Medicina

13 pages, 517 KiB

Open AccessArticle

A Single-Center Retrospective Study of Bacterial Infections After Acute Ischemic Stroke: The Prevalence Before and During the COVID-19 Pandemic

by Weny Rinawati, Abdulloh Machin and Aryati Aryati

Medicina 2024, 60(11), 1755; https://doi.org/10.3390/medicina60111755 - 25 Oct 2024

Abstract

Background and Objectives: The management of ischemic stroke involves care that is integrated and comprehensive, including the prevention of infection complications. This study aimed to investigate the prevalence and profile of bacterial infections after acute ischemic stroke both before and during the [...] Read more.

Background and Objectives: The management of ischemic stroke involves care that is integrated and comprehensive, including the prevention of infection complications. This study aimed to investigate the prevalence and profile of bacterial infections after acute ischemic stroke both before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: A retrospective cross-sectional study examined the medical records of hospitalized acute ischemic stroke patients who had microbiological cultures taken at the National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, Jakarta, Indonesia, from 1 January 2018 to 31 December 2021. The percentage of positive bacterial growth in the microbiological cultures was used to determine the prevalence of bacterial infection after acute ischemic stroke. Results: A total of 519 patients met the study criteria, including 48 and 471 patients with infections before and during the COVID-19 pandemic. The prevalence of bacterial infection after acute ischemic stroke was 17.9%. There were significant differences in the prevalence of bacterial infection after acute ischemic stroke before and during the COVID-19 pandemic (87.5% vs. 10.8%). Staphylococcus sp. and Klebsiella sp. were the most frequently observed. The risk factors that influenced bacterial infection after acute ischemic stroke were intensive care stay (OR 0.22; 95%CI 0.13–0.39, p-value < 0.001), sepsis (OR 1.99; 95%CI 1.12–3.53, p-value = 0.019), COVID-19 infection (OR 4.81; 95%CI 2.64–8.76, p-value < 0.001), the use of steroids (OR 0.31; 95%CI 0.14–0.67, p-value = 0.003), and the use of TPN (OR 0.34; 95%CI 0.13–0.86, p-value = 0.022). Conclusions: Following the start of the COVID-19 pandemic, there was a decrease in the prevalence of bacterial infections after AIS. Patients with bacterial infections had different profiles before and during the COVID-19 pandemic. Full article

(This article belongs to the Section Infectious Disease)

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14 pages, 529 KiB

Open AccessArticle

Evaluation and Management of Urological Complications Following Pediatric Kidney Transplantation: Experience from a Single Tertiary Center

by Maria Sangermano, Enrico Montagnani, Serena Vigezzi, Marco Moi, Alessandro Morlacco, Nicola Bertazza Partigiani and Elisa Benetti

Medicina 2024, 60(11), 1754; https://doi.org/10.3390/medicina60111754 - 25 Oct 2024

Abstract

Background/Objectives: Kidney transplantation is the treatment of choice for children with end-stage renal disease (ESRD), but its outcome can be affected by urological complications, with incidence rates of 2.5–25%. The aim of this study was to evaluate the occurrence of urological complications [...] Read more.

Background/Objectives: Kidney transplantation is the treatment of choice for children with end-stage renal disease (ESRD), but its outcome can be affected by urological complications, with incidence rates of 2.5–25%. The aim of this study was to evaluate the occurrence of urological complications and their management in a cohort of pediatric kidney transplant recipients. Materials and Methods: A retrospective analysis on 178 patients who received a renal transplant at our Pediatric Kidney Transplant Center between 2011 and 2023 was conducted. Demographic and clinical data were analyzed. Urological complications were categorized as early, intermediate, or late based on their onset time. Results: Out of 178 patients, 28 (15.7%) experienced urological complications. Most patients (61%) had a pre-existing uropathy. Early complications (7–30 days) were all obstructive, namely, ureterovesical junction obstruction and perirenal collections. Intermediate complications (1–3 months) comprised ureteral stenosis, symptomatic vesicoureteral reflux (VUR), and obstructive lymphocele. Late complications (>3 months) included symptomatic VUR and ureteral stenosis, with one case leading to ureteral rupture. Early complications were often detected due to acute graft dysfunction, while late ones were mainly identified during routine clinical, laboratory, or ultrasound follow-up. Urological complications requiring surgical or endoscopic therapy were 13.4%. Most ureteral stenoses were treated with initial endoscopic stents, followed by definitive surgery. VUR was treated with endoscopic correction with a high success rate (75%), while open surgery was reserved for cases where initial treatments failed or complications recurred. No clear correlations were found between patient characteristics and risk of urological complication. Urological complications required multiple diagnostic procedures and therapeutic interventions (+2.5 admissions in mean and approximately +EUR 24,000) compared to an uncomplicated post-transplant course. However, they did not significantly impact transplant outcomes, with a graft survival rate comparable to that of the control group. Conclusions: Regular post-transplant follow-up is crucial, especially for patients with known risk factors, to allow for timely detection and treatment of urological complications, avoiding detrimental effects on graft function and improving transplantation outcomes. Full article

(This article belongs to the Section Urology & Nephrology)

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18 pages, 3710 KiB

Open AccessArticle

Oral Microbial Changes in Oral Squamous Cell Carcinoma: Focus on Treponema denticola, Lactobacillus casei, and Candida albicans

by Yeon-Hee Lee, Junho Jung and Ji-Youn Hong

Medicina 2024, 60(11), 1753; https://doi.org/10.3390/medicina60111753 - 25 Oct 2024

Abstract

Background and Objectives: In this study, we aimed to explore the oral bacteria and fungi that can help discern oral squamous cell carcinoma (OSCC) and investigate the correlations between multiple key pathogens. Materials and Methods: Twelve participants (8 females and 4 males; mean [...] Read more.

Background and Objectives: In this study, we aimed to explore the oral bacteria and fungi that can help discern oral squamous cell carcinoma (OSCC) and investigate the correlations between multiple key pathogens. Materials and Methods: Twelve participants (8 females and 4 males; mean age, 54.33 ± 20.65 years) were prospectively recruited into three groups: Group 1: healthy control, Group 2: patients with stomatitis, and Group 3: patients with OSCC, with 4 individuals in each group. Unstimulated whole saliva samples from these participants were analyzed using real-time PCR to assess the presence and abundance of 14 major oral bacterial species and Candida albicans. Results: The analysis revealed significant differences for certain microorganisms, namely, Treponema denticola (T. denticola), Lactobacillus casei (L. casei), and Candida albicans. T. denticola was most abundant in the OSCC group (5,358,692.95 ± 3,540,767.33), compared to the stomatitis (123,355.54 ± 197,490.86) and healthy control (9999.21 ± 11,998.40) groups. L. casei was undetectable in the healthy control group but was significantly more abundant in the stomatitis group (1653.94 ± 2981.98) and even higher in the OSCC group (21,336.95 ± 9258.79) (p = 0.001). A similar trend was observed for C. albicans, with DNA copy numbers rising from the healthy control (464.29 ± 716.76) to the stomatitis (1861.30 ± 1206.15) to the OSCC group (9347.98 ± 5128.54) (p = 0.006). The amount of T. denticola was positively correlated with L. casei (r = 0.890, p < 0.001) and C. albicans (r = 0.724, p = 0.008). L. casei’s DNA copy number was strongly correlated with C. albicans (r = 0.931, p < 0.001). These three oral microbes exhibited strong positive correlations with each other and had various direct or indirect relationships with other species. Conclusions: In the OSCC group, T. denticola, L. casei, and C. albicans exhibited strong positive correlations with one another, further emphasizing the need for a deeper understanding of the complex microbial interactions in the OSCC environment. Full article

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15 pages, 430 KiB

Open AccessReview

Osteoporosis in Systemic Mastocytosis: A Scoping Review

by Giulia Letizia Mauro, Jessica Accomando, Sofia Tomasello, Adele Duca, Maria Silvia Mangano, Alessandro De Sire, Michele Vecchio and Dalila Scaturro

Medicina 2024, 60(11), 1752; https://doi.org/10.3390/medicina60111752 - 24 Oct 2024

Abstract

Background: Mastocytosis (MS) is a rare disease that can involve various organs, including the bone. Given the incidence of the disease in the global population, MS poses a challenge for physicians, and early therapeutic intervention in the initial stages could significantly impact [...] Read more.

