Medicina

19 pages, 917 KiB

Open AccessArticle

Using Artificial Neural Network Models (ANNs) to Identify Patients with Idiopathic Normal Pressure Hydrocephalus (INPH) and Alzheimer Dementia (AD): Clinical Psychological Features and Differential Diagnosis

by Lara Gitto, Carmela Mento, Giulia Massini, Paolo Massimo Buscema, Giovanni Raffa, Antonio Francesco Germanò and Maria Catena Ausilia Quattropani

Medicina 2025, 61(8), 1332; https://doi.org/10.3390/medicina61081332 - 23 Jul 2025

Abstract

Background and Objectives: Patients with idiopathic normal pressure hydrocephalus (INPH) present similar symptoms as other diseases, such as dementia (AD). However, while dementia is not reversible, INPH dementia can be treated through neurosurgery. This study aims to assess the Rorschach method as [...] Read more.

Background and Objectives: Patients with idiopathic normal pressure hydrocephalus (INPH) present similar symptoms as other diseases, such as dementia (AD). However, while dementia is not reversible, INPH dementia can be treated through neurosurgery. This study aims to assess the Rorschach method as a valid tool to identify INPH patients. Materials and Methods: The perception characteristics of a small sample of patients (n = 19) were observed through the Rorschach Inblok test. Artificial neural network (ANN) models allowed us to analyze the correlations between patients’ cognitive functions and perception characteristics. Results: The results obtained revealed significant insights about the independent traits in patients’ patterns of response with INPH and AD. In performing the test, patients with INPH and AD concentrated more on the cards displayed and what they perceived, while other patients concentrated on reactions related to the image proposed. Conclusions: The Rorschach test is a valid predictor tool to identify INPH patients who could successfully be treated with neurosurgery. Hence, this methodology has potential in differential diagnosis applied to a clinical context. Full article

(This article belongs to the Special Issue Advances in Public Health and Healthcare Management for Chronic Care)

14 pages, 792 KiB

Open AccessArticle

Management and Outcomes of Urinary Tract Involvement in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC): A Retrospective Cohort Study

by Feza Karakayali, Melik Kagan Aktas, Erman Aytac, Ugur Sungurtekin, Sezai Demirbas, Mustafa Oncel, Ersin Ozturk, Tahsin Colak, Mehmet Ince, Mustafa Haksal, Safak Coskun and Selman Sokmen

Medicina 2025, 61(8), 1331; https://doi.org/10.3390/medicina61081331 - 23 Jul 2025

Abstract

Background and Objectives: The combined use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is employed for the treatment of peritoneal carcinomatosis (PC). To achieve optimal cytoreduction, there may be a need for extensive resection and subsequent reconstruction of urologic structures. [...] Read more.

Background and Objectives: The combined use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is employed for the treatment of peritoneal carcinomatosis (PC). To achieve optimal cytoreduction, there may be a need for extensive resection and subsequent reconstruction of urologic structures. This study was designed to evaluate the outcomes of urinary tract resection or repair performed in CRS/HIPEC in terms of operative and oncological outcomes. Materials and Methods: After institutional review board approval, data from 550 consecutive patients who underwent the CRS/HIPEC procedure from January 2007 to July 2018 at six university hospitals was retrieved from prospectively maintained databases. Data from patients who had a concomitant curative resection and reconstruction of the bladder, ureter, or kidney during the CRS/HIPEC procedure were analyzed retrospectively. Results: A total of 50 out of 550 patients had undergone resection with a repair of the urinary tract due to tumor invasion or iatrogenic injury. Postoperative (within 30 days) urologic complications were observed in 9 of the 50 patients. It was found that having a peritoneal cancer index (PCI) equal to or greater than 20 (p < 0.009) was the sole significant risk factor associated with the occurrence of early urinary complications. Survival time post CRS/HIPEC treatment did not significantly differ between patients with and without urologic complications (median overall survival: 23 vs. 27 months, p = 0.683). Conclusions: Despite urinary tract issues during CRS/HIPEC for PC, including a PCI over 20 and potential complications from resection or repair, the procedure still offers significant survival benefits. Full article

(This article belongs to the Section Surgery)

12 pages, 549 KiB

Open AccessSystematic Review

Emerging Technologies in the Treatment of Orbital Floor Fractures: A Systematic Review

by Lorena Helgers, Ilze Prikule, Girts Salms and Ieva Bagante

Medicina 2025, 61(8), 1330; https://doi.org/10.3390/medicina61081330 - 23 Jul 2025

Abstract

Background and Objectives: Orbital floor fractures are challenging to treat, due to the complex orbital anatomy and limited surgical access. Emerging technologies—such as virtual surgical planning (VSP), 3D printing, patient-specific implants (PSIs), and intraoperative navigation—offer promising advancements to improve the surgical precision [...] Read more.

