Medicina

17 pages, 1057 KB

Open AccessReview

Integrating Multiparametric MRI and PSMA PET Imaging in Prostate Cancer: Toward a Unified Diagnostic and Risk-Stratification Paradigm

by Rosa Alba Pugliesi, Roberto Cannella, Karim Ben Mansour, Daniele Di Biagio and Pierpaolo Alongi

Medicina 2026, 62(3), 610; https://doi.org/10.3390/medicina62030610 - 23 Mar 2026

Viewed by 1598

Abstract

Prostate cancer represents a highly prevalent malignancy affecting men globally, necessitating precise staging and risk stratification for effective patient management. Multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) have individually revolutionized the diagnosis and management of prostate [...] Read more.

Prostate cancer represents a highly prevalent malignancy affecting men globally, necessitating precise staging and risk stratification for effective patient management. Multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) have individually revolutionized the diagnosis and management of prostate cancer. Recent developments emphasize the integration of these imaging modalities to improve detection capabilities, inform therapeutic interventions, and facilitate personalized management. This narrative article reviews existing literature on the clinical utilization of mpMRI and PSMA PET in prostate cancer. Key areas encompass initial diagnosis, both local and systemic staging, detection of biochemical recurrence, and their influence in treatment strategies. The integration of mpMRI and PSMA PET offers complementary insights, with mpMRI demonstrating superior capability in local tumor characterization and PSMA PET enhancing the detection of nodal and distant metastases. Quantitative imaging biomarkers, including apparent diffusion coefficient (ADC) and standardized uptake values (SUV), have the potential to improve risk stratification and inform personalized treatment strategies. Hybrid imaging techniques may improve diagnostic accuracy and guide decisions regarding surgery, radiotherapy, and systemic treatment. The integration of mpMRI and PSMA PET allows a potentially transformative advancement in the realm of precision imaging for prostate cancer. This integrated approach can improve diagnostic accuracy, better define disease extent, and support personalized management strategies. Full article

(This article belongs to the Special Issue Advances in Use of PET-CT Imaging in Disease Diagnosis)

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18 pages, 2214 KB

Open AccessSystematic Review

The Impact of Inspiratory Muscle Training on Diaphragm Thickness in Healthy Adults: A Systematic Review and Meta-Regression

by Cemre Didem Eyipınar, Tolga Altuğ, Mesut Süleymanoğulları, Aslıhan Tekin, Nicola Luigi Bragazzi, Valentina Stefanica and Halil İbrahim Ceylan

Medicina 2026, 62(3), 609; https://doi.org/10.3390/medicina62030609 - 23 Mar 2026

Viewed by 842

Abstract

Background and Objectives: The hypertrophic adaptation of the diaphragm to inspiratory muscle training (IMT) remains insufficiently characterized, particularly in healthy and athletic populations. To address this gap, we conducted a meta-analysis and meta-regression to evaluate the effects of IMT on diaphragm thickness [...] Read more.

Background and Objectives: The hypertrophic adaptation of the diaphragm to inspiratory muscle training (IMT) remains insufficiently characterized, particularly in healthy and athletic populations. To address this gap, we conducted a meta-analysis and meta-regression to evaluate the effects of IMT on diaphragm thickness and identify potential moderating factors. Materials and Methods: A systematic search was conducted across PubMed, MEDLINE, Embase, CINAHL, and SPORTDiscus as well as Google Scholar (gray literature) through November 2025. Eight studies involving 203 healthy participants met the inclusion criteria. A random-effects model was used to calculate pooled effect sizes and meta-regression estimates. Results: IMT produced a statistically significant moderate increase in diaphragm muscle thickness, with a standardized mean difference (SMD) of Hedges’ g = 0.52 (95% CI: 0.19 to 0.85; p < 0.05). Subgroup analyses indicated that IMT with 50% maximal inspiratory pressure (MIP) produces a statistically significant effect (p = 0.0069), whereas fitness status and age did not significantly influence outcomes (p = 0.589 and p = 0.126, respectively). Meta-regression analyses revealed that only baseline MIP value (β = 0.030; 95% CI: 0.009 to 0.050; p = 0.004) was associated with diaphragm hypertrophy. Conclusions: IMT with 50% of MIP elicits meaningful diaphragmatic hypertrophy in healthy individuals. This response appears independent of fitness status or age, but is significantly influenced by baseline inspiratory muscle strength (MIP). These findings support the utility of IMT in enhancing respiratory muscle morphology in health and performance contexts. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

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21 pages, 1371 KB

Open AccessArticle

Quantitative EEG Assessment of Dependence-Related Neurophysiological Patterns Using Rule- and Score-Based Modeling in Substance Use Disorders

by Merve Setenay Gürbüz, Özlem Gül, Eslem Fulya Ekşi and Kültegin Ögel

Medicina 2026, 62(3), 608; https://doi.org/10.3390/medicina62030608 - 23 Mar 2026

Viewed by 483

Abstract

Background and Objectives: Substance use disorders (SUDs) are associated with maladaptive neuroplasticity and chronic dysregulation of cortical arousal. EEG provides a non-invasive tool for quantifying these neurophysiological alterations through spectral power and reactivity indices. Prior research consistently reports elevated beta and diminished [...] Read more.

Background and Objectives: Substance use disorders (SUDs) are associated with maladaptive neuroplasticity and chronic dysregulation of cortical arousal. EEG provides a non-invasive tool for quantifying these neurophysiological alterations through spectral power and reactivity indices. Prior research consistently reports elevated beta and diminished alpha activity in SUD, reflecting cortical hyperarousal and reduced inhibitory control. This study sought to identify EEG-based markers of dependence-related neurophysiological alterations by integrating rule-based and score-based models incorporating the theta/beta ratio (TBR), alpha and beta powers, the hyperarousal index, and alpha-blocking measures. Materials and Methods: EEG recordings from 47 individuals with SUD were systematically analyzed, focusing on frontal and central cortical regions. Spectral parameters were derived using power spectral density estimation, and composite indices were computed via Python-based signal analysis. A rule-based Dependence Likelihood variable and a continuous Dependence Score (0–1 scale) classified cases as dependence-related (≥0.7), borderline (0.5–0.7), or normal (<0.5). Results: Low alpha power and an elevated hyperarousal index (mean = 3.45) characterized most participants. Dependence-related EEG profiles were identified in 87.2% of cases (mean score = 0.86). Alpha blocking remained intact in 46.8% of cases, whereas post-hyperventilation recovery was attenuated in 61.7% of cases. Segmental analysis indicated sustained cortical activation with low TBR (0.37) and elevated beta across all conditions. Conclusions: Quantitative EEG analysis revealed consistent hyperarousal and inhibitory deficits in SUD. The combined Dependence Likelihood and Score framework provides an interpretable, reproducible approach for identifying dependence-related EEG signatures and holds promise as a biomarker in addiction neurophysiology. Full article

(This article belongs to the Section Psychiatry)

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12 pages, 2236 KB

Open AccessArticle

The “Pacman Flap with Tongue” for Secondary Orbital Reconstruction in Osteoradionecrosis: A Case Series

by Michał Gontarz, Piotr Idzi, Katarzyna Egelhoff, Jakub Bargiel, Krzysztof Gąsiorowski, Kamil Nelke and Grażyna Wyszyńska-Pawelec

Medicina 2026, 62(3), 607; https://doi.org/10.3390/medicina62030607 - 23 Mar 2026

Viewed by 457

Abstract

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary [...] Read more.

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary orbital reconstruction using a combined scalp flap and temporalis muscle flap (TMF), referred to as the “Pacman flap with tongue,” performed prior to prosthetic rehabilitation. Materials and Methods: Five elderly patients with multiple comorbidities and osteoradionecrosis following orbital exenteration and radiotherapy underwent secondary orbital reconstruction using the “Pacman flap with tongue” technique. The clinical outcomes, flap viability, complications, and feasibility of subsequent prosthetic rehabilitation were assessed. After stabilization of healing, digitally planned ocular epitheses were fabricated using cone-beam computed tomography (CBCT), computer-aided design, and three-dimensional printing. Results: Healing was uneventful in all patients. No flap necrosis, wound dehiscence, or recurrent bone exposure was observed. The reconstructed orbital sockets provided a stable, well-vascularized prosthetic bed, enabling satisfactory prosthetic rehabilitation. Conclusions: The “Pacman flap with tongue” may be considered a feasible option for secondary orbital reconstruction in selected high-risk patients, particularly in the setting of osteoradionecrosis. Full article

(This article belongs to the Special Issue Head and Neck Cancer: Early Detection and Advances in Therapy)

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20 pages, 621 KB

Open AccessReview

Risk Stratification for Postoperative Mortality in Cardiac Surgery: “Quo Vadis”?

by Radu-Alexandru Iacobescu, Tiberiu Lunguleac, Sabina Antoniu, Vlăduț Mirel Burduloi, Virgil Bulimar and Grigore Tinica

Medicina 2026, 62(3), 606; https://doi.org/10.3390/medicina62030606 - 23 Mar 2026

Viewed by 912

Abstract

Risk assessment for immediate mortality is a vital component of the preoperative assessment in elective cardiac surgeries of the adult population. It is generally used to inform consent and plan postoperative care, but can also help identify patients who need preoperative optimization. Risk [...] Read more.