Background: Mastocytosis (MS) is a rare disease that can involve various organs, including the bone. Given the incidence of the disease in the global population, MS poses a challenge for physicians, and early therapeutic intervention in the initial stages could significantly impact the quality of life of affected patients. Objective: The aim of this scoping review was to provide an overview of secondary osteoporosis in systemic mastocytosis (SM), focusing on the heterogeneity of its manifestations, the benefits of early diagnosis, and appropriate pharmacological treatment. Design: A technical expert panel (TEP) consisting of 8 physicians with expertise in metabolic bone diseases conducted the review following the PRISMA-ScR model. A strength of this study is that it provides various therapeutic approaches for patients with bone involvement in SM, although the limited available literature on the topic constituted a limitation. The TEP sought evidence regarding the following diagnostic and therapeutic modalities in the management of SM: “bisphosphonate therapy”, “zoledronic acid therapy”, “denosumab therapy”, “IFN-alpha therapy”, and “IFN-alpha therapy in combination with pamidronate”. Results: Clinical data showed a correlation between densitometric outcomes, serum tryptase levels, and mast cell infiltration in the bone marrow, between increased bone mineral density and the presence of osteosclerosis in cases of advanced SM, between the severity of osteoporosis and hypertryptasemia, and also provided results on the long-term effects of bisphosphonate therapy, the therapeutic efficacy of zoledronic acid administration, the positive effect of denosumab on the reduction of serum tryptase levels (even if is proved in a limited numbers of cases) and the prevention of new fractures, and the effect of IFN-alpha in more severe cases of SM, either alone or in combination with pamidronate. Conclusions: Studies have demonstrated the effectiveness of various treatments depending on the form of mastocytosis, whether indolent systemic or advanced systemic, in the prognosis of the disease. However, this role should be further investigated in additional clinical studies, considering the limited data on the use of these interventions. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1533 KiB

Open AccessArticle

The Importance of Biochemical Parameters, Immunonutritional Status, and Social Support for Quality of Life in Chronic Hemodialysis Patients

by Batric Babovic, Natasa Belada Babovic, Filip Tomovic, Snezana Radovanovic, Mladen Debeljevic, Dusan Mustur and Olgica Mihaljevic

Medicina 2024, 60(11), 1751; https://doi.org/10.3390/medicina60111751 - 24 Oct 2024

Abstract

Background and Objectives: Chronic kidney disease (CKD) is a growing public health problem and one of the leading causes of premature death worldwide. The progressive nature of CKD is associated with serious complications that can reduce the quality of life in CKD [...] Read more.

Background and Objectives: Chronic kidney disease (CKD) is a growing public health problem and one of the leading causes of premature death worldwide. The progressive nature of CKD is associated with serious complications that can reduce the quality of life in CKD patients. Additional factors that can worsen well-being include dialysis treatment, malnutrition, inflammation, and lack of social support. The aim of our study was to analyze the quality of life of CKD patients undergoing hemodialysis and its association with certain biochemical and immunonutritional parameters, as well as with social support. Materials and Methods: This research was conducted as a cross-sectional study that included 170 patients, divided into two groups: a group of patients undergoing hemodialysis (HD group) (n = 85), and a control group of non-hemodialysis patients (group with CKD stage 3–4) (n = 85). The Health-Related Quality of Life (HRQoL) score was used to assess the quality of life of the study population. Measurement of biochemical and immunonutritional parameters was also performed in all patients. The Oslo-3 Social Support Scale (OSSS-3) was used to analyze social support. Results: The HRQoL score was significantly lower in HD patients compared to patients with CKD stage 3–4 (0.701 ± 0.137 vs. 0.832 ± 0.122, p < 0.001). It declined significantly as the concentrations of urea (β = −0.347, p < 0.001), creatinine (β = −0.699, p = 0.005), uric acid (β = −0.184, p = 0.016), β2-microglobulin (β = −0.432, p < 0.001), and parathormone (β = −0.209, p = 0.006) increased in HD patients. In addition to uremic toxins, an increase in glucose (β = −0.278, p = 0.010) and triglyceride (β = −0.354, p = 0.001) concentrations was associated with poor HRQoL in patients with CKD stage 3–4. There was a significant connection between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and HRQoL in HD patients (β = 0.229, p = 0.035). Additionally, C-reactive protein (β = −0.361, p < 0.001) and neutrophil-to-lymphocyte ratio (β = −0.288, p < 0.001), as markers of systemic inflammation, directly affected HRQoL in HD patients. In both study groups, perceived social support positively influenced the HRQoL scores (β = 0.192, p = 0.012 for hemodialysis; β = 0.225, p = 0.038 for non-hemodialysis). Conclusions: There is a decline in HRQoL in chronic hemodialysis patients, significantly affected by certain biochemical and immunonutritional parameters, along with perceived social support. Full article

(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment)

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9 pages, 586 KiB

Open AccessArticle

Elevated Urotensin-II and TGF-β Levels in COPD: Biomarkers of Fibrosis and Airway Remodeling in Smokers

by Metin Kilinc, Ibrahim Demir, Semih Aydemir, Rauf Gul and Recep Dokuyucu

Medicina 2024, 60(11), 1750; https://doi.org/10.3390/medicina60111750 - 24 Oct 2024

Abstract

Background and Objectives: Small airway fibrosis plays a critical role in the progression of chronic obstructive pulmonary disease (COPD). Previous research has suggested that Urotensin-II (U-II) and transforming growth factor-β (TGF-β) may contribute to pathological fibrosis in various organs, including the cardiovascular system, lungs, [...] Read more.

Background and Objectives: Small airway fibrosis plays a critical role in the progression of chronic obstructive pulmonary disease (COPD). Previous research has suggested that Urotensin-II (U-II) and transforming growth factor-β (TGF-β) may contribute to pathological fibrosis in various organs, including the cardiovascular system, lungs, and liver. However, their specific relationship with airway fibrosis in COPD has not yet been thoroughly investigated. This study aims to evaluate the concentrations of U-II and TGF-β in individuals with COPD, as well as in healthy smokers and non-smokers, to explore their potential roles in COPD-related fibrosis. Materials and Methods: The study included three distinct groups: a healthy non-smoker control group (n = 98), a healthy smoker group (n = 78), and a COPD group (n = 80). All participants in the COPD group had a smoking history of at least 10 pack-years. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, with only patients classified as GOLD stage 2 or higher being included in the study. Urotensin-II (U-II) and transforming growth factor-β (TGF-β) levels were measured using a commercially available ELISA kit. Results: COPD patients had a significantly lower FEV₁ (58 ± 15.4%) compared to smokers (79 ± 4.5%) and non-smokers (92 ± 3.7%) (p < 0.001). Similarly, COPD patients had a lower FEV₁/FVC ratio (55 ± 9.4%) compared to smokers (72 ± 4.2%) and non-smokers (85 ± 3.6%) (p < 0.01 and p < 0.05, respectively). SaO₂ was significantly lower in COPD patients (87%) compared to smokers (96.5%) and non-smokers (98%) (COPD vs. smokers: p < 0.05 and smokers vs. non-smokers: p > 0.05). U-II levels were significantly higher in COPD patients (175.10 ± 62.40 pg/mL) compared to smokers (118.50 ± 45.51 pg/mL) and non-smokers (85.29 ± 35.87 pg/mL) (p < 0.001 and p < 0.05, respectively). COPD patients also had significantly higher levels of TGF-β (284.60 ± 60.50 pg/mL) compared to smokers (160.00 ± 41.80 pg/mL) and non-smokers (92.00 ± 25.00 pg/mL) (p < 0.001 and p < 0.05, respectively). Conclusions: Our study supports the growing body of evidence that U-II and TGF-β play central roles in the development and progression of fibrosis in COPD. The negative correlation between these markers and lung function parameters such as FEV₁ and FEV₁/FVC indicates that they may be key drivers of airway remodeling and obstruction. These biomarkers could serve as early indicators of fibrotic changes in smokers, even before the onset of COPD. Full article

(This article belongs to the Special Issue Latest Advances in Asthma and COPD)

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12 pages, 1688 KiB

Open AccessArticle

Association of Narrow Anterior Communicating Artery or Contralateral A1 Segment with Poor Outcomes After Mechanical Thrombectomy

by Audrius Širvinskas, Giedrius Ledas, Rūta Levulienė, Jurgita Markevičiūtė, Valerija Mosenko, Andrej Afanasjev, Aleksandras Vilionskis, Saulius Lukoševičius and Algirdas Edvardas Tamošiūnas

Medicina 2024, 60(11), 1749; https://doi.org/10.3390/medicina60111749 - 24 Oct 2024

Abstract

Background and Objectives: Contralateral A1 and AComA aplasia/hypoplasia are critically important in distal ICA T occlusion as the protective collateral blood supply from the circle of Willis via the anterior communicating artery is compromised. Although the terms aplasia/hypoplasia are used broadly in the [...] Read more.

