Medical Sciences

15 pages, 431 KiB

Open AccessReview

Hyperemesis in Pregnancy: Complications and Treatment

by Angeliki Gerede, Sofoklis Stavros, Efthalia Moustakli, Anastasios Potiris, Ilias Orgianelis, Athanasios Zikopoulos, Peter Drakakis, Ekaterini Domali, Makarios Eleutheriades and Nikolaos Nikolettos

Med. Sci. 2025, 13(3), 132; https://doi.org/10.3390/medsci13030132 - 14 Aug 2025

Abstract

Background: Hyperemesis gravidarum (HG) is the leading cause of hospitalization during early pregnancy, affecting approximately 0.3–3% of pregnancies. It represents the most severe end of the nausea and vomiting in pregnancy (NVP) spectrum and is associated with substantial maternal morbidity and potential adverse [...] Read more.

Background: Hyperemesis gravidarum (HG) is the leading cause of hospitalization during early pregnancy, affecting approximately 0.3–3% of pregnancies. It represents the most severe end of the nausea and vomiting in pregnancy (NVP) spectrum and is associated with substantial maternal morbidity and potential adverse fetal outcomes. Despite extensive research, the exact pathophysiology remains poorly understood, and optimal management strategies continue to be debated. Methods: This narrative review synthesizes current evidence on the complications and treatment approaches for HG. A literature search was conducted in PubMed, Scopus, and Medline up to October 2024 using predefined keywords. Eligible sources included observational studies, cohort studies, descriptive studies, and case reports. Systematic reviews, meta-analyses, and non-English articles were excluded. Results: HG is associated with a broad spectrum of complications, including dehydration, electrolyte imbalances, Wernicke’s encephalopathy, cardiac arrhythmias, thromboembolism, and adverse pregnancy outcomes such as fetal growth restriction and preterm birth. Pharmacological treatments—most notably doxylamine-pyridoxine (the only FDA-approved therapy), ondansetron, metoclopramide, and corticosteroids—have demonstrated varying efficacy and safety profiles. Non-pharmacological interventions such as acupressure, dietary adjustments, psychotherapy, and hypnosis have also been studied, although evidence remains limited. Conclusions: HG requires a comprehensive and individualized management approach. While doxylamine-pyridoxine remains the cornerstone of therapy, other pharmacologic and supportive measures may offer additional benefit. Continued research is essential to clarify the underlying mechanisms, improve therapeutic efficacy, and develop evidence-based guidelines that integrate both medical and psychosocial care for affected women. Full article

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14 pages, 4334 KiB

Open AccessHypothesis

Left Atrial Mechanics and Remodeling in Paroxysmal Atrial Fibrillation: Introducing the EASE Score for Pre-Ablation Risk Prediction

by Fulvio Cacciapuoti, Ilaria Caso, Rossella Gottilla, Fabio Minicucci, Mario Volpicelli and Pio Caso

Med. Sci. 2025, 13(3), 131; https://doi.org/10.3390/medsci13030131 - 14 Aug 2025

Abstract

Background: Paroxysmal atrial fibrillation (PAF) is a common arrhythmia often treated with catheter ablation, particularly pulmonary vein isolation (PVI). However, recurrence remains frequent and is often linked to unrecognized structural and functional remodeling of the left atrium. Methods: We introduce the Echocardiographic Atrial [...] Read more.

Background: Paroxysmal atrial fibrillation (PAF) is a common arrhythmia often treated with catheter ablation, particularly pulmonary vein isolation (PVI). However, recurrence remains frequent and is often linked to unrecognized structural and functional remodeling of the left atrium. Methods: We introduce the Echocardiographic Atrial Strain and conduction Evaluation (EASE) score as a theoretical, noninvasive model to stratify recurrence risk in patients undergoing catheter ablation for PAF. The score is based on the hypothesis that integrated echocardiographic parameters can reflect the extent of atrial remodeling relevant to ablation outcomes. Results: The EASE score combines six echocardiographic metrics—left atrial reservoir strain (LASr), atrial conduction time (PA-TDI), left atrial volume index (LAVI), stiffness index (E/e′/LASr), E/e′ ratio, and contractile strain (LASct)—each representing structural, electrical, or mechanical remodeling. The total score ranges from 0 to 12, stratifying patients into low, intermediate, and high-risk categories for arrhythmia recurrence. Preliminary retrospective data suggest a significant association between higher EASE scores and increased recurrence rates following ablation. Conclusions: The EASE score offers a biologically plausible, multidimensional framework for noninvasive risk prediction in PAF ablation. Prospective studies are warranted to validate its clinical utility and refine its structure. Full article

(This article belongs to the Section Cardiovascular Disease)

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22 pages, 603 KiB

Open AccessReview

Cardiotoxicity in Breast Cancer Therapy: Risks, Mechanisms, and Prevention Strategies

by Annisa Eka Fitrianti, Nadea Olyvia Wardani, Astri Astuti, Kusnandar Anggadiredja, Lia Amalia, Risani Andalasia Putri and Zulfan Zazuli

Med. Sci. 2025, 13(3), 130; https://doi.org/10.3390/medsci13030130 - 14 Aug 2025

Abstract

Breast cancer is the most prevalent cancer in women. Anthracyclines are commonly used as the first line of treatment, often combined with other agents, including trastuzumab. Despite their efficacy, both drugs pose a risk of cardiotoxicity, which may impair patients’ quality of life [...] Read more.

