Medicina

13 pages, 346 KiB

Open AccessArticle

Cervical Spine Pain and the Impact on the Quality of Life of Patients with Multiple Sclerosis

by Martyna Odzimek, Hubert Lipiński, Małgorzata Błaszczyk, Patrycja Strózik, Julia Zegarek, Piotr Dubiński, Agata Michalska, Justyna Klusek, Marek Żak and Waldemar Brola

Medicina 2024, 60(12), 1923; https://doi.org/10.3390/medicina60121923 - 22 Nov 2024

Abstract

Background and Objectives: The main aim of this study was to evaluate the impact of cervical pain on the quality of life of patients with multiple sclerosis in comparison with a group of healthy people (without diseases of the Central Nervous System). [...] Read more.

Background and Objectives: The main aim of this study was to evaluate the impact of cervical pain on the quality of life of patients with multiple sclerosis in comparison with a group of healthy people (without diseases of the Central Nervous System). Materials and Methods: Data were collected at the Specialist Hospital St. Łukasz in Końskie (Poland) in the period from November 2023 to August 2024. The inclusion criteria for this study were as follows: age (20–50 years), women and men, healthy people (without diseases of the Central Nervous System) and people suffering from multiple sclerosis. People from the study group were diagnosed according to the McDonald criteria and tested with the EDSS. The mobility of the cervical spine was measured, and neck pain was assessed using the following: Visual Analogue Scale (VAS), Laitinen Scale and the Neck Disability Index (NDI). All participants self-assessed their quality of life using EuroQol 5D-5L (EQ-5D-5L). Results: 80 people took part in this study, the vast majority of whom were women (71.3%). The most common form of multiple sclerosis was relapsing-remitting (75.0%), and the average EDSS score was higher in the male group (1.6 ± 1.8). Cervical spine pain was reported by 27 people from the study group (67.5%) and 16 people from the control group (40.0%). In both groups, the cervical spine mobility was lower in people with neck pain. The level of cervical spine pain was statistically significantly (p < 0.05) higher in women, people living in small towns and in people with multiple sclerosis, depending on the type of disease and its duration. Cervical spine pain in people with multiple sclerosis was higher in all three scales (VAS mean = 5.7, ES = 0.79; Laitinen Scale mean = 10.1, ES = 0.60; and NDI Scale mean = 21.1, ES = 0.89). The study group obtained significantly higher scores on the EQ-5D scale (mean = 15.3; ES = 0.79) and EQ-VAS (mean = 53.2; ES = 0.94). Conclusions: This study proved that cervical spine pain is more common among people with multiple sclerosis. In these people, this problem is rarely diagnosed and properly treated. Full article

(This article belongs to the Section Neurology)

9 pages, 2990 KiB

Open AccessCase Report

OHVIRA Syndrome and Ureteral Ectopy Draining in the Ipsilateral Hemiuterus, Diagnosed in the Prepubertal Age Group: Case-Report and Literature Review

by Teodora Telecan, Roxana Denisa Capras, Gabriela Adriana Filip, Emanuela Maria Ionutas, Dan Vasile Stanca and Carmen-Bianca Crivii

Medicina 2024, 60(12), 1922; https://doi.org/10.3390/medicina60121922 - 22 Nov 2024

Abstract

Background: Müllerian (paramesonephric) duct anomalies (MDA) are a rare condition, occurring in 5.5% of female newborns. One of the most complex malformations is represented by Obstructed Hemivagina and Ipsilateral Renal Anomalies (OHVIRA) syndrome, also known as Herlyn –Werner–Wunderlich (HWW) syndrome. Case presentation: We [...] Read more.

Background: Müllerian (paramesonephric) duct anomalies (MDA) are a rare condition, occurring in 5.5% of female newborns. One of the most complex malformations is represented by Obstructed Hemivagina and Ipsilateral Renal Anomalies (OHVIRA) syndrome, also known as Herlyn –Werner–Wunderlich (HWW) syndrome. Case presentation: We present the case of a 7-year-old asymptomatic premenarchal female patient diagnosed with OHVIRA syndrome with ipsilateral renal hypoplasia and ectopic ureteral implantation at the level of the uterus. As the patient developed urinary incontinence after the incision of the vaginal septum, right-sided 3D laparoscopic total nephrectomy was performed. Literature review: OHVIRA syndrome associated with ureteral ectopy is a rare occurrence, being encountered in 0.0064% of cases. The premenarchal diagnosis represents a challenge, due to the underdeveloped status of the genital tract. However, it should be ruled out in female newborns with unilateral renal agenesia or multicystic dysplastic kidney. Most reported cases describe the obstructed hemivagina as the site of ureteral ectopy. To our knowledge, this is the first reported case of OHVIRA syndrome with ectopic ureter draining at the level of the ipsilateral hemiuterus, diagnosed before the pubertal age. Conclusions: OHVIRA syndrome is one of the rarest Müllerian duct abnormalities. The management of these patients should be conducted in multidisciplinary teams, with long-term urological and gynecological follow-ups. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 691 KiB

Open AccessArticle

Influence of Nociception Level Monitor (NOL)-Guided Analgesic Delivery on Perioperative Course in Breast Surgeries: A Randomized Controlled Trail

by Laima Malachauskiene, Rajesh Bhavsar, Skule Bakke, Jeppe Keller, Swati Bhavsar, Anne-Marie Luy and Thomas Strøm

Medicina 2024, 60(12), 1921; https://doi.org/10.3390/medicina60121921 - 22 Nov 2024

Abstract

Background and Objectives: Breast cancer surgeries offer challenges in perioperative pain management, especially in the presence of inherent risk of postoperative nausea and vomiting (PONV) and postmastectomy pain syndrome (PMPS). Inappropriate opioid consumption was speculated as one of the reasons. Through this study, [...] Read more.

