Medical Sciences

7 pages, 170 KiB

Open AccessCommunication

Is It Advisable to Use Probiotics Routinely After a Colonoscopy? A Rapid Comprehensive Review of the Evidence

by Matteo Piciucchi, Alice Rossi, Alissa Satriano and Raffaele Manta

Med. Sci. 2025, 13(2), 76; https://doi.org/10.3390/medsci13020076 - 9 Jun 2025

About 5–20% of patients who undergo colonoscopy, in the days and weeks following the procedure, develop various symptoms (abdominal pain, bloating, and bowel alteration) mainly related to dysbiosis induced by the propaedeutic intestinal preparation. Some studies have positively evaluated the impact of the [...] Read more.

About 5–20% of patients who undergo colonoscopy, in the days and weeks following the procedure, develop various symptoms (abdominal pain, bloating, and bowel alteration) mainly related to dysbiosis induced by the propaedeutic intestinal preparation. Some studies have positively evaluated the impact of the administration of different mixtures of probiotics in preventing and/or limiting this symptomatology. The aim of this review is to evaluate and summarize the available scientific evidence supporting the use of probiotics post-colonoscopy and to define their real efficacy as a routine treatment in a clinical setting. Full article

10 pages, 763 KiB

Open AccessArticle

Diagnostic Yield of Next-Generation Sequencing for Rare Pediatric Genetic Disorders: A Single-Center Experience

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

Med. Sci. 2025, 13(2), 75; https://doi.org/10.3390/medsci13020075 - 9 Jun 2025

Abstract

Background: Next-generation sequencing (NGS), particularly whole-exome sequencing (WES), has become a powerful diagnostic tool for rare genetic conditions. However, its success rate varies based on the underlying genetic etiology and the population studied. Methods: This retrospective study evaluated the diagnostic yield of [...] Read more.

Background: Next-generation sequencing (NGS), particularly whole-exome sequencing (WES), has become a powerful diagnostic tool for rare genetic conditions. However, its success rate varies based on the underlying genetic etiology and the population studied. Methods: This retrospective study evaluated the diagnostic yield of NGS in a cohort of 137 pediatric patients with suspected rare genetic disorders in Bulgaria, a setting where such testing is not reimbursed and must be self-funded. The patients underwent either WES or targeted gene panel testing based on clinical presentation, family history, and genetic evaluation. Results: The overall diagnostic yield was 45.99%, with WES achieving 51.25% and targeted testing achieving 38.60%. The highest yield was observed in patients presenting with both dysmorphic features and neurodevelopmental delays (62.5%), while the lowest was observed among those with isolated neurodevelopmental issues (10%). A significant portion of the identified variants (35.9%) were novel. Eight patients were diagnosed with copy number variants (CNVs) detected only through WES. Conclusions: Our findings illustrate the value of WES as a first-line test and highlight the impact of deep phenotyping on diagnostic success. This study also emphasizes the need for a population-specific reference genome and equal access to genomic diagnostics in all European countries. Full article

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12 pages, 579 KiB

Open AccessSystematic Review

The Impact of Celiprolol in Vascular Ehlers–Danlos Syndrome: A Systematic Review of Current Evidence

by Pandit Bagus Tri Saputra, Wynne Widiarti, Paulus Parholong Siahaan, Rendra Mahardhika Putra, Johanes Nugroho Eko Putranto, Raden Mohammad Budiarto, Nadya Luthfah, Chaq El Chaq Zamzam Multazam, Mario D’Oria and Firas Farisi Alkaff

Med. Sci. 2025, 13(2), 74; https://doi.org/10.3390/medsci13020074 - 9 Jun 2025

Abstract

Objectives: Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by mutations affecting collagen and extracellular matrix proteins. Vascular EDS (vEDS) stands out for its severe prognosis due to the heightened risk of arterial and organ rupture which significantly increase mortality [...] Read more.

Objectives: Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by mutations affecting collagen and extracellular matrix proteins. Vascular EDS (vEDS) stands out for its severe prognosis due to the heightened risk of arterial and organ rupture which significantly increase mortality rates. Limited strategies for treating vEDS are prompting exploration for alternatives such as celiprolol, a cardioselective beta-blocker with potential to reduce vascular stress and improve collagen integrity. This review aims to evaluate current evidence on the impact of celiprolol in managing vEDS. Methods: A comprehensive literature search was conducted across scientific databases for studies comparing celiprolol with placebo or other treatments, focusing on relevant outcomes. Results: A total of 323 participants were included across studies published from 2010 to 2023, primarily conducted in European settings. Celiprolol administration, starting at 100 mg daily and titrated up to 400 mg, significantly reduced the incidence of major vascular events such as arterial dissections and ruptures. Most studies reported improved survival rates and fewer hospitalizations due to acute arterial events. Variations in treatment response and side effects such as dizziness and hypotension were noted across studies, occasionally leading to treatment. Conclusions: Celiprolol appears to be a promising treatment for reducing vascular events in vEDS patients, potentially improving quality of life and mitigating the substantial morbidity and mortality associated with vEDS. Future research should focus on refining treatment protocols, exploring mechanisms of action, and establishing comprehensive clinical guidelines to optimize patient outcomes. Full article

(This article belongs to the Section Cardiovascular Disease)

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11 pages, 1111 KiB

Open AccessArticle

The Impact of Epithelial Inflammation in Membrane Remnants on the Outcome of Tympanoplasty

by María Fernanda Galindo-Tapia, Alejandro Esteban Deras-Quiñones, Itzel Maria Montoya-Fuentes, Eduardo Osiris Madrigal-Santillán, Ángel Morales-González, Naria A. Flores-Fuentes, Liliana Anguiano-Robledo, Raúl Rojas-Martínez, Beatriz Montaño-Velázquez and José A. Morales-González

Med. Sci. 2025, 13(2), 73; https://doi.org/10.3390/medsci13020073 - 7 Jun 2025

Viewed by 190

Abstract

Background: Chronic otitis media (COM) with tympanic perforation sometimes requires tympanoplasty. Many factors can interfere with surgical success; however, the histological status of the remaining epithelium of the perforation has not been studied as a risk factor for surgical failure. Methods: This was [...] Read more.

Background: Chronic otitis media (COM) with tympanic perforation sometimes requires tympanoplasty. Many factors can interfere with surgical success; however, the histological status of the remaining epithelium of the perforation has not been studied as a risk factor for surgical failure. Methods: This was an observational, longitudinal, and analytical study in patients with COM, candidates for tympanoplasty who met the inclusion criteria, between August and December 2024. Tympanoplasty was performed, and the tympanic ring epithelium was sent for histological analysis. After 30 days, closure or non-closure of the perforation was determined, and the results were collected. Descriptive and analytical statistics were performed according to data distribution using the SPSS 26.0 statistical package. Results: Twenty subjects were included, 80% with tubal dysfunction, 60% with central perforation, and 65% with medium-sized. In total, 13 were successful, and 7 failed. Histopathological analysis revealed dystrophic calcification, chronic lymphocytic infiltrate, histiocytic infiltrate, fibrosis, loose keratin sheets, metaplasia, and spongiosis. The logistic regression model showed an OR of 7.3 for marginal perforation and 3.4 for the OPSS score. Of the patients with surgical failure, 57.4% had epithelial inflammation. Conclusions: epithelial inflammation affected surgical success in more than 50%. Full article

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12 pages, 8298 KiB

Open AccessCommunication

Twice as Effective? Pressurized Intra-Thoracic Aerosol Chemotherapy: New Frontiers in Pleural Mesothelioma

by Maria Giovanna Mastromarino, Elena Guerrini, Raffaele Guerrieri, Gianmarco Elia, Alessandra Lenzini, Vittorio Aprile, Greta Alì, Stylianos Korasidis, Marcello Carlo Ambrogi and Marco Lucchi

Med. Sci. 2025, 13(2), 72; https://doi.org/10.3390/medsci13020072 - 2 Jun 2025

Viewed by 258

Abstract

Pressurized intra-thoracic aerosol chemotherapy (PITAC) is a novel and promising strategy for the treatment of malignant pleural effusion (MPE). PITAC enables effective pleurodesis while potentially exerting an antineoplastic effect by delivering chemotherapeutic agents as a therapeutic aerosol into the thoracic cavity via a [...] Read more.

