Medical Sciences

13 pages, 916 KiB

Open AccessReview

State-of-the-Art Review on the Treatment of Axial Spondyloarthritis

by Evripidis Kaltsonoudis, Panagiota Karagianni, Tereza Memi and Eleftherios Pelechas

Med. Sci. 2025, 13(1), 32; https://doi.org/10.3390/medsci13010032 - 16 Mar 2025

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The term axial spondyloarthritis (axSpA) encompasses patients with both radiographic (r-axSpA) and non-radiographic (nr-axSpA) forms of the disease. These are two entities within the same family that share many genetic and pathogenic factors, but they also have significant differences. For example, the male-to-female [...] Read more.

The term axial spondyloarthritis (axSpA) encompasses patients with both radiographic (r-axSpA) and non-radiographic (nr-axSpA) forms of the disease. These are two entities within the same family that share many genetic and pathogenic factors, but they also have significant differences. For example, the male-to-female ratio is 2:1 in r-axSpA and 1:1 in nr-axSpA. Additionally, the prevalence of the HLA-B27 gene is notably higher in r-axSpA. Early diagnosis remains an unmet need, with magnetic resonance imaging (MRI) being the most important tool for diagnosis and disease monitoring. Early detection is crucial, as it allows for timely treatment, increasing the chances of preventing new bone formation and long-term structural bone damage. Various cytokines, such as tumor necrosis factor (TNF)-α and interleukin-17, play active roles in the disease’s pathogenesis, although the exact mechanisms of interaction are not yet fully understood. Clarifying these mechanisms will be key to developing new classification criteria, screening methods, and more personalized, targeted therapies. Non-steroidal anti-inflammatory drugs (NSAIDs), TNF inhibitors, interleukin-17 blockers, and, more recently, Janus kinase (JAK) inhibitors, are the most effective treatments for both radiographic and non-radiographic axial spondyloarthritis. Full article

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12 pages, 465 KiB

Open AccessArticle

Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Patients with Acute Ischemic Stroke Across COVID-19 Periods in the Emergency Department: A Multi-Center Cohort Study

by Yu-Lin Hsieh, Ching-Fang Tiffany Tzeng, Maha Khan, Andrew Shedd, Thomas Damrow, Dahlia Hassani, Matthew Danley, Jaydeep Shah, Jennifer Walker and Eric H. Chou

Med. Sci. 2025, 13(1), 31; https://doi.org/10.3390/medsci13010031 - 15 Mar 2025

Viewed by 664

Abstract

Introduction: Stroke is the fifth leading cause of death and long-term disability in the United States. The current guideline for stroke management includes a 25 min timeframe from door-to-computed tomography time (DTCT). However, sociodemographic backgrounds may impact the DTCT in acute stroke patients. [...] Read more.

Introduction: Stroke is the fifth leading cause of death and long-term disability in the United States. The current guideline for stroke management includes a 25 min timeframe from door-to-computed tomography time (DTCT). However, sociodemographic backgrounds may impact the DTCT in acute stroke patients. Methods: This was a retrospective, multicenter, cohort study between January 2018 and August 2022 throughout North Texas. The primary endpoint was DTCT ≤ 25 min upon arrival to hospital for all patients suspected of acute ischemic stroke. Results: During the study period, a total of 23,364 patients were included. Only 4468 patients (19.1%) had DTCT times less than or equal to 25 min, and 16,464 patients (70.5%) had DTCT times more than 25 min. In our cohort, Black (OR 1.35; 95% CI 1.23–1.49) and Asian patients (OR 1.33; 95% CI 1.01–1.74) were more likely to have DTCT > 25 min compared to White patients. Hispanic patients (OR 1.20; 95% CI 1.07–1.34) were more likely to have DTCT > 25 min compared to non-Hispanics. Patients presenting during the COVID (OR 1.45; 95% CI 1.34–1.57) and post-COVID period (OR 1.46; 95% CI 1.30–1.65) were more likely to have DTCT > 25 min compared to the pre-COVID period. Conclusions: We demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population and an increase in DTCT time after the start of COVID-19, which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time. Full article

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18 pages, 753 KiB

Open AccessArticle

Treatment of Vitamin D Deficiency in Decompensated Patients with Cirrhosis Is Associated with Improvement in Frailty

by Raquel Díaz-Ruíz, Maria Poca, Eva Román, Berta Cuyàs, Irene Bañares, Ángela Morales, Elvira Hernández Martínez-Esparza, Rocío Panadero, Cristina Velasco, Marta Rapado-Castro, Irene Bretón, Rafael Bañares, German Soriano and Rita García-Martínez

Med. Sci. 2025, 13(1), 30; https://doi.org/10.3390/medsci13010030 - 13 Mar 2025

Viewed by 632

Abstract

Background/aim: Frailty is increasingly recognized as a relevant prognostic factor in patients with cirrhosis, regardless of liver failure. Vitamin D deficiency is frequent in these patients and has been related to frailty and sarcopenia, but the impact of its supplementation on frailty [...] Read more.

Background/aim: Frailty is increasingly recognized as a relevant prognostic factor in patients with cirrhosis, regardless of liver failure. Vitamin D deficiency is frequent in these patients and has been related to frailty and sarcopenia, but the impact of its supplementation on frailty in cirrhosis is unknown. The aim was to evaluate the effect of vitamin D supplementation on frailty in patients with decompensated cirrhosis and vitamin D deficiency or insufficiency. Methods: We included patients with cirrhosis who had vitamin D deficiency or insufficiency following their hospitalization for acute decompensation. Vitamin D was supplemented according to current recommendations, as were other micronutrients if necessary. Patients were followed for one year to evaluate changes at 6 and 12 months in frailty (Fried frailty index), health-related quality of life (SF-36, CLDQ) and mood (HADS). Body composition was assessed by DXA at baseline and at 12 months. Results: We included 39 patients, 27 of whom reached the 6-month follow-up. Serum vitamin D increased at 6 and 12 months (p < 0.001 compared to baseline). Fried frailty index improved at the 6-month visit (p = 0.004), and handgrip strength improved at 6 (p = 0.001) and 12 (p = 0.002) months, similarly in women and men. At 12 months, we observed an increase in body mass index, right arm lean mass and total fat mass. Conclusions: A multifactorial nutritional intervention, especially vitamin D supplementation after discharge in decompensated, vitamin D-deficient patients with cirrhosis, was associated with an improvement in frailty, muscular strength and lean muscle mass. However, the increase in fat mass strengthens the recommendation for diet, exercise and weight supervision. Full article

(This article belongs to the Section Hepatic and Gastroenterology Diseases)

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9 pages, 1672 KiB

Open AccessArticle

Change in Indications and Outcomes for Stereotactic Biopsy Following Transition from Full Field Digital Mammography + Digital Breast Tomosynthesis to Full Field Synthetic Mammography + Digital Breast Tomosynthesis

by Jose Net, Antoine Hamedi-Sangsari, Taylor Schwartz, Mirelys Barrios, Nicole Brofman, Cedric Pluguez-Turull, Jamie Spoont, Sarah Stamler and Monica Yepes

Med. Sci. 2025, 13(1), 29; https://doi.org/10.3390/medsci13010029 - 12 Mar 2025

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Abstract

Background: Synthetic 2D mammography was developed to decrease radiation exposure, but to our knowledge there have been no studies evaluating the impact of implementation of full field synthetic mammography/digital breast tomosynthesis (FFSM/DBT) on indications for stereotactic biopsy. Objective: To compare indications and biopsy [...] Read more.