Risk assessment for immediate mortality is a vital component of the preoperative assessment in elective cardiac surgeries of the adult population. It is generally used to inform consent and plan postoperative care, but can also help identify patients who need preoperative optimization. Risk assessment for open cardiac interventions remains difficult, as an absolute risk assessment tool is still lacking. In this narrative review, we examine recent data on the predictive performance of commonly used risk assessment tools in cardiac surgery and explore missed opportunities to improve predictive performance, including overlooked independent predictors and alternative calculation strategies, such as machine learning. The literature shows that the most popular risk assessment tools are the Parsonnet score, EuroSCORE II, STS-PROM, and ACEF. These have reasonable discriminative capabilities across most populations but occasionally suffer from poor calibration and over- or underprediction. Preoperative inflammation, functional status, physical performance, nutrition, and frailty are potentially relevant clinical factors that could improve mortality prediction modeling using traditional approaches. By far, the largest advancement comes from artificial intelligence-based models that demonstrate superior predictive capabilities utilizing the same predictors. These models are still in development, have not received external validation, are not yet trusted by physicians, and may not be accessible to all institutions due to computing limitations, and thus are not ready for global rollout. Further research in identifying novel predictors of mortality is required, and efforts are needed to validate machine learning models in external cohorts. Full article

(This article belongs to the Section Cardiology)

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21 pages, 1341 KB

Open AccessArticle

Discovery of a Secretory Granule Lumen-Enriched Serum Protein Signature in Resectable Pancreatic Ductal Adenocarcinoma

by Septimiu Alex Moldovan, Maria Iacobescu, Emil Ioan Moiș, Florin Graur, Luminiţa Furcea, Florin Zaharie, Andra Ciocan, Maria-Andreea Soporan, Ioana-Ecaterina Pralea, Simona Mirel, Mihaela Ştefana Moldovan, Andrada Seicean, Vlad Ionuț Nechita, Cristina Adela Iuga and Nadim Al Hajjar

Medicina 2026, 62(3), 605; https://doi.org/10.3390/medicina62030605 - 23 Mar 2026

Viewed by 663

Abstract

Background and Objectives: Serum biomarker discovery in resectable pancreatic ductal adenocarcinoma (PDAC) remains a critical unmet need, as over 80% of patients present with unresectable disease. Serum proteomics offers a promising approach for identifying circulating biomarkers associated with early-stage disease; however, clinical [...] Read more.

Background and Objectives: Serum biomarker discovery in resectable pancreatic ductal adenocarcinoma (PDAC) remains a critical unmet need, as over 80% of patients present with unresectable disease. Serum proteomics offers a promising approach for identifying circulating biomarkers associated with early-stage disease; however, clinical translation has been limited by inconsistent validation and the absence of clinically relevant comparator populations. Materials and Methods: We performed a discovery-phase study using data-independent acquisition mass spectrometry-based serum proteomics in 35 patients with resectable, non-metastatic PDAC and 34 non-cancer controls without hepato-biliary-pancreatic disease. Following quality filtering (≥80% detection threshold), 407 proteins were retained for analysis. Differential abundance was assessed using Welch’s t-test with Benjamini–Hochberg correction (FDR < 0.01, |FC| ≥ 1.5). Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis and logistic regression with repeated stratified 5-fold cross-validation (100 repetitions) and bootstrap resampling (1000 iterations). Functional enrichment analysis was performed using g:Profiler. Results: Ninety proteins were significantly altered in PDAC (50 increased, 40 decreased). Inter-alpha-trypsin inhibitor heavy chain H3 (ITIH3) demonstrated the highest individual diagnostic performance (AUC = 0.90), followed by coagulation factor XIII A chain (F13A1; AUC = 0.89) and ferritin light chain (FTL; AUC = 0.86). Functional enrichment revealed significant overrepresentation of secretory granule lumen components (adjusted p = 0.001) and complement/coagulation pathways (adjusted p < 0.001). An enrichment-guided three-protein panel (ITIH3, F13A1, and FTL) achieved an AUC of 0.98 (95% CI: 0.95–1.00), with a cross-validated mean AUC of 0.96, sensitivity of 83% (95% CI: 66.4–93.4%), and specificity of 100% (95% CI: 89.7–100%) within the discovery cohort. Conclusions: This discovery-phase study identifies a biologically coherent serum protein signature enriched for secretory granule lumen components in resectable PDAC. The three-protein panel demonstrates strong internal validation performance; however, these estimates may be optimistic due to feature selection performed prior to cross-validation. External validation in independent cohorts—including chronic pancreatitis controls and parallel CA19-9 assessment—will be essential to determine clinical applicability. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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16 pages, 1714 KB

Open AccessSystematic Review

Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis

by Baudolino Mussa, Gloria Passarella, Mara Marchese and Barbara Defrancisco

Medicina 2026, 62(3), 604; https://doi.org/10.3390/medicina62030604 - 23 Mar 2026

Viewed by 992

Abstract

Background and Objectives: Difficult venous access (DVA) affects 10–26% of hospitalized patients and up to 60% in high-risk populations, leading to increased patient discomfort, delayed diagnosis, and substantial healthcare costs estimated at $4.7 billion annually in the United States. This meta-analysis aimed to [...] Read more.

Background and Objectives: Difficult venous access (DVA) affects 10–26% of hospitalized patients and up to 60% in high-risk populations, leading to increased patient discomfort, delayed diagnosis, and substantial healthcare costs estimated at $4.7 billion annually in the United States. This meta-analysis aimed to systematically evaluate the effectiveness, safety, and implementation considerations of traditional and emerging strategies for obtaining blood samples in patients with DVA. Materials and Methods: We conducted a comprehensive systematic review and meta-analysis following PRISMA guidelines. We searched MEDLINE, Embase, CINAHL, and Cochrane databases from January 2016 to December 2023. Inclusion criteria encompassed randomized controlled trials, systematic reviews, and observational studies examining DVA interventions in adult and pediatric populations. Primary outcomes included first-attempt success rates, overall success rates, and complication rates. Statistical analysis used random-effects models with risk ratios and 95% confidence intervals. Results: Forty-seven studies involving 12,847 patients met the inclusion criteria. Technology-assisted approaches demonstrated superior outcomes compared to traditional techniques. Ultrasound guidance showed the highest effectiveness with a first-attempt success increase of 42% (RR 1.42, 95% CI 1.26–1.58, p < 0.001), followed by near-infrared visualization with a 28% increase (RR 1.28, 95% CI 1.14–1.42, p < 0.001). Population-specific approaches yielded significant benefits, including the use of scalp veins for infants and external jugular approaches for extreme DVA cases. Cost-effectiveness analysis revealed that ultrasound guidance achieved break-even within 8–14 months in high-volume centers. Conclusions: A systematic, stepwise approach integrating appropriate technology and techniques significantly improves success rates while reducing patient discomfort and healthcare costs. Healthcare institutions should implement comprehensive DVA protocols with adequate training, equipment access, and quality monitoring. The proposed algorithm achieved a 93% overall success rate in validation studies, representing a substantial improvement over traditional approaches. Full article

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16 pages, 1676 KB

Open AccessArticle

Multimodal Bone Fragility Profiling in People Living with HIV: Trabecular Bone Score, Calcaneal Quantitative Ultrasound, and Sarcopenia Screening

by David Vladut Razvan, Jenel Marian Patrascu, Jr., Ovidiu Rosca, Iulia Georgiana Bogdan, Livia Stanga, Adrian Vlad and Camelia Vidita Gurban

Medicina 2026, 62(3), 603; https://doi.org/10.3390/medicina62030603 - 23 Mar 2026

Cited by 1 | Viewed by 601

Abstract

Background and Objectives: Bone fragility in people living with HIV (PLWH) reflects both reduced bone mineral density (BMD) and impaired microarchitecture, while functional decline may further amplify fracture vulnerability. This study evaluated whether adding a pragmatic sarcopenia screen improves bone fragility characterization beyond [...] Read more.

