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Medicina, Volume 54, Issue 6 (December 2018)

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Cover Story (view full-size image) Considering the increasing prevalence of chronic diseases during childhood and adolescence, [...] Read more.
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Open AccessReview A Meta-Analysis on Randomised Controlled Clinical Trials Evaluating the Effect of the Dietary Supplement Chitosan on Weight Loss, Lipid Parameters and Blood Pressure
Medicina 2018, 54(6), 109; https://doi.org/10.3390/medicina54060109
Received: 12 November 2018 / Revised: 6 December 2018 / Accepted: 10 December 2018 / Published: 12 December 2018
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Abstract
Background and objectives: Erratic results have been published concerning the influence of the dietary supplement chitosan used as a complementary remedy to decrease the body weight of overweight and obese people. The published articles mention as secondary possible benefits of usage of
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Background and objectives: Erratic results have been published concerning the influence of the dietary supplement chitosan used as a complementary remedy to decrease the body weight of overweight and obese people. The published articles mention as secondary possible benefits of usage of chitosan the improvement of blood pressure and serum lipids status. We performed a meta-analysis evaluating body weight, body mass index, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure among overweight and obese patients. Materials and Methods: Searching MEDLINE, Cochrane up to December 2017 on clinical trials that have assessed the influence of chitosan used as a dietary supplement on overweight and obese patients. An additional study was identified in the References section of another meta-analysis. A total of 14 randomised control trials (RCT) were used to assess the effect on body weight, serum lipids and blood pressure. Results: The usage of chitosan as a dietary supplement up to 52 weeks seems to slightly reduce the body weight (−1.01 kg, 95% CI: −1.67 to −0.34). Considering the other parameters studied, the most significant improvement was observed in systolic and diastolic blood pressure: −2.68 mm Hg (95% CI: −4.19 to −1.18) and −2.14 mm Hg (95% CI: −4.14 to −0.14) in favour of chitosan versus a placebo. Conclusions: Based on the meta-analysis realized with 14 RCT we concluded that the usage of chitosan as a dietary supplement can lead to a slight short- and medium-term effect on weight loss and to the improvement of serum lipid profile and cardiovascular factors. Full article
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Open AccessReview The Role of Occupational and Environmental Exposures in the Pathogenesis of Idiopathic Pulmonary Fibrosis: A Narrative Literature Review
Medicina 2018, 54(6), 108; https://doi.org/10.3390/medicina54060108
Received: 19 November 2018 / Accepted: 5 December 2018 / Published: 10 December 2018
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by a progressive and irreversible decline in lung function, which is associated with poor long-term survival. The pathogenesis of IPF is incompletely understood. An accumulating body of evidence, obtained over the past
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Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by a progressive and irreversible decline in lung function, which is associated with poor long-term survival. The pathogenesis of IPF is incompletely understood. An accumulating body of evidence, obtained over the past three decades, suggests that occupational and environmental exposures may play a role in the development of IPF. This narrative literature review aims to summarise current understanding and the areas of ongoing research into the role of occupational and environmental exposures in the pathogenesis of IPF. Full article
(This article belongs to the Special Issue Idiopathic Pulmonary Fibrosis Research)
Open AccessArticle Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck
Medicina 2018, 54(6), 107; https://doi.org/10.3390/medicina54060107
Received: 5 October 2018 / Revised: 23 November 2018 / Accepted: 29 November 2018 / Published: 10 December 2018
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Abstract
Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT
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Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60–70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax ≥ 74% (p = 0.04), MTV ≥ 68% (p = 0.03), TLG ≥ 76% (p = 0.03) in primary tumor, and LN TLG decrease ≥ 74% (p = 0.03) were associated with PFS. Decrease of primary tumor SUVmax ≥ 74% (p = 0.04), MTV ≥ 69% (p = 0.03), TLG ≥ 74% (p = 0.02) and LN TLG ≥ 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, 18F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUVmax, MTV and TLG has a prognostic value in LA-SCCHN. Full article
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Open AccessReview Parietaria Allergy: An Intriguing Challenge for the Allergist
Medicina 2018, 54(6), 106; https://doi.org/10.3390/medicina54060106
Received: 18 October 2018 / Revised: 5 December 2018 / Accepted: 5 December 2018 / Published: 7 December 2018
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Abstract