Background and Objectives: Breast cancer surgeries offer challenges in perioperative pain management, especially in the presence of inherent risk of postoperative nausea and vomiting (PONV) and postmastectomy pain syndrome (PMPS). Inappropriate opioid consumption was speculated as one of the reasons. Through this study, the influence of objective pain monitoring through a nociception level monitor (NOL) on perioperative course in breast surgeries was investigated. Materials and Methods: This was a prospective randomized study conducted at a regional hospital. Sixty female patients posted for breast cancer surgery were randomized equally into study and control groups. Both groups were monitored using BIS and NOL, but in the control group, the NOL monitor was blinded by a cover. Both groups received propofol and remifentanil through target-controlled infusions (TCIs) along with interpectoral, pectoserratus (PECS II), and superficial pectointercostal block. The primary outcome was intraoperative opioid consumption. Secondary outcomes were PONV, eligibility for discharge from the recovery room, and symptoms of PMPS after three months. Results: Two patients were excluded. The study group received significantly less remifentanil (0.9 mg in the study group vs. 1.35 mg in the control group, p = 0.033) and morphine (2.5 mg in study group vs. 5 mg in control group, p = 0.013). There was no difference in PMPS symptoms between the groups. The study group showed longer duration of inadequate analgesia (i.e., 7% vs. 10% of the total intraoperative period in control and study group, respectively, p = 0.008). There was no difference in time to eligibility for discharge from the recovery room between the groups. Conclusions: NOL monitor-guided analgesic delivery reduces intraoperative opioid consumption. No difference was demonstrated on PONV, eligibility for discharge from the recovery room, or PMPS symptoms. Full article

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

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20 pages, 1153 KiB

Open AccessReview

Paternal Contributions to Recurrent Pregnancy Loss: Mechanisms, Biomarkers, and Therapeutic Approaches

by Aris Kaltsas, Athanasios Zikopoulos, Vladimir Kojovic, Fotios Dimitriadis, Nikolaos Sofikitis, Michael Chrisofos and Athanasios Zachariou

Medicina 2024, 60(12), 1920; https://doi.org/10.3390/medicina60121920 - 22 Nov 2024

Abstract

Background and Objectives: Recurrent pregnancy loss (RPL) affects numerous couples worldwide and has traditionally been attributed mainly to maternal factors. However, recent evidence highlights significant paternal influences on pregnancy viability and outcomes. This review aims to comprehensively examine male contributions to pregnancy [...] Read more.

Background and Objectives: Recurrent pregnancy loss (RPL) affects numerous couples worldwide and has traditionally been attributed mainly to maternal factors. However, recent evidence highlights significant paternal influences on pregnancy viability and outcomes. This review aims to comprehensively examine male contributions to pregnancy loss, focusing on underlying mechanisms, novel biomarkers, and integrated strategies for improved reproductive success. Materials and Methods: A comprehensive narrative review was conducted by searching databases including PubMed and Embase for the literature published from January 2004 to October 2024. Studies focusing on paternal influences in RPL—encompassing oxidative stress, genetic and epigenetic mechanisms, health conditions, lifestyle factors, environmental exposures, and advancements in sperm proteomics—were included. Inclusion criteria were peer-reviewed articles in English that directly addressed paternal factors in RPL; studies not meeting these criteria were excluded. Results: The review identified that paternal factors such as advanced age, metabolic and cardiovascular health issues, chronic diseases, lifestyle habits (e.g., smoking, alcohol consumption, poor diet), and environmental exposures significantly affect sperm integrity through mechanisms like oxidative stress, DNA fragmentation, and epigenetic alterations. Advanced paternal age and poor health conditions are associated with increased risks of miscarriage and adverse pregnancy outcomes. Novel sperm proteomic biomarkers have been identified, offering potential for enhanced diagnostics and personalized interventions. Integrated approaches involving multidisciplinary assessments, preventive strategies, and genetic counseling are essential for effectively addressing RPL. Conclusions: Integrating paternal factors into clinical evaluations is crucial for effectively addressing recurrent pregnancy loss. Recognizing and modifying paternal risk factors through lifestyle changes, medical interventions, and environmental management can improve pregnancy outcomes. The findings underscore the need for incorporating paternal assessments into standard care and highlight the importance of future research focusing on standardizing diagnostic protocols, expanding studies on paternal contributions, and integrating proteomic biomarkers into clinical practice to facilitate personalized treatment strategies. Full article

(This article belongs to the Special Issue Management and Diagnosis of Infertility and Recurrent Abortions in Obstetrics and Gynecology)

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13 pages, 1128 KiB

Open AccessArticle

Impact of Vaccination Status on COVID-19 Severity and Pulmonary Involvement

by Sorina Maria Denisa Laitin, Luminita Mirela Baditoiu, Ruxandra Laza, Razvan Sebastian Besliu, Emil Robert Stoicescu, Miruna Gug, Cristina Stefania Dumitru and Raul Patrascu

Medicina 2024, 60(12), 1919; https://doi.org/10.3390/medicina60121919 - 22 Nov 2024

Abstract

Background and Objectives: The COVID-19 pandemic has had a significant impact on global health, with serious outcomes, such as lung damage, being major determinants of patient morbidity and mortality. Immunization has been essential in attenuating these outcomes. This study aimed to evaluate the [...] Read more.