Background and Objectives: Contralateral A1 and AComA aplasia/hypoplasia are critically important in distal ICA T occlusion as the protective collateral blood supply from the circle of Willis via the anterior communicating artery is compromised. Although the terms aplasia/hypoplasia are used broadly in the literature, the need for concrete measurements and data on their clinical significance is apparent. Features of the individual anatomy of the circle of Willis may determine patient outcomes. We aim to determine the cut-off values of contralateral A1 and AComA segments that determine worse outcomes for patients with acute ischemic stroke with T occlusion of the terminal internal carotid artery. Material and Methods: Retrospective patient data from 2015 to 2020 and prospective data from 2021 to 2022 of 482 patients with diagnosed acute ischemic stroke that underwent mechanical thrombectomy at the Republican Vilnius University Hospital (Vilnius, Lithuania) were obtained. Of these patients, 70 were selected with occlusion of internal carotid artery bifurcation and extension to M1 or A1 segments. For statistically significant interactions, patient data were analyzed using two statistical methods (logistic regression and Multivariate Adaptive Regression Splines (MARS)). Results: The narrowest segment of contralateral A1 and/or AComA was statistically significant for 7-day NIHSS, and the optimal cut-off points for this variable were 1.1 mm (MARS model) and 1.2 mm (logistic regression, p = 0.0079, sensitivity 66.7%, specificity 67.9%). The other considered variables (age, gender, time from last seen well to groin puncture, intravenous recombinant tissue plasminogen activator, admission NIHSS, and ASPECT score) and their interactions were not statistically significant. Conclusions: A negative correlation was found between the narrowest segment and seven days of NIHSS. A larger diameter of contralateral A1 and AComA appears to be essential for better patient outcomes at 7-day evaluation post mechanical thrombectomy. Full article

(This article belongs to the Section Cardiology)

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10 pages, 2289 KiB

Open AccessCase Report

Emerging Vibrio vulnificus-Associated Infections After Seawater Exposure—Cases from the Bulgarian Black Sea Coast

by Stephanie Radeva, Stoyan Vergiev, Georgi Georgiev and Denis Niyazi

Medicina 2024, 60(11), 1748; https://doi.org/10.3390/medicina60111748 - 24 Oct 2024

Abstract

Objectives: The aim of the current report is to present three cases of necrotizing fasciitis and sepsis caused by Vibrio vulnificus on the Bulgarian Black Sea coast. Materials and Methods: Two of the patients are males, 70 and 86 years of age, [...] Read more.

Objectives: The aim of the current report is to present three cases of necrotizing fasciitis and sepsis caused by Vibrio vulnificus on the Bulgarian Black Sea coast. Materials and Methods: Two of the patients are males, 70 and 86 years of age, respectively, and one is an 86-year-old female. Data were collected from the patients’ examination records. V. vulnificus was isolated on 5% sheep blood agar from wound and blood samples and identified by the automated system Phoenix M50 (BD, Franklin Lakes, NJ, USA). Antimicrobial susceptibility was tested with two well-known methods (disk diffusion and broth microdilution). Results: All of the patients were admitted to our hospital due to pain, swelling, ulceration, and bullae on the legs and were febrile. They underwent surgery and received intensive care support. One of the patients developed septicemia and septic shock; one of his legs was amputated, but the outcome was fatal. The other patient received immediate approptiate antibiotic and surgical treatment, and the outcome was favorable. The third patient underwent emergency fasciotomy but died a few hours after admission. Conclusions: Global climate change is affecting the distribution of Vibrio spp., and their incidence is expected to increase. It is important to highlight the need for awareness among immunocompromised and elderly patients of the potential threat posed by V. vulnificus infections. Full article

(This article belongs to the Section Infectious Disease)

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7 pages, 556 KiB

Open AccessCase Report

The Jack-in-the-Box: Pericardial Decompression Syndrome Managed by a Multidisciplinary Approach with Early Initiation of Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report

by Carmen Orban, Tudor Borjog, Claudia Talpau, Mihaela Agapie, Angelica Bratu, Mugurel Jafal and Mihai Popescu

Medicina 2024, 60(11), 1747; https://doi.org/10.3390/medicina60111747 - 24 Oct 2024

Abstract

Post decompression syndrome (PDS) is a rare and life-threatening complication of pericardiocentesis, especially after rapid drainage of large amounts of pericardial fluid. We present the case of a 21-year-old man who presented with cardiac tamponade of unknown etiology. After preoperative optimization, surgical drainage [...] Read more.

Post decompression syndrome (PDS) is a rare and life-threatening complication of pericardiocentesis, especially after rapid drainage of large amounts of pericardial fluid. We present the case of a 21-year-old man who presented with cardiac tamponade of unknown etiology. After preoperative optimization, surgical drainage of the pericardial effusion was performed and approximately 2500 mL of fluid was released over 30 min. The patient rapidly developed hemodynamic collapse with severe biventricular dysfunction, with a left ventricle ejection fraction of 15%. Vasopressor and inotropic support were initiated with Noradrenaline and Dobutamine, further escalated to Adrenaline and Levosimendan with no improvement in clinical and hemodynamic parameters. Considering the high doses of vasoactive drugs, rescue veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was started within the first 24 h. After 10 days on V-A ECMO, the cardiac function slowly recovered, and the extracorporeal mechanical support was successfully weaned. The diagnosis of paraneoplastic PDS secondary to angiosarcoma was made and the patient was successfully discharged to the ward on the 24th day. In conclusion, far from being the last option in the management of PDS, V-A ECMO deserves early consideration for securing adequate myocardial and systemic perfusion, while the cardiac function recovers, but a risk-to-benefit assessment should be made by an experienced multidisciplinary team. Full article

(This article belongs to the Section Cardiology)

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10 pages, 614 KiB

Open AccessArticle

Radiation-Induced Hemorrhagic Cystitis in Prostate Cancer Survivors: The Hidden Toll

by René Gatsinga, Benjamin J. H. Lim, Navin Kumar, Jacinda G. G. Tan, Youquan Li, Michael L. C. Wang, Terence W. K. Tan, Jeffrey K. L. Tuan, Yu Guang Tan, Kenneth Chen and John S. P. Yuen

Medicina 2024, 60(11), 1746; https://doi.org/10.3390/medicina60111746 - 24 Oct 2024

Abstract

Background and Objectives: Radiation therapy (RT) plays a crucial role in managing prostate cancer, offering effective disease control and improving survival rates in both localized and recurrent cases. However, RT can lead to hemorrhagic cystitis, a significant late complication resulting in chronic morbidity [...] Read more.

Background and Objectives: Radiation therapy (RT) plays a crucial role in managing prostate cancer, offering effective disease control and improving survival rates in both localized and recurrent cases. However, RT can lead to hemorrhagic cystitis, a significant late complication resulting in chronic morbidity and other health issues. This study aims to evaluate the real-world incidence of radiation-induced hemorrhagic cystitis requiring surgical intervention. Materials and Methods: This retrospective cohort study analyzed data from prostate cancer survivors treated for hematuria at our center between January 2014 and January 2024. Patients were included if cystoscopy identified radiation cystitis as the cause of hematuria. Descriptive statistics were used, and binomial logistic regression analyses with univariate and multivariate analysis were performed to identify risk factors for worse outcomes. Results: Fifty-two patients met the inclusion criteria. The estimated cumulative incidence at a median follow-up of 5.3 years was 4.5%. Among the participants, 21.2% required more than two transurethral bladder fulguration (TUBF) procedures, and 38.5% needed more than two hospital admissions for hematuria management. The median time to the first fulguration was 64 months. Blood transfusions were necessary in 53.8% of cases, and 38.5% required hyperbaric oxygen therapy. Ultimately, 5.8% of the patients underwent cystectomy. Univariate analysis identified ischemic heart disease (IHD) and antiplatelet therapy as significant risk factors (OR: 5.17 and 5.18, respectively), along with longer time to first fulguration (OR: 5.02). Multivariate analysis confirmed antiplatelet therapy (OR: 2.8, p = 0.05) and time to first TUBF (OR: 1.8, p = 0.02) as significant predictors of multiple procedures. Conclusions: Radiation cystitis remains a significant burden on prostate cancer survivors. Patients on antithrombotic agents, those with delayed initial presentations, and those who received radiation as salvage therapy are more likely to experience higher morbidity. Full article

(This article belongs to the Section Urology & Nephrology)

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14 pages, 928 KiB

Open AccessArticle

Antibiotic Prescription for Treatment and Prevention of Odontogenic Infections: A Cross-Sectional Survey of Lithuanian Dentists

by Neringa Skucaite, Lukas Stundžia, Rita Veberiene, Vilma Brukiene and Vita Maciulskiene

Medicina 2024, 60(11), 1745; https://doi.org/10.3390/medicina60111745 - 24 Oct 2024

Abstract

Background and Objectives: The inappropriate use of antibiotics can lead to antimicrobial resistance. Overprescribing in dental practice has been reported. This study aimed to describe patterns of antibiotic prescription for treating and preventing odontogenic infections based on reports from Lithuanian dentists. Materials [...] Read more.

