Medicina

13 pages, 1681 KiB

Open AccessArticle

Evaluation of Maternal Ischemia-Modified Albumin Levels during Pregnancy and Their Effect on Fetal Birth Weight

by Uğur Çobanoğlu, Özer Birge, Mustafa Çetin and Emine Seda Güvendağ Güven

Medicina 2024, 60(9), 1530; https://doi.org/10.3390/medicina60091530 - 19 Sep 2024

Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women [...] Read more.

Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women ages 18 to 43. Routine pregnancy follow-up began at the first antenatal examination for all pregnant women before 14 weeks gestation, with IMA levels measured during the first, second, and third trimesters. The albumin cobalt binding test was used to determine the amount of ischemia-modified albumin (IMA). The patients’ medical, sociodemographic, and nutritional data were analyzed. The primary outcome was to investigate how changes in maternal ischemia affected albumin levels during pregnancy and the relationship between these changes and newborn weight. Results: This study included 43 cases with a mean age of 28.5 ± 5.2 years and a mean gestation period of 39.2 ± 1.3 weeks. The mean IMA levels for cases in the first trimester, second trimester, and third trimester were 0.53 ± 0.06, 0.64 ± 0.11, and 0.64 ± 0.06, respectively. The second and third trimesters showed significantly higher levels of ischemia-modified albumin (IMA) than the first trimester (p < 0.01). There was no statistically significant difference in IMA levels between the second and third trimesters (p = 1.000; p > 0.05). There was no statistically significant correlation between fetal birth and percentage changes in IMA measurements between the first and second trimesters, the first and third trimesters, or the second and third trimesters (p > 0.05). Conclusions: Our study determined that maternal ischemia-modified albumin levels during pregnancy did not correlate with fetal birth weight. Our findings revealed that age, sociodemographic changes, BMI, weight gain, and pregnancy complications had no effect on the change in IMA levels during pregnancy. We believe that this result will serve as a benchmark for future studies on IMA levels during pregnancy. Full article

(This article belongs to the Section Obstetrics and Gynecology)

► Show Figures

Figure 1

14 pages, 4006 KiB

Open AccessReview

Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species—A Meta-Analysis

by Chienhsiu Huang, Sufang Kuo and Lichen Lin

Medicina 2024, 60(9), 1529; https://doi.org/10.3390/medicina60091529 - 19 Sep 2024

Abstract

Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the [...] Read more.

Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the relatively low incidence of infections caused by Elizabethkingia spp. and the lack of published systematic evaluations of the risk factors for mortality. The aim of the present study was to investigate risk factors for mortality in patients with infections caused by Elizabethkingia spp. by conducting a meta-analysis of existing studies on these infections. Materials and Methods: Studies comparing patients who died from infections caused by Elizabethkingia spp. with patients who survived were considered for inclusion. Studies that reported one or more risk factors for mortality were considered. Clinical predisposing variables, predisposing comorbidities, and clinical outcomes of antibiotic treatment were among the risk factors for mortality. Results: The meta-analysis included twenty studies with 990 patients, and 298 patients (30.1%) died. The following risk factors for mortality were identified: intensive care unit admission, the need for mechanical ventilation, immunosuppressive or steroid therapy use, pneumonia, comorbid liver disease, and the use of inappropriate antimicrobial therapy. Conclusions: The use of appropriate antimicrobial therapy is critical for the effective management of infections caused by Elizabethkingia spp. Antimicrobial susceptibility testing would be a more reliable means of guiding treatment. The identification of the best antimicrobial drugs is needed to ensure optimal treatment recommendations for treating Elizabethkingia-related infections. Full article

(This article belongs to the Section Infectious Disease)

► Show Figures

Figure 1

16 pages, 1156 KiB

Open AccessArticle

Predominance of bla_NDM- and bla_IMP-Harboring Escherichia coli Belonging to Clonal Complexes 131 and 23 in a Major University Hospital

by Muhammad Shafiq, Iftikhar Ahmed, Muhammad Saeed, Abdul Malik, Sabiha Fatima, Suhail Akhtar, Mohsin Khurshid and Muhammad Zeeshan Hyder

Medicina 2024, 60(9), 1528; https://doi.org/10.3390/medicina60091528 - 19 Sep 2024

Abstract

Background and Objectives: Carbapenem resistance is a growing global challenge for healthcare, and, therefore, monitoring its prevalence and patterns is crucial for implementing targeted interventions to mitigate its impact on patient outcomes and public health. This study aimed to determine the prevalence [...] Read more.