Background and Objectives: The COVID-19 pandemic has had a significant impact on global health, with serious outcomes, such as lung damage, being major determinants of patient morbidity and mortality. Immunization has been essential in attenuating these outcomes. This study aimed to evaluate the impact of COVID-19 vaccination on disease severity, particularly focusing on pulmonary involvement, among hospitalized patients. Materials and Methods: A retrospective cohort study was conducted at Victor Babes Hospital, Timisoara, involving 3005 patients diagnosed with COVID-19 between December 2020 and March 2022. Patients were stratified into vaccinated and unvaccinated groups. Results: The study found that vaccinated patients had significantly lower rates of severe pulmonary involvement compared to unvaccinated patients. Specifically, only 24.24% of vaccinated patients experienced severe lung involvement, compared to 35.64% in the unvaccinated group (p < 0.001). Vaccinated individuals had shorter hospital stays (8.96 ± 6.40 days vs. 10.70 ± 6.29 days), but this difference was not statistically significant (p = 0.219). Additionally, chronic pulmonary diseases and stroke were less prevalent among vaccinated patients, highlighting the protective effect of vaccination. Conclusions: COVID-19 vaccination significantly reduces the severity of disease, particularly in preventing severe pulmonary involvement, which is a major determinant of patient outcomes. These findings underscore the importance of ongoing vaccination efforts and the need for booster doses to maintain immunity, especially as new variants emerge. The study supports the continued prioritization of vaccination in public health strategies to mitigate the long-term impact of COVID-19. Full article

(This article belongs to the Section Infectious Disease)

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15 pages, 2215 KiB

Open AccessCase Report

Primary Prostatic Stromal Sarcoma: A Case Report and Review of the Literature

by Enes Erul, Ömer Gülpınar, Diğdem Kuru Öz, Havva Berber, Saba Kiremitci and Yüksel Ürün

Medicina 2024, 60(12), 1918; https://doi.org/10.3390/medicina60121918 - 22 Nov 2024

Abstract

Background and Objectives: Primary prostatic stromal sarcoma is an exceptionally rare urological malignancy, constituting less than 0.1% of all prostatic cancers. It poses a significant clinical challenge due to its aggressive behavior and poor prognosis. Materials and Methods: We report the [...] Read more.

Background and Objectives: Primary prostatic stromal sarcoma is an exceptionally rare urological malignancy, constituting less than 0.1% of all prostatic cancers. It poses a significant clinical challenge due to its aggressive behavior and poor prognosis. Materials and Methods: We report the case of a 34-year-old male who presented with nonspecific lower urinary tract symptoms, including dysuria and increased urinary frequency. The initial diagnostic workup, including digital rectal examination and Magnetic Resonance Imaging (MRI), revealed a lobulated lesion within the prostate. A transurethral resection (TUR) was performed for diagnostic purposes, and histopathological examination revealed a “malignant mesenchymal tumor”. The patient underwent a laparoscopic radical prostatectomy. The pathology report confirmed the diagnosis of prostatic stromal sarcoma. The postoperative follow-up, including systemic CT and MRI, showed no evidence of recurrence or metastasis thus far. Results: Multidisciplinary management is essential for optimizing treatment outcomes in all urologic malignancies; however, it becomes particularly challenging and crucial in rare cases such as primary prostatic stromal sarcoma. In our case, the patient benefited from a coordinated approach involving urology, pathology, and oncology, underscoring the importance of collaborative care for rare and aggressive tumors like this. This case highlights the importance of early detection, complete surgical excision, and consideration of adjuvant therapies, given the aggressive nature of the disease. The role of novel therapeutic strategies, including immunotherapy and targeted therapies, is also discussed in the context of metastatic sarcomas. Conclusions: This case underscores the critical need for a comprehensive, multidisciplinary approach to managing primary prostatic stromal sarcoma. Ongoing research on innovative therapies offers hope for improved outcomes in metastatic stages. Full article

(This article belongs to the Special Issue Current Developments in Diagnostic and Therapeutic Aspects of Genitourinary Tumors)

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12 pages, 1546 KiB

Open AccessSystematic Review

The Association of Thyroid Disease with Risk of Dementia and Cognitive Impairment: A Systematic Review

by Silvija Valdonė Alšauskė, Ida Liseckienė and Rasa Verkauskienė

Medicina 2024, 60(12), 1917; https://doi.org/10.3390/medicina60121917 - 21 Nov 2024

Abstract

Background and Objectives: Cognitive impairment is defined as a reduced ability to perform one or more cognitive functions, potentially leading to dementia if the condition worsens. With dementia being a rapidly growing public health issue affecting approximately 50 million people worldwide, understanding [...] Read more.

Background and Objectives: Cognitive impairment is defined as a reduced ability to perform one or more cognitive functions, potentially leading to dementia if the condition worsens. With dementia being a rapidly growing public health issue affecting approximately 50 million people worldwide, understanding modifiable risk factors such as thyroid disease is crucial for prevention and early diagnosis. Thyroid hormones play a vital role in brain development and functioning, impacting processes such as neuron growth, myelination, and neurotransmitter synthesis. Recent decades have seen thyroid disorders emerging as potential independent risk factors for reversible cognitive impairment. Materials and Methods: The review adheres to PRISMA guidelines, utilizing a structured PICO question to explore whether individuals with thyroid diseases have a higher risk of developing dementia and cognitive impairments compared to those without. The literature search was conducted in PubMed, Cochrane, and ScienceDirect databases, including studies published from 1 January 2019 to 31 December 2023. The literature review discusses nine selected articles. Results: The findings highlight a complex association between thyroid dysfunction and cognitive decline, with some studies indicating significant links, particularly with hypothyroidism, and others suggesting the relationship may depend on the specific type of thyroid dysfunction or cognitive domain affected. Six out of nine articles found a link between thyroid disease and cognitive impairment, while three articles refuted this link. Conclusions: The review reveals a complex and ambiguous relationship between thyroid dysfunction and cognitive impairment. Further research is needed to elucidate the mechanisms underlying these associations and to determine whether thyroid dysfunction may be a modifiable risk factor for dementia. Full article