Pressurized intra-thoracic aerosol chemotherapy (PITAC) is a novel and promising strategy for the treatment of malignant pleural effusion (MPE). PITAC enables effective pleurodesis while potentially exerting an antineoplastic effect by delivering chemotherapeutic agents as a therapeutic aerosol into the thoracic cavity via a nebulizer. Our preliminary study involved nine patients with unresectable pleural mesothelioma (PM) treated with PITAC. Among them, one case was particularly emblematic for demonstrating notable oncological improvements in addition to well-known palliative benefits. This patient underwent two PITAC procedures, one year apart, without perioperative complications. Redo pleural biopsies from both previous and new sites revealed only fibrous tissue and inflammatory cells, with no evidence of malignancy. Beyond achieving pleurodesis, PITAC—by combining cytotoxic and sclerosing effects—may offer effective local antineoplastic control and represent a promising avenue for enhancing loco-regional therapy in PM. Full article

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14 pages, 952 KiB

Open AccessArticle

Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study

by Giovanni De Caridi, Mafalda Massara, Chiara Barilla and Filippo Benedetto

Med. Sci. 2025, 13(2), 71; https://doi.org/10.3390/medsci13020071 - 1 Jun 2025

Viewed by 195

Abstract

Background/Objectives: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in [...] Read more.

Background/Objectives: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in our institution, analyzing different types of treatment. Methods: A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, and case urgency and evaluated the incidence of graft infections, amputations, and mortality. Results: Between January 2016 and December 2021, a total of 516 bypasses were recorded (318 male, 198 female, mean age 74.2): 320 bypasses in venous material and 196 prosthetic bypasses using Dacron or PTFE. Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Thirteen other patients who submitted to prosthetic peripheral bypass in other centers presented to our institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in nine cases (31.1%). The germs involved were Gram-negative in 27.6% and Gram-positive in 41.4%. During follow-up, we recorded five deaths (17.2%) and six amputations (20.7%) directly after bypass excision; another two amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. Conclusions: Redo-bypass, active infection at the time of bypass, and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum-assisted closure therapy application, and muscle transposition seem to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy. Full article

(This article belongs to the Section Cardiovascular Disease)

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13 pages, 2427 KiB

Open AccessPerspective

Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives

by Mario Della Mura, Joana Sorino, Anna Colagrande, Maged Daruish, Giuseppe Ingravallo, Alessandro Massaro, Gerardo Cazzato, Carmelo Lupo, Nadia Casatta, Domenico Ribatti and Angelo Vacca

Med. Sci. 2025, 13(2), 70; https://doi.org/10.3390/medsci13020070 - 1 Jun 2025

Viewed by 189

Abstract

Artificial intelligence (AI) is rapidly transforming diagnostic approaches in different fields of medical sciences, demonstrating an emerging potential to revolutionize dermatopathology due to its capacity to process large amounts of data in the shortest possible time, both for diagnosis and research purposes. Different [...] Read more.

Artificial intelligence (AI) is rapidly transforming diagnostic approaches in different fields of medical sciences, demonstrating an emerging potential to revolutionize dermatopathology due to its capacity to process large amounts of data in the shortest possible time, both for diagnosis and research purposes. Different AI models have been applied to neoplastic skin diseases, especially melanoma. However, to date, very few studies have investigated the role of AI in dermatoses. Herein, we provide an overview of the key aspects of AI and its functioning, focusing on medical applications. Then, we summarize all the existing English-language literature about AI applications in the field of non-neoplastic skin diseases: superficial perivascular dermatitis, psoriasis, fungal infections, onychomycosis, immunohistochemical characterization of inflammatory dermatoses, and differential diagnosis between the latter and mycosis fungoides (MF). Finally, we discuss the main challenges related to AI implementation in pathology. Full article

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17 pages, 910 KiB

Open AccessArticle

The Combined Effects of Per- and Polyfluoroalkyl Substances, Metals, and Behavioral and Social Factors on Depressive Symptoms

by Olamide Ogundare and Emmanuel Obeng-Gyasi

Med. Sci. 2025, 13(2), 69; https://doi.org/10.3390/medsci13020069 - 1 Jun 2025

Viewed by 201

Abstract

Background: This study investigates the combined effects of PFAS metals (PFOA and PFOS), heavy metals (lead, cadmium, and mercury), behavioral factors (smoking and alcohol consumption), and social factors (income and education) on depressive symptoms. Methods: Using cross-sectional data from the National Health and [...] Read more.

Background: This study investigates the combined effects of PFAS metals (PFOA and PFOS), heavy metals (lead, cadmium, and mercury), behavioral factors (smoking and alcohol consumption), and social factors (income and education) on depressive symptoms. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES 2017–2018), blood samples were analyzed to determine the exposure levels of PFOA, PFOS, lead, cadmium, and mercury, and self-reported behavioral and social factors were evaluated in relation to PHQ-9 scores among 181 adults. Results: Education was associated with lower odds of depressive symptoms (OR = 0.68, 95% CI: 0.43–1.07). Although the result was not statistically significant, the estimate suggested a potential protective effect that warranted further investigation. Bayesian Kernel Machine Regression demonstrated that heavy metals collectively had the strongest evidence for influencing depression (group PIP = 0.6508), followed by socioeconomic factors (group PIP = 0.642). Bivariate exposure–response analyses revealed complex interaction patterns whereby exposure effects varied substantially depending on co-exposure contexts. Conclusions: These findings highlight that depressive symptoms are shaped by complex interplays between environmental contaminants, behavior, and social determinants, underscoring the importance of mixture-based approaches in environmental mental health research and the need for integrated interventions addressing both environmental and social factors. Full article

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24 pages, 5660 KiB

Open AccessReview

Biologically-Based Notions About Uterine Bleeding During Myomectomy: Reasoning on Tradition and New Concepts

by Andrea Tinelli, Giovanni Pecorella, Gaetano Panese, Andrea Morciano, Antonio Malvasi, Mykhailo Medvediev, Safak Hatirnaz, Radmila Sparic and Michael Stark

Med. Sci. 2025, 13(2), 68; https://doi.org/10.3390/medsci13020068 - 1 Jun 2025

Viewed by 267

Abstract

Uterine fibroids represent a prevalent category of tumors encountered in females of reproductive age, may present as singular or multiple entities and can manifest a variety of symptoms, which can negatively affect women’s daily lives. Pharmacological interventions may prove to be ineffective, occasionally [...] Read more.