Background and Objectives: The inappropriate use of antibiotics can lead to antimicrobial resistance. Overprescribing in dental practice has been reported. This study aimed to describe patterns of antibiotic prescription for treating and preventing odontogenic infections based on reports from Lithuanian dentists. Materials and Methods: Questionnaires were sent to all 4751 Lithuanian dentists registered in the database of the Lithuanian Dental Chamber who had consented to participate in surveys. The questionnaire addressed antibiotic prescription preferences for the treatment and prevention of various dental pathologies. The statistical analysis included chi-square tests and a factor analysis to evaluate prescription frequences in different clinical scenarios considering the respondents’ specialty and age. Results: Of 647 responses, 497 were from general dentists, 35 from oral surgeons, 40 from endodontists, 20 from periodontists, and 35 from prosthodontists. Respondents were grouped by age: A (≤35 years, n = 207), B (36–50 years, n = 224), and C (≥51 years, n = 209). Amoxicillin was the first-choice antibiotic for 81.1% of respondents (group A more frequently than other groups, p = 0.001). A 7-day treatment duration was preferred by 60.8%, while 33.6% chose 5 days. For patients allergic to β-lactam antibiotics, 63% preferred clindamycin. Over 90% cited acute apical abscess with systematic involvement as an indication for antibiotic prescription. A factor analysis of 18 clinical scenarios revealed prescription differences among dental specialists, oral surgeons, and periodontists prescribing antibiotics more frequently than general dentists and endodontists. For prophylaxis, 87.5% recommended antibiotics for patients at risk of infectious endocarditis after a cardiologist’s consultation (group C less frequently than other groups, p = 0.021). Conclusions: Lithuanian dentists generally prefer narrow-spectrum antibiotics for the treatment of odontogenic infections. There are notable differences in prescription patterns among dental specialists, with younger dentists showing a trend towards more rational antibiotic use. Full article

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

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14 pages, 1590 KiB

Open AccessArticle

Dysfunction of PTEN-Associated MicroRNA Regulation: Exploring Potential Pathological Links in Type 1 Diabetes Mellitus

by Abdulhalim Senyigit, Sinem Durmus, Aykut Oruc, Remise Gelisgen, Hafize Uzun and Omur Tabak

Medicina 2024, 60(11), 1744; https://doi.org/10.3390/medicina60111744 - 24 Oct 2024

Abstract

Background and Objectives: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease with T cell-mediated pathogenesis of pancreatic β-cell destruction, leading to insulin deficiency. MicroRNAs such as miR-223 and miR-106b, along with PTEN, have been reported to participate in the pathophysiology of diabetes [...] Read more.

Background and Objectives: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease with T cell-mediated pathogenesis of pancreatic β-cell destruction, leading to insulin deficiency. MicroRNAs such as miR-223 and miR-106b, along with PTEN, have been reported to participate in the pathophysiology of diabetes and its complications. The current study has explored the expression of miR-223, miR-106b, and PTEN and their association with various clinical and biochemical parameters in subjects diagnosed with T1DM. Materials and Methods: Sixty T1DM patients (two groups as uncomplicated/ with microalbuminuria) and fifty healthy volunteers, age- and sex-matched, were enrolled in this study. The fasting venous blood samples were collected, and PTEN and miRNAs (miR-223 and miR-106b) levels were measured by ELISA and real-time PCR, respectively. Results: The PTEN levels of patients with microalbuminuria were significantly lower than those of patients without microalbuminuria, while those of miR-223 and miR-106b were significantly increased in the T1DM group compared with the healthy control group (p < 0.001). ROC analysis indicated that PTEN, miR-223, and miR-106b could be potential biomarkers for diagnosing T1DM with high specificity but with variable sensitivities. Also, PTEN and miR-223 were negatively correlated with r =−0.398 and p < 0.0001, indicating that they were interrelated in their role within the T1DM pathophysiology. Conclusions: In the current study, it has been shown that the circulating levels of PTEN, miR-223, and miR-106b are significantly changed in T1DM patients and may back their potential to be used as non-invasive biomarkers for the diagnosis and monitoring of T1DM. Low PTEN protein expression was related to high miR-223 expression, indicating involvement of these miRNA in the regulation of PTEN. Further studies should be performed to clarify the exact mechanisms and possible clinical applications of these molecules. Full article

(This article belongs to the Section Endocrinology)

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10 pages, 446 KiB

Open AccessArticle

Neurodevelopment of Children Born with Forceps Delivery—A Single Tertiary Clinic Study

by Sanja Kostic, Katarina Ivanovic, Ivana Jovanovic, Milos Petronijevic, Natasa Cerovac, Jelena Milin-Lazovic, Danijela Bratic, Stefan Dugalic, Miroslava Gojnic, Milica Petronijevic, Milan Stojanovic, Ivan Rankovic and Svetlana Vrzic Petronijevic

Medicina 2024, 60(11), 1743; https://doi.org/10.3390/medicina60111743 - 24 Oct 2024

Abstract

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. [...] Read more.

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. We aimed to investigate a neurological outcome of neonates and children at the age of 7 who were born via forceps delivery. This would greatly improve informed decision making for both mothers and obstetricians. Materials and Methods: A single-arm cohort study was conducted from January 2012 to December 2016 among 49 women and their children born via forceps delivery at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia. The Sarnat and Sarnat classification was used to evaluate the neurological status of neonates, and logistic regression analysis was employed to explore the association with perinatal factors. Long-term neurological outcomes were assessed using the Griffiths Mental Development Scale and a questionnaire for parents based on the Motor and Social Development (MSD) scale, which was derived from the Bayley-III Scale. Results: The main indication for forceps delivery was maternal exhaustion (79.6%), followed by fetal distress (20.4%). A pathological neurological status was observed in 16.3% of newborns, with pathological ultrasound of the CNS in 3%. A statistically significant association was observed with the Apgar score, with an odds ratio of 0.575 (95% CI: 0.407–0.813, p = 0.002) and perinatal asphyxia, with an odds ratio of 9.882 (95% CI: 1.111–87.902, p = 0.04). However, these associations were unlikely to be related to the mode of delivery. Long-term adverse neurological outcomes were seen in three cases, which accounts for 6.4%. These included mild disorders such as delayed milestone, speech delay, and motor clumsiness. Conclusions: The present study highlights the safety of forceps delivery regarding children’s neurological outcomes at 7 years of age. This is an important contribution to the modern management of labor, especially in light of increasing rates of cesarean deliveries worldwide. Full article

(This article belongs to the Special Issue Modern Trends in Obstetrics and Gynecology)

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12 pages, 1583 KiB

Open AccessArticle

Investigating the Potential Overuse of Pan-Computed Tomography (PanCT) Examinations in Trauma Cases in Emergency Departments

by Haitham Alahmad, Ahmed Hobani, Mohammed Alasmi, Abdulrhman M. Alshahrani, Ahmad Abanomy, Mohammad Alarifi, Abdulmajeed Alotaibi, Khaled Alenazi and Mansour Almanaa

Medicina 2024, 60(11), 1742; https://doi.org/10.3390/medicina60111742 - 24 Oct 2024

Abstract

Background and Objectives: The increasing use of whole-body computed tomography (WBCT) examinations, also known as panCT, in emergency departments for trauma patients has raised concerns about potential overuse and the associated risk of unnecessary radiation exposure. The purpose of this study was to [...] Read more.