Breast cancer is the most prevalent cancer in women. Anthracyclines are commonly used as the first line of treatment, often combined with other agents, including trastuzumab. Despite their efficacy, both drugs pose a risk of cardiotoxicity, which may impair patients’ quality of life (QoL) and hinder treatment persistence. Anthracycline-induced cardiotoxicity is dose-dependent and generally irreversible, whereas trastuzumab is associated with potentially reversible cardiac dysfunction. This review discusses the risk factors and biological mechanisms underlying chemotherapy-induced cardiotoxicity in breast cancer and explores effective strategies for prevention and treatment. It has been demonstrated that several cardioprotective strategies, such as treatments with angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), beta-blockers, and dexrazoxane, can help lessen cardiotoxic effects. A better understanding of cardioprotective strategies may help optimize cancer treatment without compromising cardiovascular function. Full article

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13 pages, 10682 KiB

Open AccessArticle

Phenotypic and Spatial Characterization of Tumor-Associated Macrophages in Non-Metastatic Seminoma: Association with Local Tumor Progression

by Grigory Demyashkin, Vladimir Shchekin, Dmitriy Belokopytov, Tatyana Borovaya, Ivan Zaborsky, Kadir Safiullin, Oleg Karyakin, Alexey Krasheninnikov, Nikolay Vorobyev, Petr Shegay and Andrei Kaprin

Med. Sci. 2025, 13(3), 129; https://doi.org/10.3390/medsci13030129 - 14 Aug 2025

Abstract

Background: Seminoma is the most common subtype of testicular germ cell tumors in young men; however, the contribution of tumor-associated macrophages (TAMs) to disease progression remains insufficiently understood. This study aimed to quantitatively and phenotypically characterize CD68⁺ and CD163⁺ TAMs in [...] Read more.

Background: Seminoma is the most common subtype of testicular germ cell tumors in young men; however, the contribution of tumor-associated macrophages (TAMs) to disease progression remains insufficiently understood. This study aimed to quantitatively and phenotypically characterize CD68⁺ and CD163⁺ TAMs in non-metastatic seminomas (pT1N0M0 and pT2N0M0). Methods: This retrospective, multicenter, cohort, observational, analytical study was conducted from 1 January 2015 to 1 January 2025 at two branches of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation: the A. Tsyb Medical Radiological Research Center and the P. Hertsen Moscow Oncology Research Institute. Archived paraffin-embedded tumor samples from 96 patients and 21 samples of normal testicular tissue were analyzed using immunohistochemistry and digital morphometric analysis with QuPath software to assess macrophage density and spatial distribution. Results: Compared to normal testicular tissue, seminomas demonstrated more than a 10-fold increase in CD68⁺ TAMs and over a 100-fold increase in CD163⁺ TAMs. CD68⁺ cells predominantly localized to peripheral tumor regions, while CD163⁺ cells formed diffuse clusters in central tumor zones and around peripheral vessels. No statistically significant differences in CD68⁺ cell density were found between pT1 and pT2 stages. However, pT2 tumors showed a trend toward higher CD163⁺ TAMs density, suggesting increased M2 polarization with advancing tumor stage. Conclusions: These findings highlight the spatial and phenotypic heterogeneity of TAMs in seminoma and indicate a shift toward an immunosuppressive tumor microenvironment during local progression. Future studies should assess macrophage polarization and progression-free survival to evaluate their potential as prognostic biomarkers and therapeutic targets in seminoma. Full article

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17 pages, 1152 KiB

Open AccessReview

Optimizing Recovery in Cardiac Surgery: A Narrative Review of Enhanced Recovery After Surgery Protocols and Clinical Outcomes

by Arzina Jaffer, Kayleigh Yang, Alisha Ebrahim, Amy N. Brown, Ryaan EL-Andari, Aleksander Dokollari, Alex J. Gregory, Corey Adams, William D. T. Kent and Ali Fatehi Hassanabad

Med. Sci. 2025, 13(3), 128; https://doi.org/10.3390/medsci13030128 - 14 Aug 2025

Abstract

Enhanced Recovery After Surgery (ERAS) is an evidence-based, holistic perioperative recovery protocol intended to improve patient outcomes and decrease postoperative complication rates. While ERAS protocols were first introduced in 1997, specific guidelines for cardiac surgery were not established until 2019. Although the core [...] Read more.

Enhanced Recovery After Surgery (ERAS) is an evidence-based, holistic perioperative recovery protocol intended to improve patient outcomes and decrease postoperative complication rates. While ERAS protocols were first introduced in 1997, specific guidelines for cardiac surgery were not established until 2019. Although the core principles of ERAS remain constant across surgical disciplines, ERAS guidelines for cardiac surgery have remained relatively understudied, likely due to the unique complexities posed by cardiac procedures. Within this comprehensive narrative review, we aimed to explore the current guidelines and evidence for ERAS in both cardiac and non-cardiac surgeries. In non-cardiac surgeries, ERAS has been shown to improve various outcomes, including ICU length of stay, patient satisfaction, and pain management. ERAS for cardiac surgery has also shown encouraging results, including shorter ICU and hospital stays, reduced postoperative opioid use, and faster recovery times. However, there is limited consensus across studies, particularly regarding its impact on morbidity and mortality, with mixed results reported. Furthermore, the limited data on the efficacy of ERAS in minimally invasive cardiac surgeries makes it difficult to establish well-supported guidelines for these procedures. Despite its limitations, the overall outcomes of ERAS for cardiac surgery remain promising. As our understanding and application of ERAS in cardiac surgery continue to evolve, these protocols have the potential to redefine cardiac surgical care standards. Full article

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40 pages, 1714 KiB

Open AccessReview

Breathwork for Chronic Stress and Mental Health: Does Choosing a Specific Technique Matter?

by Adam Siebieszuk, Adam Filip Płoński and Marcin Baranowski

Med. Sci. 2025, 13(3), 127; https://doi.org/10.3390/medsci13030127 - 13 Aug 2025

Abstract

Modern society faces a growing prevalence of mental disorders, with stress emerging as a critical factor affecting mental well-being. In recent years, breathwork has gained public and scientific recognition as a promising approach for enhancing psychological health. Despite the rapid growth in research, [...] Read more.