Background and Objectives: Orbital floor fractures are challenging to treat, due to the complex orbital anatomy and limited surgical access. Emerging technologies—such as virtual surgical planning (VSP), 3D printing, patient-specific implants (PSIs), and intraoperative navigation—offer promising advancements to improve the surgical precision and clinical outcomes. This review systematically evaluates and synthesizes current technological modalities with respect to their accuracy, operative duration, cost-effectiveness, and postoperative functional outcomes. Materials and Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. The PubMed, Scopus, and PRIMO databases were searched for clinical studies published between 2019 and September 2024. Out of 229 articles identified, 9 met the inclusion criteria and were analyzed using the PICO framework. Results: VSP and 3D printing enhanced diagnostics and presurgical planning, offering improved accuracy and reduced planning time. Pre-bent PSIs shaped on 3D models showed superior accuracy, lower operative times, and better cost efficiency compared to intraoperative mesh shaping. Custom-designed PSIs offered high precision and clinical benefit but required a longer production time. Intraoperative navigation improved implant positioning and reduced the complication rates, though a detailed cost analysis remains limited. Conclusions: VSP, 3D printing, and intraoperative navigation significantly improve surgical planning and outcomes in orbital floor reconstruction. Pre-bent PSIs provide a time- and cost-effective solution with strong clinical performance. While customized PSIs offer accuracy, they are less practical in time-sensitive settings. Navigation systems are promising tools that enhance outcomes and may serve as an alternative to custom implants when time or resources are limited. Full article

(This article belongs to the Special Issue Craniomaxillofacial Surgery: Latest Innovations and Challenges)

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20 pages, 2796 KiB

Open AccessSystematic Review

Comparative Efficacy and Safety Profile of the Combination of Pulmonary Surfactant and Budesonide vs. Surfactant Alone in the Management of Neonatal Respiratory Distress Syndrome: An Updated Meta-Analysis

by Urooj Fatima, Naveera Naveed, Zahra Riaz, Emaan Khalid, Aemon Qamer, Shehmeen Baig, Roshaan Fatima, Asawir Hussain, Zoya Mustunsar, Ayesha Khan, Sadia Mangan, Mehak Kumari, Soban Ali Qasim, Ali Hasan and Raheel Ahmed

Medicina 2025, 61(8), 1329; https://doi.org/10.3390/medicina61081329 - 23 Jul 2025

Abstract

Background and Objectives: Neonatal respiratory distress syndrome (NRDS), resulting from a deficiency of pulmonary surfactant (PS), can cause alveoli to collapse. Glucocorticoids reduce inflammation and are effective in reducing pulmonary swelling. This study aims to assess the effectiveness of the combination of PS [...] Read more.

Background and Objectives: Neonatal respiratory distress syndrome (NRDS), resulting from a deficiency of pulmonary surfactant (PS), can cause alveoli to collapse. Glucocorticoids reduce inflammation and are effective in reducing pulmonary swelling. This study aims to assess the effectiveness of the combination of PS and budesonide in the management of NRDS. Materials and Methods: Publications between 21 May and 24 November were screened through PubMed, Cochrane and Embase. Data analysis was performed on RevMan 5.3 software. Subgroup analysis was performed to evaluate the routes of administrations. Results: The use of budesonide along with pulmonary surfactant for treating NRDS revealed the following results: (1) a reduced duration of invasive mechanical ventilation (standardized mean difference (SMD) = −1.06, 95% confidence interval (CI) = −1.55 to −0.56, p < 0.0001); (2) reduced rate of bronchopulmonary dysplasia (BPD) occurrence (relative risk (RR) = 0.72, 95% CI = 0.60 to 0.86, p = 0.0003); (3) reduced duration for hospital admittance (SMD = −0.38, 95% CI = −0.64 to −0.11, p = 0.005). The occurrence of complications, i.e., sepsis, pneumothorax, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), rate of mortality, hyperglycemia and intraventricular hemorrhage (IVH), was not significantly different among the intervention and comparison group except for patent ductus arteriosus (PDA) and pulmonary hemorrhage, with their incidence being higher in the control group (p = 0.002 and p = 0.05, respectively). Conclusions: The combination of pulmonary surfactant and budesonide decreases the occurrence of BPD, duration of mechanical ventilation, length of hospital stay and risk of pulmonary hemorrhage and PDA. It does not increase the risk of complications and death and is clinically safe. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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16 pages, 1220 KiB

Open AccessArticle

Psychosocial Determinants of Patient Satisfaction in Orthodontic Treatment: A Pilot Cross-Sectional Survey in North-Eastern

by Tinela Panaite, Cristian Liviu Romanec, Armencia Adina, Balcos Carina, Carmen Savin and Ana Sîrghie

Medicina 2025, 61(8), 1328; https://doi.org/10.3390/medicina61081328 - 23 Jul 2025

Abstract

Background and Objectives: Orthodontic treatment aims to enhance dental aesthetics and function, yet many patients report dissatisfaction. This study was designed with the following objectives: To assess overall patient satisfaction during active orthodontic treatment; to identify key psychosocial and clinical predictors of [...] Read more.

Background and Objectives: Orthodontic treatment aims to enhance dental aesthetics and function, yet many patients report dissatisfaction. This study was designed with the following objectives: To assess overall patient satisfaction during active orthodontic treatment; to identify key psychosocial and clinical predictors of satisfaction, including self-confidence, social experiences, and cost perception; to evaluate the impact of orthodontist–patient communication on satisfaction and perceived treatment outcomes; to explore the relationship between aesthetic improvement and willingness to undergo treatment again. Materials and Methods: A cross-sectional survey was conducted using structured questionnaires to assess satisfaction, pain perception, treatment expectations, and communication quality. Statistical analyses, including correlations and regression models, were used to identify predictors of satisfaction. The study included 450 orthodontic patients from the north-eastern region of Romania, undergoing active treatment at the time of data collection. Results: The strongest predictor of satisfaction was improved self-confidence and smile aesthetics (r = 0.62). Effective communication with orthodontists significantly increased satisfaction (r = 0.58, p = 0.002), while perceived high costs had a negative impact (r = −0.41). Pain and discomfort were common, with 90% of patients experiencing treatment-related pain, leading to reduced compliance. Social embarrassment due to braces also contributed to dissatisfaction (r = −0.47). Conclusions: Patient satisfaction with orthodontic treatment is primarily influenced by aesthetic improvements and effective communication. While enhanced smile perception boosts confidence, financial concerns and social discomfort may negatively affect the overall experience. Improving accessibility to treatment and providing comprehensive patient support are essential for optimizing patient satisfaction. Full article