Background and Objectives: Carbapenem resistance is a growing global challenge for healthcare, and, therefore, monitoring its prevalence and patterns is crucial for implementing targeted interventions to mitigate its impact on patient outcomes and public health. This study aimed to determine the prevalence of carbapenem resistance among Escherichia coli (E. coli) strains in the largest tertiary care hospital of the capital territory of Pakistan and to characterize the isolates for the presence of antimicrobial resistance genes. Additionally, the most prevalent sequence types were analyzed. Materials and Methods: A total of 15,467 clinical samples were collected from November 2020 to May 2022, underwent antimicrobial susceptibility testing, and were analyzed for antimicrobial resistance genes through conventional PCR and sequence typing using MLST. Results: In carbapenem-resistant E. coli (CR-EC), 74.19% of isolates harbored the bla_NDM gene, with bla_NDM-1 (66.96%), bla_NDM-5 (12.17%), and bla_NDM-7 (20.87%) variants detected. Additionally, bla_IMP was found in 25.81% and bla_OXA-48 in 35.48% of isolates. The presence of bla_CTX-M15 and bla_TEM was identified in 83.87% and 73.55% of CR-EC isolates, respectively, while armA and rmtB were detected in 40% and 65.16% of isolates, respectively. Colistin and tigecycline were the most effective drugs against CR-EC isolates, with both showing an MIC₅₀ of 0.5 µg/mL. The MIC₉₀ for colistin was 1 µg/mL, while for tigecycline, it was 2 µg/mL. MLST analysis revealed that the CR-EC isolates belonged to ST131 (24.52%), ST2279 (23.87%), ST3499 (16.13%), ST8051 (15.48%), ST8900 (9.68%), ST3329 (7.10%), ST88 (1.94%), and ST6293 (1.29%). The ST131 complex (70.97%) was the most prevalent, harboring 95.65% of the bla_NDM gene, while the ST23 complex (18.06%) harbored 62.50% of the bla_IMP gene. Conclusions: Implementing large-scale surveillance studies to monitor the spread of specific pathogens, along with active infection control policies, is crucial for the effective containment and prevention of future epidemics. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Antimicrobial Resistance)

► Show Figures

Figure 1

7 pages, 2312 KiB

Open AccessCase Report

The Impact of a Topical Oxygen-Releasing Gel (blue^®m) on Deep Periodontal Pockets: A Case Report

by Haya Alayadi, Arwa Talakey, Hajer Aldulaijan and Marwa Y. Shaheen

Medicina 2024, 60(9), 1527; https://doi.org/10.3390/medicina60091527 - 19 Sep 2024

Abstract

Periodontitis represents a prevalent oral pathological condition. Various supplementary local therapies are utilized in clinical practice. Recently introduced, topical oxygen therapy exhibits the potential to effectively hinder the growth of plaque (bacterial biofilm). Delivered in the form of an oral gel, this formulation [...] Read more.

Periodontitis represents a prevalent oral pathological condition. Various supplementary local therapies are utilized in clinical practice. Recently introduced, topical oxygen therapy exhibits the potential to effectively hinder the growth of plaque (bacterial biofilm). Delivered in the form of an oral gel, this formulation contains cellulose, glycerol, and sodium peroxoborate, releasing topical oxygen in a regulated manner. Additionally, it discharges topical oxygen and lactoferrin in a controlled manner, with the former showcasing antibacterial properties and the latter stimulating bone cell activity. The primary objective of this particular case study is to present a scenario of periodontitis featuring deep periodontal pockets, which was effectively managed through clinical treatment with the use of adjunctive topical oxygen-releasing gel (blue^®m). Full article

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

► Show Figures

Figure 1

10 pages, 4179 KiB

Open AccessHypothesis

Assessment of the Vertical Dimension of Occlusion Using Palm Width and Finger Length

by Cecilia Bacali, Mariana Constantiniuc, Antarinia Craciun and Daniela Popa

Medicina 2024, 60(9), 1526; https://doi.org/10.3390/medicina60091526 - 19 Sep 2024

Abstract

Background and Objectives: The vertical dimension of occlusion’s (VDO) assessment is a highly important issue in the everyday dentist’s practice. Patients with unstable occlusion, lost occlusal stops, extensive tooth loss in the lateral area, or complete edentulism need a proper assessment of [...] Read more.