Modern society faces a growing prevalence of mental disorders, with stress emerging as a critical factor affecting mental well-being. In recent years, breathwork has gained public and scientific recognition as a promising approach for enhancing psychological health. Despite the rapid growth in research, the field remains fragmented due to the diversity of breathing techniques. Moreover, recent findings have challenged several foundational concepts traditionally believed to underlie the therapeutic effects of breathwork. This review offers a comprehensive overview and comparison of the most widely practiced breathing techniques, with a focus on addressing key theoretical issues. We examine the primary psychophysiological pathways and mechanisms of breathwork, highlighting its influence on the nervous system as central to its effectiveness. We critically evaluate the role of breathing variables, including pace, ratio, breathing route, attention, and the use of biofeedback, in promoting the long-term neurobiological changes that have been associated with improved mental health. We argue that most breathwork techniques share core neurophysiological mechanisms that benefit well-being, regardless of the theoretical differences between specific techniques. Accumulating evidence suggests breathwork may serve as both a preventive and adjunctive therapy for chronic stress, anxiety, and depression, given its potential to target key risk factors and produce clinically relevant outcomes. Contemporary breathwork research, however, is limited by inconsistent study quality and methodological heterogeneity. By synthesizing current evidence and identifying critical knowledge gaps, this review aims to guide future research and advance understanding of breathwork’s therapeutic potential. Full article

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14 pages, 591 KiB

Open AccessReview

Artificial Intelligence and Extended Reality in the Training of Vascular Surgeons: A Narrative Review

by Joanna Halman, Sonia Tencer and Mariusz Siemiński

Med. Sci. 2025, 13(3), 126; https://doi.org/10.3390/medsci13030126 - 12 Aug 2025

Abstract

Background: The rapid shift from open to endovascular techniques in vascular surgery has significantly decreased trainee exposure to high-stakes open procedures. Simulation-based training, especially that incorporating virtual reality (VR) and artificial intelligence (AI), provides a promising way to bridge this skill gap. Objective: [...] Read more.

Background: The rapid shift from open to endovascular techniques in vascular surgery has significantly decreased trainee exposure to high-stakes open procedures. Simulation-based training, especially that incorporating virtual reality (VR) and artificial intelligence (AI), provides a promising way to bridge this skill gap. Objective: This narrative review aims to assess the current evidence on the integration of extended reality (XR) and AI into vascular surgeon training, focusing on technical skill development, performance evaluation, and educational results. Methods: We reviewed the literature on AI- and XR-enhanced surgical education across various specialties, focusing on validated cognitive learning theories, simulation methods, and procedure-specific training. This review covered studies on general, neurosurgical, orthopedic, and vascular procedures, along with recent systematic reviews and consensus statements. Results: VR-based training speeds up skill learning, reduces procedural mistakes, and enhances both technical and non-technical skills. AI-powered platforms provide real-time feedback, performance benchmarking, and objective skill evaluations. In vascular surgery, high-fidelity simulations have proven effective for training in carotid artery stenting, EVAR, rAAA management, and peripheral interventions. Patient-specific rehearsal, haptic feedback, and mixed-reality tools further improve realism and readiness. However, challenges like cost, data security, algorithmic bias, and the absence of long-term outcome data remain. Conclusions: XR and AI technologies are transforming vascular surgical education by providing scalable, evidence-based alternatives to traditional training methods. Future integration into curricula should focus on ethical use, thorough validation, and alignment with cognitive learning frameworks. A structured approach that combines VR, simulation, cadaver labs, and supervised practice may be the safest and most effective way to train the next generation of vascular surgeons. Full article

(This article belongs to the Section Cardiovascular Disease)

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22 pages, 788 KiB

Open AccessReview

Eryptosis in Liver Diseases: Contribution to Anemia and Hypercoagulation

by Saulesh Kurmangaliyeva, Kristina Baktikulova, Anton Tkachenko, Bibigul Seitkhanova, Liliya Tryfonyuk, Farida Rakhimzhanova, Rustam Yussupov and Kairat Kurmangaliyev

Med. Sci. 2025, 13(3), 125; https://doi.org/10.3390/medsci13030125 - 12 Aug 2025

Abstract

Eryptosis is a type of regulated cell death of mature erythrocytes characterized by excessive Ca²⁺ accumulation followed by phosphatidylserine externalization. Eryptosis facilitates erythrophagocytosis resulting in eradication of damaged erythrocytes, which maintains the population of healthy erythrocytes in blood. Over recent years, a [...] Read more.