Background: Synthetic 2D mammography was developed to decrease radiation exposure, but to our knowledge there have been no studies evaluating the impact of implementation of full field synthetic mammography/digital breast tomosynthesis (FFSM/DBT) on indications for stereotactic biopsy. Objective: To compare indications and biopsy outcomes for stereotactic biopsy for full field digital mammography (FFDM/DBT) to those of FFSM/DBT. Methods: Retrospective chart review of stereotactic biopsies performed from July 2014 to September 2018. Reports were reviewed and indication for biopsy, lesion size, and final pathology were recorded. Comparison between the two groups following transition to FFSM/DBT in 2016 was performed. Results: 66 of 361 stereotactic biopsies performed in the FFDM/DBT group were malignant (PPV 18.3%), compared to 60 of the 391 biopsies performed in the FFSM/DBT group (PPV 15.4%) with no significant difference in PPV (p = 0.281). There were statistically significant changes in indications for biopsies after transitioning to FFSM/DBT: with a decrease in calcifications referred for biopsy (68.03% vs. 89.75%; p < 0.001), and a statistically significant increase in referral of masses (10.74% vs. 4.43%; p < 0.001), asymmetries (15.60% vs. 5.26%; p < 0.001), and architectural distortion (5.63% vs. 0.55%; p < 0.001). PPV across all indications (21.8% in FFSM/DBT vs. 20.3% in FFDM; p = 0.213), and invasive cancer yield (5.63% vs. 3.32%; p = 0.129) remained comparable following transition to FFSM/DBT without statistically significant differences. Conclusions: Following transition to FFSM/DBT, statistically significant shifts in indications for biopsies were observed with a decrease in referral of calcifications and an increase for masses, asymmetries and architectural distortions. PPV for stereotactic biopsy was not significantly different and cancer yield across all indications remained similar, with an increase in invasive cancer diagnosis. Full article

(This article belongs to the Section Cancer and Cancer-Related Research)

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9 pages, 520 KiB

Open AccessArticle

Protective Effect of Daily Physical Activity Against COVID-19 in a Young Adult Population on Reunion Island

by Camille Cazeneuve, David Couret, Gregorie Lebeau, Wildriss Viranaicken, Marie-Eve Mathieu and Florian Chouchou

Med. Sci. 2025, 13(1), 28; https://doi.org/10.3390/medsci13010028 - 12 Mar 2025

Viewed by 430

Abstract

The global fight against pandemics is a major public health issue. Epidemiological studies showed a reduced risk of the coronavirus disease 2019 (COVID-19) severity with the practice of regular physical activity (PA) in clinical populations. Here, we investigated the effect of PA against [...] Read more.

The global fight against pandemics is a major public health issue. Epidemiological studies showed a reduced risk of the coronavirus disease 2019 (COVID-19) severity with the practice of regular physical activity (PA) in clinical populations. Here, we investigated the effect of PA against COVID-19 in a young general population. Methods: Two hundred ninety volunteers over 18 years old from Reunion Island responded to an online survey concerning sociodemographic, lifestyle and clinical information. Daily PA was studied using the International Physical Activity Questionnaire short version (IPAQ) and classified by overall score and intensities of PA. Results: Among 290 responders [179 women, median age = 27.5 years (interquartile range = 21.3 years)], 141 (48.6%) reported COVID-19 infection. Multivariate logistic analysis adjusted for age, sex, body mass index, chronic disease and alcohol consumption showed that the number of days per week of regular intense PA was independently associated with a low risk of COVID-19 infection [odds ratio (OR) 0.86; 95% confidence interval (CI) 0.24 to 0.99; p = 0.030], while regular moderate PA was not [OR 1.10; 95%CI 0.97 to 1.23; p = 0.137]. Conclusions: In a population of young adults, regular intense PA could offer a protective effect against COVID-19. Additional research is required to confirm this association in various viral infections and elucidate the fundamental mechanisms involved. Full article

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16 pages, 1669 KiB

Open AccessSystematic Review

FGF-23 as a Biomarker for Carotid Plaque Vulnerability: A Systematic Review

by Joana Oliveira-Sousa, Mariana Fragão-Marques, Luís Duarte-Gamas, Hugo Ribeiro and João Rocha-Neves

Med. Sci. 2025, 13(1), 27; https://doi.org/10.3390/medsci13010027 - 10 Mar 2025

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Abstract

Background/Objectives: Carotid artery disease is a condition affecting 3% of the general population which significantly contributes to the development of cerebrovascular events. Fibroblast Growth Factor-23 (FGF-23) is a hormone that has been linked to atherosclerosis and increased cardiovascular risk, including stroke and myocardial [...] Read more.

Background/Objectives: Carotid artery disease is a condition affecting 3% of the general population which significantly contributes to the development of cerebrovascular events. Fibroblast Growth Factor-23 (FGF-23) is a hormone that has been linked to atherosclerosis and increased cardiovascular risk, including stroke and myocardial infarction. This review explores the association of FGF-23 with carotid artery disease progression in an endarterectomy clinical context. Methods: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a search was performed relying on MEDLINE, Scopus and Web of Science, identifying publications focused on the correlation between serum FGF-23 and carotid artery disease. Assessment of study quality was made using National Heart, Lung and Blood Institute Study Quality Assessment Tool (NHLBI). Results: Three observational studies, comprising 1039 participants, were included. There was considerable heterogeneity among the populations from the different studies. Elevated FGF-23 levels were consistently associated with unstable plaque features, including intraplaque neovascularization, as identified through Superb Microvascular Imaging (SMI). Plasma levels of inflammatory mediators, such as Interleukin-6 (Il-6), Monocyte Chemoattractant Protein-1 (MCP-1), and Osteoprotegerin (OPG), positively correlated with carotid artery disease, but their link to unstable plaques is conflicting. None of the studies investigated clinical complications following carotid endarterectomy. Conclusions: FGF-23 is a potential biomarker for plaque vulnerability in carotid disease. Despite promising findings, limitations such as small sample sizes and lack of longitudinal data suggest the need for larger and more diverse studies to improve risk stratification and inform personalized treatment strategies for carotid atherosclerosis. Full article

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15 pages, 2771 KiB

Open AccessArticle

Body Integrity Dysphoria (BID): Survey of Experts and Development of a Diagnostic Guideline

by Erich Kasten

Med. Sci. 2025, 13(1), 26; https://doi.org/10.3390/medsci13010026 - 3 Mar 2025

Viewed by 695

Abstract

People who suffer from body integrity dysphoria (BID) feel a strong need to be disabled. The most common desire is for amputation or paralysis. Objectives: This study aims to gather the opinion of experts on which types of disabilities are included in BID, [...] Read more.

People who suffer from body integrity dysphoria (BID) feel a strong need to be disabled. The most common desire is for amputation or paralysis. Objectives: This study aims to gather the opinion of experts on which types of disabilities are included in BID, which therapies are useful and whether those affected should be supported in obtaining a disability. Methods: A questionnaire with 62 items and a flow chart were developed and sent to experts who have published work with regard to BID. Participants: 22 experts from 11 countries, mostly with an academic title and with an average age of 48.5 years, responded. Results: As expected, amputations and paralysis were clearly attributed to BID, other disabilities (toothlessness, incontinence, diabetes) received rather uncertain or negative scores. On average, those affected were not classified as mentally or psychiatrically ill. Neurological misconnection was considered the most likely cause. Experts did not think it was helpful to inform the health system or even the police about the desire to be disabled. Almost all experts supported the surgical solution of amputation by doctors. All participants believed that BID patients are aware of the limitations imposed by the desired disability. Finally, a flow chart is presented for diagnosis and therapy. Conclusions: The experts assume that the surgical solution is currently acceptable if it has been proven that the BID-affected person does not suffer from another mental disorder, there is a high level of suffering due to BID, other therapies have not been of any use and it is clear that the quality of life will actually increase as a result of achieving the disability. Full article

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10 pages, 6671 KiB

Open AccessCommunication

Thermo-Ablative Fractional CO₂ Lasers Combined with 1540 nm Wavelengths Is a Promising Treatment Option in Stress Urinary Incontinence

by Maurizio Filippini, Sara Elmi, Jessica Sozzi, Laura Pieri, Irene Fusco, Tiziano Zingoni and Pablo González-Isaza

Med. Sci. 2025, 13(1), 25; https://doi.org/10.3390/medsci13010025 - 1 Mar 2025

Viewed by 538

Abstract

Background/Objectives: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and [...] Read more.

