Medicina

18 pages, 521 KiB

Open AccessArticle

A Preliminary Investigation into the Use of Cannabis Suppositories and Online Mindful Compassion for Improving Sexual Function Among Women Following Gynaecological Cancer Treatment

by Samantha Banbury, Hannah Tharmalingam, Joanne Lusher, Simon Erridge and Chris Chandler

Medicina 2024, 60(12), 2020; https://doi.org/10.3390/medicina60122020 (registering DOI) - 7 Dec 2024

Abstract

Background and Objectives: The impact of gynaecological cancer and its treatments on sexual intimacy can be profound on female sexuality. However, very few registered clinical trials have addressed sexual intimacy among this cohort. Materials and Methods: This preliminary randomised control trial (RCT) and [...] Read more.

Background and Objectives: The impact of gynaecological cancer and its treatments on sexual intimacy can be profound on female sexuality. However, very few registered clinical trials have addressed sexual intimacy among this cohort. Materials and Methods: This preliminary randomised control trial (RCT) and content analysis assessed the effectiveness of a brief online mindful compassion group intervention adjunct with cannabis suppositories. Eighty-three participants aged between 18 and 50+ years who were at least six months post-cancer treatment were randomly allocated to one of four groups, depending on whether they were already using cannabis suppositories. These included a cannabis-only group (CO), a mindful-compassion group (MC), a combined mindful-compassion and cannabis suppositories group (COCM) and a care-as-usual group (CAU). Measurements of sexual function, sexual self-efficacy, mindful compassion, well-being and quality of life were taken at weeks 0, 4 and 12. Results: Sexual function, including arousal, lubrication and orgasms, improved for both the MC p = 0.002 and COCM p ≤ 0.001 groups; in addition, sexual pain was reduced in the COCM p = 0.008 and CO p ≤ 0.001 groups compared to the CAU and MC groups, where p ≥ 0.05. Feedback suggested that cannabis mediated the effects of mindful compassion and supported well-being, sexual self-efficacy, and quality of life. Participants also voiced a preference for cannabis suppositories when using dilators as part of their treatment and the use of sex toys instead of dilators, suggesting that dilators had negatively impacted their sexuality. Conclusions: These preliminary and exploratory outcomes look promising and provide a foundation for future research to develop varied healthcare options to improve mental health service delivery and quality of life for this cohort. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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16 pages, 6140 KiB

Open AccessArticle

Alterations in Biomarkers Associated with Cardiovascular Health and Obesity with Short-Term Lifestyle Changes in Overweight Women: The Role of Exercise and Diet

by Nezihe Şengün, Ragıp Pala, Vedat Çınar, Taner Akbulut, Alin Larion, Johnny Padulo, Luca Russo and Gian Mario Migliaccio

Medicina 2024, 60(12), 2019; https://doi.org/10.3390/medicina60122019 (registering DOI) - 7 Dec 2024

Abstract

Background and Objectives: In this study, the effects of an eight-week exercise and nutrition program on blood lipids, glucose, insulin, insulin resistance (HOMA-IR), leptin, ghrelin, irisin, malondialdehyde (MDA), and Growth Differentiation Factor 15 (GDF15) in overweight women were investigated. Materials and Methods: [...] Read more.

Background and Objectives: In this study, the effects of an eight-week exercise and nutrition program on blood lipids, glucose, insulin, insulin resistance (HOMA-IR), leptin, ghrelin, irisin, malondialdehyde (MDA), and Growth Differentiation Factor 15 (GDF15) in overweight women were investigated. Materials and Methods: A total of 48 women volunteers participated in this study. The participants were randomly divided into four groups: control (C), exercise (E), nutrition (N), exercise + nutrition (E + N). While no intervention was applied to group C, the other groups participated in the predetermined programs for 8 weeks. At the beginning and end of this study, body composition was measured and blood samples were taken. Results: It was determined that the body composition components, lipid profile indicators, insulin, glucose, insulin resistance, leptin, ghrelin, irisin, and MDA parameters examined in this study showed positive changes in the intervention groups. Group E had a greater effect on body muscle percentage, MDA, and irisin levels, while group N had a greater effect on blood lipids and ghrelin levels. Conclusions: As a result, it is thought that lifestyle changes are important to improve cardiovascular health and combat obesity, and that maintaining a healthy diet together with exercise may be more effective. Full article

(This article belongs to the Special Issue Chronic Stress and Obesity: Psychology, Nutrition and Modern Lifestyle Behavior)

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10 pages, 733 KiB

Open AccessArticle

Validity of Pleth Variability Index to Predict Fluid Responsiveness in Patients Undergoing Cervical Spine Surgery in the Modified Prone Position

by Won Uk Koh, Dong-Ho Lee, Young-Jin Ro and Hee-Sun Park

Medicina 2024, 60(12), 2018; https://doi.org/10.3390/medicina60122018 (registering DOI) - 7 Dec 2024

Abstract

Background and Objective: The modified prone position, which is an alteration of the standard prone position, reduces cardiac preload. Dynamic variables including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) are reliable predictors for fluid responsiveness during [...] Read more.

