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Medicina, Volume 56, Issue 2 (February 2020) – 43 articles

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Open AccessReview
Nutritional Status and the Influence of the Vegan Diet on the Gut Microbiota and Human Health
Medicina 2020, 56(2), 88; https://doi.org/10.3390/medicina56020088 (registering DOI) - 22 Feb 2020
Abstract
The human gut microbiota is considered a well-known complex ecosystem composed of distinct microbial populations, playing a significant role in most aspects of human health and wellness. Several factors such as infant transitions, dietary habits, age, consumption of probiotics and prebiotics, use of [...] Read more.
The human gut microbiota is considered a well-known complex ecosystem composed of distinct microbial populations, playing a significant role in most aspects of human health and wellness. Several factors such as infant transitions, dietary habits, age, consumption of probiotics and prebiotics, use of antibiotics, intestinal comorbidities, and even metabolic diseases may continously alter microbiota diversity and function. The study of vegan diet–microbiota interactions is a rapidly evolving field, since plenty of research has been focused on the potential effects of plant-based dietary patterns on the human gut microbiota. It has been reported that well-planned vegan diets and their associated components affect both the bacterial composition and metabolic pathways of gut microbiota. Certain benefits associated with medical disorders but also limitations (including nutritional deficiencies) have been documented. Although the vegan diet may be inadequate in calorific value, it is rich in dietary fiber, polyphenols, and antioxidant vitamins. The aim of the present study was to provide an update of the existing knowledge on nutritional status of vegan diets and the influence of their food components on the human gut microbiota and health. Full article
Open AccessReview
The Role of Blood Biomarkers for Magnetic Resonance Imaging Diagnosis of Traumatic Brain Injury
Medicina 2020, 56(2), 87; https://doi.org/10.3390/medicina56020087 (registering DOI) - 22 Feb 2020
Abstract
Background and Objectives: The annual global incidence of traumatic brain injury (TBI) is over 10 million. An estimated 29% of TBI patients with negative computed tomography (CT−) have positive magnetic resonance imaging (MRI+) findings. Judicious use of serum biomarkers with MRI may [...] Read more.
Background and Objectives: The annual global incidence of traumatic brain injury (TBI) is over 10 million. An estimated 29% of TBI patients with negative computed tomography (CT−) have positive magnetic resonance imaging (MRI+) findings. Judicious use of serum biomarkers with MRI may aid in diagnosis of CT-occult TBI. The current manuscript aimed to evaluate the diagnostic, therapeutic and risk-stratification utility of known biomarkers and intracranial MRI pathology. Materials and Methods: The PubMed database was queried with keywords [(plasma OR serum) AND (biomarker OR marker OR protein) AND (brain injury/trauma OR head injury/trauma OR concussion) AND (magnetic resonance imaging/MRI) [title/abstract]] in English. Seventeen articles on TBI biomarkers and MRI were included: S100 calcium-binding protein B (S100B; N = 6), glial fibrillary acidic protein (GFAP; N = 3), GFAP/ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1; N = 2), Tau (N = 2), neurofilament-light (NF-L; N = 2), alpha-synuclein (N = 1), and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor peptide (AMPAR; N=1). Results: Acute GFAP distinguished CT−/MRI+ from CT−/MRI− (AUC = 0.777, 0.852 at 9–16 h). GFAP discriminated CT−/diffuse axonal injury (DAI+) from controls (AUC = 0.903). Tau correlated directly with number of head strikes and inversely with white matter fractional anisotropy (FA), and a cutoff > 1.5 pg/mL discriminated between DAI+ and DAI− (sensitivity = 74%/specificity = 69%). NF-L had 100% discrimination of DAI in severe TBI and correlated with FA. Low alpha-synuclein was associated with poorer functional connectivity. AMPAR cutoff > 0.4 ng/mL had a sensitivity of 91% and a specificity of 92% for concussion and was associated with minor MRI findings. Low/undetectable S100B had a high negative predictive value for CT/MRI pathology. UCH-L1 showed no notable correlations with MRI. Conclusions: An acute circulating biomarker capable of discriminating intracranial MRI abnormalities is critical to establishing diagnosis for CT-occult TBI and can triage patients who may benefit from outpatient MRI, surveillance and/or follow up with TBI specialists. GFAP has shown diagnostic potential for MRI findings such as DAI and awaits further validation. Tau shows promise in detecting DAI and disrupted functional connectivity. Candidate biomarkers should be evaluated within the context of analytical performance of the assays used, as well as the post-injury timeframe for blood collection relative to MRI abnormalities. Full article
Open AccessArticle
Timing between Breast Reconstruction and Oncologic Mastectomy—One Center Experience
Medicina 2020, 56(2), 86; https://doi.org/10.3390/medicina56020086 - 20 Feb 2020
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Abstract
Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy [...] Read more.
Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. Material and methods: We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. Results: The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8–43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Conclusions: Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist. Full article
(This article belongs to the Special Issue Interdisciplinary Medicine)
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Open AccessArticle
Bedside Sonographic Duplex Technique as a Monitoring Tool in Patients after Decompressive Craniectomy: A Single Centre Experience
Medicina 2020, 56(2), 85; https://doi.org/10.3390/medicina56020085 - 19 Feb 2020
Viewed by 108
Abstract
Background and objectives: Bedside sonographic duplex technique (SDT) may be used as an adjunct to cranial computed tomography (CCT) to monitor brain-injured patients after decompressive craniectomy (DC). The present study aimed to assess the value of SDT in repeated measurements of ventricle dimensions [...] Read more.