Background/Objectives: Stress urinary incontinence (SUI) is a common and often under-reported condition that significantly impacts quality of life. SUI is more than just a physical issue; it can also affect social interactions, mental health, and emotional well-being due to the embarrassment and limitations it can cause. SUI is often acquired during pregnancy and childbirth as a result of pelvic floor muscle weakness. The aim of this study was to evaluate the effectiveness of an innovative dual-wavelength laser system (CO₂ + 1540 nm) in SUI management. Methods: A total of 56 women affected by SUI were enrolled in this study. Half of the patients were treated with CO₂ alone, while the other half were treated with the combination of CO₂ + 1540 nm wavelengths. The patients were split into four groups based on the type of treatment they received and their menopausal status. Data were acquired at baseline and at various follow-ups (T1, T2, and T3, respectively, after the first, second, and third treatment). The Visual Analog Scale (VAS) (score 0–10) was used. Cystoscopic images were acquired before and at the end of the laser treatment cycle. Results: At the end of the treatment, the patients in each group were very satisfied, on average. In each group, the treatment led to a statistically significant improvement in the SUI VAS score between baseline and follow-up after the first treatment; in both groups 3 and 4, the treatment led to a significant change in the dryness score, both from baseline to T1 (p < 0.05) and also for T2 and T3 compared to baseline. Finally, cystoscopic photos showed an evident increase in mucosa epithelial thickness after the laser treatment cycle. Conclusions: The use of a dual-wavelength laser system (CO₂ + 1540 nm) was proven to be well tolerated and safe, with promising outcomes in reducing SUI symptoms, especially in non-menopausal patients. Full article

(This article belongs to the Section Gynecology)

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15 pages, 1225 KiB

Open AccessArticle

Assessing Breast Cancer Awareness Among Women in Al Baha, Saudi Arabia: A Cross-Sectional Study Using the Breast Cancer Awareness Measure (BCAM)

by Mohammad A. Albanghali, Rawan K. Alnemari, Rhaff B. Al Ghamdi, Fatma Alzahraa M. Gomaa, Taif A. Alzahrani, Alya S. Al Ghamdi, Batol M. Albanghali, Yasser M. Kofiah, Eltayeb M. Alhassan and Basim A. Othman

Med. Sci. 2025, 13(1), 24; https://doi.org/10.3390/medsci13010024 - 1 Mar 2025

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Abstract

Introduction: Breast cancer (BC) awareness and preventive practices are critical for the early detection and effective management of the disease. This study aimed to assess the level of BC awareness among women residing in Al Baha, Saudi Arabia. Methods: A cross-sectional study was [...] Read more.

Introduction: Breast cancer (BC) awareness and preventive practices are critical for the early detection and effective management of the disease. This study aimed to assess the level of BC awareness among women residing in Al Baha, Saudi Arabia. Methods: A cross-sectional study was conducted using the Breast Cancer Awareness Measure (BCAM) survey tool to evaluate BC awareness among female residents of Al Baha between June and July 2023. The sample was obtained through the snowball sampling technique. Results: A total of 1007 women participated in the study, with a mean age of 29 ± 10.9 years. Overall awareness of BC warning signs and risk factors was low, with 45% of participants demonstrating poor awareness. Significant positive associations were found between BC awareness and factors such as level of education (p = 0.020), employment status (p = 0.023), field of study for students (p < 0.0001), and average monthly family income (p = 0.001). Furthermore, 75% of participants rarely or never practiced breast self-examination, and only 37% of those invited to the Ministry of Health’s screening program had attended. Conclusions: The results highlight a significant lack of awareness and knowledge about BC among women in Al Baha. These findings underscore the urgent need for targeted educational initiatives and awareness campaigns to address this knowledge gap and promote preventive practices. Full article

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14 pages, 1870 KiB

Open AccessArticle

Impact of the SARS-CoV-2 Pandemic on the Prevalence and Incidence of Enteric Protozoa in a Spanish Tertiary-Care Hospital and a Referral Center for Tropical Diseases, 2019–2023

by Alfredo Maldonado-Barrueco, Fernando de la Calle-Prieto, Marta Díaz-Menéndez, Marta Arsuaga, Julio García-Rodríguez and Guillermo Ruiz-Carrascoso

Med. Sci. 2025, 13(1), 23; https://doi.org/10.3390/medsci13010023 - 1 Mar 2025

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Abstract

Objetive: The aim of this study was to describe the impact of non-pharmaceutical interventions (NPIs) against SARS-CoV-2 in patients with symptoms of enteric protozoa (EP), including Blastocystis spp., Dientamoeba fragilis, Giardia lamblia, Cryptosporidium spp., Entamoeba histolytica, and Cyclospora cayetanensis, [...] Read more.

Objetive: The aim of this study was to describe the impact of non-pharmaceutical interventions (NPIs) against SARS-CoV-2 in patients with symptoms of enteric protozoa (EP), including Blastocystis spp., Dientamoeba fragilis, Giardia lamblia, Cryptosporidium spp., Entamoeba histolytica, and Cyclospora cayetanensis, in the overall population and in patients who were consulted at a National Referral Center for Imported Tropical Diseases (NRCITD patients) from a healthcare area in Madrid (Spain). Method: Data on patients with positive RT-PCR results for EP were collected. The periods analyzed were prepandemic (P0, 1 April 2019–31 March 2020), and the first (P1, 1 April 2020–31 March 2021), second (P2, 1 April 2021–31 March 2022), and third (P3, 1 April 2022–31 March 2023) pandemic years. We compared the prevalence, median age, absolute incidence (EP per 100,000 population of each period), and patient profile (NRCITD vs. non-NRCITD) during the study periods using Fisher’s test (p < 0.05) and the T-test (p < 0.001). Results: During P0, 24.8%, [95% CI: 23.9–25.6] of patients tested for EP RT-PCR were positive, 22.6% [95% CI: 21.5–23.7] were positive in P1, 20.4%, [95% CI: 19.5–21.3] were positive during P2, and 20% [95% CI: 19.2–20.9] of patients tested during P3 were positive. During the study, there was no difference in the median ages. The prevalence and absolute incidence of EP showed a decreasing trend during the pandemic for the NRCITD and non-NRCITD patients (p < 0.05). Conclusion: Blastocystis spp. and D. fragilis showed a lower decrease in prevalence during P1 (p > 0.05) due to the higher detection of colonized patients during the SARS-CoV-2 pandemic. However, G. lamblia and Cryptosporidium spp. showed the highest decrease in prevalence and absolute incidence during P2 (p < 0.05) because of the NPIs implemented during the SARS-CoV-2 pandemic. The NTRCID patients showed a higher prevalence of Blastocystis spp. than the non-NTRCID patients during every period studied (p < 0.001). E. histolytica and C. cayetanensis showed a homogeneous trend. Full article

(This article belongs to the Section Immunology and Infectious Diseases)

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9 pages, 221 KiB

Open AccessArticle

The Examination of the Relationship Between the Number of Births with the Symptoms of Urinary Incontinence and Low Back Pain Postpartum in Greek Women

by Eleni Katsouli, Eleni-Alexandra Karathanasi, Eleftheria Ntalagianni, Themistoklis-Marios Terpos and Anna Christakou

Med. Sci. 2025, 13(1), 22; https://doi.org/10.3390/medsci13010022 - 1 Mar 2025

Viewed by 699

Abstract

Background: Urinary incontinence and low back pain are often present during pregnancy and after childbirth. The aim of this study was to examine the relationship between the number of children with the occurrence of urinary incontinence and low back pain after pregnancy in [...] Read more.

Background: Urinary incontinence and low back pain are often present during pregnancy and after childbirth. The aim of this study was to examine the relationship between the number of children with the occurrence of urinary incontinence and low back pain after pregnancy in the Greek population. Materials and Methods: Seventy-one Greek women (M = 35.0 age, SD = ±4.3) with specific inclusion criteria completed just once the International Consultation on Incontinence Questionnaire and the Oswestry Disability Questionnaire after five years from childbirth. Results: A total of 28.2% of the participating women experienced urinary incontinence, and 38% experienced low back pain after pregnancy. No relationship has been found between urinary incontinence and the number of births (r = 0.062, p = 0.609) and low back pain with the number of births (r = −0.076, p = 0.529). Statistically significant correlations were found between urinary incontinence and low back pain (r = 0.33, p < 0.01) and the urinary incontinence and the maternal age at first delivery (r = −0.264, p = 0.026) in women who underwent a vaginal delivery in second birth had fewer urinary incontinence symptoms and increased low back pain. Conclusions: Few correlations emerged in the present study. Future research is necessary to be conducted to examine the relationship between postpartum women’s demographic data, urinary incontinence, and low back pain. Full article

9 pages, 178 KiB

Open AccessArticle

Misdiagnosis of Acute Limb Ischemia from Non-Vascular Specialists Results in a Delayed Presentation and Negatively Affects Patients’ Outcomes

by Michalis Pesmatzoglou, Stella Lioudaki, Nikolaos Kontopodis, Ifigeneia Tzartzalou, Konstantinos Litinas, George Tzouliadakis and Christos V. Ioannou

Med. Sci. 2025, 13(1), 21; https://doi.org/10.3390/medsci13010021 - 20 Feb 2025

Viewed by 545

Abstract

Background/Objectives: Acute Limb Ischemia (ALI) is a vascular emergency which is accompanied by a significant risk of limb loss or even death. Rapid restoration of arterial perfusion using surgical and/or endovascular techniques is crucial for limb salvage. Undeniably, an accurate and prompt diagnosis [...] Read more.

