Medicina

10 pages, 2658 KiB

Open AccessArticle

Retinal Hemorrhages and Long-Term Ocular Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy

by Emrah Utku Kabataş, Seda Aydoğan, Ahmet Alp Bilgiç, Nurdan Dinlen Fettah, Naciye Kabataş, Dilek Dilli and Ayşegül Zenciroğlu

Medicina 2025, 61(5), 906; https://doi.org/10.3390/medicina61050906 (registering DOI) - 16 May 2025

Abstract

Background and Objective: This study aims to investigate the clinical significance and risk factors of retinal hemorrhages (RH) and white-centered retinal hemorrhages (Roth spots, RS) in neonates with hypoxic-ischemic encephalopathy (HIE), as well as their long-term ophthalmologic outcomes. Materials and Methods: Neonates diagnosed [...] Read more.

Background and Objective: This study aims to investigate the clinical significance and risk factors of retinal hemorrhages (RH) and white-centered retinal hemorrhages (Roth spots, RS) in neonates with hypoxic-ischemic encephalopathy (HIE), as well as their long-term ophthalmologic outcomes. Materials and Methods: Neonates diagnosed with HIE were classified into three stages according to the Sarnat classification. A comprehensive ophthalmologic assessment was performed within the first three days of life and at two years of age. Retinal hemorrhages were staged based on the Egge classification, and the presence of RS was also documented. The clinical characteristics and risk factors associated with RH and RS were systematically recorded. Results: Retinal hemorrhages were identified in 178 eyes (42.3%), and RS were observed in 180 eyes (42.8%). The prevalence of both RH and RS was significantly higher in neonates with Stage 2 and Stage 3 HIE (p < 0.001). The resolution time for both RH and RS was significantly prolonged in neonates with Stage 3 HIE compared to those with lower grades (p < 0.001). Furthermore, the frequency of grade 3 RH increased with advancing HIE stages (p < 0.001). Logistic regression analysis revealed that Stage 2 HIE (OR: 5.41, 95% CI: 1.19–24.54, p = 0.03) and Stage 3 HIE (OR: 27.17, 95% CI: 5.38–137.25, p < 0.001) were significantly associated with RS. Similarly, Stage 2 HIE (OR: 4.54, 95% CI: 1.00–20.68, p = 0.05) and Stage 3 HIE (OR: 40.88, 95% CI: 7.75–215.68, p < 0.001) were significantly associated with RH. At the age of two, strabismus was identified in 34 (18.4%) patients, while refractive errors were detected in 68 (37.4%) patients. Conclusions: The prevalence of RH and RS increases in correlation with the severity of HIE. While these hemorrhages generally resolve spontaneously, the risk of refractive errors and strabismus remains elevated. Full article

(This article belongs to the Section Pediatrics)

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18 pages, 5392 KiB

Open AccessSystematic Review

Autogenous Periosteal Graft Along with Open Flap Debridement Versus Open Flap Debridement Alone for the Treatment of Grade II Furcation Defect in Chronic Periodontitis Patients: A Systematic Review and Meta-Analysis

by Swapna A. Mahale, Prasad Dhadse, Sumedha Thosar, Vedant Bhandari, Akhil Patil, Sadatullah Syed, Ranjeet Ajit Bapat, Tanay Chaubal, Sumaiya Zabin Eusufzai and Shahabe Saquib Abullais

Medicina 2025, 61(5), 905; https://doi.org/10.3390/medicina61050905 - 16 May 2025

Abstract

Background and Objectives: Periodontal regeneration involves techniques intended at restoring the lost supporting tissue around a periodontally weakened tooth. These regenerative methods frequently utilize periosteal grafts to stimulate the evolvement of vital adjacent tissues. This paper intended to evaluate the use of [...] Read more.

Background and Objectives: Periodontal regeneration involves techniques intended at restoring the lost supporting tissue around a periodontally weakened tooth. These regenerative methods frequently utilize periosteal grafts to stimulate the evolvement of vital adjacent tissues. This paper intended to evaluate the use of autogenous periosteal grafts in treating grade II furcation defects (Glickman Classification 1953) in patients with chronic periodontitis. Materials and Methods: The databases MEDLINE (via PubMed), Cochrane, EBSCO, and Google Scholar were searched for papers published in English from January 1991 till December 2022. Three individuals examined the reclaimed articles according to the inclusion norms. Randomized controlled trials (RCTs) assessing the efficacy of autogenous periosteal grafts for treating Grade II furcation defects in chronic periodontitis patients were involved. Only four related studies were identified for data extraction, involving 80 patients aged 18 to 52 years. Outcome variables measured included horizontal bone loss (HD), vertical bone loss (VD), pocket depth (PD), clinical attachment level (CAL), bone height (BH), gingival recession (GR), plaque index (PI), and gingival index (GI). Data were examined using RevMan 5.4.1 software. Mean differences and 95% confidence intervals were employed to estimate effect sizes. Results: Both groups showed similar results for reductions in PI, GI, and BOP. However, The periosteal graft also yielded better outcomes for CAL gain, BH, and GR. The meta-analysis showed a significant overall effect of Periosteal Barrier Membrane (PBM) on horizontal and vertical bony change levels, but subgroup differences between unilateral and bilateral applications were not statistically significant due to high heterogeneity. Although the bilateral subgroup demonstrated significant benefits of PBM treatment, the overall findings across the clinical attachment level group remain inconclusive. Conclusion: Current evidence suggests that while PBM may benefit bilateral mandibular sites, and autogenous periosteal grafts offer no added advantage over OFD alone in Grade II furcation defects, the overall findings remain inconclusive. Full article