Eryptosis is a type of regulated cell death of mature erythrocytes characterized by excessive Ca²⁺ accumulation followed by phosphatidylserine externalization. Eryptosis facilitates erythrophagocytosis resulting in eradication of damaged erythrocytes, which maintains the population of healthy erythrocytes in blood. Over recent years, a wide array of diseases has been reported to be linked to accelerated eryptosis, which leads to anemia. A growing number of studies furnish evidence that eryptosis is implicated in the pathogenesis of liver diseases. Herein, we summarize the current knowledge of eryptosis signaling, its physiological role, and the impact of eryptosis on anemia and hypercoagulation. In this article, upon systemically analyzing the PubMed-indexed publications, we also provide a comprehensive overview of the role of eryptosis in the spectrum of hepatic diseases, its contribution to the development of complications in liver pathology, metabolites (bilirubin, bile acids, etc.) that might trigger eryptosis in liver diseases, and eryptosis-inducing liver disease medications. Eryptosis in liver diseases contributes to anemia, hypercoagulation, and endothelial damage (via ferroptosis of endothelial cells). Treatment-associated anemia in liver diseases might be at least partly attributed to drug-induced eryptosis. Ultimately, we analyze the concept of inhibiting eryptosis pharmaceutically to prevent eryptosis-associated anemia and thrombosis in liver diseases. Full article

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

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10 pages, 520 KiB

Open AccessArticle

Over 10% of Surgically Treated High-Energy Pelvic Fractures Are Associated with Undiagnosed Ligamentous Knee Injuries: An Epidemiologic Study in Italy’s Largest Trauma Center

by Simone Giusti, Vittorio Alfonsi, Edoardo De Fenu, Claudia Franco, Stefano Cacciatore, Francesco Liuzza and Ezio Adriani

Med. Sci. 2025, 13(3), 124; https://doi.org/10.3390/medsci13030124 - 12 Aug 2025

Abstract

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge. Methods: A retrospective case series (level of evidence IV) was conducted at [...] Read more.

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge. Methods: A retrospective case series (level of evidence IV) was conducted at Italy’s largest trauma center. Medical records from 2018 to 2023 were reviewed to identify patients who underwent surgical treatment for pelvic or acetabular fractures. Eligible patients were contacted for a structured telephone interview, which included a questionnaire on knee symptoms and the International Knee Documentation Committee (IKDC) score. Associations between demographic factors, trauma mechanism, and knee outcomes were statistically analyzed. Results: Fifty-nine patients (mean age 55 years, 72.9% male) were enrolled. Undiagnosed knee ligament injuries were present in 11.9%, with an additional 8.5% reporting persistent knee symptoms. The average time to diagnosis was 6.4 months post-discharge. Patients involved in road traffic accidents showed a significantly higher incidence of knee injuries (34.8%) compared to those who fell from a height (3.9%) (p = 0.049). Patients who had undergone ligament reconstruction had significantly lower IKDC scores (62.0 ± 8.2) than non-surgical cases (82.4 ± 12.1, p = 0.0002). No association was found with age or sex. Conclusions: Ligamentous knee injuries are frequently overlooked in the acute management of high-energy pelvic fractures, particularly in road traffic accidents. A systematic knee assessment before discharge or early outpatient imaging should be considered to improve detection and outcomes. Full article

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Graphical abstract

9 pages, 204 KiB

Open AccessArticle

Bowel Dysfunctions in Young Adults with Multiple Sclerosis: A Retrospective Study

by Edoardo Sessa, Lilla Bonanno, Carla Susinna, Daniela Ivaldi, Gabriele Triolo, Roberta Lombardo, Giangaetano D’Aleo, Carmela Rifici and Viviana Lo Buono

Med. Sci. 2025, 13(3), 123; https://doi.org/10.3390/medsci13030123 - 11 Aug 2025

Abstract

Background/Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disorder mainly affecting young adults and can greatly impair quality of life (QoL). Among its often overlooked but significant symptoms are bowel dysfunctions (BD), such as constipation and fecal incontinence, which can impact physical, emotional, [...] Read more.

Background/Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disorder mainly affecting young adults and can greatly impair quality of life (QoL). Among its often overlooked but significant symptoms are bowel dysfunctions (BD), such as constipation and fecal incontinence, which can impact physical, emotional, and social well-being, especially in younger patients. This study aims to investigate the impact of BD on the QoL in young adults diagnosed with relapsing-remitting MS (RRMS) and mild disability. Methods: This retrospective cross-sectional study examined the effect of BD on QoL in 110 young adults with RRMS and mild disability (EDSS ≤ 3.5). Bowel symptoms were assessed using the Wexner Incontinence and Constipation Scales, while QoL was measured with the MSQoL-54 questionnaire. Statistical analyses were performed to examine correlations between BD severity and QoL domains. Results: Our findings showed significant correlations between the severity of intestinal symptoms and different domains of QoL, like physical functioning, emotional well-being, and social functioning. Abdominal pain and liquid fecal incontinence were especially linked to lower mental and physical health scores. Subgroup analyses also indicated gender-specific vulnerabilities, with women showing distinct effects on social and emotional dimensions. Conclusion: BD represents an important burden on bowel dysfunctions for young people with MS, deeply impacting various dimensions of QoL. This underscores an urgent need for an integrated, multidisciplinary care model that tackles physical symptoms but also psychological and social challenges. A holistic clinical strategy is vital to improving the overall well-being of this population. Full article

17 pages, 725 KiB

Open AccessArticle

Sociodemographic Factors, Healthy Habits, and Quality of Life in Relation to Insulin Resistance Risk in a Large Cohort of Spanish Workers

by María Dolores Marzoa Jansana, Pedro Juan Tárraga López, Juan José Guarro Miquel, Ángel Arturo López-González, Pere Riutord Sbert, Carla Busquets-Cortés and José Ignacio Ramírez-Manent

Med. Sci. 2025, 13(3), 122; https://doi.org/10.3390/medsci13030122 - 11 Aug 2025

Abstract

Background: Insulin resistance (IR) is a key pathogenic mechanism underlying numerous cardiometabolic disorders. While sociodemographic and lifestyle determinants of IR are well-established, their association with health-related quality of life (HRQoL) remains understudied. This study explores the relationship between IR risk, as measured by [...] Read more.