Background/Objectives: Acute Limb Ischemia (ALI) is a vascular emergency which is accompanied by a significant risk of limb loss or even death. Rapid restoration of arterial perfusion using surgical and/or endovascular techniques is crucial for limb salvage. Undeniably, an accurate and prompt diagnosis is the first step to improve patient prognosis. The typical clinical presentation is not always present and the variety of symptoms may result in non-vascular specialists missing the diagnosis. Methods: In this single-center retrospective descriptive study, we reviewed all patients hospitalized between January 2018 and January 2024 for ALI. Patients who were initially misdiagnosed, causing a delayed diagnosis > 24 h, and who therefore did not receive timely treatment, were identified. Moreover, patients with a timely diagnosis of ALI who were treated in our institution during the same time period were collected. Results: Among 280 ALI patients, 14 were initially misdiagnosed. The median time from initial symptoms to definite diagnosis was 38.8 days (range 1.5–365). Several specialties such as orthopedic surgeons, neurologists, and general practitioners were involved in patients’ initial assessment. Three patients underwent primary amputation due to irreversible ALI, while nine underwent revascularization and one conservative treatment. Thirty-day limb salvage rate was 9/14 and thirty-day mortality was observed in one patient. Secondary interventions were needed in 65% of these cases. Patients with a delayed ALI diagnosis, when compared to those with a timely diagnosis, presented a significantly lower limb salvage rate (65% vs. 89%, p-value = 0.02) and a significantly higher rate of reinterventions (65% vs. 18%, p-value < 0.001). Conclusions: Many patients with ALI are primarily referred to non-vascular specialties. Misdiagnosed and mistreated ALI negatively affects outcomes. Full article

(This article belongs to the Section Cardiovascular Disease)

10 pages, 252 KiB

Open AccessArticle

Correlation Between Blood Coagulation Profile and Viscosity: Clinical Laboratory Observational Study

by Ezekiel U. Nwose and Phillip T. Bwititi

Med. Sci. 2025, 13(1), 20; https://doi.org/10.3390/medsci13010020 - 16 Feb 2025

Viewed by 483

Abstract

Whole blood viscosity is a test for blood stasis and is an ideal evidence-based pathology parameter that is largely undervalued and retrogressing in clinical utilization. Coagulation profiles as indices of haemostasis are available but limited to central or referral laboratories and often involve [...] Read more.

Whole blood viscosity is a test for blood stasis and is an ideal evidence-based pathology parameter that is largely undervalued and retrogressing in clinical utilization. Coagulation profiles as indices of haemostasis are available but limited to central or referral laboratories and often involve long turn-around time. It is therefore important to study the correlation between the index of stasis and indices of haemostasis. Objective: To investigate the correlation of index of stasis with indices of haemostasis. Method: The clinical laboratory observational research method, using archived pathology data. Indices of haemostasis including activated partial thromboplastin time (APTT) and prothrombin time (PT), the international normalization ratio (INR), and plasma D-dimer were evaluated. On the other hand, the index of blood stasis used was the estimated whole blood viscosity (eWBV) and derived haematocrit and serum protein levels. All (N = 193) tests were collected within a calendar year from the same pathology service, and further, for the correlation, each set of variables from the same blood sample collection was used. Results: The haemostasis data are skewed (skewness > 2.0), while eWBV and platelet count are normal (skewness < 2.0). Haemostasis indices have an inverse association with eWBV (p < 0.001). The concordance and correlation of eWBV with platelet count is positive, weak, and significant (p < 0.001), but negative and negligible with PT and APTT. Conclusion: There are limitations to the possible correlation between eWBV and haemostasis indices. However, haemostasis indices have inverse associations with eWBV, and the latter can aid in the evaluation of haemostasis hence could be utilized as an alternative or complementary test to haemostasis tests. Research may normalize skewed data to obtain better correlation; therefore, further study is required to advance discourse, giving cognizance to clinical practice. Full article

(This article belongs to the Section Cardiovascular Disease)

10 pages, 213 KiB

Open AccessArticle

Outcomes in Acute Decompensated Congestive Heart Failure Admissions with Chronic Liver Disease: A Nationwide Analysis Using the National Inpatient Sample

by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Pratiksha Moliya, Nelson Gonzalez, Emelyn Martinez, Hata Mujadzic, Maggie James, Abraham Lo and Simcha Weissman

Med. Sci. 2025, 13(1), 19; https://doi.org/10.3390/medsci13010019 - 13 Feb 2025

Viewed by 746

Abstract

AIM: The aim of our study was primarily to analyze hospital outcomes for acute decompensated heart failure (ADHF) admissions with a comorbid diagnosis of chronic liver disease (CLD). METHODS: The NIS was used to select ADHF admissions. The population characteristics of general ADHF [...] Read more.

AIM: The aim of our study was primarily to analyze hospital outcomes for acute decompensated heart failure (ADHF) admissions with a comorbid diagnosis of chronic liver disease (CLD). METHODS: The NIS was used to select ADHF admissions. The population characteristics of general ADHF admissions were compared with ADHF admissions with a comorbid diagnosis of CLD. Multivariate probit logistic regression was used to analyze the association between a documented diagnosis of CLD/alcoholic liver disease and all-cause mortality in ADHF admissions. Confounders were accounted for. Propensity scoring and nearest neighbor matching were conducted to select a matched cohort with and without CLD from ADHF admissions to further look at mortality outcomes. RESULTS: ADHF admissions with a comorbid diagnosis of CLD had a significantly higher proportion of all-cause mortality, 0.054 (0.053–0.057), a higher length of hospital stay, 6.95 days (6.84–7.06), and a higher mean of total hospital charges, USD 88,068.1, when compared to ADHF admissions without a comorbid diagnosis of CLD: all-cause mortality, 0.045 (0.044–0.046); length of hospital stay, 6.18 days (6.13–6.23); and mean total hospital charges, USD 79,946.21. A comorbid diagnosis of CLD had a significant association with all-cause mortality in ADHF admissions: OR 1.23 (1.17–1.29) after accounting for confounders. In the propensity-matched cohorts, the cohort with a diagnosis of CLD from the ADHF admissions had a higher proportion of all-cause mortality, 0.042 (0.036–0.049), when compared to the cohort without a diagnosis of chronic liver disease, 0.027 (0.022–0.033). CONCLUSIONS: In analyzing the mortality and healthcare utilization outcomes for ADHF admissions, the comorbid diagnosis of CLD is shown to have significantly higher all-cause mortality, higher length of hospital stay, and higher mean total charges when compared to ADHF admissions without a diagnosis of CLD. A documented diagnosis of CLD had a statistically significant association with all-cause mortality in ADHF admissions after accounting for confounding factors. Full article

(This article belongs to the Section Cardiovascular Disease)

12 pages, 592 KiB

Open AccessArticle

The Success and Safety of Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Gastrointestinal Anatomy

by Samuel Han, Jennifer M. Kolb, Steven A. Edmundowicz, Augustin R. Attwell, Hazem T. Hammad, Sachin Wani and Raj J. Shah

Med. Sci. 2025, 13(1), 18; https://doi.org/10.3390/medsci13010018 - 11 Feb 2025

Viewed by 628

Abstract

Background/Objectives: Performing endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered gastrointestinal anatomy remains challenging, frequently necessitating the use of forward-viewing endoscopes. Given the challenge in endoscope selection based on the type of altered anatomy, the aim of this study was to examine ERCP success [...] Read more.