(This article belongs to the Special Issue Current and Future Trends in Dentistry and Oral Health)

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13 pages, 568 KiB

Open AccessArticle

Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study

by Nicola Corcione, Paolo Ferraro, Filippo Finizio, Michele Cimmino, Michele Albanese, Alberto Morello, Giuseppe Biondi-Zoccai, Paolo Denti, Antonio Popolo Rubbio, Francesco Bedogni, Antonio L. Bartorelli, Annalisa Mongiardo, Salvatore Giordano, Francesco De Felice, Marianna Adamo, Matteo Montorfano, Francesco Maisano, Giuseppe Tarantini, Francesco Giannini, Federico Ronco, Emmanuel Villa, Maurizio Ferrario, Luigi Fiocca, Fausto Castriota, Angelo Squeri, Martino Pepe, Corrado Tamburino and Arturo Giordano Show full author list Hide full author list

Medicina 2025, 61(5), 904; https://doi.org/10.3390/medicina61050904 - 16 May 2025

Abstract

Background and Objectives: Mitral valve transcatheter edge-to-edge repair (TEER) is a widely adopted therapeutic approach for managing significant mitral regurgitation (MR) in high-risk surgical candidates. While procedural safety and efficacy have been demonstrated, the impact of institutional expertise on outcomes remains unclear. [...] Read more.

Background and Objectives: Mitral valve transcatheter edge-to-edge repair (TEER) is a widely adopted therapeutic approach for managing significant mitral regurgitation (MR) in high-risk surgical candidates. While procedural safety and efficacy have been demonstrated, the impact of institutional expertise on outcomes remains unclear. We aimed at evaluating whether the institutional monthly volume of TEER influences short- and long-term clinical results. Materials and Methods: This analysis from the multicenter, prospective GIOTTO trial study evaluated the impact of institutional monthly volume on outcomes of TEER to remedy significant mitral regurgitation. Centers were stratified into tertiles based on monthly volumes (≤2.0 cases/month, 2.1–3.5 cases/month, >3.5 cases/month), and key clinical, echocardiographic, and procedural outcomes were analyzed. Statistical analysis was based on standard bivariate tests as well as unadjusted and multivariable adjusted Cox models. Results: A total of 2213 patients were included, stratified into tertiles based on institutional procedural volume: 645 (29.1%) patients in the first tertile, 947 (42.8%) patients in the second tertile, and 621 (28.1%) patients in the third tertile. Several baseline differences were found, with some features disfavoring less busy centers (e.g., functional class and surgical risk, both p < 0.05), and others suggesting a worse risk profile in those treated in busier institutions (e.g., frailty and history of prior mitral valve intervention, both p < 0.05). Procedural success rates were higher in busier centers (p < 0.001), and hospital stay was also shorter there (p < 0.001). Long-term follow-up (median 14 months) suggested worse outcomes in patients treated in less busy centers at unadjusted analysis (e.g., p = 0.018 for death, p = 0.015 for cardiac death, p = 0.014 for death or hospitalization for heart failure, p < 0.001 for cardiac death or hospitalization for heart failure), even if these associations proved no longer significant after multivariable adjustment, except for cardiac death or hospitalization for heart failure, which appeared significantly less common in the busiest centers (p < 0.05). Similar trends were observed when focusing on tertiles of overall center volume and when comparing for each center the first 50 cases with the following ones. Conclusions: High institutional monthly volume of TEER mitral valve repair appears to correlate with an improved procedural success rate and shorter hospitalizations. Similarly favorable results were found for long-term rates of cardiac death or hospitalization for heart failure. These findings inform on the importance of operator experience and center expertise in achieving state-of-the-art results with TEER, while confirming the usefulness of the proctoring approach when naïve centers begin a TEER program. Full article

(This article belongs to the Special Issue Transcatheter Therapies for Valvular Heart Disease)

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11 pages, 452 KiB

Open AccessArticle

Does Body Mass Index Impact Outcomes in Patients Undergoing Minimally Invasive Mitral Valve Surgery?

by Mariafrancesca Fiorentino, Elisa Mikus, Diego Sangiorgi, Alberto Tripodi, Simone Calvi, Elena Tenti, Antonino Costantino and Carlo Savini

Medicina 2025, 61(5), 903; https://doi.org/10.3390/medicina61050903 - 16 May 2025

Abstract

Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive [...] Read more.

Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI < 25, n = 942), overweight (BMI 25–30, n = 661), and obese (BMI > 30, n = 170). Results: The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes (p < 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation (p < 0.001), prior stroke (p = 0.023), chronic obstructive pulmonary disease (p = 0.002), and elevated preoperative creatinine levels (p < 0.001). and their euroscore II was significantly higher (p = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h (p = 0.002) and ICU stay (p = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation (p = 0.037) and required pacemaker implantation more frequently (p < 0.001). Conclusions: Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery. Full article

(This article belongs to the Section Cardiology)

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12 pages, 720 KiB

Open AccessArticle

Ultrasonography of the Vagus Nerve for ALS Patients: Correlations with Clinical Data and Dysfunction of the Autonomic Nervous System

by Ovidijus Laucius, Justinas Drūteika, Tadas Vanagas, Renata Balnytė, Andrius Radžiūnas and Antanas Vaitkus

Medicina 2025, 61(5), 902; https://doi.org/10.3390/medicina61050902 - 16 May 2025

Abstract

Background and Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the degeneration of both upper and lower motor neurons, leading to the rapid decline of motor function. In recent years, dysfunction of the autonomic nervous system (ANS) has also [...] Read more.