Background and Objective: The modified prone position, which is an alteration of the standard prone position, reduces cardiac preload. Dynamic variables including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) are reliable predictors for fluid responsiveness during surgery. To the best of our knowledge, no studies assessing dynamic variables for fluid responsiveness have been conducted in the modified prone position. This study aimed to evaluate the ability of PVI to predict fluid responsiveness in the modified prone position during cervical spine surgery. Materials and Methods: PVI, SVV, and PPV were recorded at the following times: before and after a 4 mL/kg crystalloid load in the supine position (T1, T2); after placement in the modified prone position (T3); and before and after a 4 mL/kg crystalloid administration in the modified prone position (T4, T5). Fluid responsiveness was defined as stroke volume (SV) ≥ 15%, assessed by the FloTrac/Vigileo™ (Edwards Lifesciences Corp, Irvine, CA, USA). Receiver operating characteristic (ROC) curves were analyzed to identify changes in each dynamic variable that could predict fluid responsiveness in the modified prone position. Results: Data from a total of 43 subjects were analyzed. In the supine position, 21 subjects were responders. After subjects were placed in the modified prone position, SV significantly decreased, while PVI, SVV, and PPV significantly increased (p < 0.001 for all). In the modified prone position, 13 subjects were responders, and the areas under the ROC curves for ΔPVI, ΔSVV, and ΔPPV after fluid loading were 0.524 (95% confidence interval [CI] 0.329–0.730, p = 0.476), 0.749 (95% CI 0.566–0.931, p = 0.004), and 0.790 (95% CI 0.641–0.938, p < 0.001), respectively. Conclusions: Crystalloid pre-loading could not mitigate the decrease in SV caused by the modified prone position. Changes in PVI were less reliable in predicting fluid responsiveness in the modified prone position. Full article

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

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17 pages, 1159 KiB

Open AccessReview

Impact of Exercise on Physiological, Biochemical, and Analytical Parameters in Patients with Heart Failure with Reduced Ejection Fraction

by Francisco Epelde

Medicina 2024, 60(12), 2017; https://doi.org/10.3390/medicina60122017 (registering DOI) - 6 Dec 2024

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a condition marked by diminished cardiac output and impaired oxygen delivery to tissues. Exercise, once avoided in HFrEF patients due to safety concerns, is now recognized as an important therapeutic intervention. Structured exercise improves various [...] Read more.

Heart failure with reduced ejection fraction (HFrEF) is a condition marked by diminished cardiac output and impaired oxygen delivery to tissues. Exercise, once avoided in HFrEF patients due to safety concerns, is now recognized as an important therapeutic intervention. Structured exercise improves various physiological, biochemical, and analytical parameters, including cardiac output, endothelial function, skeletal muscle performance, and autonomic regulation. Biochemically, exercise induces favorable changes in inflammatory markers, lipid profiles, glucose metabolism, and renal function. This paper reviews these changes, highlighting how exercise can be safely incorporated into HFrEF management. Further research is needed to tailor exercise interventions for individual patients to optimize outcomes. Full article

(This article belongs to the Section Cardiology)

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28 pages, 3325 KiB

Open AccessSystematic Review

Clozapine and Pneumonia: Synthesizing the Link by Reviewing Existing Reports—A Systematic Review and Meta-Analysis

by Victor Zhao, Yiting Gong, Naveen Thomas and Soumitra Das

Medicina 2024, 60(12), 2016; https://doi.org/10.3390/medicina60122016 - 6 Dec 2024

Abstract

Background and Objectives: Clozapine is a highly effective antipsychotic used for treating treatment-refractory psychotic and mood disorders. However, clozapine also has a serious risk of side effects leading to mortality, particularly its potentiated risk of leading to pneumonia. This review aims to overview [...] Read more.

Background and Objectives: Clozapine is a highly effective antipsychotic used for treating treatment-refractory psychotic and mood disorders. However, clozapine also has a serious risk of side effects leading to mortality, particularly its potentiated risk of leading to pneumonia. This review aims to overview the demographic and health-related risk factors leading to pneumonia to better inform risk assessment for clozapine users and to summarise current theories on the mechanisms for clozapine-associated pneumonia. This paper will highlight the need to prioritise pneumococcal vaccination in this population group. Materials and Method: We conducted a literary search of five online databases conforming to PRISMA. Our review includes all peer-reviewed papers with original data that discuss clozapine and pneumonia and excludes case reports. Baseline information of participants, pneumonia-related information and information regarding risk factors and mechanisms causing pneumonia were also extracted. Results: Clozapine was found to have an increased risk of pneumonia compared to other antipsychotic medications. Factors included comorbidities, higher clozapine dosages, and concurrent use of other antipsychotic medications. Key mechanisms for clozapine-associated pneumonia include clozapine-induced hyper sedation, sialorrhea and neutropoenia. Conclusions: While clozapine improves overall mortality for patients, our review confirms clozapine has the highest risk of pneumonia of all antipsychotics. The review also highlights the prevalent underuse of pneumococcal vaccines among clozapine users and the urgent need to increase uptake. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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15 pages, 1023 KiB

Open AccessReview

Cathelicidin in Urinary Tract Diseases: Diagnostic, Prognostic and Therapeutic Potential of an Evolutionary Conserved Antimicrobial Protein

by Iva Sorić Hosman, Andrea Cvitković Roić, Ivana Vuković Brinar, Tonko Gulin, Marijana Ćorić, Dunja Rogić, Ana Lončar Vrančić and Lovro Lamot

Medicina 2024, 60(12), 2015; https://doi.org/10.3390/medicina60122015 - 6 Dec 2024

Abstract

Despite being one of the most common infectious diseases, urinary tract infections (UTIs) still represent a challenge for clinicians to diagnose and treat, especially in the era of growing antibiotic resistance among uropathogenic bacteria. Recent studies investigating the pathophysiology of UTIs have discovered [...] Read more.