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

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24 pages, 743 KiB

Open AccessReview

Surgical Treatment, Rehabilitative Approaches and Functioning Assessment for Patients Affected by Breast Cancer-Related Lymphedema: A Comprehensive Review

by Paola Ciamarra, Alessandro de Sire, Dicle Aksoyler, Giovanni Paolino, Carmen Cantisani, Francesco Sabbatino, Luigi Schiavo, Renato Cuocolo, Carlo Pietro Campobasso and Luigi Losco

Medicina 2025, 61(8), 1327; https://doi.org/10.3390/medicina61081327 - 23 Jul 2025

Abstract

Introduction: Breast cancer therapy is a common cause of lymphedema. The accumulation of protein-rich fluid in the affected extremity leads to a progressive path—swelling, inflammation, and fibrosis—namely, irreversible changes. Methods: A scientific literature analysis was performed on PubMed/Medline, Scopus, Web of Science (WoS), [...] Read more.

Introduction: Breast cancer therapy is a common cause of lymphedema. The accumulation of protein-rich fluid in the affected extremity leads to a progressive path—swelling, inflammation, and fibrosis—namely, irreversible changes. Methods: A scientific literature analysis was performed on PubMed/Medline, Scopus, Web of Science (WoS), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) from inception until 30 June 2024. Results: Breast cancer-related lymphedema (BCRL) is indeed an important healthcare burden both due to the significant patient-related outcomes and the overall social impact of this condition. Even though lymphedema is not life-threatening, the literature underlined harmful consequences in terms of pain, infections, distress, and functional impairment with a subsequent and relevant decrease in quality of life. Currently, since there is no cure, the therapeutic approach to BCRL aims to slow disease progression and prevent related complications. A comprehensive overview of postmastectomy lymphedema is offered. First, the pathophysiology and risk factors associated with BCRL were detailed; then, diagnosis modalities were depicted highlighting the importance of early detection. According to non-negligible changes in patients’ everyday lives, novel criteria for patients’ functioning assessment are reported. Regarding the treatment modalities, a wide array of conservative and surgical methods both physiologic and ablative were analyzed with their own outcomes and downsides. Conclusions: Combined strategies and multidisciplinary protocols for BCRL, including specialized management by reconstructive surgeons and physiatrists, along with healthy lifestyle programs and personalized nutritional counseling, should be compulsory to address patients’ demands and optimize the treatment of this harmful and non-curable condition. The Lymphedema-specific ICF Core Sets should be included more often in the overall outcome evaluation with the aim of obtaining a comprehensive appraisal of the treatment strategies that take into account the patient’s subjective score. Full article

(This article belongs to the Section Surgery)

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14 pages, 662 KiB

Open AccessArticle

Weekly Cisplatin and 5-Fluorouracil in Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Pandemic-Era Evaluation

by Yi-Ting Hwang, Cheng-Yen Chuang and Chien-Chih Chen

Medicina 2025, 61(8), 1326; https://doi.org/10.3390/medicina61081326 - 23 Jul 2025

Abstract

Background and Objectives: The COVID-19 pandemic disrupted cancer care, prompting adaptations to reduce patient exposure while preserving treatment efficacy. This retrospective observational study compared a weekly cisplatin and 5-fluorouracil (5-FU) regimen to the standard monthly regimen for neoadjuvant chemoradiotherapy in patients with [...] Read more.

Background and Objectives: The COVID-19 pandemic disrupted cancer care, prompting adaptations to reduce patient exposure while preserving treatment efficacy. This retrospective observational study compared a weekly cisplatin and 5-fluorouracil (5-FU) regimen to the standard monthly regimen for neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma. Materials and Methods: This single-center retrospective study included 91 patients, divided into two cohorts: weekly chemotherapy (n = 30) and standard chemotherapy (n = 61). Treatment assignment was based on hospital policy changes during the pandemic, with weekly outpatient chemotherapy implemented after November 2022 to conserve inpatient resources. All patients received radiotherapy at 50 Gy in 25 fractions. The weekly regimen consisted of cisplatin 20 mg/m² and 5-FU 800 mg/m², administered over 1–2 h weekly, while the standard regimen administered the same doses over four consecutive days on weeks 1 and 5. Primary endpoints were pathologic complete response (pCR), progression-free survival (PFS), and overall survival (OS). Results: The response rates were similar between groups (weekly: 86.7% vs. standard: 90.2%; p = 0.724). The weekly regimen group showed a higher pCR (40.0% vs. 26.2%; p = 0.181) and significantly lower recurrence (26.7% vs. 52.5%; p = 0.020). Mortality was also reduced in the weekly group (6.7% vs. 34.4%; p = 0.004), though the follow-up duration was shorter (10.6 vs. 22.8 months; p < 0.001). Conclusions: In this retrospective observational study, weekly cisplatin and 5-FU demonstrated comparable efficacy to the standard regimen, with potential advantages in reducing recurrence and mortality. This modified approach may be a viable alternative for maintaining oncologic outcomes while minimizing the burden on healthcare systems during pandemic conditions, although prospective validation is needed. Full article