Background and Objectives: The increasing use of whole-body computed tomography (WBCT) examinations, also known as panCT, in emergency departments for trauma patients has raised concerns about potential overuse and the associated risk of unnecessary radiation exposure. The purpose of this study was to examine the utilization patterns and findings of panCT scans performed over one year at a major academic hospital. Materials and Methods: This retrospective cohort study included 531 stable trauma adult patients who underwent panCT scans in 2023. De-identified data for each patient, including the radiology report, age, gender, and total dose-length product (DLP) of the panCT scan, were retrieved and reviewed. Radiology reports were classified based on the findings as negative (no acute traumatic injuries) or positive, with positive reports further subclassified based on injury location. Injury severity scores (ISS) were also calculated based on the findings of the radiology reports. Statistical analysis was performed using the Python programming language to assess any association between the independent variables (age and gender) and the dependent variable (report findings: negative or positive). Results: About 57% (n = 303) of the panCT scans included in the analysis were negative. The chi-squared test and logistic regression revealed a significant association between age and report finding (negative or positive), while no association with gender was found. One-third of positive cases (n = 72) had injuries only in the head and neck (H&N) region, and another one-third (n = 72) had injuries only in chest-abdomen-pelvis (CAP) region. Most cases (n = 373; 70%) had an ISS between 1 and 8, which is a mild score. Conclusions: This study showed a high rate of negative panCT scans, suggesting potential overuse of panCT. The study results highlight the need for more selective CT imaging approaches in emergency settings. Following evidence-based guidelines and decision-support tools could promote appropriate utilization of panCT scans, reducing unnecessary radiation exposure while ensuring that high-risk patients in emergency setting receive appropriate imaging. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Concerns)

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12 pages, 4352 KiB

Open AccessArticle

The Development of a Human Respiratory Mucosa-on-a-Chip Using Human Turbinate-Derived Mesenchymal Stem Cells

by Do Hyun Kim, Sang Hi Park, Mi-Yeon Kwon, Chae-Yoon Lim, Sun Hwa Park, David W. Jang, Se Hwan Hwang and Sung Won Kim

Medicina 2024, 60(11), 1741; https://doi.org/10.3390/medicina60111741 - 24 Oct 2024

Abstract

Background and Objectives: This study aimed to investigate the influence of a respiratory mucosa-on-a-chip on the respiratory epithelial differentiation potential of human nasal inferior turbinate-derived stem cells (hNTSCs). Materials and Methods: After isolating hNTSCs from five patients, we divided the samples [...] Read more.

Background and Objectives: This study aimed to investigate the influence of a respiratory mucosa-on-a-chip on the respiratory epithelial differentiation potential of human nasal inferior turbinate-derived stem cells (hNTSCs). Materials and Methods: After isolating hNTSCs from five patients, we divided the samples from the patients into the study group with a mucosa-on-a-chip and the control group with conventional differentiation (using conventional differentiation methods). The respiratory epithelial differentiation potential of hNTSCs was analyzed by histology and gene expression. Results: In the quantitative analysis, PCR showed that the hNTSCs expressed the cytokeratin genes (KRT13, 14), transformation-related protein P63 (TP63), and vimentin of basal cells in the airway epithelium at higher levels, but cytokeratin genes (KRT6) at lower levels, in the mucosa-on-a-chip than in conventional differentiation. In the cytokine analysis (GM-CSF, IFNr, IL-1a, IL-1b, IL-4, IL-5, IL-10, IL-12(p70), IL-13, IL-17A, IL-17E/IL-25, RANTES, TNFa, IL-6, and IL-8), the expressions of IFNr, IL-13, RANTES, TNFa, IL-6, and IL-8 were significantly upregulated in the mucosa-on-a-chip than in conventional differentiation. Conclusions: We conclude that the human respiratory mucosa-on-a-chip using human turbinate-derived mesenchymal stem cells allows the respiratory differentiation of hNTSCs and shows the difference in gene and cytokine expression, which could serve as an alternative to conventional differentiation for the production of functionally competent hNTSCs for future clinical applications. Full article

(This article belongs to the Section Surgery)

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23 pages, 1480 KiB

Open AccessReview

A Multivariate Phenotypical Approach of Sepsis and Septic Shock—A Comprehensive Narrative Literature Review

by Alina Tita, Sebastian Isac, Teodora Isac, Cristina Martac, Geani-Danut Teodorescu, Lavinia Jipa, Cristian Cobilinschi, Bogdan Pavel, Maria Daniela Tanasescu, Liliana Elena Mirea and Gabriela Droc

Medicina 2024, 60(11), 1740; https://doi.org/10.3390/medicina60111740 - 23 Oct 2024

Abstract

Despite medical advances, sepsis and septic shock remain some of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Evidence suggests that pulmonary sepsis is one of the most severe forms of sepsis, [...] Read more.

Despite medical advances, sepsis and septic shock remain some of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Evidence suggests that pulmonary sepsis is one of the most severe forms of sepsis, while liver dysfunction, left ventricular dysfunction, and coagulopathy impact the prognostic. Sepsis-related hypothermia and a hypoinflammatory state are related to a poor outcome. Given the heterogeneity of sepsis and recent technological progress amongst machine learning analysis techniques, a new, personalized approach to sepsis is being intensively studied. Despite the difficulties when tailoring a targeted approach, with the use of artificial intelligence-based pattern recognition, more and more publications are becoming available, highlighting novel factors that may intervene in the high heterogenicity of sepsis. This has led to the devise of a phenotypical approach in sepsis, further dividing patients based on host and trigger-related factors, clinical manifestations and progression towards organ deficiencies, dynamic prognosis algorithms, and patient trajectory in the Intensive Care Unit (ICU). Host and trigger-related factors refer to patients’ comorbidities, body mass index, age, temperature, immune response, type of bacteria and infection site. The progression to organ deficiencies refers to the individual particularities of sepsis-related multi-organ failure. Finally, the patient’s trajectory in the ICU points out the need for a better understanding of interindividual responses to various supportive therapies. This review aims to identify the main sources of variability in clustering septic patients in various clinical phenotypes as a useful clinical tool for a precision-based approach in sepsis and septic shock. Full article

(This article belongs to the Special Issue Precision Medicine Approach in Septic Patients)

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9 pages, 572 KiB

Open AccessArticle

Pediatric In-Hospital Cardiac Arrest: An Examination of Resuscitation Outcomes

by Yakup Söğütlü and Uğur Altaş

Medicina 2024, 60(11), 1739; https://doi.org/10.3390/medicina60111739 - 23 Oct 2024

Abstract

Background and Objectives: We aimed to assess the outcomes of pediatric in-hospital cardiac arrests (IHCAs) and to identify key factors influencing survival. Materials and Methods: This retrospective, single-center study examined the demographic characteristics, symptoms, comorbidities, initial rhythm, duration of cardiopulmonary resuscitation [...] Read more.

Background and Objectives: We aimed to assess the outcomes of pediatric in-hospital cardiac arrests (IHCAs) and to identify key factors influencing survival. Materials and Methods: This retrospective, single-center study examined the demographic characteristics, symptoms, comorbidities, initial rhythm, duration of cardiopulmonary resuscitation (CPR), lactate levels, and outcomes of pediatric patients with IHCAs and compared these parameters between survivors and non-survivors. Results: A total of 43 patients were included in this study, including 21 boys (48.8%) and 22 girls (51.2%) with a median age of 36 months (range 1–203). CPR was initiated due to pulselessness in 23 patients (53.5%), respiratory arrest in 13 (30.2%), and bradycardia in 7 (16.3%). The first monitored rhythm in the emergency department was asystole in 29 patients (67.4%) and bradycardia in 14 (32.6%). Despite effective CPR, the mortality rate was 65.1% (n = 28). As a prognostic factor, asystole was found to be more common in non-survivors than in survivors (83.1% vs. 40%, p = 0.005). Additionally, lactate levels (16.6 vs. 10.6, p = 0.04) and CPR duration (45 vs. 15 min, p < 0.001) were significantly higher in non-survivors. Conclusions: IHCAs remain a critical concern, with varying outcomes influenced by factors such as initial rhythm, lactate levels, and CPR duration. Full article

(This article belongs to the Special Issue Revolutionizing Cardiopulmonary Resuscitation: Contemporary Advances and Challenges)

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23 pages, 1325 KiB

Open AccessSystematic Review

The Potential of Silver Diamine Fluoride in Non-Operative Management of Dental Caries in Primary Teeth: A Systematic Review

by Kornelija Rogalnikovaitė, Julija Narbutaitė, Vilija Andruškevičienė, Eglė Aida Bendoraitienė and Jaunė Razmienė

Medicina 2024, 60(11), 1738; https://doi.org/10.3390/medicina60111738 - 23 Oct 2024

Abstract

Background and Objectives: Dental caries has seen an increase in untreated cases, leading to significant health and quality-of-life impacts, necessitating innovative approaches like the promising non-operative management with silver diamine fluoride. This study aimed to evaluate the mechanisms of action of silver diamine [...] Read more.