Uterine fibroids represent a prevalent category of tumors encountered in females of reproductive age, may present as singular or multiple entities and can manifest a variety of symptoms, which can negatively affect women’s daily lives. Pharmacological interventions may prove to be ineffective, occasionally costly, and associated with adverse effects. In instances where symptoms escalate in severity, myomectomy becomes a requisite as uterine-preserving operative therapy. Myomectomy can be performed utilizing laparoscopic, robotic, laparotomic, vaginal or hysteroscopic techniques. Given the abundant vascular supply to the myometrium, with blood being delivered to the uterus via the uterine arteries, myomectomy carries a considerable risk of significant hemorrhage during and subsequent to the surgical procedure, with the related complications. This paper aims to elucidate the conventional methodologies employed to mitigate hemorrhage during myomectomy and in the immediate postoperative phase, evaluating the effect of chemical interventions (such as vasopressin, octreotide, tranexamic acid, and uterotonics) alongside mechanical strategies (including uterine artery clamps, embolization, and tourniquets) to curtail bleeding during the myomectomy process. Furthermore, the potential of employing the intracapsular myomectomy technique without reliance on other traditional approaches was explored. This surgical method is grounded in the principles of the biological and anatomical characteristics of the fibroid, facilitating the enucleation of the myoma from its pseudocapsule. This anatomical entity, which is formed by the myoma throughout its development within the myometrium, enables the fibroid to be detached from the uterine musculature and supplies the requisite neurovascular support for its sustenance. Finally, the narrative review also shows how the intracapsular approach, which uses the fibroid’s biology, reduces bleeding during myomectomy. Full article

(This article belongs to the Section Gynecology)

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20 pages, 2808 KiB

Open AccessSystematic Review

Sonographic Evaluation of Peripheral Nerves and Cervical Nerve Roots in Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis

by Anas Elgenidy, Ibrahim A. Hassan, Yasser Hamed, Hassan Ahmed Hashem, Osama Abuel-naga, Hazem I. Abdel-Rahman, Kawashty R. Mohamed, Belal Mohamed Hamed, Mennatullah A. Shehab, Mohamed Zeyada, Somaia Kassab, Shaimaa Sabri Abdelkarim Abdelgawad, Abdelbaki Idriss Ibrahim, Ekram Hassan Hasanin, Amira A. Elhoufey, Khalid Hashim Mahmoud and Khaled Saad

Med. Sci. 2025, 13(2), 67; https://doi.org/10.3390/medsci13020067 - 1 Jun 2025

Viewed by 613

Abstract

Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that leads to nerve atrophy. Ultrasonography has a significant role in the diagnosis of ALS. Aim: We aimed to sonographically assess the size of all peripheral nerves and cervical nerve roots in ALS compared [...] Read more.

Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that leads to nerve atrophy. Ultrasonography has a significant role in the diagnosis of ALS. Aim: We aimed to sonographically assess the size of all peripheral nerves and cervical nerve roots in ALS compared to controls. Methods: We searched MEDLINE (PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus using comprehensive MeSH terms for the keywords nerve, ultrasound, and ALS. We extracted data regarding cross-sectional area (CSA) or diameter for the following nerves: vagus, phrenic, tibial, fibular, sural, radial, ulnar, and median nerves, and the roots of C5, C6, C7, and C8 in both ALS patients and controls. Results: Our study included 2683 participants, of which 1631 were ALS patients (mean age = 60.36), 792 were healthy controls (mean age = 57.79), and 260 were patients with other neurological disorders. ALS patients had significantly smaller nerve size compared to controls. Nerve size differences were observed in the vagus nerve [MD = −0.23], phrenic nerve [MD = −0.25], C5 nerve root [SMD = −0.94], C6 nerve root [SMD = −1.56], C7 nerve root [SMD = −1.18], C8 nerve root [MD = −1.9], accessory nerve [MD = −0.32], sciatic nerve [MD = −11], tibial nerve [MD = −0.68], sural nerve [MD = −0.32,], ulnar nerve [MD = −0.80], and median nerve [MD = −1.21]. Conclusions: Our findings showed that ALS patients have a sonographically smaller nerve size than healthy controls. Therefore, this is a potential marker for neuronal diseases. Full article

(This article belongs to the Section Neurosciences)

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13 pages, 1330 KiB

Open AccessArticle

Trends and Disparities in Liver Transplantation in the United States: A Nationwide Analysis of Demographic, Clinical, and Socioeconomic Factors (2016–2021)

by Vignesh Krishnan Nagesh, Vivek Joseph Varughese, Marina Basta, Emelyn Martinez, Shruthi Badam, Lokaesh Subramani Shobana, Abdifitah Mohamed, Alin J, Simcha Weissman and Adam Atoot

Med. Sci. 2025, 13(2), 66; https://doi.org/10.3390/medsci13020066 - 1 Jun 2025

Viewed by 218

Abstract

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver [...] Read more.

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel’s test were used to assess variance and distribution homogeneity, with a significance threshold of p < 0.05. Results: A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51–52 years), with males comprising ~62% of transplants. White patients constituted the largest group of recipients (~66–68%), followed by Hispanic (~14–17%) and Black patients (~7–10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37–3.52%) and did not differ significantly by race (p = 0.23), sex (p = 0.24), or income quartile (p = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality (p = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days. Conclusions: Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations. Full article

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

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14 pages, 1136 KiB

Open AccessArticle

The Potential Effects of Sensor-Based Virtual Reality Telerehabilitation on Lower Limb Function in Patients with Chronic Stroke Facing the COVID-19 Pandemic: A Retrospective Case-Control Study

by Mirjam Bonanno, Maria Grazia Maggio, Paolo De Pasquale, Laura Ciatto, Antonino Lombardo Facciale, Morena De Francesco, Giuseppe Andronaco, Rosaria De Luca, Angelo Quartarone and Rocco Salvatore Calabrò

Med. Sci. 2025, 13(2), 65; https://doi.org/10.3390/medsci13020065 - 23 May 2025

Viewed by 300

Abstract

Background/Objectives: Individuals with chronic stroke often experience various impairments, including poor balance, reduced mobility, limited physical activity, and difficulty performing daily tasks. In the context of the COVID-19 pandemic, telerehabilitation (TR) can overcome the barriers of geographical and physical distancing, time, costs, and [...] Read more.

Background/Objectives: Individuals with chronic stroke often experience various impairments, including poor balance, reduced mobility, limited physical activity, and difficulty performing daily tasks. In the context of the COVID-19 pandemic, telerehabilitation (TR) can overcome the barriers of geographical and physical distancing, time, costs, and travel, as well as the anxiety about contracting COVID-19. In this retrospective case-control study, we aim to evaluate the motor and cognitive effects of balance TR training carried out with a sensor-based non-immersive virtual reality system compared to conventional rehabilitation in chronic stroke patients. Methods: Twenty chronic post-stroke patients underwent evaluation for inclusion in the analysis through an electronic recovery data system. The patients included in the study were divided into two groups with similar medical characteristics and duration of rehabilitation training. However, the groups differed in the type of rehabilitation approach used. The experimental group (EG) received TR with a sensor-based VR device, called VRRS—HomeKit (n. 10). In contrast, the control group (CG) underwent conventional home-based rehabilitation (n. 10). Results: At the end of the training, we observed significant improvements in the EG in the 10-m walking test (10MWT) (p = 0.01), Timed-Up-Go Left (TUG L) (p = 0.01), and Montreal Cognitive Assessment (MoCA) (p = 0.005). Conclusions: In our study, we highlighted the potential role of sensor-based virtual reality TR in chronic stroke patients for improving lower limb function, suggesting that this approach is feasible and not inferior to conventional home-based rehabilitation. Full article

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12 pages, 638 KiB

Open AccessArticle

Adherence to Mediterranean Diet and Ocular Dryness Severity in Sjögren’s Syndrome: A Cross-Sectional Study

by Celine Chaaya, Elie Raad, Francesca Kahale, Elias Chelala, Nelly Ziade and Georges Maalouly

Med. Sci. 2025, 13(2), 64; https://doi.org/10.3390/medsci13020064 - 23 May 2025

Viewed by 290

Abstract

Background: Sjögren’s syndrome (SS) is a multifaceted clinical condition characterized by various features, including ocular dryness (OD), which plays a substantial role in shaping the clinical presentation of the disease and has detrimental effects on quality of life. Recent research has acknowledged [...] Read more.