Background and Objectives: The vertical dimension of occlusion’s (VDO) assessment is a highly important issue in the everyday dentist’s practice. Patients with unstable occlusion, lost occlusal stops, extensive tooth loss in the lateral area, or complete edentulism need a proper assessment of the VDO before the prosthetic restoration is carried out. Subjective and objective methods were used over time for the restoration of VDO. The study aimed to investigate the possible correlation between finger length, palm width and the vertical dimension of occlusion. Materials and Methods: Assessment of the VDO for 236 subjects, Romanian and French dental students, was performed using the Willis Bite Gauge. The left hand of the subjects was scanned using a flat-bed scanner, and then measurements of palm width and finger length were carried out for each subject. Comparison between VDO values and finger length/palm width was conducted using one-way ANOVA and Student t-Test. Results: Higher VDO average values were found in French subjects compared with Romanian students. The same results were found according to gender; in both female and male subjects, lower values of VDO were found in the Romanian group. Higher values were obtained for women within each group when comparing to men. Statistically significant correlations of the analyzed parameters and VDO values were found. Higher statistical correlations of the studied variables were found for men compared to women in both groups. The highest statistical correlation was obtained between the VDO and the palm width measured at the fingerbase, followed by the middle finger length. Conclusions: The results showed the highest statistical correlation between the vertical dimension of occlusion and the palm width measured at the fingers’ base. Statistical correlations were also found between the VDO and the middle finger length. Simple formulas using finger length/palm width can be used for a rapid VDO determination. Full article

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

► Show Figures

Figure 1

11 pages, 592 KiB

Open AccessArticle

Presence and Causes of Sterilization Equipment Failures with Biological Indicators in Dental Offices in Mexico: A Longitudinal Cohort

by Nuria Patiño-Marín, Lorena Dafnee Villa-García, Yolanda Terán-Figueroa, Carlo Eduardo Medina-Solis, Yesica Yolanda Rangel-Flores, Marco Felipe Salas-Orozco, Fidel Martínez-Gutiérrez and Eva Concepción Aguirre-López

Medicina 2024, 60(9), 1525; https://doi.org/10.3390/medicina60091525 - 19 Sep 2024

Abstract

Background/Objectives: Sterilization in dental practice is crucial for infection prevention. The aim of this study was to identify the presence and causes of bacterial growth using biological indicators in dental sterilization equipment in San Luis Potosí, S.L.P., Mexico, with different consecutive measurements [...] Read more.

Background/Objectives: Sterilization in dental practice is crucial for infection prevention. The aim of this study was to identify the presence and causes of bacterial growth using biological indicators in dental sterilization equipment in San Luis Potosí, S.L.P., Mexico, with different consecutive measurements over a year. Methods: This longitudinal cohort, conducted from January 2022 to January 2024 in San Luis Potosí, Mexico, aimed to identify the presence and causes of bacterial growth in dental sterilization equipment using biological indicators. A total of 207 dental offices were approached, and 175 participated, providing data through questionnaires and monitoring sterilization cycles with BIs. The checks were bimonthly for one year, with a total of six checks. Results: (a) An 11% (n = 1188) incidence of bacterial growth was observed, with a higher percentage in dry heat equipment (13%). (b) Upon analyzing the six consecutive verifications over a year, no statistically significant differences were observed in the failures of the sterilization cycles when comparing the two pieces of equipment. (c) Error in temperature and time of the equipment (OR = 4.0, 95% CI = 1.6–3.9, p = 0.0001) was significantly associated with the presence of bacterial growth during the one-year period. Conclusions: Monitoring sterilization cycles and identifying the causes of bacterial growth with different consecutive verifications decreased the presence of bacterial growth (failures) during the one-year period. Full article

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

► Show Figures

Figure 1

13 pages, 10350 KiB

Open AccessArticle

Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures

by Christopher Bliemel, Jakob Cornelius, Valerie Lehmann, Ludwig Oberkircher, Denis Visser, Bastian Pass, Steffen Ruchholtz and Martin Bäumlein

Medicina 2024, 60(9), 1524; https://doi.org/10.3390/medicina60091524 - 19 Sep 2024

Abstract

Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the [...] Read more.

Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57–91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629–3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257–2834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel. Full article

(This article belongs to the Special Issue New Strategies in the Management of Geriatric Bone Fracture)

► Show Figures

Figure 1

17 pages, 1161 KiB

Open AccessArticle

Characterizing Human Peripheral Blood Lymphocyte Phenotypes and Their Correlations with Body Composition in Normal-Weight, Overweight, and Obese Healthy Young Adults

by Irina-Bianca Kosovski, Cristina Nicoleta Ciurea, Dana Ghiga, Naomi-Adina Ciurea, Adina Huțanu, Florina Ioana Gliga and Anca Bacârea

Medicina 2024, 60(9), 1523; https://doi.org/10.3390/medicina60091523 - 18 Sep 2024

Abstract

Background and Objectives: Obesity-associated chronic low-grade inflammation supports various systemic alterations. In this descriptive study, 122 apparently healthy adults aged 20 to 35 years were voluntarily included and classified based on body mass index (BMI) as normal-weight (NW), overweight (OW), and obese (OB). [...] Read more.