Background and Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the degeneration of both upper and lower motor neurons, leading to the rapid decline of motor function. In recent years, dysfunction of the autonomic nervous system (ANS) has also been increasingly recognized as a contributing factor in various neurodegenerative diseases, including ALS. This study is the second publication from our ALS research cohort at Kaunas Clinics. Our previous work examined ultrasonographic changes in the phrenic nerve as a supplementary diagnostic approach for ALS. Materials and Methods: In the present study, we investigated ultrasonographic alterations of the vagus nerve within the same ALS cohort, aiming to explore correlations with ANS involvement. We performed high-resolution ultrasonography of the vagus nerve (VN), collected clinical data, conducted heart rate monitoring, and evaluated respiratory function. Results: We prospectively included 32 ALS patients meeting “Gold Coast” criteria and 64 age- and sex-matched control patients. The average onset of ALS was 57.97 ± 9.22 years, and the duration of the disease was15.41 ± 9.04 months. For ALS patients, we found significantly reduced vagus nerve cross-sectional area (CSA) at the level of the carotid artery bifurcation bilaterally compared to controls (right VN 1.86 ± 0.21 vs. 2.07 ± 0.18 mm², p < 0.001; left VN 1.69 ± 0.21 vs. 1.87 ± 0.21 mm², p < 0.001). Reduced values of the left VN positively correlated with the reduced values of FEV1% and sO₂. Conclusions: Our findings revealed a significant bilateral reduction in vagus nerve size in ALS patients compared to controls, suggesting that vagal atrophy may serve as a potential marker of autonomic dysfunction in ALS. Full article

(This article belongs to the Special Issue Neuromuscular Disorders: Diagnostical Approaches and Treatments)

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13 pages, 1256 KiB

Open AccessArticle

Serial Changes in Vitamin D Status in Patients During Severe Acute Respiratory Distress Syndrome and Extracorporeal Membrane Oxygenation

by Martina Hermann, Jelena Poslussny, Gernot Gerger, Helmuth Haslacher, Georg Mayrhofer, Verena Eva Tretter, Mathias Maleczek and Cem Ekmekcioglu

Medicina 2025, 61(5), 901; https://doi.org/10.3390/medicina61050901 - 16 May 2025

Abstract

Background and Objectives: Therapeutic interventions, such as extracorporeal membrane oxygenation (ECMO) therapy, in patients suffering from severe acute respiratory distress syndrome (ARDS) may reduce their vitamin D levels. Many observational studies have shown associations between poor outcomes and low vitamin D levels [...] Read more.

Background and Objectives: Therapeutic interventions, such as extracorporeal membrane oxygenation (ECMO) therapy, in patients suffering from severe acute respiratory distress syndrome (ARDS) may reduce their vitamin D levels. Many observational studies have shown associations between poor outcomes and low vitamin D levels in critically ill patients. This retrospective study primarily aimed to investigate the time-dependent changes in vitamin D levels and the correlation of vitamin D levels with disease severity and inflammatory markers in patients suffering from ARDS receiving ECMO therapy. Materials and Methods: This study used a longitudinal approach to assess the serial changes and the correlations of vitamin D levels (25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D)) with disease severity and inflammatory markers in 24 invasively mechanically ventilated (IMV) patients treated using ECMO over a period of 17 days. Most of the patients in this study were suffering from severe coronavirus disease 2019 (COVID-19) (n = 19; 79%). Serial blood samples collected during routine blood draws were retrospectively analyzed to assess the dynamics of their vitamin D levels over 17 days of ICU therapy. Results: Hypovitaminosis D (25(OH)D ≤ 50 nmol/L) was prevalent in 18 (75%) patients, while values of 25(OH)D lower than 30 nmol/L were measured in 5 patients (21%), indicating severe deficiency. Additionally, 1,25(OH)2D showed a significant decrease within the first 11 days of intensive care unit (ICU) treatment (these levels dropped by 28%; p = 0.03) and then remained at similar levels throughout the observational period; 25(OH)D levels remained largely unchanged during the observation period. We observed that 25(OH)D showed a significant negative correlation with C-reactive protein (CRP) (p = 0.04), and that 25(OH)D and 1,25(OH)2D levels did not show correlations with disease severity. Conclusions: Patients suffering from severe COVID-19 ARDS showed a significant decrease in their 1,25(OH)2D levels from day 0 to day 11 in the ICU. Therefore, routine vitamin D substitution and monitoring in critically ill patients, especially for patients suffering from ARDS treated with ECMO, should be carried out to prevent hypovitaminosis D. In addition, vitamin D may be associated with inflammation. Further studies are necessary to elucidate the mechanisms behind these retrospective observations. Full article

(This article belongs to the Special Issue Intensive Care and Life Support)

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14 pages, 1034 KiB

Open AccessArticle

Prevalence of Genetic Variants Associated with Atrial Fibrillation Risk in the Asymptomatic Young Adult Population

by Manoranjani Murugan, Sambandam Ravikumar, Irisappan Ganesh, Yogesh Vetriselvan, Arunagiri Priyadharshini and Vishnu Bhat Ballambattu

Medicina 2025, 61(5), 900; https://doi.org/10.3390/medicina61050900 - 15 May 2025

Abstract

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally, leading to a high risk of stroke and heart failure. Genetic factors are known to play an essential role in AF risk. However, studies on genetic predisposition in asymptomatic [...] Read more.