Background: Sjögren’s syndrome (SS) is a multifaceted clinical condition characterized by various features, including ocular dryness (OD), which plays a substantial role in shaping the clinical presentation of the disease and has detrimental effects on quality of life. Recent research has acknowledged the advantages of the Mediterranean diet (MD) for its positive impact on various autoimmune diseases. This study aims to investigate the correlation between the severity of ocular symptoms in individuals with SS and adherence to the MD. Methods: This was a cross-sectional observational study of previously diagnosed SS patients recruited from the histopathological and immunological archives of a university hospital. The data were collected through a telephone questionnaire, including demographic and disease data, the Ocular Surface Disease Index (OSDI) score to evaluate the OD severity, and the Mediterranean Diet Adherence Screener (MEDAS) score to determine adherence to the MD. The primary outcome of the study, the correlation between OSDI and MEDAS scores, was evaluated using Spearman’s correlation coefficient. Results: The study included 114 patients, with a mean age of 51 (±13.4) years and a female proportion of 86%. OD was documented in 80.7% of the patients. The median OSDI and MEDAS scores were 23 (IQR 10–40) and 8 (IQR 5–11), respectively. A strong negative correlation was observed between the MEDAS and the OSDI scores (ρ = −0.73, p < 0.01). Additionally, there was a significant negative relationship between the richness of diet in fatty acids and the OSDI score (ρ = −0.67, p < 0.01). Conclusions: The study results suggest an association between lower OD severity in patients with SS and adherence to the MD, particularly the components related to polyunsaturated fatty acids consumption. This approach may serve as a complementary strategy with multiple health benefits, alongside conventional treatment options. Full article

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9 pages, 451 KiB

Open AccessArticle

Impact of Left Atrial Appendage Morphology and Function on Thrombosis Risk in Acute Ischemic Stroke: Insights from Transesophageal Echocardiography

by Dung N. Q. Nguyen, Dung Thuong Ho and Thanh N. H. Tran

Med. Sci. 2025, 13(2), 63; https://doi.org/10.3390/medsci13020063 - 22 May 2025

Viewed by 177

Abstract

Objective: This study aims to investigate the correlation between the morphological and functional characteristics of the left atrial appendage (LAA) and the incidence of thromboembolic events by transesophageal echocardiography (TEE) in patients with acute ischemic stroke. Methods: This cross-sectional study included 171 [...] Read more.

Objective: This study aims to investigate the correlation between the morphological and functional characteristics of the left atrial appendage (LAA) and the incidence of thromboembolic events by transesophageal echocardiography (TEE) in patients with acute ischemic stroke. Methods: This cross-sectional study included 171 patients with acute ischemic stroke, running from November 2022 to September 2024. Transesophageal echocardiography was performed to evaluate the presence of LAA thrombus. Multivariable logistic regression analysis was performed to identify risk factors for LAA thrombus. Results: Of the 171 patients, 19 (11.1%) were found to have LAA thrombus. Multivariable logistic regression identified two independent predictors of LAA thrombus formation: (1) left atrial spontaneous echo contrast (OR = 8, 95% CI: 3–19, p < 0.001) and (2) atrial fibrillation (OR = 8, 95% CI: 1.057–76.095, p = 0.044). Conclusions: Left atrial spontaneous echo contrast and atrial fibrillation are independent predictors of LAA thrombus in patients with acute ischemic stroke. The use of transesophageal echocardiography for early detection of LAA thrombus may help improve treatment strategies and prevent recurrent strokes. Full article

(This article belongs to the Section Cardiovascular Disease)

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23 pages, 7941 KiB

Open AccessReview

Idiopathic Scoliosis Progression: Presenting Rib and Segmental Rib Index as Predictors—A Literature Review

by Theodoros B. Grivas, Elias Vasiliadis, Konstantinos Soultanis, Marios Lykissas, Galateia Katzouraki, Nikolaos Sekouris, Dimitrios Lykouris, Christina Mazioti, Aristea Mamzeri, Despina Papagianni, Eleni Potamiti, Alexandros Kastrinis and Evangelos Theodosopoulos

Med. Sci. 2025, 13(2), 62; https://doi.org/10.3390/medsci13020062 - 21 May 2025

Viewed by 338

Abstract

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS [...] Read more.

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS progression based on the patient’s age at diagnosis—particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders skeletal maturity staging system, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient’s age at onset—whether in infancy, childhood, or adolescence—as well as in both untreated and braced AIS patients. Additionally, the apical convex rib–vertebra angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression. In conclusion, this concise and selective overview of predictor factors for progression in IS highlights the current understanding of IS progression factors. It also introduces the Rib and Segmental Rib Index—a rib cage deformity parameter—as a predictor of IS progression. Full article

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13 pages, 376 KiB

Open AccessArticle

Relationship Between Facial Melasma and Ocular Photoaging Diseases

by Lunla Udomwech, Chime Eden and Weeratian Tawanwongsri

Med. Sci. 2025, 13(2), 61; https://doi.org/10.3390/medsci13020061 - 16 May 2025

Viewed by 268

Abstract

Background/Objectives: Facial melasma is a common, chronic, and relapsing hyperpigmentation disorder, affecting up to 40% of adult women in Southeast Asia. Although most cases are mild, the condition may have a considerable psychological impact. Ocular photoaging diseases are also common and have been [...] Read more.

Background/Objectives: Facial melasma is a common, chronic, and relapsing hyperpigmentation disorder, affecting up to 40% of adult women in Southeast Asia. Although most cases are mild, the condition may have a considerable psychological impact. Ocular photoaging diseases are also common and have been increasingly recognized in aging populations exposed to chronic sunlight. Ultraviolet (UV) radiation is implicated in both melasma and ocular photoaging; however, their relationship remains unclear. Methods: This cross-sectional study investigated the association between facial melasma and UV-induced ocular conditions among 315 participants aged 30–80 years at Walailak University Hospital, Thailand. Facial melasma was diagnosed clinically and dermoscopically, with severity assessed using the modified Melasma Area Severity Index. Ophthalmological examinations evaluated UV-related ocular conditions, including pinguecula, pterygium, climatic droplet keratopathy, cataracts, and age-related macular degeneration. Logistic regression analyses were performed, adjusting for age, sex, and sun exposure. Results: Facial melasma was identified in 66.0% of participants (n = 208), and nuclear cataracts were significantly associated with melasma (adjusted odds ratio, 2.590; 95% confidence interval, 1.410–4.770; p = 0.002). Additionally, melasma severity correlated with nuclear cataract severity (ρ = 0.186, p = 0.001). Other ocular conditions were not significantly associated with melasma. Conclusions: These findings suggest a shared UV-related pathogenesis between facial melasma and nuclear cataracts. Sun protection measures, including regular sunscreen use, UV-blocking eyewear, and wide-brimmed hats, may help mitigate the risk of both conditions. Further multicenter studies are warranted to confirm these findings and explore the underlying mechanisms. Full article

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10 pages, 1940 KiB

Open AccessArticle

Trends in LVAD Placements and Outcomes: A Nationwide Analysis Using the National Inpatient Sample and National Readmissions Database

by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Hadrian Hoang-Vu Tran, Nikita Wadhwani, Audrey Thu, Simcha Weissman and Adam Atoot

Med. Sci. 2025, 13(2), 60; https://doi.org/10.3390/medsci13020060 - 12 May 2025

Viewed by 264

Abstract

Background: Aim of the study is to analyze the trends and outcomes in Left Ventricular Assist Device (LVAD) placements between the years 2016 and 2022 using the National Inpatient Sample (NIS). Methods: Using the NIS for the years 2016–2022, we identified the total [...] Read more.