Background and Objectives: Dental caries has seen an increase in untreated cases, leading to significant health and quality-of-life impacts, necessitating innovative approaches like the promising non-operative management with silver diamine fluoride. This study aimed to evaluate the mechanisms of action of silver diamine fluoride on arresting dental caries in primary teeth. Materials and Methods: A systematic search was conducted across MEDLINE (PubMed), Google Scholar, and Wiley Online Library, including both in vivo and in vitro studies published from 1 January 2017 to 16 October 2022. The Cochrane Risk of Bias Tool assessed bias in in vivo studies, while the Quality Assessment Tool for In Vitro Studies evaluated the methodological quality of in vitro studies. Results: Nineteen publications met the inclusion criteria. Two studies indicated that silver diamine fluoride application significantly alters oral microflora, contributing to caries arrest. Additionally, two studies reported increased mineral density and mineral content in demineralised primary teeth, emphasising silver diamine fluoride’s role in promoting remineralisation. Three studies demonstrated significant improvements in surface microhardness, enhancing tooth resistance. However, no significant qualitative changes in bacterial species composition were noted. Modified silver diamine fluoride application techniques, including light curing or laser irradiation, enhanced efficacy, with light curing notably increasing surface microhardness. Based on a limited number of studies, no statistically significant differences in clinical effectiveness were observed with higher silver diamine fluoride concentrations or extended application durations. Conclusions: Silver diamine fluoride effectively induces quantitative changes in oral microflora and enhances the microhardness and mineral density of enamel and dentine in primary teeth, with modified application methods showing potential for improved outcomes. Full article

(This article belongs to the Special Issue Boundaries Between Oral and General Health)

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12 pages, 679 KiB

Open AccessArticle

A Decade of Experience Between Open and Minimally Invasive Hepatectomies for Hepatocellular Carcinoma

by Andrew Min-Gi Park, Ye In Christopher Kwon, Kush Savsani, Aadi Sharma, Yuzuru Sambommatsu, Daisuke Imai, Aamir Khan, Amit Sharma, Irfan Saeed, Vinay Kumaran, Adrian Cotterell, Marlon Levy, David Bruno and Seung Duk Lee

Medicina 2024, 60(11), 1737; https://doi.org/10.3390/medicina60111737 - 23 Oct 2024

Abstract

Background and Objectives: Hepatic resection offers promising outcomes for patients with hepatocellular carcinoma (HCC) but can be constrained by factors like patient suitability. Continuous advancements in laparoscopic and robotic technologies have made minimally invasive hepatectomies (MIHs) a viable alternative to open hepatectomies [...] Read more.

Background and Objectives: Hepatic resection offers promising outcomes for patients with hepatocellular carcinoma (HCC) but can be constrained by factors like patient suitability. Continuous advancements in laparoscopic and robotic technologies have made minimally invasive hepatectomies (MIHs) a viable alternative to open hepatectomies with benefits in terms of recovery and complications. Materials and Methods: We completed a retrospective review on 138 HCC patients who underwent OH or MIH between 2010 and 2020 at the Hume-Lee Transplant Center. Univariate and multivariate analyses were completed on demographic, clinical, and tumor-specific data to assess the impact of these variables on overall and disease-free survival at 1, 3, and 5 years. Preoperative metrics like length of hospital stay (LOS) and operation duration were also evaluated. Results: Of the 109 OH and 29 MIH patients, MIH patients demonstrated shorter LOS and operative times. However, overall survival (OS) and disease-free survival (DFS) were similar between groups, with no significant variations in 1-, 3-, and 5-year survival rates. Age > 60 years and a lack of preoperative transcatheter arterial chemoembolization (TACE) were significant predictors of inferior OS and DFS in multivariate analyses. Conclusions: MIH is an efficient substitute for OH with comparable survival, even in older patients. The reduced LOS and operation time enhance its feasibility, and older patients previously denied for curative resection may qualify for MIH. Preoperative TACE also enhances survival outcomes, emphasizing its general role in managing resectable HCCs. Both robotic and laparoscopic hepatectomies offer acceptable short- and long-term clinical outcomes, highlighting MIH as the standard choice for HCC patients. Full article

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

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10 pages, 461 KiB

Open AccessReview

The Role of 5-Phosphodiesterase Inhibitors (PDE-5I) in Current Benign Prostatic Hyperplasia Treatment: A Narrative Review

by Konstantinos Stamatiou, Gianpaolo Perletti, Vittorio Magri and Alberto Trinchieri

Medicina 2024, 60(11), 1736; https://doi.org/10.3390/medicina60111736 - 23 Oct 2024

Abstract

Introduction: 5-phosphodiesterase inhibitors (PDE-5I) have been investigated as a treatment for urinary dysfunction for almost a decade. The general perception is that they play a significant role in managing lower urinary tract symptoms (LUTS), particularly those associated with benign prostatic hyperplasia (BPH). [...] Read more.

Introduction: 5-phosphodiesterase inhibitors (PDE-5I) have been investigated as a treatment for urinary dysfunction for almost a decade. The general perception is that they play a significant role in managing lower urinary tract symptoms (LUTS), particularly those associated with benign prostatic hyperplasia (BPH). However, the specific biochemical processes by which PDE-5I repairs urinary function are still poorly understood and there is little instrumental evidence of significant improvement in urinary symptoms. Therefore, we explore the role of 5-phosphodiesterase inhibitors (PDE-5I) as complementary to the conventional treatment of symptomatic BPH; we provide the suggested biological procedures involved in the association between PDE-5 inhibitor use and improvement in LUTS; and we propose new approaches to this topic. Material and Methods: A systematic search for clinical trials, experimental studies, and systematic reviews was performed in electronic libraries (PubMed, EMBASE, Scopus) using the terms “benign prostate hypertrophy”, “benign prostate hyperplasia”, “lower urinary tract symptoms”, “storage symptoms”, “voiding symptoms”, “bladder outlet obstruction” and the keywords “mechanism of action”, “synergy”, “PDE-5 inhibitor”, “alpha1-adrenergic antagonist”, “5-alpha-reductase inhibitors” in various combinations. There was no restriction on publication date. Results: To date, only a few randomized studies have been published in which the effect of the combination of a conventional drug for the treatment of symptomatic BPH and a PDE-5I was investigated. Almost all showed significant improvement in IPSS and QoL. Some studies showed significant improvements in maximum urine flow (Qmax) and postvoiding residual volume (PVR) with combination therapy compared with a single agent alone. Conclusions: PDE-5I seems effective in relieving symptoms of some BPH patients when administered as complementary to agents currently used to treat BPH. However, the mechanism of action of PDE-5 inhibitors in LUTS remains poorly understood and it is difficult to determine the specific subset of BPH patients who will benefit from the combination of PDE-5 inhibitors with the current treatment. Well-designed, sufficiently informative comparative studies focusing on specific target group profiles (age, urogenital parameters) are needed to define new therapeutic options. Full article

(This article belongs to the Section Urology & Nephrology)

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10 pages, 451 KiB

Open AccessSystematic Review

Clinical Spectrum and Perspective in Bilateral Acute Retinal Necrosis: Systematic Review

by Valeria Albano, Mariantonietta Di Brina, Maria Grazia Pignataro, Giacomo Scotti, Camilla Di Pardo, Giovanni Petruzzella, Antonio Salvelli, Rosanna Dammacco, Silvana Guerriero and Giovanni Alessio

Medicina 2024, 60(11), 1735; https://doi.org/10.3390/medicina60111735 - 23 Oct 2024

Abstract

Bilateral acute retinal necrosis (BARN) represents a broad ophthalmological field of severe retinal pathologies associated with poor visual prognosis and blindness. The purpose of this review is to examine the clinical spectrum in detail over the past few years, exploring laboratory and instrumental [...] Read more.

Bilateral acute retinal necrosis (BARN) represents a broad ophthalmological field of severe retinal pathologies associated with poor visual prognosis and blindness. The purpose of this review is to examine the clinical spectrum in detail over the past few years, exploring laboratory and instrumental diagnosis, and providing useful and up-to-date guidance in this field. A systematic review of this field has been performed through the PRISMA guidelines, searching in the PUBMED database. Serological laboratory tests on blood or polymerase chain reaction (PCR) on aqueous humor or vitreous samples are crucial to identifying the underlying cause and choosing the timeliest strategic treatments. Often, the main cause remains herpesviruses, with Varicella zoster (VZV) predominating over the others. There are also other causes that one needs to be carefully aware of. Anatomical and functional recovery is unfavorable if they are not individuated in a quick time. Early diagnosis and timely treatment offer a better chance of visual improvement and the avoidance of complications. Complications worsen the visual prognosis over months and may require a surgical approach. Full article

(This article belongs to the Special Issue Clinical Profile and Treatment Response of Patients with Ocular Inflammation)

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15 pages, 1516 KiB

Open AccessArticle

Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team

by João Gouveia, Marta Moura Neves, Nuno Madeira, Vítor Santos and António Macedo

Medicina 2024, 60(11), 1734; https://doi.org/10.3390/medicina60111734 - 22 Oct 2024

Abstract

Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence [...] Read more.

Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. Materials and Methods: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. Results: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. Conclusions: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments. Full article

(This article belongs to the Special Issue The Therapeutic Landscapes and Patient Management in Psychiatry and Mental Health)

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11 pages, 279 KiB

Open AccessArticle

Characteristics of Inherited Metabolic Disorders Following Kidney Transplantation: A 13-Year Observational Study

by Kirsty Dickson, Henry H. L. Wu, Reena Sharma, Karolina M. Stepien, Ana Jovanovic and Rajkumar Chinnadurai

Medicina 2024, 60(11), 1733; https://doi.org/10.3390/medicina60111733 - 22 Oct 2024

Abstract

Background and Objectives: Inherited metabolic disorders (IMDs), primarily cystinosis, Fabry disease, and methylmalonic acidemia (MMA), are genetic conditions that typically result in multi-organ disease manifestations. Kidney function progressively deteriorates in many cases, with patients eventually reaching end-stage kidney disease (ESKD) and requiring renal [...] Read more.