Background and Objectives: Bone fragility in people living with HIV (PLWH) reflects both reduced bone mineral density (BMD) and impaired microarchitecture, while functional decline may further amplify fracture vulnerability. This study evaluated whether adding a pragmatic sarcopenia screen improves bone fragility characterization beyond DXA-BMD, trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), and biomarkers, and explored the relationship between tenofovir disoproxil fumarate (TDF) exposure and microarchitectural impairment. Materials and Methods: In this single-center cross-sectional study at Victor Babeș University of Medicine and Pharmacy Timișoara, 98 adults on stable ART underwent DXA (T-scores), lumbar TBS (reported as TBS × 100), calcaneal QUS (SOS/BUA), and bone turnover markers (CTX, P1NP, 25(OH)D). Sarcopenia screening used handgrip strength and 4 m gait speed. Associations were tested using group comparisons, correlations, and multivariable modeling for degraded TBS (TBS × 100 < 124.0). Results: Sarcopenia screen-positive participants (n = 28) had lower TBS (123.8 vs. 127.7, p = 0.02), lower lumbar T-score (−1.7 vs. −1.2, p = 0.014), lower SOS (1523.3 vs. 1548.8 m/s, p = 0.002), and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001), with less frequent viral suppression (60.7% vs. 85.7%, p = 0.006). With >5 years TDF exposure (n = 28), degraded TBS prevalence was 82.1% vs. 40.0% in never-exposed (p = 0.001), alongside lower TBS (123.1 vs. 129.8, p < 0.001) and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001). Viral suppression independently reduced odds of degraded TBS (aOR 0.3, 95% CI 0.1–0.9; p = 0.034). Conclusions: In PLWH, prolonged TDF exposure and functional impairment co-occur with worse densitometric and microarchitectural profiles; viral suppression shows an independent protective association with microarchitecture. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 332 KB

Open AccessArticle

Impact of Combined Interventions and Early Home Care Activation on 30-Day Hospital Readmissions: A Retrospective Observational Study

by Gianluca Azzellino, Patrizia Vagnarelli, Ernesto Aitella, Francesca Cerratti, Luca Mengoli, Lia Ginaldi and Massimo De Martinis

Medicina 2026, 62(3), 602; https://doi.org/10.3390/medicina62030602 - 23 Mar 2026

Viewed by 891

Abstract

Background and Objectives: Thirty-day hospital readmissions are a major clinical and economic challenge, particularly among frail older patients. Integrated protected discharge models, coordinated by nurse case managers and including multidimensional hospital-to-community interventions, may improve continuity of care and reduce inappropriate readmissions. Materials [...] Read more.

Background and Objectives: Thirty-day hospital readmissions are a major clinical and economic challenge, particularly among frail older patients. Integrated protected discharge models, coordinated by nurse case managers and including multidimensional hospital-to-community interventions, may improve continuity of care and reduce inappropriate readmissions. Materials and Methods: We conducted a retrospective observational study on 200 consecutive patients aged ≥65 years, discharged between January and December 2024 from a public hospital in Italy. Frailty was assessed using BRASS scores (≥11), ADL, and IADL. The primary outcome was 30-day hospital readmission. Logistic regression models evaluated the impact of individual interventions (Model 1) and combined interventions (Model 2), defined as the simultaneous presence of four components: nurse case manager involvement, telephone follow-up, activation of home care (ADI) within 24 h, and social worker support. Results: Overall, 65 patients (32.5%) were readmitted within 30 days. In the multivariate analysis, nurse case manager involvement was associated with lower odds of readmission (OR = 0.023; 95% CI 0.008–0.064; p < 0.001). Early ADI activation was not associated with readmission in the bivariate analysis (p = 0.195) but showed higher odds of readmission in the multivariable model (OR = 3.475; 95% CI 1.384–8.725; p = 0.008). The combined interventions variable was significantly associated with readmission in Model 2. Patients who did not receive combined interventions had higher odds of 30-day hospital readmission compared with those who did (OR = 26.1; 95% CI 10.1–67.5; p < 0.001). Conclusions: An integrated protected discharge model coordinated by a nurse case manager and including combined interventions was associated with lower odds of 30-day hospital readmission among frail older patients. These findings suggest that the potential benefit of transitional care may lie not in isolated interventions but in the multidimensional integration and coordination of clinical, functional, and social support strategies, highlighting the central role of nurse case managers in transitional care pathways. Full article

(This article belongs to the Special Issue Evidence-Based Public Health: A Fundamental Concept for Public Health Practice)

13 pages, 292 KB

Open AccessArticle

Associations Between the Presence of Primary Headaches and Quality of Life in University Students

by Lukrecija Jakuš, Marina Horvat Tišlar, Ivan Jurak, Mirjana Telebuh, Gordana Grozdek Čovčić, Sonja Jandroković and Darija Mahović

Medicina 2026, 62(3), 601; https://doi.org/10.3390/medicina62030601 - 22 Mar 2026

Viewed by 435

Abstract

Background and Objectives: Headaches have become one of the global public health burdens in the 21st century. Although findings on the presence of headaches in general and older adult populations have been well-documented, little evidence has been observed for university students. Moreover, [...] Read more.

Background and Objectives: Headaches have become one of the global public health burdens in the 21st century. Although findings on the presence of headaches in general and older adult populations have been well-documented, little evidence has been observed for university students. Moreover, their level of quality of life seems to be impaired due to stressful events and the inability to cope with them. However, the mutual relations between headaches and quality of life in this population remain unknown. Therefore, the main purpose of the study was to examine the associations between lifetime headaches and the presence of headaches in the last 12 months with quality of life. Materials and Methods: In total, 1350 university students (age = 22.9 ± 2.3 years; 81.3% female) were recruited. Each participant was instructed to fulfill the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire, a reliable and valid tool to assess headache and quality-of-life characteristics. Headache characteristics, headache-related disability (HALT-90), and quality-of-life domains were analyzed using Spearman’s correlation analyses and structural equation modeling. Results: Participants with migraine reported more frequent and more intense headaches and substantially greater headache-related disability compared with those with tension-type or undifferentiated headache. The mean number of lost days in the previous 90 days (HALT-90) was 14.3 (SD 23.1) in the migraine group compared with 4.53 (SD 12.0) in the tension-type headache group and 5.77 (SD 10.9) in the undifferentiated headache group. Across most WHOQOL domains, students with migraine reported lower quality-of-life scores compared with other headache groups. The WHOQOL-8 total score averaged 30.9 (SD 4.79) in the migraine group and 33.6 (SD 3.93) among participants without headache. Greater headache burden was consistently associated with poorer quality of life, with headache-related disability showing the strongest correlation with energy for everyday life (r = −0.345, p < 0.001). Conclusions: These findings suggest that greater headache burden, particularly migraine and headache-related disability, is associated with poorer quality of life among university students. The results highlight the need for targeted prevention programs aimed at helping students manage stress more effectively and improve their quality of life. Full article

(This article belongs to the Section Neurology)

13 pages, 1634 KB

Open AccessArticle

Alterations in PD-L1⁺ Myeloid Cells and Immune Infiltration Are Associated with Atezolizumab and Paclitaxel Therapy Success in a Triple-Negative Breast Cancer Model

by Kerim Bora Yilmaz, Ece Tavukcuoglu, Hamdullah Yanik, Pelin Seçken, Ertugrul Celik, Sumeyra Guler, Mehmet Mert Hidiroglu, Ibrahim Burak Bahcecioglu, Ismail Erturk, Mehmet Ali Gulcelik, Derya Karakoc and Gunes Esendagli

Medicina 2026, 62(3), 600; https://doi.org/10.3390/medicina62030600 - 22 Mar 2026

Viewed by 704

Abstract

Background and Objectives: A combination of chemotherapy and immunotherapy may improve cancer treatment outcomes; however, determining which patient groups will benefit from immunotherapy is critical. Triple-negative breast cancer (TNBC) achieves limited benefit from immune checkpoint inhibitors (ICIs) and anti-PD-L1 blockade therapy. Materials and [...] Read more.

Background and Objectives: A combination of chemotherapy and immunotherapy may improve cancer treatment outcomes; however, determining which patient groups will benefit from immunotherapy is critical. Triple-negative breast cancer (TNBC) achieves limited benefit from immune checkpoint inhibitors (ICIs) and anti-PD-L1 blockade therapy. Materials and Methods: In this study, PD-L1 expression levels in myeloid-derived cells in the tumor microenvironment were determined in an experimental TNBC model. Results: Compared with tumor cells, granulocytes, monocytes, and macrophages had significantly higher PD-L1 expression. CD206⁺ tumor-associated macrophages (TAMs) expressed the highest level of PD-L1. PD-L1 positivity in TAMs was also significantly high in the lung, liver, lymph node, and spleen. Despite treatment initiation in late-stage tumorigenesis, the combination of paclitaxel and the anti-PD-L1 monoclonal antibody atezolizumab significantly reduced tumor growth. In addition, lung metastasis burden was reduced with combined treatment compared with chemotherapy or anti-PD-L1 monotherapy alone. Conclusions: As a result, alterations in PD-L1⁺ myeloid cells and immune infiltration can be associated with atezolizumab and paclitaxel therapy success in triple-negative breast cancer. Full article

(This article belongs to the Special Issue Future Trends in Breast Cancer Management)

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11 pages, 766 KB

Open AccessReview

Additive Manufacturing in Orthopaedic Trauma: Current Evidence and Applications

by Nikolaos A. Stavropoulos, Fotios Kantas, Dimitrios V. Papadopoulos, Vasileios S. Nikolaou and George C. Babis

Medicina 2026, 62(3), 599; https://doi.org/10.3390/medicina62030599 - 21 Mar 2026

Viewed by 452

Abstract

Additive manufacturing also known as three-dimensional printing (3D printing), provided the ability to produce precise three-dimensional structures, representing a rapidly growing field in Orthopaedics. Its clinical value has been attributed to the ability to create complex three dimensional objects with relative ease and [...] Read more.