Background: Aim of the study is to analyze the trends and outcomes in Left Ventricular Assist Device (LVAD) placements between the years 2016 and 2022 using the National Inpatient Sample (NIS). Methods: Using the NIS for the years 2016–2022, we identified the total number of LVAD placements using the PCS 10 code 02HA0QZ. In-hospital outcomes and healthcare resource utilization burden were assessed. Stratification of outcomes with Extracorporeal Membrane Oxygenation (ECMO) support were performed for the years 2018–2022. Outcome analysis variance in admissions requiring ECMO support was performed using multivariate regression analysis. A two tailed p-value < 0.05 was used to determine statistical significance. Results: A general decreasing trend was observed in the total number of LVAD placements, with 852 total admissions requiring LVAD placements identified in 2016 compared to 665 in 2022. The admissions for LVAD placements requiring ECMO support had an increasing trend, with 2.21% of admissions needing ECMO support in 2018 compared to 12.18% in 2018. After multivariate regression analysis, the association between all-cause mortality during the hospital stay for LVAD placements and requirement of ECMO was found to be significant, with an odds ratio of 2.34 (1.83–4.42, p-value: 0.001). Conclusions: A general decreasing trend in LVAD placements was observed between 2016 and 2022. All-cause mortality and hospital charges during the admission had a stable trend over the years. The requirement of ECMO support had an increasing trend from 2018 to 2022. Requirement of ECMO support during the admissions for LVAD placements had a statistically significant association with all-cause mortality during the admission. A 11.50% readmission rate was observed in the 30 days following discharge, with heart failure being the major cause of readmission. Full article

(This article belongs to the Section Cardiovascular Disease)

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11 pages, 801 KiB

Open AccessArticle

Prognostic Nutritional Index Could Serve as a Reliable Prognostic Marker in Intensive Care Population

by Ibrahim Karagoz, Songul Peltek Ozer, Bahri Ozer and Gulali Aktas

Med. Sci. 2025, 13(2), 59; https://doi.org/10.3390/medsci13020059 - 11 May 2025

Viewed by 272

Abstract

Background: Morbidity and mortality rates in intensive care units (ICUs) reflect the severe health challenges faced by critically ill patients. Nutritional and immune status, as measured by the prognostic nutritional index (PNI), are increasingly recognized as important predictors of intensive care unit [...] Read more.

Background: Morbidity and mortality rates in intensive care units (ICUs) reflect the severe health challenges faced by critically ill patients. Nutritional and immune status, as measured by the prognostic nutritional index (PNI), are increasingly recognized as important predictors of intensive care unit outcomes. Objective: We aimed to compare the prognostic nutritional index levels of survived and deceased subjects treated in intensive care units. Methods: This retrospective study examined the association between prognostic nutritional index and mortality among intensive care unit patients treated from June 2023 to June 2024. The prognostic nutritional index was calculated using serum albumin and lymphocyte levels, and patients were categorized into survived and deceased groups. Statistical analyses, including ROC and logistic regression, were used to evaluate prognostic nutritional index’s predictive capacity. Results: We revealed that deceased patients had significantly lower prognostic nutritional index values, lower platelet counts, and higher C-reactive protein (CRP) and serum creatinine levels compared to survivors. The prognostic nutritional index was independently associated with mortality, with each unit increase decreasing mortality risk by 6%. Conclusion: These findings highlight the prognostic nutritional index’s utility as a prognostic tool in intensive care unit settings, underscoring the need for nutritional assessments and targeted interventions to improve patient outcomes. Further research with larger cohorts is warranted to validate these findings and explore causative mechanisms. Full article

(This article belongs to the Section Critical Care Medicine)

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12 pages, 1096 KiB

Open AccessArticle

Exploring Treatment Protocol Adherence and Variations in Paroxysmal Supraventricular Tachycardia in the Emergency Department: A Multi-Center Cohort Study

by Kevin Ku, Jack Healy, Christian A. Lee, Maha Khan, Kevin D. Chao, Saleh Hassan, Ching-Fang Tiffany Tzeng, Yu-Lin Hsieh, Andrew Shedd, Toral Bhakta, Dahlia Hassani and Eric H. Chou

Med. Sci. 2025, 13(2), 58; https://doi.org/10.3390/medsci13020058 - 9 May 2025

Viewed by 321

Abstract

Background: Supraventricular tachycardia (SVT) is a common arrhythmia requiring prompt intervention in the emergency department (ED). Despite evidence-based guidelines recommending a stepwise approach, significant variability in clinical practice persists, particularly in adenosine dosing strategies. Objective: This study assessed adherence to SVT [...] Read more.

Background: Supraventricular tachycardia (SVT) is a common arrhythmia requiring prompt intervention in the emergency department (ED). Despite evidence-based guidelines recommending a stepwise approach, significant variability in clinical practice persists, particularly in adenosine dosing strategies. Objective: This study assessed adherence to SVT treatment protocols in the ED, focusing on the efficacy of an initial 6 mg versus 12 mg adenosine dose and the use of alternative pharmacologic agents. Methods: This multi-center, retrospective cohort study analyzed adult patients (≥18 years) diagnosed with stable SVT in urban EDs across North Texas between 1 January 2019, and 16 January 2022. Patients who spontaneously converted to normal sinus rhythm or presented with hemodynamically unstable SVT requiring immediate cardioversion were excluded. The primary outcome was the rate of successful conversion to sinus rhythm. Secondary outcomes included frequency of adenosine administration, deviations from 2020 AHA ACLS guidelines in SVT treatment, and risk factors associated with failure to convert to sinus rhythm following adenosine administration. Results: A total of 439 patients were included in the final analysis. Vagal maneuvers were attempted in 26% of cases, achieving a 31% success rate. Adenosine was used in 83% of pharmacologic interventions, with 57.5% receiving 6 mg and 42.5% receiving 12 mg as the initial dose. The 12 mg dose had a significantly higher conversion rate (54.2% vs. 40.6%, p = 0.03). Regression analysis identified key predictors of treatment success, including comorbidities, and baseline hemodynamics. Documentation inconsistencies, particularly regarding vagal maneuvers, were noted. Conclusions: In our cohort, an initial 12 mg adenosine dose was more effective than 6 mg for SVT conversion in the ED. Recognizing and addressing variations in guideline adherence can play a key role in improving patient care. Further prospective research is warranted to optimize dosing strategies and evaluate the impact of standardized protocols on clinical outcomes. Full article

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9 pages, 1996 KiB

Open AccessSystematic Review

The Placebo Effect in Chronic Thromboembolic Pulmonary Hypertension Trials: A Systematic Review and Meta-Analysis

by Daniel Caldeira, Daniel Inácio Cazeiro, Rui Plácido, Filipa Ferreira, Rita Calé and Fausto J. Pinto

Med. Sci. 2025, 13(2), 57; https://doi.org/10.3390/medsci13020057 - 7 May 2025

Viewed by 284

Abstract

Introduction: Placebo-controlled studies are crucial in clinical trials, but the placebo effect can vary across conditions. We aimed to assess the placebo effect in chronic thromboembolic pulmonary hypertension (CTEPH) trials. Methods: We conducted a systematic review and included randomized placebo-controlled trials investigating CTEPH [...] Read more.