Despite being one of the most common infectious diseases, urinary tract infections (UTIs) still represent a challenge for clinicians to diagnose and treat, especially in the era of growing antibiotic resistance among uropathogenic bacteria. Recent studies investigating the pathophysiology of UTIs have discovered the prominent role of antimicrobial peptides in the urinary tract defense system. Cathelicidin is an evolutionary conserved antimicrobial peptide encoded by one single gene in humans. Except for being stored in neutrophil cytoplasmic granules, cathelicidin is produced by uroepithelial cells rapidly upon contact with a uropathogen, even before leukocytes invade the urinary tract. In addition to its bactericidal effect, cathelicidin acts as a chemoattractant for multiple immune cells and a potent inductor of numerous cytokine synthesis. Such a crucial role in the initial pathogenesis of a UTI makes cathelicidin a potential biomarker for an early UTI diagnosis. Indeed, multiple studies over the last two decades have proved the potential clinical utility of cathelicidin as a UTI diagnostic biomarker. Furthermore, since patients after the resolution of a UTI have been found to express a lower urinary cathelicidin level than healthy controls, decreased cathelicidin levels have been suggested as a risk factor for developing UTI recurrence. Therefore, measuring cathelicidin levels in urine might help in distinguishing patients with a higher risk for a recurrent UTI. Interestingly, except in UTIs, cathelicidin has also been evaluated in other urinary tract diseases and proposed as a biomarker for diagnosing severe vesicoureteral reflux (VUR) and for recognizing renal scar development in patients with VUR. Finally, a prominent role in UTI pathogenesis also makes cathelicidin an attractive therapeutic target for treating UTIs and, lately, different therapeutic agents up-regulating cathelicidin expression have been investigated in this matter. Therefore, the present review aims to summarize the current body of knowledge on the diagnostic, prognostic and therapeutic potential of cathelicidin in urinary tract diseases. For this purpose, three databases (Scopus, Medline and Web of Science) were extensively searched to cover all the published articles. This exhaustive review will update clinicians on the contemporary state of knowledge about the potential clinical utility of cathelicidin in urinary tract diseases and hopefully encourage further research, resulting in improvement in the current management of urinary tract diseases. Full article

(This article belongs to the Section Urology & Nephrology)

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9 pages, 1392 KiB

Open AccessArticle

Comparative Analysis of da Vinci^® Xi and hinotori™ SRS Robot-Assisted Surgery Systems for Gynecologic Disorders: A Retrospective Study

by Shinichi Togami, Nozomi Furuzono, Yusuke Kobayashi, Chikako Nagata, Mika Fukuda, Mika Mizuno, Shintaro Yanazume and Hiroaki Kobayashi

Medicina 2024, 60(12), 2014; https://doi.org/10.3390/medicina60122014 - 6 Dec 2024

Abstract

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci^® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 [...] Read more.

Background and Objectives: This study aims to evaluate and compare the safety and efficacy of the da Vinci^® Xi and hinotori™ SRS robot-assisted surgical systems for gynecologic disorders. Materials and Methods: We conducted a retrospective study of 401 cases (43 benign uterine tumors; 88 pelvic organ prolapses; 270 low-risk endometrial cancers) of robot-assisted surgery performed at Kagoshima University Hospital between January 2017 and October 2024. Surgical factors such as the operative time, blood loss, and complication rates were analyzed and compared between the da Vinci^® Xi (332 cases) and hinotori™ SRS (69 cases) systems. Complications were classified according to the Clavien–Dindo classification, with Grade 2 or higher considered significant. Results: Significant differences were observed between the two groups in terms of age, body mass index, cockpit/console time, and median time from roll-in to cockpit/console start. The cockpit/console time was significantly longer for the hinotori™ SRS system (173 min) compared to the da Vinci^® Xi (156 min; p = 0.047). No significant differences were observed in the total operative time, blood loss, or length of hospital stay. Intraoperative complications were minimal, with one case of bladder injury and one case of vascular injury recorded for the da Vinci^® Xi. The overall postoperative complication rate was approximately 4%. Conclusions: Robot-assisted surgery using both the da Vinci^® Xi and hinotori™ SRS systems was found to be safe, with minimal blood loss and a low complication rate. The hinotori™ SRS system demonstrated operative outcomes comparable to those of the da Vinci Xi^® system, suggesting that it may serve as a viable alternative. Further prospective studies are warranted to evaluate the efficacy and safety of these systems. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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14 pages, 343 KiB

Open AccessReview

Gynecological Insights into Lynch Syndrome—A Comprehensive Review of Cancer Screening and Prevention

by Elena Chitoran, Roxana-Elena Bohiltea, Vlad Rotaru, Cristiana-Elena Durdu, Madalina-Nicoleta Mitroiu and Laurentiu Simion

Medicina 2024, 60(12), 2013; https://doi.org/10.3390/medicina60122013 - 6 Dec 2024

Abstract

Lynch syndrome, one of the most common genetic syndromes predisposing to cancer, is associated with a series of malignant conditions, among which the most frequent is colorectal cancer, but gynecologic cancers (especially endometrial) are also quite common. Despite the significant progress made in [...] Read more.