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

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16 pages, 726 KiB

Open AccessArticle

Exploring the Connections Between Grip Strength, Nutritional Status, Frailty, Depression, and Cognition as Initial Assessment Tools in Geriatric Rehabilitation—A Pilot Study

by Amalia Teodora Vancea Nemirschi, Andreea Alexandra Lupu, Kamer-Ainur Aivaz, Mădălina Gabriela Iliescu, Michel Deriaz, Mircea Marzan and Luiza Spiru

Medicina 2024, 60(12), 1916; https://doi.org/10.3390/medicina60121916 - 21 Nov 2024

Abstract

Background and Objective: In the context of the rapidly aging global population, the older adult vulnerability poses a significant challenge for public health systems. Frailty, cognitive and nutritional status, depression, and grip strength are essential parameters for staging the vulnerability of older adults. [...] Read more.

Background and Objective: In the context of the rapidly aging global population, the older adult vulnerability poses a significant challenge for public health systems. Frailty, cognitive and nutritional status, depression, and grip strength are essential parameters for staging the vulnerability of older adults. The objective of this study is to identify a rapid but multidimensional geriatric assessment tool that can enhance the rehabilitation process for older adults, tailored to their specific needs. Materials and Methods: This pilot study examines the relationships between grip strength, nutritional status, frailty, depression, and cognition in a group of 80 older adults with a mean age of 69.6 years, 49 male and 31 female, using standardized geriatric scales and digital grip strength measurements. The study employed a digital dynamometer, a portable and reliable tool that facilitated quick and accurate grip strength measurements. Results: The analysis revealed significant correlations among the parameters. Greater grip strength was associated with better cognitive performance (r = 0.237, p = 0.034) and improved nutritional status (r = 0.267, p = 0.016), while it was inversely related to frailty (r = −0.313, p = 0.005). Nutritional status also played a key role, showing an inverse relationship with frailty (r = −0.333, p = 0.003) and depression levels (r = −0.248, p = 0.027). Furthermore, frailty and depression were strongly interconnected, with those experiencing higher frailty levels also displaying more severe depressive symptoms (r = 0.545, p < 0.001). Marital status was also relevant: married participants exhibited higher grip strength, lower frailty, and fewer depressive symptoms, suggesting that social support positively influences both physical and mental health in older adults. Conclusions: These findings not only emphasize the need for integrated care approaches that simultaneously address physical health, nutrition, and cognitive function, but also provide a foundation for the development of a rapid and multidimensional assessment protocol, which consists of using a digital dynamometer and four geriatric scales. Such a tool could play a crucial role in the early detection of frailty syndrome and guide the implementation of multidisciplinary, tailored therapeutic strategies aimed at preserving the autonomy and improving the quality of life of older adults. Full article

(This article belongs to the Special Issue Clinical Recent Research in Physical Rehabilitation and Preventive Medicine)

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6 pages, 878 KiB

Open AccessOpinion

The Saphenous Vein Graft: Can a Frog Become a Princess?

by Antonio Maria Calafiore, Sotirios Prapas, Ignazio Condello, Konstantinos Katsavrias, Giuseppe Nasso and Mario Gaudino

Medicina 2024, 60(12), 1915; https://doi.org/10.3390/medicina60121915 - 21 Nov 2024

Abstract

The saphenous vein graft (SVG) has been a cornerstone of coronary bypass surgery, but its long-term patency is limited by accelerated atherosclerosis. Recent advancements, including the no-touch technique and the use of SVG as a limb of the left internal thoracic artery (LITA), [...] Read more.

The saphenous vein graft (SVG) has been a cornerstone of coronary bypass surgery, but its long-term patency is limited by accelerated atherosclerosis. Recent advancements, including the no-touch technique and the use of SVG as a limb of the left internal thoracic artery (LITA), have shown promise in improving outcomes. Both approaches enhance nitric oxide (NO) availability, a key factor in promoting endothelial stability and arterial-like behavior in the SVG. Among these, the LITA-SVG connection may offer superior long-term benefits due to sustained NO supplementation. This paper argues that the SVG, with proper strategies, can indeed achieve outcomes comparable to arterial grafts. Full article

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

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19 pages, 2205 KiB

Open AccessArticle

An Ultra-Fast Validated Green UPLC-MS/MS Approach for Assessing Revumenib in Human Liver Microsomes: In Vitro Absorption, Distribution, Metabolism, and Excretion and Metabolic Stability Evaluation

by Mohamed W. Attwa, Ali S. Abdelhameed and Adnan A. Kadi

Medicina 2024, 60(12), 1914; https://doi.org/10.3390/medicina60121914 - 21 Nov 2024

Abstract

Background and Objectives: Revumenib (SNDX-5613) is a powerful and specific inhibitor of the menin–KMT2A binding interaction. It is a small molecule that is currently being researched to treat KMT2A-rearranged (KMT2Ar) acute leukemias. Revumenib (RVB) has received Orphan Drug Designation from the US FDA [...] Read more.