Parietaria pollen is the most important cause of pollen allergies in the Mediterranean area, as Parietaria is widespread in this region. Many issues are associated with Parietaria allergy, including the duration of the pollen season (many doctors in fact believe that it lasts
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Parietaria pollen is the most important cause of pollen allergies in the Mediterranean area, as Parietaria is widespread in this region. Many issues are associated with Parietaria allergy, including the duration of the pollen season (many doctors in fact believe that it lasts throughout the year), pollen load (which seems to be increasing over time), the impact of age (on IgE production and symptom severity), inflammatory changes (after pollen exposure), and the choice of allergen immunotherapy (AIT). In addition, molecular diagnostics allows for the defining of a correct diagnosis, differentiating between mere sensitization and true allergy. This review considers these topics and will hopefully help the allergist in clinical practice. Parietaria allergy is an intriguing challenge for the allergist in clinical practice, but it may be adequately managed by knowing the peculiarities of respective territories and the clinical characteristics of each patient. Full article
(This article belongs to the Special Issue Pollen Allergies)
Open AccessArticle Effects of Maternal Decisional Authority and Media Use on Vaccination for Children in Asian Countries
Medicina 2018, 54(6), 105; https://doi.org/10.3390/medicina54060105
Received: 18 October 2018 / Revised: 30 November 2018 / Accepted: 3 December 2018 / Published: 7 December 2018
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Abstract
Background and objectives: It is now accepted that vaccination is a critical public health strategy in preventing child morbidity and mortality. Understanding factors that promote vaccination is a critical first step. The objective of this study was to investigated associations of maternal decisional
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Background and objectives: It is now accepted that vaccination is a critical public health strategy in preventing child morbidity and mortality. Understanding factors that promote vaccination is a critical first step. The objective of this study was to investigated associations of maternal decisional authority and media use on vaccination for children in six South and Southeast Asian countries. Materials and Methods: Data come from demographic and health surveys conducted in Bangladesh, Cambodia, Indonesia, Nepal, Pakistan, and the Philippines between 2011 and 2014 (N = 45,168 women). Main outcome variables were four types of basic vaccination for children. Independent variables were maternal decisional authority and media use. Hierarchical multivariable regression analyses were performed to examine associations. Results: Children of mothers who had more decisional authority were more likely to be vaccinated compared to those participants who did not have such authority. The likelihood to have their children vaccinated was higher among women who frequently used media than those who did not use media. Conclusions: Maternal decisional authority and media use are related to improved vaccination for children. To increase vaccination rates in developing countries in South and Southeast Asia, programs and policies that promote maternal decisional authority and the use of media for health need to be implemented to help families and local communities. Full article
(This article belongs to the Special Issue Promoting Vaccine Acceptance)
Open AccessArticle Comparison of the Body Composition of Caucasian Young Normal Body Mass Women, Measured in the Follicular Phase, Depending on the Carbohydrate Diet Level
Medicina 2018, 54(6), 104; https://doi.org/10.3390/medicina54060104
Received: 28 September 2018 / Revised: 14 November 2018 / Accepted: 2 December 2018 / Published: 5 December 2018
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Background and objectives: Some publications indicate the possibility of the influence of meal nutritional value on results of bioelectrical impedance, and of the relation between the long-term carbohydrate intake and body composition. The aim of the presented study was to evaluate the
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Background and objectives: Some publications indicate the possibility of the influence of meal nutritional value on results of bioelectrical impedance, and of the relation between the long-term carbohydrate intake and body composition. The aim of the presented study was to evaluate the influence of long-term intake of carbohydrates on body composition results assessed using the bioelectrical impedance of Caucasian young women with normal body mass, who were in the follicular phase of their menstrual cycle. Materials and Methods: Body composition was assessed in 100 women (18–30 years), according to strict rules, to minimize the influence of disturbing factors and by using two types of bioelectrical impedance device of the same operator to eliminate the influence of measurement (BIA 101/SC and BIA 101/ASE by Akern Srl, Firenze, Italy with the Bodygram 1.31 software and its equations by Akern Srl, Firenze, Italy). The analysis included validation of reproducibility of body composition assessment (fat, fat-free, body cell and muscle mass, water, extracellular water, and intracellular