Lynch syndrome, one of the most common genetic syndromes predisposing to cancer, is associated with a series of malignant conditions, among which the most frequent is colorectal cancer, but gynecologic cancers (especially endometrial) are also quite common. Despite the significant progress made in understanding this condition over time, there are still aspects in managing this condition that have not demonstrated clear benefits. This article aims to summarize the recommendations of international societies and present the latest developments in managing Lynch syndrome, focusing on gynecologic cancer screening and possible prevention strategies. Advances in genetic testing procedures and discoveries related to the association between oncological pathology frequency and the affected pathogenic variant type will probably lead to personalized medicine focused on the individual patient in the coming years. Although various screening methods for gynecological cancers in patients with Lynch syndrome have been used over time, they have not shown significant survival benefits. This highlights the need for studying and implementing new screening and diagnostic methods, which have been under investigation in recent years and are mentioned in this article. Full article

(This article belongs to the Special Issue Recent Advances in Diagnosis and Therapy of Gynecologic and Breast Cancers)

10 pages, 292 KiB

Open AccessReview

HER2-Positive Serous Endometrial Cancer Treatment: Current Clinical Practice and Future Directions

by Dimitrios Papageorgiou, Galateia Liouta, Ioakeim Sapantzoglou, Eleftherios Zachariou, Dimitra Pliakou, Katerina Papakonstantinou, Theofanis Floros and Evangelia Pliakou

Medicina 2024, 60(12), 2012; https://doi.org/10.3390/medicina60122012 - 6 Dec 2024

Abstract

The most common histological subtypes of endometrial cancer consist of endometrioid and uterine serous carcinoma, with the latter being more aggressive and accompanied by poor prognosis. Human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor associated with cell proliferation, [...] Read more.

The most common histological subtypes of endometrial cancer consist of endometrioid and uterine serous carcinoma, with the latter being more aggressive and accompanied by poor prognosis. Human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor associated with cell proliferation, differentiation, and survival. HER2 positivity can be diagnosed in many solid tumors. It has been found that approximately one-third of the patients diagnosed with serous carcinoma may overexpress HER2/neu protein and/or show the amplification of the c-erBb2 gene. The prognostic and predictive value of HER2 biomarker is nowadays highlighted and the updates of HER2-directed treatment offer new opportunities for improved efficacy and survival. A number of HER2-targeted therapies have become available in recent years and have had promising results, prompting full drug approvals and additional investigation in many cancer types, among which is endometrial cancer. Data from clinical trials combining classical chemotherapy with anti-HER2 agents, mainly trastuzumab, alone or in combination with pertuzumab, do exist and have been incorporated into international guidelines. Moreover, further research with antibody–drug conjugates and tyrosine kinase inhibitors is being conducted. Acquired resistance remains an important problem, and its underlying mechanisms in endometrial cancer are mostly unknown. Studies exploring earlier use of Her2-directed therapy are also on the way. The purpose of this literature review is to describe the available therapies in the current clinical practice and the most prominent research data regarding the future. In any case, a number of unmet medical needs do exist for HER2-positive serous endometrial cancer, and additional research and studies are warranted to provide further understanding and improved outcomes for this tumor type. Full article

(This article belongs to the Special Issue Updates on Endometrial Cancer Screening and Treatment)

10 pages, 6297 KiB

Open AccessCase Report

Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

by Wen-Jui Liao, Chun-Yuan Hsiao, Chin-Hsiu Chen, Yuan-Yun Tseng and Tao-Chieh Yang

Medicina 2024, 60(12), 2011; https://doi.org/10.3390/medicina60122011 - 5 Dec 2024

Abstract

Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head [...] Read more.

Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head trauma with a skull base fracture and brain contusion hemorrhage. The clinical manifestations of the patient included pulsatile exophthalmos, proptosis, bruits, chemosis, and a decline in consciousness. Magnetic resonance imaging (MRI) revealed engorgement of the right superior ophthalmic vein (SOV), perifocal cerebral edema in the right frontal–temporal cortex, right basal ganglia, and brain stem. Digital subtraction angiography (DSA) disclosed a direct type high-flow CCF with an aggressive cortical venous reflux drainage pattern, which was attributed to Barrow type A and Thomas classification type 5. After partial treatment by transvenous coil embolization for the CCF, the residual high-flow fistula with aggressive venous drainage had an unusual rapid spontaneous resolution in a brief period. Therefore, it is strongly recommended to meticulously monitor the clinical conditions of patients and perform brain MRI and DSA at short intervals to determine the treatment strategy for residual CCF after partial endovascular treatment. Full article

(This article belongs to the Section Neurology)

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11 pages, 1135 KiB

Open AccessCase Report

Exploring the Differential Diagnosis of Adrenal Adenoma in the Context of Situs Ambiguous: A Clinical Case Study

by Pavel E. Stanchev, Mariya Dimitrova, Desislava Makakova and Boris Tilov

Medicina 2024, 60(12), 2010; https://doi.org/10.3390/medicina60122010 - 5 Dec 2024

Abstract

Situs anomalies, including situs inversus and situs ambiguous (SAMB), are rare congenital conditions typically noted in pediatric populations, with SAMB being particularly uncommon in adults. This case study addresses the incidental discovery of situs ambiguous with polysplenia in a 65-year-old man evaluated for [...] Read more.