Background and Objectives: Obesity-associated chronic low-grade inflammation supports various systemic alterations. In this descriptive study, 122 apparently healthy adults aged 20 to 35 years were voluntarily included and classified based on body mass index (BMI) as normal-weight (NW), overweight (OW), and obese (OB). This study aims to characterize peripheral blood (PB) lymphocyte (Ly) phenotypes and investigate their correlations with body composition indices (BCIs) in healthy young adults. Materials and Methods: The following BCIs were measured: waist circumference, hip circumference, height, waist-to-hip ratio, waist-to-height ratio, total body fat mass, visceral fat level, weight, and BMI. White blood cell count (WBC), Ly absolute count, serum TNF-α, and IFN-γ were quantified. Ly subpopulations were analyzed as follows: total TLy (TTLy—CD45⁺CD3⁺), early activated TLy (EATLy—CD45⁺3⁺69⁺), total NKLy (TNKLy—CD45⁺CD3⁻CD56⁺CD16⁺), NK^dim (low expression of CD56⁺), NK^bright (high expression of CD56⁺), BLy (CD45⁺CD3⁻CD19⁺), T helper Ly (ThLy—CD45⁺CD3⁺CD4⁺), and T cytotoxic Ly (TcLy—CD45⁺CD3⁺CD8⁺). Results: Higher BMI has significantly higher WBC and BLy (p < 0.0001; p = 0.0085). EATLy significantly decreased from NW to OB (3.10—NW, 1.10—OW, 0.85—OB, p < 0.0001). Only EATLy exhibited significant negative correlations with all the BCIs. A significantly higher TNF-α was observed in the OW and OB groups compared to the NW group. IFN-γ increased linearly but nonsignificantly with BMI. TTLy showed a nonsignificant positive correlation with both IFN-γ and TNF-α, while EATLy showed a negative correlation, significant only for IFN-γ. NKLy subpopulations exhibited a consistent negative correlation with TNF-α, significant only for NK^dim (p = 0.0423), and a nonsignificant consistent positive correlation with IFN-γ. A nonsignificant negative correlation between age and both TNKLy (r = −0.0927) and NK^dim (r = −0.0893) cells was found, while a positive correlation was found with NK^bright (r = 0.0583). Conclusions: In conclusion, the baseline immunological profile of PB is influenced by excessive adipose tissue in healthy young adults. Full article

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

► Show Figures

Graphical abstract

13 pages, 2220 KiB

Open AccessArticle

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients

by Kang Hee Kim, Jaehoon Chung, Suyoung Jang, Byong-Kyu Kim, Masanori Munakata and Moo-Yong Rhee

Medicina 2024, 60(9), 1522; https://doi.org/10.3390/medicina60091522 - 18 Sep 2024

Abstract

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 [...] Read more.

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH. Full article

(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)

► Show Figures

Figure 1

13 pages, 350 KiB

Open AccessArticle

The LUSBI Protocol (Lung Ultrasound/BREST Score/Inferior Vena Cava)—Its Role in a Differential Diagnostic Approach to Dyspnea of Cardiogenic and Non-Cardiogenic Origin

by Boris Dojcinovic, Nada Banjac, Sasa Vukmirovic, Tamara Dojcinovic, Lucija V. Vasovic, Dalibor Mihajlovic and Velibor Vasovic

Medicina 2024, 60(9), 1521; https://doi.org/10.3390/medicina60091521 - 18 Sep 2024

Abstract

Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound [...] Read more.

Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound measurements of the inferior vena cava (assessment of central venous pressure) and BREST scores (risk stratification for heart failure), with the aim of establishing a more effective differential diagnostic approach for dyspneic patients. Materials and Methods: A cross-sectional study was conducted in the emergency medicine department with the educational center of the community health center of Banja Luka. Eighty patients of both sexes were included and divided into experimental and control groups based on the presence or absence of dyspnea as a dominant subjective complaint. Based on the abovementioned variables, the LUSBI protocol (lung ultrasound/BREST score/inferior vena cava) was created, including profiles to determine the nature of the origin of complaints. The biochemical marker of heart failure NT pro-BNP served as a laboratory confirmation of the cardiac origin of the complaints. Results: The distribution of NT pro BNP values in the experimental group showed statistically significant differences between individual profiles of the LUSBI protocol (p < 0.001). Patients assigned to group B PLAPS 2 had significantly higher average values of NT pro-BNP (20159.00 ± 3114.02 pg/mL) compared to other LUSBI profiles. Patients from the experimental group who had a high risk of heart failure according to their BREST scores also had a significantly higher average maximum expiratory diameter compared to those without heart failure (p = 0.004). A statistically significant difference (p = 0.001) in LUSBI profiles was observed between the groups of patients divided according to CVP categories. Conclusion: The integration of the LUSBI protocol into the differential diagnosis of dyspnea has been shown to be very effective in confirming or excluding a cardiac cause of the disease in patients. Full article