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally, leading to a high risk of stroke and heart failure. Genetic factors are known to play an essential role in AF risk. However, studies on genetic predisposition in asymptomatic young populations remain limited. This study aimed to investigate the prevalence of genetic variants in the PITX2 (rs2200733, rs10033464, and rs13143308), TBX5 (rs883079), PRRX1 (rs3903239), ZFHX3 (rs2106261), and HAND2 (rs7698692) polymorphisms and to assess their correlation with susceptibility to AF in a young adult population in India. Materials and Methods: This cross-sectional study included 250 subjects aged 18–29. Detailed lifestyle and family histories were collected for each participant. Genetic variation was determined using a specific TaqMan SNP genotyping assay. Hardy–Weinberg equilibrium (HWE) analysis and chi-square tests were employed to assess genotype frequencies, and statistical associations with lifestyle factors (body mass index, alcohol consumption, and smoking) were evaluated using t-tests and descriptive statistics. Results: Minor allele frequencies were varied across the study population, with notable frequencies in rs2200733 T (16%), rs10033464 T (27%), rs13143308 T (32%), rs883079 T (46%), rs3903239 G (25%), rs2106261 T (26%), and rs7698692 G (14%). HWE analysis confirmed that all SNPs were in equilibrium (p > 0.05). Approximately 15% of individuals carried six or more risk alleles, indicating a significant genetic predisposition to AF despite the absence of clinical symptoms. Conclusions: This study provides new insights into the genetic predisposition to AF among young adults in India. The high prevalence of risk alleles in asymptomatic young adults highlights the necessity of early genetic screening for AF risk and the role of genetic counseling in preventing cardiac complications. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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11 pages, 564 KiB

Open AccessReview

Mpox Infection and Endocrine Health: Bridging the Knowledge Gap

by Christos Savvidis, Manfredi Rizzo and Ioannis Ilias

Medicina 2025, 61(5), 899; https://doi.org/10.3390/medicina61050899 - 15 May 2025

Abstract

Mpox (MPX), caused by the Monkeypox virus (MPXV), is a zoonotic orthopoxvirus infection with increasing global relevance due to sustained human-to-human transmission. While primarily known for cutaneous and systemic involvement, emerging evidence suggests that MPX may also disrupt endocrine function. This narrative review [...] Read more.

Mpox (MPX), caused by the Monkeypox virus (MPXV), is a zoonotic orthopoxvirus infection with increasing global relevance due to sustained human-to-human transmission. While primarily known for cutaneous and systemic involvement, emerging evidence suggests that MPX may also disrupt endocrine function. This narrative review aims to synthesize current clinical, experimental, and epidemiological findings on MPX-related endocrine complications. We explore the potential impact of MPXV on the thyroid, adrenal glands, and gonads, and discuss the underlying mechanisms, clinical manifestations, and implications for patient management. MPX has been implicated in viral-induced subacute thyroiditis, with cases exhibiting thyrotoxicosis followed by hypothyroidism, likely mediated by direct viral infiltration or immune dysregulation. Additionally, MPX may contribute to adrenal insufficiency through viral invasion, immune-mediated destruction, or hypothalamic–pituitary–adrenal (HPA) axis dysfunction, exacerbating metabolic and inflammatory complications. MPXV’s persistence in testicular tissue raises concerns about reproductive health, with potential implications for fertility, hormone production, and viral transmission. The virus may also modulate host steroid pathways through interactions with glucocorticoid, androgen, and estrogen receptors, influencing immune responses and disease severity. Given these findings, clinicians should maintain vigilance for endocrine dysfunction in MPX patients, particularly in immunocompromised individuals. The role of steroid therapy in MPX remains complex, requiring careful balancing of its anti-inflammatory benefits against potential risks of viral persistence and immune suppression. Further research is essential to clarify MPX’s endocrine impact and optimize management strategies. Full article

(This article belongs to the Section Endocrinology)

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12 pages, 639 KiB

Open AccessArticle

Elevated Leukocyte Glucose Index (LGI) Is Associated with Diabetic Ketoacidosis (DKA) Severity and Presence of Microvascular Complications

by Mircea Cătălin Coșarcă, Raluca Maria Tilinca, Nicolae Alexandru Lazăr, Suzana Vasilica Șincaru, Bogdan Corneliu Bandici, Cosmin Carașca, Ráduly Gergő, Adrian Vasile Mureșan and Mariana Cornelia Tilinca

Medicina 2025, 61(5), 898; https://doi.org/10.3390/medicina61050898 - 15 May 2025

Abstract

Background and Objectives: Diabetic ketoacidosis (DKA) represents the most prevalent hyperglycemic emergency and poses a significant life-threatening metabolic risk for individuals with diabetes. The present study examines the predictive role of the leukocyte glucose index (LGI) values at baseline in diagnosing the [...] Read more.