Background: Insulin resistance (IR) is a key pathogenic mechanism underlying numerous cardiometabolic disorders. While sociodemographic and lifestyle determinants of IR are well-established, their association with health-related quality of life (HRQoL) remains understudied. This study explores the relationship between IR risk, as measured by TyG, METS-IR, and SPISE-IR indices, and HRQoL in a large cohort of Spanish workers. Methods: This cross-sectional study included 100,014 Spanish workers aged 18–69 years evaluated between January 2021 and December 2023. Exclusion criteria included incomplete clinical, laboratory, or questionnaire data. IR was assessed using TyG, METS-IR, and SPISE-IR indices. HRQoL was measured using the SF-12 questionnaire. Sociodemographic factors, physical activity (IPAQ), dietary habits (MEDAS-14), and social class (based on CNAE-11 and Spanish Society of Epidemiology criteria) were also evaluated. Statistical analysis was conducted using SPSS v29.0. Results: Higher IR risk was consistently associated with older age, male sex, lower social class, current smoking, low adherence to the Mediterranean diet, and physical inactivity. Lower HRQoL scores (both physical and mental components) were significantly associated with higher IR indices, particularly with METS-IR and SPISE-IR. These associations persisted after adjusting for sociodemographic and behavioral covariates. Conclusions: This study demonstrates a robust association between insulin resistance risk and diminished health-related quality of life. The integration of validated IR indices and subjective health perception tools such as the SF-12 may enhance early identification of at-risk individuals in occupational health settings. Full article

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23 pages, 4146 KiB

Open AccessArticle

Risk of Permanent Dysfunction of Facial Nerves After Open Rigid Internal Fixation in the Treatment of Mandibular Condylar Process Fracture

by Paulina Agier, Marcin Kozakiewicz, Szymon Tyszkiewicz and Izabela Gabryelczak

Med. Sci. 2025, 13(3), 121; https://doi.org/10.3390/medsci13030121 - 9 Aug 2025

Abstract

Background: Facial nerve palsy is a relatively common complication following open rigid internal fixation (ORIF) of a mandibular condylar fracture. The aim of this study was to investigate the risk factors that influence post-operative facial nerve function and the recovery process. Methods: A [...] Read more.

Background: Facial nerve palsy is a relatively common complication following open rigid internal fixation (ORIF) of a mandibular condylar fracture. The aim of this study was to investigate the risk factors that influence post-operative facial nerve function and the recovery process. Methods: A retrospective study was conducted based on the medical records of 329 patients who underwent ORIF treatment for condyle fractures, with the follow-up period being 24 months long. Results: During the initial post-operative examination, 50.45% of patients exhibited some signs of facial nerve dysfunction, ranging from slight to severe, and 48.63% of patients presented transient palsy, while only 1.82% presented permanent facial nerve palsy. Female patients were found to be more susceptible to post-operative facial nerve palsy. Patients with multiple mandibular fractures and bilateral condyle fractures had a worse prognosis. The preauricular approach and its modifications were identified as posing the greatest risk to the facial nerve. The safest approach was the retromandibular approach. Patients treated for injuries resulting from traffic accidents or falls had a worse prognosis than those treated for assault injuries. Conclusions: Post-operative facial nerve palsy following ORIF of the mandibular condyle is, in most cases, transient and can be effectively treated. However, it is important to choose the safest possible surgical approach. The safer approach, the retromandibular approach, should be considered when possible. Full article

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15 pages, 951 KiB

Open AccessArticle

Salivary Cortisol and Periodontitis Severity: A Cross-Sectional Biomarker-Based Assessment of Stress and Inflammation

by Velitchka Dosseva-Panova, Antoaneta Mlachkova, Marina Miteva and Dimitar Dimitrov

Med. Sci. 2025, 13(3), 120; https://doi.org/10.3390/medsci13030120 - 8 Aug 2025

Abstract

Background: Psychological stress is increasingly recognized as a potential modifier of periodontal disease through both behavioral and biological mechanisms. Cortisol, a key stress hormone, exerts complex immunomodulatory effects and may influence periodontal inflammation and tissue breakdown. This study aimed to compare salivary levels [...] Read more.