(This article belongs to the Section Oncology)

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14 pages, 3802 KiB

Open AccessArticle

Impact of Glycemic Control After Reperfusion on the Incidence of Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score-Matched Analysis

by Yeon Ju Kim, Hye-Mee Kwon, Yan Zhen Jin, Sung-Hoon Kim, In-Gu Jun, Jun-Gol Song and Gyu-Sam Hwang

Medicina 2025, 61(8), 1325; https://doi.org/10.3390/medicina61081325 - 23 Jul 2025

Abstract

Background and Objectives: Glucose instability has been established to be related to postoperative morbidity and mortality in liver transplantation. To date, the impact of maintaining optimal blood glucose (BG) levels on the incidence of acute kidney injury (AKI) following liver transplantation (LT) remains [...] Read more.

Background and Objectives: Glucose instability has been established to be related to postoperative morbidity and mortality in liver transplantation. To date, the impact of maintaining optimal blood glucose (BG) levels on the incidence of acute kidney injury (AKI) following liver transplantation (LT) remains unclear. This study aimed to determine the impact of optimal BG level after reperfusion (REP BG) on the incidence of AKI after living donor LT (LDLT). Materials and Methods: This study retrospectively reviewed 3331 patients who underwent LDLT between January 2008 and December 2019. Patients were divided into optimal (110 mg/dL < BG < 180 mg/dL) and non-optimal (BG < 110 mg/dL or >180 mg/dL) REP BG groups. Multivariable logistic regression analysis was performed to assess factors associated with AKI. Propensity score matching (PSM) was used to compare the incidence of AKI, AKI severity, and progression to chronic kidney disease (CKD) between the groups. Results: The incidence of AKI was 66.7%. After PSM, patients in the optimal REP BG group showed a lower incidence of AKI (66.5% vs. 70.6%, p = 0.032). Multivariable logistic regression analysis showed that the non-optimal REP BG group was independently associated with a higher risk of AKI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02–1.45; p = 0.037) compared to the optimal group. Similarly, the risks of severe AKI (OR, 1.32; 95% CI, 1.11–1.58; p = 0.002) and progression to CKD (OR, 1.19; 95% CI, 1.01–1.41; p = 0.039) were significantly higher in the non-optimal group after PSM. Conclusions: Maintenance of an optimal REP BG was associated with a significantly lower incidence of AKI and a reduced risk of progression to CKD within 1 year after LDLT. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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17 pages, 1660 KiB

Open AccessSystematic Review

The Effects of Trunk Intervention on Gross Motor Function, Balance, and Spasticity in Cerebral Palsy: Systematic Review and Meta-Analysis

by Mi-Soo Lim, Byung-Chan Yoo and Hyoung-Won Lim

Medicina 2025, 61(8), 1324; https://doi.org/10.3390/medicina61081324 - 23 Jul 2025

Abstract

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere [...] Read more.

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere with motor coordination and posture, evaluating its response to trunk-focused interventions may offer additional clinical insights. This systematic review and meta-analysis evaluated the effectiveness of trunk-focused interventions on trunk control, gross motor function, balance, and spasticity. Materials and Methods: A systematic search was conducted in PubMed, Embase, Web of Science, MEDLINE, and CINAHL for randomized controlled trials (RCTs) published in the last 10 years up to 11 April 2023. Studies targeting trunk-specific interventions in children with CP were included. Meta-analyses were performed using RevMan 5.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the PEDro scale. Results: Fifteen RCTs involving 454 children were included. Trunk control improved significantly (SMD = 3.67; 95% CI: 3.10–4.25; I² = 0%). Gross motor function showed a small but significant improvement (SMD = 0.49; 95% CI: 0.06–0.92; I² = 44%). Balance exhibited a large, though not statistically significant, effect (SMD = 0.90; 95% CI: −0.00 to 1.79; I² = 81%). Subgroup analysis indicated that interventions performed more than four times per week produced a significant effect on balance (SMD = 0.54; 95% CI: 0.08–1.01). Only one study assessed spasticity and found no group difference. Conclusions: Trunk-based interventions significantly improve trunk control and gross motor function in children with CP. While improvements in balance were inconsistent, higher-frequency interventions yielded more favorable results. Further research is warranted to clarify effects on spasticity and optimize intervention protocols for clinical application. Full article

(This article belongs to the Section Neurology)

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18 pages, 1154 KiB

Open AccessArticle

Predicting Major Adverse Cardiovascular Events After Cardiac Surgery Using Combined Clinical, Laboratory, and Echocardiographic Parameters: A Machine Learning Approach

by Mladjan Golubovic, Velimir Peric, Marija Stosic, Vladimir Stojiljkovic, Sasa Zivic, Aleksandar Kamenov, Dragan Milic, Vesna Dinic, Dalibor Stojanovic and Milan Lazarevic

Medicina 2025, 61(8), 1323; https://doi.org/10.3390/medicina61081323 - 23 Jul 2025

Abstract

Background and Objectives: Despite significant advances in surgical techniques and perioperative care, major adverse cardiovascular events (MACE) remain a leading cause of postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Accurate preoperative risk stratification is essential [...] Read more.

