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Medicina, Volume 61, Issue 2 (February 2025) – 177 articles

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10 pages, 524 KiB  
Review
Mathematical Modeling and Artificial Intelligence to Explore Connections Between Glaucoma and the Gut Microbiome
by Madeline C. Rocks, Priyanka Bhatnagar, Alice Verticchio Vercellin, Lorenzo Sala, Brent Siesky, Gal Antman, Keren Wood, Riccardo Sacco and Alon Harris
Medicina 2025, 61(2), 343; https://doi.org/10.3390/medicina61020343 (registering DOI) - 14 Feb 2025
Abstract
Background and Objectives: Glaucoma is a major cause of irreversible blindness, with primary open-angle glaucoma (POAG) being the most prevalent form. While elevated intraocular pressure (IOP) is a well-known risk factor for POAG, emerging evidence suggests that the human gut microbiome may also [...] Read more.
Background and Objectives: Glaucoma is a major cause of irreversible blindness, with primary open-angle glaucoma (POAG) being the most prevalent form. While elevated intraocular pressure (IOP) is a well-known risk factor for POAG, emerging evidence suggests that the human gut microbiome may also play a role in the disease. This review synthesizes current findings on the relationship between gut microbiome and glaucoma, with a focus on mathematical modeling and artificial intelligence (AI) approaches to uncover key insights. Materials and Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, covering studies from its inception to 1 August 2024. Selected studies included basic science, observational research, and those incorporating mathematical-related models. Results: Traditional statistical and machine learning approaches, such as random forest regression and Mendelian randomization, have identified associations between specific microbiota and POAG features. These findings highlight the potential of AI to explore complex, nonlinear interactions in the gut–eye axis. However, limitations include variability in study designs and a lack of integrative, mechanistic models. Conclusions: Preliminary evidence supports the existence of a gut–eye axis influencing POAG disease. Combining data-driven and mechanism-driven models with AI could identify therapeutic targets and novel biomarkers. Future research should prioritize longitudinal studies in diverse populations and integrate physiological data to improve model accuracy and clinical relevance. Furthermore, physics-based models could deepen our mechanistic understanding of the gut–eye axis in glaucoma, advancing beyond associative findings to actionable insights. Full article
(This article belongs to the Special Issue The Pathophysiology and Treatment of Glaucoma)
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15 pages, 1484 KiB  
Review
Sarcoidosis-Associated Pulmonary Hypertension
by Yoshitaka Morimatsu, Nobuhiro Tahara, Masaki Okamoto, Munehisa Bekki, Atsuko Tahara, Yoshiko Eto, Tadahiro Kugai, Yuki Koga, Shoko Maeda-Ogata, Akihiro Honda, Sachiyo Igata, Yoshiaki Zaizen, Shuichi Tanoue, Tomoaki Hoshino, Tatsuya Ishitake and Yoshihiro Fukumoto
Medicina 2025, 61(2), 342; https://doi.org/10.3390/medicina61020342 (registering DOI) - 14 Feb 2025
Abstract
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by multisystem non-caseating granulomas. Pulmonary hypertension (PH) is a well-known complication of sarcoidosis and is associated with increased morbidity and mortality. The actual epidemiology of sarcoidosis-associated PH (SAPH) remains unknown, and its pathogenesis has [...] Read more.
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by multisystem non-caseating granulomas. Pulmonary hypertension (PH) is a well-known complication of sarcoidosis and is associated with increased morbidity and mortality. The actual epidemiology of sarcoidosis-associated PH (SAPH) remains unknown, and its pathogenesis has not been fully elucidated. SAPH is classified under the miscellaneous category (group 5 of the PH classification). The clinical presentation of SAPH is variable and not always proportional to the severity of sarcoidosis. Appropriate management for SAPH by an experienced physician is important; however, no treatment algorithm for SAPH has been established. Lung transplantation should be considered in refractory cases. Pulmonary arterial hypertension-specific vasodilators targeting the endothelin pathway, nitric oxide pathway, and prostacyclin pathway have improved the clinical functions and hemodynamics in some patients with SAPH. Full article
10 pages, 266 KiB  
Article
Evaluation of Asthma Course in Patients Hospitalized in Pediatric Intensive Care Unit Due to Severe Asthma Exacerbation
by Ahmet Selmanoglu, Hatice Irmak Celik, Cankat Genis, Esra Kockuzu, Zeynep Sengul Emeksiz and Emine Dibek Misirlioglu
Medicina 2025, 61(2), 341; https://doi.org/10.3390/medicina61020341 (registering DOI) - 14 Feb 2025
Abstract
Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors [...] Read more.
Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors of patients admitted to the Pediatric Intensive Care Unit (PICU) due to severe asthma exacerbations. Materials and Methods: We assessed patients admitted to the Ankara Bilkent City Hospital PICU from January 2013 to December 2022 diagnosed with asthma based on GINA criteria. The collected data encompassed demographic and clinical characteristics, intensive care treatments, hospitalization duration, atopic conditions, and respiratory viral panel results. The current clinical status was assessed using hospital records and caregiver interviews, with a focus on recent emergency admissions, ongoing treatments, exacerbation frequency, and asthma control based on GINA guidelines. Results: The study comprised 83 patients with a mean age of 72.9 (±45.5) months, predominantly male (63.9%). The average follow-up duration post-discharge was 40.7 ± 26.9 months. Patients received respiratory support in the ICU for a mean of 3.8 (±2.8) days and systemic steroid therapy for 4 (±1.5) days. Respiratory viral panel results identified pathogens in 42 patients, with rhinovirus being the most frequent. Post-discharge, 72.3% of patients continued follow-up at pediatric allergy clinics. Of the 60 patients contacted, 67.5% were on current asthma treatment and 48.2% had experienced an exacerbation in the past year. Asthma management steps remained unchanged for 33 patients, decreased for 13, and increased for 47 (44.6%). Asthma maintenance treatments pre-admission and post-discharge showed that 44.6% (n = 47) of the patients required an increase in their GINA treatment step after PICU admission, which was statistically significant (p < 0.001). History of atopic dermatitis was a significant risk factor for escalating treatment steps in both univariate and multivariate analyses (p = 0.018, p = 0.03). Conclusions: We found that admission to the PICU due to severe asthma exacerbation not only increases the risk of recurrent asthma exacerbations but also serves as a risk factor for stepping up maintenance treatment according to GINA guidelines during long-term follow-up. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Severe Asthma)
18 pages, 7036 KiB  
Article
Comparison of Standard Neoadjuvant Therapy and Total Neoadjuvant Therapy in Terms of Effectiveness in Patients Diagnosed with Locally Advanced Rectal Cancer
by Ayberk Bayramgil, Ahmet Bilici, Ali Murat Tatlı, Seda Kahraman, Yunus Emre Altintas, Fahri Akgul, Musa Barış Aykan, Jamshid Hamdard, Sema Sezgin Göksu, Mehmet Ali Nahit Şendur, Fatih Selçukbiricik and Ömer Fatih Ölmez
Medicina 2025, 61(2), 340; https://doi.org/10.3390/medicina61020340 - 14 Feb 2025
Abstract
Background/Objectives: The study aimed to compare the treatment effectiveness of patients with locally advanced rectal cancer undergoing standard neoadjuvant therapy or total neoadjuvant therapy. It also sought to identify prognostic factors for disease-free survival and overall survival and parameters predictive of pathological [...] Read more.