Situs anomalies, including situs inversus and situs ambiguous (SAMB), are rare congenital conditions typically noted in pediatric populations, with SAMB being particularly uncommon in adults. This case study addresses the incidental discovery of situs ambiguous with polysplenia in a 65-year-old man evaluated for suspected adrenal adenoma. The patient’s medical history included benign prostatic hyperplasia and tuberculous pleurisy. Methods included a thorough physical examination and laboratory tests, which showed normal cortisol levels and ACTH rhythm. Contrast-enhanced CT imaging revealed multiple spleens near the right adrenal region, altered liver positioning, a truncated pancreas, and a right-sided stomach, while the right adrenal gland was not visualized. Notably, the patient exhibited minimal symptoms despite these significant anatomical anomalies. The findings underscore the rarity of situs ambiguous in adults and its unexpected association with endocrine pathology. This case highlights the importance of comprehensive imaging and a multidisciplinary approach in managing patients with unusual anatomical presentations. It suggests that situs anomalies may be more prevalent in adult populations than previously recognized and emphasizes the need for increased clinical awareness and evaluation in similar cases. Full article

(This article belongs to the Section Endocrinology)

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14 pages, 2304 KiB

Open AccessArticle

Our Experience and Clinical Findings in Perineal Burns: Implications for Patient Prognosis—A 3 Year Retrospective Study

by Matei Iordache, Eliza-Maria Bordeanu-Diaconescu, Andreea Grosu-Bularda, Mihaela-Cristina Andrei, Adrian Frunza, Sabina Grama, Raducu Costache, Tiberiu-Paul Neagu, Ioan Lascar and Cristian-Sorin Hariga

Medicina 2024, 60(12), 2009; https://doi.org/10.3390/medicina60122009 - 5 Dec 2024

Abstract

Background and Objectives: Burn injury represents a very important public health problem that affects all age groups. Of all burns, of particular interest is that of the perineum. Despite the importance of the subject, unfortunately, the medical literature on this anatomical region is [...] Read more.

Background and Objectives: Burn injury represents a very important public health problem that affects all age groups. Of all burns, of particular interest is that of the perineum. Despite the importance of the subject, unfortunately, the medical literature on this anatomical region is sparse. With this study we aim to analyze the characteristics of burns affecting the perineal area, the physiopathologic implications of this injury, the influence of patient prognosis, possible complications and therapeutic guidelines. Materials and Methods: This study is formed by a retrospective analysis of cases that were admitted over a period spanning 3 years with a total of 258 burned patients. After inclusion criteria, we selected 49 patients who had perineal burns and compared this group to a non-perineal burns lot of 198 patients (11 were excluded). We studied their characteristics and the demographical aspects that we deemed most important to their condition: age, sex, burn percentage of total body surface area (TBSA), the percentage of third-degree lesions, comorbidities, and associated infections, inhalation injuries and we calculated the significant scores such as the Abbreviated Burn Severity Index score (ABSI). Results: The patients in our study mostly had severe extensive burns (64.9% mean TBSA) which were also underlined by the mean ABSI of 10.88 ± 2.46 thus having a poor prognosis considering their age, the percentage of burned area, the presence of third-degree burns and inhalation injuries. In our study, perineal burns were usually associated with burns of adjacent regions abdominal wall burns comprising 51% and thigh burns comprising 97.9% of the associated injuries. This relationship both explains their presence in mostly severe cases with higher TBSA and also underlines the issues that derive from the burns of the perineum and their several complications which lead to an unbalance of the patients. The treatment of perineal burns still remains much debated in the literature when considering their indications and can become rather complex in the sequelae setting. Conclusions: The issue of burns remains one of the most important subjects in plastic surgery. Being a region hard to treat but with a big influence on patient evolution and survival chances prevention remains a key factor. Full article

(This article belongs to the Section Surgery)

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14 pages, 1350 KiB

Open AccessArticle

The Effect of Training Experience on Cardiac Morphology in Resistance Exercise Practitioners: A Study on Left Ventricular Systolic and Diastolic Parameters and Left Atrium Mechanical Functions

by Ahmet Kurtoğlu, Ertuğrul Kurtoğlu, Bekir Çar, Özgür Eken, Jarosław Muracki, Edi Setiawan, Madawi H. Alotaibi and Safaa M. Elkholi

Medicina 2024, 60(12), 2008; https://doi.org/10.3390/medicina60122008 - 4 Dec 2024

Abstract

Background and Objectives: Resistance exercises (REs) are a type of physical activity that individuals from many age groups have been doing recreationally, both as amateurs and professionally, in their daily lives in recent years. It is crucial to understand the effects of [...] Read more.