Background and Objectives: Diabetic ketoacidosis (DKA) represents the most prevalent hyperglycemic emergency and poses a significant life-threatening metabolic risk for individuals with diabetes. The present study examines the predictive role of the leukocyte glucose index (LGI) values at baseline in diagnosing the severity of DKA and their correlation with the presence of diabetes-related microvascular complications. Materials and Methods: A retrospective observational study was conducted involving a total of 94 patients who had previously confirmed diagnoses of either Type I or Type II diabetes mellitus and presented with ketoacidosis upon emergency admission to the Department of Diabetology, Nutrition, and Metabolic Disease. Demographic information, values of arterial systolic and diastolic pressure, known duration and type of diabetes, severity of ketoacidosis, routine laboratory results, and blood gas analyses were retrieved from the hospital’s electronic database. Results: Higher diastolic blood pressure (DBP) values were observed in both mild (p = 0.021) and severe DKA (p = 0.035) compared to moderate DKA. When examining laboratory data, elevated white blood cell (WBC) counts were observed in severe DKA when compared to mild DKA (p = 0.009), as well as increased neutrophil counts in both moderate (p = 0.038) and severe (p = 0.011) DKA relative to mild DKA. Furthermore, patients with severe DKA exhibited lower values of venous blood pH, partial pressure of carbon dioxide (pvCO₂), base excess (BE), and bicarbonate than the other groups (all p < 0.05), alongside higher levels of lactate, anion gap, and LGI (all p < 0.05). Regarding the parameters of arterial blood gas, we identified a negative correlation between LGI values and venous blood pH (r = −0.383, p < 0.001), serum bicarbonate (r = −0.352, p < 0.001), pCO₂ (r = −0.271, p = 0.009), and BE (r = −0.330, p < 0.001). At univariate analysis, elevated LGI values are associated with the severity of DKA (OR: 1.87, p = 0.016) and diabetes-related microvascular complications (OR: 2.16, p = 0.010). Conclusions: The positive correlation between LGI and DKA severity and between LGI and diabetes microvascular complications highlights the potential utility of LGI as a predictive marker, facilitating early risk stratification and clinical decision-making. Full article

(This article belongs to the Section Endocrinology)

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12 pages, 1115 KiB

Open AccessArticle

Breathless Strength: Ultrasonographic Insights into Expiratory Muscle Dysfunction in Spinal Cord Injury

by Burak Kutuk, Kadriye Ones and Yunus Emre Dogan

Medicina 2025, 61(5), 897; https://doi.org/10.3390/medicina61050897 - 15 May 2025

Abstract

Background and Objectives: This study aimed to evaluate the predictive value of ultrasonographic abdominal muscle thickness and thickening ratios for expiratory muscle strength in SCI patients. Materials and Methods: A case-controlled, cross-sectional study was conducted with 36 SCI patients and 30 age- and [...] Read more.

Background and Objectives: This study aimed to evaluate the predictive value of ultrasonographic abdominal muscle thickness and thickening ratios for expiratory muscle strength in SCI patients. Materials and Methods: A case-controlled, cross-sectional study was conducted with 36 SCI patients and 30 age- and sex-matched healthy controls. Ultrasonographic measurements of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were performed at rest and during forced expiration. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. Correlation and regression analyses were performed to determine the relationship between ultrasonography (USG) parameters and expiratory muscle function. Results: SCI patients exhibited significantly lower MIP (76.27 ± 29 cmH₂O vs. 91.63 ± 17.3 cmH₂O, p = 0.007) and MEP (64.52 ± 21.55 cmH₂O vs. 119.1 ± 26.48 cmH₂O, p < 0.001) compared to healthy individuals. Ultrasonographic measurements revealed a significant reduction in forced thickness and thickening ratios of EO, IO, and TrA muscles in SCI patients (p < 0.001). MEP was positively correlated with EO forced thickness (r = 0.333, p = 0.047), IO forced thickness (r = 0.501, p = 0.002), and TrA forced thickness (r = 0.530, p = 0.001). Multiple linear regression analysis identified TrA forced thickness as the strongest predictor of MEP (β = 0.49, p = 0.001). Conclusions: Ultrasonographic measurements of abdominal muscle thickness and thickening ratios provide valuable insights into expiratory muscle dysfunction in SCI patients. TrA forced thickness demonstrated the strongest association with MEP, suggesting its potential as a novel, non-invasive biomarker for expiratory muscle weakness. These results support the use of USG as a practical clinical tool for guiding respiratory assessment and rehabilitation strategies in patients with spinal cord injury. Full article

(This article belongs to the Section Neurology)

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7 pages, 1118 KiB

Open AccessArticle

Optimal Localization of the Foramen Ovale for Transseptal Puncture Using the Vertebral Body Units

by Dong Hoon Kang, Sung Eun Park, Jong Woo Kim, Seong Ho Moon, Ho Jeong Cha, Jong Hwa Ahn and Joung Hun Byun

Medicina 2025, 61(5), 896; https://doi.org/10.3390/medicina61050896 - 15 May 2025

Abstract

Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on [...] Read more.

Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on chest X-rays or computed tomography scout views, which are more cost-effective approaches to safely and effectively guide the procedure. We aimed to find the foramen ovale position on chest computed tomography scout views to effectively guide percutaneous transseptal punctures. Materials and Methods: The study population included 31 patients treated with extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, 32 patients diagnosed with atrial fibrillation (AF) who underwent MDCT, and 197 patients who underwent MDCT for non-cardiac conditions. Vertebral body units, defined as the distance between two adjacent vertebral bodies (the sixth and seventh thoracic spines) inclusive of the intervertebral disk space, were used to express the distance from the carina to the foramen ovale on computed tomography scout views. Results: The mean vertebral body units, distance from the carina to the foramen ovale (carina–foramen ovale), and distance from the carina to the foramen ovale on chest computed tomography scout views (carina–foramen ovale vertebral body units⁻¹) were 2.3 ± 0.2 cm, 6.9 ± 0.9 cm, and 3.0 ± 0.3, respectively. Multivariate analysis showed significant correlations between the carina–foramen ovale vertebral body units⁻¹ and sex (β = 0.080; p = 0.028), body mass index (β = −0.020; p < 0.001), age (β = 0; p = 0.013), and the application of extracorporeal membrane oxygenation or the presence of atrial fibrillation (β = 0.130; p = 0.004). Conclusions: Although a three-dimensional approach was not employed, the foramen ovale position may serve as a radiologic guide in various clinical settings where transseptal punctures are required. This technique may be an effective aid in transseptal puncture procedures. Full article