Background: Psychological stress is increasingly recognized as a potential modifier of periodontal disease through both behavioral and biological mechanisms. Cortisol, a key stress hormone, exerts complex immunomodulatory effects and may influence periodontal inflammation and tissue breakdown. This study aimed to compare salivary levels of cortisol, interleukin-1β, and interleukin-6 in patients with varying periodontitis severity and examine their associations with clinical periodontal parameters. Methods: A total of 67 patients diagnosed with periodontitis were classified according to the 2017 World Workshop Classification into Stage I/II vs. Stage III/IV and Grade B vs. Grade C. Unstimulated saliva samples were collected and analyzed for cortisol using electrochemiluminescence immunoassay, and for IL-1β and IL-6 using ELISA. Statistical analyses included Mann-Whitney U test, Spearman’s correlations, and multivariate regression. Results: Median salivary cortisol levels were significantly higher in Stage III/IV (11.90 nmol/L) than in Stage I/II (7.64 nmol/L; p = 0.014) and in Grade C (10.60 nmol/L) vs. Grade B (7.70 nmol/L; p = 0.019). In multivariate analysis, cortisol independently predicted both Stage III/IV (OR = 1.23, p = 0.007) and Grade C (OR = 1.24, p = 0.026) periodontitis. ROC analysis showed that salivary cortisol had moderate diagnostic performance for Stage III/IV periodontitis (AUC = 0.68, cut-off 11.57 nmol/L) and Grade C (AUC = 0.67, cut-off 9.76 nmol/L). Cortisol showed significant positive correlations with clinical markers of disease severity and with IL-1β (r = 0.399, p = 0.001) and IL-6 (r = 0.424, p < 0.001). Conclusions: Salivary cortisol is a promising non-invasive biomarker reflecting both stress-related physiological burden and clinical severity in periodontitis. Cortisol measurement may represent a valuable addition to multifactorial assessments and risk stratification in periodontitis, pending further validation in longitudinal studies. Full article

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18 pages, 819 KiB

Open AccessArticle

Adherence, Persistence, and Blood Pressure Control in Hypertensive Patients: A Cross-Sectional Study in Mureș County, Romania

by Radu Tatar, Marius-Stefan Marusteri, Dragos-Gabriel Iancu, Razvan Gheorghita Mares, Diana-Andreea Moldovan, Andreea Varga and Ioan Tilea

Med. Sci. 2025, 13(3), 119; https://doi.org/10.3390/medsci13030119 - 8 Aug 2025

Abstract

Background: Nonadherence to antihypertensive therapy affects nearly half of treated patients worldwide, and persistence often falls below 60% within the first year, contributing substantially to uncontrolled blood pressure and cardiovascular morbidity. Adherence and persistence to antihypertensive therapy among primary care patients in Mureș [...] Read more.

Background: Nonadherence to antihypertensive therapy affects nearly half of treated patients worldwide, and persistence often falls below 60% within the first year, contributing substantially to uncontrolled blood pressure and cardiovascular morbidity. Adherence and persistence to antihypertensive therapy among primary care patients in Mureș County, Romania, were assessed using validated measures, and modifiable risk factors for targeted interventions were identified. Methods: A cross-sectional study of 399 hypertensive adults (≥18 years) receiving treatment for ≥1 year across primary care clinics in Mureș County, Romania, was performed. Adherence was evaluated using the Romanian-validated Hill–Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) and confirmed by mean arterial pressure (MAP) < 100 mmHg. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal HBCTS cutoff, and multivariate logistic regression was used to identify independent predictors of adherence. Persistence was assessed via healthcare-engagement metrics over a 360-day observation period. Results: Effective blood pressure control (MAP < 100 mmHg) was achieved by 45.9% of participants. The HBCTS demonstrated good reliability (McDonald’s ω = 0.82). ROC analysis established 51 points as an optimal threshold (sensitivity = 88.0%, specificity = 38.9%). Male gender (OR = 0.47, 95% CI: 0.29–0.75, p = 0.002) and younger age (OR = 1.04 per year, 95% CI: 1.01–1.06, p = 0.001) independently predicted poor adherence. Treatment coverage days showed the strongest correlation with blood pressure control (r = −0.50, p < 0.001). Among participants, 67.7% demonstrated persistence, achieving significantly better blood pressure control than non-persistent patients. Conclusions: The validated HBCTS (≥51 points) provides an efficient screening tool for Romanian primary care settings. Treatment coverage days emerged as the strongest modifiable predictor of blood pressure control (r = −0.50), highlighting medication availability as a key intervention target. Targeted approaches for male and younger patients, combined with systematic medication continuity monitoring, represent evidence-based strategies for reducing cardiovascular morbidity in this population. Full article

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17 pages, 5338 KiB

Open AccessArticle

Plasma Biomarkers of Mitochondrial Dysfunction in Patients with Myasthenia Gravis

by Elena E. Timechko, Marina I. Severina, Alexey M. Yakimov, Anastasia A. Vasilieva, Anastasia I. Paramonova, Natalya V. Isaeva, Semen V. Prokopenko and Diana V. Dmitrenko

Med. Sci. 2025, 13(3), 118; https://doi.org/10.3390/medsci13030118 - 8 Aug 2025

Abstract

Background. Myasthenia gravis is an autoimmune neuromuscular disease characterized by fatigue of striated muscles due to impaired neuromuscular transmission. Mitochondrial dysfunction, according to published data, contributes significantly to metabolic abnormalities, oxidative stress and, as a consequence, the persistence of inflammation. MicroRNAs, which [...] Read more.