Background/Objectives: The study aimed to compare the treatment effectiveness of patients with locally advanced rectal cancer undergoing standard neoadjuvant therapy or total neoadjuvant therapy. It also sought to identify prognostic factors for disease-free survival and overall survival and parameters predictive of pathological complete response. Materials and Methods: A retrospective analysis was conducted on 239 patients diagnosed with locally advanced rectal cancer between 2016 and 2022 at several medical centers in Turkey. Clinical data, including neoadjuvant chemoradiotherapy types, chemotherapy regimens, surgical outcomes, and survival metrics, were collected. Statistical analyses included chi-square tests, Kaplan–Meier survival analysis, and Cox proportional hazard models to evaluate prognostic factors for disease-free survival and overall survival and logistic regression to identify predictors of pathological complete response. Results: Among 239 patients, 46.9% received total neoadjuvant therapy, while 53.1% underwent standard neoadjuvant therapy. Total neoadjuvant therapy was associated with a significantly higher pathological complete response rate (45.5% vs. 14.9% in standard neoadjuvant therapy; p < 0.001) and longer disease-free survival (median 124.2 vs. 72.4 months). The 3-year overall survival rate for all patients was 90.7%, and disease-free survival was 76.8%. Multivariate analysis identified pathological complete response (HR: 2.34), total neoadjuvant therapy (HR: 5.12), and type of surgery (HR: 8.12) as independent prognostic factors for disease-free survival, and pathological complete response and absence of lymphovascular invasion as independent prognostic factors for overall survival. Logistic regression analysis showed that total neoadjuvant therapy (OR: 4.40) and initial neoadjuvant chemotherapy (OR: 2.02) were independent predictors of achieving pathological complete response. Conclusions: Total neoadjuvant therapy significantly improves pathological complete response rates, disease-free survival, and overall survival in patients with locally advanced rectal cancer compared to standard neoadjuvant therapy. Total neoadjuvant therapy and achieving pathological complete response are strong independent prognostic factors for both disease-free survival and overall survival, suggesting that a more intensive neoadjuvant approach may lead to better outcomes in locally advanced rectal cancer. The increased pathological complete responses rate with total neoadjuvant therapy has created an opportunity for the development of new treatment modalities and the advancement of non-surgical management strategies in the future. Full article
(This article belongs to the Section Oncology)
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5 pages, 574 KiB  
Case Report
Cutaneous Anguillulosis During Immunotherapy for Metastatic Renal Cell Carcinoma
by Pierre Cornillon, Marie Beguinot, Denis Maillet, Wafa Bouleftour, Yanis Bouqallaba, Pierre Flori, Pauline Corbaux and Guorong Li
Medicina 2025, 61(2), 339; https://doi.org/10.3390/medicina61020339 - 14 Feb 2025
Abstract
Immunotherapy has been widely applied to treat metastatic renal cell cancer patients. Managing the side effects of immunotherapy can be a challenge. Here, we describe a rare presentation of cutaneous anguillulosis during immunotherapy. The patient experienced a rash eruption after receiving immunotherapy for [...] Read more.
Immunotherapy has been widely applied to treat metastatic renal cell cancer patients. Managing the side effects of immunotherapy can be a challenge. Here, we describe a rare presentation of cutaneous anguillulosis during immunotherapy. The patient experienced a rash eruption after receiving immunotherapy for metastatic renal cell cancer. The diagnosis of skin toxicity caused by immunotherapy was rejected after the failure of treatment by cortisone. The travelling history and a laboratory test confirmed the presence of anguillulosis infection. A diagnosis of cutaneous anguillulosis was established. Satisfactory treatment with ivermectin was achieved for cutaneous lesions. Immunotherapy was restored without any skin symptoms. We suggested the possible mechanism of cutaneous demonstration of immune inflammatory syndrome during the immunotherapy of a cancer patient with parasitic infection. It was concluded that a comprehensive search for previous infectious pathogens should be performed to ensure a correct diagnosis and timely treatment. Full article
(This article belongs to the Section Oncology)
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14 pages, 910 KiB  
Article
Causes and Clinical Outcomes of Acute Kidney Injury After Cardiac Arrest: A Retrospective Cohort Study
by Murat Aslan, Rabia Yılmaz, Dicle Birtane and Zafer Çukurova
Medicina 2025, 61(2), 338; https://doi.org/10.3390/medicina61020338 - 14 Feb 2025
Abstract
Background and Objectives: The development of acute kidney injury (AKI) in the post-cardiopulmonary resuscitation (post-CPR) period is a common pathology that has not been adequately investigated but contributes significantly to morbidity and mortality. We aimed to investigate the causes of AKI in the [...] Read more.
Background and Objectives: The development of acute kidney injury (AKI) in the post-cardiopulmonary resuscitation (post-CPR) period is a common pathology that has not been adequately investigated but contributes significantly to morbidity and mortality. We aimed to investigate the causes of AKI in the early post-CPR period. Materials and Methods: This study was performed retrospectively in 82 adult patients who survived for at least 2 days out of 312 patients admitted to the intensive care unit after cardiac arrest in 2013–2022. AKI developed in 40 (48.7%) of these 82 patients (AKI 1–3 patient, respectively: 14, 13, 13). Binary logistic regression analysis was performed separately to determine the risk factors for AKI and mortality. Results: Each unit increase in BMI increased the risk of developing AKI by 1.272-fold, and the increase was statistically significant [OR (95%CI) = 1.272 (1.089–1486); p = 0.002]. The use of VSP and INO treatment alone increased the risk of AKI by approximately 14-fold, and this increase was statistically significant [OR (95%CI) = 14.225 (1.172–172.669); p = 0.037]. The combined use of VSP and INO treatment increased the risk of AKI by approximately 42-fold, and this increase was statistically significant [OR (95%CI) = 42.089 (2.683–660.201); p = 0.008]. The COVID-19 period alone increased the risk of developing AKI by 2.8-fold compared to the non-COVID-19 period, but the statistical significance of this increase was limited [OR (95%CI) = 2.801 (0.859–9.126); p = 0.088]. The development of AKI was not associated with mortality [OR (95%CI) = 2.194 (0.700–6.872); p = 0.178]. Conclusions: Having VSP and/or INO support and high BMI in the post-CPR period are the most important reasons for the development of AKI. COVID-19 may also increase the risk of developing AKI. Full article
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12 pages, 697 KiB  
Article
Atrial Fibrillation as an Independent Predictor of Myocardial Ischemia
by Aris Bechlioulis, Aidonis Rammos, Athanassios Papadopoulos, Paraskeni Zotou, Sotiria Alexiou, Areti Kekiopoulou, Lampros K. Michalis, Katerina K. Naka, Chrissa Sioka and Christos Katsouras
Medicina 2025, 61(2), 337; https://doi.org/10.3390/medicina61020337 - 14 Feb 2025
Abstract
Background and Objectives: Atrial fibrillation (AF) and coronary artery disease (CAD) are highly prevalent cardiovascular conditions. This study investigated the role of AF in myocardial ischemia, as assessed with myocardial perfusion imaging (MPI), in patients with suspected stable CAD. Materials and Methods: Our [...] Read more.
Background and Objectives: Atrial fibrillation (AF) and coronary artery disease (CAD) are highly prevalent cardiovascular conditions. This study investigated the role of AF in myocardial ischemia, as assessed with myocardial perfusion imaging (MPI), in patients with suspected stable CAD. Materials and Methods: Our retrospective study included 259 individuals with a negative medical history of CAD who underwent 99mTc tetrofosmin MPI—single-photon emission computed tomography (SPECT)—for nonspecific symptoms to rule out stable CAD. Results: Of the enrolled patients, 90 MPIs were from patients with AF and 169 MPIs were from patients without AF. Semi-quantitative assessments of the extent and severity of perfusion abnormalities according to the summed stress score (SSS) and summed difference score (SDS) were conducted. It was found that patients with a history of AF, compared to patients without AF, were older (p < 0.001), of the male gender (p < 0.001), and had dyslipidemia (p = 0.019). History of AF was associated with increased SSS ≥ 4 (OR 5.12, p < 0.001) and SDS ≥ 2 (OR 2.66, p < 0.001). After adjustment for other risk factors, AF remained an independent predictor of myocardial ischemia on MPI-SPECT. Conclusions: In the current study, an association of AF with extensive perfusion defects in MPI-SPECT studies was found in patients with clinically suspected CAD independently of common cardiovascular risk factors. Full article
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10 pages, 539 KiB  
Article
The Effects of Remimazolam and Inhalational Anesthetics on the Incidence of Postoperative Hyperactive Delirium in Geriatric Patients Undergoing Hip or Femur Surgery Under General Anesthesia: A Retrospective Observational Study
by Jimin Kim, Sangseok Lee, Byung Hoon Yoo, Yun Hee Lim and In-Jung Jun
Medicina 2025, 61(2), 336; https://doi.org/10.3390/medicina61020336 - 14 Feb 2025
Viewed by 78
Abstract
Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19–65% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative [...] Read more.
Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19–65% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative administration of benzodiazepines, particularly midazolam, is associated with an increased incidence of POD. Remimazolam, a novel ultra-short-acting benzodiazepine, has potential benefits, such as hemodynamic stability and ease of reversal, but its effect on POD occurrence remains unclear. Materials and Methods: This retrospective study investigated patients who were aged 65 years old and older who underwent hip or femur surgery. Following the application of exclusion criteria, 502 patients were grouped according to whether anesthesia was maintained with remimazolam (R group) or sevoflurane (S group). Data regarding patients’ baseline characteristics, anesthetic details, and postoperative outcomes, including the incidence of POD, were gathered and analyzed. Propensity score matching and logistic regression were conducted to identify factors associated with POD and compare outcomes between the two groups. Results: Among the 502 patients, POD was observed in 161 (32%). The POD incidence was not statistically significantly different between the groups (p = 1.000). A multivariable logistic regression analysis indicated that remimazolam was not a determinant of POD (p = 0.860), whereas being male and polypharmacy were (p = 0.022; p = 0.047). Initial disparities in age and comorbid conditions between the groups were rectified through matching, demonstrating that remimazolam had a similar POD risk to sevoflurane. Conclusions: This study showed that remimazolam did not exacerbate the risk of POD in elderly patients undergoing hip or femur surgery. Remimazolam is a reliable anesthetic option for this vulnerable demographic. Also, this study’s results indicated that polypharmacy and being male are POD risk factors, suggesting that meticulous perioperative medication management may help alleviate the risk of POD. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)
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18 pages, 6173 KiB  
Article
Ameliorative Effect of N-Acetylcysteine Against 5-Fluorouracil-Induced Cardiotoxicity via Targeting TLR4/NF-κB and Nrf2/HO-1 Pathways
by Omer Abdelbagi, Medhat Taha, Abdullah G. Al-Kushi, Mohammad Ahmad Alobaidy, Tourki A. S. Baokbah, Hatem A. Sembawa, Zohor Asaad Azher, Rami Obaid, Omar Babateen, Bayan T. Bokhari, Naeem F. Qusty and Hesham A. Malak
Medicina 2025, 61(2), 335; https://doi.org/10.3390/medicina61020335 - 14 Feb 2025
Viewed by 98
Abstract
Background and Objectives: 5-Fluorouracil (5-FU) is a widely prescribed and effective chemotherapeutic drug, but its cardiotoxic side effects pose a significant challenge to its use. Identifying a protective agent that does not affect its anticancer efficacy is essential. Our study aimed to [...] Read more.
Background and Objectives: 5-Fluorouracil (5-FU) is a widely prescribed and effective chemotherapeutic drug, but its cardiotoxic side effects pose a significant challenge to its use. Identifying a protective agent that does not affect its anticancer efficacy is essential. Our study aimed to investigate the cardioprotective effect of N-acetyl cysteine (NAC) against 5-FU-induced cardiac injury and to elucidate the underlying mechanisms. Materials and Methods: This study included four experimental groups, each with eight rats (n = 8): Group I (control group), Group II (NAC group), Group III (5-FU group), and Group IV (combined group 5-FU+NAC). Cardiac enzymes, oxidative stress, inflammatory, and apoptotic markers were investigated, and cardiac sections from the different groups were histologically examined. Results: Co-treatment of 5-FU with NAC resulted in significantly lower levels of cardiac enzymes (alanine transaminase (ALT) by 62.1%, aspartate transaminase (AST) by 73.6%, lactate dehydrogenase (LDH) by 55.8%, and creatine kinase (CK) by 57.3%) compared to the 5-FU group, along with marked improvements in heart tissue histology. Additionally, NAC enhanced the activity of cardiac antioxidant enzymes (superoxide dismutase (SOD) by 295.6%, catalase (CAT) by 181%, and glutathione peroxidase (GPx) by 320.9%) while decreasing malondialdehyde (MDA) by 51.1%, a marker of membranous lipid peroxidation. This might be due to significant upregulation of the nuclear factor erythroid-2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway at the gene and protein levels. The combined treatment significantly decreased the gene expression of the toll-like receptor 4 (TLR4)/nuclear factor kappa-light-chain-enhancer of activated B-cell (NF-κB) pathway. Furthermore, it downregulated the protein levels of inflammatory markers, including tumor necrosis factor-alpha (TNF-α) by 29.9%, interleukin-1 beta (IL-1β) by 21.9%, and interleukin-6 (IL-6) by 49.3%. Moreover, it upregulated the antiapoptotic marker B-cell lymphoma 2 (Bcl-2) protein levels by 269% and decreased apoptotic indicators Bcl-2-associated protein x (Bax) by 57.9% and caspase-3 by 30.6% compared to the 5-FU group. Conclusions: This study confirmed that NAC prevented the cardiotoxic effect of 5-FU through its antioxidant, anti-inflammatory, and antiapoptotic properties, suggesting its potential application as an adjuvant therapy in chemotherapy to alleviate 5-FU-induced cardiotoxicity. Full article
(This article belongs to the Section Pharmacology)
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13 pages, 1112 KiB  
Case Report
Dermatomyositis as the First Manifestation of Nasopharyngeal Carcinoma—A Rare Case Report
by Bojana Knežević, Tatjana Radević and Milan Petronijević
Medicina 2025, 61(2), 334; https://doi.org/10.3390/medicina61020334 - 14 Feb 2025
Viewed by 120
Abstract
Nasopharyngeal carcinoma (NPC) with paraneoplastic dermatomyositis (DM) is an exceptionally rare clinical phenomenon, particularly among European populations. This case report details a 46-year-old woman initially diagnosed with DM, later confirmed to have NPC. Such an association is more frequently documented in Asian populations, [...] Read more.
Nasopharyngeal carcinoma (NPC) with paraneoplastic dermatomyositis (DM) is an exceptionally rare clinical phenomenon, particularly among European populations. This case report details a 46-year-old woman initially diagnosed with DM, later confirmed to have NPC. Such an association is more frequently documented in Asian populations, highlighting its unique presentation in this case. The patient first developed symptoms in December 2016, which progressed significantly by spring 2017, manifesting as progressive proximal muscle weakness, characteristic skin changes, and elevated muscle enzyme levels. Diagnostic workup, including electromyography and biopsy, confirmed DM. Persistent symptoms and secondary DM suspicion prompted further malignancy screening, which identified undifferentiated NPC with strong Epstein–Barr virus RNA positivity. Multimodal treatment comprising corticosteroids, hydroxychloroquine, chemotherapy, and radiotherapy led to temporary symptomatic improvement. Despite initial success, the patient’s condition deteriorated, and she passed away by the end of 2018. This case underscores the importance of comprehensive malignancy screening in DM patients, considering rarer cancers like NPC even in non-endemic regions. It emphasizes the role of multidisciplinary care and adherence to international guidelines for managing such complex cases. Recognizing NPC-associated DM remains critical for early intervention and tailored therapeutic approaches to improve clinical outcomes and survival. Full article
(This article belongs to the Section Dermatology)
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14 pages, 686 KiB  
Article
Echocardiographic Left Ventricular Function in the Third Year After COVID-19 Hospitalization: A Follow-Up Pilot Study in South-East of Romania
by Constantin-Marinel Vlase, Cristian Gutu, Roxana Elena Bogdan Goroftei, Andreea Boghean, Traian Florin Daniel Iordachi, Anca-Adriana Arbune and Manuela Arbune
Medicina 2025, 61(2), 333; https://doi.org/10.3390/medicina61020333 - 14 Feb 2025
Viewed by 108
Abstract
Background and Objectives: Cardiac involvement in COVID-19 has been confirmed during the acute stage of the infection. However, the prevalence and spectrum of post-infectious cardiac dysfunction remain incompletely clarified. The objective of our study was to evaluate the frequency of echocardiographic changes [...] Read more.