(This article belongs to the Section Cardiology)

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15 pages, 911 KiB

Open AccessSystematic Review

Beyond Diagnosis: Exploring Residual Autonomy in Dementia Through a Systematic Review

by Anna Anselmo, Francesco Corallo, Maria Pagano, Davide Cardile, Angela Marra, Giuseppa Maresca, Rosaria De Luca, Antonella Alagna, Angelo Quartarone, Rocco Salvatore Calabrò and Irene Cappadona

Medicina 2025, 61(5), 895; https://doi.org/10.3390/medicina61050895 - 14 May 2025

Abstract

Background and Objectives: The connection between cognitive decline and autonomy represents a complex and multifactorial area of research. Cognitive decline manifests as a progressive impairment of higher mental functions and is typical of neurodegenerative conditions such as dementia. Autonomy, on the other [...] Read more.

Background and Objectives: The connection between cognitive decline and autonomy represents a complex and multifactorial area of research. Cognitive decline manifests as a progressive impairment of higher mental functions and is typical of neurodegenerative conditions such as dementia. Autonomy, on the other hand, is defined as an individual’s ability to independently manage activities of daily living and make informed decisions. The objective of this study was to investigate whether certain daily living skills can persist despite the advancement of dementia, and what factors contribute to their preservation in maintaining autonomy. Materials and Methods: A literature review was conducted using the databases PubMed, Web of Science, Scopus, Cochrane Library, Embase, and PsycInfo. Out of an initial pool of 12,113 studies, only 19 met the inclusion criteria and were selected for analysis. Results: The findings indicate that, in non-institutionalized settings, some daily living abilities may remain preserved despite cognitive deterioration. In contrast, within institutionalized environments, a significant correlation emerged between cognitive decline and the progressive loss of personal autonomy. Conclusions: This study highlights the importance of assessing residual abilities in individuals with dementia. Recognizing and supporting these remaining skills can play a crucial role in enhancing quality of life, delaying institutionalization, and promoting autonomy even in the presence of advanced cognitive decline. Full article

(This article belongs to the Section Neurology)

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14 pages, 4013 KiB

Open AccessArticle

Platelet-Rich Plasma Provides Superior Clinical Outcomes Without Radiologic Differences in Lateral Epicondylitis: Randomized Controlled Trial

by Taha Kizilkurt, Ahmet Serhat Aydin, Taha Furkan Yagci, Ali Ersen, Celal Caner Ercan and Artür Salmaslioglu

Medicina 2025, 61(5), 894; https://doi.org/10.3390/medicina61050894 - 14 May 2025

Abstract

Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: [...] Read more.

Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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13 pages, 1102 KiB

Open AccessArticle

Impacts of an Oral Appliance on Snoring in Adults with Varying Degrees of Snoring Severity: A Preliminary Study

by Yu-Hsiang Cheng, Jui-Kun Chiang, Yen-Chang Lin, Hsueh-Hsin Kao and Yee-Hsin Kao

Medicina 2025, 61(5), 893; https://doi.org/10.3390/medicina61050893 - 14 May 2025

Abstract

Background and Objectives: Oral appliances (OAs) are commonly used to manage sleep-disordered breathing conditions, including primary snoring, and offer an alternative treatment for individuals with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP) therapy. Our study analyzed the [...] Read more.

Background and Objectives: Oral appliances (OAs) are commonly used to manage sleep-disordered breathing conditions, including primary snoring, and offer an alternative treatment for individuals with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP) therapy. Our study analyzed the possible factors associated with higher snoring rates compared with those associated with lower snoring rates. Materials and Methods: A customized dental brace with a tongue compressor was the essential part of the Lin OA (LOA). The compressor is available in various lengths, ranging from 0.5 to 3.0 cm across different versions. The participants wore the LOA throughout the night while sleeping. Their snoring rates were recorded using the SnoreClock app on their cell phones. Results: The analysis included 36 participants, comprising 30 males and 6 females. The participants had a mean age of 44.91 ± 9.96 years, a mean BMI of 26.18 ± 3.50 kg/m², and an average recording duration of 398.27 ± 77.56 min per session. In total, 4052 sleep recordings were analyzed. The number of files for females was less than that for males (563 vs. 3489). In this study, individuals belonging to the highest one-third based on the baseline snoring rate (H group) experienced a significant reduction in snoring, approximately 84.8%, when using the LOA-3 cm device equipped with a 3 cm tongue compressor. The individuals who belonged to the lower two-thirds based on the baseline snoring rate were classified as the L group. Among male participants, snoring decreased by approximately 66.4%. Similarly, among female participants in the L group, snoring decreased by approximately 69.3% when using the LOA-3 cm. Conclusions: In this study, we observed a significant reduction in snoring for the two groups of participants wearing the LOA-3 cm, with the rate decrements ranging from 66.4% to 84.8%. This reduction was more pronounced in the H group than in the male participants in the L group. Further studies are needed to explore the reasons for these findings. Full article

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

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7 pages, 1422 KiB

Open AccessArticle

Exploring the Potential of a P2X3 Receptor Antagonist: Gefapixant in the Management of Persistent Cough Associated with Interstitial Lung Disease

by Tomoyuki Takahashi, Atsushi Saito, Takafumi Yorozuya, Hirotaka Nishikiori, Koji Kuronuma and Hirofumi Chiba

Medicina 2025, 61(5), 892; https://doi.org/10.3390/medicina61050892 - 14 May 2025

Abstract

Background: Interstitial lung disease (ILD) is characterized by pulmonary inflammation and fibrosis associated with persistent and refractory cough that significantly hinders quality of life. Conventional treatments for ILD-associated cough have shown limited efficacy, necessitating alternative therapeutic approaches. Gefapixant, a P2X3 receptor antagonist, can [...] Read more.