water content), and comparison of body composition for groups characterized by carbohydrate content <50% (n = 55) and >50% of the energy value of the diet (n = 45). Results: Analysis conducted using Bland–Altman method, analysis of correlation, analysis of quartile distribution, and weighted κ statistic revealed a positively validated reproducibility, but extracellular water associations were the weakest. Depending on the device, participants characterized by higher carbohydrate intake had significantly higher intracellular water content (p = 0.0448), or close to significantly higher (p = 0.0851) than those characterized by lower carbohydrate intake, whose extracellular water content was close to significantly lower (p = 0.0638) or did not differ. Conclusions: The long-term, moderately reduced, carbohydrate intake may cause the shift of intracellular water to the extracellular space and, as a result, influence the body composition results. Full article
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Open AccessArticle Reliability and Validity of the Lithuanian Version of CASP-19: A Quality of Life Questionnaire for the Elderly
Medicina 2018, 54(6), 103; https://doi.org/10.3390/medicina54060103
Received: 5 October 2018 / Revised: 21 November 2018 / Accepted: 27 November 2018 / Published: 5 December 2018
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Abstract
Introduction: Ageing is associated with several physical, psychological, and behavioral changes. These changes are closely related with general health problems and quality of life in old age. The CASP-19 multidimensional instrument was specially designed to measure quality of life in the elderly. The
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Introduction: Ageing is associated with several physical, psychological, and behavioral changes. These changes are closely related with general health problems and quality of life in old age. The CASP-19 multidimensional instrument was specially designed to measure quality of life in the elderly. The different language versions of this scale have been used in more than 20 countries. However, Lithuanian translation was not available. The objective of our study was to test psychometric properties of the Lithuanian version of the CASP-19 questionnaire. Materials and methods: A cross-sectional study was performed with ambulatory men and women aged 60 and older, living in a community in Vilnius, Lithuania. Exclusion criteria were current acute illness, malignant tumor, and Mini-Mental State Examination (MMSE) score < 25 points. Psychometric properties of CASP-19 were tested using reliability and validity methods. Results: The study sample consisted of 132 participants, 28 (21.8%) of them were men and 103 (78.2%) women. Analysis of psychometric properties of the Lithuanian version of CASP-19 showed high internal consistency (Cronbach’s alpha 0.85), good agreement between test-retest measures with an ICC of 0.82 (95% CI 0.79–0.85) and good convergent and divergent construct validity. Conclusions: The psychometric properties indicated that the Lithuanian version of CASP-19 was reliable and valid. As such, it might be used to evaluate quality of life in elderly people. Full article
Open AccessArticle Pre-Practice Hydration Status in Soccer (Football) Players in a Cool Environment
Medicina 2018, 54(6), 102; https://doi.org/10.3390/medicina54060102
Received: 5 October 2018 / Revised: 27 November 2018 / Accepted: 3 December 2018 / Published: 5 December 2018
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Abstract
Background and Objectives: Only a few studies have reported the pre-practice hydration status in soccer players (SPs) who train in a cool climate. The primary purpose of this study was to examine the hydration status of male semiprofessional SPs immediately before their regular
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Background and Objectives: Only a few studies have reported the pre-practice hydration status in soccer players (SPs) who train in a cool climate. The primary purpose of this study was to examine the hydration status of male semiprofessional SPs immediately before their regular training session in winter. The secondary purpose was to compare the urinary indices of the hydration status of Estonian and Latvian SPs. Materials and Methods: Pre-training urine samples were collected from 40 Estonian (age 22.1 ± 3.4 years, soccer training experience 13.7 ± 3.9 years) and 41 Latvian (age 20.8 ± 3.4 years, soccer training experience 13.3 ± 3.0 years) SPs and analyzed for urine specific gravity (USG). The average outdoor temperature during the sample collection period (January–March) was between −5.1 °C and 0.2 °C (Estonia) and −1.9 °C and −5.0 °C (Latvia). Results: The average pre-training USG of Estonian and Latvian SPs did not differ (P = 0.464). Pooling the data of Estonian and Latvian SPs yielded a mean USG value of 1.021 ± 0.007. Hypohydration (defined as a USG ≥ 1.020) was evident altogether in fifty SPs (61.7%) and one of them had a USG value greater than 1.030. Conclusions: Estonian and Latvian SPs do not differ in respect of USG and the prevalence of pre-training hypohydration is high in this athletic cohort. These findings suggest that SPs as well as their coaches, athletic trainers, and sports physicians should be better educated to recognize the importance of maintaining euhydration during the daily training routine in wintertime and to apply appropriate measures to avoid hypohydration. Full article