Background. Myasthenia gravis is an autoimmune neuromuscular disease characterized by fatigue of striated muscles due to impaired neuromuscular transmission. Mitochondrial dysfunction, according to published data, contributes significantly to metabolic abnormalities, oxidative stress and, as a consequence, the persistence of inflammation. MicroRNAs, which are post-transcriptional regulators of expression, are able to contribute to the aberrant functioning of mitochondria. In this study, with the aim of searching for biomarkers at the level of circulating microRNAs and proteins, the expression of three microRNAs was analyzed and the concentration of mitochondrial proteins was measured in the blood plasma of patients with myasthenia gravis (n = 49) in comparison with healthy volunteers (n = 31). Methods. Expression analysis was performed by RT-PCR, mathematical data processing was carried out using the Livak method, and protein concentration was determined by enzyme immunoassay. Results. Our plasma expression analysis revealed a statistically significant increase in hsa-miR-194-5p expression (Log10 Fold Change = 1.46, p-value < 0.0001) and a statistically significant decrease in hsa-miR-148a-3p expression (Log10 Fold Change = −0.65, p-value = 0.02). A statistically significant decrease in plasma COQ10A concentration was also found (0.911 [0.439; 1.608] versus 1.815 [1.033; 2.916] for myasthenia gravis and controls, respectively, p-value = 0.01). Conclusion. Our data suggest hsa-miR-148a-3p and hsa-miR-194-5p, as well as COQ10A, as potential biomarkers of mitochondrial dysfunction in myasthenia gravis. Full article

(This article belongs to the Section Neurosciences)

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17 pages, 858 KiB

Open AccessArticle

Disease Burden and Unmet Medical Needs in Patients with Ulcerative Colitis in Greece: A Cross-Sectional Patient Survey

by George Gourzoulidis, Vasiliki-Rafaela Vakouftsi, George Mavridoglou, Marina Psarra and Charalampos Tzanetakos

Med. Sci. 2025, 13(3), 117; https://doi.org/10.3390/medsci13030117 - 8 Aug 2025

Abstract

Background: Ulcerative colitis (UC) requires life-long disease management. This study aimed to investigate the disease burden and unmet medical needs in UC patients in Greece. Methods: Between October 2023 and January 2024, adult UC patients who were members of the Hellenic [...] Read more.

Background: Ulcerative colitis (UC) requires life-long disease management. This study aimed to investigate the disease burden and unmet medical needs in UC patients in Greece. Methods: Between October 2023 and January 2024, adult UC patients who were members of the Hellenic Society of Crohn’s Disease and Ulcerative Colitis Patients (HELLESCC) completed a structured self-reported questionnaire. The survey questionnaire included sociodemographic characteristics, smoking habits, history of comorbidities, disease activity, disease characteristics, medications, and patient-reported outcomes (PROs; Short Inflammatory Bowel Disease Questionnaire [SIBDQ], Work Productivity and Activity Impairment [WPAI], Patient Health Questionnaire-9 [PHQ-9], treatment satisfaction, and treatment adherence). Univariate and multivariate logistic regression analyses were used to identify associated factors. Results: Datasets were obtained from 181 UC patients, of whom 48% were on advanced therapies (biological/small-molecule agents) and 54% had active disease. Around 74% reported impaired quality of life (QoL) (SIBDQ < 60), 25% work productivity loss, and 29% daily activity impairment. About 40% reported moderate to severe depressive symptoms (PHQ-9 ≥ 10). Reduced adherence and treatment dissatisfaction were reported by approximately one-third of patients. Female gender and disease activity were associated with moderately to severely impaired QoL, work productivity, and mental health. Interestingly, three out of four patients receiving advanced therapy reported moderately to severely impaired QoL and had increased odds of experiencing moderate to severe depression. Conclusions: The disease burden remains very high in UC, characterized by poor QoL and increased work impairment, depression, and disease activity among Greek patients. Marked treatment dissatisfaction and non-adherence were observed in approximately one-third of patients. Full article

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26 pages, 1953 KiB

Open AccessArticle

Risk Stratification in Acute Coronary Syndromes: The Systemic Immune-Inflammation Index as Prognostic Marker

by Elena Emilia Babes, Andrei-Flavius Radu, Noemi Adaus Cretu, Gabriela Bungau, Camelia Cristina Diaconu, Delia Mirela Tit and Victor Vlad Babes

Med. Sci. 2025, 13(3), 116; https://doi.org/10.3390/medsci13030116 - 8 Aug 2025

Abstract

Background/Objectives: Inflammation plays a key role in acute coronary syndromes (ACS). The systemic immune-inflammation index (SII), which integrates immune and inflammatory markers, may serve as a valuable prognostic tool. This study aimed to evaluate the utility of SII as a short-term predictor of [...] Read more.

Background/Objectives: Inflammation plays a key role in acute coronary syndromes (ACS). The systemic immune-inflammation index (SII), which integrates immune and inflammatory markers, may serve as a valuable prognostic tool. This study aimed to evaluate the utility of SII as a short-term predictor of mortality and major adverse cardiovascular and cerebral events (MACCE) in ACS patients. Methods: A retrospective analysis was conducted on 964 ACS patients admitted in 2023. SII was calculated from admission hematological parameters. Primary and secondary outcomes were 30-day mortality and MACCE, respectively. Results: SII levels differed significantly across ACS subtypes (p < 0.001), highest in ST-segment elevation myocardial infarction (STEMI) and lowest in unstable angina. SII was markedly higher in deceased patients (2003.79 ± 1601.17) vs. survivors (722.04 ± 837.25; p < 0.001) and remained an independent predictor of mortality (OR = 1.038, p < 0.001). Similarly, SII was elevated in MACCE cases (1717 ± 1611.32) vs. non-MACCE (664.68 ± 713.11; p < 0.001) and remained predictive in multivariate analysis (OR = 1.080, p < 0.001). Predictive accuracy for MACCE was moderate (AUC = 0.762), improved when combined with GRACE 2, especially in specificity (p = 0.07). In STEMI, SII had excellent accuracy (AUC = 0.874), outperforming neutrophil–lymphocyte ratio and C-reactive protein. SII rose at 24 h and declined at 48 h in STEMI, with a slower decline in MACCE patients. Conclusions: SII proved to be a cost-effective biomarker reflecting inflammation, immunity, and thrombosis. Elevated SII predicted short-term MACCE and mortality in ACS, with improved prognostic power when combined with GRACE 2. Persistent elevation may signal ongoing inflammation and increased MACCE risk. Full article