Additive manufacturing also known as three-dimensional printing (3D printing), provided the ability to produce precise three-dimensional structures, representing a rapidly growing field in Orthopaedics. Its clinical value has been attributed to the ability to create complex three dimensional objects with relative ease and at low cost. However, the available evidence regarding its applications in trauma was heterogeneous. This narrative review aimed to analyze the clinical applications of 3D printing in traumatology. Additionally, the research gaps that emerged in our literature search were underscored. Four application domains were selected based on their prevalence in the screened literature and relative level of clinical implementation within orthopaedic traumatology, including (1) 3D-printed anatomical models, (2) patient-specific surgical guides (PSSGs), (3) 3D-printed implants, and (4) temporary 3D-printed external fixation devices. 3D-printed anatomical models were found to help in reducing operative time, estimated blood loss, and the intraoperative radiation exposure. The use of PSSGs was shown to improve intraoperative accuracy and to provide a basis for consistent, accurate, and reproducible outcomes. However, their implementation was hindered by preparation time, the need for stable anatomical landmarks, and reduced accuracy due to potential soft-tissue injury and swelling. In contrast, 3D-printed implants and external fixation devices constituted promising but less extensively studied applications of 3D printing in trauma. The production of customized implants and external fixators, as suggested by the studies available, was deemed feasible, with comparable mechanical properties and significantly lower cost. Larger multicenter studies are required to support and validate these findings. Overall, based on the available evidence, 3D-printed anatomical models and patient-specific surgical guides demonstrate the highest level of clinical applicability, primarily in preoperative planning and intraoperative guidance. Full article

(This article belongs to the Special Issue Recent Advances and Future Challenges in Orthopaedic Trauma Surgery)

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15 pages, 323 KB

Open AccessArticle

The Hidden Cost of Delay: Post-Pandemic Evolution of Advanced Ovarian Cancer Profiles

by Alexandru Marius Petrusan, Catalin Vladut Ionut Feier, Calin Muntean, Vasile Gaborean, Andrei Stefan Petrusan, Delia Nicoara, Emil Marius Puscas, Florin Laurentiu Ignat and Patriciu Achimas-Cadariu

Medicina 2026, 62(3), 598; https://doi.org/10.3390/medicina62030598 - 21 Mar 2026

Viewed by 582

Abstract

Background and Objectives: High-grade serous ovarian carcinoma (HGSOC) remains the most lethal gynecologic malignancy, with outcomes heavily dependent on early diagnosis and timely multimodal treatment. The COVID-19 pandemic profoundly disrupted oncologic care, leading to diagnostic delays, modified treatment algorithms, and deferred surgeries. This [...] Read more.

Background and Objectives: High-grade serous ovarian carcinoma (HGSOC) remains the most lethal gynecologic malignancy, with outcomes heavily dependent on early diagnosis and timely multimodal treatment. The COVID-19 pandemic profoundly disrupted oncologic care, leading to diagnostic delays, modified treatment algorithms, and deferred surgeries. This study aimed to assess how these disruptions influenced disease presentation, surgical complexity, and postoperative outcomes during the pandemic and post-pandemic periods in a Romanian tertiary oncology center. Materials and Methods: A retrospective, single-center cohort analysis was conducted on 112 patients with histologically confirmed HGSOC who underwent surgical treatment between 26 February 2020 and 25 February 2024. The cohort was divided into two equal groups: a pandemic cohort (2020–2022) and a post-pandemic cohort (2022–2024). Clinical, pathological, and therapeutic parameters were compared, including FIGO and T staging, surgical duration, ICU admissions, and treatment intervals. Results: The post-pandemic period was marked by a significant rise in advanced-stage presentations (FIGO IV: 17.8% vs. 33.9%, p = 0.003), peritoneal carcinomatosis (58.9% vs. 82.1%, p = 0.004), and multiorgan invasion (7.1% vs. 16.0%, p = 0.039). Mean operative time increased significantly post-pandemic (94.0 ± 36.3 vs. 123.5 ± 52.5 min, p = 0.003), as did ICU admissions (35.7% vs. 60.7%, p = 0.002). While the number of neoadjuvant and adjuvant chemotherapy cycles remained consistent between cohorts, a greater surgical complexity and longer postoperative recovery characterized the post-pandemic cases, suggesting cumulative disease progression and increased treatment demands. Conclusions: The findings indicate an association between the post-pandemic period and more advanced disease profiles at presentation, as well as increased surgical complexity, highlighting potential long-term effects of healthcare disruption. These results highlight the necessity for resilient cancer care systems emphasizing early detection, multidisciplinary coordination, and adaptive treatment models to mitigate future systemic disruptions and preserve survival outcomes in women with HGSOC. Full article

(This article belongs to the Special Issue Impact on Human Health, Lifestyle and Quality of Care After COVID-19, 2nd Edition)

16 pages, 807 KB

Open AccessArticle

Impact of Chronic Kidney Disease on Contrast-Induced Nephropathy, Bleeding, and Clinical Outcomes After Rotational Atherectomy: A Multicenter Retrospective Study

by Jaeyun Lee, Jin Jung, Sang-Suk Choi, Sung-Ho Her, Kyusup Lee, Ki-Dong Yoo, Keon-Woong Moon, Donggyu Moon, Su-Nam Lee, Won-Young Jang, Ik-Jun Choi, Jae-Hwan Lee, Jang-Hoon Lee, Sang-Rok Lee, Seung-Whan Lee, Kyeong-Ho Yun and Hyun-Jong Lee

Medicina 2026, 62(3), 597; https://doi.org/10.3390/medicina62030597 - 21 Mar 2026

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Abstract

Background and Objectives: Chronic kidney disease (CKD) is associated with severe coronary calcification and increased procedural risks. We aimed to evaluate the impact of CKD on contrast-induced nephropathy (CIN), bleeding, and clinical outcomes in patients undergoing rotational atherectomy (RA). Materials and Methods [...] Read more.

Background and Objectives: Chronic kidney disease (CKD) is associated with severe coronary calcification and increased procedural risks. We aimed to evaluate the impact of CKD on contrast-induced nephropathy (CIN), bleeding, and clinical outcomes in patients undergoing rotational atherectomy (RA). Materials and Methods: This study retrospectively analyzed 652 patients who underwent RA for calcified coronary lesions from the multicenter ROCK registry and a single-center extension between 2010 and 2025. Patients were classified into CKD (eGFR < 60 mL/min/1.73 m², n = 66) and non-CKD (n = 586) groups, excluding those on dialysis. The primary endpoint was a composite of CIN and in-hospital bleeding. Secondary endpoints included 3-year target vessel failure (TVF), myocardial infarction (MI), and total bleeding. Results: The primary composite outcome occurred more frequently in the CKD group (16.7% vs. 5.1%, p = 0.001). Specifically, CIN was significantly higher in CKD patients (15.2% vs. 1.7%, p < 0.001), while in-hospital bleeding did not differ significantly. In multivariate analysis, CKD was an independent predictor of the primary outcome (adjusted OR 3.02; 95% CI 1.36–6.69; p = 0.006). At 3-year follow-up, total bleeding (10.6% vs. 3.9%, p = 0.008) and MI (6.1% vs. 2.1%, p = 0.024) were higher in the CKD group, whereas TVF and cardiac death showed no significant difference. Conclusions: CKD is a robust independent risk factor for CIN and long-term bleeding in patients undergoing RA. However, comparable clinical efficacy outcomes suggest that RA remains a feasible strategy in CKD patients when early complications are carefully managed with contrast-minimizing strategies. Full article

(This article belongs to the Special Issue Coronary Artery Disease from Acute Manifestation to Long Term Consequences)

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9 pages, 737 KB

Open AccessArticle

Comparison of Monitored Anesthesia Care with Target-Controlled Infusion and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery: A Single-Center Prospective Randomized Controlled Study

by Jaesuk Kim, Haneul Jeong and So Young Kwon

Medicina 2026, 62(3), 596; https://doi.org/10.3390/medicina62030596 - 21 Mar 2026

Viewed by 513

Abstract

Background and Objectives: Rapid recovery and patient comfort are key goals in ambulatory surgery. Although sevoflurane anesthesia is widely used, target-controlled infusion (TCI) with propofol and remifentanil has gained attention for its potential benefits. However, comparative data regarding recovery profiles and respiratory [...] Read more.