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Open AccessReview Serum and Salivary IgA, IgG, and IgM Levels in Oral Lichen Planus: A Systematic Review and Meta-Analysis of Case-Control Studies
Received: 24 September 2018 / Revised: 10 November 2018 / Accepted: 29 November 2018 / Published: 3 December 2018
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Immunoglobulins (IgA, IgG, and IgM) are significant anti-inflammatory factors. The meta-analysis aimed to assess the serum and salivary levels of Igs as more important immunoglobulins in patients affected by oral lichen planus (OLP) compared to the healthy controls. Four databases, including PubMed/Medline, Scopus,
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Immunoglobulins (IgA, IgG, and IgM) are significant anti-inflammatory factors. The meta-analysis aimed to assess the serum and salivary levels of Igs as more important immunoglobulins in patients affected by oral lichen planus (OLP) compared to the healthy controls. Four databases, including PubMed/Medline, Scopus, Web of Science, and Cochrane Library as well as Iranian databases were checked up to January 2018 without language restriction. The quality of each involved study was done using the Newcastle–Ottawa Quality Assessment Scale (NOS) questionnaire. A random-effects model analysis was done by RevMan 5.3 software applying the mean difference (MD) plus 95% confidence intervals (CIs). The CMA 2.0 software was applied to calculate the publication bias among the studies. Out of 70 studies found in the databases, 8 studies were involved and analyzed in the meta-analysis. The meta-analysis included 282 OLP patients and 221 healthy controls. The pooled MDs of serum levels of IgA, IgG, and IgM were −0.13 g/L [95% CI: −0.24, −0.02; P = 0.02], 1.01 g/L [95% CI: −0.91, 2.93; P = 0.30], and −0.06 g/L [95% CI: −0.25, 0.14; P = 0.56], respectively; whereas, the salivary IgA and IgG levels were 71.54 mg/L [95% CI: 12.01, 131.07; P = 0.02] and 0.59 mg/L [95% CI: −0.20, 1.38; P = 0.14], respectively. Considering the few studies performed on saliva, the results suggested that the salivary levels, especially IgA level had higher values than the serum levels. Therefore, the salivary immunoglobulins can play a significant function in the OLP pathogenesis. Full article
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Open AccessReview Biological Activities of Lactose-Based Prebiotics and Symbiosis with Probiotics on Controlling Osteoporosis, Blood-Lipid and Glucose Levels
Received: 17 November 2018 / Accepted: 28 November 2018 / Published: 3 December 2018
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Abstract
Lactose-based prebiotics are synthesized by enzymatic- or microbial- biotransformation of lactose and have unique functional values. In this comprehensive review article, the biochemical mechanisms of controlling osteoporosis, blood-lipid, and glucose levels by lactose-based prebiotics and symbiosis with probiotics are reported along with the
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Lactose-based prebiotics are synthesized by enzymatic- or microbial- biotransformation of lactose and have unique functional values. In this comprehensive review article, the biochemical mechanisms of controlling osteoporosis, blood-lipid, and glucose levels by lactose-based prebiotics and symbiosis with probiotics are reported along with the results of clinical investigations. Interaction between lactose-based prebiotics and probiotics reduces osteoporosis by (a) transforming insoluble inorganic salts to soluble and increasing their absorption to gut wall; (b) maintaining and protecting mineral absorption surface in the intestine; (c) increasing the expression of calcium-binding proteins in the gut wall; (d) remodeling osteoclasts and osteoblasts formation; (e) releasing bone modulating factors; and (f) degrading mineral complexing phytic acid. Lactose-based prebiotics with probiotics control lipid level in the bloodstream and tissue by (a) suppressing the expressions of lipogenic- genes and enzymes; (b) oxidizing fatty acids in muscle, liver, and adipose tissue; (c) binding cholesterol with cell membrane of probiotics and subsequent assimilation by probiotics; (d) enzymatic-transformations of bile acids; and (e) converting cholesterol to coprostanol and its defecation. Symbiosis of lactose-based prebiotics with probiotics affect plasma glucose level by (a) increasing the synthesis of gut hormones plasma peptide-YY, glucagon-like peptide-1 and glucagon-like peptide-2 from entero-endocrine L-cells; (b) altering glucose assimilation and metabolism; (c) suppressing systematic inflammation; (d) reducing oxidative stress; and (e) producing amino acids. Clinical investigations show that lactose-based prebiotic galacto-oligosaccharide improves mineral absorption and reduces hyperlipidemia. Another lactose-based prebiotic, lactulose, improves mineral absorption, and reduces hyperlipidemia and hyperglycemia. It is expected that this review article will be of benefit to food technologists and medical practitioners. Full article
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Open AccessArticle Demographic, Social, and Behavioral Determinants of Lung Cancer Perceived Risk and Worries in a National Sample of American Adults; Does Lung Cancer Risk Matter?