Background and Objectives: Despite significant advances in surgical techniques and perioperative care, major adverse cardiovascular events (MACE) remain a leading cause of postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Accurate preoperative risk stratification is essential yet often limited by models that overlook atrial mechanics and underutilized biomarkers. Materials and Methods: This study aimed to develop an interpretable machine learning model for predicting perioperative MACE by integrating clinical, biochemical, and echocardiographic features, with a particular focus on novel physiological markers. A retrospective cohort of 131 patients was analyzed. An Extreme Gradient Boosting (XGBoost) classifier was trained on a comprehensive feature set, and SHapley Additive exPlanations (SHAPs) were used to quantify each variable’s contribution to model predictions. Results: In a stratified 80:20 train–test split, the model initially achieved an AUC of 1.00. Acknowledging the potential for overfitting in small datasets, additional validation was performed using 10 independent random splits and 5-fold cross-validation. These analyses yielded an average AUC of 0.846 ± 0.092 and an F1-score of 0.807 ± 0.096, supporting the model’s stability and generalizability. The most influential predictors included total atrial conduction time, mitral and tricuspid annular orifice areas, and high-density lipoprotein (HDL) cholesterol. These variables, spanning electrophysiological, structural, and metabolic domains, significantly enhanced discriminative performance, even in patients with preserved left ventricular function. The model’s transparency provides clinically intuitive insights into individual risk profiles, emphasizing the significance of non-traditional parameters in perioperative assessments. Conclusions: This study demonstrates the feasibility and potential clinical value of combining advanced echocardiographic, biochemical, and machine learning tools for individualized cardiovascular risk prediction. While promising, these findings require prospective validation in larger, multicenter cohorts before being integrated into routine clinical decision-making. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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13 pages, 606 KiB

Open AccessArticle

Advancing Diagnostics with Semi-Automatic Tear Meniscus Central Area Measurement for Aqueous Deficient Dry Eye Discrimination

by Hugo Pena-Verdeal, Jacobo Garcia-Queiruga, Belen Sabucedo-Villamarin, Carlos Garcia-Resua, Maria J. Giraldez and Eva Yebra-Pimentel

Medicina 2025, 61(8), 1322; https://doi.org/10.3390/medicina61081322 - 22 Jul 2025

Abstract

Background and Objectives: To clinically validate a semi-automatic measurement of Tear Meniscus Central Area (TMCA) to differentiate between Non-Aqueous Deficient Dry Eye (Non-ADDE) and Aqueous Deficient Dry Eye (ADDE) patients. Materials and Methods: 120 volunteer participants were included in the study. Following [...] Read more.

Background and Objectives: To clinically validate a semi-automatic measurement of Tear Meniscus Central Area (TMCA) to differentiate between Non-Aqueous Deficient Dry Eye (Non-ADDE) and Aqueous Deficient Dry Eye (ADDE) patients. Materials and Methods: 120 volunteer participants were included in the study. Following TFOS DEWS II diagnostic criteria, a battery of tests was conducted for dry eye diagnosis: Ocular Surface Disease Index questionnaire, tear film osmolarity, tear film break-up time, and corneal staining. Additionally, lower tear meniscus videos were captured with Tearscope illumination and, separately, with fluorescein using slit-lamp blue light and a yellow filter. Tear meniscus height was measured from Tearscope videos to differentiate Non-ADDE from ADDE participants, while TMCA was obtained from fluorescein videos. Both parameters were analyzed using the open-source software NIH ImageJ. Results: Receiver Operating Characteristics analysis showed that semi-automatic TMCA evaluation had significant diagnostic capability to differentiate between Non-ADDE and ADDE participants, with an optimal cut-off value to differentiate between the two groups of 54.62 mm² (Area Under the Curve = 0.714 ± 0.051, p < 0.001; specificity: 71.7%; sensitivity: 68.9%). Conclusions: The semi-automatic TMCA evaluation showed preliminary valuable results as a diagnostic tool for distinguishing between ADDE and Non-ADDE individuals. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Therapies of Ocular Diseases)

13 pages, 407 KiB

Open AccessSystematic Review

Peripheral Vascular Access in Infants: Is Ultrasound-Guided Cannulation More Effective than the Conventional Approach? A Systematic Review

by Cristina Casal-Guisande, Esperanza López-Domene, Silvia Fernández-Antorrena, Alberto Fernández-García, María Torres-Durán, Manuel Casal-Guisande and Alberto Fernández-Villar

Medicina 2025, 61(8), 1321; https://doi.org/10.3390/medicina61081321 - 22 Jul 2025

Abstract

Background and Objectives: Peripheral vascular access in infants is a frequent but technically challenging procedure due to the anatomical characteristics of this population. Repeated failed attempts may increase complications and emotional stress for both patients and healthcare professionals. This systematic review aimed [...] Read more.