Background/Objectives: Performing endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered gastrointestinal anatomy remains challenging, frequently necessitating the use of forward-viewing endoscopes. Given the challenge in endoscope selection based on the type of altered anatomy, the aim of this study was to examine ERCP success rates by specific endoscopes for different anatomy types. Methods: This single-center retrospective study examined ERCPs performed in patients with surgically altered gastrointestinal anatomy during an 18-year period. Enteroscopy success, cannulation success, and intervention success rates were compared between the different anatomy and endoscope types. Results: This study included a total of 334 adult patients (665 total ERCPs) with altered anatomy. The pediatric colonoscope was most frequently utilized (32.2%), and the majority of procedures were performed for biliary indications. Enteroscopy success was 82.2% in Roux-en-Y gastric bypass (RYGB), 97% in Billroth II, 91.5% in Whipple, and 93.2% in Roux-en-Y hepaticojejunostomy (RYHJ). Cannulation success was 90.5% in RYGB, 90.5% in Billroth II, 83.6% in Whipple, and 90.6% in RYHJ. Intervention success was 88.2% in Billroth II, 65.1% in RYGB, 81.6% in Whipple, and 87.5% in RYHJ. In patients with RYGB and RYHJ, SBE was utilized most frequently, with rotational enteroscopy having the highest success rates. The overall adverse event rate was 5.1%, with the majority of these being mild in severity. Conclusions: This large retrospective study found ERCP with forward-viewing endoscopes to be safe and effective for a variety of surgically altered anatomy types. Despite recent advances seen with endoscopic ultrasound-guided drainage procedures, this study advocates for ERCP as the initial approach for pancreaticobiliary access in surgically altered anatomy. Full article

(This article belongs to the Section Hepatic and Gastroenterology Diseases)

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11 pages, 825 KiB

Open AccessArticle

Rheumatoid Arthritis Prevalence and Risk Factors in Korean Adults: A Focus on Age and Sex Differences

by Do-Youn Lee

Med. Sci. 2025, 13(1), 17; https://doi.org/10.3390/medsci13010017 - 9 Feb 2025

Viewed by 769

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints, causing swelling, pain, stiffness, and functional decline. This study aims to clarify the prevalence and risk factors of RA based on sex and age among Korean adults, providing essential data for [...] Read more.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints, causing swelling, pain, stiffness, and functional decline. This study aims to clarify the prevalence and risk factors of RA based on sex and age among Korean adults, providing essential data for targeted prevention and management strategies. We analyzed data from the Korea National Health and Nutrition Examination Survey 2016–2021, comprising 25,166 participants aged 20 and older. Sociodemographics, health status, and behavior factors were evaluated, with RA defined based on self-reported diagnosis. A complex sampling design was utilized to ensure representative results and multiple logistic regression was employed to determine the risk factors linked to RA. The overall prevalence of RA among Korean adults was 1.1%, showing a significant sex-based disparity: 0.6% and 1.7% in men and women, respectively. RA prevalence increased with age, peaking at 3.5% in individuals over 70. This study identified education level, subjective health status, and age as key predictors of RA. Among men, significant predictors of RA included education level and subjective health status, with a higher risk observed in men with only elementary education and poor perceived health. For women, age and subjective health status were the main risk factors, with RA risk increasing markedly in older age groups, particularly in those aged 70 and above. This study highlights the distinct prevalence and risk factors for RA among Korean adults by sex and age. Key predictors—education level, subjective health status, and age—suggest that tailored health interventions addressing these factors are crucial to reducing the RA burden and enhancing health outcomes among affected populations. Full article

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11 pages, 578 KiB

Open AccessReview

Radiological and Clinical Outcome Differences Between Standard and Short Stem in Reverse Total Shoulder Arthroplasty: A Systematic Review

by Mauro Ciuffreda, Antongiulio Lentini, Giuseppe Francesco Papalia, Domenico Grasso, Pierangelo Za, Rocco Papalia and Giacomo Rizzello

Med. Sci. 2025, 13(1), 16; https://doi.org/10.3390/medsci13010016 - 9 Feb 2025

Viewed by 1010

Abstract

Background: In recent years, the use of short cementless humeral components in reverse total shoulder arthroplasty (RTSA) has increased. This systematic review aimed to compare the radiological and clinical outcomes of uncemented RTSA using short versus standard humeral stems and assess the impact [...] Read more.

Background: In recent years, the use of short cementless humeral components in reverse total shoulder arthroplasty (RTSA) has increased. This systematic review aimed to compare the radiological and clinical outcomes of uncemented RTSA using short versus standard humeral stems and assess the impact of these radiological changes on clinical outcomes. Methods: A systematic electronic search was performed by two independent reviewers using PubMed, Scopus, and Cochrane Library databases on 10 December 2024. Inclusion criteria involved studies that assessed the radiological and clinical outcomes and overall complication rates of cementless RTSA with short or standard stems in patients with osteoarthritis, cuff tear arthropathy, post-traumatic, and rheumatoid arthritis with a follow-up of at least 1 year. The following data were extracted: radiological parameters of stems including implant subsidence, humeral loosening, and humeral osteolysis and clinical outcomes as Visual Analog Scale pain, American Shoulder and Elbow Surgeons score, Constant Score and Single Assessment Numeric Evaluation score. Results: A total of 13 studies including 1485 shoulders in 1460 patients were analyzed with a median age at surgery of 74.5 years. The short stem group recorded worse radiological outcomes examined such as humeral loosening, lucencies around the implants, and osteolysis. No significant differences were observed in the clinical outcomes and overall complications between the two types of stems. Conclusions: Both short and standard stems are valid options in cementless RTSA. Minimal differences in radiological outcomes were found in favor of RTSA implanted with short stems, while postoperative clinical outcomes were similar between the two types of implants. Full article

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17 pages, 12041 KiB

Open AccessReview

A Scoping Review on Cognition in Myelodysplastic Syndromes: Advances and Challenges

by Anna Tsiakiri, Konstantinos Frigkas, Pinelopi Vlotinou, Menelaos Papoutselis, Foteini Christidi, Efstratios Karavasilis, Ioannis Kotsianidis, Nikolaos Kourkoutsakis, Konstantinos Vadikolias and Konstantinos Liapis

Med. Sci. 2025, 13(1), 15; https://doi.org/10.3390/medsci13010015 - 7 Feb 2025

Viewed by 992

Abstract

Background/Objectives: Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and a risk of progression to acute myeloid leukemia (AML). Cognitive impairments, including deficits in memory, attention, and executive function, are frequently reported in MDS patients. These impairments are linked to [...] Read more.

Background/Objectives: Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and a risk of progression to acute myeloid leukemia (AML). Cognitive impairments, including deficits in memory, attention, and executive function, are frequently reported in MDS patients. These impairments are linked to systemic inflammation, neurotoxic treatment effects, and the psychological burden of chronic disease. This review synthesizes existing evidence on cognitive dysfunction in MDS, highlighting knowledge gaps and opportunities for future research. Methods: A scoping review was conducted following PRISMA-ScR guidelines. MEDLINE and Scopus databases were searched for studies examining cognition in MDS patients, using terms like “myelodysplastic syndromes” and “cognition.” Inclusion criteria were original, English-language studies reporting cognitive outcomes in MDS. Reviews, animal studies, and abstracts were excluded. Data on study design, patient characteristics, cognitive tests, and outcomes were extracted and descriptively analyzed. Results: The review included 25 studies involving 2390 patients with hematologic malignancies, 493 of whom had MDS. Key findings identified cognitive deficits primarily in attention, executive function, and memory. Systemic inflammation and treatment-related neurotoxicity were significant contributors, with older age compounding these effects. Longitudinal studies demonstrated persistent cognitive challenges post-treatment, though the severity varied by patient demographics and therapeutic regimens. Conclusions: Cognitive impairments in MDS are multifactorial and significantly impact patients’ quality of life. Current research highlights the need for routine cognitive assessments and targeted interventions. Future studies should focus on longitudinal designs to explore specific cognitive domains and develop therapeutic strategies to mitigate cognitive decline. Full article

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10 pages, 234 KiB

Open AccessOpinion

Acute Hepatic Porphyria Should Be Included in the Diagnostic Work-Up of Patients with Resistant Hypertension or Suspected Secondary Hypertension

by Paulo de Lima Serrano, Bruno de Mattos Lombardi Badia, João Paulo Barile, Patrícia Marques Mendes, Renan Brandão Rambaldi Cavalheiro, Kaliny Oliveira Peixoto, Igor Braga Farias, Roberta Ismael Lacerda Machado, Daniel Delgado Seneor, Wladimir Bocca Vieira de Rezende Pinto, Acary Souza Bulle Oliveira and Paulo Sgobbi

Med. Sci. 2025, 13(1), 14; https://doi.org/10.3390/medsci13010014 - 6 Feb 2025

Viewed by 706

Abstract

Secondary hypertension and resistant hypertension may result from potentially treatable acquired or hereditary diseases. Inherited Metabolic Disorders are not routinely included in the differential diagnosis of these contexts associated with hypertension, despite the key importance of diagnosis for several of them which enable [...] Read more.

