 22–39) and 55 HVs (25 F; median age 28 (24–35) were included. At baseline, no differences in regional GI transit times were found between groups. However, patients had a significantly lower gastric contraction amplitude than HVs (9 mmHg (IQR 8–11) vs. 12 (10–15: p < 0.001). In response to Prucalopride treatment, gastric emptying time was reduced from a median of 3.1 h to 1.6 h (p < 0.005). Further, the GCSI was significantly reduced from GCSI 3.0 (IQR 2.3–3.7) at baseline to GCSI 1.9 (IQR 1.3–3.2) with Prucalopride. Conclusions: Patients with chronic N/V syndrome have significantly lower gastric contraction amplitude than HVs and may symptomatically benefit from prokinetics. They do not, however, have evidence of panenteric dysmotility. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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12 pages, 411 KiB

Open AccessArticle

Influence of Sex and Cardiometabolic Risk Factors on the High-Sensitivity Cardiac Troponins at the Concentrations Used as the Thresholds for Cardiovascular Risk Stratification in a Presumably Healthy Polish Population

by Katarzyna Bergmann, Anna Stefanska, Jacek Kubica, Magdalena Krintus and Mauro Panteghini

J. Clin. Med. 2024, 13(23), 7126; https://doi.org/10.3390/jcm13237126 - 25 Nov 2024

Abstract

Background: Low but detectable cardiac troponin (cTn) concentrations may reflect cardiovascular (CV) risk in a primary prevention setting. Using previously described thresholds for CV risk stratification, we assessed the influence of sex and cardiometabolic risk factors on the concentrations of high-sensitivity cTn in [...] Read more.

Background: Low but detectable cardiac troponin (cTn) concentrations may reflect cardiovascular (CV) risk in a primary prevention setting. Using previously described thresholds for CV risk stratification, we assessed the influence of sex and cardiometabolic risk factors on the concentrations of high-sensitivity cTn in presumably healthy subjects. Methods: The prospective study included 597 presumably healthy individuals (313 women, 284 men). In all participants, hs-cTnI, hs-cTnT, lipid profile, C-reactive protein, glycated hemoglobin, estimated GFR (eGFR) and B-type naturetic peptide (BNP) were measured. Subjects were categorized into two groups of CV risk, based on hs-cTn non sex-specific cut-off of 5.0 ng/L. For hs-cTnI, sex-specific cut-off values were also used: ≥4.0 ng/L for females and ≥6.0 ng/L for males. Results: Increased CV risk, indicated by hs-cTn concentrations ≥ 5.0 ng/L, was significantly associated with age > 40 years, male sex, obesity and BNP concentrations ≥ 35 ng/L. Using the same 5.0 ng/L threshold, hs-TnT classified approximately twice as many individuals into the CV subgroup compared to hs-cTnI, particularly in males (31% vs. 13%, respectively). After applying sex-specific cut-offs for hs-cTnI, the proportion of females and males with increased risk became similar (8% vs. 9%, respectively). In contrast, using non-sex-specific cut-offs for hs-cTnI resulted in a proportion of 6% for females and 13% for males. BNP and eGFR had significant impact on CV risk stratification using sex-specific cut-offs for hs-cTnI. Conclusions: Our findings suggest the necessity of using sex-specific cut-offs for hs-cTn as a cardiovascular risk marker, in addition to other cardiometabolic factors, in the general population. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 578 KiB

Open AccessArticle

Influence of Biometric and Corneal Tomographic Parameters on Normative Corneal Aberrations Measured by Root Mean Square

by Ignacio Almorín-Fernández-Vigo, Silvia Pagán Carrasco, Inés Sánchez-Guillén, José Ignacio Fernández-Vigo, Ana Macarro-Merino, Bachar Kudsieh and José Ángel Fernández-Vigo

J. Clin. Med. 2024, 13(23), 7125; https://doi.org/10.3390/jcm13237125 - 25 Nov 2024

Abstract

Background/Objectives: To determine the impact of corneal and biometry parameters on the normative root mean square (RMS) values of corneal aberrations measured at a 6 mm diameter. Methods: The RMS values for corneal aberrations (anterior, posterior, and total) were measured along [...] Read more.