Background and Objectives: Cardiac involvement in COVID-19 has been confirmed during the acute stage of the infection. However, the prevalence and spectrum of post-infectious cardiac dysfunction remain incompletely clarified. The objective of our study was to evaluate the frequency of echocardiographic changes 2 years after hospitalization for moderate and severe COVID-19 in patients with no previously known cardiac pathology. Material and Methods: We conducted a retrospective cohort study analyzing severity markers of COVID-19 infection and echocardiographic parameters assessed ≥2 years after the acute illness, based on recent guideline recommended algorithm for echocardiographic diagnostic of left ventricular (LV) dysfunction. Results: The study included 50 Caucasian patients, 60% male, 54% aged < 65 years, and 32% with severe forms of the disease. The primary comorbidities were hypertension, obesity, and diabetes. COVID-19 severity correlated with the computed tomography (CT) lung lesion score and a neutrophil-to-lymphocyte ratio >6 but was not associated with post-COVID-19 echocardiographic changes. Left ventricular ejection fraction (LVEF) was reduced in only 18% of cases, but global longitudinal strain (GLS) impairment was observed in 46% of patients, contributing to the LV systolic subclinical dysfunction in 61%. Impaired LV diastolic disfunction with normal pressure filling was present in 30.61% of cases and with elevated pressure 10.2%. Conclusions: COVID-19 is an independent predictive factor for GLS impairment, which can indicate myocardial contractile dysfunction, even in patients with asymptomatic heart disease. This underscores the importance of regular echocardiographic monitoring for patients recovering from moderate to severe COVID-19. Full article
(This article belongs to the Special Issue New Insights into Heart Failure)
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8 pages, 225 KiB  
Article
Telehealth—An Environmentally Friendly Way to Take Care of Patients with Inflammatory Bowel Disease
by Srdjan Marković, Djordje Kralj, Tamara Knežević Ivanovski and Petar Svorcan
Medicina 2025, 61(2), 332; https://doi.org/10.3390/medicina61020332 - 14 Feb 2025
Viewed by 35
Abstract
Background and Objectives: On 11 March 2020, our hospital adapted to the COVID-19 pandemic by becoming a temporary COVID-19 facility, leading to the suspension or delegation of non-COVID-19 services. Among the international IBD community, there were significant concerns regarding the neglect of immunocompromised [...] Read more.
Background and Objectives: On 11 March 2020, our hospital adapted to the COVID-19 pandemic by becoming a temporary COVID-19 facility, leading to the suspension or delegation of non-COVID-19 services. Among the international IBD community, there were significant concerns regarding the neglect of immunocompromised IBD patients and their increased vulnerability to COVID-19. To address these challenges, the COVID-19 ECCO Taskforce recommended the implementation of telehealth. Following this recommendation, our hospital’s IT department integrated audiovisual hardware and software solutions to facilitate virtual consultations. This approach enabled patients and their local physicians to receive formal reports comparable to those issued during standard in-person care. Materials and Methods: We retrospectively analyzed data from patients diagnosed with Crohn’s disease and ulcerative colitis who participated in telemedicine consultations. Average distances and time saved were calculated using Google Maps, while carbon emissions and carbon footprint reductions were determined. Results: Between 11 August 2021 and 15 June 2023, 107 telehealth consultations were completed. Patients benefited from reduced travel distances, with an average saving of 168.28 km per consultation and a total reduction of 18,006 km. Travel time savings averaged 2 h and 22 min per consultation, amounting to a total of 252 h saved. The reduction in carbon emissions was calculated at 3.26 tons, equivalent to the annual absorption capacity of 109 fully grown trees, considering that an individual tree absorbs approximately 21.77 kg of CO2 annually. These findings underscore telemedicine’s role in reducing environmental impact while enhancing patient convenience. Conclusions: The adoption of telehealth successfully optimized outpatient clinic operations, maintaining high-quality patient outcomes while contributing to environmental sustainability. Full article
17 pages, 2811 KiB  
Systematic Review
Effectiveness and Safety of SYSADOAs Used in Eastern and Western Regions for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials—SYSADOAs Are Effective and Safe for Knee OA
by Yong-Beom Park and Jun-Ho Kim
Medicina 2025, 61(2), 331; https://doi.org/10.3390/medicina61020331 - 13 Feb 2025
Viewed by 205
Abstract
Background: According to international guidelines, glucosamine and chondroitin, regarded as slow-acting drugs for osteoarthritis (SYSADOAs), have been first-line treatments for knee osteoarthritis (OA); however, their efficacies remain controversial. Additionally, the efficacies of plant extract cocktails, SKI306X, and its newer formulation, SKCPT, have [...] Read more.
Background: According to international guidelines, glucosamine and chondroitin, regarded as slow-acting drugs for osteoarthritis (SYSADOAs), have been first-line treatments for knee osteoarthritis (OA); however, their efficacies remain controversial. Additionally, the efficacies of plant extract cocktails, SKI306X, and its newer formulation, SKCPT, have not been well investigated. Aims: To evaluate the effectiveness and safety of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) in patients with knee OA. Methods: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) assessing the effectiveness and safety of SYSADOAs, including chondroitin sulfate, glucosamine sulfate, and SKCPT/SKI306X. The outcomes included pain relief, functional improvements, and safety profiles. The outcome measurements were compared between the treatment and control groups, including placebo and non-placebo groups, within and after 3 months of follow-up. Results: Analysis of 21 RCTs showed significantly greater improvement in pain relief in the treatment group compared with the placebo group both within (standard mean difference [SMD], 0.38; 95% confidence interval [CI], 0.18–0.57; p < 0.001) and after 3 months of follow-up (SMD, 0.22; 95%CI, 0.03–0.42 p = 0.023). The treatment group also showed significantly greater functional improvements regardless of follow-up. Pain and functional improvement did not differ significantly between the treatment and non-placebo groups. Regarding the safety profile, the risk ratios did not differ significantly between the treatment and control groups, including the placebo and non-placebo subgroups. Conclusions: Glucosamine, chondroitin, and SKCPT/SKI306X improved the pain and function and were non-inferior to pharmacologic drugs for up to 12 months. These findings support the clinical use of these SYSADOAs to treat knee OA. Level of Evidence: Therapeutic Level II. Full article
(This article belongs to the Special Issue Updates on Risk Factors, Prevention and Treatment of Knee Disease)
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18 pages, 14257 KiB  
Article
Immunological Landscape of Non-Melanoma Skin Neoplasms: Role of CTLA4+IFN-γ+ Lymphocytes in Tumor Microenvironment Suppression
by Silvana Karabatić Knezović, Dora Knezović, Jelena Ban, Antonela Matana, Neira Puizina Ivić, Merica Glavina Durdov, Mladen Merćep and Irena Drmić Hofman
Medicina 2025, 61(2), 330; https://doi.org/10.3390/medicina61020330 - 13 Feb 2025
Viewed by 302
Abstract
Background and Objectives: This study explores the immunological landscapes of non-melanoma skin neoplasms (NMSNs), specifically keratoacanthoma (KA), squamous cell carcinoma (SCC), and common warts (VV). Although benign, KA shares histological similarities with low-grade SCC. The tumor microenvironment (TME) plays a key role [...] Read more.
Background and Objectives: This study explores the immunological landscapes of non-melanoma skin neoplasms (NMSNs), specifically keratoacanthoma (KA), squamous cell carcinoma (SCC), and common warts (VV). Although benign, KA shares histological similarities with low-grade SCC. The tumor microenvironment (TME) plays a key role in tumor progression, affecting angiogenesis, inflammation, and immune evasion. Viral infections, particularly human papillomavirus (HPV), are linked to NMSN development, with various HPV types identified in KA. VV, caused by HPV, serves as a comparative model due to its similar etiopathogenesis. Materials and Methods: This research examines the expression of CTLA4, a critical regulator of T-cell homeostasis, and IFN-γ, a cytokine with immunomodulatory and antiviral effects, in the TME of 41 KA, 37 SCC, and 55 VV samples using multichannel immunofluorescence. Results: The analysis revealed distinct patterns of CTLA4 and IFN-γ expression. SCC exhibited a higher prevalence of CTLA4+IFN-γ+ double-positive lymphocytes, suggesting a more immunosuppressive TME. In contrast, VV showed the highest expression of CTLA4+ cells, while both KA and VV had lower expressions of IFN-γ+ lymphocytes compared to SCC. The increased presence of CTLA4+IFN-γ+ double-positive lymphocytes in SCC suggests that the co-expression of these markers may exert a stronger effect on TME modulation than CTLA4 alone. Conclusions: These findings underscore the potential of immune profiling as a diagnostic tool to differentiate between benign and malignant lesions, such as KA and SCC. Furthermore, the presence of CTLA4+IFN-γ+ lymphocytes, particularly in SCC, may serve as a biomarker for tumor progression and a potential target for future immunotherapy strategies aimed at modulating the immune response in NMSN. Full article
(This article belongs to the Section Oncology)
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15 pages, 1219 KiB  
Article
Inhibiting MiR-33a-3p Expression Fails to Enhance ApoAI-Mediated Cholesterol Efflux in Pro-Inflammatory Endothelial Cells
by Kun Huang, Achala Pokhrel, Jing Echesabal-Chen, Justin Scott, Terri Bruce, Hanjoong Jo and Alexis Stamatikos
Medicina 2025, 61(2), 329; https://doi.org/10.3390/medicina61020329 - 13 Feb 2025
Viewed by 307
Abstract
Background and Objectives: Atherosclerosis is an inflammatory condition that results in cholesterol accumulating within vessel wall cells. Atherosclerotic cardiovascular disease is the leading cause of mortality worldwide due to this disease being a major contributor to myocardial infarctions and cerebrovascular accidents. Research [...] Read more.