Background: Interstitial lung disease (ILD) is characterized by pulmonary inflammation and fibrosis associated with persistent and refractory cough that significantly hinders quality of life. Conventional treatments for ILD-associated cough have shown limited efficacy, necessitating alternative therapeutic approaches. Gefapixant, a P2X3 receptor antagonist, can potentially alleviate chronic cough by inhibiting the ATP-mediated activation of sensory C-fibers, but its efficacy in ILD-associated cough remains unclear. This study observed the effects of gefapixant on ILD-associated refractory chronic cough. Methods: This prospective study enrolled patients with ILD-associated refractory chronic cough who received gefapixant at Sapporo Medical University Hospital between July 2022 and November 2023. Cough frequency, Leicester Cough Questionnaire (LCQ) score, cough severity visual analog scale (Cough VAS), and taste VAS were evaluated at baseline and at 2, 4, and 8 weeks after gefapixant administration. Results: Six patients completed the study. Their ILD subtypes included idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), and connective tissue disease-associated ILDs (CTD-ILDs). After 8 weeks, the cough frequency decreased from 88.5 to 44.3 episodes per 30 min, LCQ scores increased from 8.3 to 13.6, and cough VAS scores decreased from 75.8 to 40.2. However, statistical significance was not reached due to high interindividual variability, with gefapixant being effective in some and ineffective in others. The most common adverse event was taste disorder, leading to discontinuation in one patient, but symptoms tended to lessen over the course of treatment. Conclusions: Gefapixant appears to be effective in reducing refractory cough related to ILD, although these results were not statistically significant because its effectivity widely varied across individuals. Further investigation is needed to identify patient subgroups with the greatest potential for treatment responsiveness. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Interstitial Lung Disease)

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7 pages, 490 KiB

Open AccessArticle

Sex Differences in the In-Hospital Mortality of Patients with Acute Myocardial Infarction: A Cross-Sectional Study in 36 Hospitals Across Germany

by Karel Kostev, Nimran Kaur, Sabine Kluge, Marcel Konrad, Jamschid Sedighi and Mark Lüdde

Medicina 2025, 61(5), 891; https://doi.org/10.3390/medicina61050891 - 14 May 2025

Abstract

Background and Objectives: Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide and caused ~1.8 million deaths in the European Union from 2012 to 2020. This study aimed to analyze and quantify sex-based disparities, identifying both clinical and systemic [...] Read more.

Background and Objectives: Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide and caused ~1.8 million deaths in the European Union from 2012 to 2020. This study aimed to analyze and quantify sex-based disparities, identifying both clinical and systemic contributors to in-hospital mortality differences between male and female patients. Materials and Methods: This multicenter cross-sectional study from 36 hospitals across Germany included all hospitalized patients aged ≥18 years with admissions between January 2019 and December 2023 and a primary diagnosis of AMI. The primary outcome of the study was the prevalence of in-hospital mortality as a function of sex. Multivariable logistic regression analyses were conducted to assess the associations between female sex as compared with male sex and in-hospital mortality. Results: The present study included 9142 male and 4128 female patients with AMI. Women were significantly older than men (74.4 years versus 67.7 years). The proportion of non-ST elevation (NSTE-MI)-MI was higher in women than in men (70.7% versus 66.7%). Overall, in-hospital mortality was higher in women than in men (8.5% versus 7.1%). In a multivariable regression model, female sex was not significantly associated with in-hospital mortality (OR: 0.89; 95% CI: 0.77–1.04) irrespective of the MI type. Conclusions: There were no significant sex-based differences observed in the in-hospital mortality among patients suffering from AMI in Germany. Full article

(This article belongs to the Special Issue Advances in Acute Myocardial Infarction)

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16 pages, 1847 KiB

Open AccessSystematic Review

Lower Urinary Tract Symptoms in Uterine Myoma: A Systematic Review and Meta-Analysis

by Lek-Hong Tan and Li-Hsien Tsai

Medicina 2025, 61(5), 890; https://doi.org/10.3390/medicina61050890 - 14 May 2025

Abstract

Background and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates [...] Read more.