Background/Objectives: To determine the impact of corneal and biometry parameters on the normative root mean square (RMS) values of corneal aberrations measured at a 6 mm diameter. Methods: The RMS values for corneal aberrations (anterior, posterior, and total) were measured along with corneal parameters using Scheimpflug tomography on 770 normal subjects. The biometric parameters were measured with an optical biometer. A multiple linear regression model was used to assess the effect of these parameters on the RMS values for corneal aberrations. Results: The mean RMS values for low-order (LOAs) and high-order 6 mm aberrations (HOAs) were 1.883 ± 0.797 µm and 0.484 ± 0.173 µm, respectively, and for the anterior and posterior cornea, the values were 0.775 ± 0.166 µm and 0.189 ± 0.036 µm, respectively. For the anterior cornea, the main predictors of the RMS LOAs (R² = 69.8%) were anterior corneal astigmatism (ACA) and anterior corneal elevation (Ele F) on the apex (both p < 0.0001) and for the RMS HOAs (R² = 33.3%) the main predictors were age, ACA, and Ele F on the thinnest point (all p < 0.0001). For the posterior cornea, considering only the posterior corneal variables, the main predictors of the RMS LOAs (R² = 63.4%) were posterior corneal astigmatism and posterior corneal elevation (Ele B) on the thinnest point and apex (all p < 0.0001) and for the RMS HOAs (R² = 46%) the main predictors were the mean posterior keratometry and Ele B on the thinnest point and apex (all p < 0.0001). Conclusions: Normative data of RMS values for corneal aberrations measured over 6 mm are influenced by age and several corneal parameters, which should be considered when evaluating the diagnostic ability of the RMS values. Full article

(This article belongs to the Special Issue Latest Advances in Glaucoma, Cataract and Refractive Surgery: Expert Views, 2nd Edition)

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15 pages, 1194 KiB

Open AccessReview

Lights and Shadows of Long COVID: Are Latent Infections the Real Hidden Enemy?

by Francesca Serapide, Marisa Talarico, Salvatore Rotundo, Vittorio Pascale, Riccardo Serraino, Enrico Maria Trecarichi and Alessandro Russo

J. Clin. Med. 2024, 13(23), 7124; https://doi.org/10.3390/jcm13237124 - 25 Nov 2024

Abstract

Long COVID-19 (LC) is a poorly understood, multifactorial condition that persists for at least three months following SARS-CoV-2 infection. The underlying pathophysiological mechanisms responsible for the wide range of associated symptoms—including fatigue, brain fog, and respiratory issues—remain unclear. However, emerging evidence suggests that [...] Read more.

Long COVID-19 (LC) is a poorly understood, multifactorial condition that persists for at least three months following SARS-CoV-2 infection. The underlying pathophysiological mechanisms responsible for the wide range of associated symptoms—including fatigue, brain fog, and respiratory issues—remain unclear. However, emerging evidence suggests that the reactivation of latent viral infections, such as Epstein-Barr virus, cytomegalovirus, and varicella-zoster virus, may significantly contribute to the complexity of LC. These latent viruses can be reactivated by SARS-CoV-2, contributing to a chronic inflammatory state that prolongs symptomatology. This review confirms the potential involvement of latent viral infections in LC and examines whether these infections play an independent role or act synergistically with other factors. In addition, recent studies have highlighted viral persistence and immune dysregulation as key elements in LC. Our findings suggest that preventative strategies, including vaccination and antiviral treatments during the acute phase of COVID-19, show potential in reducing LC risk by preventing viral reactivation. However, tailored diagnostic and therapeutic strategies targeting these latent infections are urgently needed. Identifying biomarkers of viral reactivation, particularly for high-risk populations, could be considered another effective strategy to mitigate LC severity. Further research is crucial to better understand the interactions between SARS-CoV-2 and latent infections, and to improve the prevention and treatment of LC. Full article

(This article belongs to the Special Issue Clinical Consequences of COVID-19: 2nd Edition)