(This article belongs to the Section Emergency Medicine)

12 pages, 1973 KiB

Open AccessArticle

Intravital Position Study of the Clinical Anatomy of the Middle Lobe and Superior Poles of the Thyroid Gland

by Vladislav V. Tatarkin, Andrey I. Shchegolev, Aleksandr M. Bakunov, Yuriy L. Vasil’ev, Mikhail D. Chernyshev, Evgeniy A. Serebryakov, Ksenia L. Kaplieva, Egor O. Stetsik, Tahmina Pulotova, Ellina V. Velichko and Evgeniy M. Trunin

Medicina 2024, 60(9), 1520; https://doi.org/10.3390/medicina60091520 - 18 Sep 2024

Abstract

Background and Objectives: This study analyzes the issues of position dislocation of the head of the superior poles and lateral points of the outer edge of the middle divisions of each of the thyroid lobes (TL) changes. The purpose was to provide [...] Read more.

Background and Objectives: This study analyzes the issues of position dislocation of the head of the superior poles and lateral points of the outer edge of the middle divisions of each of the thyroid lobes (TL) changes. The purpose was to provide an intravital position study of the clinical anatomy of the middle and superior poles of the thyroid gland (TG). Materials and Methods: We used data on anthropometry obtained during the study and data from MRI of the neck organs and anatomical formations of 100 healthy individuals, comprising 55 (55%) female and 45 (45%) male participants. To evaluate the data obtained in the examined group, the minimum probability value was 0.95 (95% confidence interval or p < 0.05). Results: Maximum flexion of the neck the distance from the center of the jugular notch to the lateral points of the outer edge of the middle parts of the TL decreases in all groups of but mostly in male ectomorphs; the same distance to the superior poles of the TG changes most in ectomorphic males on the right by 38.9% (p value < 0.001) and mesomorphic females on the left by 37.8% (p value < 0.001); in rotation to the left, the maximum was found in male ectomorphs, which decreased by 9.5% on the left (p value < 0.001) and by 7.3% on the right (p value < 0.001). Conclusions: this study provided new information about the intravital anatomy of the TG position, of the superior poles, and the lateral points of the middle part of its lobes. Full article

(This article belongs to the Special Issue Developments and Innovations in Head and Neck Surgery)

► Show Figures

Figure 1

16 pages, 284 KiB

Open AccessArticle

Self-Reported Gastrointestinal Symptoms Associated with NSAIDs and Caffeine Consumption in a Jordanian Subpopulation

by Sofian Al Shboul, Omar Maloul, Hamza Al-Trad, Yazan Maloul, Wa’ed AlHarahsheh, Doa’a Mosallam, Sondos Al-Sarayreh, Rania AlRashaydah, Aya AlSarayreh, Ashraf I. Khasawneh and Tareq Saleh

Medicina 2024, 60(9), 1519; https://doi.org/10.3390/medicina60091519 - 18 Sep 2024

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) and caffeine-containing beverages are widely consumed but their impact on gastrointestinal (GI) health requires further investigation. This cross-sectional study investigated the relationship between NSAIDs use, caffeinated drink consumption, and the prevalence of self-reported GI symptoms in a Jordanian [...] Read more.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) and caffeine-containing beverages are widely consumed but their impact on gastrointestinal (GI) health requires further investigation. This cross-sectional study investigated the relationship between NSAIDs use, caffeinated drink consumption, and the prevalence of self-reported GI symptoms in a Jordanian subpopulation. Methods: An online survey was administered to 400 Jordanian individuals aged 18–65 years. Data on sociodemographics, NSAIDs use, caffeine consumption, peptic ulcer disease (PUD) history, and GI symptoms were collected. Contingency tables were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between exposures and outcomes. Results: The prevalence of self-reported PUD-related GI symptoms was 6.0%. NSAID users had higher odds of PUD (OR = 2.431) and related GI symptoms, including abdominal pain (OR = 4.688, p < 0.001) and discomfort (OR = 8.068, p < 0.001). Caffeine consumption was associated with self-reported burning stomach pain (OR = 14.104, p < 0.001), fullness (OR = 8.304, p = 0.010), and bloating (OR = 8.304, p = 0.010). Coffee, tea, soft drinks, and energy drinks were associated with increased odds of various GI symptoms (ORs 2.018-12.715, p < 0.05). Conclusions: NSAIDs use and caffeine consumption were independently associated with the increased prevalence of self-reported PUD and related GI symptoms. Despite the lack of adjustment for necessary confounders, our findings highlight the importance of considering the potential GI effects of NSAIDs and caffeine. Public health strategies promoting their safe use may help reduce the burden of GI disorders. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