Background and Objectives: Resistance exercises (REs) are a type of physical activity that individuals from many age groups have been doing recreationally, both as amateurs and professionally, in their daily lives in recent years. It is crucial to understand the effects of such sports on cardiac morphology in order to maximize the benefit of training and to tailor the training content accordingly. The aim of this study was to investigate the relationship between training experience (TE) and left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical function in healthy subjects who regularly performed RE for different durations. Materials and Methods: Forty-five healthy adults [age = 28.91 ± 10.30 years, height = 178.37 ± 5.49 cm, weight = 83.15 ± 13.91 kg, body mass index = 26.03 ± 3.42 kg/m², TE = 7.28 ± 6.49 years] who performed RE between 1 year and 20 years were included in our study. The transthoracic echocardiograms (ECHOs) of the participants were evaluated by the cross-sectional research method, which is often used to understand the current situation in a given time period. Correlations between TE and LV systolic and diastolic parameters and LA mechanical function were analyzed. Results: As a result, interventricular septal thickness (IVS; r = 0.33, p = 0.028), the aortic diameter systole (ADs; r = 0.56, p < 0.001), and aortic diameter diastole (ADd; r = 0.58, p < 0.001) were positively correlated with TE, indicating associations with increased left ventricular (LV) hypertrophy and reduced ventricular compliance, while the aortic strain (AS; r = −0.44, p = 0.002), aortic distensibility (AD; r = −0.62, p < 0.001), and diastolic flow parameters including E (r = −0.41, p = 0.005), E/A (r = −0.38, p = 0.011), and E/Em (r = −0.31, p = 0.041) were negatively correlated with TE, reflecting impairments in diastolic function. Conclusions: This study showed that diastolic parameters were adversely affected in chronic RE. Therefore, we think that these individuals may have decreased relaxation and filling functions of the heart, which may also reduce adequate oxygen and nutrient delivery to the tissues. In this context, cohort studies are needed to analyze in detail the reasons for the decrease in diastolic parameters in these individuals. Full article

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

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21 pages, 746 KiB

Open AccessArticle

Effects of Manual Therapy and Home Exercise Treatment on Pain, Stress, Sleep, and Life Quality in Patients with Bruxism: A Randomized Clinical Trial

by Merve Berika Kadıoğlu, Miraç Sezer and Bülent Elbasan

Medicina 2024, 60(12), 2007; https://doi.org/10.3390/medicina60122007 - 4 Dec 2024

Abstract

Background and Objectives: This study aimed to examine the effects of manual therapy (MT) and home exercise (HE) treatments on pain, sleep quality, stress level, and quality of life in patients with bruxism. Materials and Methods: The study included 30 bruxism [...] Read more.

Background and Objectives: This study aimed to examine the effects of manual therapy (MT) and home exercise (HE) treatments on pain, sleep quality, stress level, and quality of life in patients with bruxism. Materials and Methods: The study included 30 bruxism patients ages 18–25 years who were randomly divided into the manual therapy group (MTG) and home exercise group (HEG). Before treatment (T1), all patients were asked to fill out the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Fonseca Anamnestic Index (FAI), and Quality of Life Scale/Short Form-36 (SF-36), and additionally, the number of trigger points (NTP) and pain levels were determined. MT and HE were applied for 8 weeks, and all tests were repeated at the end of treatment (T2). A paired-samples t test was used for intra-group comparisons at T1 and T2, and an independent t test was used for inter-group comparisons. The statistical significance level was accepted as p < 0.05. Results: When the results obtained with MT and HE were examined after 8 weeks of treatment, a significant difference was found for all parameters (FAI, PSQI, PSS, SF-36, NTP, activity pain, and night pain levels, p < 0.05) except rest pain in HEG. According to the inter-group comparison, a significant difference was found in PSQI, FAI, and NTP (p < 0.05). However, it was determined that both groups showed statistically similar effects in terms of pain, perceived stress, and quality of life (p > 0.05). Conclusions: MT and HE reduce perceived stress and pain intensity and also improve quality of life and sleep in patients with bruxism. HE is as effective as MT in terms of pain, stress quality of life. MT is more effective than HE in improving sleep quality and TMD symptoms. Both manual therapy and home exercise applications can be applied as alternative treatment methods in the treatment of bruxism. Full article

(This article belongs to the Topic Diagnosis and Treatment of Dental Diseases and Tempromandibular Joints)

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11 pages, 2730 KiB

Open AccessFeature PaperArticle

The Impact of Point-of-Care Ultrasound on the Diagnosis and Management of Small Bowel Obstruction in the Emergency Department: A Retrospective Observational Single-Center Study

by Carmine Cristiano Di Gioia, Alice Alame and Daniele Orso

Medicina 2024, 60(12), 2006; https://doi.org/10.3390/medicina60122006 - 4 Dec 2024

Abstract

Background and Objectives: Small bowel obstruction (SBO) requires prompt diagnosis and management. Due to its advantages, POCUS can be beneficial when assessing SBO. However, it is still doubtful whether POCUS performed by an emergency doctor can prolong the time of patients with SBO [...] Read more.

