Journal Description

Medical Sciences

Medical Sciences (ISSN 2076-3271; CODEN: MSECFJ) is an international peer-reviewed open access scientific journal, providing a platform for advances in basic, translational and clinical research. The journal aims to publish original research, review articles and short communications about molecular and cellular processes in disease, in order to increase understanding of the fundamental principles and biological questions of medicine. Researchers in academic and clinical settings as well as health professionals are encouraged to publish their theoretical and experimental results in this journal, which aims to integrate expertise from the molecular and translational sciences, therapeutics, and diagnostics in different medical specialties.

Open Access—free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: Citations available in PubMed, full-text archived in PubMed Central.
Rapid Publication: manuscripts are peer-reviewed and a first decision provided to authors approximately 21.7 days after submission; acceptance to publication is undertaken in 3.9 days (median values for papers published in this journal in the first half of 2020).
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: Ten sections covering different medical specialties.

Imprint Information Journal Flyer Open Access

Latest Articles

Open AccessArticle

Treatment of C3 Glomerulopathy in Adult Kidney Transplant Recipients: A Systematic Review

Maria L Gonzalez Suarez,

Charat Thongprayoon,

Panupong Hansrivijit,

Karthik Kovvuru,

Swetha R Kanduri,

Narothama R Aeddula,

Aleksandra I Pivovarova,

Api Chewcharat,

Tarun Bathini,

Michael A Mao,

Arpita Basu and

Wisit Cheungpasitporn

Med Sci (Basel) 2020, 8(4), 44; https://doi.org/10.3390/medsci8040044 - 21 Oct 2020

Abstract

Background: C3 glomerulopathy (C3G), a rare glomerular disease mediated by alternative complement pathway dysregulation, is associated with a high rate of recurrence and graft loss after kidney transplantation (KTx). We aimed to assess the efficacy of different treatments for C3G recurrence after KTx. Methods: Databases (MEDLINE, EMBASE, and Cochrane Database) were searched from inception through 3 May, 2019. Studies were included that reported outcomes of adult KTx recipients with C3G. Effect estimates from individual studies were combined using the random-effects, generic inverse variance method of DerSimonian and Laird., The protocol for this meta-analysis is registered with PROSPERO (no. CRD42019125718). Results: Twelve studies (7 cohort studies and 5 case series) consisting of 122 KTx patients with C3G (73 C3 glomerulonephritis (C3GN) and 49 dense deposit disease (DDD)) were included. The pooled estimated rates of allograft loss among KTx patients with C3G were 33% (95% CI: 12–57%) after eculizumab, 42% (95% CI: 2–89%) after therapeutic plasma exchange (TPE), and 81% (95% CI: 50–100%) after rituximab. Subgroup analysis based on type of C3G was performed. Pooled estimated rates of allograft loss in C3GN KTx patients were 22% (95% CI: 5–46%) after eculizumab, 56% (95% CI: 6–100%) after TPE, and 70% (95% CI: 24–100%) after rituximab. Pooled estimated rates of allograft loss in DDD KTx patients were 53% (95% CI: 0–100%) after eculizumab. Data on allograft loss in DDD after TPE (1 case series, 0/2 (0%) allograft loss at 6 months) and rituximab (1 cohort, 3/3 (100%) allograft loss) were limited. Among 66 patients (38 C3GN, 28 DDD) who received no treatment (due to stable allograft function at presentation and/or clinical judgment of physicians), pooled estimated rates of allograft loss were 32% (95% CI: 7–64%) and 53% (95% CI: 28–77%) for C3GN and DDD, respectively. Among treated C3G patients, data on soluble membrane attack complex of complement (sMAC) were limited to patients treated with eculizumab (N = 7). 80% of patients with elevated sMAC before eculizumab responded to treatment. In addition, all patients who responded to eculizumab had normal sMAC levels after post-eculizumab. Conclusions: Our study suggests that the lowest incidence of allograft loss (33%) among KTX patients with C3G are those treated with eculizumab. Among those who received no treatment for C3G due to stable allograft function, there is a high incidence of allograft loss of 32% in C3GN and 53% in DDD. sMAC level may help to select good responders to eculizumab. Full article

(This article belongs to the Section Nephrology and Urology)

► Show Figures

Figure 1

Open AccessArticle

Mechanisms Underlying the Inhibition of Tyrosine Kinase Inhibitor-Induced Anorexia and Fatigue by Royal Jelly in Renal Cell Carcinoma Patients and the Correlation between Macrophage Colony Stimulating Factor and Inflammatory Mediators

Kojiro Ohba and

Med Sci (Basel) 2020, 8(4), 43; https://doi.org/10.3390/medsci8040043 - 09 Oct 2020

Abstract

Inflammation is a common adverse event of anti-cancer therapy. Royal jelly (RJ) modulates inflammation by regulating the levels of tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, and interleukin (IL)-6 produced by macrophages. Macrophage colony stimulating factor (M-CSF) is a crucial regulator of macrophage activities, and we hypothesized that RJ alters M-CSF levels. In this randomized controlled trial, we investigated the association between M-CSF and adverse events in renal cell carcinoma patients treated with tyrosine kinase inhibitors (TKIs) after an oral intake of RJ (n = 16) or placebo (n = 17). The serum levels of M-CSF, TNF-α, TGF-β, and IL-6 were measured by an enzyme-linked immunosorbent assay, and their temporal changes and correlation between such changes were analyzed. The post-/pretreatment ratio of M-CSF levels was associated with anorexia after 2 weeks and fatigue after 2, 4, and 12 weeks. The M-CSF level in the RJ group was higher than that in the placebo group at the same timepoints. The TNF-α level in the RJ group was lower than that in the placebo group between 6 and 12 weeks, and the TGF-β level in the RJ group was higher than that in the placebo group; however, contrasting findings were detected after 12 weeks. Additionally, the M-CSF level was significantly correlated with the TGF-β level after 4 weeks and IL-6 level after 8 and 10 weeks. Among TNF-α, TGF-β, and IL-6, the post-/pretreatment ratio of TGF-β after 12 weeks was associated with TKI-induced anorexia, and the ratios after 10 and 12 weeks were associated with fatigue. Our results demonstrated that an oral intake of RJ suppressed anorexia and fatigue via complex mechanisms associated with inflammation-related factors, such as M-CSF and TGF-β in renal cell carcinoma patients treated with TKIs. In addition, we newly found that such RJ-related effects were dependent on the treatment duration. Full article

(This article belongs to the Section Cancer and Cancer-Related Research)

► Show Figures

Figure 1

Open AccessArticle

Artificial Neural Network as a Tool to Predict Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors

Carlos M Chiesa-Estomba,

Jon A Sistiaga-Suarez,

José Ángel González-García,

Christian Calvo-Henríquez,

Xabier Altuna and

Alfonso Medela

Med Sci (Basel) 2020, 8(4), 42; https://doi.org/10.3390/medsci8040042 - 07 Oct 2020

Abstract

(1) Background: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery or the improvement in the preoperative radiological assessment, facial nerve injury (FNI) continues to be the most feared complication; (2) Methods: patients who underwent parotid gland surgery for benign tumors between June 2010 and June 2019 were included in this study aiming to make a proof of concept about the reliability of an artificial neural networks (AAN) algorithm for prediction of FNI and compared with a multivariate linear regression (MLR); (3) Results: Concerning prediction accuracy and performance, the ANN achieved the highest sensitivity (86.53% vs 46.23%), specificity (95.67% vs 92.59%), PPV (87.28% vs 66.94%), NPV (95.68% vs 83.37%), ROC–AUC (0.960 vs 0.769) and accuracy (93.42 vs 80.42) than MLR; and (4) Conclusions: ANN prediction models can be useful for otolaryngologists—head and neck surgeons—and patients to provide evidence-based predictions about the risk of FNI. As an advantage, the possibility to develop a calculator using clinical, radiological and histological or cytological information can improve our ability to generate patients counselling before surgery. Full article

► Show Figures

Figure 1

Open AccessArticle

Treatment of Swine Closed Head Injury with Perfluorocarbon NVX-428

Richard McCarron and

Med Sci (Basel) 2020, 8(4), 41; https://doi.org/10.3390/medsci8040041 - 27 Sep 2020

Abstract

Pre-hospital treatment of traumatic brain injury (TBI) with co-existing polytrauma is complicated by requirements for intravenous fluid volume vs. hypotensive resuscitation. A low volume, small particle-size-oxygen-carrier perfluorocarbon emulsion NVX-428 (dodecafluoropentane emulsion; 2% w/v) could improve brain tissue with minimal additional fluid volume. This study examined whether the oxygen-carrier NVX-428 shows safety and efficacy for pre-hospital treatment of TBI. Anesthetized swine underwent fluid percussion injury TBI and received 1 mL/kg IV NVX-428 (TBI-NVX) at 15 min (T15) or normal saline (no-treatment) (TBI-NON). Similarly, uninjured swine received NVX-428 (SHAM-NVX) or normal saline (SHAM-NON). Animals were monitored and measurements were taken for physiological and neurological parameters before euthanasia at the six-hour mark (T360). Histopathological analysis was performed on paraffin embedded tissues. Physiological, biochemical and blood gas parameters were not different, with the exception of a significant but transient increase in mean pulmonary artery pressure observed in the TBI-experimental group immediately after drug administration. There were no initial differences in brain oxygenation at baseline, but over time oxygen decreased ~50% in both TBI groups. Histological brain injury scores were similar between TBI-NVX and TBI-NON, although a number of subcategories (spongiosis-ischemic/dead neurons-hemorrhage-edema) in TBI-NVX had a tendency for lower scores. The cerebellum showed significantly lower spongiosis and ischemic/dead neuron injury scores and a lower number of Fluoro-Jade-B-positive cerebellar-Purkinje-cells after NVX-428 treatment compared to controls. NVX-428 may assist in mitigating secondary cellular brain damage. Full article

(This article belongs to the Section Neurosciences)

► Show Figures

Figure 1

Open AccessArticle

Antibiotic Prescribing in Primary Care for Urinary Tract Infections (UTIs) in Pregnancy: An Audit Study

Flavia Ghouri and

Amelia Hollywood

Med Sci (Basel) 2020, 8(3), 40; https://doi.org/10.3390/medsci8030040 - 17 Sep 2020

Abstract

Urinary tract infections (UTIs) are associated with negative pregnancy outcomes and are treated with antibiotics. Although beneficial, antibiotic use causes antimicrobial resistance (AMR), and therefore their use needs to be carefully balanced. Antimicrobial guidelines are developed to facilitate appropriate prescribing of antibiotics. This study assessed antibiotic prescribing for UTIs in pregnancy against the National Institute for Health and Care Excellence (NICE) guideline NG109. Fifty antibiotic prescribing records dated from 1st October 2018 to 1st July 2019 were identified from three London-based GP practices. The results show that a mid-stream sample of urine, which is important for the review and tailoring of antibiotic treatment, was collected in 77.6% of cases. Prescribing the first-line antibiotic is important for adequate treatment and good antimicrobial stewardship and results show that 44% of prescriptions were for the first-choice antibiotic. Most prescriptions (56%) were for a second-line or non-recommended antibiotic. Providing self-care advice is key to empowering pregnant women in managing their own health but only 16% of records documented provision of self-care advice. This study highlights important areas of concern in the management of UTIs in pregnancy. However, due to the retrospective design, future work is needed to evaluate the role of AMR in the prescriber’s treatment decision-making process. Full article

Open AccessArticle

Incidence and Impacts of Inflammatory Bowel Diseases among Kidney Transplant Recipients: A Meta-Analysis

Panupong Hansrivijit,

Karn Wijarnpreecha and

Wisit Cheungpasitporn

Med Sci (Basel) 2020, 8(3), 39; https://doi.org/10.3390/medsci8030039 - 16 Sep 2020

Abstract

Background: The incidence of inflammatory bowel diseases (IBD) and its significance in kidney transplant recipients is not well established. We conducted this systematic review and meta-analysis to assess the incidence of and complications from IBD in adult kidney transplant recipients. Methods: Eligible articles were searched through Ovid MEDLINE, EMBASE, and the Cochrane Library from inception through April 2020. The inclusion criteria were adult kidney transplant patients with reported IBD. Effect estimates from the individual studies were extracted and combined using the fixed-effects model when I² ≤ 50% and random-effects model when I² > 50%. Results: of 641 citations, a total of seven studies (n = 212) were included in the systematic review. The mean age was 46.2 +/− 6.9 years and up to 51.1% were male. The mean duration of follow-up was 57.8 +/− 16.8 months. The pooled incidence of recurrent IBD was 27.6% (95% CI, 17.7–40.5%; I² 0%) while the pooled incidence of de novo IBD was 18.8% (95% CI, 10.7–31.0%; I² 61.3%). The pooled incidence of post-transplant IBD was similar across subgroup analyses. Meta-regression analyses showed no association between the incidence of IBD and age, male sex, and follow-up duration. For post-transplant complications, the pooled incidence of post-transplant infection was 4.7% (95% CI, 0.5–33.3%; I² 73.7%). The pooled incidence of graft rejection and re-transplantation in IBD patients was 31.4% (95% CI, 14.1–56.1%; I² 76.9%) and 30.4% (95% CI, 22.6–39.5%; I² 0%). Conclusion: Recurrent and de novo IBD is common among kidney transplant recipients and may result in adverse outcomes. Full article

► Show Figures

Figure 1

Open AccessArticle

Association of Candidate Gene Polymorphism with Metabolic Syndrome among Mongolian Subjects: A Case-Control Study

Ariunbold Chuluun-Erdene,

Orgil Sengeragchaa,

Tsend-Ayush Altangerel,

Munkhzol Malchinkhuu and

Munkhtstetseg Janlav

Med Sci (Basel) 2020, 8(3), 38; https://doi.org/10.3390/medsci8030038 - 02 Sep 2020

Abstract

Metabolic syndrome (MetS) is complex and determined by the interaction between genetic and environmental factors and their influence on obesity, insulin resistance, and related traits associated with diabetes and cardiovascular disease risk. Some dynamic markers, including adiponectin (ADIPOQ), brain-derived neurotrophic factor (BDNF), and lipoprotein lipase (LPL), are implicated in MetS; however, the influence of their genetic variants on MetS susceptibility varies in racial and ethnic groups. We investigated the association of single nucleotide polymorphism (SNP)-SNP interactions among nine SNPs in six genes with MetS’s genetic predisposition in Mongolian subjects. A total of 160 patients with MetS for the case group and 144 healthy individuals for the control group were selected to participate in this study. Regression analysis of individual SNPs showed that the ADIPOQ + 45GG (odds ratio (OR) = 2.09, p = 0.011) and P⁺P⁺ of LPL PvuII (OR = 2.10, p = 0.038) carriers had an increased risk of MetS. Conversely, G allele of LPL S447X (OR = 0.45, p = 0.036) and PGC-1α 482Ser (OR = 0.26, p = 0.001) allele were estimated as protective factors, respectively. Moreover, a haplotype containing the G-P⁺-G combination was related to MetS. Significant loci were also related to body mass index (BMI), systolic blood pressure (SBP), serum high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and fasting blood glucose (FBG), adipokines, and insulin as well as insulin resistance (p < 0.05). Our results confirm that ADIPOQ + 45T > G, LPL PvII, and PGC-1α Gly482Ser loci are associated with MetS in Mongolian subjects. Full article

(This article belongs to the Section Endocrinology and Metabolic Diseases)

► Show Figures

Figure 1

Open AccessArticle

Hospital-Acquired Dysmagnesemia and In-Hospital Mortality

Wisit Cheungpasitporn,

Saraschandra Vallabhajosyula,

Fawad Qureshi and

Stephen B. Erickson

Med Sci (Basel) 2020, 8(3), 37; https://doi.org/10.3390/medsci8030037 - 01 Sep 2020

Abstract

Background and Objectives: This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. Materials and Methods: We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7–2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. Results: 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; p < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; p < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; p < 0.001) were significantly associated with higher in-hospital mortality. Conclusions: Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality. Full article

Open AccessReview

Zinc and Traumatic Brain Injury: From Chelation to Supplementation

Cathy W. Levenson

Med Sci (Basel) 2020, 8(3), 36; https://doi.org/10.3390/medsci8030036 - 17 Aug 2020

Abstract

With a worldwide incidence rate of almost 70 million annually, traumatic brain injury (TBI) is a frequent cause of both disability and death. Our modern understanding of the zinc-regulated neurochemical, cellular, and molecular mechanisms associated with TBI is the result of a continuum of research spanning more than three decades. This review describes the evolution of the field beginning with the initial landmark work on the toxicity of excess neuronal zinc accumulation after injury. It further shows how the field has expanded and shifted to include examination of the cellular pools of zinc after TBI, identification of the role of zinc in TBI-regulated gene expression and neurogenesis, and the use of zinc to prevent cognitive and behavioral deficits associated with brain injury. Full article

(This article belongs to the Special Issue Zinc: Its Molecular and Biochemical Importance, and Relevance in Medicine)

► Show Figures

Figure 1

Open AccessArticle

Spectrum of MEFV Variants and Genotypes among Clinically Diagnosed FMF Patients from Southern Lebanon

Taher Fardoun and

Med Sci (Basel) 2020, 8(3), 35; https://doi.org/10.3390/medsci8030035 - 17 Aug 2020

Abstract

Background: Familial Mediterranean Fever (FMF) is an autosomal recessive auto-inflammatory disease characterized by pathogenic variants in the MEFV gene, with allele frequencies greatly varying between countries, populations and ethnic groups. Materials and methods: In order to analyze the spectrum of MEFV variants and genotypes among clinically diagnosed FMF patients from South Lebanon, data were collected from 332 participants and 23 MEFV variants were screened using a Real-Time PCR Kit. Results: The mean age at symptom onset was 17.31 ± 13.82 years. The most prevalent symptoms were abdominal pain, fever and myalgia. MEFV molecular analysis showed that 111 patients (63.79%) were heterozygous, 16 (9.20%) were homozygous, and 47 (27.01%) carried two variants or more. E148Q was the most encountered variant among heterozygous subjects. E148Q/M694V was the most frequent in the compound heterozygous/complex genotype group, while M694I was the most common among homozygous patients. Regarding allele frequencies, M694V was the most common variant (20.7%), followed by E148Q (17.1%), V726A (15.7%) and M694I (13.2%). Conclusion: The high percentage of heterozygous patients clinically diagnosed as FMF highlights the pseudo-dominant transmission of the disease in Lebanon and emphasizes the importance of molecular testing for a more accurate diagnosis and better management and treatment of FMF. Full article

(This article belongs to the Special Issue Molecular Diagnostics and Personalized Therapy)

Open AccessReview

Integrative Management of Metabolic Syndrome in Youth Prescribed Second-Generation Antipsychotics

Jessie Rice and

Ujjwal Ramtekkar

Med Sci (Basel) 2020, 8(3), 34; https://doi.org/10.3390/medsci8030034 - 17 Aug 2020

Abstract

Weight gain and metabolic syndrome are common side effects of second-generation antipsychotics and carry significant health consequences both in childhood and into adulthood. This review highlights evidence-based, non-pharmacologic interventions to assist in the management of these side effects. Such intervention categories include dietary, physical activity, sleep, stress management, and nutritional supplementation. Interventions with the highest quality evidence include increasing the consumption of fruits, vegetables, and whole grains, increasing physical activity, improving sleep, and fish oil supplementation. We suggest that clinicians work with patients on managing metabolic side effects in a patient-centered way, incorporating principles of motivational interviewing, to reduce the risk of metabolic syndrome. Full article

(This article belongs to the Special Issue The Role of Diet and Supplements in the Prevention and Treatment of the Metabolic Syndrome)

Open AccessCommunication

Development of an ELISA for Measurement of Urinary 3-Hydroxypropyl Mercapturic Acid (3-HPMA), the Marker of Stroke

Keiko Kashiwagi and

Med Sci (Basel) 2020, 8(3), 33; https://doi.org/10.3390/medsci8030033 - 16 Aug 2020

Abstract

We previously observed an inverse correlation between stroke and urinary 3-hydroxypropyl mercapturic acid (3-HPMA), an acrolein-glutathione metabolite, through its measurement by liquid chromatography with tandem mass spectrometry (LC-MS/MS). However, the cost of equipment for LC-MS/MS and its maintenance fee is very expensive and a cost-efficient method is required. In this study, we have developed a sensitive enzyme-linked immunosorbent assay (ELISA) system to measure 3-HPMA using a chicken antibody recognizing 3-HPMA-conjugated chicken albumin as antigen. Linearity to measure 3-HPMA was obtained from 0 to 10 μM, indicating that this ELISA system is useful for measurement of urine 3-HPMA. It was confirmed that 3-HPMA in urine of stroke patients decreased significantly compared with that of control subjects using the ELISA system. Using the ELISA kit, it became possible to evaluate the risk of brain stroke by not only plasma but also by urine. These results confirm that shortage of glutathione to detoxify acrolein is one of the major causes of stroke incidence. Our method contributes to maintenance of quality of life (QOL) of the elderly. Full article

(This article belongs to the Special Issue Polyamine Metabolism in Health and Disease: Potential for Polyamine-Targeted Therapies and Prevention)

► Show Figures

Figure 1

Open AccessArticle

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

Hisham F. Bahmad and

Med Sci (Basel) 2020, 8(3), 32; https://doi.org/10.3390/medsci8030032 - 13 Aug 2020

Abstract

Background: Urinary tract infections (UTIs) are major healthcare problems that are usually treated empirically. However, antimicrobial resistance has been increasing across many settings. This study aims to elucidate the antibiotic resistance profiles of three common uropathogens, Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Proteus mirabilis (P. mirabilis) and compare between extended spectrum beta-lactamase (ESBL) and non-ESBL strains among Lebanese patients. Methods: This retrospective study was conducted at multiple tertiary healthcare centers in South Lebanon, between January and September 2017, including 551 patients of all age groups. Demographic, clinical, and laboratory data of patients were collected and analyzed statistically. Results: The prevalence of UTI in Lebanon was highest in adults between 19 and 64 years (44%). E. coli was the predominant uropathogenic organism (67.1%) followed by K. pneumoniae (10%) and P. mirabilis (3.7%). ESBL represented 32.9% of the UTI agents. The three common uropathogens studied were found to be most susceptible to imipenem (100%) and meropenem (100%). Interestingly, 115 (25.1%) out of the 458 E. coli isolates were resistant to more than eight antibiotics while 107 (23.4%) were susceptible to all antibiotics studied. Conclusions: Our study underlined the importance of adequate antimicrobial prescription for UTIs in Lebanon to avoid multidrug resistance. Full article

(This article belongs to the Special Issue Molecular Diagnostics and Personalized Therapy)

► Show Figures

Figure 1

Open AccessArticle

Short-Term Effects of Air Pollution on Coronary Events in Strasbourg, France—Importance of Seasonal Variations

Thomas Bourdrel and

Med Sci (Basel) 2020, 8(3), 31; https://doi.org/10.3390/medsci8030031 - 07 Aug 2020

Abstract

The aim of this study, is to investigate the effects of a short-term exposure to air pollutants, as assessed by Nitrogen dioxide (NO₂), Particulate Matter PM_2,5 and PM₁₀ concentrations, on coronary event onsets in Strasbourg, France. An observational, analytical, retrospective, epidemiological study was conducted in Strasbourg between 1 January 2012 and 31 December 2014. Higher daily coronary events rates were evidenced when NO₂ concentrations were measured above 40 µg/m³ (1.258 (95% CI 1.142–1.374) vs. 1.110 (95% CI 1.033–1.186); p = 0.015). The NO₂ concentration was higher than 30 µg/m³ for 677 days (61.8%). Higher daily coronary events rates were evidenced when NO₂ concentrations were measured above 30 µg/m³ (1.208 (95% CI 1.128–1.289) vs. 1.067 (95% CI 0.961–1.172) p = 0.009). A marked seasonality of NO₂, PM_2.5, and PM₁₀ concentrations characterized by an increase during winter and a decrease during the summer could be established. The seasonality of coronary events was evidenced simultaneously. After adjustments were made to account for the time and the month, no independent impact of NO₂, PM_2.5 or PM₁₀ on daily coronary events could be demonstrated. Full article

(This article belongs to the Section Cardiovascular Disease)

► Show Figures

Figure 1

Open AccessArticle

Cumulative Effects of Low-Level Lead Exposure and Chronic Physiological Stress on Hepatic Dysfunction—A Preliminary Study

Emmanuel Obeng-Gyasi

Med Sci (Basel) 2020, 8(3), 30; https://doi.org/10.3390/medsci8030030 - 05 Aug 2020

Abstract

Chronic physiological stress and hepatic injury were explored in this cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Lead exposure was measured using Blood Lead Levels (BLL), which were divided into quartiles of exposure based on the distribution within the database. Allostatic load (AL), a variable representing chronic physiological stress, was operationalized using ten clinical markers. The geometric mean values for markers of liver injury of interest (a) Aspartate Aminotransferase (AST), (b) Alanine Aminotransferase (ALT), (c) Alkaline Phosphatase (ALP), and (d) Gamma glutamyl-transferase (GGT) were explored in quartiles of lead exposure. Associations between AL and AST, ALT, ALP, and GGT among those exposed to lead were analyzed using linear regression models. In examining lead exposure in increasing quartiles, the geometric mean of the liver injury markers showed significant elevations as lead exposure levels increased. Simple linear regression revealed AL was positively associated with several markers of hepatic injury in all degrees of lead exposure. This study demonstrates the potential dangers of social and environmental exposures to liver health. Full article

Open AccessArticle

Postpartum Follow-Up of Women Who Developed Subclinical Hypothyroidism during Pregnancy

Evangelia Venaki and

Med Sci (Basel) 2020, 8(3), 29; https://doi.org/10.3390/medsci8030029 - 03 Aug 2020

Abstract

There is inconsistency in the literature regarding the management of women diagnosed with subclinical hypothyroidism (SCH) during pregnancy in the postpartum period. The purpose of our study was to assess the need for continuation of levothyroxine (LT4) treatment after delivery. We conducted a retrospective cohort study of 114 women with new-onset SCH during pregnancy and at 1-year follow-up postpartum. Criteria for continuation of LT4 after delivery were breastfeeding, thyrotropin (TSH) levels at diagnosis >5 mIU/L, positive antithyroid antibodies and LT4 dose before delivery >50 μg/day. On treatment initiation, mean TSH ± SD was 5.24 ± 2.55 mIU/L. One year after delivery, most patients (86/114) were still on LT4. This was related to TSH levels at the initiation of treatment in gestation (p = 0.004) and inversely related to primiparity (p = 0.019). In the group of patients who stopped LT4 postpartum, treatment was reinstated in 11 out of 39 (28.2%) due to SCH relapse (mean TSH ± SD = 9.09 ± 5.81 mIU/L). Most women in our study continued treatment after delivery, and a considerable number of women who had discontinued LT4 restarted treatment postpartum. These results stress the need to reassess thyroid function at 6 to 12 months postpartum. Full article

(This article belongs to the Section Endocrinology and Metabolic Diseases)

► Show Figures

Figure 1

Open AccessReview

Epidemiology, Staging and Management of Prostate Cancer

Adam Barsouk,

Sandeep Anand Padala,

Anusha Vakiti,

Azeem Mohammed,

Kalyan Saginala,

Krishna Chaitanya Thandra,

Prashanth Rawla and

Alexander Barsouk

Med Sci (Basel) 2020, 8(3), 28; https://doi.org/10.3390/medsci8030028 - 20 Jul 2020

Cited by 2

Abstract

Prostate cancer is the second most common and fifth most aggressive neoplasm among men worldwide. It is particularly incident in high human development index (HDI) nations, with an estimated one in seven men in the US receiving a prostate cancer diagnosis in their lifetime. A rapid rise and then fall in prostate cancer incidence in the US and Europe corresponded to the implementation of widespread prostate specific antigen (PSA) testing in 1986 and then subsequent fall from favor due to high rates of false positives, overdiagnosis, and overtreatment (as many as 20–50% of men diagnosed could have remained asymptomatic in their lifetimes). Though few risk factors have been characterized, the best known include race (men of African descent are at higher risk), genetics (e.g., BRCA1/2 mutations), and obesity. The Gleason scoring system is used for histopathological staging and is combined with clinical staging for prognosis and treatment. National guidelines have grown more conservative over the past decades in management, recommending watchful waiting and observation in older men with low to intermediate risk disease. Among higher risk patients, prostatectomy (robotic is preferred) and/or external beam radiotherapy is the most common interventions, followed by ADT maintenance. Following progression on androgen deprivation therapy (ADT) (known as castration-resistance), next generation endocrine therapies like enzalutamide, often in combination with cytotoxic agent docetaxel, are standard of care. Other promising treatments include Radium-223 for bone metastases, pembrolizumab for programmed death ligand-1 (PDL1) and microsatellite instability (MSI) high disease, and poly ADP ribose polymerase (PARP) inhibitors for those with mutations in homologous recombination (most commonly BRCA2). Full article

(This article belongs to the Section Cancer and Cancer-Related Research)

► Show Figures

Figure 1

Open AccessArticle

Radiologists’ Knowledge and Attitudes towards CT Radiation Dose and Exposure in Saudi Arabia—A Survey Study

Med Sci (Basel) 2020, 8(3), 27; https://doi.org/10.3390/medsci8030027 - 20 Jul 2020

Abstract

Computed tomography (CT) is a key imaging technique in diagnostic radiology, providing highly sensitive and specific information. While its use has increased dramatically in recent years, the quantity and associated risks of radiation from CT scans present major challenges, particularly in paediatrics. The fundamental principles of radiation protection require that radiation quantities be as low as reasonably achievable and CT use must be justified, particularly for paediatric patients. CT radiation knowledge is a key factor in optimising and minimising radiation risk. The objective of this study was to analyse knowledge level, expertise, and competency regarding CT radiation dose and its hazards in paediatrics among radiologists in Saudi Arabian hospitals. A self-reported, multiple-choice questionnaire assessed the attitudes and opinions of radiologists involved in imaging studies using ionising radiation. Among the total respondents, 65% ± 13.5% had a good comprehension of the dangers of carcinogenicity to the patient resulting from CT scans, with 80% presuming that cancer risks were elevated. However, only 48.5%, 56.5%, and 65% of the respondents were aware of specific radiation risks in head, chest, and abdominal paediatric examinations, respectively. Regular, frequent, and specific training courses are suggested to improve the fundamental knowledge of CT radiation among radiologists and other physicians. Full article

► Show Figures

Figure 1

Open AccessArticle

The Feasibility of Contrast-to-Noise Ratio on Measurements to Evaluate CT Image Quality in Terms of Low-Contrast Detailed Detectability

Haney A Alsleem and

Hussain M Almohiy

Med Sci (Basel) 2020, 8(3), 26; https://doi.org/10.3390/medsci8030026 - 06 Jul 2020

Abstract

Background: To evaluate contrast-to-noise ratio (CNR) measurements in assessing image quality, in the context of the detectability performance of low-contrast detail (LCD), in computed tomography (CT) images, since exposure to elevated ionising-type radiation is considered to present excessive carcinogenic risk, whilst also causing distress in study subjects. Methods: An LCD phantom module (CTP515) was utilised in the study. Three dissimilar contrast items were used to analyse the ramifications of the proportions of an object on the CNR. Three multidetector CT (MDCT) scanners were used, with 16-MDCT, 64-MDCT and 80-MDCT frameworks, respectively. The CT scans were recreated using three dissimilar remaking algorithms—soft, standard and lung. The effects exerted on the CNR by various remodelling algorithms, as well as the contrast of various objects along with the size of the objects, were explored. The Hounsfield units of each chosen object (one unit representing the outer portion of the object) and the background and the standard deviation of the noise parameter were quantified, and algorithms were developed using MATLAB. Results: The CNR information was greatly influenced by changing the image recreation calculations and was very much increased in the soft-tissue recreation images using 16-MDCT and 64-MDCT. The CNR information was also increased more in the optimum recreation images than in the reproduced images from the computational procedure used in the 80-MDCT. The results did not show any remarkable contrasts in the CNR values between the different object sizes. Overall, a higher kVp produced an improved CNR in all the CT scanners. In particular, there were prominent upgrades in the CNR information when the kVp was increased from 80 to 120. Higher mAs levels gave better CNR values overall, especially for greater section thicknesses. Based on the CNR estimations, the 64-MDCT provided the best correlation among the CT scanners. Conclusions: The objective LCD appraisal method, based on CNR measurements, was confirmed as being useful for checking the different impacts of kVp, mAs and section thickness on the nature of the picture. This procedure was similarly viable in assessing the impacts of the different reconstruction calculations and the different differentiation questions on the nature of the image. Full article

► Show Figures

Figure 1

Open AccessReview

Patent Foramen Ovale in Fetal Life, Infancy and Childhood

Bibhuti B. Das

Med Sci (Basel) 2020, 8(3), 25; https://doi.org/10.3390/medsci8030025 - 01 Jul 2020

Abstract

A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support. Full article

(This article belongs to the Section Cardiovascular Disease)

► Show Figures