Background and Objectives: Atherosclerosis is an inflammatory condition that results in cholesterol accumulating within vessel wall cells. Atherosclerotic cardiovascular disease is the leading cause of mortality worldwide due to this disease being a major contributor to myocardial infarctions and cerebrovascular accidents. Research suggests that cholesterol accumulation occurring precisely within arterial endothelial cells triggers atherogenesis and exacerbates atherosclerosis. Furthermore, inflamed endothelium acts as a catalyst for atherosclerotic development. Therefore, enhancing cholesterol removal specifically in pro-inflammatory endothelial cells may be a potential treatment option for atherosclerosis. While we have previously shown that inhibiting the microRNA guide strand miR-33a-5p within pro-inflammatory endothelial cells increases both ABCA1 expression and apoAI-mediated cholesterol efflux, it is unknown whether inhibiting the miR-33a-3p passenger strand in pro-inflammatory endothelial cells causes similar atheroprotective effects. In this study, this is what we aimed to test. Materials and Methods: We used plasmid transfection to knockdown miR-33a-3p expression within cultured pro-inflammatory immortalized mouse aortic endothelial cells (iMAECs). We compared ABCA1 expression and apoAI-mediated cholesterol efflux within these cells to cultured pro-inflammatory iMAECs transfected with a control plasmid. Results: The knockdown of miR-33a-3p expression within pro-inflammatory iMAECs resulted in a significant increase in ABCA1 mRNA expression. However, the inhibition of miR-33a-3p did not significantly increase ABCA1 protein expression within pro-inflammatory iMAECs. Moreover, we failed to detect a significant increase in apoAI-mediated cholesterol efflux within pro-inflammatory iMAECs from miR-33a-3p knockdown. Conclusions: Our results indicative that the knockdown of miR-33a-3p alone does not enhance ABCA1-dependent cholesterol efflux within pro-inflammatory endothelial cells. To gain any atheroprotective benefit from inhibiting miR-33a-3p within pro-inflammatory endothelium, additional anti-atherogenic strategies would likely be needed in unison. Full article
(This article belongs to the Special Issue Early Diagnosis and Treatment of Cardiovascular Disease)
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18 pages, 675 KiB  
Review
An Updated Review on the Use of Noninvasive Respiratory Supports in the Management of Severe Asthma Exacerbations
by Giuseppe Cuttone, Luigi La Via, Federico Pappalardo, Massimiliano Sorbello, Daniele Salvatore Paternò, Matteo Piattoli, Cesare Gregoretti and Giovanni Misseri
Medicina 2025, 61(2), 328; https://doi.org/10.3390/medicina61020328 - 13 Feb 2025
Viewed by 262
Abstract
Asthma is a reversible clinical condition characterized by airway obstruction due to bronchial smooth muscle contraction, inflammation and a hypersecretive state. Severe asthma exacerbations (SAE) may be a part of the natural history of this condition. Patients presenting with SAE are at higher [...] Read more.
Asthma is a reversible clinical condition characterized by airway obstruction due to bronchial smooth muscle contraction, inflammation and a hypersecretive state. Severe asthma exacerbations (SAE) may be a part of the natural history of this condition. Patients presenting with SAE are at higher risk of recurrent attacks, often nonresponsive to medical therapy and eventually requiring invasive mechanical ventilation (MV). The use of noninvasive respiratory supports (NRSs) may be beneficial in patients with SAE who are at risk of developing acute respiratory failure (ARF). However, their application is insufficiently supported by the evidence, as reports on their application in asthmatic patients are scarce and only a few retrospective studies with a limited number of participants have been published to date. This review discusses the potentialities of NRS in the treatment of SAE, with reference to the pathophysiological background and future perspectives on their use in asthma management. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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11 pages, 541 KiB  
Article
Is the Neutrophil-to-Lymphocyte Ratio a Predictive Factor of Pathological Complete Response in Egyptian Breast Cancer Patients Treated with Neoadjuvant Chemotherapy?
by Naglaa F. Ebaid, Khaled S. Abdelkawy, Amira S. A. Said, Mohamad M. Al-Ahmad, Mohamed A. Shehata, Heba F. Salem and Raghda R. S. Hussein
Medicina 2025, 61(2), 327; https://doi.org/10.3390/medicina61020327 - 13 Feb 2025
Viewed by 254
Abstract
Background and Objectives: The role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of response in breast cancers after neoadjuvant chemotherapy is controversial. This study aims to explore the relationship of NLR with pathological complete response (pCR) in a cohort of Egyptian breast [...] Read more.
Background and Objectives: The role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of response in breast cancers after neoadjuvant chemotherapy is controversial. This study aims to explore the relationship of NLR with pathological complete response (pCR) in a cohort of Egyptian breast cancer patients who received neoadjuvant chemotherapy. Materials and Methods: Forty-six breast cancer females received preoperative neoadjuvant chemotherapy and then underwent surgery. All resected tumors were evaluated to determine the pathologic effect of the neoadjuvant chemotherapy. A complete blood count was carried out at baseline before beginning the neoadjuvant chemotherapy. The absolute count of neutrophils was divided by the absolute count of lymphocytes to calculate the NLR. Results: Of the study patients, 18 (39.1%) were considered to have a low NLR (NLR < 1.76), and 28 (60.9%) were considered to have a high NLR (NLR ≥ 1.76). Patients with a low NLR had 18-fold higher rates of pCR when compared to patients with a high NLR (OR 18.1; 95% CI (1.058–310.757); p = 0.046). Conclusions: Our findings indicate that the pretreatment NLR is a pivotal predictor factor of the pathological complete response in Egyptian breast cancer patients treated with neoadjuvant chemotherapy. Full article
(This article belongs to the Special Issue Future Trends in Breast Cancer Management)
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17 pages, 580 KiB  
Review
The Role of Medical Therapies in the Management of Cervical Intraepithelial Neoplasia: A Narrative Review
by Ioana Cristina Rotar, Dan Boitor Borza, Adelina Staicu, Iulian Gabriel Goidescu, Georgiana Irina Nemeti, Popa Iulia, Melinda Ildiko Mitranovici, Mureșan Daniel and Petca Aida
Medicina 2025, 61(2), 326; https://doi.org/10.3390/medicina61020326 - 13 Feb 2025
Viewed by 262
Abstract
Cervical cancer and its precursors (cervical intraepithelial neoplasia (CIN)) represent a current major public health concern. Currently, the treatment of choice for patients with HSILs (high-grade intraepithelial lesions) is surgical treatment—LEEP or cold-knife conization—except for in pregnant women, where it may have significant [...] Read more.