Background and Objectives: Rapid recovery and patient comfort are key goals in ambulatory surgery. Although sevoflurane anesthesia is widely used, target-controlled infusion (TCI) with propofol and remifentanil has gained attention for its potential benefits. However, comparative data regarding recovery profiles and respiratory safety remain limited. Materials and Methods: In this prospective randomized controlled trial, 51 ASA I–II patients undergoing outpatient gynecologic surgery were assigned to either a TCI group (n = 25) or an inhalation mask (IM) group using sevoflurane and nitrous oxide (n = 26). Primary outcomes included time to postanesthesia care unit (PACU) discharge readiness and patient and surgeon satisfaction. Secondary outcomes included eye-opening time, anesthesia duration, PACU stay, and respiratory adverse events. Results: Time to Aldrete score ≥9 did not differ significantly between groups (p = 0.697). The IM group demonstrated faster eye opening (p = 0.002), while patient satisfaction was higher in the TCI group (p < 0.001). Surgeon satisfaction favored the IM group (p = 0.035). Respiratory depression occurred more frequently in the TCI group (28.0% vs. 0%, p = 0.012). Conclusions: Sevoflurane anesthesia allowed faster emergence, whereas TCI provided greater patient satisfaction but increased respiratory risk. Both techniques are feasible for ambulatory gynecologic surgery when appropriately selected. Trial registration: This study was retrospectively registered at the Clinical Research Information Service (CRIS), Republic of Korea (KCT0011352). Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice: 2nd Edition)

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11 pages, 882 KB

Open AccessArticle

The Use of Topical Lidocaine Versus Lidocaine Injection for Myringotomy and Ventilation Tube Insertion

by Filip Bacan, Emili Dragaš, Mirta Peček, Iva Kelava, Andro Košec, Mihael Ries and Jakov Ajduk

Medicina 2026, 62(3), 595; https://doi.org/10.3390/medicina62030595 - 21 Mar 2026

Viewed by 613

Abstract

Background and Objectives: Minor otologic procedures in adults are often performed under local anesthesia, either via injection or topical application, thereby avoiding general anesthesia-associated risks. This study aims to compare pain levels with the use of a lidocaine spray versus lidocaine injections. [...] Read more.

Background and Objectives: Minor otologic procedures in adults are often performed under local anesthesia, either via injection or topical application, thereby avoiding general anesthesia-associated risks. This study aims to compare pain levels with the use of a lidocaine spray versus lidocaine injections. Materials and Methods: Fifty adult patients underwent local anesthetic myringotomy and ventilation tube placement, 30 unilaterally, and 20 bilaterally. Lidocaine injections were administered to 29 patients, and 21 received a lidocaine spray. Postoperatively, they were asked to mark their perceived pain level on a visual analogue scale (VAS, 0–100 mm), verbal rating scale (VRS, 0–3), and numeric rating scale (NRS, 0–10). Data normality was assessed using the Shapiro–Wilk test, continuous variables were analyzed using analysis of variance (ANOVA), and VRS outcomes were analyzed using binary logistic regression. A p-value ≤ 0.05 indicated statistical significance. Results: Pain levels were low in both groups, although consistently lower in the topical lidocaine group. The average VAS score was 23.14 mm (±14.69) for injection versus 9.76 mm (±11.41) for topical anesthesia (ANOVA, p = 0.002), while NRS scores averaged at 2.41 (±1.57) and 1.19 (±1.17), respectively (ANOVA, p = 0.009), indicating significantly lower pain with topical lidocaine. Logistic regression of the VRS indicated the same trend, although it did not reach statistical significance (OR = 0.153, 95% CI:0.017–1.389, p = 0.095). Conclusions: Lidocaine spray was associated with lower pain levels compared to lidocaine injections in patients undergoing myringotomy and ventilation tube placement. Our findings suggest that topical anesthesia may represent an effective alternative, offering a less invasive approach and reducing the needle-related psychological distress of patients. Full article

(This article belongs to the Special Issue Advances in Otorhinolaryngologic Diseases)

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18 pages, 346 KB

Open AccessArticle

Renal Risk Awareness and Use Patterns of NSAIDs and Antibiotics in Primary Care Patients from North-Eastern Romania

by Eric Oliviu Cosovanu, Maria Bogdan, Elena Adorata Coman, Cezar Ilie Foia, Cosmin Gabriel Tartau, Elena Teona Cosovanu, Antoneta Dacia Petroaie, Liliana Lacramioara Pavel, Ana-Maria Pelin and Liliana Mititelu Tartau

Medicina 2026, 62(3), 594; https://doi.org/10.3390/medicina62030594 - 21 Mar 2026

Viewed by 538

Abstract

Background and Objectives: Self-medication and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are major public health concerns, particularly in settings with variable access to healthcare. Understanding patterns of medication use and renal risk perception can inform targeted interventions. This study [...] Read more.

Background and Objectives: Self-medication and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are major public health concerns, particularly in settings with variable access to healthcare. Understanding patterns of medication use and renal risk perception can inform targeted interventions. This study examined NSAID and antibiotic use, self-medication behaviors, and renal risk awareness among Romanian primary care patients, with attention to urban–rural differences. Materials and Methods: A cross-sectional survey was conducted among 201 primary care patients (101 rural, 100 urban). Data on NSAID and antibiotic use, self-medication practices, sources of recommendation, and renal risk perception were collected using a study-specific questionnaire. Multivariable logistic regression was applied to identify predictors of frequent NSAID use, inappropriate antibiotic use, self-medication frequency, and high perceived renal risk. Results: NSAID use was nearly universal (95%), with frequent use strongly associated with non-professional recommendations. Antibiotic misuse was more common in rural participants and largely driven by informal acquisition. Self-medication patterns differed by residence: rural participants reported system- or access-related reasons and reliance on non-professional sources, while urban participants engaged in frequent, convenience-driven self-medication. Although most participants were aware of potential renal harm, this did not consistently lead to safer behaviors. Higher educational level and trust in healthcare professionals predicted increased perceived renal risk, whereas rural residence was associated with lower risk perception. Conclusions: Medication misuse is influenced more by recommendation sources, access barriers, and trusted information pathways than by knowledge alone. Interventions should focus on improving professional guidance, addressing informal recommendation networks, and tailoring strategies to urban–rural contexts. Full article

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

14 pages, 456 KB

Open AccessArticle

Predictors of Late Adverse Outcomes After Carotid Endarterectomy

by Danka Vukasinovic, Milos Maksimovic, Slobodan Tanaskovic, Jelena Marinkovic, Andja Cirkovic, Branko Jakovljevic, Jelena Ilic Zivojinovic, Djordje Radak and Hristina Vlajinac

Medicina 2026, 62(3), 593; https://doi.org/10.3390/medicina62030593 - 21 Mar 2026

Cited by 1 | Viewed by 475

Abstract

Background and Objectives: Although carotid endarterectomy (CEA) is the gold standard in the treatment of carotid disease, a higher frequency of adverse outcomes can reduce its benefit. The aim of the present study is to identify factors related to myocardial infarction, stroke, death [...] Read more.

Background and Objectives: Although carotid endarterectomy (CEA) is the gold standard in the treatment of carotid disease, a higher frequency of adverse outcomes can reduce its benefit. The aim of the present study is to identify factors related to myocardial infarction, stroke, death and restenosis as the late adverse outcomes of CEA. Materials and Methods: The retrospective cohort study included 1597 CEAs that were performed in 1533 consecutive patients at the Vascular Surgery Clinic in Belgrade from 2012 to 2017. Late adverse outcomes within 4 years after CEA were available for the majority of them. Data for myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. The association between possible risk factors and late adverse outcomes of CEA was analyzed using univariate and multivariate Cox and logistic regression analyses. Results: During follow-up, myocardial infarction occurred after 55, stroke after 68, death after 103 and restenosis after 121 CEAs. Two factors were the most frequent predictors of late adverse outcomes, i.e., the patient’s age and diabetes mellitus (DM). Age predicted all late adverse outcomes except restenosis, and DM predicted all of them. A predictor of myocardial infarction, besides age (HR 1.08, 95% CI 1.05–1.11) and DM (HR 1.60, 95% CI 1.11–2.29), was peripheral arterial disease (HR 1.81, 95% CI 1.17–2.78) in personal history. Predictors were only age (HR 1.04, 95% CI 1.01–1.08) and DM (HR 1.68, 95% CI 1.03–2.72) for stroke, as well as for death (HR 1.17, 95% CI 1.12–1.21 and HR 1.94, 95% CI 1.17–3.21, respectively). For restenosis, in addition to DM (HR 1.78, 95% CI 2.62), predictors were hyperlipidemia (HR 3.52, 95% CI 1.27–9.76) and urgent surgery (HR 3.51, 95% CI 1.06–11.65). Conclusions: CEA should be performed with special caution in the elderly and diabetic patients. Modification of other risk factors and precise medical therapy are necessary to reduce possible adverse outcomes. Full article

(This article belongs to the Section Surgery)

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11 pages, 1773 KB

Open AccessArticle

Comparison of Different Classification Systems for Müllerian Duct Anomalies: A Retrospective Observational MRI Study

by Laura D’hoore, Eva Decroos, Pieter Julien Luc De Visschere, Ottavia Battaglia and Tjalina Hamerlynck

Medicina 2026, 62(3), 592; https://doi.org/10.3390/medicina62030592 - 21 Mar 2026

Viewed by 715

Abstract

Background and Objectives: Müllerian duct anomalies (MDAs) are congenital malformations of the female genital tract for which several classification systems have been proposed. The objective of this study is to estimate the interrater reliability of the American Fertility Society (AFS), European Society [...] Read more.