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13 pages, 290 KiB

Open AccessArticle

Prostate Dimensions and Their Impact on LUTS and Erectile Function: Is Length the Missing Link?

by Daniel Porav-Hodade, Mihai Dorin Vartolomei, Toader Septimiu Voidazan, Raul Gherasim, Iulia Andras, Ciprian Todea-Moga, Bogdan Ovidiu Feciche, Silvestru-Alexandru Big, Mártha Orsolya Katalin Ilona, Ioan Coman and Nicolae Crisan

J. Clin. Med. 2024, 13(23), 7123; https://doi.org/10.3390/jcm13237123 - 25 Nov 2024

Abstract

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions—width, height, and length—and both LUTS and IIEF and to assess patients based on risk factors [...] Read more.

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions—width, height, and length—and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. Methods: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). Results: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40–49 age group to the 80–90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (p < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (p = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (p = 0.57), diabetes (p = 0.57), smoking (p = 0.76), and alcohol consumption (p = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (p = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (p = 0.0001). Conclusions: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation. Full article

(This article belongs to the Special Issue Male Sexual and Reproductive Health: Clinical Aspects, Metabolic Profile, Environmental Factors and Lifestyle)

17 pages, 2017 KiB

Open AccessArticle

Accuracy of the Standard and Distal-to-Proximal Sequence of the Upper Limb Neurodynamic Test 1 for the Diagnosis of Carpal Tunnel Syndrome: The Role of Side-to-Side Comparisons

by Gianluca Ciuffreda, Elena Bueno-Gracia, María Irache Argüello-Espinosa, Michael Shacklock, Sonia Navarrete-Navarro, Inés Vicente-Garza, Diego Rodríguez-Mena and Elena Estébanez-de-Miguel

J. Clin. Med. 2024, 13(23), 7122; https://doi.org/10.3390/jcm13237122 - 25 Nov 2024

Abstract

Background/Objective: This study aimed to evaluate the diagnostic accuracy of two upper limb neurodynamic test 1 (ULNT1) sequences for detecting carpal tunnel syndrome (CTS) in patients with unilateral symptoms. The standard sequence (ULNT1-STD) and a distal-to-proximal sequence (ULNT1-DIST) were investigated. A local-initiated [...] Read more.

Background/Objective: This study aimed to evaluate the diagnostic accuracy of two upper limb neurodynamic test 1 (ULNT1) sequences for detecting carpal tunnel syndrome (CTS) in patients with unilateral symptoms. The standard sequence (ULNT1-STD) and a distal-to-proximal sequence (ULNT1-DIST) were investigated. A local-initiated sequence may facilitate symptoms reproduction in CTS, and comparing the affected side with the unaffected side could improve the detection of altered median nerve mechanosensitivity when symptoms are not directly reproduced. Methods: A total of 134 consecutive patients with clinically suspected unilateral CTS were recruited. Nerve conduction studies were used as a reference test. Results: When considering only symptom reproduction as the criterion for a positive test, ULNT1-STD showed a sensitivity of 0.398 and a specificity of 0.780 (positive likelihood ratio [+LR]: 1.81; negative likelihood ratio [−LR]: 0.77); whereas ULNT1-DIST demonstrated a sensitivity of 0.548 with a specificity of 0.732 (+LR: 2.04; −LR: 0.62). When a positive test was defined by symptom reproduction or inter-limb asymmetry (in range of motion or sensory response), ULNT1-STD showed an improved sensitivity of 0.613 but a reduced specificity of 0.537 (+LR: 1.32; −LR: 0.72). In comparison, ULNT1-DIST increased its sensitivity to 0.871 with a specificity of 0.683 (+LR: 2.75; −LR: 0.19). Conclusions: ULNT1-DIST offers better diagnostic accuracy for CTS compared to the ULNT1-STD sequence, especially when interlimb asymmetries in range of motion or sensory response are considered. However, side-to-side comparisons have reduced utility in cases with bilateral symptoms, limiting their application in clinical practice. Full article

(This article belongs to the Section Clinical Neurology)

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