10 pages, 1011 KiB

Open AccessArticle

An Analysis of Emergency Surgical Outcomes for Pediatric Traumatic Brain Injury: A Ten-Year Single-Institute Retrospective Study in Taiwan

by Cheng-Yu Tsai, Keng-Liang Kuo, Chieh-Hsin Wu, Tai-Hsin Tsai, Hui-Yuan Su, Chih-Lung Lin, Ann-Shung Lieu, Aij-Lie Kwan, Yu-Feng Su and Joon-Khim Loh

Medicina 2024, 60(9), 1518; https://doi.org/10.3390/medicina60091518 - 18 Sep 2024

Abstract

Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to [...] Read more.

Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to offer a real-world clinical result. Materials and Methods: Our institute presented a clinical retrospective, single-institute research study of 150 pediatric TBI cases that were diagnosed and underwent emergency surgical treatment from 2010 to 2019. Results: The incidence of radiological findings is detailed as follows: brain edema (30%, 45/150), followed by acute subdural hematoma (27.3%, 41/150), epidural hematoma (21.3%, 32/150), chronic subdural hemorrhage (10%, 15/150), skull fracture (6.7%, 10/150), and traumatic subarachnoid hemorrhage (4.7%, 7/150). Surgical intervention data revealed that decompressive craniectomy was still the main effective surgical method. The results showed longer hospital stays and higher morbidity rates in the brain edema, acute subdural hematoma, and chronic subdural hemorrhage groups, which were viewed as poor surgical outcome groups. Epidural hematoma, skull fracture and traumatic subarachnoid hemorrhage were categorized into good surgical outcome groups. Notably, the data revealed gross improvement in Glasgow Coma Scale/Score (GCS) evolution after surgical interventions, and the time to cranioplasty was a significant factor in the development of post-traumatic hydrocephalus (PTH). Conclusions: Our study provided real-world data for the distribution of etiology in pTBI and also categorized it into six groups, indicating disease-orientated treatment. In addition, our data supported that decompressive craniectomy (DC) remains a mainstay surgical treatment in pTBI and early cranioplasty could decrease the incidence of PTH. Full article

(This article belongs to the Special Issue Traumatic Brain Injury and Neurointensive Care in Intensive Care)

► Show Figures

Figure 1

19 pages, 406 KiB

Open AccessReview

Transplacental Transmission of SARS-CoV-2: A Narrative Review

by Minh Tien Bui, Cam Anh Nguyen Le, Khanh Linh Duong, Van Thuan Hoang and Trung Kien Nguyen

Medicina 2024, 60(9), 1517; https://doi.org/10.3390/medicina60091517 - 18 Sep 2024

Abstract

Background and Objectives: The study aims to explore the potential for transplacental transmission of SARS-CoV-2, focusing on its pathophysiology, placental defense mechanisms, and the clinical implications for maternal and neonatal health. Materials and Methods: A comprehensive review of the current literature was conducted, [...] Read more.

Background and Objectives: The study aims to explore the potential for transplacental transmission of SARS-CoV-2, focusing on its pathophysiology, placental defense mechanisms, and the clinical implications for maternal and neonatal health. Materials and Methods: A comprehensive review of the current literature was conducted, analyzing studies on SARS-CoV-2 infection in pregnancy, the expression of key viral receptors (ACE2 and TMPRSS2) in placental cells, and the immune responses involved in placental defense. The review also examined the clinical outcomes related to maternal and neonatal health, including adverse pregnancy outcomes and neonatal infection. Results: The expression of ACE2 and TMPRSS2 in the placenta supports the biological plausibility of SARS-CoV-2 transplacental transmission. Histopathological findings from the infected placentas reveal inflammation, vascular changes, and the evidence of viral particles in placental tissues. Clinical reports indicate an increased risk of preterm birth, intrauterine growth restriction, and neonatal infection in pregnancies affected by COVID-19. However, the frequency and mechanisms of vertical transmission remain variable across studies, highlighting the need for standardized research protocols. Conclusions: SARS-CoV-2 can potentially infect placental cells, leading to adverse pregnancy outcomes and neonatal infection. While evidence of transplacental transmission has been documented, the risk and mechanisms are not fully understood. Ongoing research is essential to clarify these aspects and inform obstetric care practices to improve maternal and neonatal outcomes during the COVID-19 pandemic. Full article