Background and Objectives: Müllerian duct anomalies (MDAs) are congenital malformations of the female genital tract for which several classification systems have been proposed. The objective of this study is to estimate the interrater reliability of the American Fertility Society (AFS), European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM) and Congenital Uterine Malformation by Experts (CUME) classification systems for Müllerian duct anomalies. Materials and Methods: This retrospective cohort study was conducted at a tertiary care hospital and included 71 patients aged up to 45 years who were assessed for a Müllerian duct anomaly between January 2000 and April 2023. Pelvic MRI images were independently evaluated by four readers, followed by a consensus meeting. The primary outcome was interrater reliability (Krippendorff’s α), and the secondary outcomes were the proportions of indeterminate and unclassifiable cases after consensus meeting. Results: The interrater reliability for MDA diagnosis was very low for all the classification systems (AFS α 0.63, 95% CI [0.57, 0.67]; ASRM α 0.46, 95% CI [0.41, 0.52]; ESHRE/ESGE α 0.33, 95% CI [0.29, 0.38]; CUME α 0.57, 95% CI [0.45, 0.72]). After consensus meeting, the ESHRE/ESGE system had more indeterminate cases (9.9%) and the ASRM system had more unclassifiable cases (20.6%). Conclusions: All the classification systems for Müllerian duct anomalies had a very low interrater reliability, with more indeterminate cases in the ESHRE/ESGE system and more unclassifiable cases in the ASRM system. We present our recommendations for the improvement of each classification system. The ultimate goal of future research should be the development of a single uniform system integrating the best features of these systems and with clinically relevant cut-off values, considering patients’ reproductive outcomes. Full article

(This article belongs to the Special Issue Interventional Radiology and Imaging in Cancer Diagnosis)

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14 pages, 634 KB

Open AccessArticle

Impact of Liver Cirrhosis on Pregnancy Outcomes: A Retrospective Cohort Study from the TriNetX Global Collaborative Network

by Ji-Ze Hsu and Dah-Ching Ding

Medicina 2026, 62(3), 591; https://doi.org/10.3390/medicina62030591 - 20 Mar 2026

Viewed by 672

Abstract

Background and Objectives: To evaluate the impact of liver cirrhosis on pregnancy outcomes using a large-scale, propensity score-matched cohort, with adjustment for numerous confounding variables. Materials and Methods: From a total of 3,701,876 pregnancies (women aged 18–49) from 1 January 2010, to 31 [...] Read more.

Background and Objectives: To evaluate the impact of liver cirrhosis on pregnancy outcomes using a large-scale, propensity score-matched cohort, with adjustment for numerous confounding variables. Materials and Methods: From a total of 3,701,876 pregnancies (women aged 18–49) from 1 January 2010, to 31 December 2024, after propensity score matching, 2498 pregnancies with cirrhosis and 2498 pregnancies without cirrhosis in TrinetX database were included in our analysis. To adjust for potential confounding, pregnancies in the cirrhosis group were matched 1:1 to those without cirrhosis using propensity scores derived from demographic, lifestyle, comorbidity, and laboratory characteristics. Relative risks (RRs), risk differences (RDs), and corresponding 95% confidence intervals (CIs) were calculated for pregnancy-related outcomes. Subgroup analyses stratified by maternal age were further performed to assess potential effect modification. Main outcomes included Gestational diabetes mellitus, preeclampsia, premature rupture membranes, preterm birth, miscarriage, stillbirth, placental abruption, dystocia, postpartum hemorrhagia, and cesarean delivery. Results: After matching, 2485 women were included in each group, with well-balanced baseline characteristics. Compared with women without cirrhosis, those with cirrhosis had a higher risk of pregnancy-related outcomes, including gestational diabetes mellitus (15.5% vs. 11.9%; RR = 1.30; 95% CI, 1.13–1.50, p < 0.001), preeclampsia (8.6% vs. 5.7%; RR = 1.52; 95% CI, 1.24–1.87, p < 0.001), and preterm birth (9.0% vs. 4.9%; RR = 1.85; 95% CI, 1.49–2.29, p < 0.001). Cirrhosis during pregnancy was also associated with a higher risk of miscarriage (6.6% vs. 4.8%), stillbirth (1.3% vs. 0.5%), placental abruption (1.8% vs. 0.8%), postpartum hemorrhage (6.9% vs. 4.3%), and cesarean delivery (20% vs. 17.2%). The limitations include the lack of detailed data on cirrhosis severity. Conclusions: Pregnancy with liver cirrhosis is associated with increased risks of diverse maternal and neonatal complications. Our findings highlight the importance of multidisciplinary management and individualized care planning in order to reduce adverse outcomes. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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12 pages, 1993 KB

Open AccessSystematic Review

Optimal Skin Incision for the Surgical Treatment of De Quervain Tenosynovitis: A Systematic Review and Meta-Analysis

by Dimitrios Kitridis, Eleni Karagergou, Alexandros Givissis, Konstantinos Tsikopoulos, Leonidas Pavlidis, Michael Potoupnis and Panagiotis Givissis

Medicina 2026, 62(3), 590; https://doi.org/10.3390/medicina62030590 - 20 Mar 2026

Viewed by 529

Abstract

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This [...] Read more.

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39–11.99; p = 0.37; I² = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, −0.03 to 0.14; p = 0.21; I² = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I² = 35%), and wound infection (RD = 0.00; 95% CI, −0.03 to 0.03; p = 0.93; I² = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, −0.70 to 1.30; p = 0.56; I² = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1836 KB

Open AccessSystematic Review

HFE p.C282Y Polymorphism and Risk of Metabolic Syndrome Components: Systematic Review and Meta-Analysis

by Dana Kaldarkhan, Gulnaz Nuskabayeva, Nursultan Nurdinov, Yerbolat Saruarov, Ugilzhan Tatykayeva, Ainash Oshibayeva and Karlygash Sadykova

Medicina 2026, 62(3), 589; https://doi.org/10.3390/medicina62030589 - 20 Mar 2026

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Abstract

Background and Objectives: Metabolic syndrome is a common condition associated with a higher risk of diabetes and cardiovascular disease. Altered iron metabolism, especially iron overload, may play a role in the development of insulin resistance, hypertension, and other metabolic abnormalities. Although the [...] Read more.

Background and Objectives: Metabolic syndrome is a common condition associated with a higher risk of diabetes and cardiovascular disease. Altered iron metabolism, especially iron overload, may play a role in the development of insulin resistance, hypertension, and other metabolic abnormalities. Although the p.C282Y polymorphism of the HFE gene affects iron regulation and may contribute to these metabolic changes, previous studies have reported inconsistent findings, thus highlighting the need for a comprehensive meta-analysis. Materials and Methods: A systematic literature search was performed in PubMed, Scopus, and Web of Science to examine the associations between the HFE p.C282Y polymorphism and components of metabolic syndrome. Observational studies were included if they compared the frequencies of diabetes, hypertension, and abdominal obesity, as well as levels of triglycerides and high-density lipoprotein cholesterol, between carriers and non-carriers of the p.C282Y variant. Results: A total of 17 studies were included in the meta-analysis, and the pooled analysis demonstrated no significant association between the HFE p.C282Y polymorphism and diabetes, hypertension, triglyceride levels, or HDL cholesterol levels under the codominant model. Similarly, analyses performed using the homozygous model did not reveal any statistically significant associations. Conclusions: This meta-analysis found no statistically significant association between the HFE p.C282Y polymorphism and any of the considered components of metabolic syndrome under the examined genetic models. Full article

(This article belongs to the Section Endocrinology)

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35 pages, 1732 KB

Open AccessArticle

Replacement and Revision Hip and Knee Surgery Projections up to the Year 2060: An Analysis Based on Data from the Romanian Arthroplasty Register

by Flaviu Moldovan and Liviu Moldovan

Medicina 2026, 62(3), 588; https://doi.org/10.3390/medicina62030588 - 20 Mar 2026

Cited by 1 | Viewed by 660

Abstract

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is [...] Read more.