Received: 3 August 2018 / Revised: 20 November 2018 / Accepted: 29 November 2018 / Published: 3 December 2018
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Abstract
Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to
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Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: “Ever smoker” status was associated with higher cancer perceived risk (b = 0.25; 95% CI = 0.05–0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18–0.50, p < 0.001), suggesting that “ever smokers” experience higher levels of cancer perceived risk and worries regarding cancer, compared to “never smokers”. Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = −0.98, 95% CI = −1.37–0.60, p < 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs. Full article
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Open AccessLetter Breast Cancer Relapse, Post-Surgical Confusion, and Dementia in the Elderly: An Unexpected Connection but with the Same Proposed Solution
Medicina 2018, 54(6), 101; https://doi.org/10.3390/medicina54060101
Received: 17 October 2018 / Revised: 21 November 2018 / Accepted: 21 November 2018 / Published: 3 December 2018
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Abstract
A simple solution may exist for both the problem of sudden dementia and confusion after surgery in the elderly and the bimodal relapse pattern among breast cancer patients who were treated with a mastectomy. Systemic inflammation by a variety of mechanisms can induce
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A simple solution may exist for both the problem of sudden dementia and confusion after surgery in the elderly and the bimodal relapse pattern among breast cancer patients who were treated with a mastectomy. Systemic inflammation by a variety of mechanisms can induce tumor outgrowth from dormant states, such as single dormant cells and avascular micrometastases. This may also explain sudden confusion and dementia for the elderly after surgery. We propose that surgery-induced inflammation may be addressed by “protective anesthesia”. We suggest ketorolac for 4 days starting at the time of surgery to prevent early relapse in breast and probably other cancers; perhaps that or something similar could be used before surgery in elderly patients to prevent post-operative cognitive dysfunction. Full article
Open AccessArticle Awareness, Attitudes, and Practices Toward Meningococcal B Vaccine among Pediatricians in Italy
Medicina 2018, 54(6), 100; https://doi.org/10.3390/medicina54060100
Received: 27 September 2018 / Revised: 20 November 2018 / Accepted: 30 November 2018 / Published: 3 December 2018
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Background and objectives: Vaccination against bacterial pathogens is decisive for preventing invasive meningococcal disease and pediatricians play a pivotal role in vaccination compliance and coverage. The aim of this study was to investigate awareness, attitude, and practices toward the vaccine against Meningococcal B
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Background and objectives: Vaccination against bacterial pathogens is decisive for preventing invasive meningococcal disease and pediatricians play a pivotal role in vaccination compliance and coverage. The aim of this study was to investigate awareness, attitude, and practices toward the vaccine against Meningococcal B serogroup (4CMenB) among a sample of Italian pediatricians. Materials and Methods: A cross-sectional study was carried out using an online questionnaire from March to May 2015. Three multivariate logistic regression models were built to identify factors associated with the outcomes of interest. Results: The data showed that 95.5% of the interviewees correctly responded about the availability of 4CMenB vaccine in Italy, while only 28.0% knew the vaccination schedule for children aged two years or under. This knowledge was significantly higher in younger pediatricians and in those who worked a higher number of hours per week. Pediatricians self-reported a positive attitude toward the utility and safety of 4CMenB vaccine. Those pediatricians with a strong positive attitude toward the utility of the vaccine, who knew the vaccination schedules for children of two years or under, and who declared a satisfactory or good knowledge about the vaccine were more likely to inform parents about its availability in Italy, recommend the vaccination, and verify patients’ vaccination status, in their daily practice. Conclusions: The study highlights factors that currently influence pediatricians’ practices regarding the 4CMenB vaccine. The results showed the possible actions recommended to improve physicians’ awareness and behaviors in order to improve the vaccination compliance and invasive meningococcal diseases prevention. Full article
Open AccessArticle Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study
Received: 25 October 2018 / Revised: 25 November 2018 / Accepted: 29 November 2018 / Published: 1 December 2018