Cervical cancer and its precursors (cervical intraepithelial neoplasia (CIN)) represent a current major public health concern. Currently, the treatment of choice for patients with HSILs (high-grade intraepithelial lesions) is surgical treatment—LEEP or cold-knife conization—except for in pregnant women, where it may have significant future consequences. In this paper, we aim to review the current evidence regarding the efficacy of non-surgical approaches for CINs. Therefore, we searched Google Scholar and PubMed for papers on CIN treatments; 91 studies published in English were included in the analysis. The results of the reviewed studies were variable depending on the agent and methodology used. Overall, the remission rates of CIN II ranged from 43 to 93%. However, for some agents, the results were contradictory. Once topical agents have been proven to be effective, they could be used as an alternative to surgical methods in treating HPV-associated CIN, with fewer adverse effects. The use of local agents could allow for more personalized treatments for patients with CINs. Future directions were also sought. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Cervical Cancer)
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22 pages, 3762 KiB  
Review
Management of Deep Neck Infection Associated with Descending Necrotizing Mediastinitis: A Scoping Review
by Bogdan Mihail Cobzeanu, Liliana Moisii, Octavian Dragos Palade, Mihai Ciofu, Florentina Severin, Mihai Dumitru, Luminita Radulescu, Cristian Martu, Mihail Dan Cobzeanu and Geanina Bandol
Medicina 2025, 61(2), 325; https://doi.org/10.3390/medicina61020325 - 12 Feb 2025
Viewed by 303
Abstract
Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and [...] Read more.
Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and poor prognosis. The aims of this scoping review are to present the etiology, bacteriology, clinical manifestations, and diagnostics, as well as treatment, in light of the research published in the last 5 years on deep neck infection associated with descending necrotizing mediastinitis. The most common primary sources of deep neck infection are odontogenic and tonsillar. The other sources that are involved in deep neck infection are salivary glands, foreign bodies, malignancies, and iatrogenic causes after endoscopic maneuvers. The bacteriologic aspect is polymorphic, including both aerobic and anaerobic species. Complications that may appear include jugular vein thrombosis, airway obstruction, acute respiratory distress syndrome, sepsis, and disseminated intravascular coagulation. Timely diagnosis is important for ensuring the positive evolution of a deep neck infection. A CT scan is important for characterizing the nature of a deep neck lesion and identifying the spaces involved, and this method represents the gold standard for diagnosis of these lesions. Following the establishment of a definitive diagnosis, antibiotic therapy is initiated empirically, and is modified according to bacteriological exam results. The administration of antibiotics is an essential part of the treatment strategy for patients with a deep neck infection. Based on CT results, different surgical methods are applied under general anesthesia. The surgical strategy involves opening and draining the cervical spaces and debriding the necrotic tissue. In the cases of odontogenic causes, drainage and extraction of the infected teeth are performed. It is especially important to follow up on the dynamic progression of the patient. In the management of a deep neck infection associated with descending necrotizing mediastinitis, a multidisciplinary team is necessary. Full article
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11 pages, 467 KiB  
Article
An Evaluation of Neuron-Specific Enolase as a Biomarker of Neurological Impact in Pacemaker-Implanted Patients with Atrial High-Rate Episodes: An Observational Study from Turkey
by Ahmet Cinar, Omer Gedikli, Muhammet Uyanik, Bahattin Avci and Ozlem Terzi
Medicina 2025, 61(2), 324; https://doi.org/10.3390/medicina61020324 - 12 Feb 2025
Viewed by 314
Abstract
Background and Objectives: An atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 min. This study aimed to evaluate whether neuron-specific enolase (NSE) levels, an indicator [...] Read more.
Background and Objectives: An atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 min. This study aimed to evaluate whether neuron-specific enolase (NSE) levels, an indicator of neurological impact, could serve as a surrogate biomarker for silent neurological ischemia in patients with atrial high-rate episodes (AHREs). Materials and Methods: Patients with AHRE detected in a pacemaker analysis and a control group without any arrhythmias were included. Patients with AHRE were divided into subgroups according to AHRE duration—Group 1: AHRE < 5 min, Group 2: AHRE ≥ 5 min–<1 h, Group 3: AHRE ≥ 1 h–<24 h, Group 4: AHRE ≥ 24 h. Neuron-specific enolase (NSE) levels were measured using a double-antibody enzyme-linked immunosorbent assay (ELISA) with a sensitivity of 0.05 ng/mL. Imaging techniques were not employed in this study, and NSE was used as an indirect measure of potential neurological impact. Results: There were 160 patients, including 80 (50.0%) in the AHRE group and 80 (50.0%) in the control group. According to AHRE duration, there were 24 (30.0%) patients in Group 1, 33 (41.2%) in Group 2, 19 (23.8%) in Group 3, and 4 (5.0%) in Group 4. Patients with AHRE had statistically significant differences in age, sPAP, transmitral E/A ratio, and NSE levels. The mean NSE levels of all groups were significantly different (p < 0.001). A correlation analysis in patients with AHRE showed a very strong positive correlation between AHRE duration and NSE values as well as correlations with age, virtual CHA2DS2-VASc score, and LA diameter. NSE levels were positively correlated with AHRE duration and LA diameter. AHRE duration was an independent predictor of elevated NSE levels. Conclusions: It was shown that AHRE is associated with silent neurological ischemia and that NSE levels can be used to demonstrate these neurological effects. Future studies can contribute to the development of more effective treatment strategies based on these findings by investigating the neurological effects of AHRE in more detail. Full article
(This article belongs to the Special Issue Early Diagnosis and Treatment of Atrial Fibrillation)
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11 pages, 1606 KiB  
Article
A Pilot Study on the Effect of Added Sugar on Response Inhibition: Event-Related Potentials in a Go/NoGo Task
by Karolina Jocbalyte and Rytis Stanikunas
Medicina 2025, 61(2), 323; https://doi.org/10.3390/medicina61020323 - 12 Feb 2025
Viewed by 269
Abstract
Background and Objectives: Added sugar usage has become an important public health issue nowadays. Therefore, the interest in studying the cognitive and emotional effects associated with sugar consumption has increased. The present study aimed to investigate how the intake of added sugar [...] Read more.
Background and Objectives: Added sugar usage has become an important public health issue nowadays. Therefore, the interest in studying the cognitive and emotional effects associated with sugar consumption has increased. The present study aimed to investigate how the intake of added sugar affects participants’ impulsivity and cognitive functions monitored during the performance of a computerized Go/NoGo task. Materials and Methods: This study included 20 subjects (10 men and 10 women). Quantitative data for this study were collected via self-report questionnaires, including demographics, the Dietary Fat and Free Sugar—Short Questionnaire (DFS), the Yale Food Addiction Scale (YFAS 2.0), and the Barratt impulsiveness scale-11 (BIS-11). Results: Event-related potentials (ERPs) were registered throughout this study. Comparing the results of psychophysiological and neuropsychological evaluations before and after the added sugar consumption reveals differences in ERPs. Specifically, the NoGo-P3 amplitude increased after the intake of added sugar. However, there were no behavioral differences between the two experimental sessions. Conclusions: Overall, the results of our study suggest that added sugar intake was associated with stronger neuronal firing in NoGo trials. One possible explanation for this could be the need for more cognitive endeavors for participants to successfully inhibit their response impulses after added sugar consumption. Full article
(This article belongs to the Section Epidemiology & Public Health)
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13 pages, 2333 KiB  
Article
MOTS-c Levels and Sarcopenia Risk in Chronic Peritoneal Dialysis Patients: A Pilot Study
by Mariateresa Zicarelli, Marta Greco, Stefanos Roumeliotis, Maria Elisa Lo Vasco, Francesco Dragone, Christodoula Kourtidou, Ioannis Alekos, Roberta Misiti, Daniela Patrizia Foti, Giuseppe Coppolino, Vassilios Liakopoulos, Evangelia Dounousi and Davide Bolignano
Medicina 2025, 61(2), 322; https://doi.org/10.3390/medicina61020322 - 12 Feb 2025
Viewed by 259
Abstract
Background and Objectives: Sarcopenia is exceedingly frequent in end-stage kidney disease (ESKD) patients on dialysis, including those undergoing peritoneal dialysis (PD), and is of multifactorial origin. MOTS-c is a mitochondrial-derived peptide that promotes muscle growth whose levels are unbalanced in ESKD. In this [...] Read more.