Background and Objectives: Revumenib (SNDX-5613) is a powerful and specific inhibitor of the menin–KMT2A binding interaction. It is a small molecule that is currently being researched to treat KMT2A-rearranged (KMT2Ar) acute leukemias. Revumenib (RVB) has received Orphan Drug Designation from the US FDA for treating patients with AML. It has also been granted Fast Track designation by the FDA for treating pediatric and adult patients with R/R acute leukemias that have a KMT2Ar or NPM1 mutation. Materials and Methods: The target of this research was to create a fast, precise, green, and extremely sensitive UPLC-MS/MS technique for the estimation of the RVB level in human liver microsomes (HLMs), employing an ESI source. The validation procedures were carried out in accordance with the bioanalytical technique validation requirements established by the US Food and Drug Administration that involve linearity, selectivity, precision, accuracy, stability, matrix effect, and extraction recovery. The outcome data of the validation features of the UPLC-MS/MS approach were acceptable according to FDA guidelines. RVB parent ions were formed in the positive ESI source and its two fragment ions were estimated employing multiple reaction monitoring (MRM) mode. The separation of RVB and encorafenib was achieved using a C8 column (2.1 mm, 50 mm, and 3.5 µm) and isocratic mobile phase. Results: The RVB calibration curve linearity ranged from 1 to 3000 ng/mL (y = 0.6515x − 0.5459 and R² = 0.9945). The inter-day precision and accuracy spanned from −0.23% to 11.33%, while the intra-day precision and accuracy spanned from −0.88% to 11.67%, verifying the reproducibility of the UPLC-MS/MS analytical technique. The sensitivity of the developed methodology demonstrated its capability to quantify RVB levels at an LOQ of 0.96 ng/mL. The AGREE score was 0.77, confirming the greenness of the current method. The low in vitro t_1/2 (14.93 min) and high intrinsic clearance (54.31 mL/min/kg) of RVB revealed that RVB shares similarities with medications that have a high extraction ratio. Conclusions: The present LC-MS/MS approach is considered the first analytical approach with the application of metabolic stability assessment for RVB estimation in HLMs. These methods are essential for advancing the development of new pharmaceuticals, particularly in enhancing metabolic stability. Full article

(This article belongs to the Special Issue Acute Myeloid Leukemia: Update on Diagnosis, Therapy, and Monitoring)

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25 pages, 10873 KiB

Open AccessReview

Debate on the Morphological Variability of the Lateral Pterygoid Muscle—Discrepancies, Speculations and New Original Anatomical Samples

by Mugurel Constantin Rusu, Corneliu Toader, Răzvan Costin Tudose and Laura Octavia Grigoriţă

Medicina 2024, 60(12), 1913; https://doi.org/10.3390/medicina60121913 - 21 Nov 2024

Abstract

The lateral pterygoid muscle (LPM), a critical component of the masticatory muscles, typically comprises upper (SLPM) and lower (ILPM) heads. However, it is essential to note that the LPM’s structure is not a constant feature, as the number of bundles and their topography [...] Read more.

The lateral pterygoid muscle (LPM), a critical component of the masticatory muscles, typically comprises upper (SLPM) and lower (ILPM) heads. However, it is essential to note that the LPM’s structure is not a constant feature, as the number of bundles and their topography can vary. Moreover, additional heads, such as medial and middle heads, and unique-headed configurations of the LPM have been reported. Several studies have demonstrated the penniform structure of the LPM, which is further supported by its diverse pattern of innervation. Anatomically, the LPM originates from the greater wing and lateral pterygoid plate of the sphenoid bone, with variations in these origins being common. For instance, the presence of a broad lateral pterygoid plate or extensions from it can enlarge the origin area of the LPM. Equally variable are the insertions of the LPM, which can include attachments to the mandibular condyle and the temporomandibular joint disc. In some cases, aberrant LPM bundles may attach to the mandibular condyle outside the mandibular notch. Rarely encountered muscles like the pterygoideus proprius, pterygospinosus, and pterygofacialis further add to the diversity of this muscle. The anatomy of the LPM is subject to modification due to factors like atrophy or hypertrophy. Therefore, it is imperative to recognize that a one-size-fits-all anatomical pattern for the LPM does not exist. Instead, a personalized therapeutic approach should be based on a case-by-case determination of the LPM’s specific anatomical configuration. This nuanced understanding challenges the simplistic view of the LPM and underscores the need for individualized clinical considerations. Full article

(This article belongs to the Section Dentistry and Oral Health)

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15 pages, 5366 KiB

Open AccessCase Report

Management of Vestibular Bone Fenestration with Periosteal Inhibition (PI) Technique During Alveolar Socket Preservation: A Case Report

by Andrea Grassi, Maria Eleonora Bizzoca, Lucia De Biasi, Rossella Padula, Ciro Annicchiarico, Gabriele Cervino, Lorenzo Lo Muzio and Filiberto Mastrangelo

Medicina 2024, 60(12), 1912; https://doi.org/10.3390/medicina60121912 - 21 Nov 2024

Abstract

Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful [...] Read more.

Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful in maintaining intact cortical bone, is examined in the context of a bone defect. Materials and Methods: After an atraumatic extraction of a damaged tooth, a vestibular bone fenestration was discovered in the 62-year-old male patient. To shield the defect, a non-resorbable PTFE membrane (OSSEO GUARD by Zimmer Biomet) was positioned between the mucosa and the fenestration site. A resorbable porcine gelatin sponge (SPONGOSTAN^TM) was used to achieve hemostasis, and a 5/0 PGCL absorbable suture was used to close the wound. A CBCT scan was performed, and a dental implant was inserted after 4 months. Results: After 4 months, the case demonstrated positive results, with full cortical remodeling and preservation of the original bone proportions. The fenestration completely healed, proving that the PI approach works even in the presence of bone flaws in cortical bone that is still intact. Conclusions: This is the first case report that shows that vestibular bone fenestration can be successfully treated with the PI approach. It has now been demonstrated that the procedure, which hitherto needed an undamaged cortical bone to work, can help bone abnormalities to repair completely. These results imply that the PI technique is a flexible and useful approach that provides predictable results in dental surgery for treating different types of alveolar bone abnormalities. Its use might be expanded with more study to include bone dehiscence treatment. Full article