Background and Objectives: Inherited metabolic disorders (IMDs), primarily cystinosis, Fabry disease, and methylmalonic acidemia (MMA), are genetic conditions that typically result in multi-organ disease manifestations. Kidney function progressively deteriorates in many cases, with patients eventually reaching end-stage kidney disease (ESKD) and requiring renal replacement therapy. Kidney transplantation has been deemed the optimal renal replacement therapy option to achieve long-term survival in patients with IMD. Whilst improved long-term survival is expected, the patterns of clinical evolution for IMD after transplantation remain largely unknown. Methods: Our group conducted a retrospective observational study that included 37 adult patients with IMD (11 with cystinosis, 20 with Fabry disease, and 6 with MMA). The study evaluated the clinical status and progression of these patients following kidney transplantation between January 2010 and December 2023. Results: This generally resulted in good graft outcomes for patients with IMD. Standard immunosuppression regimes included tacrolimus, mycophenolate mofetil, and prednisolone. The mean graft survival duration was noted to be 12 years in patients with cystinosis, 11 years in patients with Fabry disease, and 7 years in patients with MMA. Suboptimal outcomes were noted with grafts of cadaveric origin and poor adherence to the prescribed post-transplant immunosuppression regime. A greater extra-renal morbidity burden was associated with a reduced duration of graft function and increased mortality in patients with IMD. Conclusions: Our findings emphasise the need for a multi-disciplinary approach in the care of IMD patients following kidney transplantation. Full article

(This article belongs to the Section Urology & Nephrology)

14 pages, 323 KiB

Open AccessArticle

Social Support and Quality of Life in Hemodialysis Patients: A Comparative Study with Healthy Controls

by Leszek Sułkowski, Andrzej Matyja and Maciej Matyja

Medicina 2024, 60(11), 1732; https://doi.org/10.3390/medicina60111732 - 22 Oct 2024

Abstract

Background and Objectives: Hemodialysis patients face significant physical and psychological challenges, including diminished quality of life and reduced social support. This study aimed to assess the levels of social support and quality of life in hemodialysis patients and identify the sociodemographic and [...] Read more.

Background and Objectives: Hemodialysis patients face significant physical and psychological challenges, including diminished quality of life and reduced social support. This study aimed to assess the levels of social support and quality of life in hemodialysis patients and identify the sociodemographic and dialysis-related factors influencing these outcomes. Materials and Methods: This study included 115 hemodialysis patients and 107 healthy controls. Social support was measured using the Modified Social Support Survey (MSSS) and its abbreviated version (MSSS-5). Quality of life was assessed using the WHOQOL-BREF questionnaire. Demographic variables (age, sex, education, marital status) and dialysis-related factors (session duration, Kt/V, vascular access type, and urea reduction ratio) were analyzed to determine their effects on social support and quality of life. Results: Hemodialysis patients reported significantly lower scores in the Physical Health and Psychological Health domains of the WHOQOL-BREF compared to healthy controls. Males on hemodialysis scored lower than the controls in the Physical Health, Psychological Health, and Environment domains of the WHOQOL-BREF and the Affectionate Support and Positive Social Interaction subscales of MSSS. Conversely, hemodialysis females reported higher scores for Tangible Support, Emotional/Informational Support, and Affectionate Support. Longer dialysis sessions negatively impacted the Social Relationships domain. Married hemodialysis patients had higher Emotional/Informational Support and Affectionate Support scores. Conclusions: Hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational support, is crucial for hemodialysis patients, with marital status playing a key role. Addressing these psychosocial factors may improve outcomes for hemodialysis patients. Full article

(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment)

8 pages, 528 KiB

Open AccessArticle

The Relationship Between Tramadol Use and Cardio Electrophysiological Balance for Postoperative Pain Treatment in General Surgery Patients

by Hüseyin Yönder, Kenan Toprak, Mehmet Sait Berhuni, Hasan Elkan, Faik Tatlı, Abdullah Özgönül, Baran Yüksekyayla, Hamza Koyuncu, Mustafa Beğenç Taşcanov, Halil Fedai, Metin Ocak, Yakup Arğa and Ali Uzunköy

Medicina 2024, 60(11), 1731; https://doi.org/10.3390/medicina60111731 - 22 Oct 2024

Abstract

Background and Objective: This study aimed to investigate the relationship between tramadol use and cardio electrophysiological imbalance (iCEB/iCEBc) in general surgery patients with complaints of acute postoperative pain (APP). Materials and Methods: In this prospective cross-sectional study, a total of 218 consecutive patients [...] Read more.

Background and Objective: This study aimed to investigate the relationship between tramadol use and cardio electrophysiological imbalance (iCEB/iCEBc) in general surgery patients with complaints of acute postoperative pain (APP). Materials and Methods: In this prospective cross-sectional study, a total of 218 consecutive patients over the age of 18, who underwent surgical procedures in our clinic (postoperative), were included. For analgesic effect, tramadol was administered with an initial total max dose not exceeding 2 mg/kg. A single max dose (100 mg) was given intravenously, infused in 100 cc of saline over 60 min. In all patients requiring analgesia, electrocardiography (ECG) was performed in the supine position with 12 leads at 25 mm/s and 10 mm/mV, immediately before and after tramadol administration. iCEB was calculated as QT/QRS and iCEBc as QTc/QRS. Results: A total of 218 patients were included in this study, with 98 of them being male (45%) and the average age being 46.20 ± 17.19 years. The average tramadol dose for analgesic effect was 98.21 ± 7.62 mg. The QT interval (339.17 ± 36.27 vs. 349.88 ± 30.86, p = 0.001), QTc interval (407.07 ± 26.36 vs. 419.64 ± 31.78, p < 0.001), QRS duration (80.82 ± 11.39 vs. 78.57 ± 9.80, p = 0.018), iCEB (4.26 ± 0.69 vs. 4.52 ± 0.70, p < 0.001), and iCEBc (5.14 ± 0.86 vs. 5.42 ± 0.79, p = 0.001) values significantly increased compared to the baseline immediately after drug administration. Furthermore, the drug dose was identified as an independent predictor that increased iCEBc (β = 0.201, p = 0.003). Conclusions: Even at single and therapeutic doses, tramadol increases iCEB and iCEBc. Additionally, the drug dose is an independent predictor of increased iCEBc. Full article

(This article belongs to the Section Cardiology)

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9 pages, 2126 KiB

Open AccessCase Report

Neuronal Intranuclear Inclusion Disease with a Corneal Disorder: A Case Report

by Mohamed Talaat Mohamed, Daisuke Inoue, Shunsuke Yoshimura, Masafumi Uematsu, Yasser Helmy Mohamed, Mao Kusano, Diya Tang, Akio Oishi, Takashi Kitaoka, Gou Takeo and Akihiro Ohira

Medicina 2024, 60(11), 1730; https://doi.org/10.3390/medicina60111730 - 22 Oct 2024

Abstract

Background: Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder characterized by the formation of intranuclear inclusions in cells. Adult-type NIID usually develops in elderly patients with various clinical manifestations and is sometimes accompanied by ocular symptoms. A case of adult-onset [...] Read more.

Background: Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder characterized by the formation of intranuclear inclusions in cells. Adult-type NIID usually develops in elderly patients with various clinical manifestations and is sometimes accompanied by ocular symptoms. A case of adult-onset NIID with early and unique manifestations, including a progressive corneal defect and retinal changes, which are concerning at a young age, is reported. Case Presentation: A 29-year-old woman with adult sporadic NIID presented to our department with a progressive corneal disorder. Her neurological symptoms started at the age of 22 years, and she was diagnosed with NIID by skin biopsy and genetic testing. Ocular examination revealed bilateral corneal superficial punctate keratitis, right corneal opacity, decreased vision, nocturnal lagophthalmos, and early retinal changes. Corneal nerve fiber atrophy was detected by in vivo confocal microscopy. With a Cochet–Bonnet aesthesiometer, the progression of NIID and decreased corneal sensation were confirmed. Findings consistent with neurotrophic keratitis and keratoconjunctivitis due to nocturnal lagophthalmos were both suggested as being complications of her underlying NIID. Treatment with punctal plugs, sodium hyaluronate eye drops, diquafosol sodium eye drops, systemic and local antivirals, and local steroid medications resulted in the gradual improvement in the irregularity and opacity of the epithelium. Conclusions: NIID may lead to neurotrophic keratopathy due to impairment of the corneal sensory nerves. Nocturnal lagophthalmos is a remarkable finding in a case of NIID. The findings in the present case highlight the complex and multifaceted nature of NIID, with neurological and ocular manifestations requiring a multidisciplinary approach to management. Full article

(This article belongs to the Section Ophthalmology)

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7 pages, 1193 KiB

Open AccessArticle

Pediatric Microlaryngoscopy Experiences in a Tertiary Hospital: A Retrospective Analyses of 105 Procedures

by Elvan Ocmen, Hale Aksu Erdost, Sezin Ersoy, Idris Akdeniz and Taner Erdag

Medicina 2024, 60(11), 1729; https://doi.org/10.3390/medicina60111729 - 22 Oct 2024

Abstract

Background and Objectives: Anesthesia for pediatric microlaryngoscopy/direct laryngoscopy and bronchoscopy (DLB) is very challenging. Airway management methods can vary from tubeless techniques to endotracheal intubation. In this study, we analyzed the pediatric DLB patients operated on in our tertiary hospital. Materials and [...] Read more.