Introduction: Placebo-controlled studies are crucial in clinical trials, but the placebo effect can vary across conditions. We aimed to assess the placebo effect in chronic thromboembolic pulmonary hypertension (CTEPH) trials. Methods: We conducted a systematic review and included randomized placebo-controlled trials investigating CTEPH interventions. Primary outcomes were the pre–post changes in the 6 min walk test (6MWT) and quality of life in the placebo arms. Secondary outcomes included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, and NT-proBNP levels. Meta-analyses were performed using random-effects models. Results: Seven trials with 270 CTEPH patients in placebo arms were analyzed. The average 6MWT change was not significant (−1.31 m; 95%CI −12.49 to +9.79). Quality of life with EQ-5D was not significantly improved (−0.04; 95%CI −0.10 to +0.02). mPAP, PVR, cardiac index, and NT-proBNP also demonstrated non-significant changes with small magnitudes. Conclusions: The placebo effect in CTEPH trials was not statistically significant and had small magnitude but should not discourage the use of placebo-controlled trials where applicable and ethical. Full article

(This article belongs to the Section Cardiovascular Disease)

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26 pages, 768 KiB

Open AccessReview

Exploring the Impact of Emotional Eating Among University Students: A Literature Review

by Olga Alexatou, Sousana K. Papadopoulou, Maria Mentzelou, Georgia-Eirini Deligiannidou, Antonios Dakanalis and Constantinos Giaginis

Med. Sci. 2025, 13(2), 56; https://doi.org/10.3390/medsci13020056 - 5 May 2025

Viewed by 1155

Abstract

Background/Objectives: Emotional eating has been considered as a trend to consume energy concentrated and tasty foods in response to adverse emotions. Emotional eating may harmfully influence physical and mental health among university students, worsening their daily quality of life and their academic performance. [...] Read more.

Background/Objectives: Emotional eating has been considered as a trend to consume energy concentrated and tasty foods in response to adverse emotions. Emotional eating may harmfully influence physical and mental health among university students, worsening their daily quality of life and their academic performance. The aim of the present study is to critically summarize and analyze the currently available clinical data concerning the impact of emotional eating among university students. Methods: Comprehensive exploration of the currently available scientific literature was performed in the most precise scientific databases, utilizing relevant and representative keywords. Results: More than a few interrelationships were found between emotional eating and body mass index, physical activity, depression, anxiety, stress, social media overuse, nutritional behaviors, and COVID-19 lockdown concerning university students. Conclusions: The currently available clinical studies support evidence that there are significant intercorrelations between emotional eating and several aspects of physical and mental health of university students. However, most of them have a cross-sectional design that cannot establish causality effects. In this respect, prospective surveys are strongly required to delineate the impact of emotional eating in the daily life of university students. Full article

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16 pages, 2489 KiB

Open AccessArticle

Inflammatory Bowel Disease in the Post-STRIDE II Era: Epidemiology and Long-Term Clinical Outcomes from a Population-Based Study

by Fabio Ingravalle, Marco Valvano, Andrea Barbara, Dorian Bardhi, Giovanni Latella, Angelo Viscido, Mariachiara Campanale, Antonio Vinci, Carlo Viora, Giampiera Bulfone, Rocco Mazzotta and Massimo Maurici

Med. Sci. 2025, 13(2), 55; https://doi.org/10.3390/medsci13020055 - 3 May 2025

Viewed by 524

Abstract

Background/Objectives: Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The availability of an increasing number of new molecules approved for IBD treatment has increased our ability and aspirations to change the trajectory of the disease. The Selecting Therapeutic Targets [...] Read more.

Background/Objectives: Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The availability of an increasing number of new molecules approved for IBD treatment has increased our ability and aspirations to change the trajectory of the disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) II consensus (2018) is the current suggested strategy for IBD management, which recommends a treat-to-target approach. The primary objective of this study is to describe the clinical history of IBD in the post-STRIDE II era and to quantify the burden of IBD in terms of hospitalisation rate. The secondary objective is to estimate the 6-year risk of intestinal resection among IBD patients. Methods: A population-based time series analysis was conducted on administrative data; retrospective data from January 2011 to December 2021 were collected for the Local Health Authority “Roma 1” population (∼1.5 million residents). Hospitalisation and surgical events were prospectively recorded for patients newly diagnosed between January 2018 and February 2022 (n = 556), with follow-up throughout May 2024. A Kaplan–Mayer survivor analysis was performed to estimate the cumulative surgery risk. Results: In 2021, the IBD prevalence was 218.3 cases/100,000 people (77.2 CD, 141.1 UC). The incidence trend slowly increased during the last decade, up to 5.3 (CD) and 9.4 (UC) cases/100,000 ppl/year. The yearly hospitalisation rate remained stable, near 16.5%. The 6-year cumulative risk of surgery was 36% for CD and 20% for UC. Conclusions: The incidence of IBD has increased in the last few decades, with substantial stability in regard to the incidence of surgery and hospitalisations. Thus, the current IBD management approach has only had a small effect on changing the natural history of the disease. Full article

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

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13 pages, 6817 KiB

Open AccessArticle

A Potential Pitfall in the Interpretation of Microscope-Integrated Fluorescence Angiography: The Center–Periphery Effect

by Dieder Stolk, Paul Bloemen, Richard Martin van den Elzen, Martijn de Bruin and Caroline Driessen

Med. Sci. 2025, 13(2), 54; https://doi.org/10.3390/medsci13020054 - 3 May 2025

Viewed by 266

Abstract

Background/Objectives: Indocyanine green fluorescence angiography (ICG-FA) enables the real-time visualization of tissue perfusion. However, objective research on microscope-integrated fluorescence angiography (FA) has not been conducted before. This study aims to evaluate the fluorescence light distribution in images formed by ICG-FA in two surgical [...] Read more.

Background/Objectives: Indocyanine green fluorescence angiography (ICG-FA) enables the real-time visualization of tissue perfusion. However, objective research on microscope-integrated fluorescence angiography (FA) has not been conducted before. This study aims to evaluate the fluorescence light distribution in images formed by ICG-FA in two surgical microscopes using a phantom, and to provide recommendations for their application. Methods: An 11.8 by 6.8 cm ICG and Intralipid phantom was made to evaluate overall spatial fluorescence sensitivity in two surgical microscopes in multiple working distances (WDs) and magnification factors (MFs). The signal was quantified using a tailor-made software in Python 3.8.10. Results: A clear center–periphery effect was present in most settings in both microscopes, with the highest peripheral fluorescence signal loss in the lowest MF: 100% in the Tivato and 83% in the Pentero. Increasing the MF improved homogeneity, where the biggest difference was seen between the first and second MF. A 30 cm WD and 3.5× MF produced the most homogeneous images suitable for free-flap surgery. Manually opening the light beam diameter also reduced the center–periphery effect. Conclusions: Peripheral signal loss in microscope-integrated ICG-FA must be considered during clinical interpretation and for the quantification of tissue perfusion. In clinical practice during reconstructive free-flap surgery, a 30 cm WD, 3.5 MF, and manually opened light beam diameter should be applied to achieve the most homogeneous image. Full article

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10 pages, 752 KiB

Open AccessReview

Research Priorities for Diabetic Ketoacidosis: An Evidence and Gap Mapping Review

by Nicolas Sieben and Mahesh Ramanan

Med. Sci. 2025, 13(2), 53; https://doi.org/10.3390/medsci13020053 - 1 May 2025

Viewed by 431

Abstract

Background/Objectives: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes with treatment consisting of reversal of cause, insulin administration, fluid resuscitation and electrolyte repletion. Yet, many aspects of DKA management are currently based on low-quality evidence or physiological rationale. This evidence and [...] Read more.