Background and Objectives: Peripheral vascular access in infants is a frequent but technically challenging procedure due to the anatomical characteristics of this population. Repeated failed attempts may increase complications and emotional stress for both patients and healthcare professionals. This systematic review aimed to evaluate the efficacy and safety of ultrasound-guided peripheral vascular cannulation compared to the conventional or “blind” technique in infants. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. The PubMed database was searched for studies published between 2017 and 2025. Studies comparing both techniques in infants under two years of age were selected, evaluating variables such as the number of punctures, first-attempt success, healthcare staff perception, associated stress, and the role of simulation in training. Results: Eleven studies were included, comprising clinical trials, observational studies, and training program assessments from different countries. Most reported a higher first-attempt success rate with the ultrasound-guided technique (often exceeding 85%), along with fewer punctures and complications, particularly among less-experienced professionals. Improvements in staff perception were also observed following structured training. The impact on stress experienced by patients and families was less frequently assessed directly, although some studies reported indirect benefits. Conclusions: Ultrasound-guided peripheral vascular cannulation appears to be more effective and safer than the conventional technique in infants, particularly in complex or critical care contexts. Its implementation requires specific training and appropriate resources but could significantly improve clinical outcomes and the pediatric patient experience. Full article

(This article belongs to the Section Pediatrics)

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12 pages, 1502 KiB

Open AccessArticle

Long-Term Impact of COVID-19 on Osteoporosis Risk Among Patients Aged ≥50 Years with New-Onset Overweight, Obesity, or Type 2 Diabetes: A Multi-Institutional Retrospective Cohort Study

by Sheng-You Su, Yi-Fan Sun and Jun-Jun Yeh

Medicina 2025, 61(8), 1320; https://doi.org/10.3390/medicina61081320 - 22 Jul 2025

Abstract

Background and Objectives: COVID-19 may have long-term adverse effects on bone health, particularly in individuals aged ≥50 years with obesity or diabetes, who are predisposed to impaired bone quality. Materials and Methods: This retrospective cohort study used TriNetX data from 141 [...] Read more.

Background and Objectives: COVID-19 may have long-term adverse effects on bone health, particularly in individuals aged ≥50 years with obesity or diabetes, who are predisposed to impaired bone quality. Materials and Methods: This retrospective cohort study used TriNetX data from 141 healthcare organizations across North America and Western Europe. Patients aged ≥50 years with overweight (body mass index 25–30 kg/m²), obesity (body mass index ≥ 30 kg/m²), or type 2 diabetes (T2DM) and COVID-19 (2019–2024) were propensity score-matched to non-COVID-19 controls. Exclusion criteria included prior overweight, obesity, diabetes, osteoporosis, T-score ≤ −2.5, Z score ≤ −2.0, fractures, pneumonia, tuberculosis, and cancer. Outcomes included new-onset osteoporosis, fragility fractures, and low T-scores (≤−2.5). Cox regression estimated hazard ratios (HRs); sensitivity analyses assessed lag effects (1–4 years). Results: Among 327,933 matched pairs, COVID-19 was linked to increased osteoporosis risk at 3 years (HR, 1.039; 95% CI, 1.003–1.077) and 6 years (HR, 1.095; 95% CI, 1.059–1.133). Sensitivity analysis showed rising risk with longer lag times: HRs were 1.212, 1.379, 1.563, and 1.884 at 1 to 4 years, respectively. Subgroup analyses confirmed consistent trends. Conclusions: COVID-19 is independently associated with elevated long-term osteoporosis risk in older adults with new-onset overweight, obesity, or T2DM, peaking at 4 years post-infection and persisting through 6 years. Full article

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17 pages, 840 KiB

Open AccessArticle

Developing a Consensus-Based POCUS Protocol for Critically Ill Patients During Pandemics: A Modified Delphi Study

by Hyuksool Kwon, Jin Hee Lee, Dongbum Suh, Kyoung Min You and PULSE Group

Medicina 2025, 61(8), 1319; https://doi.org/10.3390/medicina61081319 - 22 Jul 2025

Abstract

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert [...] Read more.

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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13 pages, 659 KiB

Open AccessArticle

A Retrospective Analysis of the Predictive Role of RDW, MPV, and MPV/PLT Values in 28-Day Mortality of Geriatric Sepsis Patients: Associations with APACHE II and SAPS II Scores

by Adem Koçak and Senem Urfalı

Medicina 2025, 61(8), 1318; https://doi.org/10.3390/medicina61081318 - 22 Jul 2025

Abstract

Background and Objectives: Immunodeficiency associated with aging comorbidities increases the vulnerability of geriatric patients to sepsis. Early recognition and management of sepsis are essential in this population. This study evaluated the relationships between RDW, MPV, and MPV/PLT ratios and mortality in geriatric [...] Read more.