Secondary hypertension and resistant hypertension may result from potentially treatable acquired or hereditary diseases. Inherited Metabolic Disorders are not routinely included in the differential diagnosis of these contexts associated with hypertension, despite the key importance of diagnosis for several of them which enable the early treatment of them. We aim to discuss the current evidence that indicates that a significant portion of cases of unknown resistant hypertension or suspected secondary hypertension may result from unrecognized Acute Hepatic Porphyria (AHP). Diagnostic work-up for AHP is not routinely performed during the evaluation of patients with resistant or refractory hypertension nor in the investigation of secondary hypertension. AHP may present both with neurological and systemic involvement, and hypertension may be observed as part of acute dysautonomia during acute neurovisceral attacks and as a chronic complication during disease course. As AHP represent a potentially treatable group of metabolic disorders, clinicians should consider the inclusion of this group in the diagnostic evaluation of patients with secondary or resistant hypertension. Full article

(This article belongs to the Section Endocrinology and Metabolic Diseases)

29 pages, 1806 KiB

Open AccessReview

Update on the Complications and Management of Liver Cirrhosis

by Hiba Fadlallah, Diala El Masri, Hisham F. Bahmad, Wassim Abou-Kheir and Jad El Masri

Med. Sci. 2025, 13(1), 13; https://doi.org/10.3390/medsci13010013 - 5 Feb 2025

Viewed by 2298

Abstract

Liver cirrhosis represents the advanced pathological stage of chronic liver disease, characterized by the progressive destruction and regeneration of the hepatic parenchyma over years, culminating in fibrosis and disruption of the vascular architecture. As a leading global cause of morbidity and mortality, it [...] Read more.

Liver cirrhosis represents the advanced pathological stage of chronic liver disease, characterized by the progressive destruction and regeneration of the hepatic parenchyma over years, culminating in fibrosis and disruption of the vascular architecture. As a leading global cause of morbidity and mortality, it continues to affect millions worldwide, imposing a substantial burden on healthcare systems. Alcoholic/nonalcoholic fatty liver disease and chronic viral hepatitis infection, hepatitis C (HCV) in particular, remain leading causes of cirrhosis. Despite significant advances in understanding the pathogenesis of cirrhosis, its management is still complex due to the multifaceted complications, including ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma, all of which severely compromise the patient outcomes and quality of life. This review aims at filling a critical gap by providing a comprehensive summary of the latest evidence on the complications and management of liver cirrhosis. Evidence-based therapies targeting both the etiologies and complications of cirrhosis are essential for improving outcomes. While liver transplantation is considered a definitive cure, advancements in pharmacological therapies offer promising avenues for halting and potentially reversing disease progression. This review summarizes the latest management strategies for cirrhosis and its associated complications, emphasizing the importance of early intervention and novel therapeutic options for improving outcomes and quality of life in affected individuals. Full article

(This article belongs to the Section Hepatic and Gastroenterology Diseases)

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18 pages, 888 KiB

Open AccessSystematic Review

Placebo-Controlled Trials in the Management of Crohn’s Disease: An Umbrella Review of Meta-Analyses

by Richard Silva, José Nunes de Azevedo, Jorge Pereira Machado and Jorge Magalhães Rodrigues

Med. Sci. 2025, 13(1), 12; https://doi.org/10.3390/medsci13010012 - 29 Jan 2025

Viewed by 890

Abstract

Introduction: Crohn’s disease is a chronic inflammatory bowel disease characterized by abdominal pain, diarrhea, and other symptoms. It can lead to significant complications and impact patients’ quality of life. Therefore, effective management strategies are essential for improving outcomes. Methods: To assess the efficacy [...] Read more.

Introduction: Crohn’s disease is a chronic inflammatory bowel disease characterized by abdominal pain, diarrhea, and other symptoms. It can lead to significant complications and impact patients’ quality of life. Therefore, effective management strategies are essential for improving outcomes. Methods: To assess the efficacy of the treatments for Crohn’s disease, this umbrella review systematically addresses systematic reviews and meta-analyses on Crohn’s disease management published between 2013 and 2023. The quality of the included studies was assessed using the National Institutes of Health’s quality assessment tool. Results: Sixteen studies were included, evaluating various interventions for the induction and maintenance of remission. These included biologic agents (anti-TNF agents, anti-IL-12/23p40 antibodies, and integrin receptor antagonists), antimetabolites, and corticosteroids. Conclusions: The findings suggest that biologic agents may be promising options for both the induction and maintenance of remission in Crohn’s disease. Antimetabolites and corticosteroids may be effective in certain cases, but their efficacy and safety profiles require further investigation. The included studies varied in quality and sample size. More research is needed to confirm the findings and establish optimal treatment strategies. Moreover, while biologic agents show promise, the optimal management of Crohn’s disease requires further research. A personalized approach considering patient factors and disease characteristics is crucial for optimizing outcomes. Full article

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10 pages, 1407 KiB

Open AccessCase Report

An Unusual Case of Uremic Tumoral Calcinosis with Atypical Manifestation in a Patient on Peritoneal Dialysis: Case Report and Review of the Literature

by Esperanza Moral Berrio, Roger A. Cox Conforme, Raúl Elías, José C. De La Flor, Celia Rodríguez Tudero, María Dolores Sánchez de la Nieta-García, Rocío Zamora González-Mariño and Carmen Vozmediano Poyatos

Med. Sci. 2025, 13(1), 11; https://doi.org/10.3390/medsci13010011 - 29 Jan 2025

Viewed by 1038

Abstract

Background: Uremic tumoral calcinosis (UTC) is a rare yet severe complication of chronic kidney disease (CKD), predominantly occurring in patients undergoing renal replacement therapy (RRT). It is characterized by extensive soft tissue calcifications, frequently associated with chronic hyperphosphatemia and disruptions to calcium–phosphorus metabolism. [...] Read more.

Background: Uremic tumoral calcinosis (UTC) is a rare yet severe complication of chronic kidney disease (CKD), predominantly occurring in patients undergoing renal replacement therapy (RRT). It is characterized by extensive soft tissue calcifications, frequently associated with chronic hyperphosphatemia and disruptions to calcium–phosphorus metabolism. Case report: This report describes a 34-year-old woman with end-stage renal disease (ESRD) secondary to lupus nephritis, undergoing continuous ambulatory peritoneal dialysis (CAPD). She presented with a progressively enlarging calcified mass in the proximal phalanx of the third finger on her right hand, accompanied by functional impairment. Laboratory findings revealed persistent hyperphosphatemia (8.8 mg/dL), elevated parathyroid hormone levels (901 pg/mL), and low vitamin D levels (9 ng/mL), indicating significant disturbances to mineral metabolism. Imaging studies, including X-ray and whole-body 18F-Choline positron emission tomography/computed tomography (PET/CT), confirmed the presence of localized calcifications in the soft tissue of the proximal phalanx of the third finger on her right hand and parathyroid hyperplasia, respectively. Initial management included the optimization of phosphate binders and calcimimetic therapy, with the subsequent intensification of dialysis therapy. Transitioning to automated peritoneal dialysis (APD) with high-volume exchanges resulted in a notable improvement in biochemical parameters and the eventual remission of the calcified mass. Conclusion: This case underscores the importance of comprehensive management in dialysis patients, including dietary phosphate restriction, the appropriate use of non-calcium-based binders, and tailored dialysis regimens to prevent and treat CKD-related mineral and bone disorders. It also highlights the utility of imaging modalities such as PET/CT in diagnosing UTC and monitoring response to therapy. Further research is needed to elucidate the pathophysiology of UTC and optimize its management in dialysis patients. Full article

(This article belongs to the Section Nephrology and Urology)

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9 pages, 8014 KiB

Open AccessArticle

Preoperative Osteoporosis Treatment Reduces Stress Shielding in Total Hip Arthroplasty

by Ryuichi Kanabuchi, Yu Mori, Kazuyoshi Baba, Hidetatsu Tanaka, Yasuaki Kuriyama, Hideki Fukuchi, Hiroki Kawamata and Toshimi Aizawa

Med. Sci. 2025, 13(1), 10; https://doi.org/10.3390/medsci13010010 - 28 Jan 2025

Viewed by 984

Abstract

Background: Total hip arthroplasty (THA) is a widely used surgical intervention for hip osteoarthritis (HOA), with a rising demand driven by an aging population. Osteoporosis is associated with increased risks of bone loss and implant loosening after THA. While medications such as bisphosphonates [...] Read more.