(This article belongs to the Section Obstetrics and Gynecology)

10 pages, 935 KiB

Open AccessArticle

Evaluation of Left Atrial Electromechanical Delay and Left Atrial Phasic Functions in Patients Undergoing Treatment with Cardiotoxic Chemotherapeutic Agents

by Ömer Kertmen and Murat Akcay

Medicina 2024, 60(9), 1516; https://doi.org/10.3390/medicina60091516 - 18 Sep 2024

Abstract

Background: The aim of this study is to evaluate atrial involvement by comparing pre- and post-chemotherapy left atrial mechanical and electromechanical parameters in patients treated with cardiotoxic chemotherapeutic agents. Methods: We designed our study as a prospective cohort study. Sixty-eight female patients between [...] Read more.

Background: The aim of this study is to evaluate atrial involvement by comparing pre- and post-chemotherapy left atrial mechanical and electromechanical parameters in patients treated with cardiotoxic chemotherapeutic agents. Methods: We designed our study as a prospective cohort study. Sixty-eight female patients between the ages of 18 and 50, scheduled for treatment with cardiotoxic chemotherapeutic agents, were included in our study. Atrial mechanical functions and electromechanical parameters were examined and compared with basic echocardiographic parameters before and after chemotherapy. Results: The mean age of the patients was 41.6 ± 7.9 years. After chemotherapy, lateral PA, septal PA, and tricuspid PA durations showed a significant increase (p < 0.001), but there were no statistically significant changes in the left intra-atrial electromechanical delay, the right intra-atrial electromechanical delay, or the interatrial electromechanical delay values. Following treatment, LAVmax, LAVmin, and LApreA significantly increased (p < 0.001). Additionally, the left atrial passive and active emptying volumes increased (p < 0.001), while the reservoir and pump (active emptying) functions decreased (with p-values of 0.03 and 0.01, respectively). The passive emptying function, however, showed no significant change (p = 0.65). Decreases in LVEF were observed, while LVEDD, LVESD, IVS, PW, and LA diameters increased (p-value of 0.02 for IVS and <0.001 for the others). Conclusions: Significant impairment of atrial mechanical functions and electromechanical parameters was observed after treatment with cardiotoxic chemotherapeutic agents. This suggests an elevated likelihood of atrial arrhythmia linked to the use of cardiotoxic chemotherapeutic agents. Full article

(This article belongs to the Special Issue Innovations in the Field of Cardio-Oncology)

► Show Figures

Figure 1

20 pages, 1518 KiB

Open AccessReview

Insights into the Two Most Common Cancers of Primitive Gut-Derived Structures and Their Microbial Connections

by Amitabha Ray, Thomas F. Moore, Dayalu S. L. Naik and Daniel M. Borsch

Medicina 2024, 60(9), 1515; https://doi.org/10.3390/medicina60091515 - 18 Sep 2024

Abstract

The gastrointestinal and respiratory systems are closely linked in different ways, including from the embryological, anatomical, cellular, and physiological angles. The highest number (and various types) of microorganisms live in the large intestine/colon, and constitute the normal microbiota in healthy people. Adverse alterations [...] Read more.

The gastrointestinal and respiratory systems are closely linked in different ways, including from the embryological, anatomical, cellular, and physiological angles. The highest number (and various types) of microorganisms live in the large intestine/colon, and constitute the normal microbiota in healthy people. Adverse alterations of the microbiota or dysbiosis can lead to chronic inflammation. If this detrimental condition persists, a sequence of pathological events can occur, such as inflammatory bowel disease, dysplasia or premalignant changes, and finally, cancer. One of the most commonly identified bacteria in both inflammatory bowel disease and colon cancer is Escherichia coli. On the other hand, patients with inflammatory bowel disease are at risk of several other diseases—both intestinal (such as malnutrition and intestinal obstruction, besides cancer) and extraintestinal (such as arthritis, bronchiectasis, and cancer risk). Cancers of the lung and colon are the two most common malignancies occurring worldwide (except for female breast cancer). Like the bacterial role in colon cancer, many studies have shown a link between chronic Chlamydia pneumoniae infection and lung cancer. However, in colon cancer, genotoxic colibactin-producing E. coli belonging to the B2 phylogroup may promote tumorigenesis. Furthermore, E. coli is believed to play an important role in the dissemination of cancer cells from the primary colonic site. Currently, seven enteric pathogenic E. coli subtypes have been described. Conversely, three Chlamydiae can cause infections in humans (C. trachomatis may increase the risk of cervical and ovarian cancers). Nonetheless, striking genomic plasticity and genetic modifications allow E. coli to constantly adjust to the surrounding environment. Consequently, E. coli becomes resistant to antibiotics and difficult to manage. To solve this problem, scientists are thinking of utilizing suitable lytic bacteriophages (viruses that infect and kill bacteria). Several bacteriophages of E. coli and Chlamydia species are being evaluated for this purpose. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