Background and Objectives: Immunodeficiency associated with aging comorbidities increases the vulnerability of geriatric patients to sepsis. Early recognition and management of sepsis are essential in this population. This study evaluated the relationships between RDW, MPV, and MPV/PLT ratios and mortality in geriatric sepsis patients. Materials and Methods: This retrospective study was conducted between 2020 and 2024 in the Intensive Care Unit of the Department of Anesthesiology and Reanimation at a university hospital. Patients aged ≥ 65 years with a SOFA score of ≥2 were included. Demographic data (sex, age, height, weight, and BMI), hemogram parameters (RDW, MPV, and PLT), blood gas, and biochemical values were analyzed. Furthermore, their comorbidities; site of infection; ICU length of stay; vital signs; and SOFA, APACHE II, and SAPS II scores, recorded within the first 24 h following ICU admission, were evaluated. Statistical analysis was performed using the chi-square test, Student’s t-test, the Mann–Whitney U test, the Monte Carlo exact test, and ROC analysis. A p-value of <0.05 was considered statistically significant. Results: A total of 247 patients were included, with 46.2% (n = 114) classified as non-survivors during the 28-day follow-up period. Among them, 64.9% (n = 74) were male, with a mean age of 78.22 ± 8.53 years. Significant differences were also found in SOFA, APACHE-II, and SAPS-II scores between non-survivors and survivors (SOFA: 7.64 ± 3.16 vs. 6.78 ± 2.78, p = 0.023; APACHE-II: 21.31 ± 6.36 vs. 19.27 ± 5.88, p = 0.009; SAPS-II: 53.15 ± 16.04 vs. 46.93 ± 14.64, p = 0.002). On days 1, 3, and 5, the MPV/PLT ratio demonstrated a statistically significant predictive value for 28-day mortality. The optimal cut-off values were >0.03 on day 1 (AUC: 0.580, 95% CI: 0.516–0.642, sensitivity: 72.81%, specificity: 65.91%, p = 0.027), >0.04 on day 3 (AUC: 0.602, 95% CI: 0.538–0.663, sensitivity: 60.53%, specificity: 60.61%, p = 0.005), and >0.04 on day 5 (AUC: 0.618, 95% CI: 0.554–0.790, sensitivity: 66.14%, specificity: 62.88%, p = 0.001). Conclusions: The MPV and MPV/PLT ratios demonstrated statistically significant but limited predictive value for 28-day mortality in geriatric patients with sepsis. In contrast, the limited prognostic value of RDW may be related to variability in the inflammatory response and other underlying conditions. The correlations found between SOFA, APACHE II, and SAPS II scores highlight their importance in mortality risk prediction. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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14 pages, 2068 KiB

Open AccessArticle

Cellular Rejection Post-Cardiac Transplantation: A 13-Year Single Unicentric Study

by Gabriela Patrichi, Catalin-Bogdan Satala, Andrei Ionut Patrichi, Toader Septimiu Voidăzan, Alexandru-Nicușor Tomuț, Daniela Mihalache and Anca Ileana Sin

Medicina 2025, 61(8), 1317; https://doi.org/10.3390/medicina61081317 - 22 Jul 2025

Abstract

Background and Objectives: Cardiac transplantation is currently the elective treatment choice in end-stage heart failure, and cellular rejection is a predictive factor for morbidity and mortality after surgery. We proposed an evaluation of the clinicopathologic factors involved in the mechanism of rejection. [...] Read more.

Background and Objectives: Cardiac transplantation is currently the elective treatment choice in end-stage heart failure, and cellular rejection is a predictive factor for morbidity and mortality after surgery. We proposed an evaluation of the clinicopathologic factors involved in the mechanism of rejection. Materials and Methods: This study included 146 patients who underwent transplantation at the Institute of Cardiovascular Diseases and Transplantation in Targu Mures between 2010 and 2023, and we evaluated the function and structure of the myocardium after surgery by using endomyocardial biopsy. Results: Overall, 120 men and 26 women underwent transplantation, with an approximately equal proportion under and over 40 years old (48.6% and 51.4%). Evaluating the degree of acute cellular rejection according to the International Society for Heart and Lung Transplantation classification showed that most of the patients presented with acute cellular rejection (ACR) and antibody-mediated rejection (AMR) grade 0, and most cases of ACR and AMR were reported with mild changes (13% or 10.3% patients). Therefore, the most frequent histopathologic diagnoses were similar to lesions unrelated to rejection (45.2% of patients) and ischemia–reperfusion lesions (25.3% patients), respectively. Conclusions: Although 82.2% of the transplanted cases showed no rejection (ISHLT score 0), non-rejection-related lesion-like changes were present in 45.2% of cases, and because more of the non-rejection-related criteria could be detected, it may be necessary to adjust the grading of the rejection criteria. The histopathologic changes that characterize rejection are primarily represented by the mononuclear inflammatory infiltrate; in our study, inflammatory changes were mostly mild (71.9%), with myocyte involvement in all cases. These changes are associated with and contribute to the maintenance of the rejection phenomenon. Full article

(This article belongs to the Section Cardiology)

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12 pages, 3204 KiB

Open AccessSystematic Review

Association Between ABO or Rh Blood Groups and Chikungunya Virus Infection: A Systematic Review and Meta-Analysis

by Yanisa Rattanapan, Wanatsanan Chulrik, Karunaithas Rasaratnam and Thitinat Duangchan

Medicina 2025, 61(8), 1316; https://doi.org/10.3390/medicina61081316 - 22 Jul 2025

Abstract

Background and Objectives: The relationship between ABO or Rh blood groups and susceptibility to Chikungunya virus (CHIKV) infection remains unclear. This systematic review and meta-analysis aimed to synthesize available evidence on this association. Materials and Methods: Studies reporting ABO and/or Rh [...] Read more.