Background/Objectives: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes with treatment consisting of reversal of cause, insulin administration, fluid resuscitation and electrolyte repletion. Yet, many aspects of DKA management are currently based on low-quality evidence or physiological rationale. This evidence and gap map review presents an overview of the current body of literature and identifies evidence gaps in relation to therapeutic interventions for DKA. Methods: Interventions and outcomes relevant to DKA were identified and iteratively developed to produce a coding model for the proposed evidence and gap map. PubMed was searched with Me SH terms relevant to the identified interventions and outcomes. Studies identified were screened and assigned interventions and outcomes. Interventional research was uploaded to EPPI-Reviewer and EPPI-Mapper to produce the evidence and gap map. Results: The search identified 1131 studies, of which 18 were non-human and 345 were duplicates. A total of 768 unique studies were screened, and 118 were identified as interventions (52 pediatric and 66 adult studies). A total of 26 high-quality studies, 88 medium-quality studies and 4 low-quality studies were identified. These 118 studies were coded into the proposed DKA evidence and gap map. The intervention domains were fluid therapy, insulin therapy, electrolyte replacement, adjunct therapies and admission type. The outcome domains were DKA resolution, insulin duration, length of stay, morbidity and mortality, complications, and biochemical parameters. Conclusions: Fluid type and insulin infusion administration were prominent in the current literature. These studies frequently used DKA resolution and complications associated with DKA such as electrolyte disturbances and cerebral edema as the primary outcomes. Substantial gaps were identified with scant evidence to guide prophylactic electrolyte administration, enteral intake and adjunctive therapy (thiamine, bicarbonate). Even for well-investigated interventions such as fluids and insulin, substantial gaps existed, particularly for patient-centered and healthcare service outcomes. Full article

(This article belongs to the Section Critical Care Medicine)

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6 pages, 318 KiB

Open AccessArticle

Sustained Long-Term Results with Minimal Reintervention Rates in Patients with Frozen Elephant Trunk and Acute Aortic Syndromes

by Filippos-Paschalis Rorris, Christos F. Pitros, Constantine N. Antonopoulos, Konstantinos Papakonstantinou, Lydia Kokotsaki, Pantelis Tsipas, Ilias Gissis and John Kokotsakis

Med. Sci. 2025, 13(2), 52; https://doi.org/10.3390/medsci13020052 - 1 May 2025

Viewed by 250

Abstract

The Frozen Elephant Trunk (FET) technique is indicated in acute aortic syndromes with arch involvement and malperfusion of tissues. We sought to report on long-term outcomes of FET in emergent cases of acute aortic syndromes. Methods: Twenty-three adult patients were referred to our [...] Read more.

The Frozen Elephant Trunk (FET) technique is indicated in acute aortic syndromes with arch involvement and malperfusion of tissues. We sought to report on long-term outcomes of FET in emergent cases of acute aortic syndromes. Methods: Twenty-three adult patients were referred to our department for surgical management of acute aortic syndromes and underwent aortic arch replacement using the FET technique between November 2010 and January 2022. The primary outcome was long-term survival. Secondary outcomes were the 30-day mortality rate and the incidence of neurologic complications, i.e., stroke and spinal cord ischemia. Results: The mean patient age was 57.1 (±12.5) years, and the majority (20 patients, 87%) were male. The most common indication was Stanford type A acute aortic dissection (aTAAD) in 17 (74%) patients, followed by non-A non-B dissection in 2 (8.7%) patients, penetrating aortic ulcer (PAU) of the aortic arch in 2 (8.7%) patients, type A intramural hematoma (IMH) in 1 (4.3%) patient and blunt thoracic aortic injury of the aortic arch in 1 (4.3%) patient. Kaplan–Meier survival analysis revealed a 73% survival at 12 months, which persisted up to 11 years of follow-up. Conclusion: The FET technique provides a reliable solution for surgical management of patients with acute aortic syndromes. Excellent, sustained long-term results can be achieved. Full article

(This article belongs to the Section Cardiovascular Disease)

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12 pages, 1504 KiB

Open AccessArticle

Effectiveness of Stress Shielding Prevention Using a Low Young’s Modulus Ti-33.6Nb-4Sn Stem: A 7-Year Follow-Up Study

by Kazuyoshi Baba, Yu Mori, Hidetatsu Tanaka, Ryuichi Kanabuchi, Yasuaki Kuriyama, Hiroaki Kurishima, Kentaro Ito, Masayuki Kamimura, Daisuke Chiba and Toshimi Aizawa

Med. Sci. 2025, 13(2), 51; https://doi.org/10.3390/medsci13020051 - 1 May 2025

Viewed by 341

Abstract

Background: Stress shielding (SS) after total hip arthroplasty (THA) leads to proximal femoral bone loss and increases the risk of complications such as implant loosening and periprosthetic fracture. While various low-stiffness stems have been developed to prevent SS, they often compromise mechanical stability. [...] Read more.

Background: Stress shielding (SS) after total hip arthroplasty (THA) leads to proximal femoral bone loss and increases the risk of complications such as implant loosening and periprosthetic fracture. While various low-stiffness stems have been developed to prevent SS, they often compromise mechanical stability. A novel femoral stem composed of Ti-33.6Nb-4Sn (TNS) alloy offers a gradually decreasing Young’s modulus from proximal to distal regions, potentially improving load distribution and reducing SS. This study aimed to evaluate the mid-term clinical and radiographic outcomes of the TNS stem, with a particular focus on its effectiveness in suppressing SS. Methods: A prospective clinical study was conducted involving 35 patients who underwent THA using the TNS stem, with a minimum follow-up of 7 years. Twenty-one patients with Ti6Al4V metaphyseal-filling stems served as controls. Clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) scores, and radiographic SS was graded using Engh’s classification and analyzed in Gruen zones. Inter-examiner reliability and statistical comparisons between groups were performed using appropriate tests. Results: The TNS group showed significantly higher preoperative JOA scores than the control group, but no significant difference in final scores. Both groups demonstrated significant improvement postoperatively. Third-degree SS occurred in the TNS group, although the overall SS grade distribution was significantly lower than in the control group (p = 0.03). SS frequency was significantly reduced in Gruen Zones 2, 3, and 6 in the TNS group. Conclusions: The TNS stem demonstrated a significant reduction in SS progression compared to conventional titanium stems over a 7-year period, with comparable clinical outcomes. However, the occurrence of third-degree SS indicates that material optimization alone may be insufficient, highlighting the need for further design improvements. Full article

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13 pages, 1138 KiB

Open AccessArticle

Accuracy of Accuhaler, Ellipta, and Turbuhaler Testers in Patients with Chronic Obstructive Pulmonary Disease

by Narongkorn Saiphoklang, Thiravit Siriyothipun and Sarawut Panichaporn

Med. Sci. 2025, 13(2), 50; https://doi.org/10.3390/medsci13020050 - 29 Apr 2025

Viewed by 368

Abstract

Background: Peak inspiratory flow rate (PIFR) measurement is an essential tool for assessing the effectiveness of inhaler therapy in chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the accuracy of three different inhaler testers compared to the In-Check DIAL^® [...] Read more.