8 pages, 443 KiB

Open AccessArticle

Increased Dose in Spine Stereotactic Radiosurgery for Metastatic Disease: Are We Underestimating the Risks?

by Gil Kimchi, Maya Nulman, Saeda Haj, Idan Bar-Orian, Ory Haisraely and Ran Harel

Medicina 2024, 60(9), 1514; https://doi.org/10.3390/medicina60091514 - 17 Sep 2024

Abstract

Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess [...] Read more.

Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess the necessity and validity of these higher dose recommendations by evaluating the outcomes and experiences with lower radiation doses. Materials and Methods: A retrospective evaluation of SSRS patients treated at a single institute was conducted. The outcomes and complications of this cohort were compared to the current literature and the data supporting the new ESTRO guidelines. Results: A total of 149 treatment sessions involving 242 spinal levels were evaluated. The overall local control rate was 91.2%. The mean radiation dose for the local control group compared to the local failure group was similar (17.5 vs. 17.6 Gy, not significant). The overall complication rate was 6%. These results are consistent with previous publications evaluating SSRS for metastatic spinal disease. Conclusions: SSRS dose escalation may increase local control efficacy but comes with a higher risk of complications. The evidence supporting the strong recommendations in the recent ESTRO guidelines is not robust enough to justify a universal application. Given the palliative nature of treatment for metastatic patients, dose determination should be individualized based on patient conditions and preferences, with a detailed discussion about the risk–benefit ratio of increased doses and the level of evidence supporting these recommendations. Full article

(This article belongs to the Special Issue Spinal Tumors)

► Show Figures

Figure 1

9 pages, 8367 KiB

Open AccessCase Report

Diagnostic Challenges in Follicular Cholangitis Mimicking Hilar Cholangiocarcinoma: A Case Report and Review of the Literature

by Jungnam Lee, Seok Jeong, Don Haeng Lee, Suk Jin Choi and Woo Young Shin

Medicina 2024, 60(9), 1513; https://doi.org/10.3390/medicina60091513 - 17 Sep 2024

Abstract

Introduction: Distinguishing benign from malignant biliary strictures remains challenging despite diagnostic advancements. Follicular cholangitis, a rare benign condition, presents with symptoms and imaging similar to malignancies like cholangiocarcinoma, often complicating diagnosis, particularly when tumor markers are elevated and imaging suggests metastasis. Case [...] Read more.

Introduction: Distinguishing benign from malignant biliary strictures remains challenging despite diagnostic advancements. Follicular cholangitis, a rare benign condition, presents with symptoms and imaging similar to malignancies like cholangiocarcinoma, often complicating diagnosis, particularly when tumor markers are elevated and imaging suggests metastasis. Case presentation: A 57-year-old woman with hypertension and diabetes was admitted with jaundice. Elevated bilirubin and liver enzymes alongside high carbohydrate antigen 19-9 (CA19-9) levels but normal carcinoembryonic antigen (CEA) were noted. Imaging showed thickening from the hilar duct to the proximal common bile duct, accompanied by suspected lymph node metastases. Comprehensive ERCP-guided biopsies found no malignancy. Surgical resection led to a diagnosis of follicular cholangitis. Conclusions: Follicular cholangitis’ long-term prognosis is elusive due to its rarity, and preoperative diagnosis is challenging. Increased awareness may improve diagnostic and treatment approaches, as this case adds to the disease’s understanding. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

► Show Figures

Figure 1

17 pages, 1698 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease

by Sevigean Ali, Mihaela Botnarciuc, Iulia-Andreea Badea, Andreea Alexandru, Liliana-Ana Tuta, Lavinia Carmen Daba, Leonard Gurgas and Sergiu Ioachim Chirila

Medicina 2024, 60(9), 1512; https://doi.org/10.3390/medicina60091512 - 17 Sep 2024

Abstract

Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased [...] Read more.

Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients’ access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019–2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190–2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020–2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics. Full article

(This article belongs to the Section Urology & Nephrology)

► Show Figures

Figure 1

Journal Description

Medicina

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI