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Protective Effect of Daily Physical Activity Against COVID-19 in a Young Adult Population on Reunion Island
Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Acute Ischemic Stroke Across COVID-19 Periods
Treatment of Vitamin D Deficiency in Decompensated Patients with Cirrhosis Is Associated with Improvement in Frailty

Journal Description

Medical Sciences

Medical Sciences is an international, peer-reviewed, open access journal, providing a platform for advances in basic, translational and clinical research, published quarterly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, MEDLINE, CAPlus / SciFinder, and other databases.
Journal Rank: CiteScore - Q1 (General Medicine)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 24 days after submission; acceptance to publication is undertaken in 2.8 days (median values for papers published in this journal in the second half of 2024).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Sections: published in 12 topical sections.

Imprint Information Journal Flyer Open Access ISSN: 2076-3271

Latest Articles

7 pages, 170 KiB

Open AccessCommunication

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

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

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

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

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

10 pages, 763 KiB

Open AccessArticle

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

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

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

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

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

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12 pages, 579 KiB

Open AccessSystematic Review

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

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

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

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

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

(This article belongs to the Section Cardiovascular Disease)

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11 pages, 1111 KiB

Open AccessArticle

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

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

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

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

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

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12 pages, 8298 KiB

Open AccessCommunication

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

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

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

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

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

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14 pages, 952 KiB

Open AccessArticle

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

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

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

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

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

(This article belongs to the Section Cardiovascular Disease)

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13 pages, 2427 KiB

Open AccessPerspective

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

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

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

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

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

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17 pages, 910 KiB

Open AccessArticle

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

by Olamide Ogundare and Emmanuel Obeng-Gyasi

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

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

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

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24 pages, 5660 KiB

Open AccessReview

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

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

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

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

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

(This article belongs to the Section Gynecology)

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20 pages, 2808 KiB

Open AccessSystematic Review

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

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

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

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

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

(This article belongs to the Section Neurosciences)

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13 pages, 1330 KiB

Open AccessArticle

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

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

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

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

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

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

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14 pages, 1136 KiB

Open AccessArticle

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

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

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

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

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

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12 pages, 638 KiB

Open AccessArticle

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

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

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

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

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

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9 pages, 451 KiB

Open AccessArticle

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

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

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

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

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

(This article belongs to the Section Cardiovascular Disease)

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23 pages, 7941 KiB

Open AccessReview

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

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

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

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

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

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13 pages, 376 KiB

Open AccessArticle

Relationship Between Facial Melasma and Ocular Photoaging Diseases

by Lunla Udomwech, Chime Eden and Weeratian Tawanwongsri

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

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

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

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10 pages, 1940 KiB

Open AccessArticle

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

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

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

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

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

(This article belongs to the Section Cardiovascular Disease)

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11 pages, 801 KiB

Open AccessArticle

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

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

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

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

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

(This article belongs to the Section Critical Care Medicine)

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12 pages, 1096 KiB

Open AccessArticle

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

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

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

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

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

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9 pages, 1996 KiB

Open AccessSystematic Review

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

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

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

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

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

(This article belongs to the Section Cardiovascular Disease)

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