Background and objectives: Bedside sonographic duplex technique (SDT) may be used as an adjunct to cranial computed tomography (CCT) to monitor brain-injured patients after decompressive craniectomy (DC). The present study aimed to assess the value of SDT in repeated measurements of ventricle dimensions in patients after DC by comparing both techniques. Materials and Methods: Retrospective assessment of 20 consecutive patients after DC for refractory intracranial pressure (ICP) increase following subarachnoid hemorrhage (SAH), bleeding and trauma which were examined by SDT and CCT in the context of routine clinical practice. Whenever a repeated CCT was clinically indicated SDT examinations were performed within 24 hours and correlated via measurement of the dimensions of all four cerebral ventricles. Basal cerebral arteries including pathologies such as vasospasms were also evaluated in comparison to selected digital subtraction angiography (DSA). Results: Repeated measurements of all four ventricle diameters showed high correlation between CCT and SDT (right lateral r = 0.997, p < 0.001; left lateral r = 0.997, p < 0.001; third r = 0.991, p < 0.001, fourth ventricle r = 0.977, p < 0.001). SDT performed well in visualizing basal cerebral arteries including pathologies (e.g., vasospasms) as compared to DSA. Conclusions: Repeated SDT measurements of the dimensions of all four ventricles in patients after DC for refractory ICP increase delivered reproducible results comparable to CCT. SDT may be considered as a valuable bedside monitoring tool in patients after DC. Full article
Open AccessArticle
Comparison of Lateral Abdominal Musculature Activation during Expiration with an Expiratory Flow Control Device Versus the Abdominal Drawing-in Maneuver in Healthy Women: A Cross-Sectional Observational Pilot Study
Medicina 2020, 56(2), 84; https://doi.org/10.3390/medicina56020084 - 19 Feb 2020
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Abstract
Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow [...] Read more.
Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA (p = 0.001) and IO (p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM (p = 0.001, Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001, Cohen’s d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found (p = 0.055, Cohen’s d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest (p = 0.038), Cohen’s d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA. Full article
(This article belongs to the Special Issue Ultrasound in Sports Medicine: Current Concepts and Advances)
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Open AccessArticle
Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography
Medicina 2020, 56(2), 83; https://doi.org/10.3390/medicina56020083 - 18 Feb 2020
Viewed by 138
Abstract
Background and objectives: Palpation is an inherent and basic skill of health professionals—particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current [...] Read more.
Background and objectives: Palpation is an inherent and basic skill of health professionals—particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current studies that evaluate palpation concordance reliability for the SMT in this particular position. This study aimed to investigate the intra- and inter-rater reliabilities of supraspinatus muscle tendon (SMT) palpation. Materials and Methods: Thirty-six healthy participants (14 females; aged 22–35 years) were recruited. Musculoskeletal ultrasound was used to measure the SMT localization after two physiotherapists performed the SMT palpation at two different times. The distance between the two marked points was used to analyze the analysis of true agreement between examiners. Finally, we analyzed if the demographic variables influenced the palpation procedure. Results: The intra-examiner reliability showed a high percentage of concordance for examiner 1 (E.1) (first palpation procedure (P.1) = 91.7%: second palpation procedure (P.2) = 95.8%) and examiner 2 (E.2) (P.1 = 91.6%; P.2 = 97.2%) and high percentage of inter-palpation agreement for E.1 (87.5%) and E.2 (88.9%). The inter-examiner reliability showed a high total concordance for the right shoulder (E.1 = 94.4%; E.2 = 95.8%) and left shoulder (E.1 = 93.05%; E.2 = 95.05%). The agreement (%) according to both examiners was 93.05% for the right shoulder and 94.4% for the left shoulder. The agreement between both examiners and the ultrasound (% of true agreement) was 92.9% for the right shoulder and 92.8% for the left shoulder. A statistically significant association (p = 0.02) was found for weight regarding concordance reliability; this was not seen for dominant arm, age, gender, body mass index, height, and tendon depth (p > 0.05). Conclusions: The SMT palpation technique showed a high level of concordance and reproducibility. Full article
(This article belongs to the Special Issue Ultrasound in Sports Medicine: Current Concepts and Advances)
Open AccessArticle
Cortical Bone Trajectory Instrumentation with Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture
Medicina 2020, 56(2), 82; https://doi.org/10.3390/medicina56020082 - 17 Feb 2020
Viewed by 158
Abstract
Background: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the [...] Read more.
Background: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes. Method: We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months. Result: The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was −3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up. Conclusions: Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment. Full article
Open AccessArticle
Combined Effect of HPV and Several Gene SNPs in Laryngeal Cancer
Medicina 2020, 56(2), 81; https://doi.org/10.3390/medicina56020081 - 17 Feb 2020
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Abstract
Background and objectives: Laryngeal squamous cell carcinoma (LSCC) is one of the most common head and neck tumors. The molecular mechanism of LSCC remains unclear. The aim of this study was to evaluate the prevalence of Human papillomavirus (HPV) and single nucleotide polymorphisms [...] Read more.
Background and objectives: Laryngeal squamous cell carcinoma (LSCC) is one of the most common head and neck tumors. The molecular mechanism of LSCC remains unclear. The aim of this study was to evaluate the prevalence of Human papillomavirus (HPV) and single nucleotide polymorphisms (SNPs) of TP53, MDM2, MDM4, MTHFR, CASP8, and CCR5 genes in LSCC, and to assess their correlations with patient survival. Materials and Methods: 49 LSCC patients were enrolled in this study. PCR and qRT-PCR were used to detect, identify, and quantify HPV. SNPs were genotyped using PCR and PCR-RFLP. Results: By analyzing the interactions of the SNPs of the genes with clinical parameters, the majority of patients with lymph node status (N1,2) were identified as carriers of MDM2 T/G, CASP8 ins/del, CCR5 wt/wt SNP. Cluster analysis showed that patients with MDM2 T/T SNP survive longer than patients identified as CASP8 ins/ins, MTHFR C/C, and MDM4 A/A variant carriers; meanwhile, LSCC patients with MDM2 T/T polymorphic variant had the best survival. Multivariate analysis showed that HPV-positive patients without metastasis in regional lymph nodes (N0) and harboring CASP8 ins/del variant had the best survival. Meanwhile, HPV-negative patients with identified metastasis in lymph nodes (N1 and N2) and CASP8 ins/del variant had poor survival. Conclusions: This finding suggests patients survival prognosis and tumor behavior are different according HPV status, SNP variants, and clinical characteristics of the LSCC. Full article
Open AccessArticle
CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities
Medicina 2020, 56(2), 80; https://doi.org/10.3390/medicina56020080 - 15 Feb 2020
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Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing [...] Read more.
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual’s aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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Open AccessArticle
Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children
Medicina 2020, 56(2), 79; https://doi.org/10.3390/medicina56020079 - 15 Feb 2020
Viewed by 145
Abstract
Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the [...] Read more.
Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement. Full article
Open AccessArticle
Preliminary Results of an Exercise Program After Laparoscopic Resective Colorectal Cancer Surgery in Non-Metastatic Adenocarcinoma: A Pilot Study of a Randomized Control Trial
Medicina 2020, 56(2), 78; https://doi.org/10.3390/medicina56020078 - 14 Feb 2020
Viewed by 216
Abstract
Performing physical exercise after a colorectal cancer diagnosis is associated with lower mortality related to the tumor itself. In order to improve physical recovery after elective surgery, there are no specific exercise protocols after discharge from the hospital. The purpose of this study [...] Read more.
Performing physical exercise after a colorectal cancer diagnosis is associated with lower mortality related to the tumor itself. In order to improve physical recovery after elective surgery, there are no specific exercise protocols after discharge from the hospital. The purpose of this study is to show the preliminary results of an exercise program after colorectal cancer surgery. Six patients with non-metastatic colorectal adenocarcinoma addressed to respective laparoscopic were randomly assigned to a mixed supervised/home-based exercise program for six months and compared to a control group without exercise. To assess the effectiveness of the program, functional and body composition parameters were evaluated. Three months after surgery, the exercise group increased flexibility (p < 0.01, ES = 0.33), strength of lower limbs (p < 0.01, ES = 0.42) and aerobic capacity (p < 0.01, ES = 0.28). After surgery, the six patients experienced a significant reduction in body mass index (BMI) and free fat mass. More specifically, fat mass reached the lowest values, with a concomitant increase in cell mass after six months (p < 0.01, ES = 0.33). This did not occur in the control group. Colorectal cancer treatment induces a reduction in physical function, particularly during the first six months after treatment. A mixed exercise approach appears promising in countering this process after colorectal cancer surgery. Full article
(This article belongs to the Special Issue Molecular and Therapeutic Landscapes in Colorectal Carcinoma)
Open AccessArticle
Circulating Soluble Urokinase-Type Plasminogen Activator Receptor in Obstructive Sleep Apnoea
Medicina 2020, 56(2), 77; https://doi.org/10.3390/medicina56020077 - 14 Feb 2020
Viewed by 189
Abstract
Background and Objectives: Obstructive sleep apnoea (OSA) is associated with heightened systemic inflammation and a hypercoagulation state. Soluble urokinase-type plasminogen activator receptor (suPAR) plays a role in fibrinolysis and systemic inflammation. However, suPAR has not been investigated in OSA. Materials and Methods [...] Read more.
Background and Objectives: Obstructive sleep apnoea (OSA) is associated with heightened systemic inflammation and a hypercoagulation state. Soluble urokinase-type plasminogen activator receptor (suPAR) plays a role in fibrinolysis and systemic inflammation. However, suPAR has not been investigated in OSA. Materials and Methods: A total of 53 patients with OSA and 15 control volunteers participated in the study. Medical history was taken and in-hospital sleep studies were performed. Plasma suPAR levels were determined by ELISA. Results: There was no difference in plasma suPAR values between patients with OSA (2.198 ± 0.675 ng/mL) and control subjects (2.088 ± 0.976 ng/mL, p = 0.62). Neither was there any difference when patients with OSA were divided into mild (2.134 ± 0.799 ng/mL), moderate (2.274 ± 0.597 ng/mL) and severe groups (2.128 ± 0.744 ng/mL, p = 0.84). There was no significant correlation between plasma suPAR and indices of OSA severity, blood results or comorbidities, such as hypertension, diabetes, dyslipidaemia or cardiovascular disease. Plasma suPAR levels were higher in women when all subjects were analysed together (2.487 ± 0.683 vs. 1.895 ± 0.692 ng/mL, p < 0.01), and also separately in controls (2.539 ± 0.956 vs. 1.411 ± 0.534 ng/mL, p = 0.02) and patients (2.467 ± 0.568 vs. 1.991 ± 0.686 ng/mL, p < 0.01). Conclusions: Our results suggest that suPAR does not play a significant role in the pathophysiology of OSA. The significant gender difference needs to be considered when conducting studies on circulating suPAR. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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Open AccessCase Report
De novo NIPBL Mutations in Vietnamese Patients with Cornelia de Lange Syndrome
Medicina 2020, 56(2), 76; https://doi.org/10.3390/medicina56020076 - 14 Feb 2020
Viewed by 134
Abstract
Cornelia de Lange Syndrome (CdLS) is a rare congenital genetic disease causing abnormal unique facial phenotypes, several defects in organs and body parts, and mental disorder or intellectual disorder traits. Main causes of CdLS have been reported as variants in cohesin complex genes, [...] Read more.
Cornelia de Lange Syndrome (CdLS) is a rare congenital genetic disease causing abnormal unique facial phenotypes, several defects in organs and body parts, and mental disorder or intellectual disorder traits. Main causes of CdLS have been reported as variants in cohesin complex genes, in which mutations in the NIPBL gene have been estimated to account for up to 80%. Our study included three Vietnamese patients with typical CdLS phenotypes. Whole exome sequencing revealed two known heterozygous mutations c.6697G>A (p.Val2233Met) and c.2602C>T (p.Arg868X), and a novel heterozygous mutation c.4504delG (p.Val1502fsX87) in the NIPBL gene of the three patients. In silico analyses of the identified mutations predicted possible damaging and truncating effects on the NIPBL protein. Inherited analyses in the patients’ families showed that all of the mutations are de novo. Our results lead a definitive diagnosis of patients with CdLS and expand the spectrum of mutations in the NIPBL gene. These findings also confirm whole exome sequencing is an efficient tool for genetic screening of CdLS. Full article
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Open AccessArticle
Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique
Medicina 2020, 56(2), 75; https://doi.org/10.3390/medicina56020075 - 13 Feb 2020
Viewed by 135
Abstract
Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty [...] Read more.
Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm. Full article
(This article belongs to the Special Issue Dental Implants and Biomaterials Innovations)
Open AccessArticle
Vegetarian Diets along with Regular Exercise: Impact on High-Density Lipoprotein Cholesterol Levels among Taiwanese Adults
Medicina 2020, 56(2), 74; https://doi.org/10.3390/medicina56020074 - 13 Feb 2020
Viewed by 176
Abstract
Background and objectives: High-density lipoprotein cholesterol (HDL-C) is important for improving risk estimates of atherosclerotic cardiovascular disease. We investigated the effect of omnivore and diverse vegetarian diets in connection with exercise on HDL-C. Materials and Methods: Historical data of 9588 biobank participants (4025 [...] Read more.
Background and objectives: High-density lipoprotein cholesterol (HDL-C) is important for improving risk estimates of atherosclerotic cardiovascular disease. We investigated the effect of omnivore and diverse vegetarian diets in connection with exercise on HDL-C. Materials and Methods: Historical data of 9588 biobank participants (4025 exercisers and 5563 non-exercisers) aged 30–70 years were categorized as omnivores (n = 8589), former vegetarians (n = 544), lacto-ovo vegetarians (n = 417), and strict vegetarians (n = 38). We used multiple linear regression for analyses. Results: HDL-C levels were higher in exercisers compared to non-exercisers. Compared with omnivores, strict vegetarians had decreased levels of HDL-C (β = −5.705; p = 0.001) followed by lacto-ovo vegetarians (β = −3.900; p < 0.001) and former vegetarians (β = −0.329; p = 0.475). The test for trend was significant (p < 0.001). After categorization by exercise modalities, the β-value was −13.984 for strict vegetarians, −4.419 for lacto-ovo vegetarians, and −1.864 for former vegetarians, respectively (p < 0.05). There was an interaction between diet and exercise (p = 0.009). Omnivores who exercised regularly had significantly higher HDL-C, whereas strict vegetarians who exercised regularly had significantly lower HDL-C. Conclusions: In summary, strict vegetarian diets in conjunction with regular exercise might not serve as healthful behaviors to be implemented in everyday life considering the negative impact on HDL-C. Full article
Open AccessArticle
Predicting the Risk of Ischemic Stroke among Patients with Rheumatoid Arthritis Using a Simplified RA-CHADSV Score Based on the CHA2DS2-VASc Score
Medicina 2020, 56(2), 73; https://doi.org/10.3390/medicina56020073 - 12 Feb 2020
Viewed by 184
Abstract
Background and Objectives: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc [...] Read more.
Background and Objectives: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65–74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF). Materials and Methods: Using the Taiwan’s National Health Insurance Research Database, 592 patients with RA diagnosed between 2000 and 2002 were identified and followed until first occurrence of ischemic stroke or the last available date in the database. Incidence rate ratios (IRR) of ischemic stroke for the CHA2DS2-VASc score were calculated using Poisson regression models. A new prediction score RA-CHADSV was developed using multiple logistic regression analysis with bootstrap validation. Results: The area under the receiver operating characteristic curve of the newly developed RA-CHADSV score and the CHA2DS2-VASc score were 0.73 (95% confidence interval (CI) 0.64–0.82) and 0.70 (95% CI 0.61–0.79), respectively. The RA-CHADSV score was significantly associated with a higher ischemic stroke incidence in the patients who scored ≥1 (adjusted IRR 7.39, p < 0.001). Conclusions: A simplified RA-CHADSV score, with comparable efficiency as the CHA2DS2-VASc score, but easier to use clinically was developed for predicting the risk of ischemic stroke among non-AF RA patients. Full article
Open AccessCommunication
Bmi-1 Immunohistochemical Expression in Endometrial Carcinoma is Correlated with Prognostic Activity
Medicina 2020, 56(2), 72; https://doi.org/10.3390/medicina56020072 - 12 Feb 2020
Viewed by 170
Abstract
Background and objectives: B-lymphoma Mo-MLV insertion region 1 (Bmi-1) is a stem cell factor that is overexpressed in various human cancer tissues. It has been implicated in cancer cell proliferation, cell invasion, distant metastasis, and chemosensitivity, and is associated with patient survival. Several [...] Read more.
Background and objectives: B-lymphoma Mo-MLV insertion region 1 (Bmi-1) is a stem cell factor that is overexpressed in various human cancer tissues. It has been implicated in cancer cell proliferation, cell invasion, distant metastasis, and chemosensitivity, and is associated with patient survival. Several reports have also identified Bmi-1 protein overexpression in endometrial carcinoma; however, the relationship between Bmi-1 expression and its significance as a clinicopathological parameter is still insufficiently understood. Accordingly, the present study aimed to clarify whether immunohistochemical staining for Bmi-1 in human endometrial carcinoma and normal endometrial tissues can be used as a prognostic and cell proliferation marker. Materials and Methods: Bmi-1 expression was assessed in endometrioid carcinoma (grade 1–3) and normal endometrial tissues (in the proliferative and secretory phases) by immunohistochemistry; protein expression was evaluated using the nuclear labeling index (%) in the hot spot. Furthermore, we examined other independent prognostic and proliferation markers, including the protein levels of Ki-67, p53, and cyclin A utilizing semi-serial sections of endometrial carcinoma tissues. Results: The expression of the Bmi-1 protein was significantly higher in all grades of endometrial carcinoma than in the secretory phase of normal tissues. Moreover, Bmi-1 levels tended to be higher in G2 and G3 tissues than in G1 tissue, without reaching significance. Bmi-1 expression showed no notable differences among International Federation of Gynecology and Obstetrics (FIGO) stages in endometrial carcinoma. Furthermore, we observed a significant positive relationship between Bmi-1 and Ki-67, cyclin A, or p53 by Spearman’s rank correlation test, implying that high Bmi-1 expression can be an independent prognostic marker in endometrial carcinoma. Conclusions: Our study suggests that Bmi-1 levels in endometrial carcinoma tissues may be useful as a reliable proliferation and prognostic biomarker. Recently, the promise of anti-Bmi-1 strategies for the treatment of endometrial carcinoma has been detected. Our results provide fundamental data regarding this anti-Bmi-1 strategy. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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Open AccessReview
Immunological Effects of a Single Hemodialysis Treatment
Medicina 2020, 56(2), 71; https://doi.org/10.3390/medicina56020071 - 12 Feb 2020
Viewed by 153
Abstract
Immune disorders, involving both innate and adaptive response, are common in patients with end-stage renal disease under chronic hemodialysis. Endogenous and exogenous factors, such as uremic toxins and the extracorporeal treatment itself, alter the immune balance, leading to chronic inflammation and higher risk [...] Read more.
Immune disorders, involving both innate and adaptive response, are common in patients with end-stage renal disease under chronic hemodialysis. Endogenous and exogenous factors, such as uremic toxins and the extracorporeal treatment itself, alter the immune balance, leading to chronic inflammation and higher risk of cardiovascular events. Several studies have previously described the immune effects of chronic hemodialysis and the possibility to modulate inflammation through more biocompatible dialyzers and innovative techniques. On the other hand, very limited data are available on the possible immunological effects of a single hemodialysis treatment. In spite of the lacking information about the immunological reactivity related to a single session, there is evidence to indicate that mediators of innate and adaptive response, above all complement cascade and T cells, are implicated in immune system modulation during hemodialysis treatment. Expanding our understanding of these modulations represents a necessary basis to develop pro-tolerogenic strategies in specific conditions, like hemodialysis in septic patients or the last session prior to kidney transplant in candidates for receiving a graft. Full article
(This article belongs to the Special Issue Dialysis and Kidney Transplantation)
Open AccessArticle
Oxidant/Antioxidant Status of Breast Cancer Patients in Pre- and Post-Operative Periods
Medicina 2020, 56(2), 70; https://doi.org/10.3390/medicina56020070 - 11 Feb 2020
Viewed by 134
Abstract
Background and Objectives: The purpose of this study is to evaluate the level of oxidative stress before and after breast cancer surgery. Materials and Methods: Malondialdehyde (MDA) level was tested using a thiobarbituric acid (TBA) assay based on the release of a color [...] Read more.
Background and Objectives: The purpose of this study is to evaluate the level of oxidative stress before and after breast cancer surgery. Materials and Methods: Malondialdehyde (MDA) level was tested using a thiobarbituric acid (TBA) assay based on the release of a color complex due to TBA reaction with MDA. The glutathione S-transferase (GST) activity was evaluated by enzymatic conjugation of reduced glutathione (GSH) with 1-chloro-2,4-dinitrobenzene. The level of total glutathione (reduced GSH and oxidized GSSG) was detected using a recycling system by 5,5-dithiobis(2-nitrobenzoic acid). The levels of the indices were determined in the serum of 52 patients before surgery, two hours and five days after surgery, and in 42 healthy women. Results: In the patients over 50 years old the level of MDA was higher after surgery in comparison with before surgery, and GST activity was lower in comparison with the control. The GSH + GSSG level in both ages groups after surgery was lower than in the control. Significant differences of MDA level were detected in patients with stage III after surgery compared to the control. The level of GSH + GSSG was significantly lower in the patients with I–III stages compared to the control. Conclusion: The most expressed changes demonstrate the significance of MDA as a marker to evaluate oxidative stress in breast cancer patients. The degree of oxidative stress depends on the patient’s age and stage of disease. Full article
Open AccessReview
Markers of Subclinical Cardiovascular Disease in Patients with Adrenal Incidentaloma
Medicina 2020, 56(2), 69; https://doi.org/10.3390/medicina56020069 - 10 Feb 2020
Viewed by 188
Abstract
Due to the growing availability of imaging examinations the percentage of patients with incidentally diagnosed adrenal tumors has increased. The vast majority of these lesions are benign, non-functioning adenomas, although according to various estimates even up to 30%–50% of patients with adrenal incidentaloma [...] Read more.
Due to the growing availability of imaging examinations the percentage of patients with incidentally diagnosed adrenal tumors has increased. The vast majority of these lesions are benign, non-functioning adenomas, although according to various estimates even up to 30%–50% of patients with adrenal incidentaloma may present biochemical hypercortisolemia, without typical clinical features of Cushing’s syndrome. Adrenal adenomas secreting small amounts of glucocorticoids may cause morphological and functional changes in the myocardium and blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with adrenal adenoma. Vascular changes precede the development of cardiovascular diseases and can increase morbidity and mortality in patients with adrenal incidentaloma. This risk may result not only from the traditional risk factors. Seemingly hormonally inactive adrenal tumors can indeed produce small amounts of glucocorticoids that have metabolic implications. Therefore, evaluation of patients with incidental adrenal findings presenting with subclinical cardiovascular disease seems of particular importance. Full article
Open AccessArticle
Electrocardiographic Changes in Liver Cirrhosis—Clues for Cirrhotic Cardiomyopathy
Medicina 2020, 56(2), 68; https://doi.org/10.3390/medicina56020068 - 10 Feb 2020
Viewed by 160
Abstract
Background and Objectives: Cirrhotic cardiomyopathy is a chronic cardiac dysfunction associated with liver cirrhosis, in patients without previous heart disease, irrespective of the etiology of cirrhosis. Electrocardiography (ECG) is an important way to evaluate patients with cirrhosis and may reveal significant [...] Read more.
Background and Objectives: Cirrhotic cardiomyopathy is a chronic cardiac dysfunction associated with liver cirrhosis, in patients without previous heart disease, irrespective of the etiology of cirrhosis. Electrocardiography (ECG) is an important way to evaluate patients with cirrhosis and may reveal significant changes associated with liver disease. Our study aimed to evaluate ECG changes in patients with diagnosed liver cirrhosis and compare them to patients with chronic hepatitis. Materials and Methods: We evaluated laboratory findings and ECG tracings in 63 patients with cirrhosis and 54 patients with chronic hepatitis of viral etiology. The end points of the study were prolonged QT interval, QRS hypovoltage and T-peak-to-T-end decrease. We confirmed the diagnosis of cirrhotic cardiomyopathy using echocardiography data. Results: Advanced liver disease was associated with prolonged QT intervals. Also, QRS amplitude was lower in patients with decompensated cirrhosis than in patients with compensated liver disease. We found an accentuated deceleration of the T wave in patients with cirrhosis. These findings correlated to serum levels of albumin, cholesterol and ammonia. Conclusions: ECG changes in liver cirrhosis are frequently encountered and are important noninvasive markers for the presence of cirrhotic cardiomyopathy. Full article
Open AccessReview
Safety and Tolerability of Ketamine Use in Treatment-Resistant Bipolar Depression Patients with Regard to Central Nervous System Symptomatology: Literature Review and Analysis
Medicina 2020, 56(2), 67; https://doi.org/10.3390/medicina56020067 - 09 Feb 2020
Viewed by 268
Abstract
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new [...] Read more.
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration. Full article
Open AccessArticle
Quality of Life in Patients with Surgically Removed Skin Tumors
Medicina 2020, 56(2), 66; https://doi.org/10.3390/medicina56020066 - 09 Feb 2020
Viewed by 187
Abstract
Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected [...] Read more.
Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients’ mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients’ quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically. Full article
(This article belongs to the Special Issue Interdisciplinary Medicine)
Open AccessArticle
Evaluation of Pain Management after Surgery: An Observational Study
Medicina 2020, 56(2), 65; https://doi.org/10.3390/medicina56020065 - 07 Feb 2020
Viewed by 228
Abstract
Background and Objectives: Choosing a pain management strategy is essential for improving recovery after surgery. Effective pain management reduces the stress response, facilitates mobilization, and improves the quality of the postoperative period. The aim of the study was to assess the effectiveness of [...] Read more.
Background and Objectives: Choosing a pain management strategy is essential for improving recovery after surgery. Effective pain management reduces the stress response, facilitates mobilization, and improves the quality of the postoperative period. The aim of the study was to assess the effectiveness of pain management in patients after surgery. Materials and Methods: The study included 216 patients operated on in the following surgical wards: the Department of Cardiosurgery and the Department of General and Endocrine Surgery. Patients were hospitalized on average for 6 ± 4.5 days. Patients were randomly selected for the study using a questionnaire technique with a numerical rating scale. Results: Immediately after surgery, pre-emptive analgesia, multimodal analgesia, and analgosedation were used significantly more frequently than other methods (p < 0.001). In the subsequent postoperative days, the method of administering drugs on demand was used most often. Patients with confirmed complications during postoperative wound healing required significantly more frequent use of drugs from Steps 2 and 3 of the World Health Organization (WHO) analgesic ladder compared with patients without complications. Conclusion: The mode of patient admission for surgery significantly affected the level of pain perception. Different pain management methods were used and not every method was effective. Full article
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Open AccessCase Report
A Rare Case of Fatal Endobronchial Mucormycosis Masquerading as Endobronchial Tuberculosis
Medicina 2020, 56(2), 64; https://doi.org/10.3390/medicina56020064 - 06 Feb 2020
Viewed by 254
Abstract
Pulmonary mucormycosis is a relatively rare but often fatal opportunistic fungal infection that occurs mostly in immunocompromised patients. Endobronchial mucormycosis, a distinct clinical form of pulmonary mucormycosis, is very rare, and only a few cases have been reported. The most common bronchoscopic findings [...] Read more.
Pulmonary mucormycosis is a relatively rare but often fatal opportunistic fungal infection that occurs mostly in immunocompromised patients. Endobronchial mucormycosis, a distinct clinical form of pulmonary mucormycosis, is very rare, and only a few cases have been reported. The most common bronchoscopic findings in patients with endobronchial mucormycosis are stenosis, erythematous mucosa and airway obstruction. Here, we present a case of fatal endobronchial mucormycosis mimicking actively caseating endobronchial tuberculosis in a young diabetic patient living in a country with an intermediate tuberculosis burden. Full article
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Open AccessArticle
A Meta-Analysis Comparing the Efficacy and Safety of Peramivir with Other Neuraminidase Inhibitors for Influenza Treatment
Medicina 2020, 56(2), 63; https://doi.org/10.3390/medicina56020063 - 05 Feb 2020
Viewed by 347
Abstract
Background and Objectives: This meta-analysis compared the efficacy and safety of peramivir compared to other neuraminidase inhibitors (NAIs). Materials and Methods: Data from PubMed, Embase, and Cochrane databases and ClinicalTrials.gov were searched until January 2019. Randomized controlled trials (RCTs) and observational studies [...] Read more.
Background and Objectives: This meta-analysis compared the efficacy and safety of peramivir compared to other neuraminidase inhibitors (NAIs). Materials and Methods: Data from PubMed, Embase, and Cochrane databases and ClinicalTrials.gov were searched until January 2019. Randomized controlled trials (RCTs) and observational studies (OSs) comparing peramivir with other NAIs for treating influenza were included. The Grading of Recommendations, Assessments, Development, and Evaluations (GRADE) system was used to judge the overall certainty of evidence; the result was moderate. The primary outcome was time to alleviation of symptoms. Twelve articles involving 2681 patients were included in this meta-analysis. We used a random-effect model to pool the effect size, which is expressed as the difference in means (MD), risk ratio (RR), and 95% confidence interval (CI). Results: Overall, peramivir was superior to other NAIs (MD = −11.214 hours, 95% CI: −19.119 to −3.310). The incidence of adverse events (RR = 1.023, 95% CI: 0.717 to 1.460) and serious adverse events (RR = 1.068, 95% CI: 0.702 to 1.625) in the peramivir group was similar to those in the oseltamivir group. In addition, peramivir had higher efficacy than each NAI alone. Conclusion: In conclusion, the efficacy of peramivir might be higher than that of other NAIs, and this agent is tolerated as well as other NAIs. Full article
Open AccessCase Report
Rare Breast Carcinoma with Paradoxical Plasma Cell Immunoprofile: A Case Report
Medicina 2020, 56(2), 62; https://doi.org/10.3390/medicina56020062 - 05 Feb 2020
Viewed by 186
Abstract
Plasma cell features are encountered in a variety of non-plasma cell neoplasias, especially carcinomas of a discohesive type, such as those occurring in the digestive tract and breast. Lobular carcinomas of the breast present themselves in a variety of architectural patterns and many [...] Read more.
Plasma cell features are encountered in a variety of non-plasma cell neoplasias, especially carcinomas of a discohesive type, such as those occurring in the digestive tract and breast. Lobular carcinomas of the breast present themselves in a variety of architectural patterns and many cell morphologies, including plasmacytoid types. A matching plasma cell phenotype is sometimes an associated feature. We report a case of a moderate grade invasive lobular carcinoma with focal plasmacytoid morphology and aberrant expression of plasma cell markers in a patient previously diagnosed with multiple myeloma. Paradoxical plasma cell immunoprofiles can be encountered in many malignancies, causing serious diagnostic problems, even more so with those occurring in discohesive carcinomas in multiple myeloma patients. Full article
Open AccessArticle
The Impact of Prostate Cancer Upgrading and Upstaging on Biochemical Recurrence and Cancer-Specific Survival
Medicina 2020, 56(2), 61; https://doi.org/10.3390/medicina56020061 - 04 Feb 2020
Viewed by 187
Abstract
Background and Objectives: Significant numbers of prostate cancer (PCa) patients experience tumour upgrading and upstaging between prostate biopsy and radical prostatectomy (RP) specimens. The aim of our study was to investigate the role of grade and stage increase on surgical and oncological [...] Read more.
Background and Objectives: Significant numbers of prostate cancer (PCa) patients experience tumour upgrading and upstaging between prostate biopsy and radical prostatectomy (RP) specimens. The aim of our study was to investigate the role of grade and stage increase on surgical and oncological outcomes. Materials and Methods: Upgrading and upstaging rates were analysed in 676 treatment-naïve PCa patients who underwent RP with subsequent follow-up. Positive surgical margin (PSM), biochemical recurrence (BCR), metastasis-free survival (MFS), overall (OS) and cancer specific survival (CSS) were analysed according to upgrading and upstaging. Results: Upgrading was observed in 29% and upstaging in 22% of PCa patients. Patients undergoing upgrading or upstaging were 1.5 times more likely to have a PSM on RP pathology. Both upgrading and upstaging were associated with increased risk for BCR: 1.8 and 2.1 times, respectively. Mean time to BCR after RP was 2.1 years in upgraded cases and 2.7 years in patients with no upgrading (p <0.001), while mean time to BCR was 1.9 years in upstaged and 2.8 years in non-upstaged cases (p <0.001). Grade and stage increase after RP were associated with inferior MFS rates and ten-year CSS: 89% vs. 98% for upgrading (p = 0.039) and 87% vs. 98% for upstaging (p = 0.008). Conclusions: Currently used risk stratification models are associated with substantial misdiagnosis. Pathological upgrading and upstaging have been associated with inferior surgical results, substantial higher risk of BCR and inferior rates of important oncological outcomes, which should be considered when counselling PCa patients at the time of diagnosis or after definitive therapy. Full article
Open AccessArticle
Discharge Planning and Home Care Needs Assessment for Older Patients in a Nursing Hospital
Medicina 2020, 56(2), 60; https://doi.org/10.3390/medicina56020060 - 04 Feb 2020
Viewed by 192
Abstract
Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and [...] Read more.
Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90–120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Full article
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Open AccessArticle
Impact of Tree Pollen Distribution on Allergic Diseases in Serbia: Evidence of Implementation of Allergen Immunotherapy to Betula verrucosa
Medicina 2020, 56(2), 59; https://doi.org/10.3390/medicina56020059 - 04 Feb 2020
Viewed by 205
Abstract
Background and objectives: The relationship between air pollen quantity and the sensitization of allergic patients is crucial for both the diagnosis and treatment of allergic diseases. Weather conditions influence the distribution of allergenic pollen and increases in pollen concentration may negatively affect the [...] Read more.
Background and objectives: The relationship between air pollen quantity and the sensitization of allergic patients is crucial for both the diagnosis and treatment of allergic diseases. Weather conditions influence the distribution of allergenic pollen and increases in pollen concentration may negatively affect the health of allergic patients. The aim of this study was to analyze the implementation of allergen immunotherapy with regard to air pollen concentration. Material and Methods: Here we examined the relationship between Betula air pollen concentration and the usage of Betula verrucosa allergen immunotherapy in Serbia. Examination covered the period from 2015 to 2018. Measurement of airborne pollen concentration was performed with Lanzoni volumetric pollen traps. The evidence of the usage of sublingual allergen immunotherapy (SLIT) was gathered from patients with documented sensitization to specific pollen. Results: During this period tree pollens were represented with 58% ± 21% of all measured air pollen species, while Betula pollen represented 15% ± 8% of all tree pollens. Betula pollination peaked in April. Allergen immunotherapy to Betula verrucosa in Serbia is entirely conducted as sublingual immunotherapy and represents 47.1% ± 1.4% of issued tree pollen SLIT. The use of pollen SLIT increased by 68% from 2015 to 2018, with an even greater increase in usage recorded for Betula SLIT—80%. Conclusions: This analysis shows a clear causative relationship between pollination and the type/prevalence of applied allergen immunotherapy. Information about the flowering seasons of allergenic plants is very important for people who suffer from allergy, for clinical allergologists, as well as for governing authorities. The presented data is of practical importance to the proper timing of immunotherapy initiation and of importance for urban landscaping. The obtained data can be the starting point for the instatement of a thorough epidemiological study and the inclusion of Serbia on the pollen map of Europe. Full article
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