Background and Objectives: The relationship between ABO or Rh blood groups and susceptibility to Chikungunya virus (CHIKV) infection remains unclear. This systematic review and meta-analysis aimed to synthesize available evidence on this association. Materials and Methods: Studies reporting ABO and/or Rh blood groups and CHIKV infection were searched through PubMed, Scopus, EMBASE, MEDLINE, Ovid, ProQuest, and Google Scholar up to 8 July 2025. A random-effects meta-analysis was conducted to calculate pooled odds ratios (Ors) with 95% CIs. Heterogeneity was assessed using I² statistics. Subgroup analyses were performed based on study design and study quality. Sensitivity analysis was conducted using a leave-one-out method. Publication bias was evaluated via funnel plots and Egger’s test. Results: Seven studies, including 24,828 participants, were included. No significant associations were observed between blood groups A, B, AB, or Rh(D) and CHIKV infection. However, blood group O was significantly associated with an increased risk of CHIKV infection (OR: 1.52, 95% CI: 1.01–2.29, p = 0.043, I² = 95.38%) compared to non-O blood groups. Subgroup analyses showed stable results. Nevertheless, the sensitivity analysis indicated that certain studies had a greater influence on the overall results. In addition, significant publication bias was also detected. Conclusions: Current evidence indicates that blood group O is significantly associated with an increased susceptibility to CHIKV infection. In contrast, no consistent associations were observed for other ABO or Rh blood groups. Due to substantial heterogeneity and methodological limitations, these findings should be interpreted with caution. Further well-designed, large-scale studies with standardized diagnostics are needed to clarify these associations and underlying mechanisms. Full article

(This article belongs to the Section Infectious Disease)

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20 pages, 8740 KiB

Open AccessArticle

Agomelatine Ameliorates Cognitive and Behavioral Deficits in Aβ-Induced Alzheimer’s Disease-like Rat Model

by Raviye Ozen Koca, Z. Isik Solak Gormus, Hatice Solak, Burcu Gultekin, Ayse Ozdemir, Canan Eroglu Gunes, Ercan Kurar and Selim Kutlu

Medicina 2025, 61(8), 1315; https://doi.org/10.3390/medicina61081315 - 22 Jul 2025

Abstract

Background and Objectives: Alzheimer’s disease (AD) has become a serious health problem. Agomelatine (Ago) is a neuroprotective antidepressant. This study aimed to assess how Ago influences behavioral outcomes in AD-like rat model. Materials and Methods: Forty-eight Wistar albino rats were allocated into four [...] Read more.

Background and Objectives: Alzheimer’s disease (AD) has become a serious health problem. Agomelatine (Ago) is a neuroprotective antidepressant. This study aimed to assess how Ago influences behavioral outcomes in AD-like rat model. Materials and Methods: Forty-eight Wistar albino rats were allocated into four groups: Control (C), Alzheimer’s disease-like model (AD), Alzheimer’s disease-like model treated with Ago (ADAgo), and Ago alone (Ago). Physiological saline was injected intrahippocampally in C and Ago animals, whereas Aβ peptide was delivered similarly in AD and ADAgo rats. On day 15, 0.9% NaCl was administered to the C and AD groups, and Agomelatine (1 mg/kg/day) was infused into ADAgo and Ago rats via osmotic pumps for 30 days. Behavioral functions were evaluated using Open Field (OF), Forced Swim (FST), and Morris Water Maze (MWM) tests. Brain tissues were examined histopathologically. Neuritin, Nestin, DCX, NeuN, BDNF, MASH1, MT1, and MT2 transcripts were quantified by real-time PCR. Statistical analyses were performed in R 4.3.1, with p < 0.05 deemed significant. Results: In the FST, swimming, climbing, immobility time, and mobility percentage differed significantly among groups (p < 0.05). In the MWM, AD rats exhibited impaired learning and memory that was ameliorated by Ago treatment (p < 0.05). DCX expression decreased in AD rats but was elevated by Ago (p < 0.05). Nestin levels differed significantly between control and AD animals; MT1 expression varied between control and AD cohorts; and MT2 transcript levels were significantly lower in AD, ADAgo, and Ago groups compared to C (all p < 0.05). Conclusions: Ago exhibits antidepressant-like activity in this experimental AD model and may enhance cognitive function via mechanisms beyond synaptic plasticity and neurogenesis. Full article

(This article belongs to the Section Neurology)

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15 pages, 621 KiB

Open AccessReview

Cholecystectomy in the Context of Cirrhosis, Sclero-Atrophic Cholecystitis, and Gangrenous Cholecystitis: A Literature Review

by Cristian Botezatu, Dumitru Dragos Chitca, Valentin Popescu, Martina Nichilo, Angela Madalina Lazar and Bogdan Mastalier

Medicina 2025, 61(8), 1314; https://doi.org/10.3390/medicina61081314 - 22 Jul 2025

Abstract

The gallbladder pathology is mainly represented by cholelithiasis, treated with cholecystectomy, one of the most commonly performed surgical procedures, continues to raise some challenges. Despite the advancements in surgical techniques, especially in those patients presenting some particularities, such as cirrhotic patients or those [...] Read more.

The gallbladder pathology is mainly represented by cholelithiasis, treated with cholecystectomy, one of the most commonly performed surgical procedures, continues to raise some challenges. Despite the advancements in surgical techniques, especially in those patients presenting some particularities, such as cirrhotic patients or those with sclero-atrophic or acute gangrenous cholecystitis, difficulties continue to arise. This review, including an evaluation of the literature from the last 20 years, aims to explore the pathophysiological mechanisms and surgical approaches for these high-risk conditions. Emphasis is placed on tailoring management strategies in order to reduce complications and improve outcomes, offering insights for optimizing care in difficult cholecystectomies. Full article

(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)

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Medicina, Volume 61, Issue 8 (August 2025) – 19 articles

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