(This article belongs to the Special Issue Advances in Soft and Hard Tissue Management Around Dental Implants)

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11 pages, 3375 KiB

Open AccessArticle

The Recurrence Rates at Three Years for the Conservatively Managed UTUC Cases Using NBI-Assisted Flexible Ureteroscopy and Holmium Laser Vaporization

by Petrisor Geavlete, Valentin Iordache, Razvan Multescu, Alexandra Paunescu, Cosmin Ene, Razvan Popescu, Catalin Bulai and Bogdan Geavlete

Medicina 2024, 60(12), 1911; https://doi.org/10.3390/medicina60121911 - 21 Nov 2024

Abstract

Background and Objectives: This study aimed to evaluate the recurrence rates at three years for upper tract urothelial carcinoma (UTUC) cases managed conservatively, using Narrow Band Imaging (NBI)-assisted flexible ureteroscopy and Holmium laser vaporization. Materials and Methods: The study group included [...] Read more.

Background and Objectives: This study aimed to evaluate the recurrence rates at three years for upper tract urothelial carcinoma (UTUC) cases managed conservatively, using Narrow Band Imaging (NBI)-assisted flexible ureteroscopy and Holmium laser vaporization. Materials and Methods: The study group included 61 patients who were diagnosed with NBI-assisted visualization with superficial pyelo-calyceal urothelial tumor lesions, treated conservatively by the flexible ureteroscopic approach and Holmium laser vaporization, also assisted by NBI. This was compared with a control group with the same number of cases, which underwent the same procedure, but without NBI technology. Recurrence rates, the rate of patients who underwent nephroureterectomy, and cancer-specific survival were compared. Results: The relapse rate at 1 year was 3.3% in the study group, and respectively 8.2% in the control group (p < 0.05). Depending on the histological characteristics, at 1 year the relapse rates in the study group were 1.8% in patients with low-grade tumors and 20% in those with high-grade tumors. At 3 years, the relapse rate was 11.5% in the study group versus 18% in the control group, (p < 0.05): 7.1% in patients with low-grade lesions and 40% in patients with high-grade lesions versus 21.4% in patients with low-grade lesions and 100% in patients with high-grade lesions (both arms with statistically significant differences, p < 0.05). Cancer-specific survival was 93.4% in the study group versus 86.9% in the control group (p < 0.05). Conclusions: The recurrence rates at three years for the UTUC cases managed conservatively, using NBI-assisted flexible ureteroscopy and Holmium laser vaporization, were lower than in patients treated by the same technique without NBI assistance, both in low- and high-grade tumors. Cancer-specific survival was also significantly improved by the association of NBI visualization during diagnosis and laser vaporization. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 1191 KiB

Open AccessArticle

A Prospective Study of Nephrocalcinosis in Very Preterm Infants: Incidence, Risk Factors and Vitamin D Intake in the First Month

by Rasa Garunkstiene, Ruta Levuliene, Andrius Cekuolis, Rimante Cerkauskiene, Nijole Drazdiene and Arunas Liubsys

Medicina 2024, 60(12), 1910; https://doi.org/10.3390/medicina60121910 - 21 Nov 2024

Abstract

Background and objectives: Nephrocalcinosis (NC) is a common condition characterized by the deposition of calcium salts in the kidneys of very preterm infants due to tubular immaturity, intensive treatment and nutritional supplements. However, optimal vitamin D supplementation remains unclear. In most patients, [...] Read more.

Background and objectives: Nephrocalcinosis (NC) is a common condition characterized by the deposition of calcium salts in the kidneys of very preterm infants due to tubular immaturity, intensive treatment and nutritional supplements. However, optimal vitamin D supplementation remains unclear. In most patients, NC spontaneously resolves within the first year of life, but long-term kidney function data are lacking. The aim was to study nephrocalcinosis in very preterm infants, assess risk factors and evaluate vitamin D’s impact during the first month with a 2-year follow-up. Material and Methods: This was a prospective observational study conducted over a 3-year period in infants with a gestational age of less than 32 weeks. The patients’ data were compared between the NC and control groups based on kidney ultrasound results at discharge. In the first month, the mean vitamin D intake from all sources as well as biochemical markers of calcium metabolism were collected. Patients diagnosed with NC were referred to a pediatric nephrologist after discharge. Results: NC was found in 35% of a cohort of 160 infants, more common in those with a gestational age <28 weeks. Risk factors were associated with higher morbidity and necessary treatment. At 28 days, serum 25-hydroxy vitamin D levels differed between NC and control groups (p < 0.05). The NC group with GA ≥ 28 weeks had higher vitamin D intake (p < 0.05), hypercalciuria and calcium/creatinine ratio (p < 0.01) and lower parathyroid hormone levels (p < 0.05). Follow-up showed resolution in 70% at 12 months and 90% at 24 months. Conclusions: The prevalence of NC in very preterm infants is significant, associated with lower maturity and higher morbidity. Careful vitamin D supplementation and biochemical monitoring of Ca metabolism from the first month of life should support bone health and limit the risk of nephrocalcinosis. Due to the high incidence of NC in very preterm infants, long-term follow-up is essential. Full article

(This article belongs to the Section Pediatrics)

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12 pages, 667 KiB

Open AccessArticle

Continuous Risk Assessment of Late and Term Preeclampsia Throughout Pregnancy: A Retrospective Cohort Study

by Valeria Rolle, Petya Chaveeva, Ander Diaz-Navarro, Irene Fernández-Buhigas, Diana Cuenca-Gómez, Tanya Tilkova, Belén Santacruz, Teresa Pérez and Maria M. Gil

Medicina 2024, 60(12), 1909; https://doi.org/10.3390/medicina60121909 - 21 Nov 2024

Abstract

Background and Objectives: To evaluate the diagnostic accuracy of widely available biomarkers longitudinally measured throughout pregnancy to predict all and term (delivery at ≥37 weeks) preeclampsia (PE). Materials and Methods: This is a longitudinal retrospective study performed at Hospital Universitario de [...] Read more.