Background: Total hip arthroplasty (THA) is a widely used surgical intervention for hip osteoarthritis (HOA), with a rising demand driven by an aging population. Osteoporosis is associated with increased risks of bone loss and implant loosening after THA. While medications such as bisphosphonates and denosumab have shown promise in mitigating these risks, the impact of preoperative osteoporosis treatment on postoperative outcomes remains unclear. This study investigates the effect of preoperative osteoporosis treatment intervention on stress shielding and clinical outcomes in THA patients. Methods: This retrospective study included 107 patients who underwent cementless THA between April 2019 and March 2022. Patients under 60 years old, with a follow-up period of less than one year, or with prior hip surgery were excluded. Participants were divided into two groups: a treatment group receiving osteoporosis medication preoperatively and a non-treatment group. The outcomes assessed included preoperative bone metabolism markers, Bombelli classification, stress shielding grade, and clinical scores. Statistical analysis was performed using the Mann–Whitney U test and Chi-squared test, with significance set at p < 0.05. Results: The preoperative osteoporosis treatment intervention rate was 28.9%. Stress shielding grades were significantly lower in the treatment group (p = 0.001). However, no significant differences were observed in clinical scores one year postoperatively. Conclusion: Preoperative osteoporosis treatment significantly reduced stress shielding incidence, potentially influencing long-term outcomes by preventing bone atrophy-related pain and fractures. Preoperative bone density assessment and osteoporosis treatment intervention are recommended to improve THA outcomes. Larger studies are needed for further validation. Full article

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24 pages, 2017 KiB

Open AccessArticle

Evaluating the Stress State and the Load-Bearing Fraction as Predicted by an In Vivo Parameter Identification Method for the Abdominal Aorta

by Jerker Karlsson, Jan-Lucas Gade, Carl-Johan Thore, Carl-Johan Carlhäll, Jan Engvall and Jonas Stålhand

Med. Sci. 2025, 13(1), 9; https://doi.org/10.3390/medsci13010009 - 27 Jan 2025

Viewed by 565

Abstract

Background: Arterial mechanics are crucial to cardiovascular functionality. The pressure–strain elastic modulus often delineates mechanical properties. Emerging methods use non-linear continuum mechanics and non-convex minimization to identify tissue-specific parameters in vivo. Reliability of these methods, particularly their accuracy in representing the in vivo [...] Read more.

Background: Arterial mechanics are crucial to cardiovascular functionality. The pressure–strain elastic modulus often delineates mechanical properties. Emerging methods use non-linear continuum mechanics and non-convex minimization to identify tissue-specific parameters in vivo. Reliability of these methods, particularly their accuracy in representing the in vivo stress state, is a significant concern. This study aims to compare the predicted stress state and the collagen-attributed load-bearing fraction with the stress state from in silico experiments. Methods: Our team has evaluated an in vivo parameter identification method through in silico experiments involving finite element models and demonstrated good agreement with the parameters of a healthy abdominal aorta. Results: The findings suggest that the circumferential stress state is well represented for an abdominal aorta with a low transmural stress gradient. Larger discrepancies are observed in the axial direction. The agreement deteriorates in both directions with an increasing transmural stress gradient, attributed to the membrane model’s inability to capture transmural gradients. The collagen-attributed load-bearing fraction is well predicted, particularly in the circumferential direction. Conclusions: These findings underscore the importance of investigating both isotropic and anisotropic aspects of the vessel wall. This evaluation advances the parameter identification method towards clinical application as a potential tool for assessing arterial mechanics. Full article

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11 pages, 1081 KiB

Open AccessReview

Is Artificial Intelligence the Next Co-Pilot for Primary Care in Diagnosing and Recommending Treatments for Depression?

by Inbar Levkovich

Med. Sci. 2025, 13(1), 8; https://doi.org/10.3390/medsci13010008 - 11 Jan 2025

Cited by 1 | Viewed by 1812

Abstract

Depression poses significant challenges to global healthcare systems and impacts the quality of life of individuals and their family members. Recent advancements in artificial intelligence (AI) have had a transformative impact on the diagnosis and treatment of depression. These innovations have the potential [...] Read more.

Depression poses significant challenges to global healthcare systems and impacts the quality of life of individuals and their family members. Recent advancements in artificial intelligence (AI) have had a transformative impact on the diagnosis and treatment of depression. These innovations have the potential to significantly enhance clinical decision-making processes and improve patient outcomes in healthcare settings. AI-powered tools can analyze extensive patient data—including medical records, genetic information, and behavioral patterns—to identify early warning signs of depression, thereby enhancing diagnostic accuracy. By recognizing subtle indicators that traditional assessments may overlook, these tools enable healthcare providers to make timely and precise diagnostic decisions that are crucial in preventing the onset or escalation of depressive episodes. In terms of treatment, AI algorithms can assist in personalizing therapeutic interventions by predicting the effectiveness of various approaches for individual patients based on their unique characteristics and medical history. This includes recommending tailored treatment plans that consider the patient’s specific symptoms. Such personalized strategies aim to optimize therapeutic outcomes and improve the overall efficiency of healthcare. This theoretical review uniquely synthesizes current evidence on AI applications in primary care depression management, offering a comprehensive analysis of both diagnostic and treatment personalization capabilities. Alongside these advancements, we also address the conflicting findings in the field and the presence of biases that necessitate important limitations. Full article

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22 pages, 8896 KiB

Open AccessArticle

Circulating microRNAs as Biomarkers of Various Forms of Epilepsy

by Elena E. Timechko, Kristina D. Lysova, Alexey M. Yakimov, Anastasia I. Paramonova, Anastasia A. Vasilieva, Elena A. Kantimirova, Anna A. Usoltseva, Albina V. Yakunina, Irirna G. Areshkina and Diana V. Dmitrenko

Med. Sci. 2025, 13(1), 7; https://doi.org/10.3390/medsci13010007 - 8 Jan 2025

Viewed by 854

Abstract

Background: Epilepsy is a group of disorders characterized by a cluster of clinical and EEG signs leading to the formation of abnormal synchronous excitation of neurons in the brain. It is one of the most common neurological disorders worldwide; and is characterized [...] Read more.

Background: Epilepsy is a group of disorders characterized by a cluster of clinical and EEG signs leading to the formation of abnormal synchronous excitation of neurons in the brain. It is one of the most common neurological disorders worldwide; and is characterized by aberrant expression patterns; both at the level of matrix transcripts and at the level of regulatory RNA sequences. Aberrant expression of a number of microRNAs can mark a particular epileptic syndrome; which will improve the quality of differential diagnosis. Materials and Methods: In this work; the expression profile of six microRNAs was analyzed: hsa-miR-106b-5p; hsa-miR-134-5p; hsa-miR-122-5p; hsa-miR-132-3p; hsa-miR-155-5p; and hsa-miR-206-5p in the blood plasma of patients suffering from temporal lobe epilepsy (n = 52) and juvenile myoclonic epilepsy (n = 42); n—amount of participants; in comparison with healthy volunteers. The expression analysis was carried out using RT-PCR. Mathematical processing of the data was carried out according to the Livak method. Results: A statistically significant change in the expression of hsa-miR-106b-5p; hsa-miR-134-5p; hsa-miR-122-5p; and hsa-miR-132-3p was found. An increase in the expression of hsa-miR-134-5p and hsa-miR-122-5p was registered in the group of patients with temporal lobe epilepsy compared to the control; as well as an increase in the expression of hsa-miR-132-3p and hsa-miR-106b-5p in the juvenile myoclonic epilepsy group compared to the control. hsa-miR-122-5p; 106b-5p; 132-3p are also able to discriminate groups with different syndromes. Additionally; a number of microRNAs are able to discriminate patients with drug-resistant and drug-sensitive forms of epilepsy from the control; as well as patients with hippocampal sclerosis and patients without hippocampal sclerosis from the control. Conclusion. Our data allow us to propose these microRNAs as plasma biomarkers of various epileptic syndromes Full article

(This article belongs to the Section Neurosciences)

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14 pages, 1088 KiB

Open AccessArticle

Whole-Genome Sequencing of Resistance, Virulence and Regulation Genes in Extremely Resistant Strains of Pseudomonas aeruginosa

by Nerlis Pajaro-Castro, Erick Diaz-Morales, Kenia Hoyos and Cristhian Ibañez-Bersinger

Med. Sci. 2025, 13(1), 6; https://doi.org/10.3390/medsci13010006 - 3 Jan 2025

Cited by 1 | Viewed by 1074

Abstract

Background/Objectives: Pseudomonas aeruginosa is a clinically significant opportunistic pathogen, renowned for its ability to acquire and develop diverse mechanisms of antibiotic resistance. This study examines the resistance, virulence, and regulatory mechanisms in extensively drug-resistant clinical strains of P. aeruginosa. Methods: Antibiotic susceptibility [...] Read more.