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is to estimate the volumes of primary and revision hip and knee surgeries expected to be performed in Romania by 2060. Materials and Methods: We used data from the Romanian Arthroplasty Register regarding the total volume of primary hip replacement surgery (cumulative n = 51,252 across five years), hip revision surgery (cumulative n = 3579), primary knee replacement surgery (cumulative n = 32,283), and knee revision surgery (cumulative n = 943) performed in 2017–2019, 2023 and 2024—the last five years of complete registrations, excluding the pandemic period. We projected future numbers of hip and knee primary and revision surgeries using the arithmetic mean of annual procedure rates observed during the study period, combined with the average annual trend in these rates. Projections were stratified by age group (0–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) and sex and were applied to population forecasts from the National Institute of Statistics of Romania up to 2060. Results: By 2060, primary hip replacement surgery volumes will increase by 40.14% relative to 2024 levels (from 13,526 in 2024 to 18,965 in 2060), and primary knee replacement surgery volumes will increase by 79.78% (from 9003 in 2024 to 16,186 in 2060). Revision hip surgery volumes will increase by 42.02% (from 759 in 2024 to 1078 in 2060), and revision knee surgery volumes will increase by 109.25% (from 227 in 2024 to 475 in 2060). The largest relative increases are concentrated in patients aged ≥80 years, with projected growth substantially exceeding those in younger age groups across all procedure types and both sexes. These percentages represent the projected growth in procedure volumes for this age group compared with 2024 baseline volumes. Conclusions: By 2060, we project substantial increases in all arthroplasty procedure types in Romania, with the most pronounced growth among patients aged ≥80 years. Given that resource utilization and morbidity are higher in this population, the increased demand for medical interventions requires advance planning, which will have significant implications for the healthcare system. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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15 pages, 791 KB

Open AccessArticle

Kinesiophobia and Psychological Readiness of Return to Sport in High-Performance Judokas After an Injury: A Cross-Sectional Study

by Ulises Puchalt-Muñoz, Mireia Yeste-Fabregat, Helio Carratalá-Bellod, Marta Martínez-Soler, Rómulo J. González-García and Juan Vicente-Mampel

Medicina 2026, 62(3), 587; https://doi.org/10.3390/medicina62030587 - 20 Mar 2026

Viewed by 748

Abstract

Background and Objectives: Judo is an Olympic contact sport with a high risk of injury owing to its physical, technical, and competitive demands. The role of psychological factors in recovery and Return to Sport (RTS), such as kinesiophobia and self-perception, is key [...] Read more.

Background and Objectives: Judo is an Olympic contact sport with a high risk of injury owing to its physical, technical, and competitive demands. The role of psychological factors in recovery and Return to Sport (RTS), such as kinesiophobia and self-perception, is key in the injury process. These factors influence both the success and timing of return and are affected by variables such as locus of control, previous experience, and contextual factors. This study sought to analyse the relationship between sociodemographic, clinical, sports, and psychological variables with kinesiophobia and self-perception of RTS to identify psychological profiles. Materials and Methods: A cross-sectional observational study was conducted at the Centro de Alto Rendimiento de Judo (CEAR) in Valencia, Spain; involving 51 high-performance judokas (mean age 23.0 ± 3.8 years) competing at national or international level who were injured, out of competition or in the process of returning to training or competition. Data were collected using a self-administered questionnaire. Psychological variables were assessed using the Tampa Scale for Kinesiophobia (TSK-11) and the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) questionnaire. Results: No significant associations were found between sociodemographic, clinical–sports, and psychological variables (p > 0.05). The mean TSK-11 and PRIA-RS scores were 25.02 ± 5.79 and 36.49 ± 5.29, respectively. Cluster analysis identified three differentiated psychological profiles: one with high kinesiophobia, longer injury and time away from competition, and lower self-perceived readiness to RTS (n = 16); a second with lower fear, the lowest readiness, younger age, and shorter recovery time (n = 17); and a third with the lowest kinesiophobia, highest readiness, older age, and intermediate injury-related time (n = 18). Conclusions: Three psychological profiles were identified: young judokas with low self-perceived readiness to Return to Sport (RTS) and low kinesiophobia; older judokas with high readiness and minimal kinesiophobia; and a more vulnerable group with longer recovery times, high kinesiophobia, and low self-perceived readiness to RTS. Further studies with additional specific variables and biopsychosocial approaches are needed. Full article

(This article belongs to the Topic New Advances in Musculoskeletal Disorders, 2nd Edition)

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14 pages, 991 KB

Open AccessArticle

Predictors of Peripheral Neuropathy in Metabolic Disease: A Multivariable Analysis Incorporating the Toronto Clinical Scoring System and Sudomotor Assessment

by Cristina Mocanu (Chitan), Radu-Cristian Cimpeanu, Teodor Salmen, Marius-Costin Chitu, Raluca-Elena Alexa, Claudiu Cobuz, Vasilica Cristescu, Anca Pantea Stoian and Cristian Serafinceanu

Medicina 2026, 62(3), 586; https://doi.org/10.3390/medicina62030586 - 20 Mar 2026

Viewed by 667

Abstract

Background and Objectives: Peripheral neuropathy (PNP) is a frequent and debilitating complication among patients with diabetes mellitus (DM) and other metabolic conditions, substantially affecting morbidity, functional status, and quality of life. Identifying predictors of PNP is essential for optimizing early diagnostic strategies and [...] Read more.

Background and Objectives: Peripheral neuropathy (PNP) is a frequent and debilitating complication among patients with diabetes mellitus (DM) and other metabolic conditions, substantially affecting morbidity, functional status, and quality of life. Identifying predictors of PNP is essential for optimizing early diagnostic strategies and improving long-term management outcomes. The aim of this study was to determine the predictive factors of PNP in a cohort of patients with DM. Materials and Methods: A cross-sectional study including 117 patients diagnosed with DM assessed for PNP was conducted. All patients were evaluated clinically and biologically. PNP was clinically assessed using the Toronto Clinical Scoring System (TCSS) score and sudomotor function by Sudoscan. Results: The patients included were mostly males with type 2 DM and metabolic syndrome phenotypes. Moreover, the patients with PNP were much older than those without PNP (65 [57–69] vs. 59.50 [46–68] years, p = 0.008), with a longer duration of DM (10 [6–15.50] vs. 5.5 (2–14] years, p = 0.019), and associated autonomic diabetic neuropathy (χ² = 24.382, p < 0.001). Furthermore, TCSS and Sudoscan were correlated with a history of PNP, especially Sudoscan, which showed a very good discriminative ability for diabetic neuropathy diagnosis (AUC = 0.816). In a multivariable logistic regression including age, DM duration, and HbA1c, age was independently associated with PNP, with each additional year increasing the odds of neuropathy by approximately 6% (OR = 1.06, 95% CI 0.02–1.09, p = 0.002). When age was excluded, DM duration showed a borderline association with PNP (OR = 1.055, CI95% 0.997–1.117), suggesting potential overlap between these variables. Adding sudomotor assessment to the initial model improved the model performance (AUC 0.70–0.72). Conclusions: Age emerged as the main independent predictor of diabetic neuropathy, highlighting the role of cumulative metabolic exposure in the development of neural damage. Moreover, sudomotor assessment may have a complementary role in PNP assessment. Full article

(This article belongs to the Special Issue New Insights into Diabetes Complications—Diabetic Foot)

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13 pages, 685 KB

Open AccessArticle

Performance of XL Sizes of Myval Balloon-Expandable Valve in Real-World Patients with Extremely Large Aortic Annuli

by Kasparas Briedis, Kristina Morkūnaitė, Norvydas Zapustas, Evelina Zarambaitė, Žilvinas Krivickas, Sandra Kmitaitė, Agnė Rimkutė, Klaudija Tvaronavičiūtė, Kamilija Briedė, Urtė Lukauskaitė, Monika Biesevičienė, Tsung-Ying Tsai, Ali Aldujeli, Jurgita Plisienė, Ramūnas Unikas, Remigijus Žaliūnas and Lina Bardauskienė

Medicina 2026, 62(3), 585; https://doi.org/10.3390/medicina62030585 - 20 Mar 2026

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Abstract

Background and Objectives: Transcatheter aortic valve replacement (TAVR) in large aortic annuli poses challenges due to limited valve-size options and increased complication risks. The aim is to evaluate the safety and performance of XL sizes (30.5 mm and 32 mm) of the Myval [...] Read more.

Background and Objectives: Transcatheter aortic valve replacement (TAVR) in large aortic annuli poses challenges due to limited valve-size options and increased complication risks. The aim is to evaluate the safety and performance of XL sizes (30.5 mm and 32 mm) of the Myval transcatheter heart valve (THV) for treating patients with severe aortic stenosis and large aortic annuli. Material and Methods: This retrospective observational study included consecutive patients undergoing TAVR with XL sizes of the Myval THV between December 2023 and December 2024 at a single centre. During this period, 146 TAVI procedures were performed, of which 15 patients (10.3%) with large aortic annuli (mean systolic annular area 786.5 ± 48.2 mm²) received XL valves and were included in the present analysis. Patients were followed up at discharge, 3–6 months, and 1 year. Patient evaluation included echocardiography and clinical assessments following the Valve Academic Research Consortium-3 criteria. Results: All patients were male, with a mean age of 79.1 ± 5.9 years. Technical success was achieved in 100% of cases. At discharge, none of the patients had moderate or greater paravalvular leakage (PVL); 11 patients had no PVL, while 1 had trace and 3 had mild PVL. The mean effective orifice area (EOA) improved from 0.75 ± 0.15 cm² at baseline to 2.31 ± 0.21 cm² at discharge (p < 0.0001). At the 12-month follow-up, the mean EOA was 2.4 ± 0.3 cm², and no moderate or severe PVL or major adverse clinical outcomes were observed. One patient required a permanent pacemaker implantation due to an atrioventricular block. Conclusions: The XL sizes of Myval THV showed both safety and efficacy in patients with large aortic annuli, demonstrating acceptable hemodynamic performance and low complication rates. However, large-scale studies with longer follow-ups are needed to validate these findings in diverse populations. Full article

(This article belongs to the Special Issue Aortic Stenosis: Diagnosis and Clinical Management)

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30 pages, 1727 KB

Open AccessReview

Neonatal Sepsis-Induced Coagulopathy in the Light of Developmental Hemostasis: Friend or Foe?

by Paraskevi Papadogeorgou, Rozeta Sokou, Sotirios P. Fortis, Vasiliki Mougiou, Theodora Boutsikou, Nicoletta Iacovidou and Serena Valsami

Medicina 2026, 62(3), 584; https://doi.org/10.3390/medicina62030584 - 20 Mar 2026

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Abstract

The concept of ‘developmental hemostasis’ from birth to infancy and onwards to childhood and adulthood was introduced in the 1980s and is used to indicate the fundamental discrepancies of hemostatic mechanism between children and adults. The underlying differentiations are more pronounced in term [...] Read more.