Background and Objectives: Small bowel obstruction (SBO) requires prompt diagnosis and management. Due to its advantages, POCUS can be beneficial when assessing SBO. However, it is still doubtful whether POCUS performed by an emergency doctor can prolong the time of patients with SBO in the emergency department (ED). The primary outcome was time to diagnosis when using POCUS compared to not using it. Secondary outcomes included the processing time in the ED, ED length of stay (LOS), rates of abdominal radiography, hospital LOS, and mortality. Materials and Methods: We conducted a retrospective, observational study in our ED from 1 November 2021 to 31 December 2023, including patients aged 18 and older diagnosed with SBO. Both groups received confirmation of their diagnosis through contrast-enhanced computed tomography. The two groups of patients (POCUS group vs. non-POCUS group) were compared regarding the time needed to reach the final diagnosis (i.e., time to diagnosis), the ED LOS, the hospital LOS, and in-hospital mortality. Results: A total of 106 patients were included. The median time to diagnosis was 121 min for the POCUS group vs. 217 min for the non-POCUS group (p < 0.001). Median ED processing time was 276 min in the POCUS group compared to 376 min in the non-POCUS group (p = 0.006). ED LOS was also shorter in the POCUS group (333 vs. 436 min, p = 0.010). Abdominal X-ray rates were lower in the POCUS group (49% vs. 78%, p = 0.004). Hospital LOS was similar between the two groups (p = 1.000). Five non-POCUS patients died during hospitalization; none died in the POCUS group, but the difference was not statistically significant (p = 0.063). Conclusions: POCUS significantly reduced time to diagnosis and ED LOS. Further exploration is needed to assess long-term outcomes and the cost-effectiveness of integrating POCUS into ED practice. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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14 pages, 663 KiB

Open AccessSystematic Review

Disabilities and Disparities in Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis in Saudi Arabia

by Faris Yahya I. Asiri, Marc Tennant and Estie Kruger

Medicina 2024, 60(12), 2005; https://doi.org/10.3390/medicina60122005 - 4 Dec 2024

Abstract

Background and Objectives: In Saudi Arabia, persons with disabilities (PWDs) face considerable oral health challenges, including a higher prevalence of dental caries and gingival inflammation, which adversely affects their oral health-related quality of life (OHRQoL). This population experiences distinct and substantial barriers [...] Read more.

Background and Objectives: In Saudi Arabia, persons with disabilities (PWDs) face considerable oral health challenges, including a higher prevalence of dental caries and gingival inflammation, which adversely affects their oral health-related quality of life (OHRQoL). This population experiences distinct and substantial barriers in accessing adequate dental care. This systematic review and meta-analysis aims to quantify disparities in OHRQoL between PWDs and individuals without disabilities in Saudi Arabia, focusing on caries and gingivitis prevalence, and to identify specific areas for intervention. Materials and Methods: A structured search of PubMed, Scopus, Web of Science, and Google Scholar yielded 803 articles, of which seven met the inclusion criteria. These studies reported on OHRQoL and oral health outcomes in populations with autism, Down syndrome, cerebral palsy, and hearing impairments. Data on caries rates, gingival health, and self- or caregiver-reported quality of life were extracted and analysed. Results: PWDs in Saudi Arabia exhibit significantly higher caries prevalence (ranging from 60% to over 80%) and moderate-to-severe gingival inflammation (up to 60%) compared to individuals without disabilities. The caregivers of children with disabilities reported heightened stress levels, and PWDs experienced reduced functional and social well-being. These disparities were compounded by limited preventive care access and high unmet treatment needs, particularly among those with severe disabilities and limited caregiver support. Conclusions: PWDs in Saudi Arabia face marked oral health disparities, with notably higher rates of dental caries and gingivitis, severely impacting their quality of life. The findings underscore the need for targeted oral health policies and community-based interventions to enhance care accessibility, promote preventive measures, and address the unique needs of this vulnerable population. Full article

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

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12 pages, 327 KiB

Open AccessReview

Challenges and Perspectives Regarding the Determination of Gingival Crevicular Fluid Biomarkers During Orthodontic Treatment: A Narrative Review

by Anamaria Bud, Luminița Lazăr, Maria-Alexandra Mârțu, Timea Dakó, Mircea Suciu, Andreea Vlasiu and Ana-Petra Lazăr

Medicina 2024, 60(12), 2004; https://doi.org/10.3390/medicina60122004 - 4 Dec 2024

Abstract

Background: Changes in the positions of teeth occur during orthodontic treatment due to the application of forces that cause restructuring of the periodontal tissue. In the last decade, substantial research has been conducted to detect different biomarkers in the gingival crevicular fluid (GCF) [...] Read more.

Background: Changes in the positions of teeth occur during orthodontic treatment due to the application of forces that cause restructuring of the periodontal tissue. In the last decade, substantial research has been conducted to detect different biomarkers in the gingival crevicular fluid (GCF) to obtain a better assessment of the periodontal status. Aim: The purpose of this review is to describe how the levels of certain biomarkers from the gingival fluid change during tissue remodeling throughout orthodontic treatment. Materials and methods: To carry out the purpose of this research, electronic databases were searched using specific keywords, leading to 387 articles, out of which 19 were used in writing this narrative review. A sampling period of the last 10 years was used in selecting the articles. Results: The results highlight that the origin of the gingival crevicular fluid is at the gingival blood vessels’ plexus. GCF has a complex composition with differences depending on the periodontal status and the tissue restructuring which takes place in the periodontium. The levels of inflammatory mediators, enzymes, and metabolic products of tissue remodeling in GCF change during orthodontic treatment. Being aware of their specific role, they can provide valuable information about bone remodeling during orthodontic tooth movement. Conclusions: By determining the biomarkers in GCF, as an investigative method, clinicians could easily monitor the orthodontic tooth movement, and, subsequently, the treatment period could be shortened and the adverse effects associated with it could be avoided. Full article