Background: Peak inspiratory flow rate (PIFR) measurement is an essential tool for assessing the effectiveness of inhaler therapy in chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the accuracy of three different inhaler testers compared to the In-Check DIAL^® device. Methods: A cross-sectional study was conducted in clinically stable COPD patients. Participants performed PIFR measurements using the In-Check DIAL^® device and three inhaler testers (Accuhaler, Ellipta, and Turbuhaler). Optimal PIFR was defined as ≥60 L/min. Minimum PIFR was defined as ≥30 L/min. Results: A total of 82 COPD patients (93.9% male) were included, with a mean age of 73.3 ± 8.8 years. Post-bronchodilator forced expiratory volume in one second was 69.2 ± 21.0%. The prevalence of optimal PIFR was 78%, 74%, and 52% for the Accuhaler, Ellipta, and Turbuhaler testers, respectively. For detecting optimal PIFR, the Accuhaler tester demonstrated an accuracy of 80.5%, sensitivity of 100%, and specificity of 11.1%. The Ellipta tester showed an accuracy of 78.1%, sensitivity of 100%, and specificity of 14.3%, while the Turbuhaler tester achieved an accuracy of 56.1%, sensitivity of 100%, and specificity of 7.7%. All devices showed excellent accuracy (>95%), sensitivity (>98%), and specificity (100% except for the Turbuhaler tester) in detecting minimum PIFR. Conclusions: The majority of COPD patients achieved optimal PIFR across the three different devices, with the highest prevalence observed for the Accuhaler tester. All three inhaler testers demonstrated excellent accuracy in assessing PIFR in COPD patients, suggesting their potential as reliable alternatives to the In-Check DIAL^® device in clinical practice. Full article

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14 pages, 495 KiB

Open AccessArticle

Effects of Oral Doxofylline and Procaterol on Chronic Obstructive Pulmonary Disease: A Randomized Crossover Study

by Narongkorn Saiphoklang, Sarawut Panichaporn, Thiravit Siriyothipun and Pitchayapa Ruchiwit

Med. Sci. 2025, 13(2), 49; https://doi.org/10.3390/medsci13020049 - 29 Apr 2025

Viewed by 383

Abstract

Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A [...] Read more.

Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A crossover randomized controlled trial was conducted in patients with clinically stable COPD. Participants first received either doxofylline or procaterol for 4 weeks, followed by a 1-week washout period. Assessments included the modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT) scores, and 6-minute walking distance (6MWD). Pulmonary function was evaluated using spirometry with bronchodilator (BD) testing and all adverse events were recorded. Results: Twenty patients were randomly assigned to begin treatment with either doxofylline or procaterol. Their mean age was 71.7 ± 9.4 years. After four weeks of treatment, the doxofylline group showed significantly greater improvement in pulmonary function parameters (post-BD peak expiratory flow and post-BD forced expiratory flow 25–75) compared to the procaterol group. However, there were no significant differences in mMRC scores, CAT scores, or 6MWD between the two groups. More neurological adverse events were observed in the doxofylline group compared to the procaterol group (35% vs. 5%, p = 0.044). Conclusions: Doxofylline improved pulmonary function in COPD patients but did not provide superior functional performance compared to procaterol. Neurological adverse events were more frequently associated with doxofylline. Doxofylline may serve as an adjunctive therapy to enhance pulmonary function in COPD patients, but caution is advised due to its potential side effects. Full article

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

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23 pages, 1033 KiB

Open AccessReview

Memory T Cells in Respiratory Virus Infections: Protective Potential and Persistent Vulnerabilities

by Henry Sutanto, Febrian Ramadhan Pradana, Galih Januar Adytia, Bagus Aditya Ansharullah, Alief Waitupu, Bramantono Bramantono and Deasy Fetarayani

Med. Sci. 2025, 13(2), 48; https://doi.org/10.3390/medsci13020048 - 29 Apr 2025

Viewed by 838

Abstract

Respiratory virus infections, such as those caused by influenza viruses, respiratory syncytial virus (RSV), and coronaviruses, pose a significant global health burden. While the immune system’s adaptive components, including memory T cells, are critical for recognizing and combating these pathogens, recurrent infections and [...] Read more.

Respiratory virus infections, such as those caused by influenza viruses, respiratory syncytial virus (RSV), and coronaviruses, pose a significant global health burden. While the immune system’s adaptive components, including memory T cells, are critical for recognizing and combating these pathogens, recurrent infections and variable disease outcomes persist. Memory T cells are a key element of long-term immunity, capable of responding swiftly upon re-exposure to pathogens. They play diverse roles, including cross-reactivity to conserved viral epitopes and modulation of inflammatory responses. However, the protective efficacy of these cells is influenced by several factors, including viral evolution, host age, and immune system dynamics. This review explores the dichotomy of memory T cells in respiratory virus infections: their potential to confer robust protection and the limitations that allow for breakthrough infections. Understanding the underlying mechanisms governing the formation, maintenance, and functional deployment of memory T cells in respiratory mucosa is critical for improving immunological interventions. We highlight recent advances in vaccine strategies aimed at bolstering T cell-mediated immunity and discuss the challenges posed by viral immune evasion. Addressing these gaps in knowledge is pivotal for designing effective therapeutics and vaccines to mitigate the global burden of respiratory viruses. Full article

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

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21 pages, 1169 KiB

Open AccessReview

Dichloroacetate and Salinomycin as Therapeutic Agents in Cancer

by Sunny Hunt, Anita Thyagarajan and Ravi P. Sahu

Med. Sci. 2025, 13(2), 47; https://doi.org/10.3390/medsci13020047 - 23 Apr 2025

Viewed by 678

Abstract

Cancer is the second leading cause of mortality worldwide. Despite the available treatment options, a majority of cancer patients develop drug resistance, indicating the need for alternative approaches. Repurposed drugs, such as antiglycolytic and anti-microbial agents, have gained substantial attention as potential alternative [...] Read more.

Cancer is the second leading cause of mortality worldwide. Despite the available treatment options, a majority of cancer patients develop drug resistance, indicating the need for alternative approaches. Repurposed drugs, such as antiglycolytic and anti-microbial agents, have gained substantial attention as potential alternative strategies against different disease pathophysiologies, including lung cancer. To that end, multiple studies have suggested that the antiglycolytic dichloroacetate (DCA) and the antibiotic salinomycin (SAL) possess promising anticarcinogenic activity, attributed to their abilities to target the key metabolic enzymes, ion transport, and oncogenic signaling pathways involved in regulating cancer cell behavior, including cell survival and proliferation. We used the following searches and selection criteria. (1) Biosis and PubMed were used with the search terms dichloroacetate; salinomycin; dichloroacetate as an anticancer agent; salinomycin as an anticancer agent; dichloroacetate side effects; salinomycin side effects; salinomycin combination therapy; dichloroacetate combination therapy; and dichloroacetate or salinomycin in combination with other agents, including chemotherapy and tyrosine kinase inhibitors. (2) The exclusion criteria included not being related to the mechanisms of DCA and SAL or not focusing on their anticancer properties. (3) All the literature was sourced from peer-reviewed journals within a timeframe of 1989 to 2024. Importantly, experimental studies have demonstrated that both DCA and SAL exert promising anticarcinogenic properties, as well as having synergistic effects in combination with other therapeutic agents, against multiple cancer models. The goal of this review is to highlight the mechanistic workings and efficacy of DCA and SAL as monotherapies, and their combination with other therapeutic agents in various cancer models, with a major emphasis on non-small-cell lung cancer (NSCLC) treatment. Full article

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Med. Sci., Volume 13, Issue 2 (June 2025) – 44 articles

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