Background and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates and odds ratios for LUTSs in patients with UM. Materials and Methods: A systematic literature search using PubMed and Embase was conducted for articles published between 1 January 2000 and 24 September 2023. The search and review processes followed the PRISMA and MOOSE guidelines. This study was registered in PROSPERO (CRD42023474156). Data on the prevalence and odds ratios of LUTSs—including storage symptoms (frequency, urgency, nocturia), voiding symptoms, and urinary incontinence (UI) subtypes such as stress incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI)—were extracted. Pooled prevalence estimates and odds ratios were calculated using random-effects meta-analysis. Subgroup analyses and univariate meta-regression were conducted to examine associations with age, BMI, parity, WHO region, and risk of bias. The impact of UM size was assessed using standardized mean differences. Results: Of the 572 articles screened, 20 met the inclusion criteria. The overall pooled prevalence of LUTSs in UM patients was 49% (95% CI, 26–72%), with substantial heterogeneity across studies (I² = 99.8%). The pooled prevalence for urinary frequency, urgency, nocturia, voiding dysfunction, and overall UI, SUI, UUI, and MUI ranged from 15% to 54%. SUI and UUI were significantly associated with UM (OR = 2.0, 95% CI: 1.2–3.3; OR = 1.5, 95% CI: 1.1–2.0, respectively). Hysterectomy was not associated with an improvement in overactive bladder (OAB) symptoms (OR = 1.9, 95% CI: 0.6–5.7). A larger UM size was not linked to worsening LUTS. Fourteen studies (70%) had some concerns about the risk of bias, while six studies (30%) had a low risk of bias. Egger’s test showed no significant publication bias (p = 0.19). Conclusions: Approximately half of patients with UM experience LUTSs or UI. The findings emphasize the need to consider urinary symptoms in UM management. Further research is warranted to reduce heterogeneity and explore treatment-specific outcomes. Full article

(This article belongs to the Section Urology & Nephrology)

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12 pages, 299 KiB

Open AccessArticle

Prospective Evaluation of Clinical and Laboratory Profiles of Febrile and Afebrile Immunosuppressed Patients Presenting to the Emergency Department

by Tuğrul Topal, Esra Pamukçu, Muhammet Gökhan Turtay, Gülşen Yalçın, Harun Kürşat Şahingil and Mehmet Sezer

Medicina 2025, 61(5), 889; https://doi.org/10.3390/medicina61050889 - 14 May 2025

Abstract

Background and Objectives: Immunosuppressed patients are at higher risk of delayed diagnosis and atypical presentations in the emergency department (ED), requiring prompt management. This study compares febrile (≥37.5 °C) and afebrile (<37.5 °C) immunosuppressed patients admitted to the ED regarding clinical and [...] Read more.

Background and Objectives: Immunosuppressed patients are at higher risk of delayed diagnosis and atypical presentations in the emergency department (ED), requiring prompt management. This study compares febrile (≥37.5 °C) and afebrile (<37.5 °C) immunosuppressed patients admitted to the ED regarding clinical and laboratory parameters, including blood and urine tests, vital signs, final diagnoses, outcomes, and mortality. Materials and Methods: Eighty immunosuppressed patients aged 18–82 were prospectively evaluated from May 2019 to May 2020. Data on blood and urine tests, final diagnoses, outcomes, and mortality were recorded using a standardized form. Results: Among the 80 patients, 44 (55%) were female and 36 (45%) were male, with a mean age of 58.5 ± 14.72 years. The febrile patients showed higher admission levels of lactate dehydrogenase (LDH), interleukin-6 (IL-6), procalcitonin (PCT), and longer hospital stays than the afebrile patients. Mortality correlated with low albumin, oxygen saturation, platelet count, and total protein levels and elevated PCT and lipase levels. ICU admissions were linked to low albumin, total protein, and systolic blood pressure levels and elevated LDH, blood urea nitrogen, neutrophil count, and PCT levels. The fever status (febrile versus afebrile) had no significant relationship with the immunosuppression type, complaints, diagnoses, outcomes, or mortality. Final diagnoses varied by immunosuppression type: cholangitis in liver transplant recipients, respiratory infections in cancer patients, and urinary tract infections in kidney transplant recipients. Conclusions: Immunosuppressed patients can present with severe conditions, even without fever. Based on our findings, our study emphasizes that measuring PCT in immunosuppressed patients presenting to the emergency department with various complaints but without fever may help reduce the risk of delayed diagnosis. Full article

(This article belongs to the Special Issue Advances and Challenges in Prehospital Emergency Care)

16 pages, 1454 KiB

Open AccessArticle

Meta-Analysis of 16S rRNA Sequencing Reveals Altered Fecal but Not Vaginal Microbial Composition and Function in Women with Endometriosis

by Astrid Torraco, Sara Di Nicolantonio, Martina Cardisciani, Eleonora Ortu, Davide Pietropaoli, Serena Altamura and Rita Del Pinto

Medicina 2025, 61(5), 888; https://doi.org/10.3390/medicina61050888 - 14 May 2025

Abstract

Background and Objectives: Dysbiosis of the oral–gut axis is related to several extraintestinal inflammatory diseases, including endometriosis. This study aims to assess the microbial landscape and pathogenic potential of distinct biological niches during endometriosis. Materials and Methods: A microbiome meta-analysis was [...] Read more.

Background and Objectives: Dysbiosis of the oral–gut axis is related to several extraintestinal inflammatory diseases, including endometriosis. This study aims to assess the microbial landscape and pathogenic potential of distinct biological niches during endometriosis. Materials and Methods: A microbiome meta-analysis was conducted on 182 metagenomic sequences (79 of fecal and 103 of vaginal origin) from women with and without endometriosis. Fecal and vaginal microbial diversity, differential abundance, and functional analysis based on disease status were assessed. Random forest, gradient boosting, and generalized linear modeling were used to predict endometriosis based on differentially enriched bacteria. Results: Only intestinal microbes displayed distinctive taxonomic and functional characteristics in women with endometriosis compared to control women. Taxonomic differences were quantified using the microbial endometriosis index (MEI), which effectively distinguished between individuals with and without the disease. The observed functional enrichment pointed to proinflammatory pathways previously related to endometriosis development. Conclusions: Dysbiosis in the oral–gut microbial community appears to play a prevalent role in endometriosis. Our findings pave the ground for future studies exploring the potential mechanistic involvement of the oral–gut axis in disease pathogenesis. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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