(This article belongs to the Special Issue Oral Physiology: Protective Mechanisms, Immune Responses and Pathways of Inflammation in Periodontal Conditions)

10 pages, 620 KiB

Open AccessSystematic Review

MRI-PDFF Assessment of Intrahepatic Fat Changes Post-Bariatric Surgery: A Systematic Literature Review

by Danut Dejeu, Paula Dejeu, Anita Muresan, Paula Bradea and Viorel Dejeu

Medicina 2024, 60(12), 2003; https://doi.org/10.3390/medicina60122003 - 4 Dec 2024

Abstract

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is prevalent among obese individuals and can progress to non-alcoholic steatohepatitis (NASH). Bariatric surgery is known to induce significant weight loss and may improve NAFLD. This systematic review uniquely synthesizes current evidence on the [...] Read more.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is prevalent among obese individuals and can progress to non-alcoholic steatohepatitis (NASH). Bariatric surgery is known to induce significant weight loss and may improve NAFLD. This systematic review uniquely synthesizes current evidence on the effects of bariatric surgery on intrahepatic fat content, measured by magnetic resonance imaging proton density fat fraction (MRI-PDFF), and assesses study quality using the Newcastle–Ottawa Scale (NOS). Materials and Methods: The literature search was conducted across the PubMed, Scopus, and Web of Science databases up to October 2024, identifying 12 prospective cohort studies involving 613 patients who underwent bariatric surgery. Inclusion criteria included adult patients with NAFLD undergoing bariatric surgery, assessment of liver fat changes using MRI-PDFF before and after surgery, and studies reporting quantitative data on liver fat fraction and relevant clinical parameters. Data extraction focused on patient demographics, surgical procedures, specific weight loss outcomes (delta BMI), changes in intrahepatic fat content (delta MRI-PDFF), and quality assessment scores based on the NOS. Results: Significant reductions in intrahepatic fat content were observed across all studies, with delta MRI-PDFF reductions ranging from 6.9% to 14%. Weight loss outcomes varied, with excess weight loss percentages up to 81.3% and BMI reductions up to 12 kg/m². The quality assessment scores ranged from six to nine out of nine, indicating generally high-quality studies. Correlations were noted between the degree of weight loss and reduction in liver fat content. Several studies reported high rates of resolution of steatosis and NASH post-operatively. Conclusions: Bariatric surgery leads to significant reductions in intrahepatic fat content and improvements in NAFLD among obese patients. The degree of weight loss correlates with the reduction in liver fat. These findings underscore the clinical utility of bariatric surgery as a strategic intervention for managing NAFLD in obese individuals, potentially influencing clinical practice guidelines by integrating bariatric surgery as a viable treatment option for NAFLD-related hepatic conditions. Full article

(This article belongs to the Section Surgery)

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13 pages, 1067 KiB

Open AccessArticle

The Effectiveness of a Specific Exercise Program in Alleviating Work-Related Neck and Upper Back Pain and Improving Mood State in Various Occupational Populations—A Randomized Controlled Trial

by Anastasia Beneka, Paraskevi Sakellari, Katerina Daskalaki, Paraskevi Malliou and Theodoros Konstantinidis

Medicina 2024, 60(12), 2002; https://doi.org/10.3390/medicina60122002 - 4 Dec 2024

Abstract

Background and Objectives: The COVID-19 pandemic brought significant challenges across governmental, industrial, and social systems. Additionally, numerous studies have reported a sharp increase in both mental health issues and musculoskeletal disorders worldwide. This study aimed to investigate whether a specific exercise program could [...] Read more.

Background and Objectives: The COVID-19 pandemic brought significant challenges across governmental, industrial, and social systems. Additionally, numerous studies have reported a sharp increase in both mental health issues and musculoskeletal disorders worldwide. This study aimed to investigate whether a specific exercise program could alleviate neck and upper back pain symptoms and improve mood state among healthcare and office employees during the post-COVID-19 period. Materials and Methods: This was an unblinded (open label) randomized controlled trial (both the participants and the researchers knew which treatment or intervention was being administered). In total, 40 healthcare employees from a public hospital and 98 remote office employees, all of whom reported neck and upper back pain, were randomly assigned to an experimental (EG) and control group (CG). The experimental groups underwent the same exercise protocol, while their corresponding control groups underwent the assessments only. Pain assessment using the Visual Analogue Scale (VAS) and mood state using the Feeling Scale (FS) questionnaires of the participants were recorded at baseline (pre-intervention) and immediately following the exercise intervention period of 6 weeks (post-intervention). The intervention consisted of 18 exercise sessions conducted over a 6-week period, with remote office workers participating online and healthcare workers attending exercise sessions on site (at the hospital). Statistical analysis was performed using non-parametric Mann–Whitney and Wilcoxon tests, as appropriate. Results: Following the six-week intervention, the percentage of workers in the EG reporting pain decreased significantly (from 75% to 45% for healthcare workers and from 54% to 25% for office employees), whereas no change was observed for their corresponding control groups. Similarly, the mood state of the EGs significantly improved compared with the control groups, as measured between pre- and post-intervention sessions. Conclusions: The COVID-19 period exacerbated stress and musculoskeletal strain, particularly for workers in demanding occupational roles. To mitigate these effects, exercise programs that can be applied while at work should be implemented, as they are effective in enhancing mood and managing neck pain in employees with physical exertion. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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