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Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of
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Objective: To analyze the association of potential risk factors to health with body fatness and insulin resistance. Baseline measures of the ongoing longitudinal Analysis of Behaviors of Children During (ABCD) Growth Study. Materials and Methods: The sample was composed of 280 adolescents of both sexes (198 boys and 82 girls) aged from 10 to 18 years. Four risk factors were considered, as follows: no sports practice, skipping breakfast, poor sleep quality, and TV viewing. The outcomes considered were insulin resistance (HOMA-IR) and body fatness (densitometer scanner). Age, sex, maturity offset, and ethnicity were treated as covariates. Results: No sports practice and skipping breakfast were associated with higher body fatness (Sports practice: Wald: 8.786; p = 0.003. Breakfast: Wald: 9.364; p = 0.002). Poor sleep quality was related to a greater HOMA-IR index (Wald: 6.013; p = 0.014). Adolescents with ≥3 risk factors presented a higher risk of high HOMA-IR (OR = 4.89 (95%CI: 1.61 to 14.84)) than their counterparts with no risk factors. Conclusion: Lifestyle risk factors seem relevant to affect obesity and insulin resistance, while the aggregation of these risk factors affects insulin resistance, independent of adiposity. Full article
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Open AccessArticle A Systematic Review and Meta-Analysis Evaluating Antibiotic Prophylaxis in Dental Implants and Extraction Procedures
Received: 8 October 2018 / Revised: 22 November 2018 / Accepted: 26 November 2018 / Published: 1 December 2018
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Abstract
Background and objectives: The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of antibiotics has led to widespread antimicrobial resistance and the emergence of multi drug resistant strains of bacteria. The
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Background and objectives: The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of antibiotics has led to widespread antimicrobial resistance and the emergence of multi drug resistant strains of bacteria. The main aim of this work was to determine whether there is a genuine need for antibiotic prophylaxis in two common dental procedures; dental implants and tooth extractions. Methods: Electronic searches were conducted across databases such as Cochrane Register of Controlled Trials, the UK National Health Service, Centre for reviews, Science Direct, PubMed and the British Dental Journal to identify clinical trials of either dental implants or tooth extractions, whereby the independent variable was systemic prophylactic antibiotics used as part of treatment in order to prevent postoperative complications such as implant failure or infection. Primary outcomes of interest were implant failure, and postoperative infections which include systemic bacteraemia and localised infections. The secondary outcome of interest was adverse events due to antibiotics. The Critical Appraisal Skills Programme tool was used to assess the risk of bias, extract outcomes of interest and to identify studies for inclusion in the meta-analysis. Results: Seven randomised clinical trials (RCTs) were included in the final review comprising n = 1368 patients requiring either tooth extraction(s) or dental implant(s). No statistically significant evidence was found to support the routine use of prophylactic antibiotics in reducing the risk of implant failure (p = 0.09, RR 0.43; 95% CI 0.16–1.14) or post-operative complications (p = 0.47, RR: 0.74; 95% CI 0.34–1.65) under normal conditions. Approximately 33 patients undergoing dental implant surgery need to receive antibiotics in order to prevent one implant failure from occurring. Conclusions: There is little conclusive evidence to suggest the routine use of antibiotic prophylaxis for third molar extractive surgery in healthy young adults. There was no statistical evidence for adverse events experienced for antibiotics vs. placebo. Based on our analysis, even if financially feasible, clinicians must carefully consider the appropriate use of antibiotics in dental implants and extraction procedures due to the risk of allergic reactions and the development of microbial drug resistance. Full article
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Open AccessReview Paediatric Pain Medicine: Pain Differences, Recognition and Coping Acute Procedural Pain in Paediatric Emergency Room
Received: 18 September 2018 / Revised: 1 November 2018 / Accepted: 16 November 2018 / Published: 27 November 2018
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Abstract
Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is