Background and Objectives: To evaluate the diagnostic accuracy of widely available biomarkers longitudinally measured throughout pregnancy to predict all and term (delivery at ≥37 weeks) preeclampsia (PE). Materials and Methods: This is a longitudinal retrospective study performed at Hospital Universitario de Torrejón (Madrid, Spain) and Shterev Hospital (Sofia, Bulgaria) between August 2017 and December 2022. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination and first-trimester screening for preterm PE at 11 + 0 to 13 + 6 weeks’ gestation at the participating centers were invited to participate in a larger study for the prediction of pregnancy complications. The dataset was divided into two subsets to develop and validate a joint model of time-to-event outcome and longitudinal data, and to evaluate how the area under the receiving operating characteristic curve (AUROC) evolved with time. Results: 4056 pregnancies were included in the training set (59 all PE, 40 term PE) and 944 in the validation set (23 all PE, 20 term PE). For the joint model and all PE, the AUROC was 0.84 (95% CI 0.73 to 0.94) and the detection rate (DR) for a 10% screening positive rate (SPR) was 56.5 (95% CI 34.5 to 76.8). For term PE, AUROC was 0.80 (95% CI 0.69 to 0.91), and DR for a 10% SPR was 55.0 (95% CI 31.5 to 76.9). The AUROC using only information from the first trimester was 0.50 (95% CI 0.37 to 0.64) and it increased to 0.84 (0.73 to 0.94) when using all information available. Conclusions: Routinely measuring MAP and UtA-PI throughout pregnancy may improve the predictive prediction power for all and term-PE. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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7 pages, 270 KiB

Open AccessArticle

Overuse of CT for Minor Head Trauma Patients: A Retrospective Analysis from Poland and Lithuania Trauma Centres

by Kristina Blažienė, Jakub Nożewski, Vaida Cibulskė, Monika Kunigonytė, Deimantė Košytė, Karolis Bareikis and Vytautas Aukštakalnis

Medicina 2024, 60(12), 1908; https://doi.org/10.3390/medicina60121908 - 21 Nov 2024

Abstract

Background and Objectives: Head trauma is one of many conditions that trauma centres deal with daily. This study aimed to analyse the utilisation of head CT scans for patients with minor head trauma in two major hospitals in Lithuania and Poland. Materials [...] Read more.

Background and Objectives: Head trauma is one of many conditions that trauma centres deal with daily. This study aimed to analyse the utilisation of head CT scans for patients with minor head trauma in two major hospitals in Lithuania and Poland. Materials and Methods: We conducted a retrospective, descriptive study of CT utilisation in minor head trauma patients presenting to the Level 1 trauma centre Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (HLUHS KC) and Jan Biziel University Hospital in Bydgoszcz emergency departments (EDs), during the study period from 01 February to 30 April 2023. Results: During the study period, 1048 patients visited the HLUHS KC emergency department (ED) due to head trauma, and 388 patients visited the Jan Biziel University Hospital. Overall, 611 patients were included in the study. Most of the patients (92%) who suffered minimal trauma were younger than 65 years old. Eighty-two per cent of the patients older than 65 years old arrived at the ED after suffering a fall. Almost all the patients who were using antiplatelets (93%) or anticoagulants (91%) had CT scans. Non-emergency medicine (EM) physicians were more likely to order head CT scans than EM physicians (170 (83%) vs. 249 (62%), p < 0.001). There were 33 (5%) CT scans with traumatic features, and 8 (1%) of these were categorised as clinically significant. Patients who suffered clinically significant head trauma were more likely to be on anticoagulants and older than 65 when compared to normal/insignificant CT findings: 3 (38%) vs. 25 (6%), p < 0.001; and 6 (75%) vs. 146 (36%), p < 0.021. Conclusions: A significant number of head CT scans performed were not necessary according to existing head CT guidelines and risk calculators. However, even in minor head traumas, clinically significant head injuries may occur. Full article

15 pages, 2630 KiB

Open AccessArticle

Dental Decision-Making in Pediatric Dentistry: A Cross-Sectional Case-Based Questionnaire Among Dentists in Germany

by Bakr A. Rashid, Ahmad Al Masri, Christian H. Splieth, Mustafa Abdalla and Julian Schmoeckel

Medicina 2024, 60(11), 1907; https://doi.org/10.3390/medicina60111907 - 20 Nov 2024

Abstract

Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study [...] Read more.

Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study investigated the treatment recommendations of dentists actively practicing pediatric dentistry in Germany regarding different patient cases with caries in primary teeth. Materials and Methods: The questionnaire was distributed on paper or online to pediatric dentists and general dentists practicing pediatric dentistry. Five cases of children with dental treatment needs representing a variety of clinical situations were selected for the questionnaire. Considering four different scenarios regarding pain symptoms (yes/no) and cooperation level (good/low) for each case resulted in 20 questions, where the preferred treatment option could be chosen out of 21 options ranging from observation only to extraction with/without different sedation techniques. The answers were categorized into three categories for each case and scenario according to guidelines, recent scientific evidence, and recommendations (recommended, acceptable, or not recommended/contraindicated). Results: In total, 222 participants responded to the survey (161 female; 72.5%). In 55.2% of the total 4440 answers, the participants chose a “recommended” treatment option, in 16.4% “acceptable”, but in 28.4%, a “not recommended” treatment, which ranged for the five cases between 18.7 and 36.1%. While pain and low cooperation levels led to more invasive and justified treatment choices (only 26.3% “not recommended”), less severe scenarios resulted more often in “not recommended” options (pain with good cooperation: 31.0%; or low cooperation without pain: 32.6%). The dentist’s age, experience, and educational background did not significantly correlate to choosing “not recommended” treatment options. Conclusions: A child’s pain and cooperation level greatly impact the treatment decisions made by dentists, with a risk of too-invasive treatment options in low-severity cases. Substantial disparities in treatment recommendations for caries in primary teeth persist among dental practitioners regardless of their age, experience, and educational background. Full article