Background and Objectives: Sarcopenia is exceedingly frequent in end-stage kidney disease (ESKD) patients on dialysis, including those undergoing peritoneal dialysis (PD), and is of multifactorial origin. MOTS-c is a mitochondrial-derived peptide that promotes muscle growth whose levels are unbalanced in ESKD. In this study, we evaluated MOTS-c balance and its relationship with sarcopenia risk in an ESKD-PD cohort. Materials and Methods: MOTS-c was measured in serum, urine, and dialysate samples of 32 chronic PD patients. Patients were thus screened for sarcopenia risk by the SARC-F tool, anthropometric measurements, and physical performance tests. Results: PD patients with a very high sarcopenia risk (SARC-F ≥ 2) had significantly lower serum (sMOTS-c) and higher dialysate (dMOTS-c) levels, suggesting an increased peritoneal clearance of this substance (d/s MOTS-c). sMOTS-c levels were directly correlated with muscle performance in physical tests, while an opposite relationship was found with dMOTS-c and d/sMOTS-c. ROC analyses demonstrated the diagnostic potential of MOTS-c, particularly in combination with physical and anthropometric assessments, to identify PD patients at very high risk of sarcopenia. Conclusions: Chronic PD may negatively affect MOTS-c balance, which, in turn, may contribute to enhanced sarcopenia risk. Larger studies are needed to confirm these observations and to validate the potential utility of this substance as a biomarker for improving sarcopenia risk stratification in PD patients. Full article
(This article belongs to the Section Urology & Nephrology)
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9 pages, 730 KiB  
Article
Relationship Between Inflammatory Markers (IL-6, Neutrophil–Lymphocyte Ratio, and C-Reactive Protein-Albumin Ratio) and Diabetic Ketoacidosis Severity: Correlation with Clinical Outcomes
by Hatice Aslan Sirakaya, Hilal Sipahioglu, Ali Cetinkaya and Kaniye Aydin
Medicina 2025, 61(2), 321; https://doi.org/10.3390/medicina61020321 - 12 Feb 2025
Viewed by 292
Abstract
Background and Objectives: The use of additional biomarkers to predict clinical course in diabetic ketoacidosis (DKA) is becoming increasingly important. The aim of this study was to investigate the relationship between interleukin-6 (IL-6) levels and the length of stay in the intensive [...] Read more.
Background and Objectives: The use of additional biomarkers to predict clinical course in diabetic ketoacidosis (DKA) is becoming increasingly important. The aim of this study was to investigate the relationship between interleukin-6 (IL-6) levels and the length of stay in the intensive care unit (ICU) in patients with DKA without signs of infection and to investigate the relationship between the neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) albumin ratio (CAR). Materials and Methods: This retrospective, single-center study included 78 patients with DKA without infection who were treated in the Medical ICU between July 2022 and June 2024. The patients were divided into two groups: moderate DKA (Group 1) and severe DKA (Group 2). The patients’ IL-6 levels, peripheral blood inflammatory markers (CAR, NLR), Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and the duration of ICU stay were recorded. Results: The median duration of stay in the ICU was 2.00 (1–6) days in group 1 and 3.00 (1–26) days in group 2 (p = 0.001). The mean pH, HCO3, and CO2 values in Group 1 were 7.20 ± 0.07, 13.58 ± 2.11 mEq/L, and 29.45 ± 6.27 mmHg, while the mean pH, HCO3, and PCO2 values in Group 2 were 7.01 ± 0.11, 7.11 ± 1.91 mEq/L, and 20.35 ± 4.91 mmHg (p < 0.001, p < 0.001, p < 0.001, respectively). There was a strong positive correlation between IL-6 levels and the length of stay in the ICU (r = 0.813, p < 0.001). Additionally, there was a moderate positive correlation between the length of stay in the ICU with the severity of DKA (r = 0.475, p < 0.001), CAR (r = 0.336, p < 0.001), and NLR (r = 0.562, p < 0.001). Conclusions: Inflammatory markers such as NLR and CAR, and more specifically IL-6, were found to be associated with the clinical course and duration of stay in the ICU in patients with DKA. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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1 pages, 182 KiB  
Correction
Correction: Gil-Almagro et al. Anxiety Evolution among Healthcare Workers—A Prospective Study Two Years after the Onset of the COVID-19 Pandemic Including Occupational and Psychoemotional Variables. Medicina 2024, 60, 1230
by Fernanda Gil-Almagro, Fernando José García-Hedrera, Cecilia Peñacoba-Puente and Francisco Javier Carmona-Monge
Medicina 2025, 61(2), 320; https://doi.org/10.3390/medicina61020320 - 12 Feb 2025
Viewed by 140
Abstract
In the original publication [...] Full article
13 pages, 466 KiB  
Article
Central Sensitization and Its Role in Persistent Pain Among Spondyloarthritis Patients on Biological Treatments
by Nuran Öz, Aygün Özer and Mehmet Tuncay Duruöz
Medicina 2025, 61(2), 319; https://doi.org/10.3390/medicina61020319 - 12 Feb 2025
Viewed by 233
Abstract
Objectives: Spondyloarthritis (SpA) is a chronic inflammatory arthritis that mainly affects the sacroiliac joints and spine. Despite effective biological treatments, persistent pain is common in SpA patients, potentially due to central sensitization (CS), a condition of heightened central nervous system responsiveness. The [...] Read more.
Objectives: Spondyloarthritis (SpA) is a chronic inflammatory arthritis that mainly affects the sacroiliac joints and spine. Despite effective biological treatments, persistent pain is common in SpA patients, potentially due to central sensitization (CS), a condition of heightened central nervous system responsiveness. The purpose of this study was to investigate the link between disease activity and CS in SpA patients on biological therapy. Patients and Methods: One hundred and twenty SpA patients with at least six months of treatment with biological agents were included in this cross-sectional study. Patients’ demographic, clinical, and functional information were collected. The assessment of CS was conducted using the Central Sensitization Inventory (CSI), whereas disease activity and quality of life were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and Ankylosing Spondylitis Quality of Life (ASQoL). Statistical analyses included correlation assessments and logistic regression to identify predictors of CS. Results: CS (CSI ≥ 40) was present in 40.8% of patients. Disease activity was significantly higher and quality of life was lower in patients with CS. BASDAI and ASQoL scores were strongly correlated with CS (r = 0.774 and r = 0.839, respectively). Logistic regression identified ASQoL and BASDAI scores as independent predictors of CS. ROC curve analysis demonstrated that ASQoL had the highest discriminative ability for predicting CS (AUC = 0.97). Conclusions: CS is significantly associated with higher disease activity and poorer quality of life in SpA patients receiving biological therapy. Incorporating CS assessment into routine clinical practice may enhance our understanding and management of persistent symptoms in SpA, improving patient outcomes. Full article
(This article belongs to the Section Hematology and Immunology)
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16 pages, 1150 KiB  
Article
The Relationship Between Thrombophilia and Modifications in First-Trimester Prenatal Screening Markers
by Viorela Romina Murvai, Casandra-Maria Radu, Radu Galiș, Timea Claudia Ghitea, Anca-Florina Tătaru-Copos, Alexandra-Alina Vesa and Anca Huniadi
Medicina 2025, 61(2), 318; https://doi.org/10.3390/medicina61020318 - 12 Feb 2025
Viewed by 297
Abstract
Background: Thrombophilia significantly increases the risk of complications like recurrent pregnancy loss, preeclampsia, IUGR, and stillbirth. Objective: This study aimed to evaluate the impact of inherited thrombophilic mutations on first-trimester screening outcomes, focusing on their relationship with maternal biomarkers and ultrasonographic parameters. Methods: [...] Read more.