Background/Objectives: Pseudomonas aeruginosa is a clinically significant opportunistic pathogen, renowned for its ability to acquire and develop diverse mechanisms of antibiotic resistance. This study examines the resistance, virulence, and regulatory mechanisms in extensively drug-resistant clinical strains of P. aeruginosa. Methods: Antibiotic susceptibility was assessed using the Minimum Inhibitory Concentration (MIC) method, and whole-genome sequencing (WGS) was performed on the Illumina NovaSeq platform. Results: The analysis demonstrated a higher prevalence of virulence genes compared to resistance and regulatory genes. Key virulence factors identified included secretion systems, motility, adhesion, and biofilm formation. Resistance mechanisms observed comprised efflux pumps and beta-lactamases, while regulatory systems involved two-component systems, transcriptional regulators, and sigma factors. Additionally, phenotypic profiles were found to correlate with resistance genes identified through genotypic analysis. Conclusions: This study underscores the significant resistance and virulence of the clinical P. aeruginosa strains analyzed, highlighting the urgent need for alternative strategies to address infections caused by extensively drug-resistant bacteria. Full article

(This article belongs to the Section Pneumology and Respiratory Diseases)

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10 pages, 217 KiB

Open AccessArticle

Impact of Continuous Positive Airway Pressure on Patient Outcomes in Acute Cardiogenic Pulmonary Edema Within Physician-Led Prehospital Care

by Tatjana Jevtić Drkić, Armin Šljivo, Kenan Ljuhar, Amela Ahmić Tuco, Lamija Hukić Fetahović, Emina Karamehić, Amna Palikuća Ljuhar, Jasna Husejinbegović Musić, Šejla Brković Jusufbegović, Edin Jusufbegović, Selma Terzić Salihbašić, Melica Imamović Bošnjak, Riada Blažević and Amina Valjevac

Med. Sci. 2025, 13(1), 5; https://doi.org/10.3390/medsci13010005 - 1 Jan 2025

Viewed by 1043

Abstract

Background: CPAP has been shown to be particularly beneficial in the management of acute cardiogenic pulmonary edema by reducing both preload and afterload, thus decreasing the work of breathing and improving oxygenation. Methods: This study was a prospective observational study, conducted in the [...] Read more.

Background: CPAP has been shown to be particularly beneficial in the management of acute cardiogenic pulmonary edema by reducing both preload and afterload, thus decreasing the work of breathing and improving oxygenation. Methods: This study was a prospective observational study, conducted in the period from 2022 to 2024, assessing the effectiveness and safety of prehospital CPAP therapy use in patients with acute cardiogenic pulmonary edema, administered alongside standard care. Results: In this study, 50 patients with acute cardiogenic pulmonary edema were treated by physician-led emergency teams in the Canton of Sarajevo. CPAP significantly improved clinical parameters across all time points. Systolic blood pressure decreased from 151.0 ± 41.0 mmHg at initial contact to 138.4 ± 32.0 mmHg before transportation and further to 130.2 ± 28.5 mmHg upon hospital admission (p < 0.001). Diastolic pressure dropped from 85.6 ± 17.2 mmHg to 81.1 ± 15.2 mmHg before transportation (p = 0.018), with a slight further decrease to 80.2 ± 13.9 mmHg (p = 0.083). Heart rate fell from 114 ± 26.4 bpm to 111.3 ± 24.9 bpm before transportation (p = 0.003) and finally to 99.5 ± 18.2 bpm before hospital admission (p < 0.001). Respiratory rate decreased from 31.0 ± 10.2 to 28.0 ± 10.5 breaths/min (p = 0.002) and further to 22.6 ± 7.3 breaths/min (p < 0.001). End-tidal CO₂ levels increased from 28.0 mmHg (23.5; 33.5) to 30.0 mmHg before transportation (p < 0.001), and to 35.0 mmHg (32.0; 37.5) before hospital admission (p < 0.001). Oxygen saturation improved from 79.0% (72.0; 81.0) to 84.0% before transportation (p < 0.001) and reached 94.0% (91.0; 98.2) before hospital admission (p < 0.001). VAS scores for dyspnea significantly dropped from 8.0 (6.0; 8.2) at initial contact to 6.0 (4.0; 8.0) before transportation (p < 0.001) and further to 4.0 (3.0; 5.0) before hospital admission (p < 0.001), indicating substantial symptom relief. ECG findings remained stable throughout the intervention. Conclusions: Prehospital CPAP therapy significantly improved clinical outcomes in cardiogenic pulmonary edema, including reductions in blood pressure, heart rate, respiratory rate, and enhanced oxygenation and symptom relief. These findings support its broader use in emergency care, even during short transport times. Full article

16 pages, 729 KiB

Open AccessReview

Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy—A Narrative Review

by Zishan Rahman, Ahsan Nazim, Palvi Mroke, Khansa Ali, MD Parbej Allam, Aakash Mahato, Mahveer Maheshwari, Camila Sanchez Cruz, Imran Baig and Ernesto Calderon Martinez

Med. Sci. 2025, 13(1), 4; https://doi.org/10.3390/medsci13010004 - 30 Dec 2024

Viewed by 1699

Abstract

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem [...] Read more.

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem signaling for respiration. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for SAHS, reducing apnea and hypopnea episodes by providing continuous airflow. CPAP enhances sleep quality and improves overall health by reducing the risk of comorbidities such as hypertension, type 2 diabetes mellitus, cardiovascular disease and stroke. CPAP nonadherence leads to health deterioration and occurs due to mask discomfort, unsupportive partners, upper respiratory dryness, and claustrophobia. Technological advancements such as auto-titrating positive airway pressure (APAP) systems, smart fit mask interface systems, and telemonitoring devices offer patients greater comfort and enhance adherence. Future research should focus on new technological developments, such as artificial intelligence, which may detect treatment failure and alert providers to intervene accordingly. Full article

(This article belongs to the Section Pneumology and Respiratory Diseases)

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12 pages, 1819 KiB

Open AccessArticle

NIPT Integration as a Patient-Paid Prenatal Screening Option—Observations and Challenges from a Bulgarian Genetic Counseling Center

by Dinnar Yahya, Mari Hachmeriyan, Milena Stoyanova and Mariya Levkova

Med. Sci. 2025, 13(1), 3; https://doi.org/10.3390/medsci13010003 - 29 Dec 2024

Viewed by 993

Abstract

Background: NIPT is a widely implemented method for prenatal screening of chromosomal disorders. Its introduction initiated the practice of counseling women pre- and post-analytically. Since the test’s usage is established in different conditions, comparing data from various socioeconomic and cultural backgrounds would [...] Read more.

Background: NIPT is a widely implemented method for prenatal screening of chromosomal disorders. Its introduction initiated the practice of counseling women pre- and post-analytically. Since the test’s usage is established in different conditions, comparing data from various socioeconomic and cultural backgrounds would be of scientific value. Our study is the first to describe NIPT integration in Bulgaria. We aimed to evaluate current trends in demand and referral, the frequency of high-risk results, cases of fetal sex discrepancies and their impacts, as well as commonly held misconceptions during genetic counseling. We also address issues and necessary general prophylaxis and prenatal care improvements. Methods: We performed a retrospective analysis on the pregnant women who received GC for NIPT in our genetic center between 2016 and 2023. We separated this period into two due to a significant difference in the test’s price. A total of 635 women were included with their referral indications, panel width preference, fetal sex, and SCA. We assessed cases of fetal sex discrepancy, high-risk pregnancies, late NIPT (after GW 18), and commonly occurring issues and misconceptions. Results: We observed a significant increase in the demand for NIPT—63 women for 2016–2020 versus 572 for 2021–2023. The leading indications were supervision of normal pregnancy (50.4%) and advanced maternal age (>35 years) (31.2%). As for late NIPT, the most common indications for this late testing were high risk from a maternal serum screening test (33.3%) and anxiety (25%). Further, 1.1% of results were high-risk for trisomy 18 and 21 and monosomy X. We reviewed two cases of fetal sex discrepancy (0.3%) and common misconceptions twice more during pre-test GC. Conclusions: This single-center experience shows that demand for NIPT is exponentially growing, especially as a normal pregnancy screening method. Delivering thorough education to the community and guaranteeing outstanding care during genetic counseling sessions is crucial for fostering informed decisions and overall well-being. Full article

(This article belongs to the Section Gynecology)

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Med. Sci., Volume 13, Issue 1 (March 2025) – 32 articles

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