(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)

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14 pages, 3267 KiB

Open AccessArticle

Clinical Challenges in Diagnosing Primordial Dwarfism: Insights from a MOPD II Case Study

by Alexandru Daniel Jurca, Codruța Diana Petchesi, Sânziana Jurca, Emilia Severin, Aurora Alexandra Jurca and Claudia Maria Jurca

Medicina 2024, 60(11), 1906; https://doi.org/10.3390/medicina60111906 - 20 Nov 2024

Abstract

Background and Objectives. Primordial dwarfism (PD) is a rare group of genetic conditions where individuals experience severe growth restriction, both in the womb and after birth. From as early as the fetal stage, those affected are significantly smaller than their peers. What [...] Read more.

Background and Objectives. Primordial dwarfism (PD) is a rare group of genetic conditions where individuals experience severe growth restriction, both in the womb and after birth. From as early as the fetal stage, those affected are significantly smaller than their peers. What makes PD distinct is its slow but steady growth pattern, resulting in proportionate dwarfism, where all parts of the body are equally shortened. Diagnosing and managing PD presents significant challenges due to its rarity and the wide range of clinical and genetic variability. The main conditions in this group include Seckel syndrome, Microcephalic Osteodysplastic Primordial Dwarfism (MOPD) types I/III, MOPD type II, Meier–Gorlin syndrome, and Silver–Russell syndrome (SRS). The first four—Seckel syndrome, MOPD types I/III, MOPD type II, and Meier–Gorlin syndrome—are associated with microcephaly, and together they are known as microcephalic PD. Given how uncommon PD is, establishing its exact incidence is difficult. It is estimated that about 4 million infants die within the first month of life, with 99% of these deaths occurring in the neonatal period. Materials and Methods. Accurately diagnosing PD requires meticulous evaluation, as it can be easily confused with other genetic disorders that also cause dwarfism. In this article, we present the case of a 10-year-old patient diagnosed with MOPD II, the most common and well-documented form of microcephalic PD. Results. Genetic analysis revealed a pathogenic variant in the PCNT (pericentrin) gene ((c.1550dup, p.Gln518Alafs*7), alongside a deletion of exons 37–41. Conclusions. This case sheds light on the clinical and genetic complexities of primordial dwarfism, underscoring the importance of timely and accurate diagnosis for effective patient care. Full article

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

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10 pages, 1203 KiB

Open AccessArticle

Outcomes of Ixazomib Treatment in Relapsed and Refractory Multiple Myeloma: Insights from Croatian Cooperative Group for Hematologic Diseases (KROHEM)

by Josip Batinić, Barbara Dreta, Goran Rinčić, Antonia Mrdeža, Karla Mišura Jakobac, Delfa Radić Krišto, Milan Vujčić, Mario Piršić, Željko Jonjić, Vlatka Periša, Jasminka Sinčić Petričević, Božena Coha, Hrvoje Holik, Toni Valković, Marija Stanić, Ivan Krečak, Ante Stojanović, Domagoj Sajfert and Sandra Bašić-Kinda

Medicina 2024, 60(11), 1905; https://doi.org/10.3390/medicina60111905 - 20 Nov 2024

Abstract

Background and Objectives: Ixazomib, used in combination with lenalidomide and dexamethasone (IRd), has shown efficacy in clinical trials for relapsed/refractory multiple myeloma (RRMM). Materials and Methods: This study evaluates the real-world effectiveness and safety of IRd in Croatian RRMM patients. A [...] Read more.

Background and Objectives: Ixazomib, used in combination with lenalidomide and dexamethasone (IRd), has shown efficacy in clinical trials for relapsed/refractory multiple myeloma (RRMM). Materials and Methods: This study evaluates the real-world effectiveness and safety of IRd in Croatian RRMM patients. A retrospective analysis was conducted on 164 RRMM patients treated with ixazomib at nine Croatian haematology centres from November 2016 to February 2023. Data on patient demographics, treatment regimens, and outcomes were collected and analysed using Kaplan–Meier survival curves and Cox proportional hazards models in R. The median age at ixazomib initiation was 66 years (range 40–91). Results: The overall response rate (ORR) was 65.8%, with 42% of patients achieving a very good partial response (VGPR) or better. The median progression-free survival (PFS) was 15.4 months, while median overall survival (OS) was 28.2 months. Hematologic toxicities included anaemia (53%), neutropenia (50%), and thrombocytopenia (45%). Infective complications, primarily COVID-19 and pneumonia, were reported in 38% of patients. The safety profile was consistent with previous studies, indicating manageable adverse events. Ixazomib-based therapy is effective and well tolerated in a real-world Croatian RRMM population. Conclusions: The findings align with clinical trial results, demonstrating the applicability of ixazomib in routine clinical practice. Further studies are needed to optimise treatment sequencing and improve patient outcomes. Full article

(This article belongs to the Special Issue Cutting-Edge Research in Relapsed and Refractory Multiple Myeloma)

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