(This article belongs to the Section Cardiovascular Disease)

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13 pages, 1197 KiB

Open AccessSystematic Review

Catheter Ablation vs. Standard Implantable Cardioverter Defibrillator Therapy in Symptomatic Brugada Syndrome: A Systematic Review and Meta-Analysis of Controlled Studies

by Paschalis Karakasis, Panagiotis Theofilis, Konstantinos Pamporis, Antonios P. Antoniadis and Nikolaos Fragakis

Med. Sci. 2025, 13(3), 115; https://doi.org/10.3390/medsci13030115 - 6 Aug 2025

Abstract

Background: Catheter ablation of the arrhythmogenic substrate has emerged as a promising therapeutic strategy for symptomatic Brugada syndrome (BrS). However, high-quality comparative evidence against conventional implantable cardioverter-defibrillator (ICD)-based management remains limited. Objectives: This meta-analysis aimed to evaluate the efficacy of catheter [...] Read more.

Background: Catheter ablation of the arrhythmogenic substrate has emerged as a promising therapeutic strategy for symptomatic Brugada syndrome (BrS). However, high-quality comparative evidence against conventional implantable cardioverter-defibrillator (ICD)-based management remains limited. Objectives: This meta-analysis aimed to evaluate the efficacy of catheter ablation in reducing ventricular fibrillation (VF) recurrence in symptomatic BrS compared to standard therapy. Methods: Medline, Cochrane Library, and Scopus were systematically searched through 1 June 2025. Study selection, data extraction, and quality assessment were independently conducted by three reviewers. Random-effects meta-analyses were used to pool risk estimates. Results: Three studies (two randomized controlled trials, one observational cohort; 130 symptomatic BrS patients) were included. Over a median follow-up of 3.9 years, catheter ablation was associated with a significantly lower risk of VF recurrence compared to standard therapy [risk ratio (RR) = 0.19, 95% confidence interval (CI) = (0.06, 0.60); I² = 36%, p for heterogeneity = 0.21], with no deaths reported in any group. A sensitivity analysis restricted to randomized trials confirmed similar findings in favor of ablation. Conclusions: Catheter ablation was associated with reduced VF recurrence compared to ICD therapy alone, supporting its potential role as first-line treatment in symptomatic BrS or as an alternative for patients who decline ICD implantation. Full article

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13 pages, 418 KiB

Open AccessArticle

Depression and Hypomagnesemia as Independent and Synergistic Predictors of Cognitive Impairment in Older Adults Post-COVID-19: A Prospective Cohort Study

by José Guzmán-Esquivel, Brando S. Becerra-Galindo, Gustavo A. Hernández-Fuentes, Marco A. Ramos-Rojas, Osiris G. Delgado-Enciso, Hannah P. Guzmán-Solórzano, Janet Diaz-Martinez, Verónica M. Guzmán-Sandoval, Carmen A. Sanchez-Ramirez, Valery Melnikov, Héctor Ochoa-Diaz-Lopez, Daniel Montes-Galindo, Fabian Rojas-Larios and Iván Delgado-Enciso

Med. Sci. 2025, 13(3), 114; https://doi.org/10.3390/medsci13030114 - 6 Aug 2025

Abstract

Background/Objectives: Cognitive impairment in older adults has emerged as a growing public health concern, particularly in relation to COVID-19 infection and its associated neuropsychiatric symptoms. The identification of modifiable risk factors may contribute to the development of targeted preventive strategies. This study aimed [...] Read more.

Background/Objectives: Cognitive impairment in older adults has emerged as a growing public health concern, particularly in relation to COVID-19 infection and its associated neuropsychiatric symptoms. The identification of modifiable risk factors may contribute to the development of targeted preventive strategies. This study aimed to assess predictors of cognitive impairment in older adults with and without recent SARS-CoV-2 infection. Methods: A prospective cohort study was conducted from June 2023 to March 2024 at a tertiary hospital in western Mexico. Adults aged 65 years or older with confirmed SARS-CoV-2 infection within the previous six months, along with uninfected controls, were enrolled. Cognitive function (Mini-Mental State Examination), depression (PHQ-9), anxiety (Geriatric Anxiety Inventory), insomnia (Insomnia Severity Index), functional status (Katz Index and Lawton–Brody Scale), and laboratory markers were evaluated at baseline, three months, and six months. The primary outcome was cognitive impairment at six months. Independent predictors were identified using a multivariable generalized linear mixed-effects model. Results: Among the 111 participants, 20 (18.8%) developed cognitive impairment within six months. Low serum magnesium (adjusted risk ratio [aRR] 2.73; 95% CI 1.04–7.17; p = 0.041) and depression (aRR 5.57; 95% CI 1.88–16.48; p = 0.002) were independently associated with a higher risk. A significant synergistic among COVID-19, depression, and hypomagnesemia was observed (RR 44.30; 95% CI 9.52–206.21; p < 0.001), corresponding to the group with simultaneous presence of all three factors compared to the group with none. Conclusions: Depression and hypomagnesemia appear to be independent predictors of cognitive impairment in older adults with recent COVID-19 infection. These findings suggest potential targets for prevention and support the implementation of routine neuropsychiatric and biochemical assessments in this population. Full article

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