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Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood. There are a variety of pain assessment tools for children and they should be chosen according to the patient’s age, developmental stage, communication skills, and medical condition. Psychological factors such as PER environment, preprocedural preparation, and parental involvement should also be considered. There are proven methods to reduce a patient’s pain and anxiety during different procedures in PER. Distraction techniques such as music, videogames, virtual reality, or simple talk about movies, friends, or hobbies as well as cutaneous stimulation, vibration, cooling sprays, or devices are effective to alleviate procedural pain and anxiety. A choice of distraction technique should be individualized, selecting children who could benefit from nonpharmacological pain treatment methods or tools. Nonpharmacological pain management may reduce dosage of pain medication or exclude pharmacological pain management. Most nonpharmacological treatment methods are cheap, easily accessible, and safe to use on every child, so it should always be a first choice when planning a patient’s care. The aim of this review is to provide a summary of paediatric pain features, along with their physiology, assessment, management, and to highlight the importance and efficacy of nonpharmacological pain management in an urgent paediatric care setting. Full article
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Open AccessCase Report Diabetic Ketoacidosis Associated with Thyroxine (T4) Toxicosis and Thyrotoxic Cardiomyopathy
Received: 16 October 2018 / Revised: 10 November 2018 / Accepted: 22 November 2018 / Published: 26 November 2018
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Abstract
Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore,
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Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T4) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T4) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol’s solution) and was discharged a few days later. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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Open AccessArticle Multidrug-Resistant Gram-Negative Bacilli: A Retrospective Study of Trends in a Tertiary Healthcare Unit
Received: 5 October 2018 / Revised: 6 November 2018 / Accepted: 20 November 2018 / Published: 26 November 2018
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Abstract
Background and objective: Bacterial multidrug resistance is particularly common in Gram-negative bacilli (GNB), with important clinical consequences regarding their spread and treatment options. The aim of this study was to investigate the trend of multidrug-resistant GNB (MDR-GNB) in high-risk hospital departments, between 2000–2015,
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Background and objective: Bacterial multidrug resistance is particularly common in Gram-negative bacilli (GNB), with important clinical consequences regarding their spread and treatment options. The aim of this study was to investigate the trend of multidrug-resistant GNB (MDR-GNB) in high-risk hospital departments, between 2000–2015, in intervals of five years, with the intention of improving antibiotic therapy policies and optimising preventive and control practices. Materials and methods: This is an observational, retrospective study performed in three departments of the most important tertiary healthcare unit in the southwestern part of Romania: the Intensive Care Unit (ICU), the General Surgery Department (GSD), and the Nutrition and Metabolic Diseases Department (NMDD). MDR was defined as acquired resistance to at least one agent in three or more antimicrobial categories. Trends over time were determined by the Cochran–Armitage trend test and linear regression. Results: During the study period, a total of 2531 strains of MDR-GNB were isolated in 1999 patients: 9.20% in 2000, 18.61% in 2005, 37.02% in 2010, and 35.17% in 2015. The most significant increasing trend was recorded in the ICU (gradient = 7.63, R² = 0.842, p < 0.001). The most common MDR-GNB in the ICU was isolated from bronchoalveolar aspiration samples. Concerning the proportion of different species, most of the changes were recorded in the ICU, where a statistically significant increasing trend was observed for Proteus mirabilis (gradient = 2.62, R2 = 0.558, p < 0.001) and Acinetobacter baumannii (gradient = 2.25, R2 = 0.491, p < 0.001). Analysis of the incidence of the main resistance phenotypes proportion identified a statistically significant increase in carbapenem resistance in the ICU (Gradient = 8.27, R² = 0.866, p < 0.001), and an increased proportion of aminoglycoside-resistant strains in all three departments, but more importantly in the ICU and GSD. Conclusion: A statistically significant increasing trend was observed in all three departments; the most significant one was recorded in the ICU, where after 2010, carbapenem-resistant strains were isolated. Full article
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