The concept of ‘developmental hemostasis’ from birth to infancy and onwards to childhood and adulthood was introduced in the 1980s and is used to indicate the fundamental discrepancies of hemostatic mechanism between children and adults. The underlying differentiations are more pronounced in term and even more in preterm neonates. Hemostatic alterations tend to improve throughout childhood and adolescence but still imply a great example of the basic concept that children do not simply represent small adults. Many neonatal coagulation disorders lead to severe morbidities, such as intraventricular hemorrhage and intracerebral infarct, with critical consequences on long-term neurodevelopmental outcome. As the limits of viability have decreased and many preterm and severely affected neonates survive and grow up, a broad understanding of hemorrhagic and thrombotic complications in neonates is very important, in order to provide prompt identification and treatment. Coagulation abnormalities are usually induced by specific pathophysiologic disorders, and neonatal sepsis is a significant trigger of hemostatic derangement. Despite the initial protective role of coagulation activation during the early stages of sepsis, ultimately hemostatic abnormalities exert a substantial impact on clinical outcome and prognosis. This review explores developmental aspects of coagulation, particularly in relation to neonatal sepsis. Full article

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18 pages, 1322 KB

Open AccessArticle

Hospitalized Versus Outpatient Benign Acute Childhood Myositis: A 10-Year Single-Center Experience

by Yasemin Özkale, Murat Özkale, Şeyda Beşen, Tuba Karsantıözü, Nihal Aktaş, Gökçe Yegül Gülnar and Burak Poyraz

Medicina 2026, 62(3), 583; https://doi.org/10.3390/medicina62030583 - 20 Mar 2026

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Abstract

Background and Objectives: The objectives of this study were to compare the clinical, laboratory, and etiological characteristics, as well as outcomes, of hospitalized and outpatient children with benign acute childhood myositis (BACM) and to identify factors associated with hospitalization. Materials and Methods [...] Read more.

Background and Objectives: The objectives of this study were to compare the clinical, laboratory, and etiological characteristics, as well as outcomes, of hospitalized and outpatient children with benign acute childhood myositis (BACM) and to identify factors associated with hospitalization. Materials and Methods: This retrospective single-center study included children diagnosed with BACM over a 10-year period. Demographic data, clinical features, laboratory parameters, etiological agents, treatments, hospitalization status, and recurrence were analyzed. Hospitalized and outpatient patients were compared to determine factors associated with hospital admission. Results: A total of 93 patients were included. Hospitalized patients had significantly higher creatine kinase (CK) levels and a higher frequency of inability to walk compared with outpatients. No significant differences were observed between the groups regarding age, sex, gastrointestinal symptoms, serum creatinine levels, or inflammatory markers. Influenza A (INFA)-associated BACM was characterized by lower CK levels and shorter fever duration, whereas viral panel negative (VPN) cases had longer symptom duration and were more frequently hospitalized. Notably, sandfly fever virus was identified in two hospitalized patients, representing an uncommon but clinically relevant etiological agent in our cohort. Rhabdomyolysis occurred in three patients, all of whom were hospitalized and recovered without sequelae. The recurrence rate was 11.8%, with no significant association between recurrence and demographic or clinical variables. Conclusions: Although BACM is typically self-limiting, elevated CK levels and inability to walk may help identify patients who require hospitalization. Etiological differences influenced disease severity, and the detection of sandfly fever-associated BACM highlights the importance of considering regional viral agents in the differential diagnosis. Full article

(This article belongs to the Section Pediatrics)

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19 pages, 556 KB

Open AccessReview

Transforming Stroke Diagnosis with Artificial Intelligence: A Scoping Review of Brainomix e-Stroke, Aidoc, RapidAI, and Viz.ai

by Mateusz Dorochowicz, Arkadiusz Kacała, Aleksandra Tołkacz, Aleksandra Kosikowska, Maja Gewald and Maciej Guziński

Medicina 2026, 62(3), 582; https://doi.org/10.3390/medicina62030582 - 19 Mar 2026

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Abstract

Background and Objectives: Rapid diagnosis is fundamental to acute ischemic stroke management; however, access to neuroradiological expertise remains limited. This scoping review maps the diagnostic accuracy, workflow impact, and cost-effectiveness of leading AI platforms (Brainomix, Aidoc, RapidAI, and Viz.ai), characterizing industry and [...] Read more.

Background and Objectives: Rapid diagnosis is fundamental to acute ischemic stroke management; however, access to neuroradiological expertise remains limited. This scoping review maps the diagnostic accuracy, workflow impact, and cost-effectiveness of leading AI platforms (Brainomix, Aidoc, RapidAI, and Viz.ai), characterizing industry and peer-reviewed metrics. Materials and Methods: Following PRISMA-ScR guidelines, we searched PubMed, Cochrane Library, and HTA repositories for studies (2019–2025). Using a PICO-based framework, 29 studies were included for thematic mapping of the technological landscape. Results: Twenty-nine studies were included. Platforms show high proximal LVO sensitivity (78–97%), while performance for distal/MVO and posterior circulation occlusions was more variable. RapidAI is frequently mapped using historical perfusion trial parameters; however, volumetric discrepancies with platforms like Viz.ai indicate outputs are not interchangeable. Brainomix shows extensive validation for automated NCCT ASPECTS in triage. Aidoc demonstrates operational advantages via worklist prioritization, while. Viz.ai is associated with door-to-puncture time reductions (11–25 min). Economically, cost-effectiveness is driven by improved functional outcomes and expanded access to thrombectomy, rather than labor substitution. Conclusions: AI platforms function as diagnostic safety nets and workflow optimizers. Reported roles, such as perfusion-centric analysis (RapidAI) or workflow coordination (Viz.ai), reflect current research trends rather than definitive technological superiority. Institutional selection should consider these evidence clusters alongside local validation and specific clinical priorities. Full article

(This article belongs to the Special Issue AI in Imaging—New Perspectives, 2nd Edition)

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21 pages, 858 KB

Open AccessReview

Cutaneous Manifestations of Inborn Errors of Immunity: Clinical Clues to Immune Disorders

by Katarzyna Napiorkowska-Baran, Maciej Pastuszczak, Maria Płocka-Karpińska, Marta Tykwińska, Paweł Treichel, Gary Andrew Margossian, Carla Liana Margossian, Agnieszka Rogalska and Rafał Czajkowski

Medicina 2026, 62(3), 581; https://doi.org/10.3390/medicina62030581 - 19 Mar 2026

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Abstract

Background/Objectives: Cutaneous manifestations of inborn errors of immunity (IEI) are among the most common and often early signs of these disorders, estimated to affect about 40% of patients with IEI, and in some cases, they provide the first diagnostic clue. Skin findings [...] Read more.

Background/Objectives: Cutaneous manifestations of inborn errors of immunity (IEI) are among the most common and often early signs of these disorders, estimated to affect about 40% of patients with IEI, and in some cases, they provide the first diagnostic clue. Skin findings in IEI are heterogeneous and include recurrent skin infections, severe atopic dermatitis, autoimmune manifestations, as well as atypical granulomatous dermatoses, neoplastic lesions, pigmentation disorders, and changes involving hair and nails. Early recognition of these manifestations and linking them to the appropriate immunologic defect is crucial for establishing the diagnosis and initiating targeted therapy. Methods: This paper reviews the dermatologic phenotypes associated with IEI, with particular emphasis on a tabular classification of skin lesions corresponding to specific immunologic defects. Relevant literature was analyzed to summarize characteristic cutaneous presentations and current diagnostic approaches, highlighting the importance of interdisciplinary evaluation. Results: Cutaneous findings in IEI encompass a wide spectrum of infectious, inflammatory, autoimmune, and neoplastic manifestations. Systematic classification of these lesions facilitates earlier recognition of underlying immune defects and supports differential diagnosis. Dermatologic signs frequently precede systemic manifestations, making them valuable early clinical indicators of IEI. Conclusions: Recognition of dermatologic manifestations is critical for early diagnosis of IEI. Interdisciplinary collaboration between dermatologists, immunologists, and other specialists improves diagnostic accuracy and patient management. Current therapeutic strategies range from symptomatic treatment to targeted therapies, and personalized approaches improve prognosis and quality of life in patients with IEI. Full article

(This article belongs to the Special Issue Allergic and Immune Disorders: New Insights and Future Directions)

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Medicina, Volume 62, Issue 3 (March 2026) – 188 articles

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