Background and Objectives: Anesthesia for pediatric microlaryngoscopy/direct laryngoscopy and bronchoscopy (DLB) is very challenging. Airway management methods can vary from tubeless techniques to endotracheal intubation. In this study, we analyzed the pediatric DLB patients operated on in our tertiary hospital. Materials and Methods: After the ethics committee’s approval, we retrospectively searched the pediatric DLB patients operated on between 2018 and 2023. Demographic data, airway management, pathology, operation time, and complications were analyzed. Results: Fifty-seven pediatric patients and 105 procedures were analyzed. The most common pathology was subglottic stenosis (29.1%). More than half of the patients were younger than one year old (56.1%). The airway management was performed with intermittent mask ventilation (37.2%), endotracheal tube (33.3%), and tracheostomy cannula (29.5%). Intermittent mask ventilation was the airway management type in 66.0% of the infants. Conclusions: Here, we report our pediatric DLB experiences. Airway management is challenging and is dependent on the age and pathology of the child, and planned surgery. Excessive attention is required during airway surgeries such as DLB. Full article

(This article belongs to the Section Surgery)

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8 pages, 950 KiB

Open AccessArticle

The Superiority of Compressed Colchicine Tablets over Coated Colchicine Tablets for Familial Mediterranean Fever

by Mehmet Nur Kaya, Muhammed Canbaş, Özlem Kılıç, Abdullah Doğan and Sedat Yılmaz

Medicina 2024, 60(11), 1728; https://doi.org/10.3390/medicina60111728 - 22 Oct 2024

Abstract

Background and Objectives: Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent febrile attacks and serosal inflammation. The goals of FMF treatment are to prevent acute attacks and the development of amyloidosis. This study aimed to investigate the benefit [...] Read more.

Background and Objectives: Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent febrile attacks and serosal inflammation. The goals of FMF treatment are to prevent acute attacks and the development of amyloidosis. This study aimed to investigate the benefit of switching to compressed colchicine tablets in patients with FMF who are resistant or intolerant to the pharmaceutical preparation of coated colchicine tablets in terms of attack frequency and side effects. Materials and Methods: Patients who developed resistance and intolerance under coated colchicine tablet treatment and, therefore, switched to compressed colchicine tablets were identified. The attack frequencies and drug-related side effects in patients using the two different pharmaceutical colchicine preparations were compared. Results: The mean age of the 172 patients treated with compressed tablets alone following coated tablets was 36.3 ± 11.4 years, and 75 (43.6%) were male. The most common genetic mutation was detected as M694V in 111 (64.5%) patients, and 36 (20.9%) of them were homozygous. A decrease in the daily colchicine dose was found after switching to compressed colchicine tablets in patients followed for 7 years (2.1 ± 0.7 mg vs. 1.7 ± 0.5 mg; p < 0.001). Episodes lasted for one to three days and then resolved spontaneously. After treatment with the compressed tablet form of colchicine, 129 (75%), 33 (19%), and 10 (6%) patients had 0–3, 4–6, and more than 7 attacks, respectively (p < 0.001). Diarrhea and aminotransferase elevation, the most common side effects in patients using coated colchicine tablets, decreased after using compressed colchicine tablets (p < 0.001). Conclusions: Compressed colchicine tablets were shown to be effective in patients who did not respond to coated colchicine therapy and those with pre-treatment intolerance to biological agents. Full article

(This article belongs to the Section Hematology and Immunology)

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17 pages, 1396 KiB

Open AccessReview

The Effect of Androgen Deprivation Therapy on the Cardiovascular System in Advanced Prostate Cancer

by Allison B. Reiss, Samantha Vasalani, Jacqueline Albert, Wendy Drewes, Kathleen Li, Ankita Srivastava, Joshua De Leon and Aaron E. Katz

Medicina 2024, 60(11), 1727; https://doi.org/10.3390/medicina60111727 - 22 Oct 2024

Abstract

Androgen deprivation therapy (ADT) is a mainstay treatment for metastatic prostate cancer, improving progression-free survival. ADT suppresses the production of testosterone and reduces circulating levels of the hormone. Luteinizing hormone-releasing hormone (LH-RH) agonists are the most commonly used ADT modality. They can be [...] Read more.

Androgen deprivation therapy (ADT) is a mainstay treatment for metastatic prostate cancer, improving progression-free survival. ADT suppresses the production of testosterone and reduces circulating levels of the hormone. Luteinizing hormone-releasing hormone (LH-RH) agonists are the most commonly used ADT modality. They can be given alone or in combination with androgen synthesis inhibitors or androgen receptor antagonists. An estimated 40% of prostate cancer patients will receive ADT as part of their therapy during their lifetime. However, ADT has numerous adverse effects, including an increased cardiovascular risk that impacts quality of life. Relugolix is an alternative form of ADT. It is the only oral gonadotropin-releasing hormone antagonist, circumventing injection site reactions, making it easier for patients to take, and thus increasing compliance. Testosterone suppression with relugolix is excellent and testosterone recovery after discontinuation is rapid. This paper reviews the ADT and anti-androgen treatment options for men with prostate cancer and the cardiovascular effects of these therapies. There is accumulating evidence that cardiovascular risk with relugolix is lower than with other ADT medications and also lower than with androgen synthesis inhibitors and androgen receptor antagonists. This paper provides insight into the use of different ADT regimens based on the cardiovascular status and circumstances. It explores strategies to mitigate negative cardiovascular consequences and highlights the need for further study. Full article

(This article belongs to the Section Oncology)

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7 pages, 1252 KiB

Open AccessArticle

Supernumerary Head of the Biceps Brachii Muscle Influences the Topography of the Coracobrachialis and Biceps Brachii Muscles

by Yu-Ran Heo, Hyunsu Lee, Si-Wook Lee, Beom-Soo Kim, Hong-Tae Kim and Jae-Ho Lee

Medicina 2024, 60(11), 1726; https://doi.org/10.3390/medicina60111726 - 22 Oct 2024

Abstract

Background/Objectives: Anatomical variations in the biceps brachii muscle (BBM) are extremely frequent, leading to developmental and clinical implications. We studied the topography of the BBM and analyzed its correlations with other structures in the brachial region. Methods: A total of 103 cadaveric [...] Read more.

Background/Objectives: Anatomical variations in the biceps brachii muscle (BBM) are extremely frequent, leading to developmental and clinical implications. We studied the topography of the BBM and analyzed its correlations with other structures in the brachial region. Methods: A total of 103 cadaveric upper extremities were dissected. The length of the upper extremities was utilized as a reference line. The origin and insertion of the BBM, the coracobrachialis muscle (CBM), and the related neurovascular system were evaluated. Results: Each variable was calculated as a percentile and compared according to the presence of the considered variation; in particular, a supernumerary head of the BBM was found in 12/103 (11.65%) of upper extremities and was associated with a longer upper limb (506.25 ± 32.55 mm vs. 484.27 ± 30.41 mm, p = 0.022). When the variables were standardized by the length of the upper limb, the accessory head of the BBM was associated with the distal insertion point of the CBM (28.18 ± 3.54% vs. 30.59 ± 2.94%, p = 0.011) and BBM length (55.11 ± 2.17% vs. 58.18 ± 3.72%, p = 0.006). Other variables did not present significant differences with respect to the presence of the supernumerary head of the BBM. Conclusions: BBM variations may affect the topography of other structures, such as the length of the upper extremities, insertion of the CBM, and length of the BBM. Further studies are required to elucidate its clinical implications. Full article

(This article belongs to the Section Surgery)

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Medicina, Volume 60, Issue 11 (November 2024) – 31 articles

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