Background: Thrombophilia significantly increases the risk of complications like recurrent pregnancy loss, preeclampsia, IUGR, and stillbirth. Objective: This study aimed to evaluate the impact of inherited thrombophilic mutations on first-trimester screening outcomes, focusing on their relationship with maternal biomarkers and ultrasonographic parameters. Methods: A prospective observational study was conducted on 105 pregnant women during the first trimester (10–13 weeks of gestation). Genetic testing identified common thrombophilic mutations, including factor V Leiden, prothrombin G20210A, and MTHFR polymorphisms. First-trimester screening parameters, including PAPP-A, free β-hCG, and nuchal translucency (NT), were assessed. Maternal demographic and clinical characteristics, such as parity and smoking status, were recorded. Pearson correlation and risk estimates were calculated to explore associations between thrombophilic mutations, maternal factors, and screening results. Results: Lower parity (≤2) was significantly associated with a reduced risk of low PAPP-A levels (<1.0 MoM) (OR = 0.173; 95% CI: 0.044–0.676). Non-smokers showed a trend toward lower risk of low PAPP-A, although the association was not statistically significant. NT measurements <2.5 mm were consistent with normal fetal development, while maternal factors such as chronic hypertension and a history of small-for-gestational-age infants showed no significant correlations with screening markers. No significant association was observed between thrombophilic mutations and biomarker levels. Conclusions: Parity emerges as a significant factor influencing first-trimester screening outcomes, particularly PAPP-A levels, underscoring the need for tailored risk assessments in multiparous women. While smoking and thrombophilic mutations showed no definitive impact, their potential role in placental dysfunction warrants further investigation. These findings emphasize the importance of integrating maternal characteristics into screening protocols to enhance predictive accuracy and maternal–fetal outcomes. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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17 pages, 14047 KiB  
Article
Correlation Between the Clinical and Histopathological Results in Experimental Sciatic Nerve Defect Surgery
by Andrei Marin, Vlad Herlea, Alice Bancu, Carmen Giuglea, Dana Antonia Țăpoi, Ana Maria Ciongariu, Georgiana Gabriela Marin, Silviu Adrian Marinescu, Nicoleta Amalia Dobrete, Adrian Vasile Dumitru, Cristian Trambitaș, Dragoș Șerban and Maria Sajin
Medicina 2025, 61(2), 317; https://doi.org/10.3390/medicina61020317 - 11 Feb 2025
Viewed by 648
Abstract
Background and Objectives: Peripheral nerve defect regeneration is subject to ongoing research regarding the use of conduits associated with various cells or molecules. This article aims to correlate histopathological and clinical outcomes at the end of a 12-week experiment performed on a [...] Read more.
Background and Objectives: Peripheral nerve defect regeneration is subject to ongoing research regarding the use of conduits associated with various cells or molecules. This article aims to correlate histopathological and clinical outcomes at the end of a 12-week experiment performed on a rat sciatic nerve model and show which repair method has the best results. Materials and Methods: Forty male Wistar rats were divided into four groups to compare the results of four different methods of reconstruction for sciatic nerve defect: (1) nerve graft–control group, (2) empty aortic conduit, (3) aortic conduit filled with platelet-rich plasma (PRP) and (4) aortic conduit filled with mesenchymal stem cells. There were three clinical examinations: a sensitivity test, a mobility test and a footprint test. After 12 weeks, the nerves were excised and assessed microscopically using conventional Hematoxylin and Eosin staining (HE), special stains and immunohistochemistry (IHC). Results: Nerve regeneration was observed in all batches, both from the clinical and histopathological assessment; the two types of examinations correlated for each batch. Immunohistochemistry and special staining offered a more complete image of the nerve regeneration results. Conclusions: Superior nerve regeneration was achieved using an aortic conduit in combination with either PRP or stem cells, while the empty aortic conduit recorded lesser results. Full article
(This article belongs to the Special Issue Recent Advances in Plastic and Reconstructive Surgery)
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3 pages, 191 KiB  
Editorial
Updates on Caries Management in the Primary and Permanent Dentition
by Julian Schmoeckel
Medicina 2025, 61(2), 316; https://doi.org/10.3390/medicina61020316 - 11 Feb 2025
Viewed by 327
Abstract
Caries is still one of the most prevalent diseases affecting children and adults worldwide [...] Full article
(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)
10 pages, 591 KiB  
Article
Evaluation of Neurosurgery Consultations in Hospitalized Geriatric Patients During and After the COVID-19 Pandemic
by Hakan Kina and Hakan Yavuzer
Medicina 2025, 61(2), 315; https://doi.org/10.3390/medicina61020315 - 11 Feb 2025
Viewed by 326
Abstract
Background and Objectives: This study aims to evaluate neurosurgery consultations for elderly patients during and following the COVID-19 pandemic. Materials and Methods: This study included patients aged 65 and older who were hospitalized in non-neurosurgery departments at Istinye University Gaziosmanpasa Medical [...] Read more.
Background and Objectives: This study aims to evaluate neurosurgery consultations for elderly patients during and following the COVID-19 pandemic. Materials and Methods: This study included patients aged 65 and older who were hospitalized in non-neurosurgery departments at Istinye University Gaziosmanpasa Medical Park Hospital and were referred for neurosurgery consultations between 1 April 2020 and 31 May 2024. Patients in the intensive care unit and emergency department were excluded. The period from 1 April 2020 to 30 April 2022 was defined as the pandemic period, and from 1 May 2022 to 31 May 2024 as the post-pandemic period. Results: A total of 123 patients were included in this study, with 57 from the pandemic period and 66 from the post-pandemic period. The average age during the pandemic period was 73.45 years (range: 65–93), compared to 71.09 years (range: 65–94) in the post-pandemic period. During the pandemic, 26.3% of patients were recommended for physical therapy and rehabilitation, 24.6% were advised to undergo surgery, 19.3% received neurology consultations, and 17.5% received medical treatment. In the post-pandemic period, 37.9% were recommended for surgery, 16.7% for neurology, 13.6% for physical therapy and rehabilitation, and 7.6% for medical treatment. Overall, 56.4% of patients accepted surgery. Conclusions: Despite the high prevalence of comorbidities in geriatric patients, appropriate neurosurgical referrals significantly improve treatment success, enhance quality of life and mobility, and reduce mortality. We therefore recommend earlier and more attentive referrals to neurosurgery for elderly patients with relevant symptoms to facilitate timely and effective interventions. Full article
(This article belongs to the Section Surgery)
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Article
Echocardiographic Findings in Jordanian Atrial Fibrillation Patients: Analysis from Jo-Fib Study
by Zaid A. Abdulelah, Kais Al Balbissi, Mohammad Al-Dqour, Ayman Hammoudeh and Ahmed A. Abdulelah
Medicina 2025, 61(2), 314; https://doi.org/10.3390/medicina61020314 - 11 Feb 2025
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Abstract
Background and Objectives: Atrial fibrillation (AF) carries a huge socioeconomic burden as it is the most encountered cardiac arrhythmia with a significant morbidity. Echocardiographic (Echo) imaging is of monumental value in providing insight into assessing the cardiac function and anatomy, etiology, and risk [...] Read more.
Background and Objectives: Atrial fibrillation (AF) carries a huge socioeconomic burden as it is the most encountered cardiac arrhythmia with a significant morbidity. Echocardiographic (Echo) imaging is of monumental value in providing insight into assessing the cardiac function and anatomy, etiology, and risk stratification of AF patients, which will ultimately lead to the best management plan. Materials and Methods: A total of 2160 adult patients diagnosed with AF in 18 hospitals and 30 out-patient cardiology clinics in Jordan and 1 hospital in the Palestinian Territories were enrolled in this study from May 2019 to January 2021. Ultimately, 1776 patients were included in the analysis after going through the exclusion criteria. Results: The majority of our participants were found to have normal EF at the time of enrollment, with only 31.6% exhibiting a decreased EF. Only 40% of overall patients had Echo evidence of left ventricular hypertrophy (LVH). These patients were older (70.27 ± 10.1 vs. 66.0 ± 14.3, p < 0.001), more obese (45.2% vs. 37.3%, p-value < 0.001), and had a more frequent occurrence of HTN (89.0% vs. 65.6%, p < 0.001) and DM (49.2% vs. 40.1%, p < 0.001) when compared to patients without LVH. A proportion of 84.2% of female patients had abnormal left atrial (LA) size (>3.8 cm), in contrast to only 53.4% of males (LA > 4.2 cm). Pulmonary hypertension (PH) was only observed in 27.9% of our patients, and when comparing patients with PH vs. patients without PH, decreased EF (<50%) (36.9% vs. 20.6%, p = 0.001), a higher prevalence of OSA (6.7% vs. 3.8%, p = 0.009), female predominance (60.3% vs. 39.7%, p < 0.001), and older age (70.2 ± 10.7 vs. 66.7 ± 13.6, p < 0.001) were observed in patients with PH. Conclusion: This study provides the first reported insights on the atrial fibrillation-related echocardiographic findings in a Middle Eastern population. Notably, our study demonstrates that the majority of the studied population have no evidence of LVH and have preserved EF on baseline. However, LA enlargement was extremely frequent among females but not in males, warranting further evaluation to determine the factors contributing to such a difference. Full article
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